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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 2010 about 250 plans participate in the program. [3] About 20 plans are nationwide or almost nationwide, such as the ones offered by some employee unions such as the National Association of Letter Carriers, by some employee associations such as GEHA, and by national insurance companies such as Aetna and the Blue Cross and Blue Shield Association on behalf of its member companies.
Recent claim experience—whether better or worse than average—is a strong predictor of future costs in the near term. But the average health status of a particular small employer group tends to regress over time towards that of an average group. [91] The process used to price small group coverage changes when a state enacts small group ...
The class action lawsuit alleges Aetna Health is claiming reimbursement it isn't entitled to when customers settle medical malpractice cases. Lawsuit claims insurer Aetna is wrongly taking money ...
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 ...
In addition to their own research, health insurers Aetna, [15] [16] [17] Humana [18] and UnitedHealth Group [19] have all provided their own claims data for independent analyses by the Health Care Cost Institute. [20] The RAND Health Insurance Experiment (1974–1982) is considered "one of the best experimental social science studies ever ...
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The company was founded in 1986 in Nashville by Phil Bredesen. [3]In August 1998, the company merged with Principal Health Care and moved its headquarters to Bethesda, Maryland.