Tag Archives | ACA

The Evolution of Health Plans

The health plan you purchase today may not resemble the plan of your parents or grandparents at all. For decades, Americans received healthcare under the traditional fee-for-service system. Insurance companies reimbursed patients or payers based on every service provided to patients. This seemed logical on the surface, yet problems became clear as the industry realized […]

The Consumerization of Healthcare

Healthcare has changed drastically in the last six years, but these changes are not all due to the Affordable Care Act (ACA). Prior to changes in the way we purchase health insurance, advancements in technology and evolving patient preferences began to move the healthcare industry toward a more consumer-oriented landscape. This consumerization of healthcare is […]

Changes in the Exceptions Process in Prescription Coverage [Infographic]

Prescription drug coverage is changing in 2017, with new specific rules for the exceptions process. Take a look at our latest infographic to find out how the exceptions process may affect your prescription!  

Issues Facing Men’s Health Today: Lack of Preventative Care

One of the ways men stay healthy throughout their lives is by participating in continuous medical care. By going to physicians they are familiar with for regular checkups, doctors are able to guide people’s behavior and health – or more importantly, notice signs of a potential problem. The point of these checkups is preventative care, […]

Reimbursements Driving Better Clinical Outcomes in Behavioral Health

Over the past few years, America has witnessed its health care system shift from a predominately pay-for-service model to one with various reimbursement models that focus on long-term behavioral health improvements, promoting efficiency and reducing costs. It may seem like a tall order for physician payment methods to improve patient care, but the industry agrees […]

The Latest Facts on the Mental Health Crisis in America

Mental Health

Approximately 43.6 million adults in the U.S. suffer from some type of mental illness, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). That is more than 18 percent of the U.S. population. At that rate, it’s nearly impossible for someone to go their whole lives without either experiencing mental illness first hand […]

Changes Ahead for Insurers, with Implications for IROs

As we reach the last quarter of 2015, it’s worth taking a look at some of the important regulatory changes that will affect health insurers next year and in 2017.   Earlier this year, the Department of Health and Human Services released the Notice of Benefit and Payment Parameters for 2016 final rule, which contains […]

How Has the Affordable Care Act Affected IROs?

How Has the Affordable Care Act Affected IROs? A crucial consumer protection in the Affordable Care Act — the right to appeal to an outside entity when an insurance company denies payment – received relatively little public attention -but it’s creating noteworthy opportunities and challenges for independent review organizations (IROs). The Affordable Care Act (ACA) carves […]