Medical Billing

Centene Pays South Carolina $25M to Settle Overcharging Allegations

January 4, 2024 - Centene Corporation has reached a $25.89 million settlement after allegedly overcharging South Carolina’s Medicaid program for pharmacy services. Per the settlement, Centene must pay South Carolina a total of $25,898,070.69 in two installments. The payer must provide the first installment within 45 days of the date the settlement was executed...


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How Payer, Provider Alignment Enables Simplified Medical Billing Format

by Kelsey Waddill

When Banner|Aetna conducted market research and asked their members to name the primary barrier that prevented them from engaging easily with healthcare, the payer’s leadership did not expect the answer to involve medical...

Banner|Aetna Health Plan Streamlines Bill Format to Improve Medical Billing

by Kelsey Waddill

Updated 11/14/2022: The title of this article has been updated to include the Banner|Aetna name. A previous version of the title referred to the plan as an Aetna health plan. Banner|Aetna has...

Uninsurance, High Deductible Plans Linked to Greater Medical Debt

by Victoria Bailey

The prevalence of medical debt may be tied to health insurance coverage status, as uninsured individuals and those with private high-deductible health plans were more likely to have more medical debt,...

More than Half of Americans Have Low Health Insurance Literacy

by Victoria Bailey

Many Americans may have low health insurance literacy, as up to 77 percent of people were confused by basic health insurance terms, such as coinsurance, copayment, and deductible, according to a Forbes...

Oscar Health Cost Estimator Tool Aims to Increase Price Transparency

by Victoria Bailey

Oscar Health has launched an updated cost estimator tool to increase price transparency around healthcare costs and help members plan for their medical bills in advance. “Since day one, Oscar...

AHIP, BCBSA Back HHS, Interim Final Rule in Surprise Billing Lawsuit

by Victoria Bailey

AHIP and the Blue Cross Blue Shield Association (BCBSA) have filed amicus briefs that support the Department of Health and Human Services (HHS) in the surprise billing lawsuit raised by the Texas...

Most Adults Have Low Health Literacy, Strong Medical Bill Concerns

by Victoria Bailey

The majority of insured individuals in the United States are concerned about paying their medical bills, with low health literacy contributing to these concerns, according to the MITRE-Harris Poll...

High Deductibles Associated with More Medical Bill Problems

by Victoria Bailey

In the year and a half following the Affordable Care Act’s first marketplace open enrollment period, the number of families who had trouble paying medical bills decreased by nearly 10 million....

How Payers Can Make Medical Billing More Streamlined, Transparent

by Kelsey Waddill

Medical billing is notoriously complicated and taxing for members and providers alike. But payers have the ability—and, some might argue, the responsibility—to clarify and simplify the...

Texas Enacts Bill to Protect Consumers from Surprise Billing

by Kyle Murphy, PhD

On June 14, Texas joined the ranks of a score of states with consumer protections against surprise billing (or balance billing) with the signing of Senate Bill 1264. Effective this September, the bulk...

HELP Draft Legislation Targets Major Changes in Healthcare Spending

by Kyle Murphy, PhD

Before members of Congress retired for the long weekend, leaders of the Senate Committee on Health, Education, Labor and Pensions (HELP) unveiled draft legislation for the Lower Health Care Costs Act...

House Hearing Outlines Competing Solutions to Surprise Medical Bills

by Sara Heath

Legislation to address surprise medical bills must center on the patient, protecting patients from having to take part in mitigating extraordinarily high medical bills. Such was the conclusion of a...

Prevalence of Balance Bills Varies by State, Medical Specialty

by Jessica Kent

Certain states and medical specialties account for larger shares of out-of-network claims and balance bills for inpatient hospital admissions, according to a study conducted by the Health Care Cost...

Emergency Air Ambulances Put Patients at Risk for Balance Billing

by Jessica Kent

Privately insured patients transported by emergency air ambulances outside their coverage networks are at high risk of balance billing, also known as surprise billing, according to a GAO report. Just...

Payers, Providers, Lawmakers Debate Surprise Billing Guidelines

by Jessica Kent

State and federal policymakers are still considering various approaches to solve surprise billing issues and compensate out-of-network providers, including mandated values for reimbursement and...

Senators Request Payer, Provider Data on Surprise Medical Billing

by Jessica Kent

Senators from both sides of the aisle have requested information from providers and payers regarding surprise medical billing. In a recently released letter, Senators Bill Cassidy (R-LA), Michael...

Retail Clinics, Surprise Bills Changing Healthcare Purchasing Patterns

by Jennifer Bresnick

Consumers are changing the way they spend their healthcare dollars as the stress of surprise medical bills, coupled with new retail-style options, change the care delivery landscape. Two new consumer...

Healthcare Costs Vary Widely Across Geographic Regions

by Jesse Migneault

New research from the Health Care Cost Institute (HCCI) shows that healthcare costs for three common procedures, including knee injections, ACL repairs, and knee replacements, varied greatly...