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Independent Evidence Reviews Overturn Insurer Denials Of Healthcare Coverage
Policy experts suggest reform of prior authorization that would require coverage decisions be supported solely by evidence being reviewed by independent clinicians.
Trucordia acquires Connecticut insurer Paradiso Financial
The move adds a community agency with a diversified personal and small commercial book
Colorado health insurers plan to pass $40 million dollar fee onto policyholders in the state
An insider reveals the real goals of prior authorization
Years ago, Archelle Georgiou helped squash prior auths at one of America's biggest health insurers.
Son hopes dad’s legal win in Miami spares cancer patients from fighting insurers
“No sick person in the hardest moment of their life should have to stand and fight in a courtroom with lawyers for their life.”
US health insurers advance measures to standardize prior authorization requirements
UnitedHealth and CVS Health said on Friday they have standardized data and submission requirements for more than half of their prior authorizations, as part of an industry effort to reduce delays and paperwork for patients and doctors.
U.S. Health Insurers Step Up Prior Authorization Reforms
UnitedHealthcare and Aetna detailed progress toward industry commitments aimed at reducing administrative burdens and speeding patients’ access to care.
Exclusive: Insurers align pre-treatment review requirements
A standardized approach could reduce the back-and-forth between plans and providers and speed up care.
Mental health access suffers as five CT insurers violate parity law
Connecticut residents were four times more likely to use out-of-network mental health providers than for primary care, a report found.
The next time your health insurance denies a medication or procedure, here’s how to appeal it. You’ll probably win.
Your insurer is betting you won’t appeal — but research shows 1 million denials could have been overturned if patients pushed back.
AHA releases Q1 2026 Health Care Plan Accountability Update
The AHA today released its Health Care Plan Accountability Update, covering the latest developments in Medicare Advantage, legislation and regulation of private health insurers, as well as other resources from the last quarter.
Elevance Health Profits Eclipse $1.7 Billion Despite Elevated Costs
Elevance Health reported $1.7 billion in first quarter net income as cost issues continued to drag on earnings of the nation’s second-largest health insurer.
Health insurer Elevance raises annual profit forecast on medical cost controls
Elevance Health raised its annual profit forecast on Wednesday, as it looks to keep medical costs in check.
AI Startup Has Helped Reverse Thousands of Denied Health Insurance Claims
Americans rarely fight back when insurers reject treatments their doctors have prescribed. Claimable is working to change that, with a little help from Mark Cuban.
Prudential Financial Stock Is Falling on Report of Potential Misconduct at Japan Insurer
Shares were down 6% in Tuesday trading.
Health insurers raise questions about Medicare program that will offer GLP-1s to seniors for $50
Some health insurers are pushing back against a new program that will allow Medicare beneficiaries to pay $50 per month for GLP-1 medications for weight loss.
UnitedHealth Group Reports Flat First-Quarter Earnings
One of the nation’s largest insurers, the company’s profits were higher than analysts’ expectations but still fell short of showing a significant comeback.
UnitedHealth Group Reports Flat First-Quarter Earnings
One of the nation’s largest insurers, the company’s profits were higher than analysts’ expectations but still fell short of showing a significant comeback.
RFK Jr. to Reform Health Panel That Determines Which Screenings Insurers Cover
The health secretary said he would reform the panel, which determines whether insurance will cover preventive services like mammograms and colonoscopies.
Data highlights gaps in finding in-network mental health coverage
Americans across 43 states enrolled in health plans from the nation’s four largest commercial health insurers face potential disparities in finding in-network coverage for mental health care and substance use disorder treatment relative to physical health care, according to the Mental Health Parity Index released by the Kennedy Forum.
RFK Jr. will remake panel that determines which preventative services insurers must cover - Live Updates
The health secretary told the Ways and Means Committee he’s bringing on new members of the U.S. Preventive Services Task Force.
Travelers posts sharp earnings rebound as catastrophe losses normalize
Insurer reports $1.7 billion in quarterly profit, boosts dividend after strong underwriting and investment performance
This CEO wants to cover weight loss drugs for employees. They're just too expensive.
As demand for GLP-1 drugs surges, employers and insurers are struggling to keep up with the cost. Some are dropping coverage altogether.
No qualifying bids, so State Health Plan will restart search for new insurer
The initial request for bids came in less than a year and a half after the state switched to Aetna from Blue Cross NC.
Dutch Insurer Aegon Strikes $2.7B Deal to Sell UK Insurance Business to Standard Life
Aegon has agreed to sell its UK insurance business to Standard Life for a total value of 2 billion pounds ($2.7 billion), the Dutch insurer said on
Why rural hospitals in Pennsylvania and across the country are closing in increasing numbers – 5 myths about rural health care
Rural hospitals have high fixed costs, low patient volume and a large portion of patients insured through Medicaid, which typically pays less than private insurers.
Insurers Stand to Gain Big Business From Data Centers
That's how much S&P Global Ratings estimates data centers could pay in insurance premiums this year. That number compares to $5 billion a year for the entire aviation sector, the ratings firm said in a report Monday. The firm estimates the total insurable amount of data-center assets at $2 trillion
Democrat-Leaning Plan Takes Aim At Health Insurers With Proposed New Regulations
Healthcare initiatives being proposed like Patients' Bill of Rights offer a roadmap for Democrats’ priorities, with midterms looming and a presidential election in 2028.
State Farm sues Amazon after dehumidifier allegedly sparks fire
A federal agency deemed Amazon a "distributor" - now an insurer wants it to pay
Workforce health is the bedrock of global supply chains. Here's how to protect it
With workers' health under pressure from a growing array of global risks, coordinated action by governments, employers and insurers is needed to treat health protection as a broader infrastructural issue
Watch: As AI Makes More Health Coverage Decisions, the Risks to Patients Grow
Major health insurers and even Medicare are using artificial intelligence to make coverage decisions. But class action lawsuits have accused insurers of using AI to wrongfully withhold treatment, and new research illuminates the risks.
Trump promised to clamp down on health insurers. His policies are enriching them
In December, Trump said he would summon health insurance execs to the White House. It doesn't seem a meeting ever happened.
Colorado Democrats eye new fee on home insurance companies
Colorado Democrats are reviving a proposal to levy a new fee on home insurance companies, with the aim of distributing grants to fund “resilient” roofing. Introduced by Sen. Kyle Mullica, D-Thornton, Senate Bill 155 creates a government “enterprise,” which would collect a 0.5% fee of the total premium collected by an insurer on what’s called […]
Prior authorizations fell after insurer pledges
Health insurers say they've cut pre-treatment claim reviews by 11% in the past year.
Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records
The administration is asking insurers that cover federal employees and retirees to hand over details about their medical visits, their pharmacy claims, and more.
Everyone agrees AI scribes are increasing health care costs. No one agrees what to do about it
Behind closed doors, health insurers and hospitals agree that AI scribes are bumping up health care costs. But, they don't agree on a solution.
Health insurance stocks: UnitedHealth Group, CVS, and Humana are rising on Medicare Advantage news
Backtracking on an earlier proposal after intense lobbying, the Trump administration will now increase insurer payments more than expected.
Health insurers rise after US lifts 2027 Medicare Advantage payment rates
Shares of U.S. health insurers climbed in premarket trading on Tuesday after the government said it plans a larger-than-expected increase in 2027 payment rates for Medicare Advantage plans.
Health insurers secured a better Medicare Advantage rate for 2027, and their stocks are soaring
Shares of health insurers rallied in premarket trading on Tuesday after the government improved the initial Medicare Advantage rate increase for next year.
Trump administration finalizes better-than-feared Medicare Advantage payment rate in boost to health insurers
The Trump administration will increase average Medicare Advantage payments by 2.48%, or more than $13 billion, in 2027.
Health insurers score major win with higher 2027 Medicare Advantage rates
The stocks of major Medicare Advantage insurers surged on the announcement.
A key Medicare Advantage announcement is due today
Today's announcement will set the tone for how the Trump administration wants to work with private Medicare insurers.
Centene Latest Health Insurer To Shakeup Management Ranks
Centene is bolstering its management team by creating two new senior executive positions as health insurers battle higher costs and new policies at the federal level.
Lawmakers seek permanent funding for referral hotlines connecting families to mental health care
A bill heard by a Rhode Island Senate panel last week would fold funding for telephone hotlines used by pediatricians and family doctors to connect kids and parents to mental health treatment hotlines into a health department program funded by insurer contributions.
Sanders, Wyden demand hearings with health insurance CEOs
Sens. Bernie Sanders (I-Vt.) and Ron Wyden (D-Ore.) are calling on Republican committee leaders to hold hearings with the chief executives of top health insurers in the U.S. as they “continue…
Iowa Senate drops insurer, managed care limits from subacute mental health bill
Democrats argued the Senate's changes to the subacute mental health care bill would provide less assistance to Iowans than the House proposal.
She owed her insurer a nickel, so it canceled her coverage
When medical bills started rolling in, a teacher’s aide wondered why her insurance suddenly wasn’t covering them.
Health care jobs growth is stagnating at the biggest for-profit firms
Major health insurers are trimming jobs, and Medicaid cuts could soon force hospitals to lay off workers.
Kim Reynolds signs law hiking tax on private insurers to fund Medicaid
The Iowa law raises taxes on private health insurance providers, known as HMOs, to bring in funds to shore up a deficit in Iowa's Medicaid budget.
Top Senate Dems blast proposed ACA rule promoting ‘junk coverage’ that would push estimated 2 million off enrollment
A trio of top Senate Democrats led their colleagues in condemning a proposed rule by the Trump administration that would lift restrictions on the number of non-standardized plans that insurers in t…
Patients are often left ‘out of network’ as hospitals, insurers clash over cost
Insurance companies want hospitals to agree to reimbursements that don’t keep pace with rising costs. Hospitals often can’t afford that.
Mass. woman diagnosed with Alzheimer's in 30s told 'too young' for drug by insurance
A Massachusetts woman with early onset Alzheimer's fought her insurer over a denied treatment, raising questions about age limits and access to care.
NAIC Intensifies AI Regulatory Focus: What Health Insurance Payors Need to Know
The National Association of Insurance Commissioners (NAIC) is intensifying its oversight of how insurers use AI — and the pace of regulatory activity shows no signs of slowing. Over the past several…
Wisconsin passes legislation requiring insurers to cover supplemental breast imaging
Dubbed "Gail's Law" after a breast cancer care advocate, the passage follows years of advocacy from radiologists and patients.
Burcum: UCare collapsed. The Legislature needs to ask why.
"How did UCare, one of Minnesota’s largest health insurers, go from posting record earnings for 2022 to collapsing in 2025?" columnist Jill Burcum writes.
Prior authorization can delay needed health care. A new 'Gold Card' targets that bottleneck.
Getting approval for a medical procedure scan or medicine has become a frustrating hurdle in health care as insurers try to ensure that every test is appropriate...
Doulas can improve health outcomes for women and babies. Insurers are taking notice.
While more Medicaid patients and even some on private plans have gained doula coverage in recent years, United is the first major insurer to begin rolling out the benefit nationwide.
Minnesota Blue Cross CEO steps down from Sutter Health board over conflict of interest
The Eagan-based insurer says CEO Dana Erickson was recused from Sutter board discussions on acquiring Allina Health, which provides care to many Blue Cross members.
You’ve Lost Your Health Insurance. It Shouldn’t Have Been a Surprise.
You would think you’d get texts, emails, phone calls and letters if your insurer was about to drop you. But you may be wrong.
The R.I.-based pharmacy giant also owns health insurer Aetna and pharmacy benefit manager Caremark, allowing it to control how medications are priced, prescribed, and dispensed
CVS owns health insurer Aetna and pharmacy benefit manager Caremark, allowing it to control how medications are priced, prescribed, and dispensed.
Insurer and business lobbying interests kill supplemental breast imaging bill in 1 state
Earlier this year, Kansas lawmakers introduced Senate Bill 409, seeking to close insurance gaps for women who need follow-up scans after screening mammography.
Prudential New Business Profit Climbs on Hong Kong, China Growth
Prudential Plc’s new business profit rose, thanks to growth in Hong Kong and China markets, as the insurer said it will buy back an additional $1.2 billion in its own stock.
Medicare Advantage 'dark money' group tries to win higher payments for insurers
What appeared to be a surge of grassroots support for higher Medicare Advantage payments was actually driven by a pro-industry group.
An Oregon Health Insurer Outsourced Its Work To Silicon Valley. The Transition Has Not Gone Well.
On Jan. 1, some 125,000 Oregonians entered a new health insurance epoch. Or so they were told.
Fee on health insurers to fund abortion services debated in WA Legislature
Certain insurers in Washington state could soon need to foot the bill for additional abortion grant funding.
No healthcare premiums? In this economy?! Here's how.
It turns out healthcare in America CAN be cheaper. If your employer wants it to be. Today on the show, we speak with a Canadian-founded startup that has unusually generous benefits for their employees. Come see Planet Money live on stage in April! 12 cities. Details and tix here: https://tix.to/pm-book-tour. Related episodes: Health insurance premiums are going up next year — unless you work at these companiesHealth care costs are soaring. Blame insurers, drug companies — and your employerThe hidden costs of healthcare churnFor sponsor-free episodes of The Indicator from Planet Money, subscribe to Planet Money+ via Apple Podcasts or at plus.npr.org. Fact-checking by Sierra Juarez. Music by Drop Electric. Find us: TikTok, Instagram, Facebook, Newsletter.
Broward children lack hospital choices. Parents want state to force Florida Blue to negotiate
Broward County parents are contacting insurance regulators and legislators, trying to force the state to intervene in a contract dispute between the hospital systems and insurer Florida Blue
CVS taps Google Cloud to roll out AI-powered health platform
CVS Health will launch an AI-enabled platform in partnership with Alphabet's Google Cloud unit that will bring together data from diverse sources to help customers manage their health in real time, they said on Thursday. Health100 will be an integrated health care engagement platform for customers, regardless of the pharmacy or insurer they use. The initial launch of Health100 will be in 2026, with details expected to be revealed at The Check Up, Google's annual health event later in March.
A 7-Year-Old Boy’s Death Inflames Anger Over Colombia’s Health Crisis
Polls now show whoever succeeds Gustavo Petro will have to prioritize cleaning up the mess left by his failed reforms and costly feud with medical insurers.
New CEO at major health insurer with 3K CT employees. ‘Excited to build on our strong foundation’
The insurer highlighted its new CEO’s push for transformative innovation, accelerating the use of the data, technology and artificial intelligence.
Cigna CEO’s Departure Only The Latest Among Top Health Insurers
The retirement of David Cordani as CEO of The Cigna Group will be the fourth departure of a long-time health insurance executive during a turbulent time for the industry.
Exclusive: March meeting of U.S. Preventive Services Task Force postponed
The March meeting of the U.S. advisory panel that determines what cancer screenings and other preventive health measures insurers must cover has been postponed, according to a spokesman for the U.S. Department of Health and Human Services.
Even Patients Are Shocked by the Prices Their Insurers Will Pay — And It Costs All of Us
Health care prices are on the rise, and patients are flummoxed that even insurance companies aren’t doing more to control costs.
CMS set to suspend enrollment in Elevance Health's Medicare Advantage plans
The Trump administration has threatened to sanction Elevance Health's Medicare Advantage plans if the insurer does not address concerns around compliance with requirements for submitting risk adjus | The Trump administration has threatened to sanction Elevance Health's Medicare Advantage plans if the insurer does not address compliance concerns regarding the submission of risk adjustment data.
Providence Oregon CEO Discusses “Joint Decision” With Insurer to Restrict Access to Specialty Care
More than 200,000 CareOregon Medicaid members in the Portland area can no longer get new referrals to most Providence Medical Group specialists. But the Providence Oregon CEO says the system and insurer could modify the arrangement if needed.
Governor Hochul Launches Public Awareness Campaign to Educate New Yorkers on Access to Behavioral Health Treatment
Governor Kathy Hochul today announced the launch of a public awareness campaign to educate New Yorkers on regulations that improve access to mental health and substance use disorder care. The ‘Real Care, Real Access to Behavioral Health Services’ campaign highlights regulations that give New Yorkers with qualifying health plans access to initial outpatient appointments for behavioral health care within ten business days of the request and require insurers to help insured individuals access the care they are entitled to receive.
Oregon poised to become first in US to remove cost barriers to cervical cancer detection
The measure would require insurers to fully cover follow-up tests for cervical cancer after an abnormal screening.
States want to limit AI in health insurance
Regulating artificial intelligence, especially its use by health insurers, is becoming a politically divisive topic.
Lawmakers consider hiking fines for insurers who flaunt Georgia’s mental health parity law
Following recent fines for violations of mental health parity, Georgia advocates and lawmakers are pushing for stricter insurance compliance.
CT hospital, health insurer battle over contract, with patients caught in middle. Where it stands.
Without a contract between provider and the health insurer, patients may find themselves suddenly “out-of-network” and facing significantly higher out-of-pocket costs.
Ohio, DOJ sue health network for limitations on insurers
The state of Ohio and the U.S. Department of Justice are suing health network OhioHealth, alleging that they limit competition and drive up healthcare costs for patients and employees.
Insurer Agrees to Pay Millions for Failing to Fix Errors That Made It Harder for Customers to Get Mental Health Care
EmblemHealth will compensate customers who paid out of pocket for mental health care because they couldn’t secure an appointment with a provider listed as being in-network. It also pledged to take additional steps to fix its provider directory.
Insurer-backed group puts focus on hospital costs
Health care affordability is emerging as a key election-year issue.
Zurich Insurance Earnings Rise on Growth Across Business Lines
The insurer posted a 17% rise in profit for 2025 to $6.80 billion as it delivered record annual earnings.
AI Prognosis: Who's keeping tabs on how health insurers are using AI?
In this edition, AI Prognosis talks to STAT's Casey Ross, a Pulitzer finalist laser-focused on health insurers' use of AI, and more.
Trump Required Hospitals To Post Their Prices for Patients. Mostly It’s the Industry Using the Data.
Politicians have pushed for price transparency in health care. But instead of patients shopping for services, it’s mostly health systems and insurers that are using the information, as fodder for negotiations over pay.
In a financial pinch, major health insurers are turning to AI for help
Facing shrinking profits and higher costs, health insurers are accelerating adoption of AI throughout their sprawling operations.
Senate Questions Health Care Firm for Profiting Off Program Meant for Poor
The program was meant to help hospitals provide for poor patients by offering drug savings. But critics say a Texas company has turned it into a big business, driving up costs for patients and insurers.
Humana’s Profit Outlook Adds to Health Insurance Gloom
Humana Inc. forecast profit that fell short of Wall Street’s expectations for the year, the latest insurer to disappoint investors as the industry grapples with rising costs and government pressure.
House panel subpoenas 8 health insurers
House Republicans on Tuesday subpoenaed eight health insurance companies for information as part of an ongoing probe into allegations of fraud within Affordable Care Act (ACA) subsidies. The subpoe…
Republican-led House panel issues subpoenas to eight health insurers: Axios
House Republicans subpoenaed eight Affordable Care Act insurers as part of a probe of potential fraud surrounding the use of premium subsidies, Axios reported.
Republican-led US House panel issues subpoenas to eight health insurers, Axios reports
House Judiciary Committee Republicans have subpoenaed eight Affordable Care Act health insurers for documents as part of a widening investigation of potential fraud surrounding the use of premium subsidies, Axios reported on Tuesday.
Exclusive: House GOP panel subpoenas 8 health insurers
Republicans are pressing forward with their probe of the Obamacare market — and putting heat on health plans.
Hospitals are posting prices for patients. It's mostly industry using the data
The Trump administration pushed for price transparency in health care. But instead of patients shopping for services, it's mostly health systems and insurers using the information for negotiations.
Federal government turns to fresher data to rein in Medicare Advantage upcoding
CMS is taking a new approach to limit one of the ways insurers are boosting profits in Medicare Advantage.
Ninth Circuit Upholds Administrator’s Denial of Residential Mental Health Benefits Under ERISA
In an unpublished memorandum decision, the Ninth Circuit in R.R. v. California Physicians' Service d/b/a Blue Shield of California, affirmed the insurer
One in five commercial health insurance claims denied in 2024, Mass. report shows
The data highlight an overly complex system that burdens providers, insurers, and patients, Health Policy Commission head says.
CVS Health-Aetna laying off 313 remote workers, 17 in CT
CVS Health plans to lay off more than 300 additional workers at Hartford health insurer Aetna, including 17 in Connecticut, by the end of July, raising the total number of layoffs in the past two years to more than 1,000 workers.
IBX’s commitment to getting health care right
Health care costs are weighing heavily on everyday Americans and their families. Across the country, more people are seeking health care and prices for medical care and prescriptions continue to rise. As a result, health insurers are increasing premiums to keep up. At the same time, employer provided health coverage is eating into paychecks. All of this is making it more difficult for hardworking Americans to afford the coverage and care they deserve.
Medicare Advantage insurers face new curbs on overcharges in Trump plan
Federal officials have a plan that could curb billions of dollars in overpayments to Medicare Advantage plans. But will they follow through on it?