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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.
Health exchanges first emerged in the private sector in the early 1980s, and they used computer networking to integrate claims management, eligibility verification, and inter-carrier payments. These became popular in some regions as a way for small and medium-sized businesses to pool their purchasing power into larger groups, reducing cost.
Eligibility Verification – to ensure that a healthcare organization gets paid for its provided services, it is common for staff to do eligibility verification via telephone or through an interactive website. This can provide the most up-to-date verification to ensure the healthcare organization will get paid by the carrier such as Medicaid ...
According to a study by a pro-health reform group published February 11, the nation's largest five health insurance companies posted a 56 percent gain in 2009 profits over 2008. The insurers (Anthem, UnitedHealth, Cigna, Aetna and Humana) cover the majority of Americans with health insurance. [152]
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 ...
The X12 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.
Mark T. Bertolini (born 1956) is an American businessman who is currently the CEO of Oscar Health, a tech-driven health insurance company located in New York.He was the co-CEO of Bridgewater Associates, one of the world's largest hedge funds, and was previously the CEO of Aetna, a Fortune 50 diversified health care benefits company with over $60 billion in 2015 revenue.
[53] [failed verification] Aetna cancelled planned expansion of its offerings and following an expected $300 million loss in 2016 and then withdrew from 11 of its 15 states. [54] In August 2016 Anthem said that its offerings were losing money, but also that it would expand its participation if a pending merger with Cigna was approved. [55]
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