Reimbursement

One of the country's largest health insurers is being accused of having misleading information on doctor and hospital network participation for EPO and PPO plans sold in the state exchange.

With spending on diagnostics alone for cardiovascular disease likely to be a major challenge for insurers amid the baby boom wave, Aetna is turning to an emerging option as part of a strategy to avoid invasive tests and treatments.

If your modus operandi is to appeal all denied claims, you may want to reconsider because some claims are not worth it.

The insurer-owned Allegheny Health Network is partnering with a national cancer center to offer new therapies and trials in western Pennsylvania, a sign of heightening regional competition and the emergence of new models for pursuing innovative treatments.

The growth of total U.S. medical costs is slowing down, but one segment is expanding fast enough to catch insurers by surprise.

The Office for Civil Rights, the HHS division responsible for enforcing HIPAA, is slated to get a new director after the official departure of Leon Rodriguez.

As the final chapter of WellCare's fraud saga closes, the company is lining up new executives and trying to grow.

The Centers for Medicare & Medicaid Services issued a proposed rule Tuesday that would reduce Medicare payments to home health agencies by $58 million next year and hinted at changes to come.

A patient-centered medical home program with a physician-owned, multispecialty group has been so promising that Aetna is extending the arrangement.

Two years after upholding most of the Affordable Care Act, the U.S. Supreme Court has carved out a new religious exemption for employers, once again bringing women's health into the political fray and potentially adding new complications to group insurance.