Similar rules enacted six years ago by the Department of Managed Health Care didn't protect hundreds of thousands of Californians from millions of dollars in unjustified
out-of-network charges," said Consumer Watchdog attorney Laura Antonini.
Aetna Life Insurance Company is going on the offensive against a Northwest Houston hospital with an
out-of-network strategy.
Specifically, the ACP called on CMS to consider patient to physician ratios and the use of
out-of-network providers when evaluating networks in addition to time and distance standards.
While most patients remain in-network when choosing a physician,
out-of-network care is not infrequent.
The next time you get a call from a new client asking if you take an insurance for which you are not a provider, you might want to let them know that you are happy to find out their
out-of-network benefit and let them know how that might work in your practice.
Health insurance plans that include coverage for
out-of-network providers are common and have the potential to reduce health care costs and even improve quality.
The problem is that some insurers will not accept an assignment of benefits from non-contracted or
out-of-network providers.
If you provided covered
out-of-network services to patients insured by UnitedHealth Group between March 1994 and November 2009, you may be eligible to receive payments as part of a $350 million settlement reached last year.
The court's approval is an important step in finalizing a settlement that recognizes UnitedHealth's flawed payment scheme resulted in significant damages to physicians who provided
out-of-network care to patients enrolled with UnitedHealth," AMA Immediate Past President Nancy Nielsen said in a statement.
The trial beginning next week targeting the nation's largest health insurer and its California subsidiary for allegedly automatically denying requests for
out-of-network liver transplants will help shed light on the need for stronger health reform than is currently being considered.
In fact, the parity law brings new attention to managed care, enabling health plans that provide mental health and substance abuse coverage to make "medical necessity determinations" for both in-net-work and
out-of-network care.
If a plan offers
out-of-network benefits for medical or surgical care, it must also offer
out-of-network coverage for mental health and addiction treatment and provide services at parity
