The ruling in favor of Montana Health Co-op is the first to be handed down in a series of insurer lawsuits over unpaid CSRs and marks a major victory for health plans.
A lawsuit against Anthem exposes a potential flaw in Medicare Advantage that likely is driving costs higher.
Back surgery is one of the most overused types of surgery and back pain is the most common ailment that sends patients to doctors, chiropractors and physical therapists. More than $90 billion a year is spent on low-back pain alone.
Clover joins a slew of other health insurers that are busy investing in the lucrative Medicare Advantage market, where enrollment has grown steadily over the past decade and shows no signs of slowing.
Some innovative health insurers and states are tackling social determinants of health in a sustainable, scalable business model that goes beyond isolated pilot projects and community benefit dollars.
Credit rating agency A.M. Best upgraded ratings of more health insurers in the first half of 2018 than in the same period last year, as companies reported improved operating results in ACA exchanges and continued to turn a profit in other markets.
UnitedHealthcare may be required to transfer millions of dollars to New York insurers that enrolled high-cost members in their plans in 2017, based on a federal judge's decision.
Centene Corp. and Ascension signed a letter of intent to research launching a joint Medicare Advantage plan. The companies hope to hit several insurance markets in 2020.
New Jersey insurance regulators fined UnitedHealthcare $2.5 million for several insurance law violations, including sending patients to a provider of hemophilia services that hadn't been approved by the state.
National health insurer Anthem reported higher profits in the second quarter of 2018 after raising premiums and keeping medical costs in check.
Alabama and Illinois are the first states to take advantage of new flexibility to define the essential health benefits that certain insurers must provide. Their approaches show how some seek to bolster their ACA markets while others weaken them.
UnitedHealth Group is warning insurance plan members that they could lose in-network status with their Northwestern physicians after this year. The insurer and Chicago-area based Northwestern Medical Group each said they were trying to hammer out a new contract.