UnitedHealthcare Group, Cigna and CVS Health-backed insurer Aetna, three of the largest U.S. insurers by membership, each had an eventful 2023.
Here are five of the most significant updates from each of the insurance giants' last 12 months to know going into 2024, as determined by Becker's page views:
UnitedHealthcare
1. UnitedHealthcare's first of two waves of prior authorization cuts started Sept. 1. The first wave eliminated 20% of its current prior authorization requirements, and the second and final wave in November included cuts to community plans.
2. UnitedHealthcare is discontinuing some Medicare Advantage plans and exiting some service areas for 2024. In a message sent to providers, the insurer said affected plans include some plans co-branded with AARP; UnitedHealthcare MedicareDirect, a fee-for-service-based program; some dual-eligible plans; and other MA options. However, a UnitedHealthcare spokesperson told Becker's the company is expanding its overall Medicare Advantage offerings for 2024.
3. UnitedHealthcare revamped planned prior authorization policy changes after receiving pushback from medical groups and other organizations.
The insurer planned to implement new gastroenterology and endoscopy prior authorization policies June 1 but decided to enact an advance notification policy for non-screening and nonemergent GI procedures.
Gastroenterology societies and other organizations pushed back against the proposed policy, arguing it would result in delays for medically necessary care, add unnecessary paperwork burden to physicians and staff, and may violate Center for Consumer Information and Insurance Oversight recommendations.
The company then reworked its policy; however, the replacement policy was also met with criticism. Experts argued the reworked policy would still limit patient access to lifesaving procedures and that there is no evidence of overuse of the affected GI procedures that would make the restrictions necessary.
4. UnitedHealthcare plans to enhance the benefits of its UCard, an integrated insurance ID card with many uses for members.
The UCard is for Medicare Advantage and D-SNP members to use as a traditional insurance ID card to access care and fill prescriptions, along with offering a way to pay for healthy food and over-the-counter products at certain retailers, pay for utilities and check in at the gym, if eligible.
In 2024, UnitedHealthcare is expanding its MA plans to reach 96% of all Medicare-eligible individuals.
5. UnitedHealthcare was hit with a lawsuit by Greenville, S.C.-based Prisma Health that alleged the company breached its contract by disclosing information about Prisma's rate proposals to media outlets and not providing a copy of any statement to the media to Prisma 48 hours before publication. The health system requested a temporary injunction preventing UnitedHealthcare from disclosing further information.
UnitedHealthcare responded, saying it did not breach its contract with Prisma and that the health system "coordinated a media effort to put pressure" on the insurance giant. The companies were in the midst of negotiating a new contract.
Cigna
1. Cigna Group reduced its workforce, according to posts by former employees on social media in October regarding layoffs they said are occurring across the company. Becker's has not confirmed an exact number of employees who may have been affected or when layoffs would be effective, and Cigna did not respond to questions about a reduction in force or if additional layoffs are planned.
2. Cigna Group was hit with lawsuits from members and a shareholder following a ProPublica report that alleges the company denies large batches of members' claims without individual review, thereby denying them coverage for certain services. Class-action complaints have been filed in California, Minnesota and Delaware.
3. The insurer was ordered to pay more than $172 million to settle claims that it submitted false diagnosis codes to Medicare Advantage from 2016 to 2021, and that it did not verify the accuracy of diagnosis codes reported by providers before submitting to CMS and reviewed charts to identify where it could receive additional payments from CMS, from 2014 to 2019. The company promised to enter a corporate integrity agreement for five years with HHS' Office of Inspector General.
4. The company removed prior authorization requirements from more than 600 medical codes — nearly 25% of services.
5. Cigna lowered reimbursements for non-medically directed procedures performed by certified registered nurse anesthetists by 15%.
Aetna
1. CVS Health rebranded as CVS Healthspire, which includes Oak Street Health, Signify Health, MinuteClinics and Caremark. The rebrand separates CVS Healthspire's healthcare services from Aetna.
2. Aetna underwent an audit from the U.S. Office of the Inspector General that determined the insurer received at least $25.5 million in overpayments in a one-year period. The OIG suggested that Aetna refund the overpayments to the federal government.
3. It announced its 2024 Medicare products, the largest Medicare offering in its history. Medicare Advantage plans will include dental, vision and hearing benefits, reduced prescription drug costs across its Medicare Advantage prescription drug plan portfolio, and many plans will have enriched over-the-counter benefits.
4. The California Supreme Court resurrected a case initially filed by the California Medical Association in 2012 that alleges that Aetna illegally retaliated against physicians who sent patients to out-of-network clinics.
The suit alleges that Aetna harassed and fired contract physicians who referred patients to out-of-network ASCs.
5. Brian Kane took over as president of Aetna and executive vice president of CVS Health.