Reimbursement
California health officials failed to ensure that more than 9 million residents enrolled in Medicaid managed care plans had access to doctors when they needed them, the state auditor said in a stinging report.
Fallon Health is departing from Massachusetts' Medicare-Medicaid managed care program, another sign that the sought-after benefits and savings will be hard to achieve.
A bipartisan group of House and Senate legislators introduced bills last week that would require health plans to cover the growing number of oral chemotherapy pills as favorably as they do intravenous chemotherapy.
While pent-up demand and new individual customers have contributed to higher-than-hoped-for premium increases, extraordinary claims have been less than feared, leaving some more money to spread around.
National insurers think they need to get bigger or risk losing out, so payers like United and Aetna are looking expand their core health plan businesses and take new services to market.
Massachusetts health insurers and their small business customers will have another year with a sort-of sharing risk rating system, although eventually they'll be in for reckoning.
As American society ages and Alzheimer's and dementia besets seniors and their caregivers, there may be ways to make life better until new treatments arrive.
Billions of dollars in ACA exchange subsidies are at risk of being miscalculated and misappropriated, and it seems some already have been.
This is the time of year when most plans have either completed, or are in the process of completing, their annual evaluation of their Quality Improvement (QI) Program Description and Work Plan for operating year 2014.
Almost no one disputes that the implementation of the federal health law has helped Americans who were previously uninsured gain coverage. But exactly how much has the uninsured rate dropped?