Healthcare Payers

Study Finds Geographic Variation in Payer Prices for Office Visits

October 31, 2023 - Among a single health insurer, prices for office visits varied by geographic location, with the upper-Midwest and Southeast regions seeing higher costs, a study published in JAMA Health Forum indicated. In the private payer space, where rates are negotiated rather than set administratively, the Transparency in Coverage rule aims to help curb high...

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4 Key Strategies to Promote Effective Payer, Provider Alignment

by Victoria Bailey

Strong payer-provider alignment makes life easier for all healthcare stakeholders. While providers administer services to individuals, payers are responsible for reimbursing providers and ensuring members have coverage for their care....

Cigna Healthcare Invests $1M to Reduce Food Insecurity for Seniors

by Victoria Bailey

Cigna’s health benefits provider, Cigna Healthcare, will invest $1 million in community-based organizations to address food insecurity among older adults. “Too many people in our country,...

Exploring the History of the Blue Cross Blue Shield Association

by Victoria Bailey

Blue Cross Blue Shield is an easily recognizable name in the healthcare industry, but just how many health plans fall under this organization and what are the differences between them? In the following article, HealthPayerIntelligence...

How Quality Measures, Star Ratings Impact Healthcare Payers

by Editorial Staff

Quality performance metrics such as HEDIS, Medicare Advantage Star Ratings, and standardized core quality measures can give consumers an indication of healthcare payer quality. Standardized quality...

Cigna Removes Prior Authorization for 25% of Medical Services

by Victoria Bailey

Cigna Healthcare is removing prior authorization requirements for nearly 25 percent of medical services, facilitating access to care for members. The Cigna Group’s health benefits provider...

Top 5 Largest Health Insurance Payers in the United States

by Editorial Staff

The Affordable Care Act (ACA) and Medicare Advantage plans continue to bolster enrollment for major payers. Enhanced premium subsidies on the ACA market along with greater federal investments in...

KLAS: Payers Want Efficient Claims and Administration Platforms

by Victoria Bailey

Payers prefer to utilize claims and administration platforms from vendors that are efficient, manage multiple business lines, and can meet their complex needs, according to a KLAS report. The Payer...

How Payers Are Reducing Prior Authorizations, Limiting Care Disruptions

by Victoria Bailey

Although prior authorization aims to control costs and limit unnecessary medical procedures, healthcare stakeholders have continued to raise concerns that the process creates substantial administrative...

Unpacking What Price Transparency Looks Like for Health Plans

by Victoria Bailey

Consumers are struggling to understand and afford healthcare in the United States. A new federal requirement aimed at increasing healthcare price transparency aims to help, but payers can also use this newly available information to their...

ACA Marketplace Premiums Set to Rise Again, Inflation a Key Factor

by Sarai Rodriguez

Even as inflation seems to be plunging from its peak, the ongoing pressure from high medical costs is set to push ACA Marketplace premiums up to an average of 6 percent in 2024, according to...

Biden Admin Proposes Mental Health Parity in Private Health Plans

by Victoria Bailey

The Biden-Harris Administration has proposed a rule to improve access to mental healthcare for privately insured Americans by establishing mental health parity requirements. The rule supports the...

UHC Reports 13% Revenue Growth in Q2 2023 Due to Rising Enrollment

by Kelsey Waddill

UnitedHealth Group’s earnings call for the second quarter of 2023 featured revenue growth due to strong performance from the healthcare company’s insurance arm, UnitedHealthcare, and its...

How Payers Can Identify Providers for High-Performing Networks

by Victoria Bailey

Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021,...

SCAN, CareOregon Grants Help Eliminate $110M in Medical Debt

by Victoria Bailey

SCAN and CareOregon have granted $345,000 to a nonprofit organization that helps eliminate medical debt, a move expected to erase $110 million in debt for residents across five states. RIP Medical...

UnitedHealthcare Pays $91.2M After Underpaying Envision for Medical Care

by Victoria Bailey

After underpaying the medical group for essential care, UnitedHealthcare has been ordered to pay $91.2 million to Envision Healthcare (Envision). An independent three-member panel of the American...

Anthem, Valley Health Resolve Lawsuit Over Past-Due Payments

by Victoria Bailey

Regional health system Valley Health has reached a settlement agreement with Anthem Blue Cross and Blue Shield, resolving a dispute over past-due payments for healthcare claims, according to a press...

81% of Entries Are Inaccurate in Provider Directories of 5 Large Payers

by Kelsey Waddill

Most of the entries in the five large insurers’ provider directories have inaccuracies, a research letter published in JAMA Open Network explained. The researchers compared physician information...

What the Prior Authorization Proposed Rule Means for Payers

by Victoria Bailey

The CMS Advancing Interoperability and Improving Prior Authorization Processes proposed rule introduces new requirements for healthcare payers that aim to enhance patient data sharing and streamline...

Out-of-pocket Costs for Opioid Use Disorder Treatment Varied by Payer

by Victoria Bailey

Out-of-pocket costs for buprenorphine prescriptions for opioid use disorder treatment decreased between 2015 and 2020, but costs varied by payer, according to a study published in JAMA Network...

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