Payer: Page 29
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CMS finalizes rule to cut Medicaid DSH payments for some hospitals
Under the new definition, hospitals can only receive disproportionate share hospital Medicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.
By Susanna Vogel • Updated Feb. 22, 2024 -
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No Surprises implementation created uptick in in-network claims: Fair Health
From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all national claim lines increased 2.3%, the nonprofit found.
By Rebecca Pifer Parduhn • Feb. 20, 2024 -
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Deep DiveInsurers brace for continued Medicare Advantage medical costs
The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.
By Rebecca Pifer Parduhn • Feb. 20, 2024 -
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Disputes over surprise billing continue to soar, new CMS data shows
Arbiters are mostly selecting the higher payment offer in billing dispute determinations. That suggests No Surprises could actually raise premiums for consumers, one health researcher said.
By Rebecca Pifer Parduhn • Feb. 16, 2024 -
CFO Editorial Staff
SCAN Group, CareOregon abandon merger plans
The insurers have dissolved their merger a little over a year after it was announced amid rising criticism from politicians and the public.
By Susanna Vogel • Feb. 15, 2024 -
Permission granted by Elevance Health
Blue Cross of Louisiana halts sale to Elevance
It's the latest setback for the $2.5 billion deal, which was proposed early last year but has struggled to close amid a lack of buy-in from state regulators.
By Rebecca Pifer Parduhn • Feb. 15, 2024 -
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Private equity deals in Medicare Advantage decline, report finds
High interest rates and new regulations could be driving the slowdown, according to a report by the Private Equity Stakeholder Project.
By Emily Olsen • Feb. 14, 2024 -
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Humana sued over alleged 340B underpayments in Medicare Advantage
Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.
By Emily Olsen • Feb. 13, 2024 -
Permission granted by Elevance Health
Elevance lays off more employees
The health insurer has quietly laid off thousands of employees since September, according to sources.
By Rebecca Pifer Parduhn • Feb. 13, 2024 -
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FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance
The Florida-based insurer deceived tens of thousands of consumers into purchasing what they believed was comprehensive coverage, but instead amounted to a medical discount membership.
By Rebecca Pifer Parduhn • Feb. 12, 2024 -
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Molina’s redeterminations losses reach 500K members
As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.
By Rebecca Pifer Parduhn • Feb. 8, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth COO Dirk McMahon to retire
McMahon is leaving after two decades at the insurer.
By Rebecca Pifer Parduhn • Feb. 8, 2024 -
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CVS cuts 2024 outlook on Medicare Advantage caution
The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.
By Rebecca Pifer Parduhn • Feb. 7, 2024 -
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AHA calls for more payer oversight in No Surprises dispute resolution
In comments on a proposed rule, the American Hospital Association argued regulators haven’t fully addressed how they’ll handle oversight for some situations, like when an insurer fails to pay after a dispute determination.
By Emily Olsen • Feb. 7, 2024 -
Samantha Liss/Healthcare Dive
Centene echoes Humana’s concerns about proposed MA rate drop
On the insurer’s earnings call, analysts peppered Centene with questions about its Medicare Advantage business until its CFO attempted to change the subject.
By Rebecca Pifer Parduhn • Feb. 6, 2024 -
Leonardo Fernandez Viloria/Getty Images via Getty Images
Q&ABeMe’s CEO Nicki Tessler on digital behavioral health programs and payer partnerships
Depression and anxiety climbed among teens during the COVID-19 pandemic. Nicki Tessler, CEO and cofounder of BeMe Health, breaks down solutions.
By Brian T. Horowitz • Feb. 5, 2024 -
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Humana flags potential MA funding dip if proposed rate notice finalized
Despite the uncertainty, the insurer reaffirmed its earnings outlook for 2025.
By Rebecca Pifer Parduhn • Feb. 5, 2024 -
Julia Rendleman via Getty Images
Cigna is still interested in Medicare
The health insurer sees Medicare Advantage as an area for future growth, despite selling the division for $3.7 billion. Cigna’s CEO called the sale a “win-win” on a call with investors Friday.
By Rebecca Pifer Parduhn • Feb. 2, 2024 -
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Medicare Advantage plans could see rates dip slightly in 2025
The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.
By Rebecca Pifer Parduhn • Feb. 1, 2024 -
Courtesy of Humana
Humana plots CenterWell expansion in 2024
The payer is leveraging CenterWell’s growing network of primary care centers for seniors to boost margins in its hard-pressed Medicare Advantage business.
By Rebecca Pifer Parduhn • Jan. 31, 2024 -
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Cigna sells Medicare businesses to HCSC for $3.7B
The transaction exits Cigna from a sector that’s been a huge source of growth for insurers but has seen its earnings potential shrink.
By Rebecca Pifer Parduhn • Jan. 31, 2024 -
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Medicare Advantage profitability is declining, Moody’s says
Insurers' MA earnings were 2% lower in 2022 than in 2019, signaling profits in the lucrative insurance program may be weakening.
By Emily Olsen • Jan. 30, 2024 -
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Medicare ACO participation grows in 2024: CMS
However, growth in Medicare's flagship shared savings model has plateaued over the past five years, according to government data.
By Rebecca Pifer Parduhn • Jan. 30, 2024 -
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No Surprises Act prevented 10M surprise bills in first nine months of 2023, insurer groups say
AHIP and BCBSA also took aim at providers for allegedly abusing the billing dispute resolution process set up by No Surprises, in the latest salvo over the polarizing law.
By Rebecca Pifer Parduhn • Jan. 29, 2024 -
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Humana names inaugural ‘Growth President’ after posting grim financial outlook
David Dintenfass will have his hands full trying to right the ship, as Humana stares down expectations for notably slower growth in 2024 and beyond.
By Rebecca Pifer Parduhn • Jan. 26, 2024
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