Payer

California is reforming its Medicaid program, Medi-Cal, to address social determinants of health — a move that shifts state-sponsored health coverage toward whole-person health, according to CalMatters. 

Excellus BlueCross BlueShield is distributing $30 million across 31 New York providers to invest in quality improvements, according to a news release shared with Becker's. 

Payers' medical benefits ratios — the percentage of premium revenue spent on medical services — have fluctuated with the flow of the COVID-19 pandemic, resulting in industrywide increases.

Payers have been calling the Medicare Advantage market a competitive, but highly-desirable one. 

Mothers have increasingly opted to give birth in their homes during the COVID-19 pandemic, but insurers are largely refusing to cover them, according to a Feb. 11 report from Time. 

A lawsuit filed Feb. 9 in Connecticut accuses Aetna of discriminating against homosexual women through its fertility treatment coverage policies, according to Top Class Actions. 

Anthem topped the list of payers by total membership, while Aetna saw the smallest growth in 2021. 

Molina Healthcare saw sharp increases in revenues through 2021, anchored by a 47 percent jump in premium revenue. 

A North Carolina judge ruled against Aetna Feb. 9 over an "all or nothing" policy that allegedly resulted in mismatched reimbursements and denied claims for a mental health recovery, according to court documents. 

UnitedHealthcare received $42 million in fraudulent claims over four years from a South Florida clinic, the Justice Department announced Feb. 10.