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Industry News

Oct 01, 2015

It’s common knowledge that consumers have to pay more money if they choose doctors or hospitals outside of their insurance plan’s network. But a new analysis prepared by the insurance industry seeks to show just how much more in each of the 50 states.

Out-of-network providers charged patients on average 300 percent more than the Medicare rate for certain treatments or procedures, according to the analysis of 2013 and 2014 claims data released Thursday by the America’s Health...

Oct 01, 2015

Health insurers that sold plans and lost money on the Affordable Care Act's exchanges in 2014 will only receive a portion of their promised safety-valve payments, according to government data released Thursday.

The $2.5 billion still owed to insurers could be covered in 2015 and 2016. But if that doesn't happen, the agency will have to work with a Congress led by Republican members who remain hostile to the ACA to cover those remaining funds. Some smaller companies could experience “...

Oct 01, 2015

Some 32 years after work began on developing the International Classification of Diseases 10th Revision of diagnostic and procedural codes, most providers, many with fingers crossed, jumped off the ICD-10 pier at midnight Thursday.

And by most accounts, the first 12 hours have gone off without a hitch.

“I think, by and large, at least the people we've worked with, they have done so much preparation that they're eager,” said Ed Hock, managing director and ICD-10 guru with the...

Oct 01, 2015

A selection of opinions on health care from around the country.

The Washington Post: Clinton Undermines Her Health-Care Plan With One Terrible Policy Call
Hillary Clinton rolled out several modest but serious health-care proposals last week. This week she canceled out any claim to responsibility on the subject by calling for repeal of the “Cadillac tax” on employer health-care plans. The tax, set to take effect in 2018, is a key component of President Obama’s health-care...

Oct 01, 2015

The Vermont senator and presidential candidate, who describes himself as a Democratic socialist, favors approaches to health reform education and child care that would convert these industries from the current public-private mix to operations run mainly with federal money.

The Washington Post: How Bernie Sanders Would Transform The Nation
The biggest pieces of Sanders’s domestic agenda — making college, health care and child care more affordable — seek to capture these...

Oct 01, 2015

The 2010 health law sets a 40 percent tax in 2018 on coverage that costs more than $10,200 for single plans and $27,500 for family insurance. Also in related health law news, The Hill examines whether a quiet bipartisan effort is developing to revamp some parts of the law.

The Associated Press: 4 Ways Companies May Adjust To Looming Employee Benefits Tax
The taxman is coming to employer-sponsored health insurance, and his visit may trigger changes to your benefits. The...

Oct 01, 2015

If you’re struck by an orca, sucked into a jet engine, or having relationship problems with your in-laws, fear not: Your doctor now has a medical diagnosis code for that.

Today U.S. doctors, hospitals and health insurers must start using the ICD-10, a vast new set of alphanumeric codes for describing diseases and injuries in unprecedented detail.

The transition, mandated by the federal government, has been called American health care’s Y2K moment, because the codes haven’t...

Sep 30, 2015

Cone Health is joining the ranks of health systems entering the insurance business as it begins to market its new Medicare Advantage plan this week.

The Greensboro, N.C.-based system, a two-hospital group whose flagship facility is 1,004-bed Moses H. Cone Memorial Hospital, submitted its application to the CMS in February. The Medicare Advantage product represents its first venture into the insurance market.

Cone Health can begin marketing and advertising the plan starting...

Sep 30, 2015

Repeal of the Cadillac tax is picking up bipartisan steam and the support of several presidential candidates.

But few if any opponents of the tax on high-cost employer-sponsored health plans have said how they would fill the $87 billion pothole left by its repeal.

The closest idea has come from Vermont Sen. and Democratic presidential hopeful Bernie Sanders, who recently introduced legislation that would repeal the tax.

Sanders says that revenue to finance the Affordable...

Sep 30, 2015

Patients in Washington, D.C. have filed a lawsuit against two area hospitals alleging they were charged thousands of dollars to obtain medical records.

The plaintiffs have filed a lawsuit against MedStar Georgetown University Hospital and George Washington University Hospital.

They say the hospitals violated D.C. consumer protection laws by charging exorbitant amounts to obtain medical records.

According to the suit, patients in D.C. are entitled to a copy of their...