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aetna
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Carilion Clinic and the insurance company Aetna plan to join forces to develop new insurance plans aimed at rewarding providers for producing better patient health outcomes while lowering costs. The collaboration changes the health care landscape in the region by putting a major, publicly traded insurance company and the region's largest health care provider on the same side. Traditionally, insurance companies and providers often are locked in fierce negotiations over contractual payments.
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Introduction. II. ERISA Preemption and Jurisprudence. A. What is ERISA?. B. ERISA Preemption. III. The Davila Decision. A. Juan Davila and Ruby Calad. B. The Arguments. C. The Supreme Court's Ruling. IV. Implications for the Healthcare Industry. A. Implications for HMOs. 1. A Positive Development For Hmos. 2. Effects Of A Contrary Decision. 3. Are Hmos Liable After Aetna?. B. Implications for Consumers. 1. Can Consumers Sue Hmos After Aetna?. 2. Consumer Alternatives To Erisa. 3. Consumer Relief Under Erisa. C. Implications for States. 1. "Independent" Of Erisa. 2. State Insurance Laws. V. Conclusion.
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One of the nation's largest insurers has sued six North Jersey physicians over bills it considers "unlawful and excessive," including $56,980 for a 25-minute bedside consultation. In one case, Aetna Inc. claims it paid a Ridgewood neurosurgery practice $3.9 million more than it was entitled to receive. It also alleges the practice billed a patient $116,000, even after the insurer had provided payment in full.
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In a down-to-the-wire deal made hours before their contract expired, the East End Health Alliance today said they reached an agreement with Aetna that will keep its hospitals in network for two years. The group - Eastern Long Island Hospital, Peconic Bay Medical Center and Southampton Hospital - said they reached a two-year deal with Aetna US Healthcare.
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Aetna and Carilion Clinic have launched four new health plans aimed at small businesses in the Roanoke Valley. The plans, marketed under the name Aetna Whole Health, are the first commercial products to come out of the relationship between Carilion and Aetna. The partnership was announced in March with the intention of forming an accountable care organization to identify ways to improve patient health and drive down costs.
