Cigna recently announced that they will discontinue payment for consultation codes later this year. As of Oct. 19, 2019, the payer will implement a new policy on Evaluation and Management (R30) that will deny claims billed with CPT codes for consultation services as not valid. Impacted CPT codes are 99241, 99242, 99243, 99244, 99245, 99251,…
U.S. Appeals Court to Take Up Constitutionality of Obamacare
NEW ORLEANS (Reuters)—The future of Obamacare could be at stake on Tuesday when a coalition of Democratic-led states and House of Representatives urge a federal appeals court to overturn a Texas judge’s ruling that the U.S. healthcare reform law is unconstitutional. Republicans have repeatedly tried to repeal Obamacare, or the Affordable Care Act (ACA), since…
New Wins, Ongoing Challenges for ACR Insurance Subcommittee
Corrections to reimbursement system errors with Aetna and a Medicare contractor demonstrate the latest wins for all providers by the ACR’s Insurance Subcommittee. But the committee remains hard at work advocating for rheumatologists on several fronts.
U.S. Justice Department Says Obamacare Individual Mandate Unconstitutional
WASHINGTON (Reuters)—The U.S. Department of Justice (DOJ) said on Thursday that the part of Obamacare requiring individuals to have health insurance is unconstitutional, an unusual move that could lead to stripping away some of the most significant and popular parts of the law. In a brief filed in a federal court in Texas, the department…
Patients Lose When Insurance Company Forces Drug Switch
This past June, a 64-year-old man with a history of psoriatic arthritis and severe arthritis appeared at our clinic for his regular follow-up with concerns about a letter from his insurance company. The letter stated the company wouldn’t pay for the patient’s secukinumab (i.e., Cosentyx) prescription anymore and suggested he take ixekizumab (i.e., Taltz) instead,…
ACR Insurance Subcommittee Responds to Payer Policies
Since the beginning of the year, the ISC has sent eight letters to payers in response to problematic policies. Each letter outlines the ACR’s concerns and requests corrective action…
20 U.S. States Sue Federal Government Seeking End to Obamacare
(Reuters)—A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. Led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, the lawsuit said that…
Amazon, Berkshire, JPMorgan Partner to Cut U.S. Healthcare Costs
NEW YORK (Reuters)—Amazon.com Inc., Berkshire Hathaway Inc. and JPMorgan Chase & Co. said on Tuesday they will form a company to cut health costs for hundreds of thousands of their employees, setting up a major challenge to an inefficient U.S. healthcare system. The move by three of the best-known U.S. business leaders—Amazon’s Jeff Bezos, Berkshire’s…
U.S. Uninsured Rate Up by Most in Nearly a Decade
WASHINGTON (Reuters)—The number of Americans without health insurance rose by 3.2 million people between 2016 and 2017, or 1.3% points to 12.2%, according to a Gallup poll released on Tuesday, the biggest jump in the uninsured rate in nearly a decade.1 Several factors likely contributed to the jump, Gallup said, including attempts by Republicans, who…
Updated Obamacare Enrollment Figure Dips to 8.7 Million
(Reuters)—About 8.7 million people enrolled in healthcare plans for 2018 using the federal Obamacare marketplace, according to updated government figures released on Thursday. The number represented a slight decline from the 2017 enrollment figure when about 9.2 million people signed up for health insurance policies from private insurers on the HealthCare.gov platform. It was slightly…
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