Core and Group Health

"These priorities, coupled with the growing frustrations our members are expressing, should be a wake-up call for many health care stakeholders who think the status quo is acceptable and that the days of blank checks will never end," said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH).

Anthem alleged that HaloMD had exploited the resolution process to submit ineligible claims and secure higher out-of-network payment awards.

Administrative waste costs the U.S. health care system an estimated $350 billion each year. This includes $266 billion that is attributed to administrative complexity and between $59 and $84 billion caused by fraud and abuse.

Big U.S. health insurers are using pharmacy affiliates to get around the Affordable Care Act minimum medical loss ratio requirement, or profitability cap, a team of economists says.

The proposed 2027 regulations would also block California's hearing aid and wheelchair mandates, the state's governor says.

Understanding that complexity does not mean criticizing the system. It simply means acknowledging how it operates in practice in order to give employees the support they need to move through that complexity with clarity and confidence.