The lawsuit names Aetna, Cigna, UnitedHealthcare, Humana, Elevance Health, Molina Healthcare, Centene and Health Care Service Corp. as defendants. The Arizona case adds to a growing body of litigation surrounding MultiPlan's out-of-network reimbursement practices.
According to Arizona's complaint, insurers allegedly shared...National News
Aetna stabilized in the first quarter (Q1) of the year after a rocky 2025, bolstering parent company CVS Health's report. The improvement was directly related to the company's government-affiliated businesses, including Medicare Advantage (MA), Medicare Supplement plans and Medicaid managed care.
In a quarterly report released this...
The Centers for Medicare & Medicaid Services (CMS) on Monday finalized a stronger-than-expected payment update for Medicare Advantage (MA) plans in 2027, backing off from an earlier proposal from the agency that signaled flat funding, which triggered industry concern over benefit cuts and market exits.
CMS said the final rate...
Aetna, Blue Cross Blue Shield of Arizona, Centene, Cigna, and UnitedHealthcare dominate Arizona’s commercial health insurance market, covering hundreds of thousands of residents across individual and employer-based plans, according to new data from AHIP (America’s Health Insurance Plans).
Overall, more than 3.2 million Arizonans...
Get the latest on national and Arizona Medicare Advantage (MA) enrollment in The Hertel Report's annual MA Data Edition. Learn about Arizona's top-performing MA plans, enrollment leaders, MA market penetration, and our popular MA enrollment by Arizona county and more!
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Banner|Aetna, a joint venture health plan and one of the leaders in innovative, value-based care in Arizona, has announced John Byrnes as Chief Operating Officer. As COO, Byrnes will manage daily operations and lead the company’s strategic efforts to provide quality, accessible, and integrated care.
The joint venture launched in...
The Centers for Medicare & Medicaid Services (CMS) conducts Risk Adjustment Data Validation (RADV) audits to ensure diagnoses used to determine Medicare Advantage (MA) payments are backed by medical records; federal estimates suggest MA plans may overbill the government between $17 to $43 billion a year. The agency now pledges to...
Tom Grote has retired as the CEO of Banner|Aetna after eight years leading the joint venture health insurance company. His career included 30 years at Aetna.
Congratulations Tom!...Arizona News
CVS Health Corporation's (CVS) second-quarter revenues rose to $91.2 billion, a 2.6% increase from the previous year, primarily driven by growth in its Medicare and commercial businesses.
The company still faces ongoing challenges in the healthcare benefits segment. However, these losses were partly mitigated by strong performance...Arizona News
Last week Dignity Health and Aetna, a CVS Health Company, reached agreement on a new, multi-year contract that allows Aetna members to maintain in-network access to Dignity Health services, facilities and providers in Arizona, California and Nevada.
Aetna and Dignity Health have been in negotiations for several months and on April 5...Arizona News
As of last Friday, April 5, 2024, most Dignity Health facilities and providers in Arizona are no longer considered part of Aetna’s network. Dignity Health Yavapai Regional Medical Center remains in-network but Yavapai Regional Medical Group is subject to termination.
Aetna and Dignity Health have been negotiating for several months...CMS Rules
Medicare Advantage insurers are struggling to maintain strong projections of growth following the news of very meager reimbursement rate reductions.
The Centers for Medicare and Medicaid Services (CMS) anticipates that the 0.16% reduction in the MA benchmark rate in 2025 will come as an effect of modifications to the diagnostic coding...
Yesterday the Centers for Medicare and Medicaid Services reported 745,263 MA plans were sold in Arizona during the Annual Enrollment Period (AEP) that concluded December 7, 2023. The Hertel Report put together some highlights of this year's MA market.
With nearly 1.5 million Medicare eligibles, Arizona's MA market is thriving and...
A new audit conducted by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that between 2015 and 2016, insurer Aetna received $25.5 million in Medicare Advantage overpayments. Also, plans are developing new offerings that aim to target the needs of specific demographics.
The OIG audit...
On October 6, 2023, the two organizations reached a new multi-year contract agreement. The updated contract terms include an effective date of August 7, 2023, ensuring patient families receive in-network coverage since that date.
Phoenix Children’s will continue to offer comprehensive pediatric healthcare services for Aetna...Arizona News
Citing an increasingly common complaint of problematic claim denials, Arizona's revered pediatric health system terminated its agreement with Aetna as of August 7, 2023. As the two parties continue to negotiate, all Phoenix Children’s providers, including Phoenix Children’s Hospital, Phoenix Children’s Medical Group, Phoenix...
Get the latest on the national and local Arizona trends in Medicare Advantage - a lucrative and popular product now responsible for privatizing the healthcare needs of half the eligible Medicare beneficiaries in the country. We also included Arizona's PDP market info.
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New research shows 83% of entries in provider directories from America's leading insurers were inaccurate.
Most providers listed in directories from Aetna, Elevance, Cigna, Humana, and UnitedHealth had inaccuracies, but specialty information was much more likely to be accurate. Only 27.9% of physicians had consistently accurate...
Employers are increasingly moving retirement plans to Medicare Advantage health coverage, but the retirees in question are often upset with these moves.
The City of New York recently attempted such a pivot, which led to a high-profile fight in the courtroom and public politics. Perhaps most surprisingly, the City and some unions...
As the COVID-19 public health emergency winds down, insurers of Medicaid managed care plans are bracing to lose membership.
Centene is expecting it will lose 2.2 million Medicaid members during the redetermination process over the next year. According to Modern Healthcare, the company had 16 million Medicaid members at the end of...
