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Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
In a health plan, the provider enrolls in the provider panel network. After the application is submitted and credentials are verified, the approval process will involve review and approval by the network's medical director or credentialing committee. Typically, insurance companies require credentialing for the following providers Physicians MDs ...
Hackensack Meridian Health, locked in a contract dispute with Aetna, has sent letters to the insurer's customers warning them that they may lose in-network coverage if the two sides can't reach a ...
Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
Blue Cross and Blue Shield insurance companies are licensees, independent of the association and traditionally of each other, [16] offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state.
Wolf rejected Optum's request and allowed Smith's, putting court proceedings on hold until the arbitration process is complete. [ 31 ] The case garnered media attention as setting a precedent in trade secret litigation ahead of an anticipated wave of vertical integration in the healthcare industry [ 32 ] and for uncovering previously unknown ...
In 2017, CVS Health announced a merger with Aetna, completing in November 2018. [38] The takeover of PBMs have drawn regulator resistance because of fears they foster an anti-competitive environment. Insurance companies have charged that the PBM model has contributed to high drug prices because PBMs take a commission on each transaction. [39] [40]
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 ...