Payer

Blue Cross and Blue Shield of Alabama is criticizing a proposed health plan backed by the Alabama Farmers Federation (ALFA), which BCBS says would provide unregulated coverage, harm members, and discriminate based on pre-existing conditions. 

Centene and one of its subsidiaries will pay $11 million to settle allegations the company falsely certified its compliance with cybersecurity requirements. 

Blue Cross Blue Shield of Michigan will begin enforcing a long-standing policy that would charge hospitals that repeatedly appeal denied claims.  

Medicare Advantage insurers are navigating headwinds in 2025, and new data shows prior authorization requirements within the program continuing to grow. 

Humana's chief medical officer, Kate Goodrich, MD, says CMS' proposed Medicare Advantage rate increase for 2026 "does not fully account for" the rising medical costs experienced by the company over the last few years.

Major insurers are investing further in the stop-loss insurance business, while others are grappling with mounting cost pressures in the same business line.

A federal judge is allowing a lawsuit against UnitedHealth Group to partially move forward, which alleges the company used an artificial intelligence algorithm to wrongfully deny Medicare Advantage patients post-acute care. 

The Trump administration is looking to target 'program integrity' within the Affordable Care Act marketplace with a new proposed rule, while also reducing funding for the ACA navigator program to $10 million.

Payers are navigating through the second year of major Inflation Reduction Act changes. 

The country's largest payers reported year-over-year increases in medical cost ratios.