Category: Healthcare Finance News

Healthcare.gov plans denied 20% of claims in 2023

Insurers of qualified health plans (QHPs) sold on Healthcare.gov denied an average of 20% of all claims in 2023 – 19% of in-network claims and and 37% of out-of-network claims, finds a new KFF survey.
The in-network denial rate ranged widely, with sign…

Advocate Health closing Illinois clinics inside of Walgreens

Advocate Health Care is closing 47 clinics it operates inside Walgreens in Illinois.

HIMSSCast: Personalized care through AI 

There’s always been personalization for every patient, said Mudit Garg, CEO and cofounder of Qventus. But personalization at scale requires technology.
Over the last 10 to 20 years, many technical systems have been built that allow for mass personaliza…

Prisma Health opens $3.7 million behavioral health facility

Prisma Health, headquartered in Greenville, South Carolina, will triple patient access to outpatient behavioral health services in upstate South Carolina with the opening of its new $3.7 million Behavioral Health and Wellness Pavilion.
The opening took…

Bipartisan House bill introduced to stop physician pay cut 

A group of 10 bipartisan representatives this morning has introduced a bill to stop the 2.8% payment cut to physician pay.
The Medicare Patient Access and Practice Stabilization Act of 2025, introduced this morning in the House by Representatives, woul…

Many independent pharmacists will not stock drugs in the price negotiation program

The National Community Pharmacists Association has submitted comments to the Centers for Medicare and Medicaid Services warning that more than 90% of independent pharmacies may decide, or have already decided, to not stock drugs in the Medicare Drug Pr…

Medicare Advantage insurers made about 50 million prior authorization determinations in 2023

Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023, reflecting steady increases over the past few years as the number of MA enrollees has grown, according to a new KFF analysis.

RFK Jr.: Senators want definitive answers on vaccines, autism and Medicaid

Robert F. Kennedy Jr. was grilled for a second day in the Senate on his views on vaccines, autism, Medicaid and more.
Senator Bill Cassidy R-La., chairman of the Senate Committee on Health, Education, Labor  & Pensions wanted Kennedy to answer “yes or …

Confusion persists over spending freeze and its effect on Medicaid

Confusion reportedly exists over a memo issued by The White House Office of Management and Budget rescinding President Trump’s federal financial assistance spending freeze.

Cigna Q4 profit takes hit due to medical costs

The Cigna Group saw profits take a hit in the fourth quarter, reaching $1.4 billion, while it struggled with elevated medical costs, officials said during an earnings call today.
Cigna’s profits for the year were $3.4 billion, a decrease from the $5.2 …