Insurance, Coverage, and Costs: Feb. 16, 2023

A Baby Spent 36 Days in an In-Network NICU. Why Did the Hospital Next Door Send a Bill?
By Harris Meyer A baby spent more than a month in a Chicago NICU. A big bill revealed she was treated by out-of-network doctors from the children’s hospital next door. Her parents were charged despite a state law protecting patients from such out-of-network billing — and sent to collections when they didn’t pay up.

Your Money or Your Life: Patient on $50,000-a-Week Cancer Drug Fears Leaving Behind Huge Medical Debt
By Fred Schulte When Medicare stops paying for a pricey drug that prolongs life, an Ohio man considers giving up treatment to spare his family enormous debt.

Did Your Health Plan Rip Off Medicare?
By Fred Schulte KHN has released never-before-seen details of federal audits as the government weighs action against dozens of Medicare Advantage plans.

Government Lets Health Plans That Ripped Off Medicare Keep the Money
By Fred Schulte In a surprise decision, U.S. officials yield to insurance industry demands — at least for now.

Montana Lawmakers Seek More Information About Governor’s HEART Fund
By Keely Larson Republican Gov. Greg Gianforte’s Healing and Ending Addiction Through Recovery and Treatment fund has spent $5.2 million since 2021. With a proposed increase, providers and lawmakers alike want to tap into the money.

Some Addiction Treatment Centers Turn Big Profits by Scaling Back Care
By Renuka Rayasam and Blake Farmer, Nashville Public Radio Private equity groups are cashing in on rising rates of alcohol and drug addiction in the U.S. But they aren’t necessarily investing in centers with the best treatment standards, and they often cut extra services.

Decisions by CVS and Optum Panicked Thousands of Their Sickest Patients
By Arthur Allen Pharmacy closures by two of the biggest home infusion companies point to grave shortages and dangers for patients who require IV nutrition to survive.

The Pill Club Reaches $18.3 Million Medicaid Fraud Settlement With California
By Don Thompson The online women’s pharmacy agreed to pay $15 million to the state Department of Justice and $3.3 million to the Department of Insurance over claims it overbilled Medi-Cal.

Watch: In Insurers’ Eyes, Not All Midwives Are Equal
The first installment of InvestigateTV and KHN’s “Costly Care” series explores one California mother’s experience struggling to get reimbursed for midwifery care and the differences between providers that may determine whether insurance covers them.

Montana’s Tax-Exempt Hospitals Oppose Increased Oversight by State Officials
By Katheryn Houghton As Montana officials seek to make nonprofit hospitals prove the benefits they provide the community justify their tax exemptions, industry leaders propose their own changes — which state officials say would further limit the state’s authority.

‘We Ain’t Gonna Get It’: Why Bernie Sanders Says His ‘Medicare for All’ Dream Must Wait
By Arthur Allen As he takes the reins of the Senate Health, Education, Labor & Pensions Committee, the independent from Vermont and implacable champion of “Medicare for All” maps out his strategy for negotiating with Republicans — and Big Pharma.

Era of ‘Free’ Covid Vaccines, Test Kits, and Treatments Is Ending. Who Will Pay the Tab Now?
By Julie Appleby Insurers, employers, and taxpayers will all be affected as drug manufacturers move these products to the commercial market.

As Pandemic-Era Medicaid Provisions Lapse, Millions Approach a Coverage Cliff
By Phil Galewitz States are trying to reach millions of Medicaid enrollees to make sure those still eligible remain covered and help others find new health insurance.

Health Policies Were a Prominent Theme in Biden’s State of the Union Speech
By KFF Health News and PolitiFact staffs Our partners at PolitiFact fact-checked a range of President Joe Biden’s statements, including key health-related comments.

Armed With Hashtags, These Activists Made Insulin Prices a Presidential Talking Point
By Bram Sable-Smith Twitter has been a hotbed for the burgeoning insulin access movement and activism surrounding other medical conditions. For people with diabetes, the platform has helped propel concern about insulin prices into policy. Can it continue to win with hashtags?

Community Resurrects Colorado Birth Center Closed by Private Equity Firm
By Claire Cleveland A private equity firm bought a birth center and then shut it down. The community brought it back as a nonprofit.

Nursing Home Owners Drained Cash During Pandemic While Residents Deteriorated
By Jordan Rau As the federal government debates whether to require higher staffing levels at nursing homes, financial records show owners routinely push profits to sister companies while residents are neglected. “A dog would get better care than he did,” one resident’s wife said.

Doctors Are Disappearing From Emergency Rooms as Hospitals Look to Cut Costs
By Brett Kelman and Blake Farmer, Nashville Public Radio As a money-saving strategy, emergency rooms are turning to nurse practitioners, physician assistants, and other staffers who earn far less than physicians.

Centene Agrees to $215 Million Settlement With California for Alleged Medicaid Overbilling
By Samantha Young The nation’s largest Medicaid insurer denies wrongdoing after the California attorney general’s office investigated it for inflating prescription drug costs.

California’s Resolve Questioned After It Grants Medi-Cal Contract Concessions
By Bernard J. Wolfson and Samantha Young After the Department of Health Care Services canceled Medi-Cal contract awards under pressure from major insurers, some consumer advocates question the administration’s willpower to improve care in the safety-net program.

California Author Uses Dark Humor — And a Bear — To Highlight Flawed Health System
By Rachel Scheier A new graphic novel by Kathleen Founds follows an angst-ridden bear on his quest for mental health treatment. Founds drew on her own experience with bipolar disorder.

Journalists Follow Up on Radon Mine Health Spas, Open Enrollment, and Health Fraud
KHN and California Healthline staff made the rounds on national and local media this week to discuss their stories. Here’s a collection of their appearances.

Readers and Tweeters Diagnose Greed and Chronic Pain Within US Health Care System
KHN gives readers a chance to comment on a recent batch of stories.

Políticas de salud fueron tema prominente en el discurso del Estado de la Unión de Biden
By KFF Health News and PolitiFact staffs A diferencia de sus discursos anteriores, éste fue a Cámara llena, y sin limitaciones por covid-19. Y los legisladores en la audiencia, tanto partidarios como opositores, parecían estar de un humor estridente.

Se acaba la era de las vacunas y las pruebas gratuitas contra covid. ¿Quién va a pagar?
By Julie Appleby Las personas podrán obtener estas vacunas a bajo costo o sin costo mientras duren los suministros del gobierno. Luego, dependerá de su seguro de salud.

Millones en riesgo de perder Medicaid, mientras terminan protecciones por la pandemia
By Phil Galewitz Los estados se están preparando para remover a millones de personas de Medicaid, a medida que expiran las protecciones que se implementaron al comienzo de la pandemia de covid-19.