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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Anthem Blue Cross Blue Shield said Thursday that the health insurance provider is reversing a policy that was set to go into effect in February that would have limited anesthesia coverage during ...
Founded in 1948, [26] Arkansas Blue Cross Blue Shield (ABCBS) [27] is an independent licensee of the Blue Cross Blue Shield Association, and the largest healthcare provider in the state. [28] It donated $1.98 million to The Walton College of Business toward founding its Robert L. Shoptaw Master of Healthcare Business Analytics Program. [ 29 ]
In 1995, The Associated Group acquired Community Mutual Insurance, a provider of Blue Cross and Blue Shield insurance plans in Ohio with over 1.9 million policy holders), then set up Anthem Blue Cross and Blue Shield. [16] [17] In 1996, The Associated Group changed its name to Anthem Insurance Company. [17]
Mercy also stated that Anthem reported a 24.12% increase in year-over-year net income and a 24.29% increase in its year-over-year net profit margin in June 2024.
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UnitedHealth Group, the largest Medicare Advantage provider with 7.6 million people in its plans, generated $257 billion in premium revenues in 2022, some 13% over the previous year.
A 2015 study found 14% of privately insured consumers received a medical bill in the past two years from an out-of-network provider in the context of an overall in-network treatment event. Such out-of-network care is not subject to the lower negotiated rates of in-network care, increasing out-of-pocket costs.