Tag Archives: Aetna
Big Insurers Underspend On Medical Care, Senate Probe Finds
Posted on 03. Nov, 2009 by Editor.
Which big health insurance company did lawmakers single out? Is it the one that gives you the most denials trouble?
A US Senate probe confirms what many coders and billers have been suspecting all along — that six major medical insurers aren’t spending as much as they should providing actual health care.
Insurance industry officials say that all health insurers spend an average of 87 cents of every dollar on medical care, reports The Wall Street Journal. For the trade-group-curious, America’s Health Insurance Plans (AHIP) came up with the ‘87 cents’ figure.
And I bet you can tell me the names of the insurers that ‘underspend’ without reading the rest of the article. But just for grins — they’re Aetna Inc., Cigna Corp., Coventry Health Care Inc., Humana Inc., Unitedhealth Group Inc. and Wellpoint Inc., reports the Journal. These big fish spend an average of 74 cents on every dollar individuals pay in premiums on medical care (if they’re on individual plans). That figure goes up a bit for small group (80 cents). However, even the large group insurance average (84 cents) for these six insurers doesn’t hit AHIP’s estimate of how much premium money goes to actual medical care.
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Aetna Announces New Policy of Payment Refusal for ‘Never Events’
Posted on 29. Sep, 2009 by Editor.
Make sure you know the extra steps your practice must take as well.
Many payers are jumping on the “never event” bandwagon, and Aetna is the most recent. The payer announced recently that it will no longer pay you for any care related to 28 preventable medical errors, such as wrong surgeries, wrong person surgeries, or surgeries on the wrong side of the body.
If you practice is dealing with a never event, Aetna is also requiring you to take the following 3 steps:
• Alert Aetna and at least one agency concerned with patient safety such as the Joint Commission or your state’s medical error reporting programs.
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Pssssssst. Payer Report Cards Are Out
Posted on 05. Aug, 2009 by Editor.
If you know your payers’ strengths and weaknesses, you’re better equipped to fight denials and negotiate contracts that are in your best interest.
So check out the American Medical Association’s second annual National Health Insurer Report Card. The AMA has gathered data and rated large payers on criteria like payment timeliness, accuracy, claim edit sources and denials, according to an American Medical News article that summarizes trends in the report card.
Drawback: The AMA’s payer report card looks only at big, national insurers (Aetna, Anthem, Blue Cross and Blue Shield, Cigna, Coventry, Health Net, Humana, UnitedHealthcare and Medicare). To get the dirt on smaller or regional payers, check out this resource from Athenahealth.
To see the AMA’s payer report card, go here.
Are your payers ‘remedial’ at best? USE THE APPEALS PROCESS LIKE A PRO, with APPEALS QUEEN Barbara Cobuzzi.
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Aetna EOB Makes New Mom Feel Like a Babe in the Woods
Posted on 27. May, 2009 by Editor.
If you’d like a glimpse of what your coding or billing job might feel like to a patient, check out Anna Wilde Matthews’ tale of trying to decipher her $36,625 bill after she vaginally delivered a healthy baby. “Bringing my newborn son home was a joy. Figuring out the hospital bill wasn’t,” Matthews writes in the Wall Street Journal.
Follow Matthews as she dissects her bill, wrangles with Aetna’s customer service system, and tries to understand why some seemingly incidental things are so expensive. ”The experience left me befuddled,” she writes.
I’m a little befuddled by some of the story’s details as well, such as a $530.29 epidural tray at Cedars-Sinai Medical Center … More …
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AMA Sues Aetna, Cigna for Out-of-Network Reimbursement Rates
Posted on 23. Feb, 2009 by Editor.
The American Medical Association isn’t stopping with the $350 million United Healthcare settlement. Now, a class action suit involving the AMA has set its sights on Aetna and Cigna.
Still at issue: The fact that United Healthcare owns Ingenix, the supposedly ‘independent’ research outfit that has supplied UNH, Aetna & Cigna with reimbursement rates. The providers in the suit allege a conflict of interest … To read the AMA’s press release and the court complaints, go here …
FACT: Last year, family & internal medicine practices lost out on $9 million of their rightful reimbursement. Get the strategies YOU need to appeal.
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NY AG Fines United Health $50 Million for Under-Reimbursement
Posted on 15. Jan, 2009 by Editor.
Getting money from big insurers may be like squeezing blood from a stone, but New York Attorney General Andrew Cuomo is trying, says NBC’s Today Show.
Cuomo’s Beef: Oxford Insurance and its parent company, United Health Group, say they use an “independent research from across the health care industry” to determine reimbursement rates. Cuomo contends Oxford unfairly relies on a research firm United Health actually owns: Ingenix.
Other major insurers that use Ingenix include Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield … More …
Rhonda Buckholtz teaches you to go mano-a-mano with big payers at contract negotiation time.
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