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Research & KnowledgeEvent: September 1, 2026

Healthfirst published a case study comparing two dual-eligible members in an unaligned Medicare and Medicaid plan where a member received improper balance bills for covered services.

Published

Signal category

Research & Knowledge

Quote

In this case study, this played out with two dual-eligible members. In an unaligned plan, a member kept receiving improper balance bills for covered services.

Marcos Moura, RN,BSN|Healthfirst team

Company

Healthfirst

We provide no-and low-cost health insurance in NYC, Long Island, Orange, Rockland, Sullivan, and Westchester counties.

Industry
Hospitals and Health Care
Location
New York, US
Company size
5,413 employees

Healthfirst believes that every New Yorker deserves access to the best available healthcare. As one of New York’s highest quality not-for-profit health insurers serving close to two million New Yorkers, we make this a reality for our members. Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first. Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage. Our offerings include Medicaid plans, Medicare Advantage plans, Child Health Plus plans, Essential Plans, Long-Term Care plans, and Qualified Health plans. For more information on Healthfirst, please visit healthfirst.org.

Founded 1993

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Healthfirst published a case study comparing two dual-eligible members in an unaligned Medicare and Medicaid plan where a member received improper balance bills for covered services. | SeedOps