Western Health Advantage displaced Health Net for a spot next to Kaiser Permanente in the health benefits program offered by the Elk Grove Unified School District, effective Monday. The school district has just fewer than 10,000 employees and dependents, plus 2,500...
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Stay informed with Medbill’s blog, where we share expert guidance, practical tips, and industry updates to help DME providers navigate the industry’s complexities.
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Aetna Revises DME Policies for TENS
Aetna Health Plan has revised their TENS policy effective 6/25/2013 to state that TENS is considered experimental and investigational for chronic low back pain. Change in Stance Aetna now considers transcutaneous electrical nerve stimulators (TENS) medically necessary...
Many States Handing High-Risk Insurance Programs to Federal Govt.
Pennsylvania and 16 other states are handing over their special insurance programs for people with pre-existing health conditions to the federal government Monday. Consumers enrolled in the so-called high-risk pool, PA Fair Care, have received letters telling them the...
Highmark, UPMC align arguments against anti-trust lawsuit
Highmark and UPMC argued on Monday that a federal judge should throw out an antitrust case filed by insurance premium payers because even if they could prove collusion between the insurer and hospital system, the plaintiffs can't win damages. Royal Mile Co., a...
Blue Cross Blue Shield of NC Report it has Exceeded Health Care Spending Benchmarks
Blue Cross Blue Shield of North Carolina reported Thursday that it had exceeded health care spending benchmarks by spending 87 percent of premium revenues on paying for care for its customers. Under the Affordable Care Act, insurance carriers must spend at least 80...
Highmark Invests $11 million in Partnership with CMU
Health insurer Highmark Inc. and its affiliated hospital network will invest $11 million to further develop a laboratory meant to improve health care through science and engineering in conjunction with Carnegie Mellon University. The Disruptive Health Technology...
Highmark and UPMC Battle of Patients
UPMC could lose $1.2 billion in annual revenue in its contract fight with Highmark Health Services. With that kind of money at stake, why would Western Pennsylvania's largest hospital network gamble its financial future by ending its relationship with the state's...
WellPoint Cap Program to Provide Savings
The nation’s largest pension fund worked with Indianapolis-based health insurer WellPoint Inc. to cut medical costs 19 percent by capping the price of some surgeries, in the latest sign payers are taking a tougher line against rising hospital claims. The California...
Allstate Files $6.6 Million Lawsuit against DME Companies and Owners
Allstate Insurance Company is seeking to recover $6.6 million in treble damages against 80 New York and Florida area defendants in its 4th insurance fraud lawsuit of 2013. Since 2003, Allstate has filed 48 fraud lawsuits in New York State seeking more than $237...
Oregon Revives Bill to Crack Down on Regence BCBS Payments to ASCs
Oregon's House of Representatives has revived a measure that will prevent abusive payment practices to ASCs by Regence BlueCross BlueShield, according to The Lund Report. The measure, called the rider amendment, was tacked onto Senate Bill 724, which passed a House...
Choice of Health Plans to Vary Sharply From State to State
When a typical 40-year-old uninsured woman in Maine goes to the new state exchange to buy health insurance this fall, she may have just two companies to choose from: the one that already sells most individual policies in the state, and a complete unknown nonprofit...
Blue Shield may Take L.A. Contract from Anthem Blue Cross
Blue Shield of California is poised to take a lucrative health insurance contract for city workers away from rival Anthem Blue Cross. The proposed three-year deal is still subject to approval by L.A. Mayor Antonio Villaraigosa. Under Blue Shield's offer, the city...