American Medical Association

AMA: Commercial Coverage of Digital Medicine Services is Inconsistent

September 28, 2023 - Commercial coverage policies for digital medicine Current Procedural Terminology (CPT) codes are inconsistent and lag behind Medicare, an issue brief from the American Medical Association (AMA) found. Commercial payers often cover similar services as Medicare, but coverage and payment policies may differ between private and public plans. As digital...

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AMA Defends Affordable Care Act’s Preventive Care Coverage Requirement

by Kelsey Waddill

The American Medical Association (AMA) defended the Affordable Care Act’s preventive care coverage requirement in an amicus brief in the case of Braidwood Management Inc, et al v Becerra. The...

AMA: 79% of Medicare Advantage Markets Have Little Competition

by Victoria Bailey

Nearly 80 percent of metropolitan statistical areas (MSAs) had highly concentrated Medicare Advantage markets, highlighting the lack of competition in the commercial health insurance market. The...

Industry Reacts to Report on Payer Mental Health Parity Compliance

by Kelsey Waddill

Healthcare stakeholders are responding to the 2022 Mental Health Parity and Addiction Equity Act (MHPAEA) Report, with the American Medical Association (AMA) releasing a statement saying that this...

Top 5 Largest Health Insurers in the US by National Market Share

by Kelsey Waddill

Overall, the list of the top five largest health insurers at the national level has remained stable over the past six years, but the list experienced some small shifts in 2020, according to data from...

Health Insurance Industry Consolidation Grew from 2014 to 2020

by Kelsey Waddill

Health insurance industry consolidation continued to increase, restricting consumers’ options for coverage, an American Medical Association report argued. “As merger...

AMA: 56% Increase in Payer Market Consolidation In Past 5 Years

by Kelsey Waddill

Payer market consolidation has been increasing over the past five years and this consolidation is having negative effects on consumers, the American Medical Association (AMA) asserted in its latest...

Payer Industry Consolidation Threatens Independent Providers, Premiums

by Kelsey Waddill

Seventy-five percent of the payer industry is made up of highly concentrated markets, a number that has been rising since 2014, an American Medical Association (AMA) study found. And in turn, public...

Payers, Providers Spar Over Proposed Prior Authorization Regulation

by Kelsey Waddill

America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) joined together to defend prior authorizations in a statement submitted to the Committee on Small...

AHIP Warns Congress of High Costs Tied to Provider Consolidation

by Kyle Murphy, PhD

Mergers and acquisitions are commonplace in healthcare, but leading payers in the United States claim provider consolidation is costing consumers. In testimony submitted to the Senate Subcommittee on...

AMA: Fix ACA Premium Tax Credits and CSR to Cover Uninsured

by Kelsey Waddill

The annual meeting of the AMA House of Delegates reaffirmed the organization’s commitment to decreasing the number of uninsured individuals through the Affordable Care Act’s (ACA) premium...

AMA, Industry Orgs Object to Short-Term Health Plan Expansion

by Thomas Beaton

The American Medical Association and other industry trade groups have filed amici curiae in support of a lawsuit contesting the legality of short-term health plans. The Association for Community...

AMA Expresses Concern with Medicare Part D Formulary Changes

by Thomas Beaton

New Medicare Part D formulary policies introduced by CMS in August may increase patient safety risks and complicate the prior authorization process, said AMA President Barbara L. McAneny, MD, to...

AMA: CVS-Aetna Merger Would Reduce PBM Competition, Raise Prices

by Jennifer Bresnick

The American Medical Association is urging the Department of Justice to squash the proposed merger between CVS Health and Aetna.  The combined entity would drastically reduce competition in many...

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

by Thomas Beaton

Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have...

AHIP, AMA, AHA to Congress: Fund Cost Sharing Reductions to 2019

by Thomas Beaton

AHIP, AMA, and AHA and four other healthcare organizations urged Congress to continue funding cost sharing reductions (CSRs) through 2019, warning of continued instability in the health insurance...

AMA: Health Insurance Merger Cuts Medicare Advantage Competition

by Vera Gruessner

The American Medical Association (AMA) announced in a press release earlier this week their position against the health insurance merger between Aetna and Humana, particularly regarding its impact on...

AMA Urges NY Regulators to Reject Health Insurance Mergers

by Vera Gruessner

The Anthem-Cigna and Aetna-Humana health insurance mergers are facing more and more scrutiny throughout the medical industry and among federal officials. While the US Department of Justice filed a...

Payers’ Perspective: Insurance Mergers Benefit Consumers

by Vera Gruessner

As previously reported, the Department of Justice (DOJ) has announced that it will be blocking the Anthem-Cigna and Aetna-Humana insurance mergers due to the potential harm it may bring to consumers...

Major Health Insurance Mergers May Leave Consumers “Worse Off”

by Vera Gruessner

Four of the top five major payers in the nation are looking to consolidate into two combined health insurance companies. The Anthem-Cigna and Aetna-Humana health insurance mergers could lead to a...

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