Health plans terminate contracts with EHS and transition patients to other entities As previously reported, the California Department of Managed Health Care (DMHC) issued a cease-and-desist order on December 26, 2017, requiring nine health plans to terminate their contracts with Employee Health Systems (EHS) Medical Group Inc. This order comes after SynerMed—a company closely affiliated with EHS—was accused of blocking patient access to specialists to hold down costs. EHS has 600,000 patients statewide—90 percent of whom are Medi-Cal managed care patients. As required by DMHC, health plans affected by this order were required to submit a transition plan by January 3, 2018, ... February 5, 2018 Managed Care, Medi-Cal Continuity of Care, Department of Managed Health Care, DMHC, Health Plans, Insurance, Medi-Cal, Payor Contracting 0 0 Comment Read More »
Updated payor profiles for 2017 now available The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge ... August 1, 2017 CMA, Managed Care, Medi-Cal, Medicare Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Insurance, Medi-Cal, Medicare, Noridian, Payor, Payor Profiles, Running a Practice, UnitedHealthcare 0 0 Comment Read More »
AMA urges quick action to stabilize individual insurance market With the window quickly closing to properly price individual insurance products for 2018, the American Medical Association (AMA) is urging President Trump and Congressional leaders to commit to continued funding for the cost-sharing reductions that are critical to stabilizing the individual market. AMA, along with other groups representing insurers, hospitals, health plan purchasers and physicians, sent a letter urging quick action to deliver short-term stability and affordable coverage while broader marketplace stabilization efforts are developed. Nearly 60 percent of all individuals who purchase coverage via the exchange receive financial assistance to ... April 19, 2017 General, Managed Care ACA, Affordable Care Act, AMA, American Medical Association, Health Insurance Exchange, Insurance 0 0 Comment Read More »
Anthem-Cigna mega-merger compromises health care access, quality and affordability Today, the U.S. Department of Justice (DOJ) and a bipartisan group of state attorneys started court proceedings to block the $48 million mega-merger between Anthem and Cigna (U.S. v. Anthem Inc., 16-cv-1493). “The California Medical Association has opposed the Anthem-Cigna mega-merger since day one because it will hurt patients and increase health care costs,” said California Medical Association (CMA) President Ruth E. Haskins, M.D. “Limiting market competition would compel insurers to contract with fewer physicians, resulting in higher premiums and longer wait times for referrals – not to mention forcing ... November 22, 2016 Managed Care Anthem Blue Cross, Cigna, Insurance, Legal Advocacy 0 0 Comment Read More »
Health plan group pilots program to improve physician directories America's Health Insurance Plans (AHIP) is launching a pilot program to ensure that physician directories are more accurate and up-to-date, the organization announced last week. The pilot program involves two directory vendors, BetterDoctor and Availity, and will include providers in three states: California, Florida and Indiana. The pilot program will run from April to September, according to AHIP, and will include the following eight California plans: Anthem Blue Cross Blue Shield of California Health Net of California Humana ... April 4, 2016 Managed Care Insurance, Medical Provider Networks, Provider Networks, Health Plans 0 0 Comment Read More »
Gallup poll says rates of uninsured continue to drop in most states According to a Gallup poll released Monday, the national uninsured rate has fallen to 11.7 percent, down from 17.3 percent in 2013. The poll shows that states that have expanded Medicaid under the Affordable Care Act – and have at least helped in the running of their health insurance marketplaces, rather than leaving it entirely to the federal government – have seen larger drops in uninsured rates. In the 22 states that took both of those measures, including California, the uninsured rate dropped to an average of 7.1 percent. California's uninsured ... August 17, 2015 Managed Care, Medi-Cal, Medicare Affordable Care Act, Health Insurance Exchange, Uninsured, ACA, Insurance 0 0 Comment Read More »
Changes to Anthem Blue Cross reimbursement policies and claims software Anthem Blue Cross recently notified physicians of upcoming changes to the insurer’s reimbursement policies and claims editing software, called ClaimsXten. The changes will go into effect on July 1, 2015. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem provided a comprehensive grid outlining the new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. The changes include additions to the types of service Anthem will consider bundled ... May 15, 2015 Managed Care Billing/Coding, Insurance, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
Gallup poll finds U.S. uninsured rate at lowest level in seven years. According to a nationwide Gallup Poll, the Affordable Care Act (ACA) has steadily reduced the number of people without insurance across the United States. The group conducted phone interviews (landline and cell) in 2013 and 2014, as part of the Gallup-Healthways Well-Being Index, with a random sample of 178,072 adults in 2013 and 176,702 adults in 2014. The survey found that the nationwide rate of uninsured adults declined from 17.3 percent in 2013 to 13.8 percent in 2014. The lowest uninsured rates continue to be primarily in the Northeast and ... March 9, 2015 Managed Care Insurance, Uninsured, Affordable Care Act 0 0 Comment Read More »
Online tool that gives consumers average costs for over 70 medical procedures now live A new online tool that gives consumers an idea of the cost for several health care procedures went live last week. Launched by the Health Care Cost Institute (HCCI), an independent, non-partisan, non-profit organization, Guroo.com shows average amounts paid for over 70 common care episodes in most states, including much of California. Using data supplied by Aetna, Assurant Health, Humana and UnitedHealthcare, the website pulls cost information from the medical claims of more than 40 million U.S. residents. According to HCCI, the prices are averages of the total payments to ... March 2, 2015 General Insurance, United Healthcare, Aetna 0 0 Comment Read More »
State issues report cards for HMOs, PPOs and large medical groups The California Office of the Patient Advocate yesterday released its 14th annual “California Health Care Quality Report Cards” that rate the state's health plans and medical groups on a four-star scale. Available in English, Spanish and Chinese, the report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys for 2013. Users can drill-down ... October 17, 2014 General Insurance/Reimbursement, Insurance 0 0 Comment Read More »
