Anthem Blue Cross Blue Shield of New York, a subsidiary of Elevance Health, faces a proposed class action from policyholders accusing the insurer of listing out-of-network providers, especially for mental healthcare, in its directories. These so-called "ghost networks" deter patients from accessing care, inflate costs, and create...
About 30 years ago, Blue Cross of California created WellPoint Health Networks, a for-profit managed care organization. The name was shortened to just WellPoint in 2004 and then rebranded as Anthem after its acquisition in 2014. Last year, Anthem was rebranded to Elevance Health - Amerigroup is an Elevance Health subsidiary.
Following...Arizona News
This week in Medicare Advantage news, prior authorization reform garners the support of the Better Medicare Alliance, Puerto Rico offers insight into the future of the MA program, a CMS rule on third-party marketing goes into effect and we share some acquisition news.
Last week, the Better Medicare Alliance, the largest lobby for...National News
This week, the Centers for Medicare and Medicaid Services (CMS) is learning from prior models and plans to make adjustments within Medicare Advantage for dual eligibles and hospice care. In other MA news, Anthem and UnitedHealthcare were penalized for failing to meet the medical loss ratio (MLR) threshold of 85%.
CMS is moving forward...National News
The Centers for Medicare & Medicaid Services (CMS) is looking forward for the potential for alternative payment models this week, and wants to leverage the potential of value-based care to support the Biden administration's quest for health equity for marginalized communities.
CMS has spent the past several months...
The special enrollment period for individual health care plans offered through the Affordable Care Act has been a boon for major health insurers participating in the Marketplace. But many insurers are concerned that extending the SEP could cause unintended issues for insurers and enrollees alike. Also, the Brookings Institute says that...
UnitedHealthcare's announcement it would begin denying payments for non-urgent emergency department visits was met with fierce criticism from hospitals, doctors groups and patient advocacy organizations. As a result the insurance giant has said it will delay the policy.
UnitedHealthcare covers nearly 425,000 Arizonans on Medicaid...Arizona News
The nation's largest health insurer by membership announced a new policy to deter patients from seeking care in hospital emergency departments. UnitedHealthcare announced the change would take effect on July 1, and it would evaluate emergency room claims using "a number of factors" to determine whether or not the issue was truly an...National News
In President Biden's American Families Plan, subsidies under the expanded Obamacare have been extended indefinitely. Rebates or another stimulus check from insurance companies can be expected.
Another stimulus check might be coming from health insurers
The Obamacare subsidies were expanded in March when the COVID relief plan...Arizona News
In the early months of the pandemic, the federal Medicare program and private health insurance companies wanted to encourage people to use alternatives to in-person care by talking with a doctor over video or by telephone. There has been a 3,200% spike in telemedicine visits in Arizona, according to AHIP.
Now, some Americans will...National News
The healthcare sector led the market rally on Wednesday following a Super Tuesday Joe Biden victory that drove stocks higher.
In an emergency decision, the Fed cut rates 50 basis points on Tuesday, offering little relief for the market that closed down 2.8 percent - erasing any intra-day gains. With Biden the clear representative of...Arizona News
With two-thirds of U.S. Medicaid beneficiaries receiving care from managed care organizations, private insurers are unlikely to suffer from the Medicaid block grant plan.
A majority of states contract with MCOs to provide coverage and the government space is still perceived as a prime growth strategy for large insurers such as...National News
San Francisco-based start-up Ooda Health announced the launch of its cloud-based software platform focused on relieving the administrative burdens of medical billing for payers and providers.
Oodapay places the responsibility of cumulating patient payments on payers rather than the physician or hospital. The company is working on...Arizona News
Healthcare stocks took quite the beating last week and continue to decline into the third week of April. Even insurance giant United Healthcare cannot escape the downturn as it stays on track for its worst month in a decade. Analysts are already pointing the finger at 'Medicare for All,' claiming the political pressure is not good for...Arizona News
Anthem individual insurance plans bid goodbye to Affordable Care Act (ACA) markets across the nation to focus on the growth of its Medicare Advantage business, an experience more sweet than bitter; the insurance giant's third quarter profits were up 29 percent, year over year.
Enrollment in Anthem's insurance plans may have taken...Arizona News
In May, a final rule from the Centers for Medicare & Medicaid Services (CMS) opened the doors for Medicare Advantage (MA) insurers to offer long-term care benefits to members. About 7.5 percent of MA plan enrollees in 2019 may have access to in-home support services or extra benefits, according to CMS officials.
In a speech...Arizona News
MA insurers are auditing patient's medical charts to find more diagnosis codes in effort to get larger reimbursements from the Medicare program. The business of insurance encourages the documentation of all possible diagnoses to generate billions in profits. Modern Healthcare cites an Anthem lawsuit as an example of the returns...Arizona News
Many MA plans offer over the counter (OTC) supplementary benefits and even a special OTC card for use at the point of sale - in 2019 Anthem MA customers can get free two-day shipping from Walmart for qualifying OTC purchases when orders total $35 or more.
When 90 percent of U.S. households live within 10 miles of America's largest...National News
Uncertainty surrounds potential mega-healthcare mergers as the CVS-Aetna deal and Cigna's acquisition of Express Scripts are in question. Just last year, the Justice Department thwarted the Cigna-Anthem and Aetna-Humana mergers.
The California Insurance Commissioner is adamant that the CVS-Aetna $69 billion merger proposal be blocked...National News
Medicare Advantage enrollment is projected to rise to 38 million, or 50% market penetration, by the end of 2025.
Anthem, Humana and WellCare Health Plans are signaling plans to aggressively grow their Medicare Advantage businesses with the help of mergers and acquisitions. The three health insurers are in a competitive battle with...
