Insurance, Cost & Coverage
States Attacking ACA Would Suffer Most If Preexisting Conditions Shield Gets Axed
Harriet Blair Rowan
A coalition of Republican states has launched a legal challenge to the Affordable Care Act, including provisions requiring insurers to offer coverage to people with preexisting conditions without raising rates. An analysis shows that some of these states have the highest proportion of such residents.
Staggering Prices Slow Insurers’ Coverage Of CAR-T Cancer Therapy
Michelle Andrews
Some state Medicaid programs are not paying for the procedures, and Medicare’s complicated payment rates have hospitals concerned that it will not cover all the costs.
Insurers Fall Short In Catching And Reporting Medicaid Fraud, Inspectors Find
Chad Terhune
Medicaid has struggled for years with poor oversight and billions lost to improper payments. A new report finds that despite their fraud-fighting rhetoric, Medicaid managed-care companies are not as rigorous as they should be in ensuring the integrity of the Medicaid payment system.
Outrageous Or Overblown? HHS Announces Another Round Of ACA Navigator Funding Cuts
Phil Galewitz
Advocates of the sweeping health law view this move by the Trump administration as its most recent act of sabotage. But not everyone views it as a mortal blow.
Can Insurers Use Genetic Testing Results? A Reader Wants To Know
Michelle Andrews
Other readers ask what can be done to challenge unexpected medical bills — whether the result of an emergency room visit or after a change in prescription drug coverage.
A Baby Was Treated With A Nap And A Bottle Of Formula. The Bill Was $18,000.
Jenny Gold and Sarah Kliff, Vox
An ER patient can be charged thousands of dollars in “trauma fees” — even if they weren’t treated for trauma.
Father’s And Son’s Injuries Lead To The Mother Of All Therapy Bills
Stephanie O'Neill and Heidi de Marco
A father and son suffered serious hand injuries nine days apart. They both needed surgery and lots of follow-up occupational therapy to rehab their hands. But insurance paid for just a fraction of those OT bills, and the family owed more than $8,500.
‘Holy Cow’ Moment Changes How Montana’s State Health Plan Does Business
Julie Appleby
Other states are watching to see if controlling how much hospitals get paid can continue to hold down costs in “Big Sky Country.”
Unwieldy Health Costs Often Stand Between Teachers And Fatter Paychecks
Emmarie Huetteman
Cash-strapped school boards, cities and legislatures scrounge to cover pay raises and pricey benefits and turn to teachers to fork over more of their shrinking take-home pay.
A Hospital ER Charges An ‘After-Hours’ Fee. Who Has To Pay It?
Michelle Andrews
Tacking on an after-hours surcharge to an emergency department bill strikes some consumers as unfair, since the facilities are open 24 hours a day.
Benefit Change Could Raise Costs For Patients Getting Drug Copay Assistance
Michelle Andrews
More health plans are refusing to count the copayment assistance offered by drug makers as part of the patients’ deductibles or out-of-pocket limits.
Insurer Slashes Breast Pump Payments, Stoking Fears Fewer Moms Will Breastfeed
Samantha Young
Anthem, one of the country’s largest insurers, has cut the reimbursement rate it pays for breast pumps by nearly half, fueling concerns that new moms — especially ones with lower incomes — will not be able to afford the pumps they need.
Lack Of Insurance Exposes Blind Spots In Vision Care
Michelle Andrews
As many as 16 million people in the United States have undiagnosed or uncorrected vision problems that could be fixed with eyeglasses, contact lenses or surgery.
When Credit Scores Become Casualties Of Health Care
Shefali Luthra
The complexity of health insurance coverage rules, along with market trends that leave consumers open to more out-of-pocket costs, lead to mounting medical debt for consumers.
Sprained Your Ankle? The Cost Of A Brace Could Sprain Your Wallet.
Michelle Andrews
Your health insurance might not cover items such as wheelchairs, walkers, crutches and braces, or you may have to deal with a supplier that has a contract with your insurer.
Calif. Bill Targets Profiteering In Addiction Treatment, Dialysis Industries
Chad Terhune
The legislation is intended to curb schemes in which some treatment providers sign patients up for private plans, pay their premiums and then rake in profits from inflated claims.
Bill Of The Month: For Toenail Fungus, A $1,500 Prescription
Shefali Luthra
How a prescription wiped out one woman’s health reimbursement account, raising questions about prescription drug price tags and about how health care professionals deal (or don’t) with medical costs.