STAT

JANUARY 10, 2024

A lawsuit between a large hospital system and a dominant vendor that works for health insurance companies is getting a lot more heated — with one party calling the other an “economic parasite.”

Hospitals 329

Hospitals Health Insurance Companies 329

STAT

JUNE 4, 2024

The federal government inappropriately lowered the 2024 Medicare Advantage star ratings of SCAN Health Plan, which led to the health insurance company in California losing hundreds of millions of dollars in bonuses from the government, a judge ruled Monday.

Health Insurance Companies 342

Health Insurance Companies Hospitals 342

STAT

JANUARY 17, 2024

The Biden administration moved Wednesday to force insurance companies to give specific reasons for denying coverage, and to speed up the pre-approval process in general. The new rule applies to health insurance companies that offer Medicare, Medicaid, Children’s Health Insurance Program, and Obamacare plans.

Insurance Coverage and Processing 340

Insurance Coverage and Processing Health Insurance Companies Hospitals 340

STAT

OCTOBER 23, 2024

Having worked as a medical director for several large health insurance companies and having suffered through the Change fiasco herself as a rehab doctor with a private practice in Kansas City, she figured that if her data had been exposed in that February breach, she would have been notified by now.

HIPAA 340

HIPAA Health Insurance Companies 340

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 346

Health Insurance Companies Hospitals 346

STAT

OCTOBER 21, 2024

Does it make sense for a chain of drug stores to own a major health insurance company? That has been the existential question for CVS Health for six years, since its $70 billion acquisition of the massive insurer Aetna. The biggest pharmacy chain in the U.S.

Health Insurance Companies 326

Health Insurance Companies 326

STAT

JANUARY 8, 2024

Medicare Advantage members continue to go to the doctor and get health care procedures a lot more than predicted, CVS Health executives said at the J.P. Morgan Healthcare Conference on Monday.

Health Insurance Companies 338

Health Insurance Companies 338

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 315

Health Insurance Companies Documentation 315

STAT

JULY 3, 2024

More than two dozen Medicare Advantage insurers received higher quality marks for 2024, based on a STAT review of new data released July 2 by the federal government.

Health Insurance Companies 302

Health Insurance Companies 302

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 364

Health Insurance Companies Documentation 364

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 342

Health Insurance Companies 342

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.

Health Insurance Companies 267

Health Insurance Companies 267

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 261

Health Insurance Companies 261

STAT

OCTOBER 2, 2024

It worked maybe a little too well for CVS, as the surge in new customers backfired when the medical costs for those sporty seniors spiraled well beyond the company’s expectations. Now, after the Woonsocket, R.I.-based

Health Insurance Companies 297

Health Insurance Companies 297

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 286

Health Insurance Companies Documentation 286

STAT

JUNE 3, 2024

Geisinger’s 10 hospitals and 1,700 employed physicians are now officially part of the group, known as Risant Health. Kaiser, which is both a health insurance company and a network of providers, said it wants to add at least five to six more health systems by 2028.

Hospitals 311

Hospitals Health Insurance Companies 311

STAT

JULY 10, 2024

Since 2021, hospitals have been required to post the prices they have negotiated with all health insurance companies, as well as their cash prices. Those two groups have excoriated hospitals’ high prices and profits and lobbied aggressively to ensure hospitals are held accountable for publishing pricing information.

Hospitals 323

Hospitals Health Insurance Companies Documentation 323

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 286

Hospitals Health Insurance Companies 286

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 246

Health Insurance Companies 246

STAT

APRIL 26, 2024

Patients are waiting, but I’d be unwise to put off the caller: a physician calling from a health insurance company. This peer-to-peer call is part of the prior authorization process; my “peer” needs information to determine whether the company will cover a procedure I requested for one of my patients.

Health Insurance Companies 302

Health Insurance Companies 302

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 323

Health Insurance Companies 323

STAT

OCTOBER 4, 2024

  Italian pharma company Recordati said it will buy from Sanofi the global rights to an approved drug to treat cold agglutinin disease , a rare autoimmune disorder, for $825 million, Reuters reports.    The Medicare Advantage market is expected to grow in 2025, despite big changes from insurers , STAT reports.

Health Insurance Companies 273

Health Insurance Companies Diabetes 273

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.

Health Insurance Companies 246

Health Insurance Companies 246

STAT

SEPTEMBER 10, 2024

Financial terms of the deal weren’t disclosed, and IU Health declined to answer questions from STAT.    Earlier this year, Baystate Health in Massachusetts sold its health insurance company , Health New England, to Point32Health, the insurer formerly known as Harvard Pilgrim Health Care.

Health Insurance Companies 267

Health Insurance Companies Hospitals 267

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 315

Health Insurance Companies Hospitals 315

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 292

Health Insurance Companies 292

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 246

Health Insurance Companies Hospitals 246

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 254

Health Insurance Companies Drug Pricing 254

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 246

Health Insurance Companies 246

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 286

Health Insurance Companies 286

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.

Health Insurance Companies 254

Health Insurance Companies 254

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 246

Health Insurance Companies Inpatient Hospitals 246

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 246

Health Insurance Companies Hospitals 246

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?

Hospitals 246

Hospitals Health Insurance Companies 246

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.

Drug Pricing 246

Drug Pricing Health Insurance Companies 246

PhRMA

MAY 8, 2023

This new law will ensure that Indiana patients aren’t paying more for their medicines than their health insurance company or the middlemen known as pharmacy benefit managers (PBMs). This week, Governor Holcomb signed into law Senate Bill 8 recently passed by the Indiana legislature.

Health Insurance Companies 115

Health Insurance Companies Pharmaceutical Companies Pharmaceutical Companies 115

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 138

Health Insurance Companies Hospitals Drug Pricing 138