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 »
Large insurers drop barriers to prescribing medications for opioid use disorder Three of the nation's largest insurers—Aetna, Cigna, and Anthem Blue Cross—have in recent months announced that they will no longer require physicians to seek prior approval before prescribing medication to treat opioid use disorder. These policy changes come as more than 2.2 million people meet the diagnostic criteria for an opioid use disorder. Treatment of opioid use disorder with opioid maintenance therapies has been shown to be cost-effective, safe and successful when used appropriately. Increasing access to treatment is crucial to addressing opioid misuse and overdose, and the California Medical Association ... March 2, 2017 General Aetna, Anthem Blue Cross, Cigna, Opioids, Preauthorization 0 0 Comment Read More »
CMA applauds U.S. Justice Department lawsuit against health insurance mega-mergers The California Medical Association (CMA) today applauded the U.S. Department of Justice (DOJ) for filing two lawsuits challenging the proposed merger of Anthem and Cigna and of Aetna and Humana — all of which are among the largest health insurance companies in the country. “We applaud the DOJ for protecting patients against mega-mergers that would drastically reduce competition in the health insurance market, leaving patients at a huge disadvantage in the pursuit of timely and affordable health care,” said CMA President Steven Larson, M.D., MPH. “We also commend California Insurance ... August 5, 2016 Managed Care Aetna, Anthem Blue Cross, Cigna, Department of Justice, DOJ, Advocacy, Humana 0 0 Comment Read More »
DOJ files lawsuit to block two health insurance mega-mergers The U.S. Department of Justice (DOJ) today filed two lawsuits to block health insurance mega-mergers that would compromise patients’ access to care, and negatively impact the quality and affordability of health care across the country. “If allowed to proceed, these mergers would fundamentally reshape the health insurance industry,” U.S. Attorney General Loretta Lynch said at a press conference. “They would leave much of the multi-trillion dollar health insurance industry in the hands of three mammoth insurance companies, restricting competition in key markets.” The California Medical Association (CMA) has long-held concerns over ... August 5, 2016 Managed Care Cigna, Department of Justice, DOJ, Aetna, Anthem Ble Cross, Humana 0 0 Comment Read More »
CMA seeking physician feedback on proposed health insurance mergers Proposed mergers of the some of the largest national health insurance companies have been announced, with Aetna reaching a $37 billion deal to purchase Humana, and Anthem agreeing to purchase Cigna for $48.4 billion. State and federal regulators are interested in knowing the prospective effects of these possible mergers on your practice and patient care. The California Medical Association (CMA), in collaboration with the American Medical Association, is asking for your feedback on these proposed mergers. The survey should take about 8-9 minutes to complete. Only de-identified data will be used ... February 9, 2016 Managed Care Anthem Blue Cross, Cigna, Humana, Aetna 0 0 Comment Read More »
Aetna issues physician terminations over frequency of E/M visits The California Medical Association (CMA) has received several reports from physicians in the San Francisco Bay Area that they’ve received contract termination notices from Aetna due to their above-average use of high-level Evaluation and Management (E/M) codes. The termination letters, issued by Aetna in mid-January, advised physicians that upon review of claims for a one year period, their usage of high level E/M codes was “significantly outside the norm” of comparative physicians within their market. CMA has learned that approximately 40 physicians within the Northern California Aetna PPO network were ... July 6, 2015 General Billing/Coding, Coding and Documentation, Practice Resources, Aetna 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 »
Aetna seeks to terminate its proposed $120 million class settlement over use of Ingenix to underpay out-of-network claims Late last year, Aetna, Inc. announced a proposed class settlement of up to $120 million over its use of the flawed Ingenix database. The nationwide settlement would have required Aetna to reimburse providers and Aetna PPO subscribers for losses arising from Aetna's underpayment for out-of-network medical care. A hearing had been scheduled for March 18, 2014, in the U.S. District Court in New Jersey for the court to determine whether final approval of the settlement should be granted. Less than a week before the hearing, however, Aetna notified the ... March 27, 2014 General Ingenix, Insurance/Reimbursement, Legal Advocacy, Aetna 0 0 Comment Read More »
Online payment portals: Physicians beware Recently, a number of payors have begun to offer online payment portals that allow patients to pay for physician services via the Internet. Physicians should be aware, however, that while these online payment portals typically do not charge setup fees for participating, physicians will be assessed a per transaction fee, similar to the transaction fees associated with credit card or merchant transactions. Aetna, for example, partnered with Citi to provide an online patient health care payment option called Money² for Health. This online payment tool will allow patients to securely ... November 18, 2013 General Payment Plan, United Healthcare, Aetna 0 0 Comment Read More »
Plan departures leave questions for California policy holders While much attention has been given to the successful signing of health plans participating in Covered California’s new online insurance marketplace, it’s worth noting that some major players in the state’s current insurance market are refusing to play ball. In June, both United Healthcare and Aetna announced that they would not be participating in California’s individual market following the end of 2013. In announcing their departures, both companies noted that only a small portion of their overall business was conducted in California, and given the coming changes promised through the ... August 19, 2013 General Covered California, United Healthcare, Aetna, Health Care Reform 0 0 Comment Read More »
