Payer

A Louisiana appeals court ruled that Blue Cross and Blue Shield of Louisiana must face a 2016 lawsuit over rate reimbursements, according to an opinion released Feb. 14. 

Optum launched Specialty Fusion Feb. 17, a new solution from the UnitedHealth Group subsidiary that allows payers and providers to manage specialty drug treatments with real-time data. 

The demand for service dogs to help patients navigate disabilities is swelling, but lofty costs tied to getting a canine are largely left to patients, according to Kaiser Health News.

Hospitals on average are charging patients and payers twice the price specialty pharmacies charge for the same drugs, according to a Feb. 16 report from America's Health Insurance Plans. 

Lawmakers in South Dakota rejected a Republican-led effort to expand the state's Medicaid program via a state statute, now leaving it to voters to approve the move, according to the Argus Leader. 

Grand Rapids, Mich.-based payer Priority Health told members Feb. 14 that an unauthorized user accessed private information through its Priority Health Member Portal. 

Profits were down year over year for half of the country's largest payers in 2021, but didn't stop double-digit growth for others. 

Six payers dominate the health insurance landscape in the United States, but each has taken dramatically different paths that define their approaches to the industry today. 

Payers, including Blue Shield of California, have been strong-armed to contract with the entire Sutter Health hospital system instead of being able to pick specific facilities to bring into their networks, according to Law360. 

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.