Payer

There are major disruption opportunities ahead in the employer group insurance market by way of individual exchange coverage, and some payers are hedging their bets on the market through a newer product: ICHRAs.

Humana is expecting higher medical costs and lower Medicare Advantage enrollment to hurt its year-end earnings. 

A federal appeals court upheld UnitedHealth Group's win in a class-action lawsuit by more than 200 physicians who said they were not paid facility fees for office-based surgeries. 

Blue Cross and Blue Shield of Minnesota incorrectly imposed a state provider tax on self-funded health plan customers and violated its fiduciary duties under the Employee Retirement Income Security Act of 1974, according to a lawsuit filed against the payer…

Medicare Advantage insurers are increasingly becoming providers too, according to the Medicare Payment and Advisory Commission's 2024 status report. 

Coding intensity and the types of enrollees who select Medicare Advantage plans will drive an additional $88 billion in payments to the program in 2024 compared with what traditional Medicare would receive, according to estimates from the Medicare Payment and…

Though some contract negotiations with providers came "down to the wire" last year, UnitedHealthcare executives said the payer did not see more contract splits than usual in 2023. 

RSV vaccinations brought more older adults to their primary care offices in the last months of 2023, one factor behind rising medical costs in Medicare Advantage, UnitedHealth Group executives said. 

UnitedHealth Group recorded double-digit growth in revenue year over year across its core lines of business at UnitedHealthcare and Optum, according to the company's fourth quarter earnings report released Jan. 12.

Outdated eligibility systems and staff shortages are making the Medicaid redetermination process more difficult, state officials told KFF.