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Insurance, Coverage, and Costs: 092222

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Wednesday, Sep 21 2022

The $18,000 Breast Biopsy: When Having Insurance Costs You a Bundle

Lauren Sausser

An online calculator told a young woman that a procedure to rule out cancer would cost an uninsured person about $1,400. Instead, the hospital initially charged almost $18,000 and, with her high-deductible health insurance, she owed more than $5,000.

‘It’s Becoming Too Expensive to Live’: Anxious Older Adults Try to Cope With Limited Budgets

Judith Graham

Three women explain how life’s surprises can catapult their efforts to carefully manage limited budgets and lead to financial distress.

Court Ruling May Spur Competitive Health Plans to Bring Back Copays for Preventive Services

Harris Meyer

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.

Many Preventive Medical Services Cost Patients Nothing. Will a Texas Court Decision Change That?

Julie Appleby

A federal judge in Texas issued a decision this week that affects the Affordable Care Act. It says one way that preventive services are selected for no-cost coverage is unconstitutional.

Centene to Pay $166 Million to Texas in Medicaid Drug Pricing Settlement

Andy Miller and Samantha Young

Texas is at least the 12th state to settle with St. Louis-based Centene Corp. over allegations that it overcharged Medicaid prescription drug programs.

Rural Americans Have Difficulty Accessing a Promising Cancer Treatment

Debby Waldman

Chimeric antigen receptor T-cell therapy has eliminated tumors in some late-stage cancer patients, but the cost and complexity of care mean rural Americans have trouble accessing the treatment.

Hospitals Divert Primary Care Patients to Health Center ‘Look-Alikes’ to Boost Finances

Phil Galewitz

Medicare and Medicaid pay “look-alike” health centers significantly more than hospitals for treating patients, and converting or creating clinics can help hospitals reduce their expenses.

Genetic Tests Create Treatment Opportunities and Confusion for Breast Cancer Patients

Michelle Andrews

Doctors are divided on whether blanket testing of breast cancer patients is warranted, since scientists and physicians are sometimes unsure about how to interpret the results.

Medical Coding Creates Barriers to Care for Transgender Patients

Helen Santoro

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.

A Disability Program Promised to Lift People From Poverty. Instead, It Left Many Homeless.

Fred Clasen-Kelly

A federal disability program meant to provide basic income for people unable to work has left many of its recipients homeless. Advocates for the poor say the crisis is growing worse as rents rise and Congress decides whether to make changes to the program that would affect millions of people.

Montana Health Department Seeks to Ax Board That Hears Public Assistance Appeals

Matt Volz

Applicants for cash, food, and health care assistance would need to go to court to appeal rejections if the Montana legislature approves a proposal to eliminate the Board of Public Assistance.

As State Institutions Close, Families of Longtime Residents Face Agonizing Choices

Tony Leys

Iowa, under federal pressure to improve care for people with intellectual or developmental disabilities, is set to join 45 other states that have closed most or all of their state institutions for such residents.

Impending Hospital Closure Rattles Atlanta Health Care Landscape and Political Races

Sam Whitehead and Andy Miller

The nonprofit owners of Atlanta Medical Center, a 460-bed Level 1 trauma center in the heart of the city, plan to close the hospital in November. As many community members worry about the hole the closure will leave in the city’s safety net, the news has thrust health care into the political spotlight less than two months before Election Day.

Readers and Tweeters Place Value on Community Services and Life-Sustaining Care

KHN gives readers a chance to comment on a recent batch of stories.

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