At the inaugural Practice Innovation Summit, two experts offered advice on negotiating insurance contracts.
Talking to Patients About Medicare Choices: Q&A with the Arthritis Foundation’s Nick Turkas, MS
Access to care is critical for treating arthritis and other chronic rheumatic conditions. That’s why choosing the best Medicare plan fit is such an important decision. Use these tips from the Arthritis Foundation’s Nick Turkas, MS, to help your patients make their best choice for insurance coverage.
Executive Order Targets Prescription Drugs & Health Insurance to Promote Competition
On July 9, U.S. President Joe Biden issued an Executive Order designed to promote competition in the U.S. economy. The order includes 72 initiatives related to various aspects of the economy, including prescription drugs and health insurance.1 For prescription drugs, Americans pay more than 2.5 times as much for the same prescription drugs as patients…
A Call to Action to Use the Pandemic to Transform Rheumatic Disease Care
No event in recent history has caused such far-reaching changes within the medical industry as the ongoing COVID-19 pandemic. Similar to its ability to spread indiscriminately—infecting people regardless of age, race or socioeconomic background—the virus is inducing immediate and, likely, permanent changes across the entire spectrum of healthcare. Comfortable routines of healthcare delivery have been…
U.S. Insurers Often Limit Biosimilar Coverage
(Reuters Health)—U.S. commercial health plans only covered biosimilar treatments as preferred products in 14% of coverage decisions last year, according to an analysis of publicly available data on coverage decisions.1 Researchers examined records from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database, which has information on coverage decisions made by 17 of…
Few Medicare Advantage Plans Cover Social Needs for Chronically Ill Patients
(Reuters Health)—Most Medicare Advantage plans are not offering chronically ill enrollees supplemental benefits to address social needs, which were added to the government health program in 2018 in an effort to improve health outcomes and achieve cost savings, a U.S. study suggests.1 Researchers examined publicly available data on benefits and plan design for Medicare Advantage…
U.S. Supreme Court Rules for Insurers over $12 billion Obamacare Claims
WASHINGTON (Reuters)—The U.S. Supreme Court ruled in favor of health insurers seeking $12 billion from the federal government under a program set up by the Obamacare law aimed at encouraging them to offer medical coverage to previously uninsured Americans. The 8–1 ruling authored by liberal Justice Sonia Sotomayor paves the way for a significant one-time…
ACR Urges Commercial Payers to Provide Relief from Prior Authorizations, Practice Disruptions
The ACR is urging insurance companies to expand access to telehealth services and provide relief from administrative burdens to help providers focus on patient care at this critical time.
Experts Discuss Current Insurance Issues Challenging Rheumatology
ATLANTA—From step therapy requirements to infusion center locations to evaluation and management coding, insurance issues bring frequent headaches to clinicians and patients. Experts discussed some of the most recent concerns in a session at the 2019 ACR/ARP Annual Meeting. Chris Phillips, MD, chair of the ACR’s Insurance Subcommittee (ISC), and Gary Bryant, MD, delegate to…
One-Third of U.S. Healthcare Spending Is Administrative Costs
(Reuters Health)—U.S. insurers and providers spent more than $800 billion in 2017 on administration, or nearly $2,500 per person—more than four times the per-capita administrative costs in Canada’s single-payer system, a new study finds. Over one-third of all healthcare costs in the U.S. were due to insurance company overhead and provider time spent on billing,…
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