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Tag: Insurance: Misc.

A $69 billion merger between health insurer Aetna and pharmacy manager CVS Health has been approved

Aetna-CVS Merger Approved

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Under the approval, Aetna must sell off its private Medicare drug plans
From 2016 to 2017

More Non-Elderly Americans Uninsured in 2017 Versus 2016

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More than 700,000 Americans uninsured in 2017 versus 2016, despite broad economic improvement
Association health plans will provide small businesses with more choices

Association Health Plans Can Help Small Businesses Offer Coverage

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But AHPs may undermine ACA marketplace, as they are not required to comply with ACA regulations
Workers in small firms are more likely to have higher deductible levels and lack employer contributions to help pay for out-of-pocket expenses compared to workers in larger firms

Advantages for HDHP Enrollees in Large Versus Small Firms

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More than twice as many HDHP enrollees in small versus large firms lack employer-funded accounts
Knowing payer policies and regulatory requirements is critical to appealing denials

Experts Offer Tips for Provider Appeal of Denied Medical Claims

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Recommendations include asking for exceptions to payer policies and citing regulatory information
Underinsured and never insured adults are more likely than adequately insured adults to report poor/fair health and frequent mental distress

Insurance Status Tied to Higher Self-Perceived Poor/Fair Health

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Underinsured and never insured adults more likely to report poor/fair health
There is considerable variation in specialty drug coverage across commercial health plans

Variation in Specialty Drug Coverage Across Health Plans

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Plans restrict coverage of drugs indicated for cancer less often than drugs indicated for other diseases
There are large coverage gaps in short-term health plans that were approved Wednesday by the Trump administration

New Short-Term Health Plans Have Large Coverage Gaps

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Plans don't have to cover existing medical conditions, provide limited benefits
Interruptions in private health insurance coverage are common among U.S. adults with type 1 diabetes and are associated with an increase in glycated hemoglobin and in use of acute care services

Health Coverage Interruptions Common in Adults With T1DM

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Use of acute care service five-fold higher after interruption in insurance versus before interruption
Insurance companies sometimes underpay doctors the contracted amount for a service or procedure

Insurers May Be Underpaying Doctors

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Practices need to incorporate efforts to double check reimbursement against contracts