Urban Hospitals Go Rural Chic, UnitedHealth Struggles But Don’t Worry—You’ll Pay For It, And Cigna’s AI Fights Your Doctor’s AI For Billing Dominance

Hey all,

Happy Tuesday! Now that I finally got prior authorization for Mounjaro, I’m trying to claw back the $5,000 I already spent out of pocket on Zepbound and Omnipod Dash pods—expenses racked up while OptumRX and United Healthcare dragged their feet like they were guarding the gates of Winterfell. I’m betting they’ll deny the Zepbound claim by saying I was only approved for Mounjaro (same drug, different brand), and as for the Dash pods, who knows—probably some vaguely worded stall tactic meant to sound legitimate while meaning nothing. Honestly, at this point I’m just grateful they haven’t asked me to submit my claims in Elvish on a scroll blessed by three physicians and a notary public.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Modern Healthcare) Urban Hospitals Claiming Rural Status

A new study reveals that the number of urban hospitals securing rural designations has surged from three in 2017 to 425 in 2023, potentially diverting critical support from genuinely rural providers. This loophole allows metro-area hospitals to access taxpayer-funded programs like the $50 billion Rural Health Transformation Fund, 340B drug discounts, and additional medical residency slots, raising concerns that these benefits may be misallocated and further jeopardize rural healthcare systems. Without reform, it looks like yet another well-meaning program will end up enriching non-profit investment funds—sorry, non-profit health systems. Full Article

(HEALTH CARE un-covered) The Systemic Fallout Behind UnitedHealth’s Struggles

 There’s no satisfaction in seeing UnitedHealth Group falter—not when the fallout lands on patients, providers, and workers who are trapped in a system designed to prioritize investor returns over human wellbeing. As the company responds to declining profits and stock value with cuts that will hurt access to care, it underscores a grim reality: United’s troubles are not a moral comeuppance but a warning signal that the entire health insurance model is unsustainable and rigged against those who rely on it most. And truly, not a single drop of schadenfreude—just a warm, bitter respect for the consistency with which misery is redistributed downward. Full Article.

(BenefitsPro) Cigna Battles Hospitals' AI Billing Systems

Cigna executives report a growing technological arms race between their AI systems and those used by hospitals and providers to maximize billing, driving up costs in employer-sponsored health plans. As AI intensifies the billing complexity, large employers are reacting with caution—delaying benefits decisions and exploring disruptive cost-cutting solutions—while Cigna also fights regulatory battles like Arkansas' anti-PBM law and sees evolving employer preferences toward self-insured plans and fewer vendors. Full Article.