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On Aug., 1, 2017, Brittany Cloyd of Frankfort, Kentucky, said she experienced pain "worse than childbirth." Her mother -- who had been to nursing school -- drove her to the nearest emergency room. Brittany thought her appendix had burst, but tests at the ER found she had ovarian cysts. She was given pain medication and told to follow up with her primary doctor.

Cloyd had an Anthem Blue Cross PPO health insurance plan and thought she would get charged just a co-pay for her ER visit. Instead, 15 days later she received a letter from health insurer Anthem. "Your condit...

A new study from public accounting, technology and consulting firm Crowe suggests that hospitals think long and hard before outsourcing their revenue cycle. It's not a financial no-brainer for everyone.

Crowe analyzed hospitals in 45 states: 553 hospitals within Medicaid expansion states and 378 hospitals in non-expansion states as of 2018. Metrics included accounts receivable, denials, bad debt, credit balance and cash to expected pay.

The analysis found that while hospitals that outsource that revenue cycle collect more patient balance payments, getting the money t...

Optum subsidiary Optum360 and U.S. Bank are partnering on innovation geared toward enhancing providers' ability to optimize the revenue cycle. 

The two companies are partnering on an expanded suite of capabilities to help hospitals and providers better manage their revenue cycle, combining Optum's focus on healthcare technology and US Bank's financial expertise. Said Samuel Robb, U.S. Bank  senior vice president and head of receivables in the Global Treasury Management Group.

The technology suite called Healthcare Receivables Manager is slated to launch later in the...

The DC District Court cited damaging market ownership and considerably large anti-competitive implications as basis for the Cigna-Anthem merger block.

The full opinion of United States District Court for the District of Columbia blocking Anthem’s acquisition of Cigna became publicly available earlier this week and provides details into the court’s decision.

In the memorandum opinion, Judge Amy Berman Jackson based the bulk of her decision on the effects of the Anthem-Cigna merger on market competition. In particular, the judge keyed in on the example of the insurance...

California has one the nation’s lowest number of hospital emergency rooms per capita, and Bay Area legislators are calling this shortage a crisis, as the number of people who need urgent care services keeps growing. They are pushing for a bill that would require non-profit hospitals to obtain approval from the state Attorney General and hold at least one public hearing before closing their emergency departments.

In February, California State Senator Nancy Skinner, who represents the 9th District covering both Richmond and Oakland, introduced Senate Bill 687, designe...

The megamerger between the health insurers Aetna and Humana has been blocked by a federal judge.

The deal, in which Aetna proposed to buy Humana for $37 billion, has been ruled anticompetitive by US District Judge John Bates.

"In this case, the government alleged that the merger of Aetna and Humana would be likely to substantially lessen competition in markets for individual Medicare Advantage plans and health insurance sold on the public exchanges," Bates' decision said.

"After a 13-day trial, and based on careful consideration of the law, evidence, and arguments, th...

HSBC Holdings Plc will pay $32.5 million to settle claims that it failed to follow a U.S. regulator’s orders to improve mortgage foreclosure practices that led to borrowers being harmed after the 2008 credit crisis.

The Office of the Comptroller of the Currency levied the fine after concluding that HSBC is now in compliance with the agency’s orders going back to 2011. The London-based bank was one of many big U.S. mortgage servicers that reached agreement with regulators to review problems that led to borrowers facing improper foreclosures.

“We’re pleased with the OC...

The Association of American Physicians and Surgeons (AAPS) filed suit in U.S. District Court on Friday asking the Court to block California AB 72, the so-called “Surprise Medical Bill” law signed last month by Governor Jerry Brown.

“This new law gives insurance bureaucrats the power to decide what out-of-network physicians can be paid for life-saving medical care,” said AAPS General Counsel Andrew Schlafly. “Independent doctors, already under attack from all directions, could be forced to shut their doors. Patients are already having trouble finding doctors, and thi...

Gov. Jerry Brown is approving legislation that seeks to stop surprise medical bills from doctors not covered by a patient’s health plan.

Brown said he’s signed AB72 by Assemblyman Rob Bonta of Alameda.

Unions and patient advocacy groups say patients shouldn’t face massive bills if they visit a hospital that accepts their insurance but are treated by a doctor who doesn’t. Unexpected bills commonly come from radiologists, pathologists and anesthesiologists who get involved in diagnosing or caring for hospitalized patients.

“This is a big win for Californians who have be...

The N.C. Department of Insurance has levied a record $3.6 million fine against Blue Cross and Blue Shield of North Carolina for chronic malfunctions that have led to billing and enrollment errors for Blue Cross customers since January.

The Insurance Department and Blue Cross, the state’s largest health insurer, agreed to the fine amount Thursday, ending a six-month agency investigation in what has been the most challenging year in the insurance company’s history. The agency cited a spate of problems, including over-billing, double-billing, failing to confirm coverag...

The scandal that hit Wells Fargo has revealed a number of things still wrong with our financial system and reminds Main Street participants that Wall Street continues to not play by the rules. Wells Fargo Chairman and CEO John Stumpf testified before the U.S. Senate Banking Committee this month, skirting around the fraud committed by his employees for opening fictitious bank accounts to boost sales quotas.

Mr. Stumpf repeatedly offered his apologies for the behavior of some 5,300 employees opening over two million bogus consumer accounts, but refused to accept...

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