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Category: Insurance


Study shows more than 50% of providers never bill out of network, while majority of those billing out of network do it less than 10% of the time; Most out of network billing comes from a select few specialties

Jean Fuglesten Biniek, John Hargraves, Bill Johnson, Kevin Kennedy Health Care Cost Institute Author Healthcare HandoutPosted on May 29, 2020May 29, 2020Categories Hospitals, Insurance Go Deeper
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BCBS plans from 6 states sue CVS for fraud, alleging they inflated generic drug prices

Alex Kacik Modern Healthcare Author Healthcare HandoutPosted on May 28, 2020May 28, 2020Categories Pharmacy, InsuranceTags CVS Go Deeper
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Employer and physician groups ask California legislature to mandate health insurers pay $2.5B of prospective monthly payments to primary care practices for 2020, 2021

Shelby Livingston Modern Healthcare Author Healthcare HandoutPosted on May 27, 2020May 27, 2020Categories Insurance, Primary Care Go Deeper
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With primary care practices in financial trouble, private insurance could help by temporarily boosting payments; Would benefit insurers in the long run through avoiding specialist coverage, further practice consolidation

Leemore Dafny, J. Michael McWilliams Health Affairs Author Healthcare HandoutPosted on May 22, 2020May 22, 2020Categories Primary Care, Insurance Go Deeper
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Centene waives telehealth cost-sharing for Medicare Advantage members through end of 2020

Jackie Drees Becker's Hospital Review Author Healthcare HandoutPosted on May 21, 2020May 21, 2020Categories Insurance, COVID-19, Medicare Advantage Go Deeper
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More insurers are discounting 2020 premiums as a way of getting ahead of predicted large MLR rebates in 2021; Including for profit and non-profit plans

Shelby Livingston Modern Healthcare Author Healthcare HandoutPosted on May 21, 2020May 21, 2020Categories Insurance, COVID-19
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Cigna adds Talkspace to list of covered telehealth offerings; 14M members with employer-sponsored insurance now have access to the mental health app

Bruce Japsen Forbes Author Healthcare HandoutPosted on May 21, 2020May 21, 2020Categories Mental Health, Insurance, TelehealthTags Cigna, Talkspace Go Deeper
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Major employer groups ask congress to subsidize 90-100% of COBRA premiums for laid off workers, provide direct relief funds to primary care practices, and prevent mergers by practices accepting CARES Act relief funding

Shelby Livingston Modern Healthcare Author Healthcare HandoutPosted on May 19, 2020May 19, 2020Categories Employer Benefits, Insurance, Primary Care
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Kaiser Permanente now including subscription meditation app Calm as a free member benefit, a $70/year value; Kaiser has been using Calm clinically for two years

Ari Levy CNBC Author Healthcare HandoutPosted on May 19, 2020May 19, 2020Categories Mental Health, Insurance, StartupsTags Calm, Kaiser Permanente
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Study shows more ACOs are led by physician groups than hospitals, with new growth driven by physician groups; Argues future regulation and model development should focus on physician needs

David Muhlestein, Tianna Tu, Carrie H. Colla American Journal of Managed Care Author Healthcare HandoutPosted on May 18, 2020May 18, 2020Categories ACO, Government, Hospitals, Insurance
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White House pushing Congress to require hospitals and insurers to disclose negotiated prices in future COVID-19 relief bills

Jennifer Jacobs, Shira Stein Bloomberg Author Healthcare HandoutPosted on May 16, 2020May 16, 2020Categories Hospitals, Government, Insurance
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Hospitals are facing unprecedented drops in revenue due to coronavirus & readying for a shifting insurance landscape. Some are dipping into investments to fund shortfalls, while others are reliant on federal relief to keep operating

Sarah Kliff The New York Times Author Healthcare HandoutPosted on May 15, 2020May 15, 2020Categories Hospitals, COVID-19, InsuranceTags Mayo Clinic Go Deeper
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BCBS of Tennessee makes expanded telehealth coverage policies permanent; Will now cover telehealth for in-network providers as regular visits

Laura Dyrda Becker's Hospital Review Author Healthcare HandoutPosted on May 15, 2020Categories Telehealth, InsuranceTags BCBS
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Premera Blue Cross launches lower premium PPO plan that requires members to access primary care via 98point6 telehealth app

Susan Morse Healthcare Finance Author Healthcare HandoutPosted on May 15, 2020May 15, 2020Categories Insurance, Primary Care, TelehealthTags 98point6
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Gawande confirms he's stepping down from Haven CEO role, becoming Chairman

Casey Ross STAT Author Healthcare HandoutPosted on May 13, 2020May 13, 2020Categories Big Tech, InsuranceTags Amazon, Haven
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IRS gives employers ability to allow employees to change health benefits elections outside enrollment periods; Includes dropping coverage, adding family members, switching plans

Margot Sanger-Katz, Ron Lieber The New York Times Author Healthcare HandoutPosted on May 13, 2020May 13, 2020Categories Insurance, Government
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Analysis: As of May 2, 27 million have lost employer sponsored insurance; 79% of those are eligible for subsidized coverage through Medicaid or subsidized exchange plans

Rachel Garfield, Larry Levitt, Gary Claxton, Anthony Damico Kaiser Family Foundation Author Healthcare HandoutPosted on May 13, 2020May 13, 2020Categories Insurance, CMS, COVID-19
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UnitedHealthcare plans to offer individual plans on the ACA exchange in Maryland in 2021

Paige Minemyer Fierce Healthcare Author Healthcare HandoutPosted on May 12, 2020May 13, 2020Categories InsuranceTags UnitedHealth Go Deeper
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Kaiser Permanente reports Q1 loss of $1.1B driven by investment declines; Health plan & hospitals Q1 operating income $1.3B, down 1.7% YOY

Tina Reed Fierce Healthcare Author Healthcare HandoutPosted on May 11, 2020May 11, 2020Categories Hospitals, COVID-19, Insurance
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Report: Atul Gawande looking to leave day-to-day management of Haven; Wants to focus on policy and advocacy work as Chairman of the Amazon/Berkshire Hathaway/JPMorgan venture

Anna Wilde Mathews, David Benoit The Wall Street Journal Author Healthcare HandoutPosted on May 9, 2020May 13, 2020Categories Big Tech, InsuranceTags Amazon, Haven Go Deeper
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CMS issues new rules for insurance exchanges including tweaks to special enrollment periods, redeterminations of eligibility for financial help, and how prescription drug rebates count towards OOP maximums and MLR totals

Shelby Livingston Modern Healthcare Author Healthcare HandoutPosted on May 8, 2020May 8, 2020Categories Insurance, Government
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UnitedHealth Group is offering 5-20% premium credits for some plans during pandemic; Company says credits will total $1.5B

Bruce Japsen Forbes Author Healthcare HandoutPosted on May 7, 2020May 13, 2020Categories Insurance, COVID-19Tags UnitedHealth Go Deeper
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CVS Health beats analyst expectations, sees 41% boost in Q1 profits YOY on 7.7% revenue growth; Affirms 2020 earnings guidance

Paige Minemyer Fierce Healthcare Author Healthcare HandoutPosted on May 6, 2020May 13, 2020Categories Pharmacy, Insurance, Retail HealthcareTags CVS
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Empty hospitals are losing millions per day due to declines in revenue and increased costs related to coronavirus; Health insurers seeing increased profitability

Empty hospitals are losing millions per day due to declines in revenue and increased costs related to coronavirus; Health insurers seeing increased profitability
Christina Farr CNBC Author Healthcare HandoutPosted on May 6, 2020May 6, 2020Categories Hospitals, COVID-19, Insurance Go Deeper
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First Dollar raises $5M seed round; Building a consumer-friendly HSA experience while also administering the accounts for employers

Natasha Mascarenhas TechCrunch Author Healthcare HandoutPosted on May 5, 2020May 5, 2020Categories Startups, Insurance
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Humana waives cost-sharing for primary care & behavioral health services for Medicare Advantage members in 2020; Sending 'safety kits' to all MA members including masks, educational materials

Paige Minemyer Fierce Healthcare Author Healthcare HandoutPosted on May 5, 2020May 13, 2020Categories Medicare Advantage, COVID-19, InsuranceTags Humana
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Robert Wood Johnson Foundation estimates 25-43 million could lose employer health coverage due to pandemic

Bowen Garrett, Anuj Gangopadhyaya Robert Wood Johnson Foundation Author Healthcare HandoutPosted on May 4, 2020May 4, 2020Categories COVID-19, Insurance, Public Health
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Health insurers are telling investors they're largely untroubled by the pandemic, while their lobbying group, AHIP, is asking Congress for relief funds

Isaac Arnsdorf ProPublica Author Healthcare HandoutPosted on May 1, 2020May 1, 2020Categories Insurance, COVID-19, Government Go Deeper
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Molina to buy Magellan's Medicaid and Medicare plans for $820M; represents 150k members and $2.7B in revenue

Bruce Japsen Forbes Author Healthcare HandoutPosted on April 30, 2020April 30, 2020Categories Insurance
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Analysis: Government and private insurers must act to alleviate unprecedented & systemic financial pressures facing independent practices

Michael L. Barnett, Ateev Mehrotra, Bruce E. Landon NEJM Author Healthcare HandoutPosted on April 30, 2020April 30, 2020Categories COVID-19, Government, Insurance, Small Practices
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Cigna, like most insurers, unaffected by pandemic; Beats analysts estimates, driven by 20% YOY revenue growth in ExpressScripts Q1 revenue

Paige Minemyer Fierce Healthcare Author Healthcare HandoutPosted on April 30, 2020April 30, 2020Categories Insurance, PBM
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Analysis: How the Amish health care system produces comparable results to the American system at a fraction of the cost

Scott Alexander Slate Star Codex Author Healthcare HandoutPosted on April 29, 2020April 29, 2020Categories Government, Insurance, Public Health
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Anthem beats analyst expectations, but is bracing for large drop in commercial plans and a shift to Medicaid and exchange-based customers

Shannon Muchmore Healthcare Dive Author Healthcare HandoutPosted on April 29, 2020April 29, 2020Categories Insurance
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Humana beats Q1 analyst projections, revenues up 21% on Medicare Advantage growth

Robert King Fierce Healthcare Author Healthcare HandoutPosted on April 29, 2020April 29, 2020Categories Insurance, Medicare Advantage
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Analysis of the Supreme Court's ruling on risk corridors and what happens now: the effect on MLRs, who will receive funds, and other impacts of the decision

Katie Keith Health Affairs Author Healthcare HandoutPosted on April 28, 2020April 28, 2020Categories Government, Health Policy, Insurance
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UnitedHealth's Optum is in advanced talks to acquire remote mental health provider AbleTo for about $470 million

Ari Levy, Christina Farr CNBC Author Healthcare HandoutPosted on April 27, 2020April 27, 2020Categories Insurance, Mental Health
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Supreme Court rules commercial health insurers are owed $12B in payments from government; Ruling settles legal uncertainty around the ACA's risk corridor program

Shannon Muchmore Healthcare Dive Author Healthcare HandoutPosted on April 27, 2020April 27, 2020Categories Government, Insurance
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Cigna researchers corroborate anecdotal evidence, uncover declines in hospitalizations for strokes, heart attacks, and other serious conditions during pandemic

Shelby Livingston Modern Healthcare Author Healthcare HandoutPosted on April 27, 2020April 27, 2020Categories COVID-19, Insurance, Public Health
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Despite assurances from insurers and government, patients are still getting billed for COVID-19 related telehealth visits

Jay Hancock Kaiser Health News Author Healthcare HandoutPosted on April 27, 2020April 27, 2020Categories Telehealth, COVID-19, Government, Insurance
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Clever Care Health Plan raises $20M Series A; plans to launch Medicare Advantage plan that integrates holistic medicine

Jonathan Shieber TechCrunch Author Healthcare HandoutPosted on April 24, 2020April 24, 2020Categories Medicare Advantage, Insurance, Startups
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Moody's predicts health insurers will remain profitable through COVID-19 crisis in all but the most severe scenarios

Elise Reuter MedCityNews Author Healthcare HandoutPosted on April 21, 2020April 21, 2020Categories Insurance
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Analysis: Despite government action to make testing free, COVID-19 evaluation often comes with cost-sharing

Kao-Ping Chua, Rena M. Conti Health Affairs Blog Author Healthcare HandoutPosted on April 20, 2020April 20, 2020Categories COVID-19, Government, Insurance
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HHS bars surprise billing for COVID patients, also views 'every patient as a possible case of COVID-19'. Could be interpreted as wholesale outlawing surprise billing during pandemic

Emmarie Huetteman Kaiser Health News Author Healthcare HandoutPosted on April 18, 2020April 18, 2020Categories COVID-19, Government, Insurance
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Initial estimates show insurers expected to return $2.7 billion in MLR rebates in 2020; double 2019 number

Rachel Fehr, Cynthia Cox Kaiser Family Foundation Author Healthcare HandoutPosted on April 17, 2020April 18, 2020Categories Insurance
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Amazon is teasing a new health insurance offering — for its sellers; circulated survey asking about current insurance coverage

Jason Del Rey Vox Author Healthcare HandoutPosted on April 16, 2020April 18, 2020Categories Insurance, Big Tech
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UnitedHealth Group Weighing Return To Obamacare Markets

Bruce Japsen Forbes Author Healthcare HandoutPosted on April 16, 2020April 18, 2020Categories Insurance, Government
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Report: How health costs might change with COVID-19

Cynthia Cox, Robin Rudowitz, Tricia Neuman, Juliette Cubanski, Matthew Rae Health System Tracker (KFF-Peterson) Author Healthcare HandoutPosted on April 16, 2020April 18, 2020Categories Government, COVID-19, Insurance
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Report: Comparing Medicare and private insurance reimbursement rates shows private insurance consistently averages 1.5x+ cost for same services

Eric Lopez, Tricia Neuman, Gretchen Jacobson, Larry Levitt Kaiser Family Foundation Author Healthcare HandoutPosted on April 16, 2020April 18, 2020Categories COVID-19, Government, Insurance
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UnitedHealth Group posts $3.4B in Q1 profit, beats analyst projections

Paige Minemyer Fierce Healthcare Author Healthcare HandoutPosted on April 15, 2020April 18, 2020Categories Insurance
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HHS partners with UnitedHealth to quickly disperse $30B in COVID-19 funding to providers

Robert King Fierce Healthcare Author Healthcare HandoutPosted on April 13, 2020April 18, 2020Categories COVID-19, Government, Hospitals, Insurance
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Healthcare Handout Everything worth knowing in healthcare tech and business.
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