STAT

OCTOBER 2, 2023

Arbitration, the land where nobody is happy After Congress officially outlawed most types of surprise medical bills last year, there’s been endless, litigious debate as to how health insurance companies and providers should settle their differences while patients are held harmless.

Health Insurance Companies 334

Health Insurance Companies Hospitals 334

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 325

Health Insurance Companies 325

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 330

Health Insurance Companies Hospitals 330

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 275

Health Insurance Companies 275

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 235

Health Insurance Companies Diabetes 235

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 298

Health Insurance Companies Documentation 298

STAT

JUNE 14, 2024

The federal government is rescoring the quality ratings of this year’s Medicare Advantage plans, which could lead to an additional $1 billion of taxpayer money flowing into the coffers of health insurance companies.

Health Insurance Companies 337

Health Insurance Companies 337

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

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 254

Health Insurance Companies Hospitals 254

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.

Health Insurance Companies 343

Health Insurance Companies 343

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 272

Hospitals Health Insurance Companies 272

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 256

Health Insurance Companies 256

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

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 294

Hospitals Health Insurance Companies 294

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 271

Hospitals Health Insurance Companies 271

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 317

Health Insurance Companies Hospitals 317

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 249

Health Insurance Companies 249

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 275

Health Insurance Companies Documentation 275

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 288

Hospitals Health Insurance Companies Documentation 288

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

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 311

Health Insurance Companies 311

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

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 262

Health Insurance Companies 262

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 288

Health Insurance Companies 288

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 273

Health Insurance Companies 273

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 251

Health Insurance Companies Drug Pricing 251

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 273

Health Insurance Companies 273

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 251

Health Insurance Companies 251

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 236

Health Insurance Companies Hospitals 236

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

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 294

Health Insurance Companies Hospitals 294

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 237

Health Insurance Companies Hospitals 237

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 242

Hospitals Health Insurance Companies 242

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 234

Drug Pricing Health Insurance Companies 234

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 92

Health Insurance Companies Pharmaceutical Companies Pharmaceutical Companies 92

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 118

Health Insurance Companies Hospitals Drug Pricing 118

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 246

Health Insurance Companies 246