Reimbursement

Pennsylvania's smaller Blue-licensed insurer is boasting of some notable results in its accountable care arrangements and is looking to bring similar contracts to small primary care practices.

After $300 million, thousands of hours of labor and a few lost government careers, one of the biggest disappointments in progressive health policy has reached the end of the road.

After a fractious price battle with Blue Shield, Sutter Health is offering more patients a direct option through its own health plan.

The nation's second largest insurer is taking some flak for declining a second opinion on its information technology security.

Starting next year, health insurers have to give Americans in Medicare Advantage plans and federal exchange policies up-to-date details about which doctors are in their plans and taking new patients.

An increasingly popular strategy in drug plan affordability is again coming under scrutiny from Medicare regulators concerned that some urban seniors are being left out.

The Catholic Health Care System, aka ArchCare, allowed Medicare to be billed for patient care at the highest therapy-based levels, even though its subcontractor RehabCare, was often not providing therapy at those levels, according to the U.S. Attorney's Office.

Inaccuracies in the Medicare Advantage directories may trigger penalties of up to $25,000 a day per beneficiary or bans on new enrollment and marketing.

Health insurers and patients could get a bit of relief after years of paying more and more for biologic speciality pharmaceuticals, but some think there are still barriers to affordability.

One of the Bay Area's most popular health systems is expanding its new health plan, trying to craft a unique value proposition in changing times and picking up some notable clients along the way.