Suzanne York

Cigna has announced a delay in implementing a policy that would have required physicians to submit clinical documentation whenever they submit a claim with certain Evaluation and Management (“E/M”) CPT® codes appended with a modifier 25. Modifier 25 is used to indicate that a patient’s condition requires a significant, separately identifiable E/M service on the […]

UnitedHealthcare had been preparing to implement a policy beginning on June 1, 2023 that would have required prior authorization for most GI endoscopic procedures, including colonoscopies.  The policy was strongly opposed by provider groups including the American Hospital Association, the American Gastroenterological Association, the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, and

Highmark Health has reported first quarter 2023 revenues of $6.7 billion, an increase of 4.6% from the prior year quarter.  This increase follows strong revenue growth of 18% in 2022, with total 2022 revenues of $26 billion.  Highmark also reported net income of $227 million for the first quarter. In a press release announcing its

Kaiser Family Foundation Health News (“KFF”) has published a news perspective entitled “Denials of Health Insurance Claims are Rising – and Getting Weirder” that shows a sharp increase in denials of health insurance claims. A recent KFF study of Affordable Care Act (“ACA”) plans found that health insurance companies denied an average of 17% of

An American Hospital Association post highlighted findings from a Crowe Research report (“the Report”) showing that one in three inpatient claims submitted by providers to commercial insurers was not paid for over three months and that 15% of inpatient and outpatient claims were initially denied.  The AHA post also highlighted the Report’s findings that: claims

Last month after a tragic mass shooting in Dadeville, Alabama, 15 of the gunshot victims were brought by ambulance and private vehicle to Lake Martin Community Hospital in Dadeville for treatment.  Last week, Ivy Creek recognized those first responders with a special lunch.  Without the outstanding work of Lake Martin Community Hospital and the other

In a strongly worded letter sent to UnitedHealth Group’s CEO on May 8, 2023, 175 state and specialty medical associations and physicians’ groups have opposed United’s new policy requiring prior authorization for most GI endoscopic procedures, including colonoscopies, and urged United not to implement the policy as scheduled on June 1, 2023. The letter states

Beating analysts’ expectations, the Cigna Group reported strong profits of $1.3 billion and revenues of $46.5 billion for the first quarter of 2023. Cigna revenues were stronger than analysts expected in all market segments, but were particularly strong in its health insurance business, Cigna Healthcare.  Cigna Healthcare’s first quarter revenues of $12.7 billion were up

CVS Health Corporation reported strong first quarter 2023 profits of $2.1 billion. It also reported strong first quarter revenues of $85.3 billion, up 11% from the prior year quarter. Both CVS’s first quarter profits and revenues beat analysts’ expectations. Revenues were also sharply up at CVS’s health care benefits segment, which includes Aetna.   CVS reported

The health insurers who have reported first quarter 2023 earnings – Elevance Health (Anthem), Humana, UnitedHealth Group, and Centene – have reported strong revenues and profits. These profits have been fueled, in part, by low medical costs, including lower payments to providers than anticipated.  One of the ways that health insurers reduce their healthcare costs