July 21, 2016
Within a three-week span last summer, four of the five biggest health insurers announced two mergers totaling $85 billion. Suddenly, what was five would be three, reshaping the industry.
But on Thursday, antitrust regulators said, Not so fast.
The proposed mergers, she said, “would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies.”
“If these mergers were to take place, the competition among insurers that has pushed them to provide lower premiums, higher-quality care and better benefits would be eliminated,” she said.
By: Jenny Deam
No final decisions have been made regarding our 2017 Texas offerings,” spokesman Gustavo Bujanda said in a statement emailed to the Houston Chronicle.
“The rates we have submitted for review and approval are supported by strong actuarial principles, science and data,” the statement continued.
According to filings listed on healthcare.gov, Blue Cross and Blue Shield seeks increases between 57.33 percent and 59.35 percent for two of its Blue Advantage Plus plans. A Blue Advantage Health Maintenance Organization Plan is asking for a 58.6 percent hike.
TUPELO -For the second time in a year, a BlueCross BlueShield insurer is cutting ties with North Mississippi Medical Center-Tupelo.
After Sept. 30, NMMC-Tupelo will no longer be a part of the preferred provider network for BlueCross BlueShield of Alabama, apparently because of national BlueCross rules. NMMC-Hamilton will not be affected by the change.
The change could force West Alabama residents to drive twice as far to receive specialized care, said David Graham, executive director of the Community Development Foundation in Hamilton, Ala.
“It could substantially impact people financially,” Graham said. “I’m certain they’re going to be very agitated.”
The Alabama organization had not been a part of the discount rate disagreement between NMMC and BlueCross BlueShield of Mississippi.
Kaiser Health News
In its first detailed disclosure on executive pay, nonprofit Blue Shield of California said Chief Executive Paul Markovich made $3.5 million last year – a 40 percent increase since he took the top job in 2013.
The San Francisco-based health insurer has faced criticism for years from consumer advocates about its lack of transparency on executive compensation, and the issue attracted even more scrutiny after a state audit raised questions about the insurer’s big pay increases and large financial reserves.
Following that audit, in 2014, California revoked Blue Shield’s state tax exemption, which it had held since its founding in 1939.
Humana Inc. is dropping all its Alabama plans from the health insurance exchange set up under Obamacare, leaving the state with just one remaining company, Blue Cross Blue Shield of Alabama.
Humana is also leaving the exchange in Virginia, according to news reports.
The announcement by Human comes just weeks after UnitedHealth Group announced it would be dropping plans in most states, including Alabama. Now that both companies have dropped out of the exchange, only Blue Cross Blue Shield of Alabama remains on the marketplace.
Decreased funding and changes in the model for mental health coverage have forced Alabama Psychiatric Services to shut its doors, effective Feb. 13, according to a statement released by the company.
The statewide psychiatric care group announced the closure yesterday to employees and posted signs in its offices blaming the closure on Blue Cross Blue Shield of Alabama. According to the letter to patients posted in an office on Montclair Road, Blue Cross Blue Shield of Alabama recently shifted several members to plans with higher co-pays and deductibles, and reduced membership in a plan that sustained Alabama Psychiatric Services.
April 13, 2016
An executive at Chicago-based Health Care Service Corp., which operates Blue Cross plans in Illinois and four other states, told a court Tuesday that the proposed merger between Downers Grove, Ill.-based Advocate Health Care and Evanston, Ill.-based NorthShore University HealthSystem could be bad for the Chicago area.
Steve Hamman, senior vice president of provider engagement and enterprise network solutions at HCSC, served as one of the Federal Trade Commission’s witnesses in a hearing this week to block the proposed merger.
Under questioning from the FTC, Mr. Hamman said the combined system would have more leverage with payers that sell plans in the Chicago area and more bargaining power “typically manifests itself in higher prices for services,” according to the Chicago Tribune.
Mr. Hamman’s testimony supported the FTC’s argument that the merger would lead to higher healthcare costs for consumers and diminish incentives for the combined entity to upgrade services and improve quality.
However, under cross-examination it became clear Blue Cross has another reason to oppose the merger. The insurer is also worried that after the merger, Advocate and NorthShore would create their own health insurance company, according to the report.
U.S. hospitals are stepping up their bid to stop Anthem Inc.’s takeover of rival health insurer Cigna Corp., saying the deal will increase the dominance of Blue Cross Blue Shield plans and potentially raise premiums for consumers.
The enhanced bargaining power of the Blue Cross plans will undermine competition and should compel the Justice Department to stop the deal, the American Hospital Association wrote in a letter to the department’s antitrust chief Bill Baer.
Blue Cross Blue Shield is an association of independent insurers operating across the country. Anthem operates health insurance plans under the brand in 14 states.
“The acquisition threatens to both reinforce existing barriers to entry and raise new ones, further entrench dominant Blue plans, and exacerbate conditions conducive to abuse of market or monopoly power,” according to the letter, which was dated Monday.
March 22, 2015
A change in the rankings of 18 hospitals by the state’s largest insurer, Blue Cross Blue Shield of Alabama, could result in higher out-of-pocket costs for patients across the state.
Blue Cross Blue Shield of Alabama introduced its hospital tiered network in 2006, which classified hospitals as Tier 1 or Tier 2 based on the quality and the value of care. Patients save money by using preferred Tier 1 hospitals, and pay more out-of-pocket for Tier 2 hospitals.
Blue Cross moved 18 hospitals to Tier 2, a change that becomes effective next month. Eight hospitals moved to Tier 1 from Tier 2 and will cost less starting in April.
Insurers across the country have similar programs, which are intended to steer patients to high-quality, low-cost hospitals. Blue Cross Blue Shield of Alabama employees evaluate hospitals based on cost, quality and patient experience. Many of the criteria come from the Centers for Medicare and Medicaid Services, which provides online hospital rankings.
Hospitals in the lower tier are still in the Blue Cross network, but patients pay more in co-pays and deductibles. A spokeswoman for Blue Cross could not provide an estimate of the difference in cost.