Latest news with #AnthemBlueCrossBlueShield
Yahoo
09-04-2025
- Health
- Yahoo
Colorado couple's insurer denied claim for $94K air ambulance bill after husband had heart attack
When Bob and Marjean Taylor went to stay in a friend's cabin an hour from the nearest hospital back in 2022, neither expected that Bob would have his second heart attack within four months while they were vacationing. Unfortunately, that's exactly what happened. Marjean took him to the local hospital, but they were told he needed more care than the facility could provide. An air ambulance arrived, transporting him to a medical center where his cardiologist was waiting to repair a stent that had torn. The procedure saved his life, but sadly, Bob's troubles weren't over. I'm 49 years old and have nothing saved for retirement — what should I do? Don't panic. Here are 5 of the easiest ways you can catch up (and fast) Nervous about the stock market in 2025? Find out how you can access this $1B private real estate fund (with as little as $10) Here are 3 'must have' items that Americans (almost) always overpay for — and very quickly regret. How many are hurting you? Soon after they returned home, the Pueblo, Colorado couple received notice that their insurer, Anthem Blue Cross Blue Shield, was denying their claim for the air ambulance, saying the transport wasn't medically necessary and sticking the Taylors with a bill totaling around $94,000. 'It gave me a heart attack, almost,' Marjean told Denver7 Investigates of the unexpected bill. Unfortunately, air ambulances have become very expensive, and a growing number of insurers are denying claims for them, leaving Americans who've suffered medical crises holding the bag. Here's what you need to know. Air ambulances are helicopters or planes designed to provide timely transport of patients to medical facilities. They're often used in rural areas where medical care is scarce. With an aging population, more people relocating to remote areas during COVID-19, and the increased prevalence of infectious diseases, the market for air ambulances is growing. In fact, according to Technavio, a market research group, the air ambulance market saw 9.63% year-over-year growth from 2022 to 2023 and is expected to increase by $6.77 billion between 2024 and 2026. Sadly, prices for air ambulances have skyrocketed, as a growing number of private equity firms have moved into the market. One would think that insurance companies would cover the costs of air ambulance services in most cases, since they're almost always called in emergencies. Unfortunately, data shows a growing number of insurers are denying claims. Part of the problem is that when an air ambulance is called, patients aren't checking if the company is in-network or not. This may not be a high priority when you're being airlifted to a hospital during a heart attack or in the wake of an accident. It shouldn't matter if the ambulance service is in-network, as starting in 2022, policyholders were supposed to be protected from unexpected bills under the No Surprises Act. This act prohibited surprise bills for: Most emergency services, regardless of whether they're in network or out-of-network Out-of-network services provided when a patient visits an in-network facility (such as anesthesia administered by an out-of-network anesthesiologist at an in-network hospital) Read more: Trump warns his tariffs will spark a 'disturbance' in America — use this 1 dead-simple move to help shockproof your retirement plans ASAP However, insurers can still pass on out-of-network costs to claimants if the service isn't considered medically necessary. Perhaps unsurprisingly, insurers now claim that many ambulance trips aren't needed. In fact, the National Association of EMS Physicians warned policymakers in a February 2024 letter that they have seen a 'spike in denials of claims on the basis of 'lack of medical necessity.'' Being transported to a hospital during a heart attack seems pretty necessary — and yet the Taylors were still told they had to pay. They had to go through multiple appeals over two years and ultimately get the press involved before the insurer finally resolved the issue, blaming unclear communication for the problem. Not everyone will be lucky enough to get the press involved, though, and the couple faced a lot of stress in the meantime. 'I just felt like we were stuck in the middle of all these companies and nobody cared,' said Marjean. 'After I got off the phone, I said, 'I cannot believe this is done,' and I started crying. But I wasn't giving up. I was not going to give up. I was not paying for it.' Air ambulance costs are a growing issue, but there are other ways you could find yourself stuck with a hefty bill for health care services. Here are some steps you can take to protect yourself: Get pre-approval for medical services from your insurer in non-emergency situations Know your rights under the No Surprises Act Shop carefully for the right insurance policy that offers comprehensive coverage from a provider with a good reputation. Visit in-network providers whenever you have the option Request itemized bills to understand what you're being charged for Negotiate with providers and the billing department if you think you're being overcharged Appeal denied claims, and be prepared to provide documentation Hire a medical bill advocate to help you fight unfair bills These steps can help you avoid the financial devastation that comes with big medical bills your insurer should pay for, but does everything possible to avoid. Want an extra $1,300,000 when you retire? Dave Ramsey says this 7-step plan 'works every single time' to kill debt, get rich in America — and that 'anyone' can do it Rich, young Americans are ditching the stormy stock market — here are the alternative assets they're banking on instead Cost-of-living in America is still out of control — and prices could keep climbing. Use these 3 'real assets' to protect your wealth today, no matter what Trump does This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
Yahoo
03-04-2025
- Health
- Yahoo
Anthem removes access to MU Health Care for thousands of patients
KANSAS CITY, Mo. — Anthem Blue Cross Blue Shield (Anthem) notified MU Health Care earlier this week that it no longer wishes to negotiate on its commercial contracts. Effective as of Tuesday, April 1, MU Health Care's more than 1,200 providers, 80 clinics and seven hospitals were removed from Anthem, Blue Cross Blue Shield—and HealthLink commercial plans that patients get through their employer or the Affordable Care Act (ACA) marketplace. This means patients may have to pay more out-of-pocket to see their MU Health Care doctors and care teams or may need to find a new, in-network provider for their care. In February, Anthem made the decision to stop negotiating on a new Medicare Advantage contract and to remove MU Health Care from that network. Following this decision, MU Health Care said it continued negotiating with Anthem to remain in their commercial insurance network. 'It is our highest priority to help our patients who currently have Anthem coverage navigate their care options including continuing care with MU Health Care, if possible,' said Dr. Stevan Whitt, MU Health Care chief medical officer. Patients with certain ongoing medical conditions may qualify for continuity of care to extend their in-network coverage. Anthem makes the final determination on eligibility, but MU Health Care has provided instructions for patients to help them determine if they are eligible, and how to apply. This network change does not impact Healthy Blue Medicaid or University of Missouri Student Advantage plans, prescriptions Anthem members get through Mizzou Pharmacy or patients who need medically necessary emergency care. MU Health Care has also established a dedicated call center at 573-650-5409 available Monday through Friday from 8 a.m. to 6 p.m. CST to answer patient questions and help them understand their options. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Associated Press
11-03-2025
- Business
- Associated Press
Helius Medical Technologies, Inc. Announces First Reimbursement by A Major Healthcare Provider for its Portable Neuromodulation Stimulator (PoNS®) Device
--Anthem Blue Cross Blue Shield approves claim for PoNS Device at out-of-network adjusted list price-- --Provides further validation of PoNS pricing-- NEWTOWN, Pa., March 11, 2025 (GLOBE NEWSWIRE) -- Helius Medical Technologies, Inc. (Nasdaq:HSDT) ('Helius' or the 'Company'), a neurotech company focused on delivering a novel therapeutic neuromodulation approach for balance and gait deficits, today announced its first reimbursement payment from a major healthcare provider, Anthem Blue Cross Blue Shield, for its PoNS Device. 'The first reimbursement from a commercial healthcare provider is a significant achievement for Helius and MS patients. The payment at out-of-network adjusted list price further validates the therapeutic benefit of PoNS and its economic value for payers,' said Dane Andreeff, Helius President and Chief Executive Officer. 'This is an important milestone in the pursuit of third-party reimbursement and coverage and as we appeal the current CMS payment rates. We will remain steadfast in prioritizing increased patient access to support more MS patients and drive growth of the business.' 'Importantly, this was an out-of-network total lump sum reimbursement payment, which typically is 30 to 40% below in-network contracted payment rates. Therefore, we believe this reimbursement payment, including patient co-payment, of $15,420 for the PoNS controller and mouthpiece establishes an important benchmark as we approach major commercial insurance carriers to negotiate reimbursement payment rates for PoNS,' concluded Andreeff. About Helius Medical Technologies, Inc. Helius Medical Technologies is a leading neurotech company in the medical device field focused on neurologic deficits using orally applied technology platform that amplifies the brain's ability to engage physiologic compensatory mechanisms and promote neuroplasticity, improving the lives of people dealing with neurologic diseases. The Company's first commercial product is the Portable Neuromodulation Stimulator. For more information about the PoNS or Helius Medical Technologies, visit About the PoNS Device and PoNS Therapy The Portable Neuromodulation Stimulator ('PoNS') is an innovative, non-implantable, orally applied therapy that delivers neurostimulation through a mouthpiece connected to a controller while it's used, primarily at home, with physical rehabilitation exercise, to improve balance and gait. The PoNS device, which delivers mild electrical impulses to the tongue, is indicated for use in the United States as a short-term treatment of gait deficit due to mild-to-moderate symptoms from multiple sclerosis ('MS') and is to be used as an adjunct to a supervised therapeutic exercise program in patients 22 years of age and over by prescription only. PoNS has shown effectiveness in treating gait or balance and a significant reduction in the risk of falling in stroke patients in Canada, where it received authorization for sale in three indications: (i) for use as a short-term treatment (14 weeks) of gait deficit due to mild and moderate symptoms from stroke and is to be used in conjunction with physical therapy; (ii) for use as a short-term treatment (14 weeks) of chronic balance deficit due to mild-to-moderate traumatic brain injury ('mmTBI') and is to be used in conjunction with physical therapy; and (iii) for use as a short-term treatment (14 weeks) of gait deficit due to mild and moderate symptoms from MS and is to be used in conjunction with physical therapy. PoNS is also authorized for sale in Australia for short term use by healthcare professionals as an adjunct to a therapeutic exercise program to improve balance and gait. For more information visit Cautionary Disclaimer Statement Certain statements in this news release are not based on historical facts and constitute forward-looking statements or forward-looking information within the meaning of the U.S. Private Securities Litigation Reform Act of 1995 and Canadian securities laws. All statements other than statements of historical fact included in this news release are forward-looking statements that involve risks and uncertainties. Forward-looking statements are often identified by terms such as 'believe,' 'expect,' 'continue,' 'will,' 'goal,' 'aim' and similar expressions. Such forward-looking statements include, among others, statements regarding the appeal of CMS payment rates; the pursuit of third party reimbursement and coverage; . There can be no assurance that such statements will prove to be accurate and actual results and future events could differ materially from those expressed or implied by such statements. Important factors that could cause actual results to differ materially from the Company's expectations include uncertainties associated with the Company's capital requirements to achieve its business objectives, availability of funds, the Company's ability to find additional sources of funding, manufacturing, labor shortage and supply chain risks, including risks related to manufacturing delays, the Company's ability to obtain national Medicare insurance coverage and to obtain a reimbursement code, the Company's ability to continue to build internal commercial infrastructure, secure state distribution licenses, market awareness of the PoNS device, future clinical trials and the clinical development process, the product development process and the FDA regulatory submission review and approval process, other development activities, ongoing government regulation, and other risks detailed from time to time in the 'Risk Factors' section of the Company's Annual Report on Form 10-K for the year ended December 31, 2023, and its other filings with the United States Securities and Exchange Commission and the Canadian securities regulators, which can be obtained from either at or The reader is cautioned not to place undue reliance on any forward-looking statement. The forward-looking statements contained in this news release are made as of the date of this news release and the Company assumes no obligation to update any forward-looking statement or to update the reasons why actual results could differ from such statements except to the extent required by law. Investor Relations Contact Philip Trip Taylor
Yahoo
28-01-2025
- Health
- Yahoo
Illinois bill would bar time limits on anesthesia coverage
SPRINGFIELD, Ill. (WCIA) — A bill in the Capitol would bar insurance companies from putting time limits on anesthesia coverage. 'The goal is to make sure that Illinoisans get the coverage that they paid for and that they deserve and that they were promised,' State Rep. Bill Hauter (R-Morton) said. Health insurers now required to cover pregnancy, postpartum care in Illinois It comes after Anthem Blue Cross Blue Shield said they would tie payments in some states to the length of time a patient was under anesthesia. The health insurance provider planned to base the length of time a surgery or procedure is estimated to take based on the Centers for Medicare and Medicaid Service's physician work time values. After public outcry, they reversed the decision in December saying there was 'significant widespread misinformation' about the policy. The proposal in the State Capitol would guarantee that insurance companies cover anesthesia regardless of how long the procedure takes. Dignity in Pay Act signed into Illinois law 'The patient doesn't have any control over that, the anesthesiologist certainly doesn't have any control over it, and the surgeon sometimes has very little control if there's an issue with anatomy or there's a complication or there's a problem with the equipment in some way,' Hauter, who is also a physician and anesthesiologist, said. 'You can see how that would be ludicrous and almost dangerous.' If the bill becomes law, it would apply to insurance policies that begin at the start of January next year. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
