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American Hospital Association on House budget: "Urge Congress to reject" "dramatic reductions" in Medicaid

Trump just now adds Medicaid to his pledge on not hurting benefits.... "We're going to love and cherish social security, medicare, medicaid, we're not going to do anything with that other than if we can find some abuse or waste....

Greetings to those of us described by @LorenAdler as "random people on Twitter" who were in opposition to @ElevanceHealth policy announced the other month that they would place time limits on anesthesia codes which would limit reimbursement to anesthesiologists in CT, NY & MO (see quote below). If the quote is accurate, please random people let him know how wrong @AnthemBCBS was which resulted in them withdrawing their announced policy. @ASALifeline @CRCook1978 @ZachJonesForTX @813JAFERD @sonodoc99 @mass_marion @MarilynHeineMD @AmerMedicalAssn @FAHhospitals @ahahospitals @DGlaucomflecken Meanwhile, per this article and their statement, @BCBSM has announced that they will be charging clinicians for appeals of claims. I believe Mr. Adler had argued that the previous Anthem anesthesia policy could simply be countered by clinician claim appeals and the policy did not really have to change from what was proposed. So, Anthem charges the employer and employee for health insurance and then they charge the clinician for appealing claim denials--lose, lose and lose again--great deal, where do we sign? January 22, 2025 Modern Healthcare "Insurers inventing more roadblocks to claims, providers say Healthcare providers say insurance companies are innovating new ways to make it harder to get paid. Physicians, hospitals and other providers have always complained of low rates, delayed payments and the usual red tape. But rules insurers such as Blue Cross Blue Shield of Michigan, UnitedHealthcare and Elevance Health have recently announced may be a new battleground in the age-old fight between the two camps. Health insurance companies justify utilization management and claims review as crucial to constraining healthcare spending and ensuring that patients receive appropriate care. They also maintain that many claims are turned down because of provider error and that clarifying what's required upfront makes the reimbursement process more efficient. Whatever the case, providers and patients have grown increasingly frustrated with the health insurance industry, which has attracted political attention. Nearly one in five patients had a claim denied within the previous year, according to a survey the health policy research organization KFF conducted in February and March 2023. Prior authorization denials have become more common over the past five years, 74% of physicians reported in an American Medical Association survey last June. “I appeal absolutely everything, and everything is a fight,” said Julie Baak, practice manager at the Arthritis Center, an independent infusion clinic in Bridgeton, Missouri, outside St. Louis. Relationships between insurers and providers are deeply strained. Rates and timely reimbursements have always been sticking points, but providers say health insurance companies are snarling them with restrictions, such as more stringent prior authorization requirements. “There's this whole front accelerating between insurers and providers that is not really about rates. It's more about appeals and denials. Insurers would much rather say no to a provider than a patient,” said Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation, a philanthropy that finances health research. Now, one insurer is testing a new tactic: Charging providers to appeal rejected claims. Beginning in March, Blue Cross Blue Shield of Michigan will assess fees when providers appeal some commercial claims. If a state external review board rules in favor of Blue Cross twice, the insurer will bill providers for the administrative costs associated with defending itself. The nonprofit insurer introduced the policy in 2021 but has not invoked it. Independent reviewers upheld its denials in 85% of cases last year, Blue Cross Blue Shield of Michigan said in a statement. “We hope enforcing this policy will reduce unnecessary appeals costs in the future,” Blue Cross Blue Shield of Michigan said. UnitedHealthcare is tightening up access to some screenings by requiring more documentation. The UnitedHealth Group subsidiary is rolling out the fourth and final phase of a new system for molecular pathology tests in March. Under this policy, hospitals must submit additional, non-billing codes for commercial claims for hundreds of such tests. In addition to the standard Current Procedural Terminology reimbursement codes, providers will have to include Z-codes — which describe patient health status — for procedures such as prenatal screenings, genetic counseling and cancer tests. Medicare has the same rules, a UnitedHealthcare spokesperson wrote in an email. “The Z-code allows for faster and more accurate provider reimbursement with fewer follow-up requests for records or information, reducing appeals and resubmissions, leading to a more accurate and positive provider claims experience,” the UnitedHealthcare spokesperson wrote. To the contrary, said Terrence Cunningham, director of administrative simplification policy at the American Hospital Association. This new process adds to providers' administrative burden, not reduces it, he said. “This is an emerging trend. Plans are trying to engage in additional medical assessment, and control costs more. In this case, they’re doing this in a way that is not efficient and leads to significant administrative costs being thrust upon providers,” Cunningham said. Moreover, he said, UnitedHealthcare vowed two years ago to ease access to genetic testing by cutting back on prior authorization requirements. UnitedHealth Group CEO Andrew Witty made a similar promise last Thursday. Quantifying administrative burden is essentially impossible, in part because there are little publicly available data about what health insurance companies do and how often they do it. Starting in 2027, insurers participating in Medicare, Medicaid and the exchanges will be required to disclose how often and why they deny claims. In the meantime, policymakers and the public are left with anecdotal accounts from healthcare professionals such as Baak, which increasingly are disseminated on social media platforms such as X and TikTok. These posts are finding a sympathetic audience amid the furor that arose after UnitedHealthcare CEO Brian Thompson's murder last month. That backlash against the insurance industry coincided with one major company backtracking on a new cost-saving effort after providers protested. Elevance Health subsidiary Anthem Blue Cross Blue Shield had planned to cap reimbursements in Connecticut, New York and Missouri for surgical anesthesia by setting time limits. But a successful pressure campaign led by the American Society of Anesthesiologists, fueled by news coverage and social media outrage, led the company to reverse itself, citing “significant widespread misinformation.” Loren Adler, associate director for the Brookings Institution Center on Health Policy, said the "completely out of proportion" frenzy against Anthem forced the company to change course even though its policy was misrepresented as a threat to turn off anesthesia in the middle of operations. “They got a bunch of random people on Twitter to get upset about it, and it was a snowball effect,” he said. This presents providers with a playbook they can duplicate in the current environment, Adler said. “I assume every anesthesia group is going to be like, ‘Well, now we're going to really write this into the contract and make it crystal clear what you can do here.'” (emphasis added)

UnitedHealthCare needs to be broken up. They own PBM’s, Pharmacies, Hospitals, Physicians and even a Bank. Multiple levels of Conflicts of Interest.