TAG:

managed care contracting

Anthem Rolling Out More Anatomic Path Price Cuts

CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology groups. Getting most of the attention at the moment are the insurer’s letters announcing price cuts for anatomic pathology services of 50% to 70% of Medicare fees. But another major change may also tr…

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Anthem Rolling Out New Pathology CPT Code Cuts

This is a synopsis of a 2,120-word article in the July 1, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group.  CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology (AP) groups. Getting most o…

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Lower Prices, More Data in UHC’s New Lab Network?

CEO SUMMARY: It’s been a common strategy among managed care payers to seek the lowest prices for clinical laboratory testing when negotiating contracts with labs. However, lower prices may become less important over time as the health system moves away from fee-for-service payment towar…

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UnitedHealth Rumored to Be Excluding Labs from Its Network

IN RECENT DAYS, RUMORS HAVE SURFACED that UnitedHealthcare has begun to terminate the contracts it holds with a number of regional and non-national clinical laboratories. This news surfaced just as The Dark Report went to press. Given its importance to the clinical laboratory indust…

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Seismic Shift in Managed Care Contracting for Labs?

RECENTLY TWO OF THE NATION’S LARGEST HEALTH INSURERS abandoned a managed care contracting strategy that they adopted 11 years ago. Back in 2007, UnitedHealthcare and Aetna each were willing to grant exclusive national provider status to a single lab company in exc…

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Lab’s Low Gene Test Price Gets Insurers’ Attention

CEO SUMMARY: At a time when most molecular and genetic testing companies are struggling to gain coverage for their tests, this Silicon Valley-based lab company has become an in-network lab provider for a number of health insurers—including three of the nation’s largest payers. It did …

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California company shows labs the way with low genetic testing cost

This is an excerpt from a 1,485-word article in the June 5, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. CEO SUMMARY: At a time when most molecular and gene…

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March 13, 2017 Intelligence: Late Breaking Lab News

There’s bad news for clinical labs and pathology groups that lack the capability of collecting copays, deductibles, and out-of-pocket payments from patients at time of service. As of October, 2016, four out of every 10 Americans under the age of 65 with health insurance had a high-deductible health…

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Attorney Jane Pine Wood to Be Chief Legal Counsel at Bio-Reference

One of the most widely-respected and trusted attorneys serving the clinical laboratory industry and anatomic pathology profession is leaving private practice to join the corporate world. …

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Anatomic Pathology Profession Faces Challenges, Opportunities

CEO SUMMARY: For 10 years, three primary trends have reshaped the anatomic pathology profession. They are declining reimbursement, competition from physicians establishing in-office pathology labs, and a host of new government laws and regulations. More changes are coming, predicts one bu…

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