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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 ...
For-profit insurers, like Aetna, continue to reap the benefits of multi-year contracts that do not reflect the current health care landscape, with reimbursement increases substantially lower than ...
Providers may seek to maximize profit by avoiding patients for whom reimbursement may be inadequate (e.g., patients who do not take their drugs as prescribed), by overstating the severity of an illness, by giving the lowest level of service possible, by not diagnosing complications of a treatment before the end date of the bundled payment, or ...
Aetna, et al., a frustration succinctly summarized in his quote from a previous decision in "Andrews-Clarke v. Travelers Ins. Co., " (a Complaint by a widow for the death of her husband as a consequence of a Managed Care Utilization review decision that cut short her husband's physician's recommended in-hospital treatment plan) as follows:
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 ...
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.
Aetna has about 200,000 Medicare Advantage customers in the state. And it has begun to offer plans to nearly 600,000 state employees and teachers for coverage that would go into effect July 1 ...
Self-funding involves a transfer of risk from the employee and his/her dependents to the employer directly. Self-funded health plans pay health claims out of plan assets; there is no element of traditional insurance on these programs, and the employer assumes all additional liability for claims that have not been paid by plan (trust) assets.
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