KHN: Insurance, Coverage & Costs

A ‘No-Brainer’? Calls Grow For Medicare To Cover Anti-Rejection Drugs After Kidney Transplant
By JoNel Aleccia Banking on new cost estimates, a bipartisan coalition in Congress is poised to try — once again — to end a three-year limit on coverage for lifesaving medication required to keep the organs functioning.

Hospitals Block ‘Surprise Billing’ Measure In California
By Ana B. Ibarra California lawmakers on Wednesday pulled legislation that would have protected some patients from surprise medical bills for emergency care, citing opposition from hospitals. They vowed to resurrect the bill next year.

1 In 6 Insured Hospital Patients Get A Surprise Bill For Out-Of-Network Care
By Rachel Bluth On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge, most of those came from doctors offering treatment at the hospital, according to a study by the Kaiser Family Foundation.

Trump Has Blessed States’ Exploration Of Importing Drugs. Will It Catch On?
By Phil Galewitz Colorado, Florida and Vermont — with the support of President Donald Trump — are exploring plans to bring drugs across the border from Canada to help lower costs.

Stem Cell Company Persuades Employers To Steer Workers Toward Controversial Therapy
By Liz Szabo Regenexx, which runs a string of clinics, says stem cell injections can save employers a lot of money, but critics say there’s no proof.

Even When HIV Prevention Drug Is Covered, Other Costs Block Treatment
By Michelle Andrews The U.S. Preventive Services Task Force recommended that people who are at high risk of contracting HIV take PrEP, a preventive treatment. The decision means most health plans will be required to cover the drugs without charging patients. But the recommendation doesn’t apply to the other clinical and lab services people need.

How To Get A Cheaper Prescription Before Leaving The Doctor’s Office
By Phil Galewitz A pricing tool embedded in their electronic health record and prescribing system lets doctors see how much patients will pay out-of-pocket based on their insurance and the pharmacy. But doctors have been slow to adopt the technology, which has limitations.

Dropped From Health Insurance Without Warning: Was It Legal?
By Julie Appleby People who buy insurance on their own may have little notice when something goes amiss. It’s a quirk in health policy at the heart of the next episode of ‘An Arm and a Leg’ podcast.

Churches Wipe Out Millions In Medical Debt For Others
By Roxie Hammill In a mission of forgiveness, churches around the country are buying up medical debt for pennies on the dollar then erasing the debts of strangers. Since the start of 2018, at least 18 churches nationwide have abolished more than $34 million burdening America’s most debt-ridden patients.

‘Sham’ Sharing Ministries Test Faith Of Patients And Insurance Regulators
By JoNel Aleccia Officials in Washington and other states are cracking down on companies that avoid health insurance regulations by masquerading as faith-based care.

Walmart Charts New Course By Steering Workers To High-Quality Imaging Centers
By Phil Galewitz Walmart, the nation’s largest private employer, is recommending that employees and dependents use one of 800 imaging centers identified as providing trustworthy care.

A Year After Spinal Surgery, A $94,031 Bill Feels Like A Back-Breaker
By Jon Hamilton, NPR News A service called neuromonitoring can cut the risk of nerve damage during delicate surgery. But some patients are receiving unexpected and large bills for the service.

Not Funny: Midwife Slapped With $4,836 Bill For Laughing Gas During Her Labor
By Lauren Weber As nitrous oxide makes a comeback for pain relief during childbirth, one medical professional fights back over an overblown charge for using it.

KHN’s ‘What The Health’: Who Will Pay To Fix Problem Of Surprise Medical Bills?
Lawmakers and patients want to eliminate “surprise” out-of-network medical bills. Hospitals, doctors and insurers say they want to eliminate them, too, but their opposition to one another’s proposals could complicate legislative efforts. Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Kimberly Leonard of the Washington Examiner join KHN’s Julie Rovner to discuss this, plus the latest in news about reproductive health and health care sharing ministries.

‘An Arm And A Leg’: Journalist Learns The Hard Way That CPAP Compliance Pays
By Dan Weissmann Check the fine print. When you get a prescription for expensive medical equipment, you may need to follow the doctor’s orders — to the letter — to get your health insurance company to pay up.

‘An Arm And A Leg’: The Full Story Of Insulin And Its Cost ― No Sugarcoating It
By Dan Weissmann Skipping meals. Rationing medicine to make it last. The high cost of insulin has pushed some people with diabetes to make hard choices. Hear about insulin’s backstory and the hacks that might make it affordable.

‘An Arm And A Leg’: Why Are Drug Prices So Random? Meet Mr. PBM
By Dan Weissmann Beware at the pharmacy counter: Your insurance company could be in cahoots with a pharmacy benefit manager — and the negotiations that go on between them are trade secrets.

‘An Arm And A Leg’: Can You Shop Around For A Lower-Priced MRI?
By Dan Weissmann Doctors routinely order MRIs, but the price patients pay can be unpredictable. Hear how one determined woman scanned her options to find the best deal.

‘An Arm And A Leg’: Forget The Shakedown. To Get Paid, Hospitals Get Creative.
By Dan Weissmann An unexpected hospital bill can bust the family budget. That leaves lots of people with bills they can’t pay. Turns out, that’s a crisis for hospitals too, and some are getting creative about collecting debt.

‘An Arm And A Leg’: Expecting A Baby And Unexpectedly Dropped By Insurer
By Dan Weissmann Health care — and how much it costs — is scary. But you're not alone with this stuff, and knowledge is power. "An Arm and a Leg" is a podcast about these issues, and its second season is co-produced by KHN.

Did Your Health Plan Deny You Care? Fight Back.
By Bernard J. Wolfson Most patients don’t argue when their health insurance won’t cover treatment or medication, but they should: Consumers win about half of their appeals. The process can sometimes be overwhelming, but there are ways to prepare and get help.