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Billing experts and lawmakers are playing catch-up as providers find ways to get around new surprise-billing laws, leaving patients like Danielle Laskey of Washington state with big bills for emergency care.
As hospital systems and insurers adjust to the pandemic, their contract negotiations grow increasingly fraught. Contracts for in-network care are ending without a new deal, leaving patients suddenly with out-of-network bills or scrambling to find new in-network providers.
Patients sometimes find themselves scrambling for affordable care when a contract dispute causes a hospital — and most of the doctors and other clinicians who work there — to be dropped from an insurance network. Here are six things to know if that happens to you.
A kindergartner in Missouri needed eye surgery. Her insurer granted approval for her to see a specialist nearby, yet her parents were confused when they still owed more than $13,000. Then her uncle, a former state senator, reached out to a colleague who contacted the hospital and the insurer.
A doctor in Colorado became the patient after an accident totaled her car and sent her to the operating room. The hospital kept her overnight, but her insurer stopped paying after she left the emergency room.
About 90,000 people spent months in limbo as central Missouri’s major, and often only, provider fought over insurance contracts. Patients getting caught in the crossfire of disputes has become a familiar complication, as about 8% of hospitals have left an insurer network since 2021. Trump administration policies could accelerate the trend.
A Wisconsin retiree with glaucoma needed her eyes examined. Her Medicare Advantage plan from UnitedHealthcare listed her optometrist’s clinic as in-network, but she learned the hard way that a clinic can be in-network and out-of-network at the same time.
The No Surprises Act, which was signed in 2020 and took effect in 2022, was heralded as a landmark piece of legislation that would protect people who had health insurance from receiving surprise medical bills. And yet bills that take patients by surprise keep coming.
Deductible. Copay. Out-of-pocket limit. What do these health insurance terms actually mean? We explain common phrases from insurance policies so navigating your plan is less of a headache.
The administration is facing a May 12 deadline to declare if it will defend Biden-era regulations that aim to enforce laws requiring parity in insurance coverage of mental and physical health care.
A San Francisco man had friends drive him to the hospital after he was hit by a car. Doctors checked him out, then sent him by ambulance to a trauma center — which released him with no further treatment. The ambulance bill? Almost $13,000.
A Colorado bill banning surprise billing for ambulance rides passed unanimously in both legislative chambers, only to be met with a veto from the governor. As more states pass such legislation, some are hitting the same snag — concerns about raising premiums.
The Trump administration’s first round of sweeping staff cuts to federal agencies eliminated dozens of positions at the Center for Consumer Information and Insurance Oversight, which is tasked with implementing the No Surprises Act.
It’s a difficult rite of passage for young adults without job-based insurance. Here are some tips for getting started.
Agreeing to an out-of-network doctor’s own financial policy — which generally protects their ability to get paid and may be littered with confusing insurance and legal jargon — can create a binding contract that leaves a patient owing.
The record-long federal shutdown is over after a small group of Democrats agreed to a deal with most Republicans that funds the government through January — but, notably, does not extend more generous Affordable Care Act tax credits. Plus, new details are emerging about how the Trump administration is using the Medicaid program to advance its policy goals. Anna Edney of Bloomberg News, Shefali Luthra of The 19th, and Sandhya Raman of CQ Roll Call join KFF Health News’ Emmarie Huetteman to discuss these stories and more. Also this week, KFF Health News’ Julie Rovner interviews KFF Health News’ Julie Appleby, who wrote the latest “Bill of the Month” feature.
Why are patients facing bigger bills than they expect for out-of-network care? In this episode of “An Arm and a Leg,” the show explains the hidden mechanics of MultiPlan, a data firm that helps health insurers set these rates and make bigger returns.
Since 2018, readers and listeners sent KFF Health News-NPR’s “Bill of the Month” thousands of questionable bills. Our crowdsourced investigation paved the way for landmark legislation and highlighted cost-saving strategies for all patients.
Millions of middle-class Americans who have Affordable Care Act marketplace plans are facing soaring premium payments in 2026. Some people are contemplating big life changes to deal with new rates that kicked in on Jan. 1.
Homemade hot sauce sent a Colorado man to the emergency room with what he called “the worst pain of my life.” But stomach cramps were only the beginning. Two years later, the bill came.
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