payers
publication date
Clinical Care
Patient Advocates Pan Latest Medicare Drug Pricing Proposal
Health plans, meanwhile, suggest the changes could empower them to reduce drug spending while continuing to meet beneficiary needs.
Finance
3 Reasons to Care About Balance Billing Legislation
Hospitals should keep an eye on state and federal efforts to ramp up consumer protections against surprise medical bills.
Strategy
Trump Administration Plots Costly Private-Care Expansion for Veterans
The plan sets up a clash with Democrats, who say the administration is thwarting congressional intent and will starve the...
Branded Drug Price Hikes Outpace Generic Savings, BCBSA Says
Branded prescription drugs were 17% of total prescriptions filled by Blue Cross Blue Shield commercial plans in 2017, but they...
Finance
If Anthem's Policy Spreads, 1 in 6 ER Visits Could Be Denied Coverage
If the cost savings are there, other insurers will likely follow in Anthem's footsteps.
Finance
Bad Debt Grows as Out-Of-Network Benefits Shrink
A lack of OON benefits leads to never-ending financial obligations for patients and a greater likelihood of bad debt for...
DOJ Indicts 4 Florida Men in $1B Telemedicine Fraud Conspiracy
Private payers, including Blue Cross Blue Shield of Tennessee, were bilked out of about $174 million in the compounding pharmacy...
Finance
Navigating the Medical Necessity Battleground When Payers Balk
When claim denials result from factors like ineligible members and untimely filing, there's often little to argue. Medical necessity, though,...
Strategy
Why Texas Hospitals' Urge to Merge Takes Precedence
Health system M&As may be necessary as insurers with greater access to capital are expanding low-cost outpatient centers into Texas...
Finance
Tech Startup OODA Working With Insurers Toward Real-Time Claims Payments
Giving patients the capability to pay for healthcare upfront is typically hamstrung by the claims process. OODA Health aims to...
Clinical Care
3 Ways Providers can Improve Healthcare Access in Rural Areas
Rural healthcare providers can pursue multifaceted strategies to improve care availability, accessibility, and affordability.
Finance
Anthem's ER Policy: HHS Response Leaves Senator Unsatisfied
A lawmaker behind the 'prudent layperson' standard has been pressing HHS, DOL, and CMS for progress reports on what he...