Payers have faced state penalties in 2024 for slow reimbursements, improper claims denials, or the sale of unapproved products. 12 recent examples of payers fined or agreeing to settlements with ...

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Some insurers are sounding the alarm that Medicare coverage of weight loss drugs could increase premiums. On Nov. 26, CMS issued its proposed rule for Medicare Advantage plans in 2026. The rule ...

An Illinois lawmaker has introduced legislation that aims to provide greater oversight of how insurers use artificial intelligence in decision-making processes. If enacted, the state would have the ...

At the National Association of Insurance Commissioners Fall 2024 meeting on Nov. 18, state insurance regulators focused on artificial intelligence, mental health parity and other emerging challenges ...

CareSource has closed on its acquisition of Radiant Alliance, a nonprofit senior care organization composed of Metta Healthcare (parent company of Ohio's Hospice and Pure Healthcare), United Church ...

CMS proposed major reforms on Nov. 26 for the Medicare Advantage and Part D programs for contract year 2026, including changes to prior authorization and weight loss drug coverage. The agency is also ...

Massachusetts' insurance commissioner has approved the sale of Springfield-based Baystate Health's insurance subsidiary, Health New England, to Point32Health. Point32Health is the parent company of ...

Most Medicare Advantage markets are highly concentrated, but in a handful of markets, one payer controls more than 70% of the MA landscape, according to the American Medical Association's annual ...

Humana misrepresented the providers its Medicare Advantage plans will be in-network with in 2025, Minnesota Attorney General Keith Ellison alleged. Mr. Ellison sent a letter to Humana CEO Jim Rechtin ...

Utah has the highest percentage of residents enrolled in commercial health plans (60%), New Mexico has the highest percentage enrolled in Medicaid (34%), and West Virginia has the highest percentage ...