David Newton’s Post

Insurers reap hidden fees by slashing payments. A recent investigation by The New York Times reveals how data firm MultiPlan, helps health insurers make more money by cutting payments to out-of-network providers. These providers are feeling the strain and often, patients can still end up with large bills for the difference. MultiPlan's aggressive "cost-containment" approaches have led to concerns about fairness and transparency in healthcare billing. Insurers “have a large and mostly hidden financial incentive to cut…reimbursements as much as possible,” wreaking havoc on patients and the healthcare system. Based on extensive research and powerful personal interviews, this piece highlights tragedies and challenges patients face when they must receive care from out-of-network providers. As they struggle, insurers continue to “line their pockets” and refuse to take responsibility for fees. As Ms. Lawson points out, (who has a $100k bill, thanks to United Healthcare): isn’t this why you pay for insurance in the first place? Read more: https://lnkd.in/ev3nY-76 #MultiPlan #HealthInsurance

NEW: Article shows the shocking ways some insurance companies put profits over patients. Recent reporting shows how corporate insurers are misusing upwards of $50 billion in Medicare funds, hurting patients' health outcomes with prior authorization. Read more below.

"It is incredibly hard to do anything constructive as a fully insured plan. When an employer is self-funded, they are able to access more detail on their claims data. They can see on a per-member or on a per-service basis what amount was paid by their plan." https://lnkd.in/eGf-seXz #fullyinsured #selffunded #insurance #employeebenefits #medical #medicalinsurance #healthcare

CVS posts big earnings miss, cuts profit outlook on higher medical costs. CVS Health on Wednesday reported first-quarter revenue and adjusted earnings that missed expectations. The company also lowered its full-year profit outlook, citing higher medical costs that are dogging the broader U.S. insurance industry. Insurers have been seeing medical costs spike as an increasing number of Medicare Advantage patients return to hospitals to undergo procedures they had delayed during the pandemic. $CVS https://lnkd.in/gbwFTtMa #tradeguard #receivableputoptions #arputs #receivableputs #tradereceivables #accountsreceivables

The cost of healthcare often leads to delayed treatment. The Kaiser Family Foundation reports that 35% of adults in the U.S. postpone dental care due to expenses. This is significant, reflecting the high out-of-pocket costs not fully covered by insurance. Vision care is the second most delayed at 25%. These expenses, including eye exams and corrective lenses, are sometimes not included in standard health plans. Doctor visits are third, with 24% of adults postponing due to costs, even with insurance, due to copays and deductibles. Delaying these essential services due to financial constraints can lead to more severe health issues and increased costs over time. For instance, neglected dental care can result in advanced decay, requiring more complex treatment. These trends underscore the importance of selecting health insurance that provides adequate coverage for these essential services to prevent postponement of necessary care. It also emphasizes the need for better healthcare coverage and cost-effective solutions. 👉🏼To receive more information about healthcare costs and insurance options, contact us at https://lnkd.in/dm9iH9RP. Stay connected with us on social media for the latest updates and helpful tips! #MarbleCityInsurance #MarbleCity #Knoxville #insurance #insurancematters #insuranceawareness #lifeinsurance #healthinsurance #carinsurance #homeinsurance #businessinsurance

CVS Health has revised its expectations for enrollment in its Medicare Advantage plans for individuals aged 65 and above, anticipating surpassing earlier targets in 2024 due to robust sales and member retention. The company, which owns health insurer Aetna, now aims to add at least 800,000 members to its Medicare Advantage plans in 2024, up from the previous forecast of 600,000. CVS' Medicare Advantage plans, competing with UnitedHealth and Humana, received favorable "star ratings" from the Centers for Medicare & Medicaid Services, influencing reimbursement levels and member choices. The company has reaffirmed its 2024 adjusted profit forecast of at least $8.50 per share. CVS had adjusted its 2024 earnings forecast in November, considering potential higher medical costs. Tom Cowhey has been formally appointed as the chief financial officer, succeeding Shawn Guertin, who will leave the company on May 31, 2024. Ed Gonzalez, egonzalez@gmsconnect #medicare #healthcare #insurance #medicaid #healthinsurance #health #callcenter #business #contactcenter #bpo #customerservice #telemarketing #marketing #outsourcing #callcenterlife #callcenteragent https://lnkd.in/eVNsJUYK

CVS Health has revised its expectations for enrollment in its Medicare Advantage plans for individuals aged 65 and above, anticipating surpassing earlier targets in 2024 due to robust sales and member retention. The company, which owns health insurer Aetna, now aims to add at least 800,000 members to its Medicare Advantage plans in 2024, up from the previous forecast of 600,000. CVS' Medicare Advantage plans, competing with UnitedHealth and Humana, received favorable "star ratings" from the Centers for Medicare & Medicaid Services, influencing reimbursement levels and member choices. The company has reaffirmed its 2024 adjusted profit forecast of at least $8.50 per share. CVS had adjusted its 2024 earnings forecast in November, considering potential higher medical costs. Tom Cowhey has been formally appointed as the chief financial officer, succeeding Shawn Guertin, who will leave the company on May 31, 2024. Ed Gonzalez, egonzalez@gmsconnect #medicare #healthcare #insurance #medicaid #healthinsurance #health #callcenter #business #contactcenter #bpo #customerservice #telemarketing #marketing #outsourcing #callcenterlife #callcenteragent https://lnkd.in/eECnfD8m

Change healthcare. A common sentiment among many. It's an actual company, which has very little to do with changing healthcare. What it actually is, is a third party clearing house to process medical claims. Unsurprisingly the FTC was unable to block United Healthcare from purchasing it a few years back. At it to the long list of their quest to completely own healthcare in the US. It was recently targeted by a cyberattack and went down. The issue is that many hospitals and medical practices have no real good way to get paid by insurance companies until it goes back up. Some have resorted to paper claims. Many of these businesses operate on paper thin margins already, so a lack of cash flow can be devastating. Unsurprisingly, Optum (owned by United Healthcare) is offering these companies payday loans to cover their costs in the mean time. It all boils down to this: taking health insurance seems like a stable option for your medical practice. It actually is very risky to only take health insurances and not have any cash bases. In the best of scenarios your are completely at the mercy of these healthcare companies, both in terms of reimbursements and overhead (staff hiring to process claims and RCM). A quick change of the rules can put you out of business. I refuse to take any health insurances so my practice is unaffected by this, but I know there are a lot of people on here who were hit pretty hard. If I left any details out, please fill them in! #medicine #healthcare #healthinsurance

It's 2015 all over again: Cigna and Humana are in discussions to merge, according to WSJ reporting today. A deal could be final by the end of this year, and the Biden administration is almost certain to go over the major combination with a fine-toothed comb. Potentially to avoid stumbling blocks for the tie-up, Cigna is reportedly exploring a sale of its Medicare Advantage business (MA is Humana's bread and butter). Meanwhile, Humana is currently winding down its employer plans (Cigna's core business) to focus on government programs exclusively. Would love to hear any and all thoughts on the ramifications of this potential deal on the health insurance sector. Comment, or email me: rpifer@industrydive.com

I've been in various meetings this quarter with health plans and health systems that are dropping their MA segment. Many of them mentioned that if they had known about Tele911 earlier, they would have reconsidered their decision. Here are the top reasons why health systems are dropping MA: - 📍Denial rates: MA plans are denying claims more frequently. - 📍Payment:MA plans are paying less than what providers bill for and are slow to pay. - 📍Authorization: MA plans are taking too long to review requests to authorize care. - 📍Reimbursement: Health systems are not receiving adequate reimbursement. - 📍Inflation:Inflation and labor shortages have increased costs for hospitals, and government programs pay less than commercial programs. - 📍Federal guidance:The federal government is issuing new guidance on how MA plans can be run, which could threaten some insurance companies. - 📍Allegations: Some MA carriers have been accused of billing fraud by the federal government and are being investigated by lawmakers. Put all those reasons into a bucket and understand it really is a fiscal decision. MA strategies that partner with Tele911 experience a 3:1 to 5:1 ROI on ED avoidance. The choice is clear. https://lnkd.in/evzUEfrY