Latest KFF Health News Stories
Court Ruling May Spur Competitive Health Plans to Bring Back Copays for Preventive Services
The Affordable Care Act required that health insurers provide many medical screenings and prevention services at no out-of-pocket cost to health plan members. But insurers and employers may consider adding cost sharing for preventive services now that a federal court ruled the ACA’s mandate is unconstitutional.
Medical Coding Creates Barriers to Care for Transgender Patients
The codes used by U.S. medical providers to bill insurers haven’t caught up to the needs of trans patients or even international standards. Consequently, doctors are forced to get creative with what codes they use, or patients spend hours fighting big out-of-pocket bills.
Timely Mental Health Care Is a Key Factor in Strike by Kaiser Permanente Workers
A new California law requires timely follow-up appointments for mental health and addiction patients. But striking workers at Kaiser Permanente in Northern California say patients continue to wait up to two months.
Health Insurance Price Data: It’s Out There, but It’s Not for the Faint of Heart
Health insurers and self-insured employer plans are now required to post their negotiated rates for almost every type of medical service. But navigating through the trove of information is no easy task.
Even Well-Intended Laws Can’t Protect Us From Inaccurate Provider Directories
State and federal laws require health plans to offer accurate lists of participating doctors and facilities, but consumers still struggle to get timely appointments with providers.
Ad Targeting Manchin and AARP Mischaracterizes Medicare Drug-Price Negotiations
The advocacy group American Commitment said empowering Medicare to negotiate drug prices would raid it of billions of dollars. Drug pricing experts say that that’s not the case and that such policies would instead reduce costs for the Medicare program and seniors.
No-Bid Medicaid Contract for Kaiser Permanente Is Now California Law, but Key Details Are Missing
California Gov. Gavin Newsom signed a bill last month that authorizes a statewide Medicaid contract for HMO giant Kaiser Permanente. But details still need to be worked out in a memorandum of understanding.
Es cierto que pequeños cambios en los ingresos pueden hacer que la elegibilidad cambie, pero si se ingresa información incorrecta en un sistema informático compartido por Covered California y Medi-Cal, o se elimina información precisa, eso les puede causar grandes dolores de cabeza a los afiliados.
Computer Glitches and Human Error Still Causing Insurance Headaches for Californians
Covered California and Medi-Cal share a computer system for eligibility and enrollment. Nearly a decade since the Affordable Care Act expanded coverage options in the state, enrollees can be diverted to the wrong program — or dropped altogether — if erroneous information gets into the system.
Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?
Preventive care, like screening colonoscopies, is supposed to be free of charge to patients under the Affordable Care Act. But some hospitals haven’t gotten the memo.
Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments
Insurers say prior authorization requirements are intended to reduce wasteful and inappropriate health care spending. But they can baffle patients waiting for approval. And doctors say that insurers have yet to follow through on commitments to improve the process.
Medicare Surprise: Drug Plan Prices Touted During Open Enrollment Can Rise Within a Month
Even the savviest Medicare drug plan shoppers can get a shock when they fill prescriptions: That great deal on medications is no bargain after prices go up.
After Medical Bills Broke the Bank, This Family Headed to Mexico for Care
The Fierro family owed a Yuma, Arizona, hospital more than $7,000 for care given to mom and dad, so when a son dislocated his shoulder, they headed to Mexicali. The care was quick, good, and affordable.
La familia Fierro le debe a un hospital de Yuma, Arizona, más de $7,000 por dos situaciones médicas. Así que cuando uno de los hijos se dislocó el hombro, fueron a Mexicali, México. La atención fue rápida, buena y económica.
Is My Drug Copay Coupon a Form of Charity — Or a Bribe?
Drug copayment assistance is a form of profitable charity — and, yes, that’s an oxymoron. Amid skyrocketing drug prices, it’s understandable that patients desperately need help affording medicine, especially when their health is on the line. But these programs create a mirage that perpetuates our health care system’s reckless spending.
Battle Lines Are Drawn Over California Deal With Kaiser Permanente
A controversial proposal to grant HMO giant Kaiser Permanente a no-bid statewide Medicaid contract is headed for its first legislative hearing amid vocal opposition from a coalition of counties, competing health plans, community clinics, and a national health care labor union.
The Case of the $489,000 Air Ambulance Ride
Diagnosed with aggressive leukemia on a Western trip, a young man thought his insurance would cover an air ambulance ride home to North Carolina. Instead, questions about medical necessity left him with an astronomical bill.
An $80,000 Tab for Newborns Lays Out a Loophole in the New Law to Curb Surprise Bills
The insurance company said that the birth of the Bull family’s twins was not an emergency and that NICU care was “not medically necessary.” The family’s experience with a huge bill sent to collections happened in 2020, but it exposes a hole in the new No Surprises law that took effect Jan. 1.
In May 2021, Lags Medical Centers, one of California’s largest chains of pain clinics, abruptly closed its doors amid a cloaked state investigation. Nine months later, patients are still in the dark about what happened with their care and to their bodies.
California Inks Sweetheart Deal With Kaiser Permanente, Jeopardizing Medicaid Reforms
The backroom deal with politically connected Kaiser Permanente, which infuriated other Medi-Cal health plans, allows the health care giant to continue selecting the enrollees it wants.
