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Local hospital, Blue Cross & Blue Shield don’t reach contract

Published on November 11, 2015 by in News

By: Jaime McCutcheon


MOREHEAD CITY, Carteret County –

Carteret Health Care and Blue Cross and Blue Shield of North Carolina have not been able to reach a new contract, according to BCBSNC. This means Carteret Health Care will become out of network for BCBSNC customers seeking non-emergency care at the hospital in Morehead City.

Carteret Health Care responded with this: “Carteret Healthcare (CHC) is deeply troubled by BlueCross BlueShield of North Carolina’s (BCBSNC) announcement [Monday]. The state’s largest insurer has decided to give notice of ending our long-standing relationship effective February 1, 2016. We are disappointed that BCBSNC has chosen to take such a public and aggressive action rather than work collaboratively with us to reach a new, rebalanced agreement.”

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Alabama anti-trust case against Blue Cross will move ahead, judge rules

Published on November 10, 2015 by in News

al_com_logoBy: Amy Yurkanin



A Birmingham-based judge recently decided to move forward with the Alabama portion of a lawsuit alleging a widespread conspiracy to divide territory and limit competition between Blue Cross Blue Shield affiliates nationwide.

U.S. District Court Judge David Proctor issued the order on Oct. 30, which sets out a schedule for the Alabama portion of the lawsuit.

A trial in the case could happen sometime after January 2018, when the parties are set to meet for pretrial conference.

Alabama has the least competitive health insurance market in the country, according to recent studies by the American Medical Association. Blue Cross covers 93 percent of privately insured patients in Alabama, according to the lawsuit.

“It’s significant because it allows us to focus on Alabama and allows us to show how providers are treated worse because of the market concentration,” said Joe Whatley, an attorney representing the plaintiffs suing Blue Cross.

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Judge David Proctor Sets Streamline Scheduling Order MDL 2406: IN Re: Blue Cross and Blue Shield Antirust Litigation

Published on November 3, 2015 by in News

Judge David Proctor of the Northern District of Alabama issued an order on October 30, 2015 denying the Defendants motion to dismiss, streamlining scheduling issues and setting a January 2018 scheduling conference in preparation for the trial setting. . The order set a trial schedule for the following cases Conway v. Blue Cross and Blue Shield of Alabama et al, and American Motor Services Inc. v. Blue Cross and Blue Shield of Alabama et al. The case will continue as directed by the Court. Parties were instructed to be ready for pretrial conference in January 2018.

To Read the Order Click the Link Below:

October 30 Order : Denying Motions to Dismiss and Establishing Streamline Scheduling Order


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How Merger’s Damage the Economy

Published on November 2, 2015 by in News

By: The Editorial Boardthe-new-york-times-logo

The New York Times


In many industries, like airlines, telecommunications, health care and beer, mergers and acquisitions have increased the market power of big corporations in the last several decades. That has hurt consumers and is probably exacerbating income inequality, new research shows.

A recent paper by two economists, Jason Furman and Peter Orszag, says that consolidation might have contributed to the trend of some businesses earning “super-normal returns” that are about 10 times as large as the median returns, up from three times in the early 1990s. This trend may have driven the rise in income inequality by increasing the income of executives and shareholders of those businesses relative to everybody else.

In addition, two finance professors at the University of Southern California estimate that nearly a third of American industries were highly concentrated in 2013, up from a quarter of all industries in 1996, according to The Wall Street Journal.

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Did Blue Shield dump Stanford over high costs, then raise theirs?

Published on October 29, 2015 by in News

By: Chris Rauber

San Francisco Business Times


Some Blue Shield of California customers on the Peninsula say their premium rates will jump significantly in January even after Stanford Hospital and Lucile Packard Children’s Hospital are booted out of Blue Shield’s individual and family plan networks.

Early this month, as first reported by the Business Times, Blue Shield said it’s kicking the two Stanford hospitals out of the PPO network because of high costs, effective Jan. 1.

Entities affected include Stanford Health Care, Stanford Medical Center, Lucile Packard, Stanford Medical Group, Lucile Packard Medical Group, and Stanford’s University Health Alliance.

But some Blue Shield enrollees in the area are calling foul.

Blue Shield is decreasing our access to quality health care while raising our premium 29 percent,” said one enrollee who asked not to be identified. It’s ‘not clear how that supports either prong of their so-called mission,” referring to the health plan’s stated missions of ensuring access to care at affordable rates.

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Blue Shield of California still in hot seat over executive pay

Published on October 28, 2015 by in News

By: Heather Caspihealthcare_stackedlogo_olive_CMYK



Dive Brief:

  • Following months of scrutiny over its nonprofit status, $4.2 billion in reserves, and other financial concerns, Blue Shield of California continues to face questions about its executive compensation.
  • CEO Paul Markovich said the company would disclose more information in the future, but specific details regarding past executive pay would remain secret.
  • The lack of transparency may not fly with state regulators investigating whether the organization intentionally misled them.

​Dive Insight:

Blue Shield of California raised executive pay by $24 million in 2012, amounting to a 64% increase from the previous year, The Los Angeles Times previously reported. What concerns regulators is whether the company excluded some of its pay data from public filings in order to cloak massive sums paid to outgoing execs, including former CEO Bruce Bodaken.

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Blue Shield may be heading to showdown with regulators over executive pay

Published on October 27, 2015 by in News

la times logoBy: Chad Terhume



In response to mounting criticism, Blue Shield of California’s chief executive is vowing to improve the nonprofit insurer’s poor ratings from patients and to disclose more about executive compensation.

But CEO Paul Markovich warned that certain details on executive pay will remain secret, portending a potential showdown with regulators.

Markovich has been dogged by questions for months surrounding the insurance giant’s nonprofit status, lack of transparency and repeated rate increases despite holding $4.2 billion in reserve.

The 48-year-old CEO cleared one major hurdle this month when state officials approved his $1.2-billion acquisition of Care1st Health Plan, a Medicaid insurer based in Monterey Park.

Auditors said the company didn’t deserve the lucrative tax break because of its excessive surplus and the failure to provide lower-cost coverage or other substantial community benefits.

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Blue Cross Franchisee Looks To Duck Suits in Antitrust MDL

Published on October 21, 2015 by in News

Law360By: Gail Sullivan


Law360, New York (October 20, 2015, 10:28 PM ET) — Blue Cross & Blue Shield of Mississippi urged an Alabama federal court Monday to toss seven antitrust suits from multidistrict litigation challenging how the insurance giant divvies up territories among franchisees, saying it didn’t do enough business in certain states to be sued there.
Suits by health care providers accusing the insurance giant and its independent regional units of price-fixing and conspiring not to compete were consolidated in Alabama federal court in 2012.

In May, U.S. District Judge R. David Proctor denied bids by several Blue Cross units to dismiss the suit, saying the providers were entitled to discovery to determine where the cases should be heard. His order noted that the health care providers had also sued those same Blue Cross units, including Blue Cross of Mississippi, in their home states.

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Blue Cross to end certain gold and platinum plans

Published on October 16, 2015 by in News

al_com_logoBy: Amy Yurkanin



Customers with certain gold and platinum plans from Blue Cross Blue Shield of Alabama will need to shop for new coverage starting next month, the insurer announced last week.

Blue Cross is discontinuing its Blue Choice Platinum and Blue Access Gold plans at the end of the year. Consumers covered by the plans can select new plans during open enrollment, which starts in November.

Clients at AIDS Alabama will be among the customers searching for new coverage at the end of the year. Some HIV-positive patients who had been using the state’s AIDS Drug Assistance Program have been able to purchase insurance through the federal exchange, and all of them had platinum-level plans, said Alex Smith, director of policy and advocacy for AIDS Alabama.

“I’m not sure what we’re going to do next,” he said.

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Connecticut Agency to play key role in Anthem/Cigna merger

Published on October 8, 2015 by in News

washington-post-logo-verticalBy: Susan Haigh


Washington Post

HARTFORD, Conn. — Connecticut’s Department of Insurance is playing a major role in a deal that could create the nation’s largest health insurer, leading a 26-state review of Anthem Inc.’s proposed merger with Bloomfield-based Cigna.

Since Cigna is based in Connecticut, state insurance regulators are tasked with coordinating the review by other states with legal Cigna entities within their borders, informing them about Connecticut’s evaluation of the massive merger, and hosting conference calls between the various state regulators.

“This transaction has a large number of states,” said Connecticut Insurance Commissioner Katharine Wade. “Having 26 states involved, coordinating among regulators, is significant.”

The application process for the proposed merger includes multiple steps, including approvals from shareholders. The U.S. Justice Department is currently reviewing Anthem’s planned $54.2 billion acquisition of Cigna to determine whether the merger will hurt competition and consumers. About 53 million customers could be affected.

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