Anthem Sues Express Scripts for Over-Charging

Hospitals and providers aren’t the only suspected culprits in over-charging payers for services. Pharmacy benefit managers may also bear some of the responsibility for escalating claim costs.

According to the article, Anthem sued Express Scripts for $15 billion last year, claiming the company had charged too much for drugs and sought to terminate a 10-year contract.

http://www.stl.news/st-louis-based-express-scripts-to-lose-its-biggest-client/22727/

Struggling with high-dollar claims? We can help.

 

Three of the Biggest Issues in Healthcare

Three of the biggest issues in healthcare today:

1. Transparency.

2. Transparency.

3. Transparency.

For payers, the lack of transparency represents hidden charges, overcharges, duplicate charges, unnecessary procedures and upcoded procedures that often lead to high-dollar claims. Most rely on in-network discounts to offset the cost and believe that in-network claims can’t be negotiated and willingly pay without review. But that’s not always the case.

Check out this article on medical billing transparency:

http://www.latimes.com/business/lazarus/la-fi-lazarus-healthcare-billing-transparency-20160816-snap-story.html

 

Have high-dollar in-network claims? Give us a call. We can help.

Erik Fuglestad Returns to EthiCare Advisors

EthiCare Advisors Welcomes Back Erik Fuglestad We are excited to announce that Erik Fuglestad has re-joined the EthiCare Advisors team as Managing Director & Chair of the Management Committee. In this new role, Erik will oversee the Dialysis Team as well as the Sales and Operation Depts. In addition to his previous tenure at EthiCare, Erik has worked in management positions for multiple dialysis providers. His dialysis claims expertise and proven management skills are a great addition to our team and a great asset for our clients. Erik@EthiCareAdvisors.com, 888.838.4422 ext 706.

Dialysis Centers Continue to Consolidate

Competition in the dialysis treatment center market continues to dwindle with DaVita’s purchase of Purity Dialysis (see linked article below). With ongoing market consolidation in the dialysis treatment industry, medical claim payers have fewer and fewer options. And fewer options equates to less pricing competition which in turn adds to DaVita’s $14.6 billion in revenue last year.

http://www.jsonline.com/story/money/business/health-care/2017/05/08/davita-buys-purity-dialysis/101438464/

Will Partnership Save Payers Money on Dialysis Claims?

The linked article draws attention to the anticipated cost savings of the Cigna/Fresenius partnership and highlights Medicare as the largest payer. But what is the takeaway here for commercial payers? We presume they’ll continue to receive high-dollar dialysis claims while Cigna and Fresenius will increase their revenues. “If Fresenius Health Partners, the care management arm of the multinational company, is able to reduce overall costs, Cigna and Fresenius will share in the savings.”

http://www.courant.com/business/hc-dialysis-managed-care-20170406-story.html