2+ day, 22+ hour ago  (687+ words) About 14% of ACA enrollees didn't pay premiums in January, a higher rate than usual, according to Wakely. Wakely's data is the clearest signal to date on just how drastically the ACA exchanges could contract this year due to the expiration…...

4+ day, 19+ hour ago  (470+ words) It's a major victory for controversial billing intermediary Halo MD, which cheered the court's decision. Elevance said it plans to appeal. Ever since the No Surprises Act was passed in 2020 to prevent consumers from being hit with unexpected out-of-network bills,…...

5+ mon, 3+ week ago  (532+ words) Plans determined that 39% of claims submitted to independent dispute resolution last year were actually ineligible for the process. Since becoming law in 2020, the No Surprises Act has shielded millions of consumers from unexpected medical bills. The law requires insurers and…...

3+ day, 17+ hour ago  (495+ words) Study authors, who reviewed data from New York, said that rising overturn rates suggest that insurers" claims reviews processes might not be working as intended. Insurers are currently under a harsh spotlight for business practices that can prevent patients from…...

8+ mon, 1+ week ago  (515+ words) The survey also found high rates of alternative funding programs, controversial arrangements in which employers outsource access to pricey specialty drugs to third parties. Rising spending on pricey pharmaceuticals has led insurers to lean on utilization management controls like prior…...

5+ day, 19+ hour ago  (680+ words) Regulators are proposing to send $1. 4 billion more to acute care hospitals and debut the first nationwide, mandatory payment model to lower the cost of joint replacements. Hospitals pushed back. Medicare on Friday proposed to increase net payment rates for inpatient…...

1+ week, 5+ day ago  (223+ words) It's the'latest in a flurry of executive appointments from health insurers looking to strengthen their leadership teams amid regulatory headwinds and elevated medical costs. Centene is the largest insurer in both the Medicaid and ACA markets, with its almost 28 million…...

2+ week, 1+ day ago  (1008+ words) Regulators cut almost a dozen metrics that factor into the quality ratings and reverted back to an older and more generous bonus system. The Trump administration has finalized a rule overhauling the Medicare Advantage star ratings system that's expected to…...

8+ mon, 1+ week ago  (360+ words) However, the new deal excludes the telehealth vendor's behavioral health and automated care programs, leading Amwell to cut its revenue guidance for the year. The virtual care company, in partnership with technology firm Leidos, first won the contract worth up…...

1+ week, 3+ day ago  (277+ words) The health system claims the policy, which reduces reimbursement for some inpatient hospital stays, violates federal law and its reimbursement contract with Aetna. Aetna says its new policy, which went into effect at the start of the year, is meant…...