Private Payers News

Employer-Sponsored Health Plans Face High Costs for SUD Treatment

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Employer-sponsored health plans paid $35.3 billion to cover substance use disorder treatments in 2018, a recent study published by JAMA Network Open found. The researchers used Merative MarketScan...

Elevance Health Will Acquire BCBSLA, Improve Care Access in LA

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Elevance Health has announced plans to acquire Blue Cross and Blue Shield of Louisiana (BCBSLA), with the payers aiming to improve care access, quality, and affordability for Louisiana...

Medicare Pays Medicare Advantage Plans 6% More Than FFS Medicare

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Medicare Advantage enrollment as a share of overall Medicare enrollment continued to rise in 2022, but payment inequity calls for serious reforms, according to a presentation from MedPAC. The Medicare...

Tufts Health Plan, Harvard Pilgrim Collab Boosts Access to LGBTQ+ Care

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Tufts Health Plan and Harvard Pilgrim Health Care have partnered with a connected healthcare delivery platform to improve access to LGBTQ+ care for commercial health plan members. The collaboration...

Private Payers Reimbursed Telehealth, In-Person Care Equally in 2020

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In 2020 when the coronavirus pandemic forced a major shift to telehealth and virtual care, private payers were reimbursed for telehealth and in-person care equally, research from Peterson-Kaiser Family...

BCBSRI Grants $740K to Improve Health Equity, Access to Stable Housing

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Blue Cross & Blue Shield of Rhode Island (BCBSRI) is awarding $740,000 to 11 community-based organizations that address health inequities by improving access to stable housing. The funding is part...

Deductibles, Copayments, OOP Max Trends Indicate Cost-Sharing Growth

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From 2013 to 2020, cost-sharing trends shifted: deductibles grew, copayments increased for certain services and depending on union employment, and out-of-pocket healthcare spending maximums rose,...

Provider Orgs Join Full-Risk Value-Based Care Contracts with BCBSM

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Blue Cross Blue Shield of Michigan (BCBSM) is helping advance the shift to value-based care by initiating full-risk reimbursement arrangements with six provider organizations. The agreements are for...

Women with Employer Sponsored Health Insurance Face Affordability Issues

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Among people with employer-sponsored health insurance, women were more likely to report being unable to afford healthcare than men, according to a study published in JAMA. In addition to facing unique...

CA, AZ Payers Boost Care Access for Active-Duty Service Members

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Blue Shield of California and Blue Cross Blue Shield of Arizona will help boost access to care for active-duty service members and their families in the TRICARE West Region by supporting a contract...

Court Says BCBSIL Cannot Exclude Coverage of Gender-Affirming Care

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A United States district court has ruled against Blue Cross Blue Shield of Illinois (BCBSIL), stating that the payer cannot exclude coverage for medically necessary gender-affirming care in its...

Harvard Pilgrim, Tufts Health Plan Increase Caregiver Support for Members

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Harvard Pilgrim Health Care and Tufts Health Plan have partnered with a digital care concierge service to provide commercial members with personalized caregiver support. The two health plans announced...

Blue Cross MN Value-Based Contract Reduced Cancer Care Costs

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Blue Cross and Blue Shield of Minnesota (Blue Cross) has announced that its value-based contract with Minnesota Oncology reduced the total cost of care for patients during the first two years of the...

93% of Employees Satisfied with Employer Sponsored Health Insurance

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The majority of Americans are satisfied with their employer-sponsored health insurance and cited it as the most important benefit an employer can offer, according to a poll conducted by Seven Letter...

Nonprofit Sues GA for Refusing to Cover Transgender-Related Healthcare

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The Transgender Legal Defense and Education Fund (TLDEF) has filed a lawsuit against the state of Georgia for denying coverage of transgender-related healthcare for members of the Georgia State Health...

SCAN Group, CareOregon Plan to Combine, Form HealthRight Group

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SCAN Group and CareOregon have announced that they will combine under the name HealthRight Group (HealthRight). “For far too long, America’s not-for-profit managed care organizations have...

ACAP Health Plans Will Identify Birthing-Friendly Hospitals in Directories

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Nine safety net health plans that are part of the Association for Community Affiliated Plans (ACAP) announced they would include the CMS birthing-friendly hospital designation in their provider...

Payer Announces Partnership to Offer In-Home Care with Flexible Hours

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Blue Shield of California (Blue Shield) has partnered with an in-home care organization to help members recover from injuries and illnesses. The goal was to make care more accessible and convenient...

Aetna Grants $9.3M to Support Behavioral Health for Youth in Foster Care

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Aetna’s Medicaid plan in West Virginia has granted $9.3 million to 10 community-based organizations to support behavioral health and social care needs for children in foster care. The funding...

Heat-Related Illness Diagnoses Among Private Payer Members Are Increasing

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Privately-insured Americans experienced higher rates of heat-related illness diagnoses in 2021 compared to 2016, in some cases a more than 37 percent increase, according to a report from FAIR...