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UnitedHealthcare to Eliminate Prior Authorization for 1,700 Diagnostic Codes Starting October 1

UnitedHealthcare to Eliminate Prior Authorization for 1,700 Diagnostic Codes Starting October 1

UnitedHealthcare, the largest health insurer in the U.S., announced it will no longer require prior approval for 1,700 diagnostic codes across various treatments, effective October 1. This initiative is part of a broader goal to reduce administrative burdens by 30% by the end of 2026. The changes will impact a wide array of clinical specialties, including cardiology, genetic and laboratory testing, chiropractic care, physical, occupational, and speech therapy, and orthopedic and musculoskeletal procedures. These adjustments will apply to UnitedHealthcare’s commercial plans, Medicare Advantage for older adults, and individual insurance plans under the Affordable Care Act (ACA), also known as Obamacare, as well as some other plan types. The company stated that these actions are designed to reduce unnecessary paperwork, simplify information, and allow patients and care providers more time to focus on care. Additionally, UnitedHealthcare is reducing administrative requirements for eligible rural hospitals and ...
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Medicare Advantage Plans Implement Network Restrictions and Out-of-Pocket Limits for 2026

Medicare Advantage Plans Implement Network Restrictions and Out-of-Pocket Limits for 2026

Medicare Advantage plans are implementing network restrictions and new out-of-pocket limits for 2026. These plans, managed by private companies, utilize restricted networks of doctors, hospitals, and specialists who agree to lower rates. This approach helps reduce monthly premiums and allows for additional benefits like dental, vision, and gym memberships. For 2026, the in-network maximum out-of-pocket (MOOP) limit is set at $9,250, while PPO plans with out-of-network usage can have a combined limit of up to $13,900. New rules also mandate faster and more transparent prior authorization processes, requiring responses within 7 calendar days for standard requests and 72 hours for urgent ones. If a doctor leaves a network mid-year, plans are legally required to provide at least 30 days' notice. Beneficiaries undergoing active, serious treatment may qualify for continuity of care, allowing them to continue seeing their current doctor at in-network prices for up to 90 days.
Sarasota Herald-Tribune Sarasota Herald-Tribune
Sarasota rehab center earns prestigious national recognition

Sarasota rehab center earns prestigious national recognition

A Sarasota rehabilitation center was named among America's best for 2026, adding to a growing list of national honors and top rankings.
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Anthem Launches Video Series to Simplify Health Insurance for Consumers

Anthem Launches Video Series to Simplify Health Insurance for Consumers

Anthem, in partnership with GET Creative and USA TODAY, has launched a new video series aimed at demystifying health insurance for consumers. The series features actress and Anthem member Katherine LaNasa, who breaks down complex aspects of healthcare, including terminology, choosing appropriate care, and managing costs. The initiative seeks to provide clear, practical guidance to help individuals better understand their health plan benefits, make informed decisions about their care, and confidently manage healthcare expenses. The series covers various topics, from understanding health insurance terms to utilizing digital tools and support for finding care and managing costs. This effort comes as many consumers find healthcare confusing, particularly when navigating treatment options, care locations, and associated costs.
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Cigna Healthcare Introduces Integrated Supplemental Benefits for High-Deductible Health Plans

Cigna Healthcare Introduces Integrated Supplemental Benefits for High-Deductible Health Plans

Cigna Healthcare Introduces Integrated Supplemental Benefits for High-Deductible Health Plans
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CHI St. Vincent Exits Arkansas Blue Cross Blue Shield Network Amidst Stalled Negotiations

CHI St. Vincent Exits Arkansas Blue Cross Blue Shield Network Amidst Stalled Negotiations

CHI St. Vincent, part of CommonSpirit Health, has officially withdrawn from the healthcare provider networks of Arkansas Blue Cross and Blue Shield (ABCBS) and its associated health plans, effective September 1, 2026. This decision impacts four hospitals, 80 medical clinics, and over 300 employed healthcare providers within the CHI St. Vincent system in Arkansas. The affected plans include Arkansas Blue Medicare, BlueAdvantage Administrators of Arkansas, the Federal Employees Program, Health Advantage, Octave Blue Cross and Blue Shield, and Skai Blue Cross and Blue Shield. Negotiations between CHI St. Vincent/CommonSpirit Health and ABCBS reportedly spanned several months, with ABCBS offering multiple proposals that were ultimately rejected by CHI St. Vincent. According to Alicia Berkemeyer, executive vice president and chief health management officer for Arkansas Blue Cross, the insurer is disappointed by the decision but remains open to future discussions. CHI St. Vincent, however, stated that ABCBS was ...
Evergreen Daily Evergreen Daily
7 Questions to Consider When Deciding Where to Seek Care

7 Questions to Consider When Deciding Where to Seek Care

Feeling sick but not sure where to go? Answering these seven questions can help you choose between the ER, urgent care, your doctor, and telehealth.
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Governor Maura Healey Announces $17.9 Million in Grants for Massachusetts Community Health Initiatives

Governor Maura Healey Announces $17.9 Million in Grants for Massachusetts Community Health Initiatives

Governor Maura Healey has announced the allocation of $17.9 million in grants to 31 community organizations, cities, towns, and regional planning commissions across Massachusetts. This funding is intended to enhance public health and support residents in leading healthier lives. The initiatives will focus on critical areas such as access to healthy food and housing, behavioral health services, and healthy aging programs. According to Governor Healey, these investments directly empower local organizations, who possess intimate knowledge of their communities' needs, to address these challenges. Lieutenant Governor Kim Driscoll emphasized that these grants provide local leaders with the resources to transform ideas into actionable solutions, ranging from improving access to healthy food and housing to assisting older adults in maintaining independence. This marks the fourth round of funding from the Massachusetts Community Health and Healthy Aging Funds, which have collectively invested $63 million in 113 org...
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U.S. Health Systems Increase Efforts to Combat Homelessness, Focus on Housing Initiatives

U.S. Health Systems Increase Efforts to Combat Homelessness, Focus on Housing Initiatives

More than half of the 200 largest U.S. health systems are implementing programs to mitigate homelessness, with a significant focus on housing initiatives, according to new research from Cornell University. These programs aim to reduce emergency care costs associated with homelessness. The study, published in Health Affairs Scholar, is the first to investigate the national scope and drivers of such initiatives. Researchers found that programs addressing homelessness are more prevalent in states that expanded Medicaid coverage under the Affordable Care Act and possess more robust shelter capacities. This suggests that health systems are leveraging existing infrastructure to implement these programs. The federal government's 2024 estimate indicated a record high of 771,480 people experiencing homelessness on a single night in the U.S. Homeless individuals are frequently referred to as 'frequent utilizers' of emergency rooms, accounting for 1% to 5% of the total patient population but 12% to 18% of emergency r...
AP News AP News
Florida set to carry out 14th execution this year in the nation's busiest death chamber

Florida set to carry out 14th execution this year in the nation's busiest death chamber

A Florida man convicted of fatally shooting a 16-year-old girl who rejected his romantic advances and wounding two of her friends is set to be executed
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VillageCare Seeks Manager for Healthcare Claims to Optimize Audit Processes in New York

VillageCare Seeks Manager for Healthcare Claims to Optimize Audit Processes in New York

VillageCare, a community-based, not-for-profit organization in New York City, is actively seeking a Manager for Claims Healthcare. This role is crucial for developing strategies to optimize the claims audit and review process. The manager will be responsible for overseeing the completion of claims audits and reviews of delegated vendors, ensuring compliance with health plan and regulatory standards, as well as internal policies. Additionally, the position involves monitoring key performance indicators (KPIs) to guarantee accurate and timely claims processing. The successful candidate will also ensure that third parties adhere to agreed-upon delegated authority contracts and performance standards. This role requires a minimum of five years of experience in claims analytics, with at least two years in managing and training staff within a healthcare setting. Knowledge of medical terminology, ICD-10, CPT, HCPCS coding, CMS guidelines, and Encoder Pro is essential.
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Lifepoint Health Expands Healthcare Network and Physician Opportunities in North Carolina

Lifepoint Health Expands Healthcare Network and Physician Opportunities in North Carolina

Lifepoint Health, a diversified healthcare delivery network operating across 29 states, is expanding its presence and services, particularly highlighted by opportunities at Frye Regional Medical Center in Hickory, North Carolina. Frye Regional Medical Center, a 355-bed hospital, is part of the Duke Lifepoint healthcare system, which combines Duke University Health System's clinical expertise with Lifepoint Health's operational experience and financial resources. The medical center is actively seeking a Board Certified/Board Eligible Sleep Medicine physician to join an established Pulmonary & Critical Care group. This position offers a leadership opportunity as a Sleep Lab Medical Director, requiring experience and offering flexible Public Service Announcement (PSA) contract with PRN (as needed) hours. The role involves providing outpatient Sleep Clinic coverage two days a week minimum, with an option for remote reads. Candidates must have completed an ACGME Sleep Medicine fellowship and be board-certified....