Centene partners with insurers to eliminate prior authorizations for leading providers
Dive Brief: Centene revealed on Tuesday its plans to introduce a gold card program next month as part of the larger efforts within the healthcare sector to reform the prior authorization system. This initiative will exempt top-performing providers from the usual prior authorization requirements for certain medical services, procedures, or prescriptions. According to the insurer, […]
Mehmet Oz requests insurers to utilize brokers that document calls for fraud prevention
Dr. Oz Advocates for Recording Conversations in Obamacare Enrollment Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, is pressing health insurers to collaborate exclusively with brokers who document their discussions with Obamacare applicants. This initiative is part of the Trump administration’s intensified efforts to address unauthorized enrollments, which officials argue […]
Doctors and insurers take legal action against Newsom regarding rising health insurance premiums.
IN SUMMARY In June, lawmakers approved a healthcare tax aimed at addressing cuts to federal Medicaid, potentially raising premiums for Californians. In a new lawsuit, the California Medical Association and the California Association of Health Plans argue that this tax contravenes Proposition 35, which voters approved in 2024. On Friday, a group of doctors and […]
US Consumers Might Be Misled About How Much Insurers Really Spend on Medical Care, Report Indicates
A recent report from the Insurance Watchdog Coalition suggests that some health insurers may not be fully transparent about their medical care expenditures. The findings, first reported by The Daily Caller News Foundation, reveal that Medicare Advantage (MA) plans reported a Medical Loss Ratio (MLR) of nearly 90% for 2023. However, according to their own […]
Vermont health insurance costs will increase in 2027, but the hikes are smaller than what insurers asked for.
Vermont Health Insurance Premiums Set to Increase in 2027 The Green Mountain Care Commission has decided to reduce the proposed increases in health insurance premiums for Vermont by $24 million, even though rates will still rise next year. Blue Cross Blue Shield of Vermont and MVP Health will increase their premiums in 2027, but the […]
Insurers in California are allowed to set higher rates for single adults following a ruling.
California Court Ruling on Auto Insurance Premiums In a surprising decision, Californians who are divorced, widowed, or single may face higher auto insurance rates. A ruling from the California Court of Appeals upheld a regulation dating back to 1996, permitting auto insurance companies to consider marital status when determining premiums, citing a “substantial relationship to […]
Medicare regulations made insurers appear as the bad guys.
Debate Over Alzheimer’s Treatment Decisions Imagine being diagnosed with Alzheimer’s disease. A doctor evaluates your individual requirements and risks, then suggests a tailored treatment plan aimed at enhancing both your lifespan and quality of life. But here’s a thought: who ultimately decides if you get that treatment? Is it you, your family, your doctor, or […]
Big Medicare Advantage insurers seem to reject care for financial gain, federal watchdog discovers
Medicare Advantage Denials Raise Concerns A recent investigation has intensified worries that Medicare Advantage (MA) insurers might be denying necessary care to seniors in order to boost profits. The Department of Health’s Office of Inspector General (HHS OIG) released reports indicating alarmingly high denial rates for post-acute care, particularly from major insurers like UnitedHealth, Humana, […]
Health insurers recover after years of losses linked to GLP-1 drugs
Point32Health and Blue Cross Report Operating Income While Adjusting GLP-1 Coverage Point32Health, which owns both Harvard Pilgrim and Tufts Health Plans, announced an operating income of $86 million this quarter, a notable improvement compared to a loss of $39 million in the same timeframe last year. The organization serves around 2 million members, whereas Blue […]
Doulas can enhance health results for mothers and infants, attracting attention from insurers.
Natalia Marin Torres, a first-time mom from Colombia, felt a mix of excitement and anxiety when she learned she was pregnant last August. She had a disagreement with her OB-GYN and realized she needed additional assistance to cope with the U.S. healthcare system. “Being away from family and familiar culture can, I think, be quite […]