Payer

From several states advancing legislation to CMS considering reforms, here are seven prior authorization updates Becker’s has reported since April 24:  1. HHS will not enforce mental health parity regulations opposed by some large employers and insurers as it reconsiders…

On average, insurers pay 4.7% higher commercial prices to hospitals that are a part of their Medicare Advantage networks compared to those not in network, according to a study published May 8 in Health Services Research. The study analyzed 5,654…

UnitedHealthcare has agreed to pay more than $9 million to settle a class-action lawsuit alleging that the insurer wrongfully denied coverage for proton beam therapy, a type of specialized cancer treatment.  According to court documents filed May 9, the insurer…

Medicare Advantage insurers and brokers are facing a sweeping lawsuit from the Justice Department, and rising costs continue to hurt payers’ finances.  Here are eight Medicare Advantage updates to know: 

Portland, Ore.-based Providence Health Plan, a division of Renton, Wash.-based Providence, has laid off about 4% of its workforce due to “strong financial headwinds and challenges” over the last year, a spokesperson for the organization  told Becker’s.  The 4% reduction translates…

Blue Cross Blue Shield of Vermont is taking steps to shore up its finances in the face of unprecedented challenges, VTDigger reported May 7.  In July 2024, BCBS Vermont said it was in a “fragile financial state,” in the face…

The salary of a Blue Cross Blue Shield CEO can vary significantly depending on factors such as company size, location, recent growth, and internal pressures. Some BCBS companies include executive compensation data within their annual financial reports, which are filed…

A group of Democratic lawmakers is urging Republicans to turn their attention toward Medicare Advantage to cut healthcare spending.  In a letter to Senate Majority Leader John Thune and House Speaker Mike Johnson, 36 members of Congress urged leaders to…

The first half of the year has been challenging for major insurers, with disappointing financial results, market exits, and pulled products. In contrast, smaller, often single market-focused payers have seen a surge in revenues and continued growth in membership. Some…

Aetna’s exit from the individual market is both “sad” and an “opportunity” for Oscar Health, CEO Mark Bertolini told investors.  In May, Aetna said it would exit the individual exchange at the end of 2025. The exit will leave around…