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Taxing the Blues: Rifts open scrutiny of nonprofits


Blue Shield of California is in the position of trying to keep its state tax exemption, while also defending its public image and defining its future mission to customers. Read more »

Grappling with the ACA's administrative costs


How much overhead in private and government insurance will it take to have universal coverage under the ACA? Quite a bit in one current view of the data. Read more »

When shopping for low-priced CT scan doesn't pay off


Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them into smart shoppers. So he shopped. Read more »

Docs score in dispute with UHG


After more than a decade of legal turmoil, physicians in four states have won a concession from the nation's largest insurer to make getting paid less of a hassle, if not to get paid more. Read more »

CMS seeks market alignment in Medicaid managed care overhaul


The federal government has crafted the first regulatory change to Medicaid managed care in a decade, as more health plans take the challenge from states to cover growing Medicaid populations at a sustainable cost. Read more »

'Cap-the-copay' movement takes off


As California goes, so goes the country in capping consumer costs for medicines? That's what patient advocacy groups and and some pharmaceutical companies may be hoping. Read more »

Aetna, BCBSMI settle 'most favored nation' dispute


A national for-profit giant and Michigan's largest health insurer are coming to a resolution over the long-standing, fractious trade issues of excluding and favoring. Read more »

Medical groups rank the best payers


A mix of old and new school insurers are the best health plans in the eyes of the 59,000 physicians and providers using the digital billing and record-keeping services of athenahealth. Read more »

The rise of provider-sponsored health insurance


In 10 years, the relationships between health systems and insurers could be quite different if provider-sponsored plans can offer what health insurers currently cannot. Read more »

7 traits to seek in a validation audit vendor


As dry as the decision may appear, insurers literally have millions of dollars on the line when CMS comes knocking. That makes picking the right auditor, and doing so the first time, absolutely critical. Read more »

Ignagni departing AHIP, with industry in ACA transition


The chief lobbyist for American health insurance is taking a job at a regional nonprofit insurer, after shaping a once-in-a-generation reform aimed at benefiting both the public and the industry. Read more »

CareFirst attack breaches data on 1.1 million


It was only a matter of time until a big regional Blue Cross insurer got hacked, except that time was a year ago and security experts just recently uncovered it. Read more »

A penalty for covering abortions, missing autism benefits


Aetna has found itself in the odd position of being fined for covering something some members wanted, while not being fully up to speed covering another condition. Read more »

Insurers line up for CMS oncology pilot


The trajectory of cancer care is so costly and problematic that insurers are flocking in droves to the federal government’s multi-payer alignment experiment. Read more »

Double digits: Some individual plans seek steep rate hikes


With little more than a year of claims experience on the new individual market, some insurers are looking for premium increases of more 30 percent, including the Blues. Though affordability is still relative. Read more »

Selling a Medicaid plan to save Medicare Advantage


Molina Healthcare is acquiring a financially beleaguered Medicaid plan from a nonprofit insurer trying to preserve another managed care business. Read more »

ICD-When? AMA wants to wait for 11


Four months until the ICD-10 deadline, and the American Medical Association is peddling the logic of waiting for the next iteration of the disease coding system, or at least delaying a bit more. Read more »

Mandate brings another all-payer database to market


Health insurers in one large West Coast state now have to disclose claims data that for decades was proprietary, in a reluctant but heralded move towards transparency. Read more »

Redesign silver plans with lower deductibles, consumer group urges


Health insurers need to change their silver-tier health plans to use more modest and predictable cost-sharing, instead of four-figure deductibles, according to patient advocates. Read more »

Here come new Medicaid MCO regulations: 5 issues to watch


In the first update to federal MCO rules in more than a decade, the government is set to push a range of tweaks, reforms and requirements that could set a new baseline for a bustling public payer segment. Read more »

Feds: No cost-sharing for anesthesia in colonoscopies


The federal government clarified that insurers can’t charge people for anesthesia administered during a preventive colonoscopy to screen for colorectal cancer, although there are unresolved questions. Read more »

Optimizing the 'nudge' for interventions


What’s the best way to get members to stop smoking? A financial nudge and a pinch show some promise, for a range of health and wellness choices. Read more »

Big and bigger: What's the next insurer takeover?


Aetna is plotting an acquisition seeking "inorganic growth" that could make it a rival for the largest insurer in the country, if the hype of one boutique Wall Street analyst is to be believed. Read more »

L.A. Care hikes minimum wage to $15


On the West Coast, the nation's largest municipal-operated health plan is trying to mesh its compensation structure with its nonprofit mission. Read more »

PBM giant finds surge in patients with six figure drug spending


$52 billion and growing is the trend in high-cost pharmacy benefits, as more and more Americans use prescription drugs with expenses exceeding the U.S. median household income. Read more »

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