Insurance Coverage & Costs: March 31, 2022
The Case of the $489,000 Air Ambulance Ride
Julie Appleby
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.
How to Avoid Surprise Bills — And the Pitfalls in the New Law
Dan Weissmann
The No Surprises Act offers protection from many surprise medical bills — but that protection may be only as good as a patient’s knowledge of the law and ability to make sure it’s enforced. Here’s what you need to know.
Medicare Advantage Plans Send Pals to Seniors’ Homes for Companionship — And Profits
Phil Galewitz
Many Medicare Advantage plans send caregivers to the homes of seniors periodically to help with housework and provide companionship. But the workers may also prod seniors into activities that boost the plans’ Medicare ratings and federal reimbursements.
Want Vulnerable Californians to Have Healthier Pregnancies? Doulas Say the State Must Pay Up.
Rachel Bluth
California was supposed to start paying doulas this year to help Medicaid enrollees have healthy pregnancies. But the benefit has been delayed because doulas feel lowballed by the state’s proposed reimbursement rate, which is below what most other states pay.
Seeking to Shift Costs to Medicare, More Employers Move Retirees to Advantage Plans
Susan Jaffe
Private and public employers are increasingly using the government’s Medicare Advantage program as an alternative to their existing retiree health plan and traditional Medicare coverage. As a result, the federal government is paying the “overwhelming majority” of medical costs, according to an industry analyst.
$35 Insulin Cap Is Welcome, Popular, and Bipartisan. But Congress May Not Pass It Anyway.
Michael McAuliff
Spun off from the ailing but not-quite-dead Build Back Better legislation, a popular proposal to cap out-of-pocket insulin costs at $35 a month faces tough political realities that could kill it.
Patients Divided Over Alzheimer’s Drug: Is It a ‘Risk I’m Willing to Take’ or Just a ‘Magic Pill’?
Judith Graham
Medicare has proposed limiting coverage of Aduhelm, the costly new drug to treat Alzheimer’s disease, and several prominent groups representing patients and their families are pressing the program to make it more widely available. But among individuals facing the disease, the outlook is more nuanced.
Missouri Tried to Fix Its Doctor Shortage. Now the Fix May Need Fixing.
Bram Sable-Smith
Five states have created “assistant physician” licenses that allow medical school graduates to practice without completing residency training. But a federal indictment in Missouri of one assistant physician has some original supporters trying to rein in the medical specialty.
Delays for Autism Diagnosis and Treatment Grew Even Longer During the Pandemic
Andy Miller and Jenny Gold
Despite increased public awareness, research advances, and wider insurance coverage for autism therapies, children often wait months — in some cases more than a year — to get an autism diagnosis and begin intervention services. The waits can be longer for Black and Latino children, and families in rural areas are also disadvantaged, without access to providers.
Readers and Tweeters Remain Vigilant on Masking and Billing
Terry Byrne
KHN gives readers a chance to comment on a recent batch of stories.
California Governor’s Big Promises on Drug Prices Are Slow to Materialize
Angela Hart and Rachel Bluth and Samantha Young
Gov. Gavin Newsom has launched several initiatives to cut rising drug prices, but the savings haven’t been as monumental as he promised. And his plan to have California make its own generic drugs hasn’t gotten off the ground.
‘An Arm and a Leg’: Need an Expensive Drug? Here’s What You Need to Know
Dan Weissmann
Even a personal finance expert can get stuck with a huge unexpected bill for a drug. Listen up for what you need to know about "copay accumulators."
‘An Arm and a Leg’: A Fight for the Right to Help
Dan Weissmann
It's illegal for a person who isn't a lawyer to give even basic legal advice to people being sued for medical debt. Two New Yorkers are suing to change that.
Listen: An Unsettling Investigation Into the Closure of a Chain of Pain Clinics
KHN senior correspondents Jenny Gold and Anna Maria Barry-Jester joined KVPR’s Kathleen Schock on “Valley Edition” to discuss their investigation into the abrupt closure of one of California’s largest chain of pain clinics — and the patients left behind.
Cómo evitar facturas médicas sorpresa… y las “trampas” de la nueva ley
Dan Weissmann
Aunque una ley supuestamente protege a los pacientes de las cuentas sorpresa, también tiene grietas por donde pasa la trampa.