Payer
HaloMD, a major player in surprise billing disputes, released a report claiming the No Surprises Act has cut out-of-network emergency care spending by billions. However, researchers from Georgetown and Brookings question the assumptions and data behind these estimates, noting potential conflicts of interest.
An HHS OIG audit shows that Medicare Part D paid $587.7 million between 2021 and 2023 for five drugs that had been switched to over-the-counter status, primarily involving generic versions of Voltaren. CMS's reliance on outdated FDA data and failure to promptly notify plans led to increasing non-compliant payments each year. The OIG recommended that CMS issue timeframes similar to the FDA's, and CMS has agreed.
UnitedHealth Insurance announced that starting in October, it will eliminate prior authorization requirements for approximately 1,700 medical codes, covering commercial, Medicare Advantage, Medicaid, and ACA plans, accounting for about 30% of its total prior authorizations. This move aims to respond to public dissatisfaction with administrative barriers and to address regulatory pressure.
A new Epic Research analysis finds that as Medicaid enrollment has significantly declined after the pandemic, the proportion of patients paying out of pocket in U.S. emergency departments and other healthcare settings has risen notably. In the second quarter of 2026, the self-pay rate in emergency departments reached 7.6%, up 2.1 percentage points from 5.5% in early 2022, while Medicaid coverage fell from 18.2% to 16.1%. The study is based on over 550 million visits and notes that the budget reconciliation bill passed by Republicans last year will further cut nearly $1 trillion in Medicaid funding, with an estimated nearly 6 million people expected to lose this insurance over the next decade.
According to the latest Aon research, the average healthcare cost per employee for U.S. employers in 2027 is expected to exceed $19,000, up 9.5% year-over-year, marking the fourth consecutive year of near-double-digit increases. Employee out-of-pocket costs have also risen significantly, reaching an average of $5,297 per person in 2026. The cost surge is driven by the high prevalence of chronic diseases, the adoption of specialty drugs and GLP-1 therapies, and AI-assisted clinical coding inflating bills. Employers face a dilemma between benefit budgets and salary growth.
Carelon Behavioral Health, a division of Elevance, announced that Dr. Patrick Fox has assumed the role of president effective immediately, succeeding Corbin Petro. Fox brings thirty years of clinical psychiatry and behavioral health leadership experience and previously served as president of Wellpoint New Jersey. Concurrently, Patrick Gillespie has taken over as president of Wellpoint New Jersey.
Revenue cycle management firm R1 announced an agreement to acquire Humata Health, a company focused on AI-powered prior authorizations. The deal, expected to close in Q3, will integrate Humata's technology into R1's platform, aiming to reduce administrative burden and improve approval rates.
Humana announced Thursday that Dr. Shantanu Nundy will become its chief medical officer, effective Aug. 31. Nundy, who previously served as executive vice president of care delivery and chief health officer at Accolade, will bring a clinical perspective to product design, platform development, and AI use. He replaces Kate Goodrich, who left in October 2025 for a role at UnitedHealth. The appointment comes as Humana focuses on margin improvement and operational efficiency.
U.S. District Judge Nathaniel Gorton ruled that HHS unlawfully revised essential health benefit scope without a required CMS actuary certification. The decision, hailed by California AG Rob Bonta, reinstates ACA cost-sharing protections for gender-affirming care but leaves administrative details unresolved.
Epic has deployed a new API that lets clinicians instantly check if prior authorization is required for medical treatments, initially adopted by four health systems. The tool aligns with federal interoperability rules and aims to reduce administrative burden.