Blue Shield Disaster Assistance, Health Net Renews with Sutter Health, Cigna Sells Medicare Businesses, Updates, News & More
Thursday, February 01 2024
Governor Gavin Newsom declared a state of emergency to support disaster response and relief in the California counties of San Diego and Ventura. Blue Shield of California is working to help ensure the safety and care of our members during this difficult time. You may be eligible for assistance if you're a Blue Shield of California or Blue Shield of California Promise Health Plan member in the affected counties. How to access the care you need Allowing the immediate refill of prescriptions for members in affected counties – even if they are not due to be refilled. Blue Shield will reach out to members enrolled in care and disease management programs who are in affected counties to ensure continuity of care. Some plans offer virtual care options that may differ slightly depending on your plan. Some of these telehealth options are Teladoc and NurseHelp 24/7SM. To view your plan options, please visit your plan websites: Blue Shield of California: www.blueshieldca.com Blue Shield of California Promise: www.blueshieldca.com/promise For behavioral health services, contact the Customer Service number listed on the back of your member identification (ID) card or call: Blue Shield of California (800) 327-7451 [TTY: 711] from 8 a.m. to 8 p.m., weekdays Blue Shield of California Promise Health Plan (855) 765 - 9701 [TTY: 711] from 8 a.m. to 8 p.m. weekday For mental health crises, call text, or chat with the National Suicide Prevention Lifeline by dialing 988 or calling (800) 273-8255 [TTY: 711], 24 hours a day, 7 days a week. Vision plan members in affected areas can get a replacement pair of lenses and/or frames. You can use out-of-network providers as needed with claims paid at in-network costs. Please call Vision Customer Service at: Blue Shield of California (877) 601-9083 Blue Shield of California Promise Health Plan (800) 877-7195 [TTY: 711 (800) 428-4833] from 5 a.m. to 6 p.m. on weekdays and 7 a.m. to 5 p.m. on weekends If you have been displaced, you may see an out-of-network provider at in-network benefit levels. You may also replace medical equipment and supplies if needed. If you have lost your member identification (ID) card, you can view and print your card from our website at www.blueshieldca.com/login or www.blueshieldca.com/promise. Alternatively, you can use the Blue Shield of California mobile app to access your ID card on your mobile device. Plan information and services Blue Shield want to respond to the urgent needs of all affected members.If you need assistance, please call the customer service number on your member ID card. If you do not have your member ID card, call: Blue Shield of California Commercial plans: (800) 393-6130 [TTY: 711] Medicare plans: (800) 776-4466 [TTY: 711] from 8 a.m. to 8 p.m., seven days a week. Blue Shield of California Promise Health Plan (800) 605-2556 [TTY: 711] from 8 a.m. to 6 p.m. weekdays California Emergency Alerts Californians are reminded to dial 2-1-1 or 3-1-1 to get help or ask questions. If you have a critical emergency, call 911. Stay informed by signing up for emergency alerts including warnings and evacuation notices. Go to CalAlerts.org to sign up to receive alerts from your county officials. Click Here For More Information
BLOOMFIELD, Conn., Jan. 31, 2024 -- Global health company The Cigna Group (NYSE: CI ) today announced that it has entered into a definitive agreement whereby Health Care Service Corporation (HCSC) will acquire The Cigna Group's Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D and CareAllies businesses, for a total transaction value of approximately $3.7 billion. As part of the transaction, The Cigna Group and HCSC have agreed to enter into a four-year services agreement under which Evernorth Health Services, a subsidiary of The Cigna Group, will continue to provide pharmacy benefit services to the Medicare businesses, effective on closing of the transaction.The transaction is expected to close in the first quarter of 2025, subject to receipt of applicable regulatory approvals and other customary closing conditions. There is no financing condition. . "The agreement will enable The Cigna Group to drive meaningful value for all our stakeholders, providing an enhanced ability to accelerate investment and growth in our services platform, while further deepening our commitment to our existing health benefits platform. In tandem, the transaction will position our Medicare businesses and CareAllies for additional growth as they continue to serve the needs of their customers as part of HCSC," said David M. Cordani, Chairman and Chief Executive Officer of The Cigna Group. "This decision is aligned with our highly disciplined approach to managing our portfolio and allocating resources toward growth opportunities in our Evernorth Health Services and Cigna Healthcare portfolios. While we continue to believe the overall Medicare space is an attractive segment of the healthcare market, our Medicare businesses require sustained investment, focus, and dedicated resources disproportionate to their size within The Cigna Group's portfolio. We continue to see significant, meaningful growth opportunities for government services, including Medicare, in our Evernorth Health Services portfolio of businesses." Click Here to Read the Full Release
(By Stephanie Armour) The Biden administration finalized requirements to streamline the process for doctors and patients seeking health insurance approval for medical care and treatments. The rule aims to shorten the timeline for the so-called prior authorization process to as little as 72 hours for many of the tens of millions of people who get their health insurance through Medicare Advantage, Medicaid or an Affordable Care Act health plan by automating some of the processing of the requests. Plans would also have to share more information with doctors about the status of decisions and information on denials, with a turnaround time of seven calendar days for non-urgent requests. Prior authorization is among the most contentious processes in healthcare. Health plans require it before agreeing to pay for certain care to avoid unnecessary treatment and control costs. But doctors and patients loathe the process because it often involves filling out lots of paperwork and can delay care. The process has become such an object of popular frustration that some major private insurers, such as UnitedHealth Group’s UnitedHealthcare and Cigna Group, have said they were rolling it back. Both Republicans and Democrats have urged the administration to finalize a prior authorization rule for people covered by Medicare Advantage, which are plans offered by insurers that administer the program for seniors and some people with disabilities. Some of the new policies will take effect in 2026. Other provisions would start later to give health insurers and doctors time to build the automated electronic processes. After it was first proposed by the Centers for Medicare and Medicaid Services in December 2022, the rule faced some opposition from AHIP, the trade group for the insurance industry, which said the requirements would be expensive because health plans and doctors would have to install the software. AHIP on Wednesday said HHS’s Office of the Coordinator for Health Information Technology should swiftly require vendors to build prior authorization capabilities into the electronic health records. “We cannot afford to delay any further when it comes to implementing electronic prior authorization capabilities,” the group said. The American Hospital Association, a trade group for the industry, applauded the decision and said it would “help alleviate significant burdens for patients and providers” in Medicare Advantage plans. CMS estimated that the requirements would lead to cost-saving efficiencies, saving doctor practices and hospitals more than $15 billion over 10 years. Click Here For More Information
Health Net of California, Inc. (Health Net) has reached an agreement with Sutter Health (Sutter) to continue to be contracted with Health Net for all products that participate with Sutter. Health Net has reached a 3-year agreement with Sutter Health through 12/31/2026. The contract includes all currently contracted Sutter Health providers including: Hospitals, Physicians and Ancillary Providers. For More Information or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep!
(By Paige Minemyer) Patients were protected from more than 10 million surprise medical bills thanks to reforms in the No Surprises Act, according to a new survey. The analysis, backed AHIP and the Blue Cross Blue Shield Association, found that nearly 80% of claims disputed under the law were resolved before reaching the independent dispute resolution (IDR) stage, a process that has drawn ire—and legal challenges—from providers. In addition, the survey found that 67% of the 21 insurers surveyed said they have grown their provider networks since the act has taken effect, and none have narrowed their networks. The surveyed payers represent 139 million covered lives in the commercial market, or about 65% of that sector. Adam Beck, senior vice president of commercial product and employer policy at AHIP, told Fierce Healthcare that this is the third time the organizations have conducted this survey, and all three point to the same idea: Patients benefit from the No Surprises Act's changes. "I think what each of them has underscored is that the No Surprises Act is working really well for patients," he said. "And it's impacting millions of patients and millions of consumers every year, whether they realize it or not." Click Here to Read More