Medicare Advantage insurers "substantially overestimate" how many in-network dermatologists can treat patients in several different markets. Many of the doctors weren't actually available--including some that are dead, retired or not accepting new patients, according to a new study published in the Journal of the American Medical Association Dermatology.
Through its patient-centered medical home, Highmark has been able to improve patient care, including lowering emergency room and prescription drug use, according to data released by the Pittsburgh, Pennsylvania-based insurer.
"It's like fourth grade," Judge Dan Pellegrini said of a court hearing Wednesday regarding the ongoing dispute between Pittsburgh health giants Highmark and the University of Pittsburgh Medical Center.
As Pennsylvania officials have attempted to force Highmark into expanding its Medicare Advantage network, Highmark pushed back by claiming that the state lacks authority over the federal program.
Medicare Advantage plans are frequently lauded for providing high-quality insurance coverage. And they're widely popular among Medicare-eligible consumers. But there's a dark side to these plans as well. In fact, dozens of federal audit reports indicate that Medicare Advantage plans are making the same kind of deficiencies year after year, especially when it comes to inappropriately rejecting claims. The Centers for Medicare & Medicaid Services found that in 61 percent of the audits, insurers turned down claims for prescription drugs when they shouldn't have. This is not something to take lightly. Many seniors take prescription medications, and many of those drugs are vital to their health and medical conditions. To potentially block their access to those drugs could prove extremely detrimental.
Horizon Blue Cross Blue Shield of New Jersey is expanding its patient-centered practices to its newest Medicare Advantage plan.
The Centers for Medicare & Medicaid Services should implement tighter audit standards to prevent Medicare Advantage plans from using unfair billing practices that lead to excessive reimbursements, a senior official with the U.S. Department of Health & Human Services told the Center for Public Integrity.
Overall performance for Medicare Advantage plans with and without prescription drug coverage is on the rise--and the Centers for Medicare & Medicaid Services credits its Star Ratings program for driving quality improvement.
Medicare health plans are in the spotlight once again, but not in a good way. Federal officials aren't pleased with the plans, citing dozens of federal audit reports that indicate the same kind of d eficiencies year after year, reports the The New York Times.
The Pennsylvania Attorney General and the departments of health and insurance want Highmark to expand its Medicare Advantage plans to include the University of Pittsburgh Medical Center within its network.