Health Insurance - Health Care Compliance Brief

Singapore unveils online health insurance planning tool and more briefs

Healthcare It News

MARCH 27, 2025

Singapore launches online health insurance planning tool Singapore's Ministry of Health and the Central Provident Fund (CPF) Board have unveiled a digital tool for health insurance planning.

Health Insurance

Health Insurance Hospitals Public Health Doctors

House Republicans unveil Medicaid cuts including work requirement, provider tax freeze

Healthcare Dive

MAY 12, 2025

But Republicans’ policy proposals would still result in millions of Americans losing health insurance. The House Energy and Commerce Committee is backing more moderate reforms to Medicaid.

Medicaid

Medicaid Medicaid Health Insurance

Offering health insurance is becoming less lucrative

Healthcare Dive

NOVEMBER 18, 2024

In the third quarter, the seven major publicly traded insurers’ medical loss ratios increased an average of 3.3 percentage points year over year — a major jump in medical costs.

Health Insurance

Nirvana Raises $24.2M Series A to Revolutionize Health Insurance Verification

Healthcare IT Today

OCTOBER 15, 2024

By leveraging AI, Nirvana provides instant verification of insurance and highly accurate cost estimates to providers and their patients. Nirvana ’s platform sheds light into the opaque world of healthcare benefits.

Health Insurance

Trends shaping the business of health insurance in 2024

Healthcare Dive

JANUARY 16, 2024

The uninsured rate will rise. Medicare Advantage enrollment will swell, with fewer sweeping regulatory changes. Major pharmacy benefit managers will launch more transparent products. Here’s what experts see coming down the pike for 2024.

Health Insurance

Health Insurance Medicare Medicare

Medicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2

Healthcare Dive

AUGUST 15, 2024

Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by growing health services divisions.

Medicaid

Medicaid Medicaid Health Insurance Medicare

The health of a community depends on fair health insurance practices

Healthcare Dive

MARCH 17, 2023

Access to local and convenient care is critical for a community’s health. However, the current approach from payers puts this at risk, argues Antonio Rios, chief of population health at Northeast Georgia Health System.

Health Insurance

Health insurance customer experience starts at open enrollment

Healthcare Dive

NOVEMBER 28, 2022

Why health plan consumer experience matters; from the perspective of a stressed-out son.

Health Insurance

Biggest takeaways from health insurers’ third-quarter earnings

Healthcare Dive

NOVEMBER 8, 2023

Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics? Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s.

Health Insurance

Health Insurance Medicaid Medicaid Medicare

Rising health insurance premiums linked to wage stagnation, study finds

Healthcare Dive

JANUARY 17, 2024

Families with employer-sponsored plans missed out on an average of more than $125,000 in earnings over more than three decades as premiums increased, according to a study published in JAMA Network Open.

Health Insurance

A Compelling AI Use Case for Health Insurers

HealthIT Answers

MAY 7, 2025

By Shannon Smith - With volatility in Medicaid reimbursement as well as both administrative and medical costs continuing to rise rapidly, health plans need to be as strategic as possible when it comes to allocating resources if they are to serve members well while remaining financially solvent.

Health Insurance

Health Insurance Medicaid Medicaid

Health insurers ignore surprise billing decisions, providers allege

Healthcare Dive

AUGUST 4, 2023

Payers didn’t reimburse doctors in more than half of arbitration award cases, according to a survey from clinician group Americans for Fair Health Care.

Health Insurance

Health Insurance Doctors

Nearly 1 in 4 gig workers lacks health insurance, survey finds

Healthcare Dive

NOVEMBER 15, 2022

A majority of those workers cited affordability as the main barrier to getting coverage, according to a poll from insurance broker Stride Health.

Health Insurance

The Health Insurance Premium for a Family Averages $25,572 in 2024 – KFF’s Annual Update on Employer-Sponsored Benefits

Health Populi

OCTOBER 14, 2024

The premium for employer-sponsored health plans grew by 6-7% between 2023 and 2024, according to the report on Employer Health Benefits 2024 Annual Survey from the Kaiser Family Foundation, KFF’s 26th annual study into U.S. companies’ spending on workers’ health care. will indeed keep on keepin’ on.

Health Insurance

Health Insurance Prescription Drug Pricing COVID-19 Governance

AdventHealth sues MultiPlan for alleged ‘cartel’ with health insurers to fix prices

Healthcare Dive

AUGUST 14, 2023

The health system alleges providers have lost at least $19 billion per year as a direct result of MultiPlan’s anticompetitive agreements with major payers, including UnitedHealth, Aetna and Elevance.

Health Insurance

Georgetown CHIR & Association of Health Care Journalists Release Update to Health Insurance Tool

Center for Health Insurance Reform

JANUARY 9, 2025

The Association of Health Care Journalists has released an updated, interactive 50-state Media Guide to help journalists navigate the complexities of the U.S. health care system, offering detailed data on health insurance coverage, state policies, and regulatory agencies.

Health Insurance

Health Insurance State Policy

Poor Member Digital Experience Weighs Heavily on Health Insurers, J.D. Power Finds

HIT Consultant

APRIL 9, 2025

What You Should Know: – Health insurance members, both in commercial and Medicare Advantage plans, are increasingly relying on their health plan’s websites and mobile apps for communication. However, health insurance providers have a lot of work to do to close the gap to other industries.

Health Insurance

Health Insurance Medicare Medicare

Nearly half of consumers are in debt due to medical bills, survey finds

Healthcare Dive

OCTOBER 26, 2022

Many are struggling to afford their private health insurance and are unprepared for a medical emergency, a poll conducted for telehealth provider Babylon showed.

Medical Billing

Medical Billing Health Insurance

AMA sues MultiPlan, insurers alleging ‘cartel’ to fix physician prices

Healthcare Dive

OCTOBER 25, 2024

MultiPlan, which denies the allegations, has been sued dozens of times over concerns the company is conspiring with health insurers to underpay doctors for out-of-network care.

Health Insurance

Health Insurance Doctors

CMS’ first No Surprises audit targets Aetna, finds some noncompliance

Healthcare Dive

JULY 12, 2024

The findings are a “big deal,” according to one expert, as CVS’ health insurer didn’t follow some “major requirements that are essential to ensuring that the IDR process runs smoothly.”

Health Insurance

Appeals court upholds ACA’s preventive services mandate, but opens door to future challenges

Healthcare Dive

JUNE 24, 2024

The Fifth Circuit Court of Appeals’ decision Friday is a win for the upwards of 150 million people that receive health insurance through their employers. However, it paves the way for future lawsuits from opponents of the ACA.

ACA

ACA Health Insurance

Nearly a quarter of Americans are underinsured: report

Healthcare Dive

NOVEMBER 27, 2024

Twenty-three percent of working-age adults with health insurance face high out-of-pocket costs that make it difficult to afford care, according to a survey by the Commonwealth Fund.

Health Insurance

Q&A: J.D. Power study spotlights the state of health insurers' digital experience

Mobi Health News

APRIL 17, 2025

Power, told MobiHealthNews that health insurance companies should learn from other industries' use of digital properties. Eric McCready, director of digital solutions at J.D.

Health Insurance

Cigna, Humana in talks to merge: WSJ

Healthcare Dive

NOVEMBER 29, 2023

health insurance industry, and would almost certainly face a regulatory challenge. The merger would have major effects for the makeup of the U.S.

Health Insurance

Blue Shield of California is promising a simpler, cheaper pharmacy benefits model. Can it deliver?

Healthcare Dive

OCTOBER 25, 2023

Big questions hang over the California health insurer's bold experiment — having five vendors carry out PBM functions previously performed by one — that could threaten BSCA's expected savings.

Health Insurance

Humana sues HHS over calamitous Medicare Advantage star ratings decrease

Healthcare Dive

OCTOBER 21, 2024

It’s the latest in a string of lawsuits from health insurers scrambling to protect their prized quality scores and the money that ratings represent.

Medicare

Medicare Medicare Health Insurance

A Cigna-Humana merger could face a long regulatory delay. But it might get approved.

Healthcare Dive

DECEMBER 4, 2023

As rumors swirl that the two major health insurers are inching toward a merger, experts say antitrust agencies have grounds to block a deal — but may not be successful.

Health Insurance

Millions of Americans Remain Uninsured or Underinsured Despite ACA Gains

HIT Consultant

NOVEMBER 22, 2024

What You Should Know: – A new report from the Commonwealth Fund reveals that despite significant progress in expanding health insurance coverage under the Affordable Care Act (ACA), millions of Americans still lack adequate and affordable healthcare.

ACA

ACA Health Insurance Medicaid Medicaid

Insurers brace for continued Medicare Advantage medical costs

Healthcare Dive

FEBRUARY 20, 2024

The big question coming out of the health insurance earnings season is how much elevated utilization among seniors will carry over into 2024.

Medicare

Medicare Medicare Health Insurance

Republicans can’t meet budget target without Medicaid cuts: CBO

Healthcare Dive

MARCH 10, 2025

Excluding large health insurance programs, spending under the House Energy and Commerce Committee's purview falls far short of the budget blueprint’s $880 billion goal for cuts.

Medicaid

Medicaid Medicaid Health Insurance

Centene names new COO following leadership turnover

Healthcare Dive

NOVEMBER 15, 2023

Current SVP Susan Smith will take the reins as the health insurer’s chief operating executive starting next year.

Health Insurance

Insurance lobby blasts Medicare Advantage audit rule

Healthcare Dive

JANUARY 31, 2023

America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed.

Medicare

Medicare Medicare Health Insurance

CMS requires 30 states to pause Medicaid disenrollments after systems error

Healthcare Dive

SEPTEMBER 22, 2023

Nearly 500,000 people will regain Medicaid or Children’s Health Insurance Program coverage after being improperly removed from the rolls during redeterminations, according to the HHS.

Medicaid

Medicaid Medicaid Health Insurance

Molina, Elevance nab Iowa Medicaid contracts on heels of California win

Healthcare Dive

SEPTEMBER 1, 2022

Iowa will soon have three health insurers to manage its $7 billion Medicaid program.

Medicaid

Medicaid Medicaid Health Insurance

The Payer Journey: Understanding Health Plans and the Importance of Data Collection

MRO Compliance

MAY 15, 2025

Health Insurance Marketplace: Established under the Affordable Care Act (ACA), the Marketplace provides competitive, commercial insurance plans for individuals and small groups. Health Insurance Marketplace: Redistribute funds from low risk to high-risk plans, finalized after Risk Adjustment Data Validation (RADV) audits.

Electronic Medical Records

Electronic Medical Records Medicaid Medicaid ACA

Humana becomes second major payer to flag higher outpatient volumes in Q2

Healthcare Dive

JUNE 16, 2023

Pent-up demand for healthcare delayed during COVID-19 is making a reappearance, pressuring medical costs for health insurers that had a financial windfall during the pandemic.

COVID-19

COVID-19 Health Insurance

HHS pauses surprise billing arbitration after Texas court decision

Healthcare Dive

FEBRUARY 13, 2023

The process by which health insurers and medical providers hash out payments for surprise bills is still in flux due to a series of lawsuits threatening the dispute resolution process.

Health Insurance

Bright Health explores sale of California MA business

Healthcare Dive

MAY 1, 2023

The move, if completed, would mean the end of the company as a health insurer.

Health Insurance

Cigna is still interested in Medicare

Healthcare Dive

FEBRUARY 2, 2024

The health insurer sees Medicare Advantage as an area for future growth, despite selling the division for $3.7 billion earlier this week. Cigna’s CEO called the sale a “win-win” on a call with investors Friday.

Medicare

Medicare Medicare Health Insurance

Humana posts big loss, dour outlook on Medicare Advantage cost spike

Healthcare Dive

JANUARY 24, 2024

The health insurer’s stock plunged Thursday morning following its 2023 results, which fell startlingly short of Wall Street’s expectations.

Medicare

Medicare Medicare Health Insurance

China to pilot standards for virtual primary care

Healthcare IT News - Telehealth

NOVEMBER 10, 2024

A study proposed increasing health insurance reimbursements, reducing out-of-pocket expenses of patients, and providing patient discounts as ways to address people's reluctance. Enterprise Taxonomy: Telehealth Patient Access Population and Public Health Healthcare Reform Regulation Care Public Policy

Doctors

Doctors Public Health Nurses Hospitals

UnitedHealth under antitrust investigation by DOJ: reports

Healthcare Dive

FEBRUARY 28, 2024

Regulators are reportedly looking into the massive healthcare conglomerate’s potential anticompetitive effects, including the relationship between its health insurer UnitedHealthcare and physician network Optum.

Health Insurance

Health Care, AI, and the Law: An Emerging Regulatory Landscape in California

Bill of Health

OCTOBER 17, 2024

Finally, SB 1120 limits the degree to which health insurers can use AI to determine medical necessity for member health care services. SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit.

Medicare

Medicare Medicare Health Insurance Licensing

Elevance lays off more employees

Healthcare Dive

FEBRUARY 13, 2024

The health insurer has quietly laid off thousands of employees since September, according to sources.

Health Insurance

Singapore unveils online health insurance planning tool and more briefs

House Republicans unveil Medicaid cuts including work requirement, provider tax freeze

Trending Sources

Offering health insurance is becoming less lucrative

Nirvana Raises $24.2M Series A to Revolutionize Health Insurance Verification

Trends shaping the business of health insurance in 2024

Medicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2

The health of a community depends on fair health insurance practices

Health insurance customer experience starts at open enrollment

Biggest takeaways from health insurers’ third-quarter earnings

Rising health insurance premiums linked to wage stagnation, study finds

A Compelling AI Use Case for Health Insurers

Health insurers ignore surprise billing decisions, providers allege

Nearly 1 in 4 gig workers lacks health insurance, survey finds

The Health Insurance Premium for a Family Averages $25,572 in 2024 – KFF’s Annual Update on Employer-Sponsored Benefits

AdventHealth sues MultiPlan for alleged ‘cartel’ with health insurers to fix prices

Georgetown CHIR & Association of Health Care Journalists Release Update to Health Insurance Tool

Poor Member Digital Experience Weighs Heavily on Health Insurers, J.D. Power Finds

Nearly half of consumers are in debt due to medical bills, survey finds

AMA sues MultiPlan, insurers alleging ‘cartel’ to fix physician prices

CMS’ first No Surprises audit targets Aetna, finds some noncompliance

Appeals court upholds ACA’s preventive services mandate, but opens door to future challenges

Nearly a quarter of Americans are underinsured: report

Q&A: J.D. Power study spotlights the state of health insurers' digital experience

Cigna, Humana in talks to merge: WSJ

Blue Shield of California is promising a simpler, cheaper pharmacy benefits model. Can it deliver?

Humana sues HHS over calamitous Medicare Advantage star ratings decrease

A Cigna-Humana merger could face a long regulatory delay. But it might get approved.

Millions of Americans Remain Uninsured or Underinsured Despite ACA Gains

Insurers brace for continued Medicare Advantage medical costs

Republicans can’t meet budget target without Medicaid cuts: CBO

Centene names new COO following leadership turnover

Insurance lobby blasts Medicare Advantage audit rule

CMS requires 30 states to pause Medicaid disenrollments after systems error

Molina, Elevance nab Iowa Medicaid contracts on heels of California win

The Payer Journey: Understanding Health Plans and the Importance of Data Collection

Humana becomes second major payer to flag higher outpatient volumes in Q2

HHS pauses surprise billing arbitration after Texas court decision

Bright Health explores sale of California MA business

Cigna is still interested in Medicare

Humana posts big loss, dour outlook on Medicare Advantage cost spike

China to pilot standards for virtual primary care

UnitedHealth under antitrust investigation by DOJ: reports

Health Care, AI, and the Law: An Emerging Regulatory Landscape in California

Elevance lays off more employees

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