If the publicly traded insurer Cigna and for-profit Tenet don't reach an agreement by the end of the year, Arizona Cigna beneficiaries will be out of network when receiving healthcare services at Abrazo health facilities across the state, which includes four hospitals with the lowest quality ratings in Arizona, along with dozens of ASCs...
This analysis of Arizona Rate Review Submissions by The Hertel Report only includes filing by returning Arizona Marketplace insurers, which offers insight into expected premium costs and the drivers of expected increases for 2026 Arizona plans marketed on HealthCare.gov
Arizona rate review submissions to the Arizona Department of...
The Health Care Service Corporation (HCSC) has rebranded the Medicare Advantage plans it purchased from Cigna. A federal court rules in favor of Alignment and against the Centers for Medicare and Medicaid Services (CMS). A new bill introduced in Congress would automatically enroll seniors in Medicare Advantage.
The new HCSC Medicare...
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...
Cigna's deal to sell its MA plans to Health Care Service Corporation is on track to close in the first quarter of 2025. The insurer recently reported its 2024 profits were down year over year (YOY) missing Wall Street expectations due to higher medical costs in its employer stop-loss insurance business. To recover lost profits, the...National News
After years of churning in the rumor mill, the Cigna Group has directly stated that it is not pursuing a merger or acquisition with Humana Inc.
The two companies began talks for a potential merger late last year, but the discussion was tabled after they were unable to reassure investors. Earlier this fall, rumors reignited that the...Arizona News
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...National News
More insurance companies have posted their first quarter results this week, and the outcomes from Cigna and CVS Health show that Medicare Advantage is not turning out to be the winning ticket to infinite growth that some companies thought it would be.
CVS Health's stock tanked on Wednesday last week after it released its earnings...National News
Late last year the Cigna-Humana merger fell through after the two sides couldn't agree on a price and a hostile antitrust regulatory environment and industry opposition to consolidation ended the deal, but with Humana stock down 32% and Cigna's up 36% the math now works for a possible deal.
In December 2023 the two companies announced...Arizona News
Cigna is one step closer to dropping its Medicare business this week after finalizing the sale of its MA plans to the Health Care Service Corp. (HCSC) for $3.3 billion, so long as federal regulators approve the deal. It is set to finalize by the first quarter of 2025.
Late last year, the insurance giant was scrambling to find...
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...
Nationally CMS reports 20.3 million people have chosen a Marketplace plan during the open enrollment period which closes January 16, 2024; about 3.7 million of those consumers were first-time shoppers on the ACA Health Insurance Marketplace.
It's already a historic year for the Marketplace with more than 18 million people in the...National News
Cigna is very ready to be done with its Medicare Advantage program, and may have finally found a buyer for its existing plans.
Last week, the Wall Street Journal reported that Cigna was in advanced talks with the Health Care Service Corp (HCSC) to sell the MA business for between $3 and $4 billion. HCSC is the nonprofit insurer that...National News
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...
It appears likely that Cigna and Humana, two of the country's largest insurers, are discussing a merger that some report could be finalized by the end of the year.
The first report of the potential deal came from the Wall Street Journal, which reported that the structure and terms of the deal were under wraps, but the deal does...
UnitedHealth Group (UHG) is facing a class action lawsuit initiated by two families of deceased Medicare Advantage policyholders who say that the insurer's use of proprietary AI software developed by UGH subsidiary NaviHealth, denied coverage for post-acute care and left them with an untenable bill.
The family members filed suit in...Arizona News
As regulators make efforts to rein in prior authorization delays and denials by private insurers and Medicare Advantage (MA) plans, Medicare and Medicaid managed care organizations (MCOs) are also garnering scrutiny over denials and network adequacy.
A new consumer survey from Kaiser Family Foundation (KFF) found that roughly 60% of...Arizona News
The health insurer covers about 13,000 Medicare lives across five counties in Arizona and earned a four-star rating in 2023 for its Medicare Advantage (MA) plans in the greater Phoenix area where Evernorth Care Group, the medical practice division of Cigna HealthCare of Arizona, operates 20 healthcare centers.
Devoted Health MA...Arizona Comings & Goings
On Tuesday, CVS Health announced that it had completed its acquisition of Oak Street Health, a primary care provider which boasts 170 medical centers in 21 states. The acquisition is the latest in a long line of efforts by retailers to break into healthcare.
CVS Health paid $10.6 billion in cash for the network, and intends to grow...
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...
