STAT

NOVEMBER 14, 2023

We reveal that the nation’s largest health insurance company pursued a strategy to pressure 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.

Health Insurance Companies 126

Health Insurance Companies Documentation Insurance 126

STAT

NOVEMBER 22, 2023

The lawsuit builds on the Federal Trade Commission’s complaint filed in September, which argued USAP and Welsh Carson illegally bought up anesthesia practices across Texas as a way to concentrate market power, gain negotiating leverage over health insurance companies, and raise prices.

Health Insurance Companies 135

Health Insurance Companies Insurance Hospitals 135

STAT

FEBRUARY 5, 2024

Health insurance companies take a while to reach profitability because they need to enroll a lot of people, which then allows them to spread medical costs across a bigger pool. And Devoted isn’t sharing many details about its progress, either.

Health Insurance Companies 126

Health Insurance Companies Insurance 126

PhRMA

MARCH 2, 2023

These include things like making sure patients aren’t paying more for their medicines than their health insurance company or requiring first-dollar coverage, so insurance companies cover the cost of certain lifesaving medicines from day one of the plan year.

Health Insurance Companies 295

Health Insurance Companies Hospitals Insurance 295

STAT

OCTOBER 2, 2023

Health care providers and health insurance companies are closing the books on their third quarters, and one major question continues to hang over them: How much care is everyone actually getting, now that Covid-19 isn’t scaring so many away from doctors and hospitals?

Hospitals 114

Hospitals Health Insurance Companies Insurance 114

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.

Health Insurance Companies 145

Health Insurance Companies Insurance Documentation 145

STAT

JANUARY 13, 2023

Oscar Health has excelled at one thing in particular since its inception a decade ago: burning cash. The health insurance company did not plan to be profitable immediately. It was staking its future on the new Affordable Care Act marketplaces and had to grow quickly to compete with larger insurance carriers.

Insurance 142

Insurance Health Insurance Companies 142

STAT

APRIL 28, 2023

Bright Health Group started as a health insurance company. Bright is looking to sell off the Medicare Advantage plans it manages in California, the company said Friday. But it will no longer be one.

Insurance 105

Insurance Health Insurance Companies 105

STAT

OCTOBER 15, 2023

7, allowing eligible older adults and people with disabilities to sign up for traditional Medicare coverage or Medicare Advantage, the alternative option that is run by health insurance companies. Medicare’s annual enrollment period kicked off Sunday and runs through Dec.

Health Insurance Companies 134

Health Insurance Companies Insurance 134

STAT

OCTOBER 17, 2022

The Department of Justice filed a new lawsuit against Cigna Monday, alleging the health insurance company overcharged the federal government by purposefully inflating how sick its Medicare Advantage members were. Read the rest…

Health Insurance Companies 114

Health Insurance Companies Insurance 114

STAT

MARCH 21, 2023

People and organizations that sometimes make it difficult to access medication can include doctors, methadone clinics, health insurance companies, recovery groups, law enforcement agencies, jails, prisons, drug courts, and labor unions. Read the rest…

Health Insurance Companies 98

Health Insurance Companies Insurance 98

STAT

JANUARY 12, 2024

The Medicare Payment Advisory Commission, a group that advises Congress on Medicare policy, gathered to discuss its pending March report on the state of Medicare Advantage, the alternative to traditional Medicare that is run by health insurance companies.

Health Insurance Companies 114

Health Insurance Companies Insurance 114

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.

Health Insurance Companies 114

Health Insurance Companies Insurance Documentation 114

STAT

SEPTEMBER 7, 2022

A federal judge in Texas has ruled that parts of the Affordable Care Act mandating health insurance companies cover many preventive services and drugs for free are unconstitutional.

Health Insurance Companies 104

Health Insurance Companies Insurance 104

STAT

NOVEMBER 6, 2023

The federal government is proposing to rein in health insurance companies that entice brokers with lavish bonuses to sell their Medicare Advantage plans by placing a firmer cap on broker compensation.

Health Insurance Companies 116

Health Insurance Companies Insurance 116

Fierce Healthcare

OCTOBER 12, 2023

The partnership will allow the Green Mountain State insurer to gain access to better technology and other innovations without losing its appeal as a local health insurance company, according to plan officials.

Health Insurance Companies 64

Health Insurance Companies Insurance 64

STAT

MARCH 31, 2023

WASHINGTON — The Biden administration backed off some of its plans to rein in billions of dollars from wasteful spending in Medicare Advantage next year, after intense lobbying from health insurance companies.

Insurance 98

Insurance Health Insurance Companies 98

STAT

JULY 17, 2023

Two dominant Blue Cross Blue Shield companies in California intentionally underreported premiums of certain health plans so they could avoid paying Affordable Care Act taxes, according to new federal whistleblower complaints.

Health Insurance Companies 98

Health Insurance Companies Insurance 98

STAT

OCTOBER 2, 2023

After Congress officially outlawed surprise medical bills last year, there’s been endless, litigious debate as to how health insurance companies and providers should settle their differences over how much to pay for out-of-network medical bills.

Health Insurance Companies 125

Health Insurance Companies Insurance Hospitals 125

STAT

MAY 4, 2023

Option Care Health is buying Amedisys in an all-stock merger valued at $3.6 billion, creating a national company that specializes in almost all types of home care that can be provided from cradle to grave.

Health Insurance Companies 97

Health Insurance Companies Insurance Hospitals 97

STAT

AUGUST 10, 2023

AdventHealth, a large religious-affiliated hospital system, has sued MultiPlan, alleging the company has worked with health insurers to create a “cartel” that systematically underpays hospitals and doctors for care that is delivered out of an insurance company’s network.

Health Insurance Companies 97

Health Insurance Companies Insurance Hospitals 97

STAT

JUNE 14, 2023

UnitedHealth is one of the country’s largest health insurance companies, and also owns a major chain of ambulatory surgery centers. A vast majority of the care has come from Medicare enrollees who are getting hip and knee replacements and heart procedures in outpatient clinics, he said.

Insurance 101

Insurance Health Insurance Companies 101

STAT

JANUARY 20, 2023

It’s a complex tangle of drug manufacturers who’ve been resisting generics , health insurance companies trying to keep up impressive profits , plus the wholesalers who distribute medicines to pharmacies and the pharmacies that provide them to patients.

Health Insurance Companies 101

Health Insurance Companies Insurance 101

STAT

MARCH 13, 2023

Health insurance companies hire NaviHealth to mine medical data and predict the post-acute care a patient will need. A STAT investigation found Medicare Advantage insurers are routinely using that unregulated technology to deny care, unbeknownst to patients and regardless of whether they need the treatment.

Health Insurance Companies 98

Health Insurance Companies Insurance Hospitals 98

STAT

JANUARY 3, 2023

The pandemic’s “public health emergency” has been a boon for state Medicaid rolls and the health insurance companies that manage those programs. What will happen to the pandemic Medicaid enrollees?

Insurance 98

Insurance Hospitals Health Insurance Companies 98

STAT

AUGUST 17, 2023

Blue Shield of California, a health insurance company that covers almost 5 million people, is restructuring how it will pay for prescription drugs by dividing the work up among five different vendors — two of which include Amazon and Mark Cuban’s pharmacy company.

Health Insurance Companies 97

Health Insurance Companies Insurance 97

pharmaphorum

JANUARY 27, 2023

According to court documents, SaveOnSP works ‘in partnership’ with PBM Express Scripts and specialty pharmacy group Accredo Health to operate the programme, which is described as “one way a PBM […] maximises its profits (and, in turn, commercial health insurance companies’ profits) at plaintiff and patients’ expense.”

Specialty Pharmacies 105

Specialty Pharmacies Insurance Health Insurance Companies Documentation 105

pharmaphorum

JUNE 16, 2022

.” Sidekick is also working with a number of other pharma companies on companion apps for drug therapies, including Pfizer in the area of atopic dermatitis and Bayer in peripheral artery disease. The new Lilly alliance is one of three that Sidekick expects to announce in the coming months.

Health Insurance Companies 103

Health Insurance Companies Insurance 103

The Checkup by Singlecare

APRIL 10, 2024

Check your insurance coverage before switching. It’s always a good idea to check with your health insurance company before switching medications so you know whether you’ll be covered and be prepared for any out-of-pocket costs. It might take several weeks to figure out the best new medication and dosage for you.

Labelling 98

Labelling Dosage Insurance Coverage Health Insurance Companies 98

pharmaphorum

DECEMBER 1, 2020

Make Helsinki Ltd. founded in 2015 brings complementary services spanning Virtual Reality, Customer Experience, Design, Augmented Reality and recruitment for Clinical Trials on top of a full service agency.

Health Insurance Companies 52

Health Insurance Companies Insurance 52

pharmaphorum

MAY 5, 2022

The Iceland-based digital health company – which has just raised $55 million in second-round funding – has been working with Bayer on an app/medicine combination for patients with peripheral artery disease since 2019, and in the following year cut a deal with Pfizer to take a similar approach to five inflammatory disease.

Health Insurance Companies 52

Health Insurance Companies Insurance 52

The Checkup by Singlecare

MARCH 21, 2024

“You need to call your prescription plan to determine whether they will cover Nurtec,” says Adria Goldman Gross , a medical bill advocate and CEO and president of MedWise Insurance Advocacy in Monroe, New York. Your prescription program might have you try less expensive medications before they will cover you for Nurtec.”

Insurance 52

Insurance Insurance Coverage Health Insurance Companies Pharmaceutical Companies 52

The Checkup by Singlecare

SEPTEMBER 7, 2023

Step therapy focuses on using cost-effective treatments for various conditions, which may help save money in the long run for insurance companies and the people they cover. Step therapy is a process used by health insurance companies to manage and control prescription drug costs. What is step therapy?

Insurance 97

Insurance Health Insurance Companies Documentation Communication 97

STAT

OCTOBER 5, 2022

The federal government wants to create a national directory that houses accurate, up-to-date information for all doctors and providers across the country — an ambitious attempt to rectify the plethora of error-riddled directories that are maintained by health insurance companies.

Insurance 94

Insurance Health Insurance Companies Hospitals 94

STAT

SEPTEMBER 6, 2022

But health insurance companies — most of which make sizable profits on the MA plans they offer — are defending the private alternative to traditional Medicare. They say MA remains popular among those who pick their plans and provides extra benefits that help keep older adults healthy.

Health Insurance Companies 98

Health Insurance Companies Insurance 98

pharmaphorum

JUNE 24, 2022

The company has also developed an aligned business solutions model that sees it partner with pharma companies and other organisations to develop customised versions of the app with disease-specific contents as digital therapeutics. ” The post Biogen and Happify partner on digital support for MS patients appeared first on.

Health Insurance Companies 40

Health Insurance Companies Insurance 40

The Checkup by Singlecare

APRIL 21, 2023

Instead of calling the pharmacist, consider calling your health insurance company. Oftentimes, however, customers call the pharmacist to ask questions that really should be directed elsewhere. For example, you may be wondering why your prescription copay has increased since last month.

Insurance 98

Insurance Health Insurance Companies Labelling Vaccines 98