Amalgamated Medical Care Management Granted Full URAC Accreditation for Health Utilization Management and Independent Review Organization

Amalgamated Medical Care Management, a leading national resource for comprehensive, high quality care management services, was recently granted full URAC® accreditation in two service areas – Health Utilization Management and Independent Review Organization. The awards of both accreditations are effective from April 1, 2021 to April 1, 2024. In its letters granting full accreditation to…


Strategies to Help Lower Healthcare Costs

Based on the latest data on the healthcare costs incurred by American businesses, employers are in need of new strategies. According to research conducted by the Kaiser Family Foundation, the average annual premium is now $7,470 for a single employee and $21,342 for family coverage; a 54% increase over the prior ten years. Of these…


Telehealth’s Value Demonstrated during the Pandemic

Even before the pandemic, telehealth was gaining real traction as more and more payers began to recognize the benefits across the healthcare continuum – for patients, providers and payers. Its value proposition in terms of facilitating quicker response to patient needs, more collaboration between healthcare professionals, and perhaps most significantly, in reducing unnecessary Emergency Department…


New CMS OPPS/ASC Rule Demands Effective Utilization Management and Case Management

On December 2nd, 2020, the Centers for Medicare & Medicaid Services (CMS) released its 2021 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) Final Rule. Among the significant changes are: The elimination of the inpatient only list over three calendar years beginning with the removal of an estimated 300 musculoskeletal-related charges. The list will be…


Utilization Reviews Can Uncover New Revenue Opportunities

The Healthcare Financial Management Association (HFMA) recently wrote about utilization reviews (UR) and how many acute care hospitals are losing revenue due to common “breakdowns” in the UR processes. Cited were five key areas where problems often lie. They included: department organization and management, failure to understand or properly adopt regulatory guidelines, challenges relating to…


New Survey Reveals COVID-19 Impacts on Employee Benefits

Recently, the International Foundation of Employee Benefit Plans (IFEBP) published the results of an employer survey that sheds light on how COVID-19 has been affecting employee benefits. The Employee Benefits in a COVID-19 World: April 2020 Survey Report revealed some interesting findings which can help plan sponsors better prepare for the year ahead. Employers Are…


The Costs for Treating COVID-19 Patients

COVID-19 has introduced new costs for plan sponsors. Some of these costs are known.  For instance, approximately 15% of people who become infected with the Coronavirus may require hospitalization. The Commonwealth Fund estimated that by October 31, 2020, the U.S. will spend approximately $24 billion on inpatient COVID-19 care; 0.6% of all projected 2019 national…


Utilization Management Helps Self-funded Plans Contain Healthcare Costs

From all projections, U.S. employers should expect their healthcare costs to rise in 2021.  Self-insured and fully-insured plans could see their premiums increase between 5-6% according to projections by the consulting firm of Willis Towers Watson.  Factors that will influence their premium increases include: the potential of new COVID-19 waves, the costs of a vaccine…


Today’s Value-Based Care Models Introduce New Demands on Utilization Management

Utilization management (UM) has proven to be an extremely valuable tool for facilitating prudent medical consumption. When first introduced in the late 1980s at which time fee-for-service models dominated, UM was primarily regarded as a cost-cutting tool. It has since come to be viewed as a means for ensuring the medical necessity of various procedures…



In the past few weeks there have been numerous restrictions placed on businesses throughout the United States. Many states and localities across the country have enacted temporary restrictions on non-essential business operations, requiring millions of workers to stay home. Amalgamated Life Insurance Company, which is based in New York, is considered an essential business and therefore is not subject to these temporary restrictions.

However, in an effort to protect the health and safety of our employees, their families and communities, we have taken a series of company-wide actions, across all Amalgamated Family of Companies locations, to implement work from home and other flexible arrangements where feasible. Despite these changes, we will continue to provide you and your members with the customer service levels you have come to expect from us prior to the coronavirus outbreak.

We are diligently working with our partners and vendors to utilize our remote capabilities and infrastructure. We are also in constant communication with UPS and the USPS to stay informed of any potential changes in service. For the duration of this state of emergency, Amalgamated Life Insurance Company will comply with any required Notice Obligations by emailing and/or mailing notices to all consumers.

If you have any questions or concerns please reach out to your Amalgamated Family of Companies representative or our customer service center at: 914-367-5000. They are well-prepared to answer your questions and can address your specific needs.