Over the past 16 months, three of the nation’s largest commercial payers – UnitedHealthcare, Anthem and CIGNA – have instituted new policies affecting how and whether they will pay for high-cost drugs administered in hospital...more
The move by some employer plans to a “reference-based” pricing model has created a need for healthcare providers to develop a strategy to confront payment challenges that these plans create. A prevalent model of...more
12/13/2019
/ Affordable Care Act ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Health Care Providers ,
Health Insurance ,
Out-of-Pocket Expenses ,
Pricing ,
Public Health Service Act ,
Regulatory Standards ,
TPAs ,
Uniform Commercial Code (UCC)
On June 9, 2017, the United States Court of Appeals for the Seventh Circuit affirmed the lower court’s grant of summary judgment in Methodist Health Services Corp. v. OSF Healthcare System d/b/a Saint Francis Medical Center,...more