From The AIS Report on Blue Cross and Blue Shield Plans - Blues plan operator HealthNow New York, Inc. will pay a $60,000 civil penalty and $1.6 million in wrongfully denied claims to patients who sought outpatient psychotherapy and nutritional counseling related to eating disorders, New York Attorney General (AG) Eric Schneiderman said Aug. 22. The Buffalo-based company, which operates BlueCross BlueShield of Western New York and BlueCross BlueShield of Northeastern New York, has about 578,000 members. Read more
From Health Plan Week - New research makes a case for including emergency department (ED) services in alternative payment models (APMs) that are being promoted by HHS as part of the movement away from traditional fee-for-service (FFS) reimbursement. But according to one of the authors of the report, the ED segment is not an easy one to include in accountable care, bundled payment or capitation systems due to its unique role in the care continuum. Read more
From The AIS Report on Blue Cross and Blue Shield Plans - In an effort to counter losses from the state’s insurance exchange, Blue Shield of California will trim administrative costs by extending the Labor Day weekend by four days. Most of the insurer’s 6,000 employees will be affected. The company is providing health coverage to many members “well below our cost, and this situation is not sustainable over the long term,” spokesperson Clinton McGue tells The AIS Report. “As a result, we… Read more
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