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Private Payers News

Emergency Air Ambulances Put Patients at Risk for Balance Billing

March 22, 2019 - 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 under 70 percent of air ambulance transports conducted in 2017 were out-of-network, a significantly higher rate than other emergency services, the report found. Air ambulances provide...


Articles

Health Plans Ask Congress for Unified Action on Surprise Billing

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Health plans are asking Congress to take swift action on surprise billing, which can leave consumers with enormous out-of-pocket expenses for unexpected or out-of-network services. In a letter to leaders of both the House and the Senate,...

Blue Shield of California Reduces Member Opioid Use by 56%

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Blue Shield of California’s Narcotic Safety Initiative has achieved a 56 percent reduction in opioid use among members with chronic pain, surpassing its 2018 year-end goal by six percentage points. While opioid prescriptions have...

Cambia Streamlines Health Data Exchange with FHIR, Da Vinci Project

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Cambia Health Solutions has partnered with two healthcare provider networks to enhance health data exchange by leveraging FHIR. As part of the Da Vinci Project, Cambia is working with Oregon Health & Science University (OHSU) and...

Congress Opens Probe into Short-Term Limited Duration Insurance

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The House Energy & Commerce Committee (E&C) has opened an inquiry into short-term limited duration insurance (STLDI) plans and companies that may be acting against consumer interests by selling these health coverage options. The...

Prescription Drug Spending Increased Nearly $100B from 2012 to 2016

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Net prescription drug spending increased from $250.7 billion in 2012 to $341 billion in 2016, according to a new report from the Pew Charitable Trusts. The report also found that over the same period, the share of commercial insurance...

AMA: Payers Moving Too Slowly on Prior Authorization Fixes

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Physicians are still frustrated by problematic prior authorization (PA) procedures and believe that health payers are moving too slowly on necessary solutions, finds a new survey by the American Medical Association (AMA). Building on data...

Cambia Health Solutions, Blue Cross NC Enter Strategic Affiliation

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Cambia Health Solutions and Blue Cross of North Carolina have announced a new strategic affiliation that will combine management operations into a single entity retaining the Cambia name. The two not-for-profit companies hope that the...

Payers, Providers, Lawmakers Debate Surprise Billing Guidelines

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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 independent dispute resolution, according to...

Revised Tax Policies Needed to Reduce Individual Market Premiums

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Policymakers should revise current tax policies and work to eliminate financial barriers to health insurance in order to reduce individual market premiums, says a new brief from the Blue Cross Blue Shield Association (BCBSA). Over 14...

UnitedHealth Behavioral Health Unit Used Flawed Denials Guidelines

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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...

CMS Seeks Comment on Purchasing Health Insurance Across State Lines

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CMS is soliciting public comments on strategies that would allow enrollees to purchase health insurance across state lines in an effort to increase competition and improve affordability for consumers. The request for information (RFI)...

Affordability Concerns Lead Consumers to Short-Term Health Plans

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Consumers are turning to short-term health plans primarily because they cannot afford other options, according to a new survey from insurance portal eHealth.com. Instead of using short-term plans to bridge gaps in more comprehensive...

CMS: Healthcare Spending to Rise by 5.5% Annually to $6T in 2027

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National healthcare expenditures are expected to grow at an average of 5.5 percent annually from 2018 to 2027, reaching $6.0 trillion by 2027, according to a report from the Office of the Actuary at CMS. The report also projects that...

Noncitizens, Lawful Immigrants Much More Likely to Be Uninsured

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Non-US citizens, including immigrants lawfully present in the country, are significantly more likely than citizens to be uninsured, according to new data from the Kaiser Family Foundation (KFF). The uninsured rate for adult undocumented...

State Legislatures Debate Value of Association Health Plans

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State legislators in Vermont and North Carolina are considering legislation that would impact the viability of association health plans (AHPs) in their states. State bills in Vermont and North Carolina would alter the health insurance...

Prescription Drug Prices Set for 3.8% Increase in 2020

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Premier Inc. is projecting a 3.8 percent rate of inflation for prescription drug prices in plan year 2020, with non-acute care items comprising the majority of price increases. While price increases are never welcome, Premier notes that...

70% of Employers Offer Packaged Health, Dental, Pharmacy Benefits

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Seventy-one percent of employers with 100 or more employees are either actively integrating or considering integrating their medical, dental, vision, and pharmacy benefits under their health and wellness programs in the next five years,...

Cigna, Sentara Healthcare Join Payer Blockchain Initiative

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Cigna and Sentara Healthcare have joined a new healthcare-focused collaborative that aims to build, share, and deploy solutions using blockchain technology. The collaborative also includes Aetna, Anthem, Health Care Service Corporation...

Insurers Notch Legal Wins in Cost Sharing Reduction Fights

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Multiple court cases have been decided in the favor of insurers looking to recoup millions of dollars in cost sharing reduction (CSR) payments withheld by the Trump Administration in 2017. Health payers have fought vigorously against the...

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