Tag Archives: In-Network Providers

CVS Health to acquire Aetna for $69B: 5 things to know

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https://www.beckershospitalreview.com/payer-issues/cvs-health-to-acquire-aetna-for-69b-5-things-to-know.html

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CVS Health inked a definitive merger agreement to acquire all outstanding shares of Aetna for roughly $69 billion in cash and stock.

Here are five things to know.

1. The deal, unanimously approved by the boards of directors of each firm Dec. 3, is one of the largest transactions this year. It values Aetna at about $207 per share, higher than previous estimates of $200 to $205 per share. When including the assumption of Aetna’s debt, the transaction totals $77 billion.

2. Upon closing, Aetna’s Chairman and CEO Mark Bertolini will join CVS Health’s board of directors, along with two other Aetna leaders. Aetna will operate as a standalone business unit under the CVS Health umbrella, and the insurer’s management team will helm the subsidiary.

3. The companies said the deal will provide localized, community-based care across CVS Health’s 9,700-plus pharmacies and 1,100 clinics. Sources familiar with the deal told Reuters CVS Health plans to significantly extend health services at its pharmacies under the merger.

4. The transaction is slated to close in the second half of 2018. It is subject to regulatory approvals.

5. Rita Numerof, PhD, president of Numerof & Associates, said in an emailed statement to Becker’s Hospital Review, “Having the combined market clout puts Aetna more in a position akin to UnitedHealthcare in its ability to leverage an integrated PBM in negotiating prices and establishing preferred tiers with manufacturers.” She added, “With CVS’s large and growing clinical services footprint, Aetna can steer patients to CVS pharmacies and clinics — in many cases avoiding the costs of higher ER or other outpatient services. The merger can make expanded CVS services in-network and others out-of-network, putting additional pressure on conventional health systems to lower the costs of their outpatient services.”

Seven Ways Patients Can Protect Themselves From Outrageous Medical Bills

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https://www.propublica.org/article/seven-ways-patients-can-protect-themselves-from-outrageous-medical-bills

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Experts in reducing charges for medical services say patients need to push for detailed answers up front about the true costs of their care.

A doctor offers a surgical add-on that leads to a $1,877 bill for a young girl’s ear piercing. A patient protests unnecessary scans to identify and treat her breast cysts. A study shows intensive-care-level treatment is overused.

ProPublica has been documenting the myriad ways the health system wastes money on unnecessary services, often shifting the costs to consumers. But there are ways patients can protect themselves.

We consulted the bill-wrangling professionals at Medliminal, one of a number of companies that negotiate to reduce their clients’ charges for a share of the savings. After years of jousting with hospitals, medical providers and insurers, their key advice for patients and their families is to be assertive and proactive.

Here are seven steps patients can take to protect themselves:

  1. Make sure the proposed test or treatment is necessary. Ask what might happen if you didn’t get the service right now.
  2. Ask the price before the test or treatment. (Prices may not be negotiable if they’re set by an insurance company contract.)
  3. Write on your financial agreement that you agree to pay for all treatment provided by providers who are in-network, which means they have set rates with your insurance company. (The medical providers may not accept the altered form.)
  4. If possible, get the billing codes the medical provider will use to charge you and contact your insurance provider to make sure that each code is covered.
  5. If you are having a procedure see if you can get the National Provider Identifier and/or Tax ID number of the surgeons, anesthesiologists and their assistants. Contact your insurance company to see if the providers are in-network, which results in the negotiated rates.
  6. Demand an itemized bill, and then look at each specific charge. Medical bills are often riddled with errors.
  7. Ask if the provider has a financial assistance policy, which could result in a sliding scale discount. Many people qualify, and discounts can range from 20 to 70 percent.