Moda Health

Moda Will Take Its Case To U.S. Supreme Court

A federal appeals court rejected Moda's request on Tuesday to rehear its petition for millions in payments from the federal government over losses under the Affordable Care Act, but the case is not closed.

A federal court has rejected a request from Moda Health to consider its appeal in a case involving millions in federal funds that’s been bouncing around the courts for two years.

Moda Negotiating A Major Infusion of Capital

Confidential sources tell The Lund Report that a deal is in the works that could eventually lead to another insurance company holding a majority of seats on Moda's board.

Speculation has swirled for years that Moda Health, Inc. would fail or be taken over.

Now it looks as if it will be the latter. 

Moda Health Responds to Complaints about Payment Delays

Mental health professionals insist the insurer is holding up payments.

Mental health practitioners insist that Moda Health is holding up their claim payments, at times for up to 90 days, to make sure people haven’t canceled their insurance policy.

If that’s true, Moda would be in violation of the state’s prompt payment law requiring insurers to pay claims within 30 days.

Moda Health the Initial Favorite for Revamped Teacher Health Plan Contract

The Oregon Educators Benefit Board is redoing its contract, hoping to reduce medical inflation for school districts by asking insurers to do a better job coordinating care. The contract may be Moda’s to lose, since it currently provides care to most teachers. But Kaiser and Providence could be added in certain counties, and Regence and UnitedHealthCare also have competitive statewide bids.

The Oregon Educators Benefit Board has winnowed down its finalists for its revamped contract, calling back five health plans to be interviewed by the board members later this month.

OEBB Enrollment Moving Toward Cheaper Health Plans

State educators and others insured through the Oregon Educators Benefit Board have been migrating heavily toward catastrophic and coordinated care health plans offered by Moda Health. OEBB has encouraged this movement through lower premiums and copayments. Meanwhile, OEBB director James Raussen was suspended with pay last month.

The number of people who signed up for Moda Health’s coordinated care options through the Oregon Educators Benefit Board more than doubled this school year to nearly 38,000, up from 16,000 in 2015-2016.

OHSU President and Moda CEO Having Friendly Discussions

In emails obtained by The Lund Report, the two leaders mention talking to their collective board membership, but spokespeople from OHSU and Moda insist nothing is imminent.

Could OHSU and Moda be moving toward an equity arrangement? In emails obtained by The Lund Report under the Freedom of Information Act, Dr. Joe Robertson, president of OHSU, and Robert Gootee, CEO of Moda Health, could be headed in that direction.

PEBB Slides Under Cost Caps for Biennium at Negotiation Table

The Public Employees Benefit Board signed off on 2017 premium rates for its menu of health plans, which after extensive negotiation, came in at a 4 percent hike, for an average of 3.2 percent over two years. A Providence researcher also showed the health engagement module is lowering costs for people with more complex medical needs.

Harder-nosed negotiations between the Public Employees Benefit Board and its insurers should allow the health plan for state workers and university employees to meet the budget limits set by the Legislature for the 2015-2017 biennium.

Moda Given the Okay by Insurance Division

The health insurer now has the green light and no longer faces sanctions.

Moda Health can breathe a sigh of relief after the Oregon Insurance Division lifted the Feb. 6 consent order, which required the company to sell a variety of assets and take steps to improve its financial position so it could continue serving its members.

Regulators, Moda Map Route to Financial Recovery

Financially struggling Moda Health Plan will resume offering individual health plans under an agreement reached with regulators in three states to raise $179 million in capital and agree to closer oversight by Alaska, Oregon and Washington

Moda Health Plan will resume selling individual and group health insurance in Oregon and Alaska under an agreement reached with regulators in three states, the Oregon Department of Consumer and Business Services said on Monday, less than two weeks after the insurer was placed under government sup

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