Wash. State Insurer, Official Clash Over Drug Coverage Cutbacks
A fight between the Washington State insurance commissioner and the state’s largest seller of individual health insurance is spotlighting problems in that increasingly troubled market. The spat arose over insurers’ efforts to curb soaring premiums by restricting or eliminating prescription drug benefits. Experts say they haven’t yet seen similar moves by insurers in other states to […]
Feds Jump-Start Health Insurance Co-Ops With Loans
Seven organizations will receive a total of $639 million in federal low-interest loans to launch new health insurance plans in eight states, the federal government announced Tuesday.
Collaborative Efforts Can Save Money And Improve Care
Employers, insurers and hospitals are banding together in several areas of the country to tackle cost and quality issues.
Weighing Berwick’s Top Five Accomplishments At CMS
Dr. Donald Berwick’s 15-month tenure at the Centers for Medicare & Medicaid Services was marked by ambitious efforts to improve the nation’s health care system.
Housing Bust Derails Some Seniors’ Assisted-Living Care
With the real estate market depressed, thousands of seniors are unable to move because they can’t sell their homes.
Under Health Law, Colonoscopies Are Free – But It Doesn’t Always Work That Way
The billing can get complicated if doctors find a polyp during a screening: Some insurers
New Long-Term Care Insurance Will Provide Flexible Cash Benefits
The CLASS Act, part of the health care overhaul, will provide about $75 a day to people who sign up for the long-term care insurance policy. Advocates say it could help people stay in their homes. But critics raise concerns about the financial viability of the program.
Catholic Directive May Thwart End-Of-Life Wishes
A directive passed last November in Tulsa, Okla., raises fresh questions about the ability of patients to have their end-of-life treatment wishes honored – and whether and how a health care provider should comply with lawful requests not consistent with the provider’s religious views.
The High Price of FDA Approval
The Food and Drug Administration is trying to get some unapproved drugs off the market. But sometimes the brand-name replacement is much more expensive.
Some Insurers Trade In Jargon For Plain English
A number of insurers are replacing jargon with plain English. Aetna has published a book called “Navigating Your Health Benefits for Dummies.” CIGNA employees are taught, for example, that they should use “doctor” instead of “provider” in communicating with the public.
Confusing Insurance Jargon Prompts Call For Reform
Insurers sometimes make it difficult for consumers to understand and use their benefits. One U.S. senator has drafted legislation to hold insurers to higher standards, but the industry is already moving to make changes.
Washington State Takes a Hard Look at New Treatments and Tests
A Washington state program decides whether to cover new treatments and tests by comparing them with the standard alternatives. If there’s no real difference, a panel of medical professionals can pick the least expensive. Decisions are binding for employees insured by the state, workers’ compensation claimants and patients in Medicaid, the state-federal program for the poor.
Insurers Apply Different Methods In Making Coverage Decisions
Public and private insurance plans say they evaluate medical services for coverage by looking at published scientific research, rating the evidence and making comparisons based on effectiveness and safety. But their approaches vary widely in terms of transparency, comprehensiveness in reviewing evidence, openness to outside suggestions and explicit consideration of cost.
