Suzanne York

Humana, Inc. has reported strong third quarter 2023 earnings, with its adjusted earnings per share of $7.78 beating analysts’ estimates. For the first three quarters of 2023, Humana has earned $3 billion in profit. Humana also announced that it expects to increase its Medicare Advantage membership to 860,000 in 2023, an increase of 19%, and …

HUMANA REPORTS THIRD QUARTER EARNINGS AND ANNOUNCES A SHARP INCREASE IN MEDICARE ADVANTAGE ENROLLMENT Read More »

Beating analysts’ expectations, the Cigna Group reported strong profits of $1.4 billion and revenues of $49 billion for the third quarter of 2023. Through the first nine months of the year, Cigna reported $4.1 billion in profit and $144.2 billion in revenue. Cigna’s revenue growth was particularly strong in its health insurance business, Cigna Healthcare. …

THE CIGNA GROUP REPORTS STRONG PROFITS FOR THE THIRD QUARTER OF 2023, BEATING ANALYSTS’ EXPECTATIONS Read More »

Whatley Kallas, LLP is representing 340B hospitals seeking recovery from Medicare Advantage plans for past underpayments for outpatient drugs.  Now that CMS has issued its final rule requiring a one-time lump sum payment for the underpaid 340B drugs from the Medicare Program, it is time for 340B hospitals to demand these payments from Medicare Advantage …

CMS ISSUES FINAL RULE REQUIRING LUMP SUM PAYMENTS TO 340B HOSPITALS FOR UNDERPAID OUTPATIENT DRUGS Read More »

CVS Health Corporation reported strong third quarter 2023 profits of $2.3 billion. It also reported strong third quarter revenues of $89.8 billion, up 8.6% from the prior year quarter. Revenues are up 10.6% for the year compared with 2022.  Both CVS Health’s third quarter profits and revenues beat analysts’ expectations. Revenues were also sharply up …

CVS HEALTH (AETNA) REPORTS STRONG THIRD QUARTER REVENUES AND PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »

In a strongly worded letter that includes specific examples of how prior authorization requirements harm patient care, the American Hospital Association has urged CMS to expeditiously finalize its Advancing Interoperability and Improving Prior Authorization Processes proposed rule.  The proposed rule would generally apply to Medicare Advantage plans, state Medicaid and CHIP plans, and plans purchased …

THE AHA URGES CMS TO EXPEDITIOUSLY FINALIZE ITS PROPOSED PRIOR AUTHORIZATION RULE Read More »

In response to federal court orders and input from providers, the Administration has issued proposed rules governing the Independent Dispute Resolution (“IDR”) process under the No Surprises Act (“the Act”), which should facilitate its use by providers. The IDR process was intended to resolve disputes between payers and providers regarding the amount insurers would pay …

PROPOSED NEW RULES GOVERNING THE NO SURPRISES ACT IDR PROCESS SHOULD FACILITATE ITS USE BY PROVIDERS Read More »

Following strong profits in 2022 and in the first half of 2023, UnitedHealth Group (“United”) again reported strong profits for the third quarter of 2023, with double-digit revenue growth at both UnitedHealthcare and Optum. United posted profits of $5.8 billion for the third quarter, an 11% increase from the prior year quarter.  United also posted …

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE THIRD QUARTER OF 2023 Read More »

At a time when the nation is facing a mental health crisis, health insurers have sharply criticized the Administration’s proposed mental health parity rules issued under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“the MHPAEA”). Unfortunately, these criticisms represent an additional effort by health insurers to pad …

IN CONTRAST TO PROVIDERS, HEALTH INSURERS OPPOSE EFFORTS TO IMPROVE MENTAL HEALTH PARITY RULES Read More »

Elevance Health, Inc. (formerly known as Anthem) reported strong third quarter 2023 profits of $1.3 billion, beating analysts’ expectations. Operating gain, excluding adjustment items, grew 12.6% year over year to $2.5 billion.  Elevance also reported strong third quarter operating revenues, which grew 7.2% over the prior year quarter to $42.5 billion. In its health benefits …

ELEVANCE HEALTH (ANTHEM) POSTS STRONG THIRD QUARTER PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »