Elevance Says Its Controversial Fine For OON Referrals Will Soon Apply To NY
The insurer's policy to penalize hospitals that send patients to out-of-network providers has been introduced in 11 other states. In New York, with a few exceptions, hospitals’ pay could be cut by 7.5% if the insurer's members are directed elsewhere for care.
Modern Healthcare:
Elevance Health’s Out-Of-Network Penalty Expands To New York
Elevance Health will apply its policy deducting pay from hospitals that refer some members to out-of-network providers to facilities in New York. Starting July 1, Elevance Health’s Anthem Blue Cross Blue Shield subsidiary may reduce New York hospitals’ pay by 7.5% or terminate facilities from its network if hospitals refer commercial members to inpatient or outpatient providers without a contract. (DeSilva, 4/3)
More about the health care industry —
Stat:
What Does UnitedHealth Group's Massive AI Push Mean For Patients?
UHG is spending billions to embed AI to manage claims and care decisions. As 22,000 software engineers go to work, what are the benefits — and risks? (Ross, 4/6)
Modern Healthcare:
Employer Health Plan Fraud: How Insurers Use AI To Fight Back
The federal government is not the only target for health insurance shenanigans. Fraud in employer-based insurance may not reach the heights or capture the headlines that Medicaid, Medicare and exchange incidents do, but schemes are on the rise. driving up costs for companies and their workers. Health insurers are investing in new technologies to tamp down on fraud before it comes out of their employer customers’ pocketbooks. At the same time, more third-party payment integrity firms are emerging to dispute bills employers already have paid. (Tepper, 4/3)
KFF Health News:
KFF Health News’ ‘On Air’: Journalists Capsulize Weight Loss News And ACA Premium Pressures
Céline Gounder, KFF Health News’ editor-at-large for public health, discussed a new weight loss pill approved by the FDA on CBS News’ CBS Mornings on April 2. (4/4)
In pharma and tech news —
Stat:
How A Four-Month FDA Delay Forced A Small Biotech Company To Close Its Doors
By the time FDA agreed to meet with Kezar Life Sciences it was in the process of closing. The chain of events fits a pattern of FDA volatility recently. (Chen, 4/6)
CBS News:
Scientist Whose Mother And Sisters Died Of ALS Complications Hopes Experimental Treatment Will Save His Life
Jeff Vierstra's mother and two sisters all died following complications from ALS, or Amyotrophic Lateral Sclerosis, but the scientist and skier is hoping an experimental treatment and the first known attempt to prevent the neurodegenerative disease can help save his life. Vierstra was only two years old when his mother died. All her siblings also died of ALS in their late thirties and early forties. (LaPook, 4/4)
NBC News:
Eye Drops Sold At Walgreens, CVS Recalled Over Safety Concerns, FDA Says
A pharmaceutical company has issued a voluntary recall of over 3 million of its over-the-counter eye-drop products after the Food and Drug Administration cited a “lack of assurance of sterility.” According to the FDA notice, K.C. Pharmaceuticals, of Pomona, California, manufactures the products for a number of brands sold under names such as “Dry Eye Relief Eye Drops,” “Sterile Eye Drops” and “Artificial Tears Sterile Lubricant Eye Drops.” The recall of 3,111,072 bottles began in early March. (Ozcan, 4/3)
Los Angeles Times:
Microplastics Have Been Found Everywhere. That's A Problem For Research
As the science of detecting microplastics matures, so too does consensus about their ubiquity. Everywhere researchers have looked to find them, there they’ve been: In human brains and lungs; in breast milk and semen; in alpine snow and deep-sea sediment; in corn plants and beer. And that, say researchers, is the rub: Scientists are not just finding them in our livers, arteries and ovaries. They are also everywhere else: in research laboratories, pipettes, refrigerators, solvents, bottles, goggles and the very lab coats investigators are wearing to find them. (Rust, 4/5)
