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July 7, 2011

Today’s issue is brought to you by AIS's Health Plan Week, the industry's leading source of objective business, financial and regulatory news of the health insurance industry.

Today's Featured Story

Anthem Agrees to Settle Class-Action Suit; Will Cap Hikes, Let Members Switch Plans
Reprinted from Health Plan Week

Anthem Blue Cross of California, a division of WellPoint, Inc., has agreed to a preliminary settlement of a class-action lawsuit that alleges that the company in September 2009 illegally closed four individual PPOs to new enrollees, which pushed rates higher and forced patients into lower-benefit, higher-deductible products. Anthem admitted no wrongdoing under the settlement, the company noted in a prepared statement. WellPoint has about 40% of the state’s individual insurance market .... Read Full Story


From the AIS Blogs

Winning Over Providers for Care Management

There is a saying in Latin that seems to have particular meaning for the Medicare Advantage plans these days. It's "ad astra per aspera," which loosely translated means "to the stars through difficulties." And it clearly is difficult for MA plans to boost their all-important CMS star quality ratings these days, especially since a good part of the ratings depends on what providers rather than the plans do ... Read more


Quote of the Day

“PBMs can be very predatory when it comes to self-directing prescriptions to their own subsidiary, whether it is a specialty pharmacy or mail service.”

— Bill Sullivan, principal consultant for Specialty Pharmacy Solutions LLC, told AIS’s Specialty Pharmacy News.

Click here to read the SPECIALTY PHARMACY NEWS article in which this quote appeared. (Free for SPN subscribers; $17 for non-subscribers).


Today's Datapoint

3 million … middle-class Americans would qualify for Medicaid in 2014 as a result of the reform law, as a result of a glitch in the health reform law discovered by actuaries.



FierceHealthPayer News from our partner FierceMarkets

CMS to publish new rules for eligibility and claims status transactions

Electronic transaction standards already used voluntarily by many payers in insurance eligibility and claims status transactions will become mandatory under an interim final rule set to publish July 8. The new CMS standards will take effect Jan. 1, 2013, for all health plans, providers and claims clearinghouses ... Read more


Today from Washington

People on the Move

CiToxLAB named Paul Barrow director of scientific projects and client consulting. He was director of toxicology at Ricerca Biosciences....MedData appointed Barb Astler vice president of human resources (HR). Astler was vice president of HR at Medfinders.


Today's Featured Health Business Job Opening

B. E. Smith
Director - Sales and Marketing - Health Plans
Sioux Falls, S.D.

Place Your Ad Here

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Thursday, July 14, 2011

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2012 Plan Design: What New Products Will Health Plans and Employers Roll Out This Fall?
Thursday, July 21, 2011

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Tuesday, August 23, 2011

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Health Plan Week
AIS's Health Business Daily