6 days Ago
Consumer Cost Concerns – In Their Own Words
Shereese Hickson has a 9-year-old son and an income of just $770 per month. She was also diagnosed with multiple sclerosis in 2012. With her limited income, the bill she received for a new MS treatment left her shocked and worried; her share would cost over $3,000, NPR reports. Total bill: $123,019 for two Ocrevus […]
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In addition to surprise medical bills they may incur from emergency departments, hospitals, and doctors, consumers need to be aware of surprise bills from medical labs. An Iowa woman who needed a biopsy thoroughly prepared and thought she had everything preapproved for her procedure. She still received a surprise medical bill for hundreds of dollars […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of transparency and other roadblocks to accessing the health care they need. Many have taken to social media to discuss their experiences with things like high deductibles, unexpected emergency room bills and other challenges. Here, we highlight posts from individuals sharing their stories […]
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Over the past decade, hospital systems have merged at rapid rates, creating large scale organizations that impact consumers’ care on virtually all levels. As the mergers continued, expanding to include physicians’ and doctors’ groups, hospitals have said that coordinated services and savings would trickle down to consumers and result in cheaper prices. But an analysis […]
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The family of an Oklahoma woman who was denied cancer coverage by Aetna has been awarded $25.5 million, in what is believed to be the largest individual verdict for a “bad faith” insurance case in the state’s history. CNN reports that the jurors warned that Aetna should heed their verdict as a message for the […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of transparency, and other roadblocks when it comes to accessing the health care they need. Many have taken to social media to discuss their experiences with things like high deductibles, unexpected emergency room bills and other challenges. Here, we highlight posts from individuals […]
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A new Blue Cross Blue Shield plan being offered on North Carolina’s exchange for 2019 will save consumers between 30 and 33 percent on their monthly premiums, but it comes with an important and costly caveat: it has no provider network, meaning all doctors and hospitals will be treated as out-of-network and can charge consumers […]
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Janet Winston has always had sensitive skin. For years, she avoided lipstick and cosmetics. After an antifungal cream prescribed to treat a rash only made it worse, she decided it was time to see a specialist, Kaiser Health News reports. Knowing her local dermatologist would be booked for months, Winston drove six hours to Stanford […]
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Wilmington’s WECT News recently highlighted a local pharmacist who is helping patients fight against drug price inflation. Gerald Michael, who runs a family owned pharmacy, recounts the discrepancies between what he pays for prescription medications and what the pharmacy benefit manager (PBM) is telling him to charge patients. In one instance, a prescription that cost […]
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When Diane Parnell’s youngest son, Brandon, woke up in the middle of the night complaining of severe abdomen pain for a third day in a row, she decided it was time to take him to the emergency room. Brandon’s older brother, Jamie, had spent 3 days in the hospital fighting sepsis, after his appendix had […]
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A new analysis shows that the controversial Anthem emergency department policy could result in the denial of claims for as many as 16 percent of visits if expanded nationally, Reuters reports. The study, which was reported in JAMA Network Open, found that consumers could be denied even when their symptoms are identical to symptoms of […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of transparency, and other roadblocks when it comes to accessing the health care they need. Many have taken to social media to discuss their experiences with things like high deductibles, unexpected emergency room bills and other challenges. In our new series, “Consumer Cost […]
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The state of Texas has fined insurer Humana $700,000 for “network adequacy deficiencies,” FierceHealthcare reports. The fine comes amid increasing attention on consumers who have received surprise medical bills and could signal the intent of state regulators to take more direct action against surprise bills. Surprise bills often occur when insurance companies have contracts with […]
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Photo by Heidi de Marco/KHN Lara Herscovitch says that her transition to working as a freelance musician has been “joyful,” but there have been some challenges. Since the former Connecticut state troubadour left her full time job, Hersovitch’s health care costs have increased over 600 percent. She expects that she will end the year with […]
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Before Becky Frank was diagnosed with stage 3 breast cancer, she was energetic and spent time with her five grandchildren. When Frank was diagnosed, her daughter, Cherlyn Edwards, was sad but determined to help her fight the disease. She found her mother an oncologist who specializes in triple negative breast cancer, the aggressive and difficult […]
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Steve Zangla waited as long as he could but eventually his stomach pain became unbearable. Steve and his wife Colleen went to the emergency room at Riddle Hospital in Media, PA. The Zanglas had positive experiences at the hospital before. Once there, the Zanglas learned that Steve had a kidney stone. Weeks later, they were […]
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Richard Wyler was working on a construction project near Las Vegas, when he awoke with a stomach ache. He thought it was probably food poisoning and got himself to work the next day, according to KSL. “I probably wouldn’t have gone to the emergency room unless my work made me,” Wyler said. “I honestly didn’t […]
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In a recent op-ed in the Houston Chronicle, a cancer patient recounted his battle with his insurer, Blue Cross Blue Shield. When Randy Montgomery was diagnosed with oral cancer last year, it sparked a whirlwind of tests, decisions, and significant life changes. The same treatments that would fight off the cancer carried “life-altering side effects […]
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In April, CQC wrote about Matthew Timion’s fight to get his adopted son coverage for acute psychological issues. After years of battling with the state, Timion is giving an update on his son’s health. At age 10, Timion’s son began to act out aggressively and threaten violence. At one point, Timion was bringing his son […]
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A year after the deadly mass shooting at the Route 91 concert in Las Vegas, survivors are still dealing with the aftermath. Even for many of the fully-insured survivors, mounting medical bills are part of a new reality, Las Vegas Review-Journal reports. Rose Janise has been dealing with the medical bills for her daughter, Rylie […]
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Photo by Heidi de Marco/KHN Adam and Rondi Kauffmann are battling TennCare, Tennessee’s Medicaid program, to get care for their disabled daughter, FOX 17 News reports. Adelaide, the couple’s 10-month-old daughter, has Spinal Muscular Atrophy Type 1. The disease leads to a weakness and lack of control over the muscles and causes breathing concerns. Before […]
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As consumers are impacted by high deductibles, surprise bills, balance billing, and other health care challenges, they have taken to social media to discuss their experiences. This is an opportunity for consumers to air grievances, ask for help, and share their stories. In our new series, “Consumer Cost Concerns – In Their Own Words,” CQC […]
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A story in the Wall Street Journal reveals large hospitals and hospital systems have been using secret contracts with insurance companies to restrict cost saving opportunities for consumers. Hospitals do anything from demanding insurers include their facilities in insurance plans to masking their prices from consumers. As the Wall Street Journal reports: Dominant hospital systems […]
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A Virginia family received a huge hospital bill after their teenage son was rushed to the hospital after a baseball pitch hit him in the face. As NBC Washington reports: A family unknowingly let an out-of-network doctor treat their teenage son and wound up with a bill for tens of thousands of dollars. Zack Hamilton, […]
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Consumers across the country continue to face the harsh reality of expensive medical bills. Reicedo Concepcion does not remember many details about the day he was struck by a car. The incident landed him the in hospital with stitches and five broken ribs, KSAT reports. “Now I can’t take air,” he said, explaining how it’s […]
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Photo by Heidi de Marco/KHN A group of Charlottesville consumers have banded together to take on the area’s high health insurance rates, The Washington Post reports. After 2018 brought soaring premiums on the Affordable Care Act’s individual market place, Ian Dixon found himself questioning the high prices. Dixon, an app developer, was facing a 300 […]
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A recent New York Times column highlighted the role of hospital emergency rooms in ever-increasing health care costs. Glenn Melnick, a professor of public policy at the University of Southern California’s Schaeffer Center for Health Policy and Economics, wrote that well-intentioned regulations have given hospital ERs incredible leverage to price services however they wish. Most states have […]
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According to a new study, the ACA’s bundled payment program is working better than some expected, Vox reports. The program pays hospitals a single, flat amount for joint replacement surgeries. The program aimed to get hospitals to lower the costs of these surgeries while maintaining or improving consumers’ quality of care. The hope for bundled […]
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In an effort to take control over parts of the drug-supply chain, a group of major hospitals has started a generic drug company, named Civica Rx, the The Washington Post reports. Several hospital leaders said shortages and price spikes on old drugs are managed on a near-daily basis. The cost isn’t just the price of […]
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A new study highlights how even small medical debts can have lasting impacts, Associated Press reports. The study, published in Health Affairs, highlights how vulnerable consumers are to medical bills, especially surprise bills or balance bills. When sent to collections, even small medical bills can impact consumers’ credit scores and financial health. Researchers found that […]
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Photo by Heidi de Marco/KHN The Department of Health and Human Services’ inspector general has launched an examination into skilled nursing facilities to ensure they are meeting Medicare’s minimum staffing requirements, Kaiser Health News reports. This attempt to ensure that nursing homes provide safe, quality care to patients follows a KHN and New York Times […]
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Todd Smith and Benjamin Bove have worked with pharmaceutical companies across the country, offering a “sure-fire fix” to increase revenues by exploiting loopholes and raising prices, Bloomberg reports. After Smith and Bove were consultants at Novum Pharma, a tube of Alcortin A, a skin gel, jumped from $189 in 2015 to $7,968. At another company, […]
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Before Drew Calver had his heart attack in April 2017, he considered himself to be in good health. At 44, Calver was an avid swimmer and had just completed an Ironman triathlon a few months before. Kaiser Health News reports on the health scare that upended Calver’s life and the subsequent bill that he never […]
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After a routine mammogram, Kathy Salerno was called back for a second mammogram, an ultrasound, and a biopsy. The tests confirmed any family’s fear: breast cancer. Salerno’s surgery was successful, removing the tumor and lymph node with good margins. Subsequent tests came back clear, and Salerno’s doctors recommended radiation to kill any cancer left in […]
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As expensive premiums, high deductibles, and surprise medical bills continue to impact consumers, more are turning to coverage alternatives to “rig their own safety nets,” Bloomberg reports. The Kaiser Family Foundation has found that most American families that do not have coverage find it too expensive. This was the case for Lindsie and Chris Bergevin. […]
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Photo by Heidi de Marco/KHN A new survey from Bankrate is highlighting just how opaque and confusing insurance coverage and subsequent bills are for many Americans. The survey found that 41 percent of consumers that received medical treatments were surprised by the cost. The story is all too familiar: someone heads to the doctor, gets […]
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Photo by Heidi de Marco/KHN A new group of drugs may be unnecessarily costly for consumers. The drugs, nick-named “convenience drugs,” combine the ingredients of two common, generic medications to create a more expensive alternative. Axios found that many convenience drugs could be replaced by a combination of generics and over-the-counter medication for around $20. […]
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Graph by Wall Street Journal Pinning down the price of care can be difficult, if not impossible, for consumers. The Wall Street Journal reports even the hospitals that provide the care don’t know its true cost. After hearing of potential payment changes, Gundersen Health System’s hospital in La Crosse, WI, decided to track the costs […]
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Gretchen Liu was on vacation in China when she suffered a mini stroke. When she returned to San Francisco, her doctor prescribed a generic blood pressure medication, telmisartan. Liu and her husband Z. Ming Ma used their insurance to buy a 90-day supply of the drug through Anthem’s online pharmacy run by Express Scripts. The […]
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Two new studies examine the impact of medical bills on consumers. Together, they provide a glimpse into what many consumers face after receiving medical care. Contrary to the reason many individuals purchase health insurance, it does not a guarantee protection against high medical bills, USA Today reports. A Bankrate survey of 1,000 individuals found that […]
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Previously, Consumers for Quality Care has reported on the wild price discrepancies for the same tests at different facilities, like when Benjamin Hynden paid 33 times more to receive a CT scan from a hospital than from an imaging center. Now, The Philadelphia Inquirer has reported on a man who paid 18 times more for […]
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Photo by Heidi de Marco/KHN More consumers are turning to crowdsource fundraising sites, like GoFundMe, to help pay for medical bills they have trouble affording, MPR News reports. Rob Soloman, the company’s CEO, says that medical fundraisers now account for one third of the site’s campaigns. Often, it’s family members or friends – like Tammy […]
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As soon as Michele Brough was diagnosed with Stage 3 breast cancer, her doctors wanted move forward with treatment. Brough’s oncologist quickly reached out to her insurance company, Anthem Blue Cross Blue Shield, to apply for pre-approval for a drug to strengthen her immune system as she underwent chemotherapy. Los Angeles Times reports that Brough […]
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Blue Cross Blue Shield will begin a controversial emergency room policy in Texas, Houston Chronicle reports. The insurer will no longer cover some out-of-network ER visits if it determines that the patient should have sought treatment elsewhere. The policy change will impact roughly 500,000 Texans. Blue Cross Blue Shield of Texas said medical directors would […]
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A new study from St. Jude Children’s Research Hospital is shedding light on the long-term financial impact of childhood cancer. The study found that the long-term health risks associated with childhood cancer treatments, as well as screenings for recurrences and new complications, carry high financial tolls for children and their families. Kristi Lowery, who participated […]
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The prevalence of high deductible health care plans has largely been propelled by the idea that consumers would be more responsible with their health care spending if they had a larger stake in it. The logic assumes consumers know what kind of care is necessary and what is superfluous. The reality of how consumers use […]
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High hospital prices have been a strain on the American health care system, Axios reports. Ever-increasing hospital spending has a major impact on consumers. CMS data shows that hospital care costs more than $3,300 per capita, roughly three times that of prescription drug spending. Chart by Axios In total, hospital and doctor services account for […]
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The Trump administration has scrapped the National Guideline Clearinghouse website, guideline.gov. The website housed an online database of best practice guidelines for doctors, other medical professionals, and researchers, Vox reports. The National Guideline Clearinghouse’s repository of evidence-based clinical practice guidelines and related documents was “a one-stop shop for doctors who were trying to figure out […]
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Photo By Heidi de Marco/KHN The Center on Budget and Policy Priorities is highlighting how a recent move from Centers for Medicare & Medicaid Services (CMS) could increase drug prices and hurt consumers. Recently, CMS rejected a Massachusetts proposal to limit consumers’ access to prescription drugs. After rejecting the proposal, however, CMS suggested even more […]
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Maria and Jake Grey’s daughter Brighton has a rare chromosomal disorder called Wolf-Hirschhorn Syndrome. The disorder means that Brighton, who is six, needs round-the-clock care. Still a newborn by developmental standards, Brighton has seizures, vision, hearing, heart and kidney problems, and more. The Greys are considering divorce as an answer to their health care costs […]
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An editorial in The New York Times examines the state of Medicaid coverage in the United States and criticizes the ideology behind work requirement programs. District Court Judge James Boasberg recently ruled in favor of a group of 16 Kentuckians, including a law student with a heart condition and a housekeeper with rheumatoid arthritis, who […]
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Vox’s Sarah Kliff recently sat down with PBS to discuss some of the common, hidden costs in consumers’ emergency room bills. Kliff is currently working on a project that collects, examines and reports on consumers’ ER bills, and exposes their hidden costs. Kliff, who has collected more than 1,300 medical bills, discussed what is hurting […]
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Consumers may see big benefits from a new health venture that seeks to innovate the American health care system. The project, established by Amazon, Berkshire Hathaway, and JP Morgan, is looking for ways to improve the care received by those on their plans. An initial focus of the efforts is eliminating middlemen to cut costs […]
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A South Korean family received a hospital bill for nearly $20,000 for a nap and baby formula after an accident landed their son in the ER. Jang Yeo-im was on vacation in San Francisco when her 8-month son, Park Jeong-whan fell off the bed, hitting his head. Although there was no blood, Jeong-whan was inconsolable. […]
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Carla and John Jordan thought they were prepared if one of their family members became sick. The family had insurance through Carla’s employer, which they believed would cover them if anything were to happen. But a disastrous health year taught the family they were wrong, Bloomberg reports. Carla needed a gallbladder operation. Her husband John […]
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Photo by Heidi de Marco/KHN Kylah Goodfellow Klinge, who has battled Type I Diabetes since her early 20s, wrote a piece for STAT where she recounted her experiences with insurance coverage, echoing many common consumer frustrations. Goodfellow Klinge was about to graduate college when she received her diagnosis. [J]ust before my college graduation, odd symptoms […]
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A new study has found that while the number of emergency room visits has stayed consistent, the cost of these visits has nearly doubled, The Houston Chronicle reports. In 2016, the average amount spent nationally by insurers and patients for emergency room visits was $247 per insured person. In 2009 it was $125, the Health […]
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A new Missouri law aims to protect consumers from Anthem’s emergency room policy, News-Leader reports. The controversial policy, which CQC has previously reported on, states that consumers’ claims for emergency room visits can be retroactively denied if Anthem does not consider the visit an emergency. Since implementing the policy in six states, Anthem has denied […]
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A little more than a year after Nick Williams was diagnosed with ALS, he had to leave his job of 14 years as a high school wrestling coach. Williams coached his last season from the confines of a wheelchair, which he found himself needing just 3 months after his diagnosis. Since then, many every day […]
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Nathaniel Killgore, born with hemophilia, was in the process of moving to a new state when he began to bleed internally in his knees and arms. Killgore was in pain and having trouble getting around. He knew he needed a clotting factor to help ease the bleeding and pain. To get his life-sustaining medication, Killgore […]
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Amanda Schornhorst wasn’t too alarmed when she felt a lump in her breast. Six years prior, she had been diagnosed with cysts, WTHR reports. She expected a mammogram to show the same thing this time around. When Schornhorst went to the doctor for a routine check-up a few months later, she was not surprised when […]
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Photo by Heidi de Marco/KHN Tammy Oliver was diagnosed with Stage IV cancer in 2015. Her doctors told her there was not much they could do, but she started new medications and hoped for a miracle, WTHR reports. The injection Oliver started receiving was around $9,000 a month. Tammy Oliver and her husband Pastor Brent […]
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Scott Kohan was brutally attacked in January. When he came to, after the attack, he was laying in an emergency room. The attack had left him unconscious and he was transported to the hospital after witnesses called 911. Kohan called for the nurse, who explained his injuries and that he would need jaw surgery. Kohan […]
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Jim Burton was working in his garage when he felt a pain in his back and dropped to his knees. Burton contacted a friend who is an EMT, who advised Burton to go to the emergency room. They worried he may have slipped a disk in his back. Luckily, the doctors at the ER found […]
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Photo by Heidi de Marco/KHN Sarah Benoit has been waiting for her insurance company to approve the drug her doctors tell her could help slow the progression of her ALS. The drug, called Radicava, was approved by the FDA and prescribed by her doctors. However, her insurer Blue Cross of California will not approve the […]
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Erica Zak was diagnosed with cancer when her daughter was only a week old. What she thought were pregnancy pains turned out to be colon cancer, which metastasized to her liver. Zak underwent treatment and the cancer was successfully removed from her colon, but a microwave ablation surgery to remove tumors from her liver went […]
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Photo by Heidi de Marco/KHN A Colorado man’s credit score was threatened after he received a surprise medical bill for out-of-network doctors at an in-network hospital. Jeff Woodard was hospitalized after a horse-riding accident and ran up hundreds of thousands in medical bills, which his insurer covered. But then he was hit with surprise medical […]
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A woman in Oklahoma was charged $15,075 for four screws in her foot. In 2017, Sherry Young had surgery on her shoulder and foot at Oklahoma University Medical Center. Her insurer, BlueCross BlueShield of Oklahoma originally balked at paying her $115,000 bill for the surgeries. As a result, Young examined her bill to determine why […]
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As Consumers for Quality Care has reported, last year Anthem announced that consumers’ emergency room visits would not be automatically covered. Instead, the insurer said it would evaluate whether the patient’s issue constituted an emergency, and cover the care accordingly. Consumers, consumer advocates, and politicians alike have been vocal about their apprehension about the policy’s […]
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A woman was charged $5,751 for an ice pack and a bandage, according to Vox. In 2016, Jessica Pell fainted, fell and hit her head, and cut her ear. She went to emergency room where she received an ice pack and bandage for her ear. Pell was wary of receiving surprise medical bills, so she […]
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The American College of Emergency Physicians (ACEP) has launched the next part of its campaign against Anthem Blue Cross Blue Shield’s emergency room coverage policy. CQC wrote about this harmful policy and its impact on consumers in the past. In this new iteration of its campaign, ACEP released two videos depicting how Anthem’s policy might […]
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Hospitals are sending large bills to newborn babies, Splinter News reports: There are frantic posts about it on new mom message boards all over the internet: About $5,000 charges for “newborn nursery” services billed to the baby when it never left the hospital room, or surprise charges to infants women thought were covered under their […]
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Doctors are speaking out against insurance companies’ use of ‘step therapy,’ in treatment approvals. Insurers argue that the practice helps cap increasing drug costs but doctors argue that the practice is making their patients worse. Step therapy requires patients to try cheaper drugs before moving on to more expensive medications. Doctors are highlighting stories like […]
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Tommy Jones lost his right arm in a farming accident when he was just 17. For the last 35 years, Jones has worked as a heavy equipment operator. Thanks to a prosthetic arm, he has been able to work and live independently. Now, however, Jones has had to fight his insurance company, Blue Cross Blue […]
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Consumers and advocates are speaking out against lapses in the nation’s mental health parity laws, which are supposed to ensure mental health and substance abuse coverage in health care. Despite the law’s passage ten years ago, disparity persists, Chicago Tribune reports. Matthew Timion’s adopted son was 10 when he started to act out, often violently, […]
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Benjamin Hynden had been experiencing mild discomfort in his abdomen for a few weeks when he made an appointment to see his internist last fall. The doctor recommended that Hynden get a CT scan at a local imaging center, Kaiser Health News reports. Hynden received the CT scan, which was inconclusive, and paid a $268 […]
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Three senators have demanded answers about price increases for a decades-old cancer drug. According to The Hill: The drug in question, lomustine, was introduced in 1976 to treat brain tumors and Hodgkin lymphoma. Lomustine, which has no generic competition, cost $50 for a capsule with the highest dose in 2013. Now a capsule with the […]
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Legislation in Iowa to allow Affordable Care Act-exempt plans could leave consumers vulnerable. The bill would allow certain health plans to be exempt from the law’s mandates, Des Moines Register reports. It would allow small employers to band together and buy insurance through association health plans, which can charge more, deny coverage for pre-existing conditions […]
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Photo by Heidi de Marco/KHN Next month, Medicare enrollees will receive a new Medicare card that will help prevent scams. According to Kaiser Health News: The new cards address these concerns by removing each member’s Social Security number and replacing it with a new, randomly generated 11-digit “Medicare number” (some capital letters are included). This […]
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The nation’s largest health insurer has announced a new ER policy that could have negative consequences for consumers. UnitedHealthcare will analyze claims submitted by hospitals to determine if the ER had upcoded. According to Naples Daily News: UnitedHealthcare will be using an “emergency department claim analyzer tool” that will determine the appropriate coding “based on […]
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Photo by Heidi de Marco/KHN Two recent studies found that hospitals routinely inflate costs related to cancer care, sometimes charging upwards of five times more, MedScape reports. A study by Martin A. Makary and colleagues, published in the American Journal of Managed Care (AJMC), found that hospitals routinely charge patients more for cancer care than […]
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Photo by Heidi de Marco/KHN In a recent letter to eye surgeons, Anthem introduced a new anesthesia policy, writing that they do not find that, in most cases, an anesthesiologist or nurse anesthetist is medically necessary for procedures. This means that surgeons preforming cataract surgery may soon have to monitor their patient’s anesthesia at the […]
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A recent Kaiser Health News article highlights an increasingly popular trend that is potentially harmful for consumers. In a new scheme designed to ensure hospitals are getting paid for the services they provide, the facilities are pairing with lending services and offering patients loans on the spot. Private doctors’ offices and surgery centers have long […]
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Consumers for Quality Care hosted a telebriefing on Thursday, Feb. 22, with speakers from the Georgetown University Health Policy Institute and the DC Health Benefit Exchange Authority, who provided an overview of the Department of Labor (DOL) proposed rule on Association Health Plans (AHPs), and discussed the policy implications with dozens of stakeholders who joined […]
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Blue Cross of Idaho will sell five health insurance plans that do not comply with ACA standards, The Idaho Statesman reports. The announcement comes after Idaho’s Governor Butch Otter signed a controversial executive order allowing insurers to create “state based” plans. These plans would be required to meet lower state requirements. “We’re excited that they’ve […]
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After facing pushback from hospitals, patients, and health care advocates, Anthem has decided to modify its emergency room coverage policy but many do not believe the insurer has gone far enough. As Consumers for Quality Care reported, last year Anthem announced that consumers’ emergency room visits would not be automatically covered. Instead, the insurer said […]
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After Aetna’s former medical director admitted that he did not review patients’ records when approving or denying a claim, the state of California has launched an investigation into the company’s patient claims review process, CNN reports. Dr. Jay Ken Iinuma was deposed as part of a lawsuit against the insurer brought by Gillen Washington, a […]
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More and more consumers are finding themselves saddled with expensive emergency room bills as a result of Anthem’s decision to stop covering visits it deems to be non-emergencies. That’s exactly what happened to Kimberly Fister-Mesch. According to Consumer Reports, Fister-Mesch woke up in the middle night with a severe headache. She took Motrin and Tylenol, […]
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As consumers continue to receive surprise medical bills, they often do not have the money to pay, Fierce Healthcare reports. After arriving at an in-network hospital, consumers can be unknowingly treated by out-out-network physicians. That’s exactly what happened to Reid Rupp, who received a $17,000 bill from an out-of-network plastic surgeon after a medical emergency […]
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A St. Louis man is fighting his insurance company after it went against his doctor’s treatment advice and denied his treatment for lung cancer, KMOV reports. After undergoing surgery to remove his left lung, David Starzyk’s doctor developed a treatment plan for his other lung. His doctors at Siteman Cancer Center made plans for radiation […]
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Photo By Heidi de Marco/KHN The Trump administration recently announced changes to Medicaid’s non-emergency medical transportation (NEMT) services, allowing states to apply for waivers so they are no longer required to provide this key benefit. But, as Kaiser Health News reports, NEMT services have been an integral part of the Medicaid program since its inception […]
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4-month old Jensen Kittle was born with Severe Combined Immunodeficiency (SCID), a life-threatening genetic disorder that leaves Jensen with virtually no immune system to battle every day germs. According to local CBS affiliate WRGB: “Without an immune system he has no ability to fight against the flu, the common cold, even wearing the wrong fragrance […]
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As a part of Vox’s dive into emergency room billing, Sarah Kliff recently reported on how Anthem’s new emergency room policy – which essentially requires patients to diagnose themselves in order to ensure their condition is serious enough to be deemed an emergency by Anthem, and therefore covered by their insurance – is impacting consumers. […]
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Photo By Heidi de Marco/KHN Hospital conglomerates are changing their business models, consolidating care at regional hospitals, and often cutting services at more remote facilities. As services are cut from these facilities, they become de facto outpatient clinics. Hospital executives argue that the changing medical landscape has made long inpatient stays more sparse and hospitals […]
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Idaho has announced it will take formal steps to allow insurance companies to sell non-compliant plans on the state’s ACA market place, the Associated Press reports. The change means some consumers who opt for cheaper plans could end up with health insurance that doesn’t cover their needs. Under Idaho’s guidelines, insurers can offer plans that […]
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A new lawsuit claims that health insurance company Centene Corporation provides plans that have less coverage than advertised. The lawsuit claims the insurance company’s slim coverage makes it difficult, if not impossible, for consumers to find adequate care, according to Bloomberg. The company misled customers about the number of doctors covered under its health plans, […]
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Health insurance giant Aetna has agreed to a $17 million settlement after it breached consumers’ privacy in an incident that revealed the HIV statuses of thousands of policy-holders, according to The Associated Press. Consumers for Quality Care reported on the breach over the summer. Court documents say the Hartford, Connecticut-based company sent a mailing in […]
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The Trump administration has frozen the National Registry of Evidence-based Programs and Practices (NREPP), a national database of mental health and substance abuse treatments and interventions, a move that could have negative consequences for consumers. Health professionals and community groups use the database to identify resources to help individuals in need of these services. According […]
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Photo by Heidi de Marco/KHN The Trump administration announced it would allow states to implement work requirements for Medicaid recipients, the Washington Post reports. The change signifies a fundamental shift in the program’s policy. At the time of the announcement, 10 states had already requested federal permission to add work requirements to their Medicaid programs […]
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Comedian Samantha Bee recently highlighted how American hospitals are failing on maternity care. In the segment, Bee focused on a number of stories that examine how the U.S. has the worst maternal mortality rate in the developed world. A 2015 statistic found that American women die in childbirth at twice the rate of women in […]
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Sen. Claire McCaskill has requested information from insurance giant Anthem over a policy change that impacts Missouri consumers’ emergency room coverage, according to St. Louis Business Journal. As Consumers for Quality Care has previously reported, Anthem has told patients in a number of states that their ER visits may no longer be covered, if they […]
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Despite the Affordable Care Act (ACA) open enrollment period ending on December 15, some consumers may still be eligible to enroll in a health plan for 2018. Most residents in states that established their own marketplaces have later deadlines, according to the Kaiser Family Foundation. State-based Marketplaces (SBMs) have flexibility to set their own dates […]
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A Florida woman’s life was thrown into turmoil after she was hospitalized and received a massive bill that she couldn’t pay. According to Bloomberg: [Angelia] Fowler had been sick for months in November 2015 when her son finally took her to the emergency room with what turned out to be pneumonia. She spent much of […]
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In a recent Medium column, Consumers for Quality Care board member Donna Christensen discusses the potential dismantling of Massachusetts’ health care system. The Commonwealth, once a national leader on health care, is on the verge of cutting thousands of vulnerable Massachusetts citizens’ coverage. The Massachusetts government recently submitted a waiver request (known as a 1115 […]
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Photo by Heidi de Marco/KHN Recently, UnitedHealthcare has come under fire for rolling back coverage of Truvada, a pre-exposure prophylaxis (PrEP) medication. When used correctly, the drug has at least a 92% success rate in preventing HIV transmission. The drug is normally expensive, and many patients use secondary insurance, such as copay cards or manufacturer […]
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Cara Pressman, a 15-year-old with epilepsy, has some tough words for her insurance company after it denied her coverage of a minimally invasive brain surgery. One day when Cara was 9, she incessantly complained of a severe headache. That night Cara had her first seizure. When her parents came to her room she was covered […]
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The latest installment of Vox’s series on hospital billing and prices examines the monopoly powers of emergency rooms and how consumers are hurt by facility fees. Nearly all emergency room bills include a facility fee, a charge that is applied just for seeking care. According to Vox: Emergency rooms argue that these fees are necessary […]
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A new Pro Publica report examines how unnecessary procedures and overtreatment are contributing to skyrocketing costs of care. Some doctors and hospitals are performing redundant or unnecessary tests, scans, and procedures. Patients, often lacking knowledge and understanding of why these procedures are being recommend, authorize them. Later, these patients face extreme medical bills for the […]
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Consumers for Quality Care board member and former Congresswoman Donna Christensen recently made a number of appearances to inform consumers on how to choose the best plan during open enrollment. Speaking on news networks in Charleston, W. Va.; Chicago; Portland, Oregon; and Seattle, Christensen educated consumers about potential changes and issues to be on the […]
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The federal government has allowed Iowa to rollback its retroactive eligibility benefit, making it the fourth state to do so, Kaiser Health News reports. The benefit, which has been a feature of Medicaid for years, allowed for new enrollees’ medical bills to be paid retroactively up to 3 months. The other states include Arkansas, Indiana, […]
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California’s managed care regulator has fined Anthem $5 million, alleging “systemic violations and a long history of flouting the law in regard to consumer complaints,” the Los Angeles Times reports. The fine adds to the $6 million which the insurer has been fined for similar reasons, since 2002. “Anthem Blue Cross’ failures to comply with […]
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As consumers navigate open enrollment for ACA insurance plans, narrow networks continue to be a problem. In an interview with NPR’s Michael Martin, Kaiser Health News’ Julie Rovner explained how narrow networks came about and how they impact consumers: “[When insurers] were starting to put together their plans, they thought, how are we going to […]
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A recent Chicago Tribune article examined the lack of accountability from hospitals and doctors related to complications. These unforeseen costs can be extreme and often become the patient’s responsibility. Whether because of mistakes, infections or plain bad luck, those who go in don’t always come out better. More than 400,000 Americans die annually in part […]
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MedPage Today recently published an article by Dr. Milton Packer, describing a peculiar lunch he attended and the lesson he learned about consumer-unfriendly practices insurance companies employ in conducting preauthorization assessments for drugs and medical procedures. Dr. Packer was invited to give a presentation on heart failure to a group of doctors. He noticed that […]
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A recent study of US pharmacy claims found that less than half of patients prescribed a new cholesterol drug receive insurance coverage for the drug. The drug, a PCSK9 inhibitor, has been shown to give patients a 27 percent or lower chance of developing a heart attack, 22 percent lower chance of cardiovascular revascularization, and […]
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Photo By Heidi de Marco/KHN Alex Ostrowski was just 12 when she suffered a life-threatening accident. A boat ran over her Jet Ski and she ended up pinned between its propeller and the boat’s diving board. The propeller crushed her hip and pelvis and cut the entire left side of her body. Miraculously, Ostrowski survived […]
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Consumers in a few states are beginning to grapple with Anthem’s new Emergency Room policy to reject claims that are ultimately deemed as non-emergencies. One Kentucky woman suffered severe stomach pain and was stuck with a bill when the insurer decided she hadn’t been in an emergency situation. According to The Associated Press: Alison Wrenne […]
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As Consumers For Quality Care previously reported, Massachusetts recently submitted a Medicaid 1115 waiver request to the Centers for Medicare & Medicaid Services (CMS) that would make substantial changes for current MassHealth recipients, cutting health care coverage for those who need it most. More than 400 groups submitted comments with serious concerns about the Massachusetts […]
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By Heidi de Marco/KHN As Consumers For Quality Care previously reported, Massachusetts recently submitted a Medicaid 1115 waiver request to the Centers for Medicare & Medicaid Services (CMS) that would make substantial changes for current MassHealth recipients, cutting health care coverage for those who need it most. More than 400 groups submitted comments with serious […]
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Photo by Heidi de Marco/KHN As extreme hospital and insurer bills continue to be a phenomenon in American healthcare, Vox’s Sarah Kliff has launched a new project, which aims at bringing transparency to high hospital bills and to tackle the question of “why these prices are such a problem for the American health care system.” […]
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Photo by Heidi de Marco/KHN Three year-old Elodie Fowler went to Lucile Packard Children’s Hospital for an MRI. She has a rare genetic condition and her doctors wanted to have a better understanding of what was causing swelling in the right-side body and digestion issues, Vox reports. The scan only took about 30 minutes. When […]
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9-month-old Connor Richardson is battling brain cancer and his insurance company. Recently, Connor and his parents received a letter informing them the insurer would not cover an experimental but necessary cancer treatment. According to The Daily Beast: Connor was only seven months old when he had an uncharacteristic bout of crying through the night. His […]
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A new article from Kaiser Health News highlights the lack options for mental health treatment in Appalachia, and the measures many consumers and physicians take in order to meet the community’s need. In at least one county in West Virginia, there are no psychiatrists. The lack of available care options means that many individuals have […]
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Transgender consumers in Rhode Island were recently polled on a range of issues by the National Center For Transgender Equality. RI Future highlighted the survey’s findings, including issues with health care coverage and mental health. The survey found that many respondents reported harassment, coverage denial, and distress because of their gender identity. According to RI […]
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In the wake of the failed ACA repeal and replace, President Trump has signed an executive order on health care, which could have a negative impact on consumers. Former CMS Director Andy Slavitt has argued the move would eliminate protections for pre-existing condition protections and make the individual exchanges a high-risk pool. The White House […]
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Numerous patient and advocacy groups have spoken out against Massachusetts’ proposed Medicaid waiver request, which would take away transportation benefits for many MassHealth beneficiaries. The waiver would eliminate transportation services for non-disabled adults in non-emergency situations, The Republican reports. Massachusetts claims the change would save $5 Million in 2020 – a small fraction of the […]
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The Commonwealth of Massachusetts is asking the federal government to be allowed to make cuts to Medicaid, curtail access to long-term and in-home health care supports, and limit drug coverage. According to Modern Healthcare: The state has asked for permission to move childless, non-disabled adults with incomes above the federal poverty level into subsidized commercial […]
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Consumers who are looking to get mental health treatment while being insured by a narrow network plan may have a difficult time finding a doctor in their network. A new study published in Health Affairs has found disparities between coverage for mental health and medical/surgical coverage in narrow network plans. Kaiser Health News reports that […]
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Joe Stanziano had recently undergone his fourth back surgery in five years, when his doctor prescribed an opioid to aid his recovery. As recovery progressed, his doctor decided to start tapering off the pain meds by prescribing a lower dose. Stanziano’s insurer denied coverage of the medication. PAMED recently reported Stanziano’s experience to highlight the […]
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Many senior citizens believe that their insurance would cover costs related to a fall or accident; but a hidden policy – called observational care – may jeopardize their care, Reader’s Digest reports. Elisa Roland chronicles the obstacles in getting her mother adequate care, after she suffered a fall and could not walk. Before the accident, […]
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As debate over the affordable care act continues many questions remain about the future of our health care system. However, one thing is certain, America’s health insurance companies are doing very well: Combined, the nation’s top six health insurers reported $6 billion in adjusted profits for the second quarter. That’s up more about 29 percent […]
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A recent study found that narrow-network plans offer even more limited mental health care, Reuters reports. Narrow-network plans were created to bring lower-cost health insurance plans to ACA markets. These plans generally limit coverage to fewer than 25 percent of providers in a given market. The study found that while narrow-network plans cover 24 percent […]
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Consumers are almost always justified in visiting the emergency room despite recent cutbacks from insurers. A new study from the University of California at San Francisco has found that only 3.3 percent of ER visits are considered avoidable, Axios reports. The study found 3 major conclusions: The definition of “avoidable” is what splits most parties. […]
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Photo by Heidi de Marco/KHN Despite state law, consumers in Virginia may have difficulty getting proton therapy, a treatment for cancer, covered. The parent company of Virginia’s only proton therapy center has issued a statement accusing insurers of violating a state law, which exists to give people access to the therapy, the Daily Press reports. […]
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Aetna has come under fire after exposing some costumers’ HIV status. The insurer sent letters to consumers, which contained information about changes in access to HIV medications. According to the Washington Post, the envelopes’ clear window made the contents of the letters visible without opening the mail. For some of these customers, a plastic window […]
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A new study by the Doctors-Patient Rights Project (DPRP), found that over 50 million Americans are lacking access to health treatments, despite having insurance. Specifically, the study looked at insurance denials and their long-term effects on patients. According to the study, one third of patients who experienced insurance denials have had their health adversely effected […]
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Indiana residents covered by Anthem will soon have to think twice before visiting the emergency room. The insurer will notify customers that their ER visits might not be covered by their insurance, Fox 59 reports. Last week, Consumers For Quality Care sent a letter to the Indiana Insurance Commissioner that urged him to reject the […]
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Almost a year after Mylan Pharmaceuticals was the subject of an outpouring of public disapproval; the Justice Department has reached a settlement with the company. The settlement includes reimbursements to Medicaid programs in every state, which will make the programs more solvent for consumers. Mylan was accused of overcharging the government for the emergency allergy […]
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A new study published in the American Journal of Medicine suggests that poorer patients are spending more for hospital care. While Medicare patients pay a fixed amount for inpatient treatment, the charges incurred when patients are not sick enough for inpatient care can be higher. Reuters reports: [P]eople who aren’t sick enough for an inpatient […]
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Photo by Heidi de Marco/KHN Hospitals’ public announcements of their newest and most innovative surgeries, procedures and technologies are less than helpful to consumers, Axios reports. Hospitals will often issue press releases or mass e-mails announcing these services. These blasts can go on to be picked up by local news stations or other services. This past […]
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Patients groups representing individuals with hemophilia have filed a civil rights complaint in Iowa that accuses health insurer Wellmark of engaging in discrimination, Washington Examiner reports. National Hemophilia Foundation, The Hemophilia Federation of America, and Hemophilia of Iowa allege that Wellmark exited the ACA market in Iowa to avoid paying for patients with hemophilia, including […]
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An insurer is changing a company policy regarding Truvada, an HIV medication, after pushback from activists, NBC reports. UnitedHealth recently came under fire after a denial letter for the medication was circulated online. In the rejection letter, the insurer cited the patient’s “high risk homosexual behavior” as its reason for the denial. The letter came […]
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Chet Hartley, a retired law enforcement officer, was in for a shock when he received a letter from his insurer saying they would not cover his surgery, months after it had taken place. KUTV explains, the letter said the surgery would not be covered, despite the fact that Hartley received pre-approval and had already paid […]
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Matthew Nunley, a veteran, is facing the battle of his life. He has been diagnosed with congestive heart failure and is battling Anthem to cover the device keeping him alive, reports WDRB. Nunley’s diagnoses came in November 2016, after he got the flu. Doctors told Nunley it was a one-in-10,000 chance a virus would attack […]
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As surprise medical bills continue to be a concern for consumers, more people are taking notice. A recent Yale study highlighted the growing phenomenon. Now, Huffington Post offers a first-person example of how to deal with the common issues that result in unexpectedly expensive hospital bills and discusses strategies for consumers to fight back. These […]
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As health care costs continue to rise in the United States, patients are increasingly being stuck with a larger and larger portion of the bill. According to the Kaiser Family Foundation, the average deductible among covered workers with a deductible has gone up nearly $1,000 in just ten years: Writing in The Huffington Post, Dr. […]
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In another chapter of an ongoing trend, consumers across the country have been facing steep medical bills after hospital visits they thought were in their insurance network. One California woman, Debra Brown, was shocked to get $500 out-of-network hospital bill from a doctor who she said never identified himself and only briefly touched her injured […]
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Customers that have narrow network health plans probably can’t see top cancer experts. According to HealthDay: Less-expensive “narrow network” health plans are much less likely to cover treatment by doctors at centers affiliated with the U.S. National Cancer Institute, said study lead author Laura Yasaitis. The information comes from a recent study by the University […]
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Gail Tapp, woke up from a minor surgery at Forth Worth’s USMD Hospital to find that her front teeth had been knocked out, CBS DFW reports. Tapp said doctors at USMD Hospital in Fort Worth told her husband they had accidentally knocked out three teeth while removing her breathing tube after routine bladder surgery. The […]
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Blue Shield of California is facing a class-action lawsuit that claims the insurer improperly denied outpatient and residential care for patients, Kaiser Health News reports. The suit was filed on behalf of two parents who say their children were denied coverage to treatment for mental health and substance abuse issues. The suit also claims that […]
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A Utah insurance company, Select Health, has come under scrutiny for refusing to pay for a surgery after preapproving the procedure, KUTV reports. Kristine LaMay submitted a pre-approval for her knee-replacement surgery. After she gained approval from her insurance company, she received the surgery. Now, the insurance company is saying it won’t pay. [N]early a […]
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Patients who need cholesterol drugs are having a very difficult time getting them. The Wall Street Journal reports: Some doctors believe PCSK9 inhibitors could be a lifesaving solution for millions of heart-disease patients and could transform treatment for the most difficult cases—patients with FH, as well as those with a history of heart disease or […]
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Photo by Heidi de Marco A prominent consumer advocacy organization in Connecticut elected to skip public health insurance rate request hearings hosted by the state Insurance Department. The Universal Health Care Foundation of Connecticut explained their non-attendance was intended as a protest to the timing and format of the meetings. The group complained the meetings […]
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Minneapolis’ City Pages recently reported one woman’s battle to get her medication covered by her insurer, Blue Cross Blue Shield of Minnesota. The experience, she says, leaves her furious. I am furious. Furious that my insurance company preferred to pass me between divisions, departments, and parent companies rather than take responsibility for dealing with my […]
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Photo by Heidi de Marco An Alaska woman is battling her insurance company to receive a life-saving surgery, the Alaska Dispatch News details. Barbara Ross, who supports a family of ten, has a hereditary lymphedema, which causes her body to retain fluid under the skin. After an injury, her condition worsened. She lost the ability […]
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Georgia’s Insurance Department announced it would monitor a new Blue Cross Blue Shield policy that seeks to limit coverage for certain types of emergency room visits. According to Georgia Health News: The state insurance department says it will monitor the new emergency room policy of Blue Cross and Blue Shield of Georgia “to make sure […]
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For consumers, there seems to be an ever-expanding list of negative headlines. Consumers have seen big premium increases on the ACA exchanges. Networks have narrowed leaving families and individuals with little choice in their health care. Services that some consumers have taken for granted, like heading to the Emergency Room in case of an emergency, […]
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Photo by Heidi de Marco/KHN The Boston Globe recently reported on a growing trend of insurance companies refusing to cover mental health programs. Wilderness Therapy, a form of behavioral therapy, is increasingly accepted by mental health professionals to treat behavioral, substance abuse and mental health issues in teenagers. The programs use many of the same tactics […]
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A new report from CNN highlights a young man’s story of being denied a life-saving medicine by his insurance company. He filed a lawsuit in 2015 and the suit’s trial is set for this summer. In November 2014, Gillen Washington, a Northern Arizona University student, went into his clinic. It should have been a routine […]
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Anthem Blue Cross Blue Shield sent letters to customers in three states that warned some emergency room visits wouldn’t be covered. In Georgia, Missouri, and Kentucky, plans will no longer pay for visits that Anthem deems are no longer necessary. Emergency room physicians are upset about the letters. Dr. Becky Parker, president of the American […]
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A recent investigative article from the New Jersey Star-Ledger details one woman’s struggle with a growing trend: unexpected, out-of-network hospital billings. Margo Anderson of New Jersey had a medical emergency and took care to go to a hospital that was considered “Tier 1” for her health plan. In other words, she went to a hospital […]
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A new study from the Journal of the American Medical Association found that uninsured individuals and minority groups are often the highest billed emergency room patients. As Vox reports: Welcome to the arcane and arbitrary world of billing practices at US hospitals today, as detailed in a new JAMA Internal Medicine study. The researchers, […]
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The state of Illinois is conducting a “market conduct exam” of Blue Cross Blue Shield for the first time in 27 years. The reviews examine how insurers pay claims and handle customer complaints among other things. According to the Chicago Tribune: Blue Cross and Blue Shield of Illinois confirmed the review this week, in […]
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Last month, Blue Cross Blue Shield of North Carolina filed a request to raise premiums by 23 percent in 2018. Its customers have faced double digit increases for years: “Steep rate increases have been a consistent feature of Blue Cross’s ACA coverage in North Carolina, and Thursday’s announcement follows a 24.3 percent rate increase […]
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