Wednesday, July 23, 2008
Buffalo-based HealthNow New York fined $1 million for denying claims for infertility treatment and other violations
State insurance regulators on Monday imposed a hefty $1 million fine on HealthNow New York for multiple violations of state law, but the Buffalo-based company said it has already corrected past claims practices.
The state penalized Buffalo’s largest health insurer for improperly denying claims for infertility treatment and for not giving consumers enough notice of rate hikes.
Thursday, June 19, 2008
The CEOs of HealthNow New York, Independent Health Association and Rochester’s Excellus Health Plan, which owns Univera Healthcare, took home more than $6.5 million combined last year in salary and other pay.
That’s a 72 percent increase from $3.77 million in 2006
Friday, April 25, 2008
Highmark Inc. will pay $9.9 million and change the way it does business with doctors, including how appeals are handled, to settle a class action lawsuit that was filed in 2003 against Blue Cross Blue Shield plans nationwide, according to terms of a preliminary agreement.
"The news is the reforms Highmark has agreed to adopt," said attorney William Maruca, who practices with the Downtown offices of Fox Rothschild LLC and represents the Allegheny County Medical Society. "The major impact will be in improving the way Highmark deals with physicians."
Among the terms of the proposed settlement is disclosure of fee schedules to participating physicians; expanded arbitration provisions for claim disputes; an end to recovering overpayments after 18 months except in cases of fraud; and establishment of a 12-person physician advisory committee to consult with the insurer on a variety of matters, such as clinical quality improvements. The tentative agreement also requires a committee of physician peers to evaluate medical necessity issues and an external review panel to mediate appeals of insurance claims that have been denied.
"Payments vary sometimes, and it's hard to tell why," Maruca said.
Tuesday, April 22, 2008
Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients, and receive lower private insurance payments than their counterparts treating fewer such patients, according to a national study published today as a Health Affairs Web Exclusive. These same physicians also reported more problems providing high-quality care, ranging from inadequate time with their patients to difficulty obtaining specialty care. In addition, the Commonwealth Fund-sponsored study examined how higher Medicaid payments might help physicians treating mostly minority patients provide high-quality care and reduce racial and ethnic disparities.
Wednesday, April 2, 2008
ALBANY — The 2008 state budget will prod Medicaid patients into less expensive outpatient and home settings, provide prescription drug discount cards for 400,000 senior citizens and disabled people and restore hundreds of millions of dollars that hospitals and nursing homes were facing in cutbacks.