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In January 2018, a class action lawsuit accused Centene's Ambetter marketplace healthcare plans of misleading enrollees about plan benefits. [37] [38] According to the lawsuit, people who bought Centene's plans had difficulty finding medical providers that accepted patients covered under Centene's policies. [39]
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:
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This process uses the same standards and technologies as an electronic claims transmission with small changes to the transmission format, this format is known specifically as X12-270 Health Care Eligibility & Benefit Inquiry transaction. [17]
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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.