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In 2010 about 250 plans participate in the program. [3] About 20 plans are nationwide or almost nationwide, such as the ones offered by some employee unions such as the National Association of Letter Carriers, by some employee associations such as GEHA, and by national insurance companies such as Aetna and the Blue Cross and Blue Shield Association on behalf of its member companies.
The healthcare provider has been in negotiations with Aetna to renew its commercial HMO, POS, PPO, Medicare Advantage and Aetna Whole Health provider agreements in California, Arizona and Nevada ...
Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
Most provider markets (especially hospitals) are also highly concentrated—roughly 80%, according to criteria established by the FTC and Department of Justice [137] —so insurers usually have little choice about which providers to include in their networks, and consequently little leverage to control the prices they pay. Large insurers ...
Health exchanges first emerged in the private sector in the early 1980s, and they used computer networking to integrate claims management, eligibility verification, and inter-carrier payments. These became popular in some regions as a way for small and medium-sized businesses to pool their purchasing power into larger groups, reducing cost.
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The X12 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.
[53] [failed verification] Aetna cancelled planned expansion of its offerings and following an expected $300 million loss in 2016 and then withdrew from 11 of its 15 states. [54] In August 2016 Anthem said that its offerings were losing money, but also that it would expand its participation if a pending merger with Cigna was approved. [55]
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