Category Archives: Uncategorized

Walmart to remain in CVS Network

A lot of back and forth, with public announcements in the last 10 days, but in the end- Walmart has reached an agreement to remain in the CVS network.  So, nevermind!

The battle was over Walmarts demand for higher-reimbursements for its in-store pharmacies.

Oxford New Assistant Surgeon and Co-Surgeon Protocol eff Jan 1, 2019

NOTE- in the past an in-network surgery was generally considered in network for all providers.  This is slowly changing.. and may have financial implications, as most Oxford members do NOT have out of network coverage:

 

We are implementing an assistant surgeon and co-surgeon services protocol with our New York participating (network) providers. Under the protocol, network providers are required to tell their Oxford patients if they are recommending, involving or referring a nonparticipating (out-of-network) assistant surgeon or co-surgeon in the member’s care. The protocol is consistent with New York law that includes protection for consumers from surprise medical bills.

What is changing?

consent form has been created to confirm the members choice of provider when assistant or co-surgeon services are needed. Beginning Jan. 1, 2019, doctors and members will discuss the option of a non-participating assistant or co-surgeon and the financial consequences of using an out-of-network provider. Members will read and sign the consent form confirming their choice to use a network or out-of-network provider and their understanding of the financial impact.

Cigna dispute with Atlantic Health System in New Jersey

From CIGNA.  Note that both companies continue to negotiate and that this is a normal and required notice during these negotiations::

I am writing to let you know about a potential change to the Cigna network of participating hospitals in New Jersey that may affect some of your employees.

We have been negotiating with Atlantic Health System for a contract renewal but have not been able to reach an agreement at this time.  If we are unable to reach an agreement, the effective termination date will be February 1, 2019. At this time, we are mailing required notices to impacted customers to share an update about this potential change.

To comply with New Jersey law, Cigna and Atlantic Health System must continue to cover all services and abide by all terms of the contract for a four-month period (the “cooling off” period) following the termination of the contract.   During this period, members with HMO/HMO POS Cigna products may continue to access inpatient and outpatient services at Atlantic Health System as in-network covered services subject to our usual authorization and referral processes. For members in these plans, the hospital will be out of network effective June 1, 2019.

The New Jersey statutory “cooling off period” provisions described above do not apply to hospital services for members who are not covered HMO/HMO POS products. For members outside of these plans, the hospital will be out of network effective February 1, 2019.

Atlantic Health System has been a valued part of our health care professional network for many years and Cigna prefers that they remain in the network.  We are committed to continuing discussions with them and are hopeful that we will come to a mutually acceptable agreement. We would welcome Atlantic facilities and physicians to remain part of our network, but only on fair terms that ensure local access to care at an affordable cost now and in the future. Atlantic Health is already generating a healthy profit margin on Cigna’s business, well in excess of their costs. According to our analysis, if we were to agree to what Atlantic Health System is requesting, our clients and customers would be charged more than what the competitive rate for Atlantic’s services are in the market. If you’d like to reach out to Atlantic Health Systems’ leadership to urge them to work with us to reach a fair deal, please reach out to Kevin Lenahan, SVP Chief Financial & Administration Officer at (973) 660-3565.

Cigna has a broad network in New Jersey and our customers will continue to have access to hospital services through the remaining Cigna network of hospitals in the area.  A full listing of hospitals is available in our online directory located at www.cigna.com.

 

Cigna closes $54 billion purchase of Express Scripts

NEW YORK (Reuters) – Cigna Corp (CI.N) on Thursday closed its $54-billion deal to buy Express Scripts Holding Co, creating one of the biggest providers of pharmacy benefits and insurance plans in the United States, a combination it says will help it improve healthcare coordination and cut costs.

Cigna’s deal puts it in direct competition with two other healthcare companies set up the same way – Aetna with CVS Health Corp (CVS.N) and UnitedHealth Group Inc (UNH.N) with Optum. Cigna’s deal has already passed antitrust scrutiny.

Cigna will start offering new products next year to its corporate health insurance customers, including access to Express Scripts’ specialty pharmacy, which has cost savings programs in treatment areas such as cancer, its top executive said in an interview on Thursday.

Prescription drugs that require special handling and are delivered to a doctor’s office or patient home by specialty pharmacies are a growing part of employer healthcare spending and rising U.S. drug costs. Many new drugs costs tens of thousands of dollars when they are launched and drugmakers raise the price of older drugs once or twice a year.

The company will also try to improve products and services by integrating healthcare data, he said.

“There’s a lot of data available today but it’s either not aggregated in a singular place or coalesced in a way that’s intuitive,” Cigna Chief Executive Officer David Cordani said in an interview.

Oxford/United health agrees with CityMD

Highlights

We are pleased to announce that UnitedHealthcare has reached a new agreement with CityMD.

Members may continue to use CityMD on an in-network basis, with no disruption in care. We are sending letters to impacted members who got our earlier notice about the potential network disruption to let them know about this good news. Sample letters are enclosed for your reference.

Attachments

  • Broker eBulletin
  • Sample UnitedHealthcare fully insured member letter
  • Sample Oxford member letter
  • Sample UnitedHealthcare employer letter template
  • Sample Oxford employer letter template

 

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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