$5.5 billion dollars. This number reflects UnitedHealth Group’s recently reported net earnings in Q2 alone - up 8 percent year over year. UnitedHealth Group's second-quarter earnings report was released July 14 and reflected double-digit growth in revenue year over year across UnitedHealthcare and Optum. Total revenues in the second quarter were $92.9 billion, up 15.7 percent YoY. These numbers powerfully contrast with shrinking provider profit margins and reflect the imbalance between two systems that will need to work together in order to keep healthcare accessible. Learn more about the Q2 report: https://zurl.co/DOHK #healthcare #healthinsurance
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ECURE Health is now Allia Group. Why the name change? We wanted our name to be equally as powerful as the work we do. Read the story below to learn more. How did Allia Group get its name? Let’s travel back in time over 5,000 years to Ancient Rome, where a major battle at the Allia River between the powerful city-state and the much smaller Gaul army of Italy changed the course of history forever. This Roman defeat at the Allia River had a profound impact on their military—what Rome won in over a hundred years was lost in a single battle. This battle is similar to the one being fought today. For years, insurance carriers have built an empire while severely underpaying healthcare providers. What insurance carriers have amassed in power, Allia Group counteracts, balancing the scales by creating power in numbers and defeating these insurance goliaths. Read the full story: https://lnkd.in/gTzQqBzm #healthcare #healthinsurance #outofnetwork #revenuerecovery #revenuecyclemanagement #emergentcare #capitalsolutions #healthsystems #alliagroup
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This amicus brief in support of #airambulance entities is a crucial step in ensuring that #emergencycare providers, whether air ambulances, clinicians, or hospitals, receive the compensation they deserve for life-saving services. For the #NoSurprisesAct IDR process to be effective, its arbitration awards must be enforceable in federal court.
The US Gov’t amicus brief to the US Court of Appeals for the Fifth Circuit supporting the plaintiff air ambulance entity’s right to sue in federal court to enforce the determination by the Independent Dispute Resolution (IDR) Entity (IDRE) in a #NoSurprisesAct IDR is significant on several important points. That the plaintiff here is an air ambulance entity would not negatively impact the decision if the plaintiff were a clinician or hospital. The IDR rules are slightly different for air ambulance but that would lessen the importance of a positive ruling to the gov’t case by the Fifth Circuit. Here’s a brief summary of their argument: The U.S. government’s case in this document centers on defending the right of medical clinicians, particularly air ambulance companies, to enforce payment awards from the independent dispute resolution (IDR) process established under the No Surprises Act (NSA). The NSA was designed to prevent patients from receiving unexpected medical bills from out-of-network providers, such as air ambulances, by requiring insurers to pay these providers a fair rate determined by an arbitration process if they cannot agree on a payment. The government’s argument explains that the IDR process should be binding, meaning that once an arbitrator decides how much the insurance company owes the clinician, that decision should be enforceable in court if the insurance company refuses to pay. The government also argues that under another law called ERISA (which protects employee health plans), patients and their medical providers can sue insurance companies if they don’t pay the amount set by the IDR process. In short, the government supports air ambulance companies’ right to get paid for their services according to the rules set by the No Surprises Act, and it wants to ensure that these companies can take insurance companies to court if they refuse to pay what the arbitrator decided. Without getting overly technical, the NSA incorporates the Federal Arbitration Act (FAA) by reference to say that IDRE awards may only be set aside by a federal court if they were found to have been impacted by fraud or malfeasance. Arbitration awards that incorporate the FAA generally may be enforced in federal court. Here, the US Gov’t says essentially that and that Congress fully intended by their express language in the NSA that such awards could be enforced in federal court. There is also a US district court case in NJ that reached a positive conclusion on enforceability. The lower federal district court in TX reached the opposite conclusion, and hence the appeal.
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Neurointerventionalists face significant challenges recovering out-of-network payments from underpaying insurers. A study by the Harvey L. Neiman Health Policy Institute has found that the #IDR process is financially unviable for most neurointerventionalists due to high fees and low claim batching opportunities. For large stroke centers, only 13.2% of claims were able to recover payments exceeding the IDR costs, while medium and small centers saw even lower success rates. The study highlights the limited ability to batch sufficient claims to make the process cost-effective, leaving many providers under-reimbursed despite the IDR option. “Rulemaking provided insurers with lopsided power resulting in potential diminution of in-network providers," stated Dr. Joshua Hirsch, MD, Neiman Institute Affiliate Senior Research Fellow and Vice Chair Procedural Services, Massachusetts General Hospital. Allia Group’s pioneering litigation platform can be a favorable alternative to IDR for neurointerventionalists looking to recover revenue. Learn more: https://lnkd.in/eFQNZHGv #NoSurprisesAct #HealthInsurance #Underpayments #RevenueRecovery
Neurointerventionalists rarely recover payment for out-of-network mechanical thrombectomy under No Surprises act
medicalxpress.com
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Payer #ClaimsDenials continue to torment providers, as nearly three in four healthcare providers reported an increase in #denials between 2022 and 2024. A recent survey from Experian Health revealed that #reimbursement wait time has increased, and 77% of providers expressed moderate to extreme concern that payers will not cover promised healthcare costs. In order for the system to work for patients and providers, payers must be held accountable for their share of #healthcare costs. Learn about the survey findings here: https://zurl.co/T7dL #healthinsurance
Providers say claims denials are increasing: survey
healthcaredive.com
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A Louisiana jury awarded the St. Charles Surgical Hospital and Center for Restorative Breast Surgery over $421 million in a lawsuit against Blue Cross Blue Shield (BCBS) of Louisiana for underpaying claims. The hospital accused BCBS of not reimbursing them for 9,000 previously authorized procedures over a decade. The jury ruled 11-1 in favor of the hospital, citing that BCBS either slow-paid, low-paid, or failed to pay for these procedures, leading to one of the largest awards of its kind in Louisiana. A co-founder of the hospital celebrated this verdict as a “landmark” win “for all those who have felt bullied by big corporate #healthinsurance and the self-serving things they do.” For more information, visit https://lnkd.in/gGeH9Ts2 #reimbursement #underpaidinsuranceclaims #litigation
Hospital gets $421m ‘landmark’ verdict after insurer found to underpay claims
theguardian.com
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Litigation against insurance giants can be complex, time-consuming, and incredibly costly for healthcare providers, often making it financially unfeasible to pursue unpaid claims. Allia Group’s unique litigation platform changes the game. By bundling claims from multiple providers into a single lawsuit, we improve the economics of the case and expose the systemic underpayment practices of insurers, maximizing returns for all involved. Let Allia Group handle the legal and data heavy lifting so you can focus on what matters most: patient care. Learn about this strategy from our general counsel and head of litigation strategy, Justin Fitzdam. For more healthcare legal finance insights, read our blog: https://lnkd.in/esEm2kVG #HealthcareRecovery #RevenueOptimization #LitigationSupport
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The FTC filed a lawsuit last week against the three largest PBMs in the U.S.— including UnitedHealthcare’s OptumRx—accusing them of engaging in anticompetitive practices that inflated the prices of #insulin. The suit alleges that these PBMs manipulated the #pharmaceutical supply chain by steering patients towards higher-priced insulin drugs in exchange for larger rebates from drug manufacturers, leaving many patients with higher out-of-pocket costs. The FTC claims that these PBMs, controlling about 80% of U.S. #prescriptions, abused their power, forcing patients to pay more for essential medication. The FTC pointed to a stark increase in insulin prices—Eli Lilly’s Humalog rising from $21 in 1999 to over $274 by 2017—as an example of the impact of #PBM practices. Lawsuits like this help to address harmful consolidation trends and bad behavior in the #healthcareindustry. For more details, read the full article: https://lnkd.in/dT_KRM7S
FTC sues major pharmacy benefit managers over insulin prices
healthcaredive.com
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#Healthcare #providers are facing unprecedented challenges due to reduced margins, largely driven by insurers' underpayments. To counteract this, providers must adopt innovative #reimbursement strategies. #LegalFinance solutions, like Allia Group’s pioneering platform, empower providers to challenge insurers and secure fair reimbursement - without straining their resources and allowing them to focus on patient care. Learn how this approach transforms healthcare reimbursement and revenue recovery in our series, “6 Ways Legal Finance is Transforming Healthcare Provider Reimbursement Strategy.” Read the full article by visiting https://lnkd.in/esEm2kVG.
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Blue Cross Blue Shield of Texas has stuck a Columbine shooting survivor with a $72,000 medical bill after denying any coverage for an #AirAmbulance flight, claiming it was "not medically necessary." In 2020, Joey Blom experienced a mental health crisis stemming from PTSD and medication changes, which led to her being airlifted during a life-threatening emergency. Despite the medical transport company supporting the appeals, Blom’s #healthinsurance continues to deny coverage, leaving her under constant financial stress as she receives frequent bills. Blom's case predates the protections of the #NoSurprisesAct. Since the law is not retroactive, it cannot assist her situation. Insurers should presume medical necessity for air-ambulance rides as the transport can be the key difference in saving a life. For more information, visit https://lnkd.in/eQ_Pi2nC.
Columbine survivor stuck with $72K medical helicopter bill after insurance said they won’t pay
https://kdvr.com
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A recent report by Americans for Fair Health Care (AFHC) revealed that over one-fifth (22%) of insurers failed to pay awards determined by the federal #IDR process in 2023, and 35% of payments were not made within the required 30 days. This has led to significant financial strain on #healthcareproviders, who are often forced to rely on IDR for reimbursement due to contract cancellations and other insurer actions. This report also found that 94% of insurers frequently submitted #QPA values at or below Medicare rates, skewing IDR in favor of insurers. Despite a reduction in some problematic behaviors compared to 2022, such as threats of contract terminations (down from 100% in 2022 to 53% in 2023), insurers' non-payment and delayed payment behaviors persist, exacerbating financial challenges for providers. For more detailed insights, read https://lnkd.in/eJhvT8Ea
More than one-fifth of insurers failed to pay No Surprises awards last year, provider lobby says
healthcaredive.com
