Blue Cross Blue Shield groups weigh potential cost sharing strategies

The Wall Street Journal reports that Highmark Inc. is, with other health groups, part of very early-stage discussions regarding “combining some operations to share costs.” The talks apparently include Blue Cross-affiliated companies including Philadelphia’s Independence Health Group, the parent company for Independence Blue Cross, according to the paper. “The parent of Independence Blue Cross is Read more about Blue Cross Blue Shield groups weigh potential cost sharing strategies[…]

Medicare to cut payments to employer-sponsored Advantage plans

A new federal proposal would slash over payments made to Medicare Advantage plans sponsored by employers and unions years after an advisory board recommended the policy. The CMS proposed terminating the bidding process for employers and unions that offer 2017 Medicare Advantage plans to their retirees. The policy was included in the recent 228-page Medicare Read more about Medicare to cut payments to employer-sponsored Advantage plans[…]

Highmark to cut doctors’ payments for ACA plans

Citing an estimated $500 million loss last year on health insurance plans sold on the Affordable Care Act marketplace, Highmark Inc. said Friday it plans to reduce what it pays doctors who treat patients with the plans. Highmark plans to reduce payments to the physicians by 4.5 percent starting April 1 as part of a Read more about Highmark to cut doctors’ payments for ACA plans[…]

UPMC analysis contends Highmark no longer top insurer in Western Pa.

More people in Western Pennsylvania now have health insurance from UPMC than from Highmark Inc., according to a UPMC analysis, marking a potential milestone in the rivalry between the nonprofits. Highmark, which for decades has dominated the region’s health insurance market, declined to say Thursday whether it has arrived at the same conclusion. “Highmark will Read more about UPMC analysis contends Highmark no longer top insurer in Western Pa.[…]

Proposed Medicare loss is a gain for insurers

When is a loss a gain? It seems the answer is when the loss wasn’t nearly as bad as expected. That’s what major health insurers discovered when the Centers for Medicare and Medicaid Services proposed a slight decline in payments for Medicare Advantage plans. The proposal issued late last week to drop payments by 0.95%, Read more about Proposed Medicare loss is a gain for insurers[…]

Justice Department investigating Humana billing practices

Humana Inc. reports that it is cooperating with a Department of Justice inquiry into whether it exaggerated the severity of elderly patients’ illnesses to generate higher Medicare reimbursements. The Louisville, KY-based firm disclosed the Justice Department’s “information request” in its annual report filed Feb. 18 with the Securities and Exchange Commission, according to a Center Read more about Justice Department investigating Humana billing practices[…]

Highmark offers grace to members on out-of-network rate

Highmark Inc. is offering a second chance to members who stray out of network, but just once. The health insurer will cover care that is provided out of network just once at lower, in-network rates, spokesman Aaron Billger said. But members will be billed at much higher, out-of-network rates for subsequent visits to a provider Read more about Highmark offers grace to members on out-of-network rate[…]

Medicare Advantage funding could be cut

Supporters of Medicare Advantage program are roundly criticizing President Obama’s fiscal 2016 budget plan to slash more than $36 billion in its funding over the coming decade. In a Feb. 2 statement from the Better Medicare Alliance, interim executive director Krista Drobac said the cuts would only exacerbate the financial burden on enrollees who already Read more about Medicare Advantage funding could be cut[…]