Latest news with #BlueCrossBlueShield
Forbes
21 hours ago
- Health
- Forbes
Health Insurers Take Major Accountability Step On Prior Authorization
The nation's biggest health insurance companies are poised to ease prior authorization, the process ... More of insurers reviewing hospital admissions and medications. Details of the changes will be announced as early as Monday, June 23, 2025. getty The nation's biggest health insurance companies are poised to ease prior authorization, the process of insurers reviewing hospital admissions and medications. The policy change, expected to be announced as early as Monday by America's Health Insurance Plans, also known as AHIP, and the Chicago-based Blue Cross Blue Shield Association has been at the forefront of legislative efforts in Washington and state capitals across the country. The health insurers effort to improve accountability, transparency and customer support after an outpouring of public anger at the health insurance industry following the Dec. 4 UnitedHealthcare CEO shooting. Doctors complain prior authorization has delayed needed treatment and put patient health in jeopardy while wasting physician time to jump through hoops and adding to physician burnout. Over the past several years, prior authorization increasingly has become a concern for patient access to needed services, according to almost 30% of physicians responding to an American Medical Association survey in 2023. Health insurers involved in the effort say companies have agreed to streamline, simplify and reduce prior authorization, according to two health plans with knowledge of the changes. Neither AHIP nor the Blue Cross Blue Shield Association would comment when reached Friday afternoon. AHIP represents some of the biggest names in health insurance including CVS Health's Aetna, Centene, Cigna, Humana and Elevance Health. Blue Cross Blue Shield Association represents the nation's Blue Cross plans including Florida Blue and Health Care Service Corp., parent of Blue Cross and Blue Shield plans in five states. Sources close to the effort from participating plans say the insurers are committed to the changes in all health plans that they sell including commercial coverage, Medicare Advantage for seniors and Medicaid health plans that they administer for low-income Americans via contracts with states. The changes could benefit more than 250 million Americans. Further details weren't available. The effort is the latest and biggest so far among health insurers. Earlier this year, The Cigna Group announced a new multi-year effort to improve accountability. Cigna's announcement to launch 'actions to drive positive change for customers and patients' came just days after company chief executive David Cordani addressed analysts and investors on the industry's need to provide customers with more support and resources to navigate the healthcare system. 'In early December, we all witnessed the tragic murder of Brian Thompson, a leader at the UnitedHealth Group,' Cordani told analysts and investors on the company's fourth quarter and full year 2024 earnings call. 'The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry. At The Cigna Group, we are further accelerating improvements in innovations to increase transparency, expand support and drive even greater accountability." Cigna was the first rival of UnitedHealth Group's UnitedHealthcare to roll out some reforms since the shooting in New York on the company's annual investor day. Thompson's death unleashed a barrage of scrutiny on health insurer denials of medical care and certain other business practices from social media trolls and industry critics including some in Congress who say they'd like to see reform.
Yahoo
4 days ago
- Climate
- Yahoo
Site of this week's Korn Ferry Tour event badly damaged after overnight storm
A severe storm that produced triple-digit wind gusts and caused significant damage to the Wichita, Kansas, area overnight Monday didn't spare the host of this week's Korn Ferry Tour event. Crestview Country Club, located just east of downtown Wichita, sustained downed trees and flooding while several grandstands and other tournament structures were also damaged. A wind gust of 101 mph was recorded at nearby Eisenhower International Airport early Tuesday morning. The course and practice area were closed on Tuesday as maintenance staff worked to clear debris. Tournament officials hoped to reopen the grounds on Wednesday, though severe weather is expected again beginning Tuesday night. Advertisement "Due to extensive storm damage throughout Wichita, the golf course and practice facilities at Crestview Country Club have been closed for the remainder of the day,' the Korn Ferry Tour said in a statement. 'The agronomy team is working tirelessly to repair damages and prepare the grounds for the tournament competition. The golf course grounds are planning to reopen tomorrow morning." The Blue Cross and Blue Shield of Kansas Wichita Open is scheduled to start on Thursday.
CBS News
12-06-2025
- Business
- CBS News
Blue Cross Blue Shield of Michigan announces additional layoffs, job cuts
Hundreds of open and filled positions have been eliminated at Blue Cross Blue Shield of Michigan, adding to the over 500 employees who had already accepted a Voluntary Separation Offer. This latest step eliminates nearly 220 filled positions and more than 400 positions from its staff, the company said in a statement issued Tuesday. All of this is part of a strategic goal that began in 2024 to reduce administrative expenses by $600 million over three years. The Voluntary Separation Offers issued earlier this year were a financial incentive for non-bargaining unit employees to leave. That resulted in $94 million in cost savings, the company said. In addition, the company cut nearly 250 contractor roles in recent months. But "additional employment actions were necessary," the statement said. "Over the last year, our CEO has been clear and transparent with our employees about the significant cost pressures facing our business. Rising medical and pharmacy costs, and surging use of an expensive health care system are pressuring health insurance premiums and our financial performance," the company said. "Our administrative costs comprise nine cents of every premium dollar, and in this time when we are taking double-digit premium increases to our customers, we owe it to them to look inward and take steps to manage our own costs." Blue Cross Blue Shield of Michigan is the largest health insurer in the state, with 830,000 members in Michigan. It also claims the largest health network in the state, with more than 37,000 doctors and 150 hospitals working with one or more of the company's plans.
CBS News
11-06-2025
- Health
- CBS News
Hoffman Estates OB-GYN Mona Ghosh gets 10 years in prison for insurance, Medicaid fraud
Former OB-GYNB Mona Ghosh was sentenced to 10 years in prison for insurance and Medicaid fraud, officials announced. Ghosh owned and operated Progressive Women's Healthcare in Hoffman Estates. Between 2018 and 2022, prosecutors accused of submitting fraudulent claims to federal programs Medicaid TRICARE, and to private insurance companies including Blue Cross Blue Shield of Illinois, as well as making her employees do so. The fraudulent claims were for procedures and services not medically necessary for her patients, including endometrial ablations and biopsies, ultrasounds, vaccinations, lab tests and STI tests. Prosecutors said some procedures were performed without patient consent. Prosecutors said she would also inflate the length and complexity of her appointments, both in person and through tele-health, and create false medical records to support the bogus claims. The 52-year-old pleaded guilty to two counts of health care fraud in 2024, and Monday she was sentenced to 10 years in prison and to pay a $1.5 million fine in restitution.
Business Wire
10-06-2025
- Business
- Business Wire
Blues vs. Non-Blues 5-Year Enrollment Trends Analyzed by Mark Farrah Associates
CANONSBURG, Pa.--(BUSINESS WIRE)--Health insurance companies provided fully insured coverage for approximately 186.5 million people in 2024, an increase of over 12.3 million from 2020. Blue Cross Blue Shield (BCBS) association members, parent organizations, and their subsidiaries insured about 37.5% of the total health insurance market. In the latest Healthcare Business Strategy report, Mark Farrah Associates (MFA), examined health insurance enrollment changes in key segments for Blue Cross Blue Shield (BCBS) and Non-BCBS companies between 2020 and 2024. Some highlights include: Individual enrollment for BCBS companies increased 36.6% over the last 5 years, and non-BCBS companies reported a 106.1% increase during the same period. Fully insured Group enrollment, which includes the Federal Employees Health Benefits Program (FEHBP), continued to experience decreases throughout the 5-year timeframe for both Blues and non-Blues plans. During the 5-year period, Medicare Advantage (MA) enrollment experienced a 32.8% increase for BCBS plans, and non-BCBS MA enrollment saw a 32.3% increase. Total 4Q24 Medicaid enrollment for BCBS plans was over 15.2 million and nearly 62.5 million for non-BCBS companies. To read the FREE full text of " Five Year Health Enrollment Trends Comparing Blues & Non-Blues Plans", visit the MFA Briefs library on Mark Farrah Associates' website. Healthcare Business Strategy is a FREE brief that presents analysis of important issues and developments affecting healthcare business today. If you would like to be added to our email distribution list, please submit your email to the " Subscribe to MFA Briefs" on our website. Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry. Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, 5500 Employer Health PLUS, and Health Plans USA™. For more information about these products, refer to the brochures available under the Our Products section of the website ( or call 724-338-4100. Follow us on LinkedIn!
