A federal judge has certified a class-action lawsuit against Blue Cross and Blue Shield of Montana that alleges the payer denied thousands of “large dollar” claims, the Daily Montanan reported June 16. The lawsuit alleges that the company routinely denies…
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UnitedHealthcare is ending broker commission payments for some of its Medicare Advantage plans. In a statement shared with Becker’s June 17, a spokesperson said the company will not pay commissions for new enrollments for a “small percentage” of its Medicare…
Humana’s five-year plan entails a transformation from a health services company to a consumer healthcare company, CEO Jim Rechtin told investors. The company held its annual investor day June 16. Mr. Rechtin said the company will expand its reach within…
Medicare Advantage enrollees receive fewer home health visits than their counterparts in fee-for-service Medicare, according to the Medicare Payment and Advisory Commission. The commission, which advises Congress on Medicare and Medicaid issues, published a report to Congress June 12. Here…
Medicare Advantage isn’t living up to its promise, Former U.S. Rep. Jim Greenwood wrote in an op-ed published in The Hill June 15. Mr. Greenwood was one of the authors of the Medicare Modernization Act of 2003, which created the…
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St. Louis-based Mercy and Humana have opened two joint primary care clinics for older adults. The first two clinics in Springfield, Mo., and Nixa, Mo., opened in June, according to a June 12 news release. The clinic sites will be…
The federal government will spend an estimated $86 billion on Medicare Advantage supplemental benefits in 2025, according to a report from the Medicare Payment and Advisory Commission. MedPAC, which advises the federal government on Medicare policy, published the report to…
Chapel Hill-based UNC Health has filed lawsuits against Aetna and Humana, alleging both insurers underpaid for 340B drug claims in violation of their contractual agreements. The lawsuits, filed June 10 in a North Carolina federal court, claim the payers improperly…
Generative AI Pioneering the Future of Utilization Management The healthcare industry is rapidly positioning Generative AI (GenAI) at the forefront of Utilization Management (UM) reform. Far from being a speculative technology of the future, GenAI is here to transform stagnant…
Congress is tasked with making decisions that affect health coverage for millions of Americans — but what kind of insurance do lawmakers have? Senators are weighing the “One Big Beautiful Bill,” a sweeping budget package. According to the Congressional Budget…