Over 100 CIGNA Administered Plans Sued For Embezzlement

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By Mark Flores

Just eight days after a federal court slammed CIGNA with a $13M judgement, 113 of CIGNA’s self-insured clients, along with their Plan Administrators have been named as defendants in a massive fraud lawsuit, alleging the plans “participated in a conspiracy and pattern of unlawful, reckless, and deceptive conduct to conceal an embezzlement and/or skimming scheme”.

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More Proof Reference Based Pricing Is Growing Market Share

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The following article illustrates the angst hospitals are undergoing in defending their indefensible and egregious pricing strategies through their PPO collaborators. The solution posed in this article by a hospital advocate is: Identify Reference Based Pricing (RBP) patients and don’t treat them! But that short sighted response brings on Cash Pricing strategies through companies like Asserta Health (www.assertahealth.com) which often times saves plan sponsors even more money than otherwise would have been paid hospitals under a typical RBP plan. Making lemonade out of lemons……………

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Illinois Extents Hep. C Treatment for Medicaid Recipients

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If Medicaid allowed overseas treatment for Hep. C (Harvoni) the savings by utilizing a five star hospital system 495 miles south of Florida would save taxpayers 753 X ($95,000 – $19,000) = +$57 million...

For Information on Health City, contact Sarah Rusk, Health City Cayman Islands
t 345-640-4257  m 345-525-2131  healthcity.ky

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Healora – Cash Pay Health Plans Make Sense

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Imagine being in control of your individual employee healthcare costs. Our low cost network puts you in control of your daily healthcare spend. You decide whether the employee is better off using existing insurance options or pre-paying for the specific procedure. Our pre-paid pricing is based on discounts of up to 70% and can save companies millions of dollars a year.

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California Senate Approves Reference Based Pricing

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“The bill would relieve patients from having to pay surprise medical bills out of pocket by requiring insurers to reimburse out-of-network doctors and other health providers a “fair amount” and doctors to accept the payments, said its author, Assemblyman Rob Bonta (D-Oakland).”

“That rate would be 125 percent of the amount Medicare pays for the same service or the insurer’s average contracted rate for the service, whichever is greater.”

Editor’s Note: If California passes this bill into law (very likely), Reference Based Pricing in California will take off in the private sector. No network plans, similar to what we have implemented in Texas since 2007, will have solved the problem of balance billing risk. And if Texas passes a similar law TPA’s like Caprock Health Plans and Continental Benefits, both of which administer Reference Based Pricing plans will achieve new business sales that will make Ben Feldman look like an amateur.

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