Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Insurance

UnitedHealth Behavioral Health Unit Used Flawed Denials Guidelines

March 7, 2019 - A federal court has found that United Behavioral Health (UBH), a unit owned by UnitedHealth Group, used a flawed methodology to deny mental health and substance abuse treatment services to beneficiaries. UBH, which also operates as OptumHealth Behavioral Solutions, employed overly-strict criteria for denying care to individuals, potentially excluding thousands of members, including...


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Medicare, Medicaid Best Private Plans for Containing Health Costs

by Jessica Kent

Medicare and Medicaid contain per enrollee health spending growth better than private insurance which likely indicates that recent policies will be key to sustaining this control, revealed a report conducted by the Urban Institute and...

Optum Sues Over Alleged Trade Secrets Brought to Amazon

by Jennifer Bresnick

Optum is suing former employee David Smith over allegations that Smith has shared Optum’s trade secrets with his new employer, the as-yet-unnamed collaboration between Amazon, JP Morgan Chase, and Berkshire Hathaway. Optum is...

AHIP Urges “Careful Planning” of Health Reimbursement Arrangements

by Jennifer Bresnick

AHIP is cautioning federal regulators to move slowly and carefully when expanding the availability of health reimbursement arrangements (HRAs) as a more prominent means of paying for healthcare services. In response to a request for...

CVS Closes $69B Acquisition of Aetna, Altering Consumer Landscape

by Jennifer Bresnick

CVS Health has announced that its $69 billion takeover of Aetna has been completed.  The acquisition promises to radically transform the healthcare industry by creating new care delivery options for consumers. “Today marks...

NB and IA Offer New Individual Market Plan For Open Enrollment

by Thomas Beaton

An new individual market plan created out of Medica and CHI Health will be available to consumers during the open enrollment period in Nebraska and Iowa, the health networks announced in a press release. The Medica with CHI Health plan...

Healthcare Coverage, Access Disparities Remain Even After ACA

by Thomas Beaton

While the Affordable Care Act has helped to significantly reduce care and access disparities between socioeconomic groups, more work is needed to create true coverage equity, according to a new study from Oregon Health and Sciences...

Boston Children’s, Cleveland Clinic Partner for Pediatric Care

by Thomas Beaton

Boston Children’s Hospital and Cleveland Clinic have announced a partnership to provide complex pediatric heart care through Cleveland Clinic’s national employer-based insurance network. “Together, our goal to develop...

Payers Leaving Affordable Care Act Insurance Exchanges in 2017

by Jesse Migneault

Questions over the future of the Affordable Care Act (ACA) and its cost-sharing reduction (CSR) payments have prompted many payers to abandon ACA state health insurance exchanges in part or entirely in 2017.  Insurers cited the usual...

BCBS Georgia Plan to Charge for Unnecessary ER Visits Draws Ire

by Jesse Migneault

Blue Cross of Georgia is facing criticism from the American College of Emergency Physicians (ACEP) for a policy directive that would charge members for emergency department visits that result in a non-emergency diagnosis. The policy,...

Single-Payer Healthcare Plan May Cost California $400 Billion

by Jesse Migneault

California’s proposed single-payer healthcare system would come with a $400 billion price tag, says a report from the state Senate on bill SB 562. The goal of the universal healthcare bill is two-fold: to tackle the issue of runaway...

Kaiser Permanente Will Stay in ACA Health Insurance Exchange

by Jesse Migneault

Kaiser Permanente will continue to offer coverage options through the ACA health insurance exchanges during 2018, the payer and provider announced this week. “Kaiser Permanente will continue to offer coverage—including access...

CMS Offers Resources for High-Risk Pools, Reinsurance Waivers

by Jesse Migneault

The Centers for Medicare and Medicaid Services (CMS) has just released a checklist for states to use on applications for Section 1332 waivers.    The waivers are specifically targeted at helping states establish high-risk...

AHIP Sees 28% Increase in Medigap Enrollment Among Seniors

by Jesse Migneault

AHIP has released data showing that enrollment in the Medicare Supplement, Medigap, has seen a steady increase from 2014 to December 2015.   The data represents statistics from 11.8 million enrollees with policies from 305...

Medicaid Expansion Boosts Coverage, Quality at Health Centers

by Jacqueline LaPointe

Federally funded health centers in states that underwent Medicaid expansion through the Affordable Care Act faced higher levels of insured patients and improved care quality compared to their peers in non-expansion states, a recent Health...

ACA Health Insurance Exchanges Bring Challenges for 2017

by Vera Gruessner

The Affordable Care Act (ACA) health insurance exchanges will have some key differences next year. Health insurance companies have faced various obstacles when selling health plans through the exchanges. These challenges include a higher...

How a Public Option May Preserve Health Insurance Exchanges

by Vera Gruessner

Multiple healthcare payers have been struggling with operating successfully on the Affordable Care Act’s health insurance exchanges. Some experts and lawmakers suggest that establishing a public option on the health insurance...

Health Insurance Acquisitions Impede Competition in 24 States

by Vera Gruessner

The American Medical Association (AMA) announced today in a press release the results of a new study show that the health insurance acquisitions between Anthem-Cigna and Aetna-Humana would obstruct competition in the health insurance...

4 Motives Why Hospitals Adopt Provider-Sponsored Health Plans

by Vera Gruessner

Due to the many new transformations taking place within the healthcare industry today such as the transition from fee-for-service reimbursement to value-based care payments, the potential for creating provider-sponsored health plans has...

How the Affordable Care Act Impacts First Quarter Earnings

by Vera Gruessner

The health insurance industry has had a topsy turvy time learning how to function effectively in the new landscape the Affordable Care Act has brought to the medical field. When it comes to the financial well-being of top payers, the...

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