$ELV

New Hampshire Insurance Department fined Anthem Health Plans of New Hampshire Inc. and Matthew Thornton Health Plan $520,000 for “hundreds of violations” found in a market conduct exam covering Jan 1, 2022 to Nov 30, 2023. The issues involved provider credentialing, provider directory accuracy, and mental health parity. $300,000 is due within 30 days; $220,000 is suspended for two years if compliance is maintained.

Wisconsin insurers filed ACA marketplace rate requests for 2027, citing higher medical costs and increased utilization. The average proposed increase is 20.9%, with 12 insurers seeking 11% to over 30%. Common Ground (30.88%), Anthem Blue Cross (16.48%), Healthpartners (15.59%), Medica (24.56%), Security Health (10.72%). Advocates cite subsidy loss and affordability concerns; decisions expected by end of August.

The article says Georgia’s Medicare Advantage market has 180 plans from 14 carriers across 159 of 160 counties, with an average monthly premium of $6.74, down from $13.76 in 2025, and 1.8 million beneficiaries. It also describes an Anthem (Elevance Health) policy from January 2026 imposing a 10% hospital penalty for out-of-network physician participation, which Indiana banned via SB 189 in March 2026.

Anthem Blue Cross, part of Elevance Health, filed a federal lawsuit on Jan. 5, 2026 against 11 California hospitals operated by Prime Healthcare, alleging they improperly used the No Surprises Act independent dispute resolution process. Anthem claims over 6,000 of 9,000+ IDR claims were ineligible and that hospitals extracted more than $15 million in awards. An Aug. 11 hearing is scheduled.

CMS said Medicare Advantage payments to private insurers will rise 2.48% next year, implying about $13 billion in additional payments, and 4.98% after risk-score trends. UNH, HUM, CNC and ELV shares rose 5% to 11% in extended trading. CVS and MOH also gained, after a January proposal for a near-flat increase.

Oregon Health & Science University research in Health Affairs analyzed 2022 Medicaid claims and found millions of adolescents are covered by managed care organizations owned by five national firms: Centene, Elevance Health, UnitedHealth Group, Molina Healthcare, and CVS Health. Compared with other MCOs, these firms showed lower screening, more psychotropic prescriptions without psychotherapy, and higher emergency/inpatient mental health use.

Sentara Health says Anthem owes it over $105 million in claims more than 90 days overdue for care already delivered to Anthem members in Virginia. Sentara requested a 6.2% rate increase; Anthem countered with a 1% reduction. Sentara notified intent to let some contracts expire, with commercial and Medicare in-network status through Dec 31, 2026.

Sentara Health said talks with Anthem Blue Cross Blue Shield of Virginia have stalled for eight months and contracts covering about 380,000 Anthem members could expire by year end or early next year if negotiations fail. Sentara claims Anthem owes millions in unpaid claims. No coverage changes are expected now. Sentara reported $14.2B operating revenue and $1.7B net income; Anthem is owned by Elevance Health.

Health insurers and industry groups are criticizing the No Surprises Act independent dispute resolution (IDR) process, saying disputes and payouts are rising and some providers are exploiting arbitration. Cigna CEO Brian Evanko cited “abuses” and said payouts were manageable. A Wall Street Journal analysis of CMS data shows 2025 payouts near $15B vs $4.08B in 2024. Courts have largely rejected insurers’ challenges.

Missouri Medicaid faces federal penalties under a new law requiring the state to cut its error rate below 3% starting Oct. 2029. The state is considering extending managed care contracts through FY2028 for plans including Healthy Blue (Elevance Health), Home State Health (Centene) and UnitedHealthcare Community Plan. Advocates cite a report estimating up to $259 million annual general-revenue savings if run directly, while insurers dispute the premise. Missouri spent $7.6B on managed care in FY2