Although UnitedHealthcare's national footprint is expanding in 2024, the nation's and Arizona's largest MA insurer said last week it was reducing some MA service areas and discontinuing certain plans including AARP Medicare Advantage, UnitedHealthcare MedicareDirect, UnitedHealthcare Dual Complete or other UnitedHealthcare Medicare...Arizona News
Arizona's top MA insurer's two-phased approach is expected to eliminate the prior authorization requirement for many procedure codes, equaling nearly 20% of UnitedHealthcare’s overall prior authorization (PA) volume.
Starting September 1, some vein procedures, durable medical equipment, breast reconstruction, radiology,...
Second quarter, 2023 year-over-year financials were anything but grim for America's top for-profit insurers. Thanks to UnitedHealthcare and Optum, brand giant UnitedHealth Group reported quarterly revenues of $92 billion up 16%. And, as it faces increased MA costs, CVS Health posted revenues of $88.9 billion in the second quarter up...
The U.S. Department of Labor (DOL) has filed suit against a subsidiary of the UnitedHealth Group alleging it denied thousands of claims without reviewing them for medical necessity.
The complaint was filed in the U.S. District Court for the Western District of Wisconsin against UMR, a third-party administrator within the...National News
More than 300 members of Congress sent a letter to the Biden administration asking it to use its regulatory authority to reduce the ability for insurers to use administrative hurdles like prior authorization to inhibit patient access to care.
The letter was signed by a bipartisan group of 61 senators and 233 members of the House of...
After months of negotiating on a contract set to expire May 31, 2023, the parties brokered a multi-year agreement for UnitedHealthcare's employer-sponsored and individual commercial plans.
Rising staffing and technology costs, inflation and the increased use of excessive prior authorization and claim denials are making for contentious...
As UnitedHealthcare and Phoenix Children's continue their negotiations the insurer is asserting the regional pediatric hospital system is demanding unreasonable language changes and a 30% price increase over three years. Not true, according to Phoenix Children's in a letter to employees which stated UHC had offered a 3.1% cumulative...
This week, CommonSpirit Health said it's newly focused on expense reduction after reporting a net loss of $244 million in its FY 2023 Q-3 financial results and as expected, the physician staffing company Envision Healthcare declared bankruptcy after a long and bitter dispute with UnitedHealthcare. Oscar Health, now led by former Aetna...
After months of tough negotiations, a new agreement between Blue Cross Blue Shield of Arizona (BCBSAZ) and Dignity Health's Yavapai Regional Medical Center is now in effect as Phoenix Children's announced its conducting contract negotiations with UnitedHealthcare (UHC).
Increasingly difficult negotiations are now happening between...
A crisis of mental health continues to grip the U.S. and Arizona, with a special focus on young people struggling with mental and behavioral health issues.
In Arizona, the patients with serious mental illness (SMI) at the Arizona State Hospital (ASH) may fall under the care of new management if a bill passes Arizona's legislature this...
While regulators, insurers and administrators make progress on rectifying the issues of prior authorization (PA), new data shows that a record number of prior authorization requests were made to Medicare Advantage (MA) insurers in 2021.
Beneficiaries enrolled in traditional Medicare are rarely subject to prior authorization, but...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...
Most shoppers who qualify for a subsidy won't feel the cost of rising Marketplace premiums and with eligibility expanded to include the cost of family coverage, HealthCare.gov may see the busiest season ever as it celebrates its 10th open enrollment period (OEP) Nov. 1, 2022 through January 15, 2023.
Eight insurers, but not...
Seven insurers, but not Bright Health, are offering individual and family coverage in Arizona on HealthCare.gov including last year's newcomers Banner/Aetna and Medica Community Health Plan. We reviewed the plan data from the Arizona Department of Insurance and Financial Institutions and provide readers a Marketplace snapshot.
Nearly...
Every year, ahead of the Medicare Advantage open enrollment period, the Centers for Medicare and Medicaid Services (CMS) publish Medicare Part C and Part D Star Ratings to give Medicare beneficiaries a metric by which to assess plans. Last week, CMS released the 2023 Star Ratings for qualifying MA plans.
Medicare Advantage plans are...
The pharmacy and benefits manager and provider (PBM) Optum, a subsidiary of UnitedHealth Group, helped to push growth expectations bringing UnitedHealthcare (UHC) net earnings outlook to $20.45 to $20.95 per share and adjusted net earnings to $21.40 to $21.90 per share. UnitedHealth Group reported revenues of $80.3 billion, demonstrating...
Arizona's Medicare Advantage market continues to grow in Arizona with 48% penetration. UnitedHealthcare dominates enrollment in the state with its AARP branded offerings including the only 5-star plans in Arizona. Humana and Centene were the only two insurers to knock UnitedHealthcare off its No. 1 spot in a handful of Arizona...
Patricia Tan, MD, is now chief medical officer in UnitedHealthcare’s employer and individual divisions for Arizona and New Mexico.
She was formerly the regional medical director at Optum Enterprise Clinical Services for its Arizona Medicaid business.
Last week was Black Maternal Health Week in the U.S., and with it came a number of announcements on support services through both public and private programs to improve health outcomes for pregnant or postpartum women of color and their children across the country and in Arizona.
In a short blog post for the Arizona Department of...
The success of Medicare Advantage (MA) can't be understated. In the last 11 years, the program has grown to represent nearly 50% of the Medicare-eligible market, a benchmark it will likely pass within the next year.
Arizona MA growth reflects the program's national success. At the Hertel Report's 2020 Winter State of the State, Dan...
