Suzanne York

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 […]

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

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

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

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

Becker’s Healthcare has published an article headlined “Hospitals are dropping Medicare Advantage left and right” due to denials and late payments. As the president and CEO of Scripps Health, Chris Van Gorder, stated in the article: “It’s become a game of delay, deny and not pay.” The article also cites the example of the St.

The Departments of Health and Human Services, Labor and the Treasury (“the Departments”) have issued proposed rules governing the establishment of fees for the Independent Dispute Resolution (“IDR”) process under the No Surprises Act.  The new rules were necessitated after a federal court struck down the previous increased fee of $350, which had been challenged

After a highly profitable 2022, the nation’s health insurers continue to reap strong profits in 2023.  The major health insurers have all reported on their second quarter earnings and they all reported strong earnings. Of the nation’s largest health insurers, UnitedHealth Group posted the highest profits for the second quarter 2023 with $5.5 billion in

The Kaiser Family Foundation has reported that the federal government is poised to pay Medicare Advantage plans at least $12.8 billion in quality bonus payments this year, an increase of 30% over 2022.  Annual bonus payments to Medicare Advantage plans have increased every year since 2015. According to the report, UnitedHealthcare will receive $3.9 billion,

For the third time, United States District Court Judge Jeremy D. Kernodle of the Eastern District of Texas has struck down certain rules implementing the arbitration process under the No Surprises Act (“the Act”) after a challenge by the Texas Medical Association (“the TMA”). Specifically, the Court struck down CMS guidance increasing the fee for