Aetna Fined $500,000 After Denying 93% of ER Claims in 2019 Aetna has been in the news quite a bit lately and it seems the insurance giant can’t get out of its own way. On August 25, 2020, the California Department of Managed Health Care (DMHC) ordered Aetna to...
Medical Providers Fire Back At Cigna’s Motion, Telling The Judge That “Cigna Does Not Follow The Law, And It Misrepresents How It Actually Administers The Plans.” In the Reply Brief of Plaintiffs Advanced Gynecology and Laparoscopy of North Jersey, et al v....
Self-insured health plans nationwide should look to recover $30 to $45 billion in Plan Asset refunds from the past 10 years of successful plan assets TPA/ASO anti-fraud recoupments and managed care savings in both the public and private sector As we have...
Self-Insured Employer Health Plan Administrators, Plan Sponsors, and key decision-makers would do well to heed the old adage: if it sounds too good to be true, it probably is. In the ever-changing employer healthcare landscape, there has been an increasing group of...
On January 15, 2019, in what turned out to be a belated Christmas gift for patients, out-of-network medical providers and self-insured health plans, the 8th Circuit Federal Appeals Court stood with out-of-network medical providers, ruling they have standing to...
