STAT

NOVEMBER 3, 2023

1  start to the annual open enrollment period, the advertising engines for state health insurance marketplaces, and the federal exchange,  healthcare.gov , have been revving up. The woes of the uninsured are well-documented. ’Tis the season — open enrollment season, that is. Since before the Nov.

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Insurance Documentation Hospitals 137

STAT

DECEMBER 28, 2023

Health insurance giant UnitedHealth Group used secret rules to restrict access to rehabilitation care requested by specific groups of seriously ill patients, including those who lived in nursing homes or suffered from cognitive impairment, according to internal documents obtained by STAT.

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Nursing Homes Documentation Insurance 145

The Checkup by Singlecare

JULY 2, 2025

Without insurance, one 40 gm tube of fluorouracil 5% topical cream costs about $363. How much does fluorouracil cost without insurance? Your cost for fluorouracil may vary depending on your diagnosis, treatment regimen, length, and insurance coverage. Without insurance, it can cost around $233 for a single 40 g tube of cream.

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Insurance Insurance Coverage Chemotherapy Documentation 52

The Checkup by Singlecare

DECEMBER 13, 2022

Meanwhile, the radiologist’s office contacts your insurance to get the service approved. Your insurance provider decided to deny the claim, which means you can’t have the scan. Or, worst-case scenario, you’ve already gotten it and your insurance denied the claim after the fact. What is an insurance appeal letter?

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STAT

OCTOBER 11, 2022

Bright Health Group is drastically cutting back its health insurance offerings for next year, including a full exit of the individual Affordable Care Act marketplaces, and is attempting to raise $175 million to keep the company afloat. Just last month, Bright hosted health insurance brokers on a yacht ahead of the open enrollment season.

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STAT

NOVEMBER 20, 2023

Financial documents at a prominent hospital system in Los Angeles show just how large those discounts are — and how raw of a deal uninsured patients could be getting. 30, according to new financial documents. Hospitals’ list prices for surgeries, therapies, and other procedures always come with massive discounts.

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Hospitals Documentation Insurance 132

The Checkup by Singlecare

JUNE 6, 2025

Although insurance plans may cover Ozempic to treat Type 2 diabetes, coverage for fatty liver disease might not be so straightforward. Several factors that can affect coverage include someone’s health history, specific insurance plan, and what it’s prescribed for. Does insurance cover Ozempic for fatty liver disease?

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The Checkup by Singlecare

JUNE 10, 2025

But its prices can look intimidating, leaving some looking to insurance for help. Insurance coverage for Contrave depends entirely on each individual patient’s insurance plan,” says Dr. Jennifer Brown, MD, a medical writer for MyObesityTeam. Some Aetna healthcare plans may cover Contrave, but it depends on several factors.

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STAT

MARCH 26, 2024

Troubled hospital operator Steward Health Care, grappling with a financial crisis that’s engulfed its eight Massachusetts hospitals, has moved to shore up its finances by striking a deal to sell its nationwide physician network to insurance giant UnitedHealth’s Optum Care unit. Continue to STAT+ to read the full story…

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Hospitals Documentation Insurance 145

The Checkup by Singlecare

JUNE 28, 2024

Although some healthcare providers prescribe Ozempic off-label for weight loss, insurance often won’t cover Ozempic for these uses unless it’s medically justified and no alternative treatments exist. We’ll explain when insurance covers Ozempic and how to advocate for coverage. When does insurance cover Ozempic for weight loss?

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STAT

NOVEMBER 14, 2023

The nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation care for older and disabled Americans as profits soared, a STAT investigation has found.

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Health Insurance Companies Insurance Documentation 145

STAT

FEBRUARY 27, 2024

antitrust regulators into pharmaceutical industry middlemen has been stymied because the companies have failed to provide many of the documents that, in some cases, were requested as far back as June 2022. A much-anticipated inquiry by U.S.

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The Checkup by Singlecare

JUNE 5, 2025

While health insurance plans do not always provide coverage of Zepbound for weight loss, coverage may be more likely if the drug is prescribed for sleep apnea. Many insurance plans often do not cover weight loss medications in general,” says Luis Vinas , a board-certified plastic surgeon at Palm Beach Gynecomastia Center.

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Insurance Customer Service Compounding Documentation 52

The Checkup by Singlecare

JUNE 5, 2025

Some health insurance formularies cover Mounjaro, while others list it as a nonpreferred drug. Even if your BCBS health plan covers Mounjaro, you may need to get prior authorization from the insurance company to confirm they’ll pay for it. Without insurance, Mounjaro costs an average of $1,486 per 4, 0.5 mL of 5 mg/0.5

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STAT

NOVEMBER 14, 2023

For more than a year, our reporters have documented how the use of artificial intelligence is driving denial of claims or delaying treatment for seriously ill patients. This latest story goes even deeper, establishing how the denial of claims was by design.

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Health Insurance Companies Documentation Insurance 121

STAT

JANUARY 30, 2023

The federal government and health insurance companies have been clashing for more than a decade over how Medicare Advantage plans should be audited and how the well-documented overpayments to those plans should be clawed back.

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Health Insurance Companies Documentation Insurance 110

STAT

NOVEMBER 2, 2023

Mothers, children, and the disabled clutch passels of documents along the sidewalk. They wait to reauthorize their Medicaid insurance. We would all be healthier if we brought the two lines together. The first line forms every morning before the building opens. Read the rest…

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STAT

JULY 10, 2024

This document is where the government has in the past rolled out changes to the so-called hospital price transparency rule, but the Biden administration did not address the issue in this edition. Since 2021, hospitals have been required to post the prices they have negotiated with all health insurance companies, as well as their cash prices.

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Hospitals Health Insurance Companies Documentation Insurance 123

STAT

MAY 17, 2023

Senators warned the country’s largest Medicare Advantage insurers at a hearing on Wednesday that they must abide by Medicare’s coverage rules and cannot rely on algorithms to deny care that patients need. Congress is ramping up its oversight, too.

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STAT

APRIL 14, 2025

Canadian officials have obtained a court order that requires Express Scripts to produce documents in connection with an investigation into whether the pharmacy benefits manager violated antitrust laws. We asked Cigna, the health insurer that owns Express Scripts, for comment and will update you accordingly.

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Mail-Order Pharmacies Documentation Insurance 88

The Checkup by Singlecare

JULY 2, 2025

Like other brand-name drugs, Vyvanse can be expensive without coupons or insurance. Some Aetna plans may cover Vyvanse, but as is often the case with health insurance, it depends on the specific plan’s formulary, the prior authorization requirements, and the reason it’s prescribed. Does Aetna cover Vyvanse?

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The Checkup by Singlecare

JULY 2, 2025

Coverage for weight loss medications varies by plan, though, and some insurance plans require prior authorization. According to United Healthcare (UHC), employers may opt to cover weight loss medication in their health insurance plans if they are able to comply with UHC’s prior authorization requirements. How much does Saxenda cost?

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STAT

FEBRUARY 23, 2023

attorney general is specifically looking at “communications with AKF, documents relating to donations to the AKF, and communications with patients, providers, and insurers regarding the AKF.” DaVita disclosed the new “civil investigative demand” in its latest annual financial filing to investors.

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Communication Documentation Insurance 98

STAT

DECEMBER 29, 2022

The downfall of Aduhelm, the first new treatment for Alzheimer’s disease in two decades, is largely the story of a drug company choosing to maximize its potential profits at the expense of patients and taxpayers, according to a congressional investigation that cites thousands of pages of internal Biogen documents.

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STAT

OCTOBER 23, 2023

Starting in the first quarter of 2024, Optum’s post-acute-care companies will be called Home & Community Care, according to internal documents obtained by STAT. However, Optum advised employees that “Home & Community Care should not be directly next to the Optum logo” in marketing materials.

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The Checkup by Singlecare

APRIL 24, 2025

While its an effective drug, Mounjaro may be expensive, even with insurance. How much does Mounjaro cost without insurance? Without insurance, the cost of Mounjaro can vary depending on different factors, such as the pharmacy and location. Does Kaiser cover Mounjaro? The average retail price for a box of four 5 mg/0.5

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STAT

MARCH 18, 2024

CVS Caremark, the PBM owned by CVS Health that oversees the prescription drug benefits of 103 million people, told its employer clients that it anticipated “more lower-cost products (including specialty biosimilars) may become preferred products” on its lists of approved drugs for 2024, according to documents obtained by STAT.

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STAT

NOVEMBER 14, 2023

Internal documents revealed that managers within the company set a goal for clinical employees to keep patients rehab stays within 1% of the days projected by the algorithm. The lawsuit filed in the U.S.

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Nursing Homes Documentation Insurance 145

STAT

MAY 17, 2023

By seeking documents from Zinc Health Services and Ascent Health Services, the agency is attempting to unravel what critics complain is an opaque set of business practices and relationships. Pharmacy benefit managers are linchpins in the pharmaceutical pricing system, and are under increased scrutiny for allegedly driving up consumer costs.

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The Checkup by Singlecare

JUNE 9, 2024

Although Tresiba may be covered by insurance, people without health insurance may bear the full retail cost of the medication. Is Tresiba covered by insurance? Most commercial insurance plans cover Tresiba. How much does Tresiba cost without insurance? A 10 mL vial may cost around $450 without insurance.

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The Checkup by Singlecare

APRIL 15, 2025

If you want to test out the Zepbound to reduce your body weight , its important to note that getting it covered by your insurance plan can be tricky especially if its for weight loss rather than treating sleep apnea. From my clinical experience, most health insurance plans require pre-authorization to cover Zepbound , said Dr. Makhija.

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Insurance Insurance Coverage Documentation Health Insurance Companies 52

The Checkup by Singlecare

JUNE 5, 2025

Many people with a Mounjaro prescription look to health insurance, Medicaid , or Medicare to help lower their out-of-pocket costs. Insurance often does come through if the prescription is for diabetes management, not weight loss. However, insurance coverage depends on the insurance company and plan. Others don’t.

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STAT

JUNE 25, 2025

   Ross also discusses what it’s like to be the recipient of a confidential document that UnitedHealth inadvertently emailed to him during the reporting process. The story is part of their ongoing investigative series into UnitedHealth Group , and it’s a pretty fascinating saga.  

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STAT

JUNE 8, 2023

… The pharmaceutical industry has spent the past year speaking out against new mechanisms that could limit how much governments or insurers pay for certain new medicines, but U.S. Wall Street analysts wrote investors that the documents seemed to suggest the agency will approve the drug. Have a smashing time.

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FDA Documentation Insurance 98

Pharmaceutical Technology

JULY 15, 2022

The documents state that a partnership with a CMO would be cheaper than the state directly manufacturing insulin. In April, the US House of Representatives passed the Affordable Insulin Act, which set a price cap of $35 a month for Medicare and private insurance users.

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STAT

DECEMBER 6, 2023

million worth of stock on Tuesday, according to the documents filed with the Securities and Exchange Commission. Stephen Hemsley, the board chair and former CEO of UnitedHealth Group, has sold nearly $113 million worth of company stock since the middle of October, new filings show. Hemsley most recently sold $36.4 The other $76.5

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Documentation Insurance 121

STAT

JANUARY 8, 2024

In a country with a well-documented obesity epidemic, Wegovy and other members of a new type of weight-loss drug are highly effective: In clinical trials, people on Wegovy typically lose 15% of body weight , and a similar medication, retatrutide, has shown up to 24% weight loss.

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