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
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
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
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
Cigna adds Talkspace to list of covered telehealth offerings; 14M members with employer-sponsored insurance now have access to the mental health app
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
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
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
White House pushing Congress to require hospitals and insurers to disclose negotiated prices in future COVID-19 relief bills
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
BCBS of Tennessee makes expanded telehealth coverage policies permanent; Will now cover telehealth for in-network providers as regular visits
Premera Blue Cross launches lower premium PPO plan that requires members to access primary care via 98point6 telehealth app
IRS gives employers ability to allow employees to change health benefits elections outside enrollment periods; Includes dropping coverage, adding family members, switching plans
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
Kaiser Permanente reports Q1 loss of $1.1B driven by investment declines; Health plan & hospitals Q1 operating income $1.3B, down 1.7% YOY
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
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
UnitedHealth Group is offering 5-20% premium credits for some plans during pandemic; Company says credits will total $1.5B
CVS Health beats analyst expectations, sees 41% boost in Q1 profits YOY on 7.7% revenue growth; Affirms 2020 earnings guidance
Empty hospitals are losing millions per day due to declines in revenue and increased costs related to coronavirus; Health insurers seeing increased profitability
First Dollar raises $5M seed round; Building a consumer-friendly HSA experience while also administering the accounts for employers
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
Robert Wood Johnson Foundation estimates 25-43 million could lose employer health coverage due to pandemic
Health insurers are telling investors they're largely untroubled by the pandemic, while their lobbying group, AHIP, is asking Congress for relief funds
Molina to buy Magellan's Medicaid and Medicare plans for $820M; represents 150k members and $2.7B in revenue
Analysis: Government and private insurers must act to alleviate unprecedented & systemic financial pressures facing independent practices
Cigna, like most insurers, unaffected by pandemic; Beats analysts estimates, driven by 20% YOY revenue growth in ExpressScripts Q1 revenue
Analysis: How the Amish health care system produces comparable results to the American system at a fraction of the cost
Anthem beats analyst expectations, but is bracing for large drop in commercial plans and a shift to Medicaid and exchange-based customers
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
UnitedHealth's Optum is in advanced talks to acquire remote mental health provider AbleTo for about $470 million
Supreme Court rules commercial health insurers are owed $12B in payments from government; Ruling settles legal uncertainty around the ACA's risk corridor program
Cigna researchers corroborate anecdotal evidence, uncover declines in hospitalizations for strokes, heart attacks, and other serious conditions during pandemic
Despite assurances from insurers and government, patients are still getting billed for COVID-19 related telehealth visits
Clever Care Health Plan raises $20M Series A; plans to launch Medicare Advantage plan that integrates holistic medicine
Moody's predicts health insurers will remain profitable through COVID-19 crisis in all but the most severe scenarios
Analysis: Despite government action to make testing free, COVID-19 evaluation often comes with cost-sharing
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
Initial estimates show insurers expected to return $2.7 billion in MLR rebates in 2020; double 2019 number
Amazon is teasing a new health insurance offering — for its sellers; circulated survey asking about current insurance coverage
Report: Comparing Medicare and private insurance reimbursement rates shows private insurance consistently averages 1.5x+ cost for same services
