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Bruised by Government Report, Cigna's Pharmacy Business Sues the Federal Trade Commission

HEALTH CARE un-covered • 579 implied HN points • 20 Sep 24
🏥 Health Politics Insurance Practices
  1. Cigna's pharmacy business, Express Scripts, is suing the Federal Trade Commission to challenge a report that claims they inflate drug prices and harm patients.
  2. The FTC's report has raised awareness about the power and practices of big pharmacy benefit managers, which control a large share of the market.
  3. Cigna is trying to protect its financial interests in pharmacy benefits, as they now make up a huge portion of the company's revenues, while also facing potential reforms from lawmakers.

As UnitedHealth and Cigna are Sued for AI-Based Claims Denials, Documents Suggest Major AI Expansion

HEALTH CARE un-covered • 739 implied HN points • 11 Jul 24
🏥 Health Politics Insurance Practices
  1. UnitedHealth and Cigna are facing lawsuits for denying medical claims using a flawed AI system, which many believe does not work correctly. This has led to patients not receiving the care they need or having to pay high costs for care.
  2. Despite the lawsuits and public criticism, these companies plan to expand their use of AI in health care decision-making. They are investing more in technology, aiming for efficiency even at the risk of more denied claims.
  3. Experts warn that using AI in health care can leave patients feeling helpless and confused when their claims are denied. They believe that patients under AI-driven systems may struggle to advocate for their own health needs effectively.

Rx Exec on a Mission to Eliminate Unnecessary Middlemen and Slash Generics Spending

HEALTH CARE un-covered • 519 implied HN points • 25 Jul 24
🏥 Health Politics Insurance Practices
  1. Removing middlemen from the prescription drug process can help lower costs. These middlemen often increase prices unnecessarily, making medications more expensive for everyone.
  2. Generic drugs make up a large portion of prescriptions, yet many people don’t realize they often pay more for them due to the complicated pricing system in healthcare. Focusing on providing generics can make medications more affordable.
  3. There's a need for more transparency in how drug benefits are designed for employers. By simplifying the system and cutting out extra layers, businesses can save money on prescription costs.

Private Medicare Plans and Vertical Integration Yield UnitedHealth $15.8 Billion in Profits Between January and June

HEALTH CARE un-covered • 619 implied HN points • 16 Jul 24
🏥 Health Politics Insurance Practices
  1. UnitedHealth made a massive profit of $15.8 billion in just six months by using strategies to boost its income from private Medicare plans. This shows how profitable these plans can be for insurance companies.
  2. The company has been increasing its earnings by owning many of the doctors and clinics its patients visit. This vertical integration gives them more control and helps them profit more from the services they provide.
  3. UnitedHealth has found ways to maximize its Medicare Advantage funding by misreporting patient conditions. This has earned them billions from the government, which has raised questions about their practices.

Medicaid and Medicare Claims Managed by Insurers Are Rising. Why Aren’t They Worried About Their Profits?

HEALTH CARE un-covered • 819 implied HN points • 11 Jun 24
🏥 Health Politics Insurance Practices
  1. Insurers are seeing more claims for Medicaid and Medicare, but they aren't worried about profits. This is surprising to many people looking at the rising costs.
  2. Insurance companies can limit patient care by using tactics like prior authorization, which makes it hard for people to get needed treatment. This helps them keep their profits high.
  3. Medicare Advantage plans allow insurers to charge seniors more out-of-pocket costs. Insurers do this to maximize their profits while still getting a steady payment from the government.
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Health Insurers Increasingly Prevent Care for Children, New Congressional Report Finds

HEALTH CARE un-covered • 599 implied HN points • 13 Jun 24
🏥 Health Politics Insurance Practices
  1. Health insurers are making it harder for children to get necessary medical care. This often happens through a process called prior authorization, where doctors need approval from insurers before treating patients.
  2. A recent government report found that private insurers have inconsistent rules about approving basic health screenings and treatments for kids, which is crucial for their long-term health.
  3. The report suggests the Centers for Medicare and Medicaid Services should check if insurers can really ask for prior approval for care that doesn't need it according to regulations. This is important to ensure all children get the preventative care they need.

The Real Villains

Caitlin’s Newsletter • 2905 implied HN points • 06 Dec 24
🇺🇸 U.S. Politics Insurance Practices
  1. The murder of a health insurance CEO sparked discussions about the harm caused by insurance companies. Many people feel upset with how these companies treat patients, especially when they deny claims.
  2. The legal system often protects powerful corporations rather than regular people. It's important to recognize that the real problems in society often come from legal actions that allow harm to happen.
  3. Big corporations make massive profits while exploiting workers and environments. This exploitation leads to suffering and poverty, showing that profit-driven systems can be very harmful.

Five Medicare Advantage fixes we can all get behind (except the health insurance industry, of course)

HEALTH CARE un-covered • 499 implied HN points • 29 Feb 24
🏥 Health Politics Insurance Practices
  1. Aligning prior authorization standards between Medicare Advantage and traditional Medicare can reduce delays in care. This change can help patients get the treatment they need faster and ensure insurers are held accountable.
  2. Protecting seniors from misleading marketing scams is crucial. Congress and CMS are taking steps to ensure that ads for Medicare Advantage plans are clear and truthful, which is good for seniors.
  3. Medicare Advantage plans should offer real supplemental benefits that seniors actually use. It's important for these plans to track how these benefits are being utilized to ensure they improve health outcomes.

Retirees in Cortland County, New York, opposed UnitedHealth's Medicare grab and won. At least, for now.

HEALTH CARE un-covered • 579 implied HN points • 29 Nov 23
🏥 Health Politics Insurance Practices
  1. Retirees in Cortland County successfully resisted being moved to a Medicare Advantage plan from UnitedHealth. This shows that organized opposition can make a difference.
  2. Healthcare insurers often hide important information about coverage and approval processes, making it hard for patients to understand what they are entitled to. This lack of transparency can lead to patients missing out on necessary care.
  3. There is growing pressure for legislative changes to protect retirees' choices between traditional Medicare and Medicare Advantage plans. This means that there might be more options for seniors in the future.

Once health care's “good guy," Kaiser Permanente is being investigated for defrauding taxpayers.

HEALTH CARE un-covered • 59 implied HN points • 02 Aug 21
🏥 Health Politics Insurance Practices
  1. Kaiser Permanente is under investigation for allegedly defrauding taxpayers by making Medicare patients appear sicker than they are. This means they might be getting more money from the government than they're supposed to.
  2. The company once had a good reputation as a nonprofit but seems to have started using similar tactics as for-profit companies to keep up in the competitive health insurance market. They began drifting from their basic HMO model into high-deductible plans.
  3. Many people are moving to Medicare Advantage plans because they often offer better benefits compared to traditional Medicare. This shift makes it important for Congress to improve traditional Medicare to keep it competitive.