July 31, 2023
Payers | Tea Leaves
  • Colorado insurance officials announced Wednesday that despite their best efforts, they cannot keep troubled insurtech Friday Health Plans afloat and will instead liquidate the company on August 31. State officials put Friday Health Plans into receivership on June 21 in the hope that their oversight of the company’s finances would allow the approximately 35,000 enrollees in the state to keep their coverage until the end of the year, but it was not to be. Officials hoped that keeping the company afloat over the next several months would help members avoid restarting deductibles and out-of-pocket costs. (Article here)
  • The Centers for Medicare and Medicaid Services (CMS) is taking action to stem the tide of Medicaid and Children’s Health Insurance Program enrollees losing benefits for procedural reasons as states carry out eligibility redeterminations, federal officials said Wednesday. So far, at least 3 million Medicaid beneficiaries have lost coverage in 33 states and the District of Columbia since eligibility checks resumed in April, according to data compiled by KFF. The redeterminations process, suspended during the COVID-19 public health emergency, is intended to remove people who no longer qualify for the programs, yet a significant portion of those disenrolled have lost benefits for other reasons, such as state agencies being unable to contact them. (Articles here and here)
  • Private health insurance companies paid by Medicaid denied millions of requests for care for low-income Americans with little oversight from federal and state authorities, according to a new report by U.S. investigators published Wednesday. The report by the inspector general’s office of the U.S. Department of Health and Human Services details how often private insurance plans refused to approve treatment and how states handled the denials. Doctors and hospitals have increasingly complained about what they consider to be endless paperwork and unjustified refusals of care by the insurers when they fail to authorize costly procedures or medicines. The companies that require prior authorization for certain types of medical services say these tools are aimed at curbing unnecessary or unproven treatments, but doctors claim it often interferes with making sure patients receive the services they need. (Article here)