Peter Salgo, MD: Here [it] comes, I’m afraid to say this, the $64-billion question: cheap drugs, new expensive drugs? What are the coverage criteria for these CGRPR [calcitonin gene-related peptide ...

Coverage and reimbursement decisions are hardly predictable or consistent within and across US payers. Payers are in the position of determining which drugs to pay for, for whom, and at what level to ...

U.S. Magistrate Judge Joseph Spero, Northern District of California (Photo: Jason Doiy/ALM) A federal judge in San Francisco has found that an affiliate of UnitedHealthcare, the nation's largest ...

A UnitedHealth Group subsidiary breached its fiduciary duty by adopting coverage guidelines that did not reflect general standards of care, a federal judge said this week in a ruling that advocates ...

Despite some end-of-year confusion between a powerful hospital lobby and a payer giant, UnitedHealthcare — the nation's largest private health insurer — has no immediate plans to institute stricter ...

Although the literature has investigated utilization management practices, how they align with clinical practice guidelines is not well understood. 10, 11 A better understanding of this alignment ...

New for 2015, the CPT codes for vertebroplasty and kyphoplasty were revised to include radiology supervision and interpretation. With the revision the previously existing Local Coverage Determinations ...

Anthem is America’s 2nd largest commercial health insurer and joins more than 35 other health plans to offer coverage exclusively for the triangular iFuse Implant System SANTA CLARA, Calif., Aug. 02, ...

A federal judge ruled Tuesday that United Behavioral Health breached its fiduciary duty to patients by using unreasonable and overly restrictive guidelines to make coverage decisions for tens of ...

A federal judge in San Francisco has found that an affiliate of the nation's largest health insurer breached its fiduciary duty to policyholders by following coverage guidelines for mental health ...