Anthem Blue Cross Blue Shield of New York, a subsidiary of Elevance Health, faces a proposed class action from policyholders accusing the insurer of listing out-of-network providers, especially for mental healthcare, in its directories. These so-called "ghost networks" deter patients from accessing care, inflate costs, and create...
The National Association of Insurance Commissioners report provides financial and market intelligence on the insurance industry - another tool for insurers to identify their competitors and comparative market share. The Hertel Report collected the top 10 leaders in Arizona including UnitedHealth Group, Blue Cross Blue Shield of Arizona...Arizona News
Insurance company Centene defied the odds for the third quarter and overcame issues with Medicaid reimbursement for higher returns than investors had anticipated.
Centene reported $713 million in profit for Q3 on $42 billion in revenue, up from $469 million and $38 billion last year. Following the Medicaid redetermination period, more...National News
Humana's rough patch continues as it sues the U.S. Department of Health and Human Services over star ratings and revisits a potential merger with Cigna.
This month, Humana reached a $90 million settlement with the United States over allegations of fraudulent bids submitted to the Centers for Medicare and Medicaid Services (CMS) for...National News
More than 67 million Americans are Medicare-eligible. This month, as Medicare Advantage (MA) plans promote low co-pays and extra benefits to potential enrollees, plan sponsors are pushing back against CMS's cuts to star rating bonuses. Meanwhile, a former CMS official advises stricter regulation of MA plans as they continue to woo...Arizona News
Banner-University Family Care, Mercy Care, and UnitedHealthcare Community Plan will continue to serve members enrolled in the Arizona Long Term Care System for the elderly and physically disabled through September 30, 2025.
Last week, On September 8, 2024, The Arizona Health Care Cost Containment System (AHCCCS) dismissed the...Arizona News
On September 8, 2024, The Arizona Health Care Cost Containment System (AHCCCS) dismissed the recommendation of an administrative law judge and denied the appeal of Mercy Care, Health Choice Arizona and Banner-University Family Care after all three local non-profits contested the agency's award of its Arizona Long Term Care EPD contracts...
On Monday, the Centers for Medicare and Medicaid Services (CMS) finalized the Rate Announcement for Medicare Advantage (MA) and Medicare Part D programs for Calendar Year (CY) 2025 which includes a rate increase of 3.7% in addition to finalized Part D rules.
The final rule didn't deviate much from the CMS proposed payment rate issued...
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...
The Arizona Health Care Cost Containment's (AHCCCS) procurement process ended in December when Arizona's Medicaid agency chose Centene (Arizona Complete Health) and UnitedHealthcare (UHC Community Plan) to provide integrated healthcare to Medicaid eligible Arizonans who are elderly and/or have a physical disability in the Arizona Long...
Our annual data edition focusing on the Arizona Health Care Cost Containment System (AHCCCS) covers a lot of territory and 15 pages to help readers keep tabs on the agency charged with overseeing the managed care plans contracted with the state to deliver care to about 2.2 million Arizona Medicaid members.
Correction: On Page 4 the...
Cigna will no longer pursue a deal to merge with Humana, putting an end to the potential $140 billion health insurance behemoth.
The companies were unable to reach an agreement on price or other terms, the Wall Street Journal reports. WSJ was the first to report last month that the two anticipated reaching a deal by the end of the...Arizona News
Collectively, UHC Community Plan and Arizona Complete Health Complete Care Plan will provide health care services to the approximately 26,000 members enrolled in the Arizona Long Term Care System (ALTCS) and who are elderly and/or living with a physical disability, known as the ALTCS-EPD program. It marks the first time members across...Arizona News
Modern Healthcare published its annual list of the 100 Most Influential People in Healthcare, which honors individuals throughout healthcare who have been recognized for their influence and leadership within the industry.
Peter S. Fine, CEO of Banner Health was on the list for the 10th consecutive year, ranked 93rd. Fine joined Banner...
Humana has revised its outlook, confident that its expected Medicare Advantage enrollment will increase even more than it originally anticipated in 2023. But Centene has reported the opposite, expecting to lose money in Medicare Advantage and from Medicaid redeterminations.
Centene released its first quarter (Q1) corporate reports on...
With the Great Unwinding looming at the end of spring, insurers are now speaking up about their role in Medicaid redeterminations and a special enrollment period (SEP) for enrollees who may lose coverage in the process.
In a memo released at the end of January, the Centers for Medicare and Medicaid Services (CMS) announced that the...Arizona News
It's the time of year for insurers to file their fourth quarter (Q4) earnings reports for 2022. This week, Molina, Kaiser Permanente and Oscar Health posted financial metrics.
Oscar Health beat the odds in 2022 by improving its medical loss ratio from 88.9% in 2021 to 85.3%, Modern Healthcare reports. But the healthtech company still...National News
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...Arizona News
This year's surprising exit of Bright Health on the Marketplace leaves $4 billion in ACA revenue up for grabs for brand name giants including UnitedHealthcare, Centene, Cigna, and CVS, but it's some lesser known short-term plans and Healthcare Sharing Ministries that are also gaining consumer attention with deceptive marketing touting...
