Latest news with #BlueCrossBlueShield
Boston Globe
4 days ago
- Business
- Boston Globe
Amid financial challenges, Point32Health hires a new chief executive
Gilligan said his appointment at Point32Health, which serves nearly 2 million members, comes at a 'pivotal time in the health care industry.' 'As we enter this important next chapter for our organization, we will position Point32Health to perform at its full potential and to drive growth,' he said in a statement. Advertisement Point32Health, which was formed in 2021 by the merger of Tufts and Harvard Pilgrim, has suffered serious financial setbacks in recent years. Point32Health struggled last year. For the first six months of 2024, the insurer reported an operating loss of $155 million on $4.7 billion in revenue, according to an Aug. 15 news release. Advertisement Like other health insurers, it has faced skyrocketing costs for prescription drugs, including medications that fight obesity. Last month, following the lead of Blue Cross Blue Shield, Point32Health said it was significantly scaling back its coverage of costly Starting Jan. 1, Point32Health will dramatically change how and when it pays for Zepbound — the insurer's Similar to Blue Cross Blue Shield, Point32Health will give large employers the option of paying extra to continue covering the weight-loss drug for its workers. But for patients who are insured by a smaller employer or who purchase their plans through the state's marketplace, Point32Health is ending coverage of the popular but pricey drug for weight loss altogether. The change comes as Eileen Auen, executive chair of Point32Health's board of directors, had served as interim head of the insurer since Hayes's departure. A selection committee of the board oversaw the recruitment of a new chief executive and retained a national executive search firm to assist in the process. Gilligan is a native of New England and graduate of the College of the Holy Cross, according to Point32Health. Advertisement Jonathan Saltzman can be reached at
Yahoo
28-05-2025
- Business
- Yahoo
No treatment, and a $250 bill: Barriers to dental care send people to unprepared ERs
When Michael McCoy's tooth suddenly fell out in October, he went to the emergency room at Columbia St. Mary's in Milwaukee for help. After getting his blood pressure and weight checked and a brief wait, McCoy was told there was nothing the hospital could do — but he was still charged $250. McCoy, 67, was sure the charge must be a mistake, so he contacted Public Investigator. But according to Ascension and his insurer, Blue Cross Blue Shield, the bill was correct. The charge represents "facility fees" — the portion of the bill that covers the costs of delivering care, including medical equipment, nurses and other medical support staff. "They could have told me as soon as I got there that they didn't do dental work of any kind there, instead of finding reasons to stall and bill me," McCoy said. McCoy's situation isn't unheard of. Dental hygienist Matt Crespin told Public Investigator that across the country, people often turn to the ER for urgent dental care but are not aware that ERs usually aren't equipped to treat dental emergencies. And because of the Emergency Medical Treatment and Labor Act, a federal law that requires hospitals to provide at least a screening to anyone who comes to the ER, hospitals can't turn a patient away. For many, dental care is too expensive and difficult to access, Crespin said, making regular upkeep out of reach. That sends people to ERs with problems that are often preventable. When it comes to dental pain, Crespin said most hospitals can't offer much more than ibuprofen and a referral to a dentist or a specialist. But even a referral can be a challenge, he said. In Wisconsin, only about 30% of dentists accept Medicaid or other state-sponsored plans. "Finding a provider that's willing to take a patient in — particularly one on an emergency basis — can be pretty challenging," Crespin said. People with private dental insurance also face barriers to dental care. According to a 2023 analysis by KFF, a health policy research group, more than one in four adults delayed or skipped some form of health care due to cost, with dental care being the most commonly missed. Nearly half of dentists surveyed in a 2024 American Dental Association report said they were considering dropping more insurance networks or had already done so. The survey found that nearly all dentists who dropped insurance networks last year cited low reimbursement rates as the main reason. Many also cited "administrative burden," the study said. To increase profits, Crespin said many dentists stop accepting private insurance at all, catering instead to patients who can afford to pay out-of-pocket for preventive and cosmetic services. "I drive by a dental office every day near my home in the suburbs of Milwaukee that's advertising teeth whitening and Botox," he said. "That's not treating dental disease." In McCoy's case, the hospital sent him home with instructions to take Tylenol or ibuprofen and contact a dentist in the morning. McCoy ultimately paid his ER bill, but said he did so reluctantly. "I still think it's ridiculous to pay $250 for nothing," he said. Crespin said Wisconsin has earned national recognition for its efforts to expand access to dental care. In 2017, the state became one of the first to allow dental hygienists to provide care without the presence of a licensed dentist. Wisconsin also passed legislation in 2023 to authorize the licensure of dental therapists — mid-level providers who offer preventive and restorative dental care when there are shortages of dentists. They must practice in federally designated shortage areas or serve high-need populations, according to the law. Crespin is also on the advisory committee for a new dental therapy training program at Northcentral Technical College in Wausau that's set to start training providers to practice in places like hospitals, K-12 schools and nursing homes. "We have to continue to find different ways for patients to access dental providers in places where they already are," he said. Crespin, who is also the executive director of the Children's Health Alliance of Wisconsin, said the organization is piloting a project to integrate dental care into pediatrician visits. 'That seems to be helping,' Crespin said, 'but we're still early in that work.' While barriers to dental care remain, there are some local programs working to close the gap, including: DentaMed Healthcare's Mobile Dental Van: Every Thursday, a mobile clinic parked outside of the Sinai Medical Center in Milwaukee treats ER patients referred for dental care on-site. The van also visits schools throughout Milwaukee, Racine and Waukesha to provide free preventive services. Wisconsin Association of Free and Charitable Clinics: You can use their online search tool to find a clinic in your area that provides free care, including dental services. Federally Qualified Health Centers: These are clinics and health centers across Wisconsin that provide low-cost or sliding scale dental care to uninsured, Medicaid, and privately insured patients. Ascension Seton Dental Clinic: Ascension St. Francis Hospital at 3267 S. 16th Street offers a dental clinic for urgent dental services during weekdays from 8 a.m. to 5 p.m., closing earlier at 4:30 p.m. on Mondays and Wednesdays. The clinic provides low-cost care for patients who may struggle to afford traditional dental treatment. Quinn Clark is a Public Investigator reporter for the Milwaukee Journal Sentinel. She can be emailed at QClark@ This article originally appeared on Milwaukee Journal Sentinel: People seeking dental care turn to ERs, then face hefty bills
Forbes
27-05-2025
- Business
- Forbes
Anthem Dental Insurance Review 2025
Why You Can Trust Forbes Advisor We analyzed costs and benefits information for 32 stand-alone dental insurance plans. We looked at price quotes, coverage limits and deductibles, and reimbursement levels. Advertisers do not and cannot influence our ratings. We use data-driven methodologies so all companies are measured equally. You can read more about our editorial guidelines and the methodology for the ratings below. Anthem offers multiple dental insurance plan tiers that vary by cost, coverage, reimbursement level and waiting period. Anthem Dental provides dental coverage in 14 states: Anthem Dental insurance plans have slightly higher-than-average premiums compared to other companies. The two highest-rated plans, Essential Choice PPO Platinum and Essential Choice PPO Gold, have higher premiums than the national average. However, the added costs come with better coverage than that of many competitors. Here's a look at the dental insurance cost differences of top-scoring plans for eight dental insurance companies. Anthem, also known as Elevance Health, is an independent Blue Cross Blue Shield Association licensee. BCBSA has 33 independent licensees that cover members across all 50 states. Elevance, aka Anthem, covers 118 million people with multiple types of insurance plans across 14 states. Anthem's health plans cover an estimated 47 million. In addition to dental insurance, Anthem offers: Anthem has one of the best complaint ratios to state insurance departments. That may signify higher customer satisfaction than competitors. AM Best financial strength rating: A (Excellent) Credit rating agency AM Best gave Anthem an A (Excellent) financial strength rating. AM Best praised Anthem's 'balance sheet strength, highlighting the company's 'strong operating performance, favorable business profile and appropriate enterprise risk management.' To find the best dental insurance companies, we scored 32 stand-alone dental insurance plans. We got quotes from each company and dug into each dental plan to find out what each one covers, what they reimburse for different types of coverage, and coverage limits and deductibles. Only the top-scoring plans from each company are shown. Benefit details can vary by state, so check the plan brochure for details. Ratings are based on the following criteria. Anthem Dental offers multiple plans that we rated highly, including Essential Choice PPO Platinum. Anthem's comprehensive plans may cost more than those of some competitors, but they also come with higher coverage and the flexibility to get dental care outside the plan's provider network. You can shop for Anthem Dental plans by visiting the company's website and entering your ZIP code in the Find Plans in Your Area tool. Anthem will ask for your name, date of birth and email address and will provide you with quotes for plans in your area. You can also call Anthem at (855) 875-1584. You can cancel your Anthem Dental policy by calling the phone number on your dental insurance card. Anthem may ask that you send a letter requesting cancellation.
NDTV
26-05-2025
- Health
- NDTV
US Doctor Who Falsely Diagnosed Patients For 2 Decades, Gets 10 Years Jail
For almost two decades, a US doctor falsely diagnosed patients with chronic illnesses they didn't have, gave them unnecessary, costly treatments and made money by filing false insurance claims. He minted over $28 million through this scheme to lead a luxurious life until it all came apart one day. From 2000 to 2018, Dr Jorge Zamora-Quezada lied to patients, falsely diagnosing them with rheumatoid arthritis, giving them toxic medications and urging them to go for unnecessary tests like X-rays and MRIs to trick insurance companies such as Medicare, Medicaid, TRICARE and Blue Cross Blue Shield, the US Department of Justice's Office of Public Affairs said. The 68-year-old lied about his patients' conditions to the insurers, made fake medical records and filed over $118 million in fraudulent insurance claims, it said. Matthew R. Galeotti, Head of the Justice Department's Criminal Division, said, "Dr Zamora-Quezada funded his luxurious lifestyle for two decades by traumatizing his patients, abusing his employees, lying to insurers, and stealing taxpayer money." Dr Zamora-Quezada's false diagnosis and toxic medications have caused severe harm to his patients, including strokes, hair loss, liver damage, necrosis of the jawbone, and severe pain while performing simple tasks like cooking, driving and bathing. One of his patients explained his situation, saying he was constantly in bed, unable to get up from bed alone, and was pumped with medication. "I didn't feel like my life had any meaning," the Justice Department quoted the patient as saying. Some felt they were being used as lab rats, others claimed they were living the life of an elderly person. Dr Zamora-Quezada, a licensed rheumatologist practitioner in Texas, Arizona, and Massachusetts, has now been arrested and sentenced to 10 years in prison followed by three years of supervised release. After a 25-day trial in January 2020, he was found guilty of one count of conspiracy to conduct healthcare fraud, seven counts of healthcare fraud, and one count of conspiracy to obstruct justice. Since then, all of his medical licenses have been revoked. During the trial, other doctors from Texas's Rio Grande Valley stated that they treated hundreds of patients he falsely told had rheumatoid arthritis. He was also charged with creating a toxic work environment for his clinic's staff, many of whom were in the country on work visas. He allegedly threatened to fire them and try to cancel their visas if they spoke out against him, reported PEOPLE. He has been asked to forfeit over $28 million worth of property, including 13 houses, a private jet, and a luxury Maserati car.
Yahoo
26-05-2025
- Health
- Yahoo
Doctor, Who Falsely Diagnosed Patients in $118M Fraud Scheme to Fund His 'Luxurious Lifestyle,' Sentenced to 10 Years in Prison
A Texas doctor, who was found guilty of orchestrating a $118 million medical fraud scheme for his own financial gain, was sentenced to 10 years in federal prison on May 21 Dr. Jorge Zamora-Quezada falsely diagnosed his patients with illnesses such as rheumatoid arthritis and billed their insurance companies for procedures and tests they did not need He is also being forced to forfeit about $28 million, including 13 real estate properties, a jet and a Maserati sports carA Texas doctor, who was found guilty of fraud for falsely diagnosing patients with diseases they did not have, has been sentenced to 10 years in federal prison. According to a press release from the U.S. Department of Justice's Office of Public Affairs, Dr. Jorge Zamora-Quezada was sentenced on May 21 to 10 years in prison and three years of supervised release for his role in a health care fraud scheme that involved more than $118 million in false claims and the payment of more than $28 million by insurers. During Zamora-Quezada's Texas trial, prosecutors said he falsely diagnosed his patients with illnesses and billed their insurance companies for procedures and tests they did not need for his own financial gain. Following his sentencing, Zamora-Quezada, 68, is also being forced to forfeit about $28 million, including 13 real estate properties, a jet and a Maserati GranTurismo sports car. "Zamora-Quezada falsely diagnosed his patients with rheumatoid arthritis and administered toxic medications in order to defraud Medicare, Medicaid, TRICARE and Blue Cross Blue Shield," the press release stated. "The fraudulent diagnoses made the defendant's patients believe that they had a lifelong, incurable condition that required regular treatment at his offices." "After falsely diagnosing his patients, Zamora-Quezada administered unnecessary treatments and ordered unnecessary testing on them, including a variety of injections, infusions, X-rays, MRIs and other procedures — all with potentially harmful and even deadly side effects," the press release continued. "To receive payment for these expensive services, Zamora-Quezada fabricated medical records and lied about the patients' condition to insurers." According to the DOJ, Zamora-Quezada was a rheumatologist who was licensed to practice medicine in Texas, Arizona and Massachusetts. All of his medical licenses have since been revoked. Prosecutors also argued that Zamora-Quezada attempted to cover up the fraud and "falsified patient records to support the false diagnoses after receiving a federal grand jury subpoena." His scheme lasted nearly 20 years and involved about $325 million, the DOJ previously said. Zamora-Quezada was found guilty on one count of conspiracy to commit health care fraud, seven counts of health care fraud and one count of conspiracy to obstruct justice in 2020. Local outlet KRGV reported that his sentencing was delayed several times because prosecutors and Zamora-Quezada's defense attorneys could not agree on a number of victims in the scheme or agree on the amount of money that was stolen. Want to keep up with the latest crime coverage? Sign up for for breaking crime news, ongoing trial coverage and details of intriguing unsolved cases. Zamora-Quezada was also accused of creating a toxic environment for his clinic's employees — many of whom were on work visas to live in the U.S. — by getting angry if they did not meet a quota for procedures or saying that he would fire them and try to revoke their visa if they spoke out against him. "Testimony at trial established that Zamora-Quezada told employees to 'aparecer' the missing records — 'to make them appear,' " the DOJ said. "Former employees also recounted being sent to a dilapidated barn to attempt to retrieve records. There, files were saturated with feces and urine, rodents and termites that infested not only the records but also the structure." According to the DOJ, other rheumatologists in Texas' Rio Grande Valley region testified during Zamora-Quezada's 2020 trial that they saw hundreds of patients whom he had falsely diagnosed with rheumatoid arthritis. One doctor even testified that it would be "obvious" to "most" doctors that these patients did not have the autoimmune condition. Prosecutors also argued that the false diagnoses and medications that Zamora-Quezada prescribed to patients caused "debilitating" side effects, including strokes, necrosis (or cell and tissue death) of the jawbone, hair loss, liver damage and severe pain. "Constantly being in bed and being unable to get up from bed alone, and being pumped with medication, I didn't feel like my life had any meaning," one patient testified during the trial, per the DOJ. Another patient's mother testified that she felt like her child served as a "lab rat," and other patients testified that they were "living a life in the body of an elderly person." "Dr. Zamora-Quezada funded his luxurious lifestyle for two decades by traumatizing his patients, abusing his employees, lying to insurers and stealing taxpayer money,' Matthew R. Galeotti, the head of the DOJ's criminal division, said in the press release. "His depraved conduct represents a profound betrayal of trust toward vulnerable patients who depend on care and integrity from their doctor," Galeotti added. Read the original article on People
