Tagged with Humana
Anthem recently announced that it will stop pursuing Cigna. The insurer claims Cigna sabotaged the deal and states it will not pay the agreed-upon breakup fee of $1.8 billion.
Aetna has announced plans completely withdraw from the ACA insurance exchanges for 2018, citing financial losses as the deciding factor, specifically its individual commercial products lost nearly $700 million between 2014 and 2016 and could lose another $200 million this year.
Gallup-Healthways Well-Being Index poll shows uninsured rate increased to 11.3% in the first quarter of 2017 from a record low of 10.9% in the last half of 2016.
Starting July 1, Cigna will require prior authorization for physicians prescribing a long-acting opioid that is not being used for cancer treatment, palliative, and end-of-life care.
Two separate studies investigated why consumers respond to high-deductible plans by using less healthcare services, which in turn leads to a decrease in doctor visits and clinical laboratory test orders.
The U.S. Justice Department recently disclosed that there will be an investigation into four more major health insurers as part of a False Claims Act lawsuit filed against UnitedHealth Group in 2011.
Humana has announced its plans to cease sales of individual health insurance plans through the ACA’s exchanges by 2018, potentially leaving more than 150,000 customers without a carrier.
A new study reveals insurers with the largest share of local markets can negotiate lower prices for physician office visits.
A federal judge ruled against Aetna’s proposed acquisition of Humana, maintaining the Justice Department’s decision that the multi-billion deal would be anticompetitive and raise prices for consumers.
A new report from Healthcare Financial Management Association (HFMA) suggests that value-based care and price transparency will add value to hospital mergers, including lower prices for consumers.
Eleven private insurers have joined forces in seeking action from the Congressional Budget Office (CBO) to expand data collection when scoring congressional proposals to include telemedicine data from non-Medicare sources as a means to support value-based care efforts.
Humana, UnitedHealthcare, WellCare, Blue Cross and Blue Shield of Florida and CVS Health are among those participating in a Medicare Part D model that gives insurers financial incentives to offer innovative programs that encourage patients to take their medications.
Indiana University Health Plans has announced it will not offer plans on the state’s Affordable Care Act marketplace in 2017.
Effective September 19, Humana will update claim processing edits for Surgery procedures, including: sigmoidoscopy, colonoscopy, other medical and surgical service during the postoperative period, FL Medicaid services included in delivery, birth center non-covered services, Florida Medicaid, and extracorporeal photopheresis.
Effective September 19, Humana will update claim processing edits for Internal Medicine procedures, including: Sequential IV push, Telephone assessment and management, Home visit, Polysomnography, and Immune globulin.
Effective September 19, Humana will update claim processing edits for Anesthesia procedures, including: Medical supervision and medical direction of anesthesia services, Consistency of reduced or discontinued anesthesia services between professional and facility providers, Discontinued anesthesia services between professional and facility providers, and Anesthesia for colorectal cancer screening.
Effective September 19, Humana will update claim processing edits for Lab / Pathology procedures, including: prenatal screening, Independent Labs – Covered Services and frequency limits, and services included in prenatal care.
Effective September 19, Humana will update radiology claim processing edits, including: procedure code guidelines policy, obstetric ultrasound frequency,Zika virus, radiation treatment delivery, computed tomographic colonography, consultation on x-ray, magnetic resonance spectroscopy, and radiological examination of the hips and lower extremities.
Effective September 19, Humana will update Cardiology claim processing edits for frequency of echocardiographies and cardiovascular evaluation with tilt-table testing.