ACA Exchange Plan Carriers Denied Nearly 1 in 5 Claims In 2024: Report
Fewer than 1% of denials were appealed by members, and insurers stood by their original decisions in 66% of challenges. The trade and advocacy group AHIP said in a statement: “The vast majority of denials are due to incorrect or incomplete claim submissions from providers, duplicate claims, claims for unproven or unsafe treatments and services, or for services that are not part of covered benefits.”
Modern Healthcare:
ACA Exchange Plans Denied 19% Of In-Network Claims In 2024: KFF
Health insurance exchange carriers rejected nearly one-in-five in-network claims in 2024. That’s according to federal health insurance exchange claims data analyzed by the health policy research institute KFF. The 19% denial rate is tied with 2023 for the highest since the Affordable Care Act of 2010 marketplaces debuted in 2015. (Tepper, 3/27)
KFF Health News:
She Owed Her Insurer A Nickel, So It Canceled Her Coverage
Last summer, Lorena Alvarado Hill received a series of unexpected medical bills. A teacher’s aide in Melbourne, Florida, Hill is a single mom who works shifts at J.Crew on the weekends to send her daughter to college. Hill and her mother, who lives with her, had been enrolled in an insurance plan through HealthFirst. Hill paid nothing toward the premiums for the government-subsidized plan, which previously had covered her scans and other appointments. Then the bills came. (Rosenthal, 3/30)
The Washington Post:
Why Millions Of Seniors Have Suddenly Lost Health Care Coverage
Elderly people are forced to hunt for options when Medicare Advantage plans withdraw from unprofitable markets. (Rowland, 3/28)
Modern Healthcare:
States Push Hospital Price Cap Legislation Despite Opposition
Legislative efforts to limit what hospitals can charge for services are gaining traction coast to coast. State legislators say capping prices for healthcare services is a decisive action against out-of-control costs that place financial burden on patients. Providers point to insurers and their increasing premiums as big drivers behind those rising costs, and say price caps could limit access to care. (Hudson, 3/27)
MedPage Today:
What To Expect For Prior Authorization In 2026
Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has triggered a backlash, stirring some policymakers into action. Whether these changes actually fix prior authorization for patients and clinicians is an open question. Meanwhile, stakeholders are weighing the risks versus benefits of artificial intelligence (AI) to streamline processes, according to a recent Health Affairs Insider report. (Firth, 3/27)
Stat:
Health Care Giants Are Trimming Jobs, Not Driving Employment Growth
Over the past five years, the American workforce has grown in large part due to the health care industry. But large, for-profit health care companies have not been driving that job growth. Some parts of health care — notably, health insurers — are cutting jobs, some of which has not been previously reported. (Herman, 3/30)
Los Angeles Times:
Kaiser Made $9.3 Billion Last Year. Critics Say It Has Strayed From Its Charitable Mission
Kaiser Permanente, the nation's largest non-profit health group, has veered from its charitable mission and is now scarcely distinguishable from a corporation keenly focused on its bottom line, according to critics. (Petersen, 3/29)
Politico:
New Factories And Supersized Obamacare Premiums: North Carolina Considers What Trump Has Wrought
Democrats expect North Carolinians will make the GOP pay for cuts they made last year that have cost 200,000 residents their health insurance. Republicans think they’ll be rewarded for President Donald Trump’s push to create good-paying pharma factory jobs in decaying tobacco and textile towns. How North Carolina voters assess Republicans’ weighty health care moves could determine who replaces retiring Republican Thom Tillis in the Senate and controls the chamber. But in a recent swing through the Tar Heel State, POLITICO found voters, even ones directly affected by federal policy, are reluctant to switch sides. (Chu, 3/30)
In other health care industry developments —
Chicago Tribune and Pioneer Press:
Deal To Re-Open West Suburban Medical Center Under Discussion
A deal might be in the works to keep West Suburban Medical Center open, after the Oak Park hospital abruptly announced it was suspending patient care this week. (Schencker and Hardy, 3/27)
St. Louis Post-Dispatch:
Ex-Mercy Exec Blackmailed For Construction Work, Filings Say
The trial scheduled to begin Monday in Clayton appeared, on the surface, to be a typical construction contract dispute. As the trial neared, however, Pitt Development Group — the Springfield, Missouri, builder that filed the 2023 lawsuit against Mercy Health — wanted to bring in evidence that made it anything but. (Barker, 3/29)
Bloomberg:
Spotify Co-Founder Is Behind Body Scan Startup Competing With Prenuvo
It’s been 15 years since Spotify co-founder Daniel Ek brought the streaming platform to the US, changing the way Americans discover and consume music. His next project—a startup that offers full-body health scans—will soon arrive stateside with its own ambitious plans to reshape an industry. Neko Health, founded in 2018 as Ek began planning for life after Spotify Technology SA’s initial public offering, operates in Sweden and the UK. If Neko receives regulatory approval in the US, something it’s working through now, the company’s first American location will open in New York as soon as this spring, with more US clinics planned in the following months, says Chief Executive Officer Hjalmar Nilsonne. (Ojea, 3/27)
KFF Health News:
Inside The High-Stakes Corporate Fight Over Feeding Preterm Babies
In 2013, a scientist at Abbott Laboratories saw study results with potentially big implications for the company’s profits and the lives of some of the world’s most fragile people: preterm infants. The upshot, she wrote in an email: Babies fed rival Mead Johnson Nutrition’s acidified liquid human milk fortifier — a nutritional supplement used in neonatal intensive care units — developed certain complications at higher rates than those given an Abbott fortifier, a researcher at the University of Nebraska had found. At least one of those complications can be deadly. (Hilzenrath, 3/30)
