Insurer-provider contract impasses leave many patients without care
Indiana physicians are keeping an eye on the trend of large insurers dropping medical practices from their networks, which they call a classic case of David versus Goliath.
Health Insurance
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Tensions boil between ER docs, insurers as no-surprises law rolls out
The federal No Surprises Act—which took effect Jan. 1 and protects patients from receiving surprise medical bills resulting from unexpected, out-of-network coverage—is already creating huge waves.
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Arcane world of pharmacy benefit managers slowly unraveling
A series of federal and state actions are putting the $400 billion PBM industry under a spotlight.
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Insurers push hard to win Medicare Advantage customers
In Indiana last year, dozens of insurers across the state rolled out plans hoping to get a sizable piece of the fast-growing market.
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Battle over where to purchase specialty drugs hits Indiana
Health care practitioners and insurers are fighting over the hefty prices hospitals charge for specialty drugs to treat patients with cancer, vision loss, low white-blood-cell count and other serious diseases.
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Articles
Federal ruling against Healthy Indiana Plan potentially jeopardizes program
Former Gov. Mitch Daniels first introduced the consumer-driven, cost-sharing approach in 2007 when the state expanded Medicaid to moderate-income workers. Gov. Mike Pence developed the program even further.
Health care providers dig out from ransomware attack
A Feb. 21 cyberattack against a Nashville, Tennessee-based medical-billing clearinghouse sent shock waves across Indiana’s health care system.
ACA enrollment grows as Indiana unwinds Medicaid coverage
Nearly 300,000 Hoosiers secured health insurance coverage through the Affordable Care Act Marketplace during the open enrollment period for 2024, part of the record 21.3 million consumers nationally utilizing the program for the upcoming year.
Insurers clamping down on doctors who prescribe Ozempic for weight loss
Indianapolis-based Elevance Health, which operates Anthem plans, said that in most cases, it won’t cover Ozempic unless a patient is diagnosed with diabetes and has tried another medication to manage it, but physicians can still prescribe it.
Elevance Health buys Louisiana insurer, pushing operations into 15th state
The two companies said the combination builds on a seven-year collaboration in Louisiana through joint ownership of Healthy Blue, which serves Medicaid and Medicare Dual Eligible members.
Three bills in Indiana Senate take aim at health-care costs, practices
The proposals aim to lower prescription drug costs, promote competition among physicians and end the practice that allows for inaccurate medical billing in certain circumstances.
Beth Keyser: Working together to make health care more affordable
The longtime industry standard of negotiating hospital reimbursement as a discount on the hospital’s billed charges is being replaced with fixed rates based on what Medicare would pay for a given service.
Hackers hit health companies, insurers with increasing regularity
Of all the industries in the country, health care might be the juiciest for cyberhackers. And around central Indiana, institutions large and small are paying the price.
Anthem sues former executive over trade secrets
Indianapolis-based health insurer Anthem Inc. is suing a former executive, claiming he stole trade secrets, went to work for a direct competitor, and breached a contract involving restricted stock agreements.
Anthem Inc. to change corporate name to Elevance Health
The Indianapolis-based health insurer said the name change will better reflect its mission of “elevating whole health and advancing health beyond healthcare.”
Medicare opens up access to free at-home COVID-19 tests
Starting in early spring, up to eight free tests will be available each month to people who have Medicare’s “Part B” outpatient benefit, which about 9 in 10 enrollees sign up for.
Two former Anthem employees sue company, claim high quotas resulted in unpaid overtime
Two former employees of Anthem Inc. claim the Indianapolis-based health insurer set work quotas so high that it was impossible to meet them in a 40-hour week, forcing them to work unpaid overtime. Anthem declined to comment.
Health insurance premiums still on rise, topping $22,000 a year for family coverage
Over the past decade, premiums for family coverage under employer-sponsored health insurance has climbed 47%, faster than wages (31%) or inflation (19%), according to the Kaiser Family Foundation Employer Health Benefits Survey.
Anthem jumps back into Indiana ACA marketplace three years after departing
The Indianapolis-based insurer, which left the program in 2018 after racking up huge losses, is jumping back in under a partnership with three hospital systems covering 45 of Indiana’s 92 counties.
Indiana health officials say ‘white bagging’ should be regulated, but do not call for a ban
A new report submitted to the Indiana Legislative Council calls for the regulation of “white bagging,” a practice that requires hospitals to buy drugs from an outside pharmacy, which delivers them premixed ahead of time of the patient’s visit. It is a growing practice, aimed at lowering the cost of care, but many providers say it can compromise care.
Indiana hospitals should hold annual meetings to explain prices, consumer group says
The group, Hoosiers for Affordable Healthcare, is pushing an amendment that would require most of Indiana’s hospitals to hold annual public meetings to explain their prices, including any price increases, and to take questions about their finances.
State seeks to regulate pharmacy benefit managers
Three bills advancing through the Indiana General Assembly would provide tighter regulation of pharmacy benefits managers (PBMs).
Carmel-based CNO acquires employee benefits administrator for $50M
The benefits administrator, DirectPath LLC, offers a variety of technology-driven services for employees and employers.
Anthem paying $594M to settle antitrust litigation, but deal terms might fuel growth
Paying a half-billion-dollar settlement might seem painful, but health care observers say resulting changes to Blue Cross Blue Shield rules are so favorable to Anthem’s growth prospects that the deal is a huge win.