May 8, 2017 | Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
Mergers that would have reshaped the nation’s largest insurance companies would directly affect the provider networks independent medical laboratories rely on
For pathology groups and medical laboratories, the news about two thwarted deals involving mega insurance companies might be seen as a positive development.
The proposed deals—Anthem’s $48-billion bid to buy Cigna, and a proposed $37-billion Aetna–Humana merger—would have reshaped the US health insurance industry had they not been blocked by federal judges who cited possible harm to market competition, Bloomberg reported.
For now, all four health insurance companies will continue to use their existing provider networks, which is good news for clinical laboratories. Experts had expected the bigger players in each deal—Anthem and Aetna—to possibly prune the provider networks of Cigna and Humana, respectively, which could have financially burdened thousands of healthcare organizations and independent medical laboratories. (more…)
Sep 2, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
News reports state that Anthem and Cigna have denied payment for some multigene panel tests, saying that the tests are unproven. Other insurers, such as UnitedHealthcare and Priority Health, pay for such tests but only for certain patients
A conflict is building between patients and health insurers over the reluctance among health plans to pay for new, expensive molecular diagnostic assays and genetic tests that clinical laboratory companies offer.
This conflict has caught the attention of the nation’s media. That is probably because it makes a great story, for example, to interview parents who can assert that their sick child suffered because their health insurance plan would not pay for a genetic test the parents believed would make a difference in their child’s clinical care. Of course, pathologists and medical laboratory professionals know that there are a significant number of expensive genetic tests being offered by various lab companies that lack extensive data to support their clinical efficacy. (more…)
Jan 2, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
MGMA-ACMPE hopes survey data ultimately reduces distractions and resource diversion for physicians—including pathologists—that result from interactions with payers
When physicians and their practice managers are surveyed about their satisfaction with health insurers, the Medicare program outscores all private health insurers. This was just one finding of an annual survey on this topic conducted by Medical Group Management Association-American College of Medical Practice Executives (MGMA-ACMPE).
Certainly pathologists have their opinion about the service levels of different health insurers. However, MGMA’s survey does not break out physician satisfaction by different medical specialties. The survey findings reveal that most physicians are neutral or dissatisfied to some degree when queried about different aspects of service provided by Medicare and private health insurers. (more…)
