Tag Archives: unitedhealthcare

Expect more pushback from insurers and hospitals over rules to limit surprise bills

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Largest U.S. Health Insurers of 2021 by 2020 revenue.

ValuePenguin and LendingTree.Largest U.S. Health Insurers of 2021 by 2020 revenue. (Click to enlarge.)

On July 1, the nation’s largest health insurer, UnitedHealthcare (UHC), stopped paying out-of-network claims when its fully insured members seek non-emergency care outside of their local coverage areas, according to Nona Tepper’s reporting in Modern Healthcare.

UHC’s decision to end some out-of-network coverage caught hospitals, physicians and other providers by surprise, she wrote, adding that the move could be aimed at controlling costs and reducing payment to providers.

If providers are surprised, so too could be many of UHC’s 49 million members, particularly those who need to get care outside of their coverage areas, such as those who live in rural counties and those who need treatment for substance abuse, Tepper wrote. Continue reading →

Joseph Burns (@jburns18), an independent journalist who resides in Brewster, Massachusetts, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Lawsuit claims UnitedHealthcare concealed Medicare Advantage enrollment fraud complaints

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Credit: Kaiser Family Foundation
UnitedHealthcare has 4.6 million Medicare Advantage members, 24 percent of the U.S. Medicare Advantage market.

A recently unsealed whistleblower lawsuit claims that UnitedHealthcare concealed from federal officials hundreds of complaints of enrollment fraud and other misconduct in its Medicare Advantage program.

Brought by two UnitedHealthcare sales professionals in Wisconsin, this suit is worth watching because it is the third in recent months that whistleblowers have brought using knowledge they gained while working for Minnetonka, Minn.-based health insurance giant. Continue reading →

Joseph Burns (@jburns18), an independent journalist who resides in Brewster, Massachusetts, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

CPI: Insurers prepare $20 mil lobbying effort

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On the Center for Public Integrity’s PaperTrail blog, Peter Stone reports that five of biggest insurers in America are preparing to go to the mat for round two, this time with the intertwined goals of swinging midterm elections and influencing health reform implementation regulations.

According to Stone, Aetna, Humana, United HealthCare, WellPoint and (maybe) Cigna will pool something like $20 million. Look for the new lobbying organization, probably a 501(c) (4) nonprofit, in the next few months. Television ads and a variety of other campaigns will likely follow.

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Lewin group linked to private insurers

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In the Columbia Journalism Review, Trudy Lieberman, president of AHCJ’s board of directors, scolded journalists for not mentioning that Lewin Group, the consultants who released a recent study claiming that a public insurance option would cost doctors and hospitals money, is ultimately part of a major insurance company.

(Lewin Group is) part of Ingenix, which is owned by United Healthcare Group, the insurance behemoth that has been buying up insurance companies left and right, expanding its reach into just about every segment of the health-insurance market. Its flagship, UnitedHealthcare, helps make it the largest health insurer in the country. It’s a safe bet that United is not too keen on a public plan that might shrink its business.

The relationship is disclosed in the study and Lieberman turned up evidence indicating that there may be no formal protections in place for Lewin Group’s editorial independence. She wondered why journalists, particularly those behind a widely used AP story, did not provide readers with any information or context on Lewin’s insurance industry ties and called on reporters to remedy their error next time Lewin Group comes up.

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.