Payer

Employer-sponsored plans pay much higher rates for physician-administered drugs than Medicare, a research letter published Feb. 10 in JAMA Health Forum found. 

The Pennsylvania Insurance Department fined Highmark Inc. $205,000 for violations including incorrectly denied claims, untimely payments and violations of mental health parity requirements. 

The reason for most in-network claim denials in ACA plans is not reported in price data, according to an analysis from Kaiser Family Foundation. 

The nation's largest payers have filed their fourth quarter earnings reports, revealing which have the most U.S. commercial members.Commercial includes fully- and self-insured members

UnitedHealthcare has the most Medicare Advantage members among large payers, while MA makes up a relatively small slice of Cigna's business. 

Oscar Health reported major gains in total membership but posted a net loss of $606 million in 2022, according to the company's fourth quarter earnings published Feb. 9.

From bills introduced in North Carolina and Kansas, to another dying on the Wyoming House floor, here are five recent updates on state Medicaid expansion efforts: 

Kansas Gov. Laura Kelly is making a push for the state to become the 40th to expand Medicaid, The Center Square reported Feb. 8. 

Minnesota lawmakers are considering a bill to expand MinnesotaCare, the state's program for those with low incomes, to all residents, the Pioneer Press reported Feb. 8. 

KLAS Research, a healthcare IT data and insights company, named its "Best in KLAS" payer tools for 2023.