Insurance News Updates Archives
Insurance News Updates Archives

Insurance News Updates Archives

Anthem, a subsidiary of BCBS, has been fined $5 Million by the Georgia Insurance Commissioner for claims processing errors dating back to 2015. Just one of the claims processing errors caused claims for services by in-network providers to be billed as out-of-network.


Anthem BCBS is in contract negotiations with Northside Hospital System. Coverage has been extended to April 15, 2022. If you are on an Anthem Medicare Advantage Plan or other HMO/PPO you are affected by these negotiations. Those on Anthem Medigap and BCBS Medigap plans are not affected.


The Biden Administration has had talks about cutting funding for Medicare Advantage plans in order to help fund their infrastructure package. Cutting funds to MA plans would greatly increase the cost of these plans for beneficiaries and could greatly reduce benefits.


CMS has announced the Medicare Part B Premium will go up to $170.10 (Standard) and the Part B Deductible will be $233 in 2022. Keep in mind, you will receive a 5.9% COLA increase on your Social Security.


Effective January 1, 2022, the entire Wellstar Hospital system, including Wellstar providers, are out-of-network with UnitedHealthcare. All contract requests were agreed to by UnitedHealthcare with the exception of one: group plans would see an increase in reimbursements by as much as 50% making it unaffordable to employees. Wellstar is already the highest paid hospital system in Georgia. Read more about it here


The Biden Administration has had talks about cutting funding for Medicare Advantage plans in order to help fund their infrastructure package. Cutting funds to MA plans would greatly increase the cost of these plans for beneficiaries and could greatly reduce benefits.


October 12, 2021, UnitedHealthcare has confirmed Wellstar Health System in-network access has been extended to December 31, 2021. Wellstar’s contract with UnitedHealthcare ended October 3, 2021, and negotiations are ongoing.


October 8, 2021, Centers for Medicare and Medicaid has issued guidance to insurers regarding deceptive marketing practices. Statistically, 62.6 million people are enrolled in Medicare and marketing to this group is rampant with fraud. At the heart of this fraud are commercials and call centers. The commercials feature well known spokepersons who promise “free benefits” not availble for most people and play upon fears. Additionally, phone calls and door knockers are included in this group. It remains to be seen when changes will be occur.


In Georgia, Wellstar Health Systems may be out of network for UnitedHealthcare Medicare Advantage Plans effective October 3, 2021. Contract negotiations are ongoing. Wellstar Health Systems is seeking a reimbursement increase of over 20%, making their services 50% higher than other hospitals in Georgia.


A new infusion therapy drug purported to treat mild Alzheimer’s, has been rushed through FDA approval despite serious concerns about its effectiveness as well as side effect including swelling and brain bleeding during clinical trials. If ineffective, this infusion therapy would cost thousands in out-of-pocket costs for Medicare Advantage members.


Bipartisan legislation that would establish electronic prior authorization for Medicare Advantage plans has been introduced to House of Representatives. Improving Seniors’ Timely Access to Care Act (H.R. 3107) would establish electronic prior authorization for Medicare Advantage plans allowing for real-time decisions on tests and services commonly approved. Electronic PA would improve patient access to timely care and reduce paperwork and appeals.


Medicare recipients in Georgia, Alabama, Florida, North Carolina, Tennessee and Virginia may be eligible for a Special Election to make a plan change. Please contact us for further information.


Biden Adminsitration has approved a Special Enrollment Period for individual health plans. If you missed the annual enrollment, you now have until August 15, 2021, to choose a plan.