Payer: Page 19
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Courtesy of UnitedHealth Group
Investors ask UnitedHealth for answers about delayed, denied care
A faith-based group of investors has requested UnitedHealth prepare a report looking into how its practices could be leading to “delay or abandonment of medical treatment and serious adverse events for patients.”
By Rebecca Pifer Parduhn • Jan. 13, 2025 -
Alex Wong via Getty Images
CMS proposes Medicare Advantage payment hike in 2026
The Biden administration’s last MA rule is a boon for insurers, though it remains to be seen how the incoming Trump administration might put its stamp on the regulation before it’s finalized this spring.
By Rebecca Pifer Parduhn • Jan. 13, 2025 -
Samantha Liss/Healthcare Dive
Centene appoints first head of ICHRA products
Longtime WTW executive Alan Silver was named the inaugural president of Ambetter Health Solutions. Silver’s mandate is to accelerate growth in Centene’s ICHRA plans.
By Rebecca Pifer Parduhn • Jan. 9, 2025 -
Eric Risberg/AP
Blue Shield of California restructures, launches health services business and names first female CEO
The bevy of changes for the massive California nonprofit is meant to improve operations, and should also give Blue Shield a financial leg-up as it competes with well-funded for-profit peers.
By Rebecca Pifer Parduhn • Jan. 9, 2025 -
Joe Raedle via Getty Images
ACA signups set to smash record at 24M with enrollment continuing
The Biden administration attributed the growth to generous subsidies that are scheduled to expire at the end of this year.
By Rebecca Pifer Parduhn • Jan. 8, 2025 -
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Transcarent to acquire fellow health benefits navigator Accolade for $621M
If closed, the deal will take Accolade private and create a single firm with more than 1,400 employer and payer clients.
By Emily Olsen • Jan. 8, 2025 -
Mario Tama via Getty Images
CVS successfully converts commercial pharmacy contracts to “cost plus” model
CVS’ efforts to reform how its pharmacies are paid have reached a significant milestone that should stabilize flagging margins.
By Rebecca Pifer Parduhn • Jan. 8, 2025 -
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Deep DiveHealth insurers will step off the roller coaster in 2025
After a turbulent year, things should calm for payers with the advent of a business-friendly Trump administration — though challenges will persist. Here are experts’ biggest predictions for 2025.
By Rebecca Pifer Parduhn • Jan. 8, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth, Amedisys delay close date of $3.3B merger
The massive healthcare company and the home health provider have agreed to push back the timeline of their deal after the Department of Justice sued to block it.
By Rebecca Pifer Parduhn • Jan. 7, 2025 -
Aetna sues drugmakers over alleged price-fixing scheme
The complaint alleges nearly two dozen pharmaceutical companies colluded to limit competition, causing costs for certain generic medications to skyrocket.
By Emily Olsen • Jan. 7, 2025 -
Yin Yang via Getty Images
Independent Health settles with Justice Department over alleged Medicare Advantage upcoding
The $100 million settlement is one of the larger recent sums agreed to by an MA payer accused of inflating its members’ sicknesses to get higher reimbursement from the government.
By Rebecca Pifer Parduhn • Jan. 3, 2025 -
Kent Nishimura via Getty Images
Biden signs funding bill extending telehealth flexibilities, but no relief for doctors — or PBM reform
Physician groups slammed Congress for allowing a 2.8% cut to their Medicare pay to go into effect.
By Rebecca Pifer Parduhn • Dec. 23, 2024 -
Win McNamee via Getty Images
Stopgap funding bill includes sweeping PBM reform, preserves telehealth flexibilities
The bipartisan agreement will fund the government through March. It could also reshape the pharmacy supply chain by reforming how controversial drug middlemen do business.
By Rebecca Pifer Parduhn • Dec. 18, 2024 -
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GoodRx appoints former PBM exec as permanent CEO
Wendy Barnes will take up the role more than a year after the drug discount and digital health company’s founders stepped down as co-chief executives.
By Emily Olsen • Updated Dec. 19, 2024 -
Chip Somodevilla via Getty Images
Q&AFormer HHS Secretary Tom Price’s vision for the second Trump administration
President-elect Trump will likely resuscitate policies from his first term like Medicaid work requirements, Price said. The former HHS secretary also shared leadership advice for RFK Jr.: Appreciate the expertise of HHS staff.
By Rebecca Pifer Parduhn • Dec. 17, 2024 -
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CMS says private Medicare plans can’t automatically deny Biogen’s ALS drug
In a rare move, the U.S. agency behind Medicare is warning Medicare Advantage providers they can’t have blanket policies that deny coverage of Qalsody because it’s “experimental and investigational.”
By Jacob Bell • Dec. 13, 2024 -
Rebecca Pifer/Healthcare Dive
Centene lobbies Trump administration to preserve Medicaid, ACA following ‘tragic’ year
The insurer warned Republicans about the political ramifications of cutting healthcare programs during its investor day, which began with a moment of silence for slain UnitedHealthcare CEO Brian Thompson.
By Rebecca Pifer Parduhn • Dec. 13, 2024 -
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MedPAC supports add-on payments for low-income Medicare patient care
Commissioners on the Medicare Payment Advisory Commission also largely supported recommendations to increase pay for physicians and other health professionals slightly less than inflation in 2026.
By Emily Olsen • Dec. 13, 2024 -
Win McNamee via Getty Images
Democrats question Oz over Medicare Advantage advocacy, UnitedHealth stock
Lawmakers argued Mehmet Oz, who was nominated to oversee the CMS, has pushed to expand MA while owning stock in the largest MA plan provider, UnitedHealth.
By Emily Olsen • Dec. 12, 2024 -
Joe Raedle via Getty Images
Consumers who delayed choosing health insurance cite concerns with Trump administration: survey
About half of Americans say they’re worried about how the incoming administration could impact their health insurance, while 22% of people who put off choosing a plan cited the presidential turnover directly.
By Rebecca Pifer Parduhn • Dec. 11, 2024 -
Mario Tama via Getty Images
New bipartisan legislation would force insurers, PBMs to sell pharmacy businesses
The PBM Act would make companies like CVS and UnitedHealth that own health insurers or PBMs sell pharmacy assets. That would help independent pharmacies, but may not help patients, according to one expert.
By Rebecca Pifer Parduhn • Dec. 11, 2024 -
Getty Images
FTC warns 21 healthcare marketers against deceptive claims
The warnings come less than a week after the fatal shooting of a UnitedHealthcare CEO unleashed expressions of anger on social media about health insurer practices.
By Maura Webber Sadovi • Dec. 10, 2024 -
Joe Raedle via Getty Images
Premiums could rise, millions could lose coverage if enhanced ACA subsidies expire: CBO
The number of uninsured Americans will increase by 3.8 million on average each year from 2026 to 2034 if the subsidies lapse, according to an estimate by the Congressional Budget Office.
By Emily Olsen • Dec. 10, 2024 -
Spencer Platt via Getty Images
Health insurers remove executive bios, images from websites after UnitedHealthcare CEO killing
UnitedHealth, Elevance and some BCBS plans have deleted senior leadership pages from their corporate sites, while Centene and CVS scrubbed images of their executives online.
By Rebecca Pifer Parduhn • Dec. 6, 2024 -
Permission granted by Elevance Health
Elevance cancels plan to cap anesthesia coverage for surgeries
The insurer’s Anthem Blue Cross Blue Shield subsidiary is pulling the controversial policy, citing “significant widespread misinformation.”
By Rebecca Pifer Parduhn • Dec. 5, 2024
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