Stories


6 days Ago

Consumer Cost Concerns – In Their Own Words

Consumer Cost Concerns – In Their Own Words

Mother Receives Huge Bill For Her MS Treatments
1 week Ago

Mother Receives Huge Bill For Her MS Treatments

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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Beware Of Big Surprise Bills From Medical Labs
2 weeks Ago

Beware Of Big Surprise Bills From Medical Labs

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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Consumer Cost Concerns: Consumers Contact CQC
4 weeks Ago

Consumer Cost Concerns: Consumers Contact CQC

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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New York Times Investigation Shows Hospital Consolidation Increases Prices for Consumers
4 weeks Ago

New York Times Investigation Shows Hospital Consolidation Increases Prices for Consumers

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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Jury Awards Family $25.5 Million After Aetna Denies Coverage
4 weeks Ago

Jury Awards Family $25.5 Million After Aetna Denies Coverage

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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Consumer Cost Concerns – In Their Own Words
1 month Ago

Consumer Cost Concerns – In Their Own Words

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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New Blue Cross Plan Has Consumers Pay, Wait For Reimbursement
1 month Ago

New Blue Cross Plan Has Consumers Pay, Wait For Reimbursement

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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Woman’s Allergy Test Cost Nearly $50,000
1 month Ago

Woman’s Allergy Test Cost Nearly $50,000

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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Local News Station Highlights PBMs’ Effects On Consumers
1 month Ago

Local News Station Highlights PBMs’ Effects On Consumers

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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Mother’s Story, Government Data Show Power In Appealing Denials
1 month Ago

Mother’s Story, Government Data Show Power In Appealing Denials

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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Controversial ER Policy Could Result In Denials For As Many As 16% Of Visits
1 month Ago

Controversial ER Policy Could Result In Denials For As Many As 16% Of Visits

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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Consumer Cost Concerns – In Their Own Words
2 months Ago

Consumer Cost Concerns – In Their Own Words

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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Texas Fines Humana Over Narrow Network
2 months Ago

Texas Fines Humana Over Narrow Network

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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Connecticut Consumers Speak Out Over Health Care Costs
2 months Ago

Connecticut Consumers Speak Out Over Health Care Costs

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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Grandmother With Breast Cancer Asks For Help
2 months Ago

Grandmother With Breast Cancer Asks For Help

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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Man Receives Surprise Bill After Going To In-Network Hospital
2 months Ago

Man Receives Surprise Bill After Going To In-Network Hospital

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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ER Visit Lands Utah Man With $80,000 In Bills
2 months Ago

ER Visit Lands Utah Man With $80,000 In Bills

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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Cancer Treatment With Fewer Side Effects Often Denied By Insurance
2 months Ago

Cancer Treatment With Fewer Side Effects Often Denied By Insurance

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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Father Gives Update On Son’s Treatment After Battle For Coverage
2 months Ago

Father Gives Update On Son’s Treatment After Battle For Coverage

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 Later, Las Vegas Survivors Battle Insurance Bills
2 months Ago

A Year Later, Las Vegas Survivors Battle Insurance Bills

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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Family Battling TennCare, Facing Devastating Decisions To Get Care For Daughter
2 months Ago

Family Battling TennCare, Facing Devastating Decisions To Get Care For Daughter

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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Consumer Cost Concerns – In Their Own Words
2 months Ago

Consumer Cost Concerns – In Their Own Words

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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Consumers Lose When Hospitals And Insurers Agree To Secret Contracts
3 months Ago

Consumers Lose When Hospitals And Insurers Agree To Secret Contracts

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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Virginia Family Hit With Huge Surprise Medical Bill After Out-Of-Network Treatment at In-Network ED
3 months Ago

Virginia Family Hit With Huge Surprise Medical Bill After Out-Of-Network Treatment at In-Network ED

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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Many Consumers Receive Surprise Medical Bills, Most Blame Insurers
3 months Ago

Many Consumers Receive Surprise Medical Bills, Most Blame Insurers

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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Charlottesville Consumers Band Together Against High Premiums
3 months Ago

Charlottesville Consumers Band Together Against High Premiums

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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Hospital ERs To Blame For High Health Care Costs
3 months Ago

Hospital ERs To Blame For High Health Care Costs

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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New Study Suggests Bundled Payments Are Working
3 months Ago

New Study Suggests Bundled Payments Are Working

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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Hospital Group Creates Generic Drug Company to Lower Prices for Consumers
3 months Ago

Hospital Group Creates Generic Drug Company to Lower Prices for Consumers

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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Even Small Medical Debts Cause Complications For Consumers
3 months Ago

Even Small Medical Debts Cause Complications For Consumers

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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HHS Takes Steps To Ensure Safe Nursing Homes
3 months Ago

HHS Takes Steps To Ensure Safe Nursing Homes

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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These Pharma Bros Specialize in How to Raise Drug Prices
3 months Ago

These Pharma Bros Specialize in How to Raise Drug Prices

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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After Heart Attack, Teacher Is Billed Twice His Annual Salary
3 months Ago

After Heart Attack, Teacher Is Billed Twice His Annual Salary

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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Breast Cancer Treatment Results In Surprise Bills
3 months Ago

Breast Cancer Treatment Results In Surprise Bills

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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Growing Number Of Consumers Turn To Alternative Plans
3 months Ago

Growing Number Of Consumers Turn To Alternative Plans

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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Consumers Don’t Understand Insurance Plans Or Bills, Survey Shows
3 months Ago

Consumers Don’t Understand Insurance Plans Or Bills, Survey Shows

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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Consumers Could Save Money By Avoiding Convenience Drugs
3 months Ago

Consumers Could Save Money By Avoiding Convenience Drugs

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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Not Even Hospitals Know True Cost Of Care
4 months Ago

Not Even Hospitals Know True Cost Of Care

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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Consumers’ Copay Often More Expensive Than The Drug
4 months Ago

Consumers’ Copay Often More Expensive Than The Drug

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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New Studies Examine Impact Of Medical Bills On Consumers
4 months Ago

New Studies Examine Impact Of Medical Bills On Consumers

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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Same Test, Same Patient, Same Insurance – Two Prices
4 months Ago

Same Test, Same Patient, Same Insurance – Two Prices

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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More Consumers Turn To Crowdsourcing To Help Pay Medical Bills
4 months Ago

More Consumers Turn To Crowdsourcing To Help Pay Medical Bills

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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Insurer Reverses Pre-approval For Cancer Drug
4 months Ago

Insurer Reverses Pre-approval For Cancer Drug

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 Begins Controversial ER Policy In Texas
4 months Ago

Blue Cross Blue Shield Begins Controversial ER Policy In Texas

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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Cost Of Childhood Cancer Follows Survivors Into Adulthood
4 months Ago

Cost Of Childhood Cancer Follows Survivors Into Adulthood

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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Flawed Assumptions Behind High Deductible Plans Leave Consumers Paying More
4 months Ago

Flawed Assumptions Behind High Deductible Plans Leave Consumers Paying More

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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Hospital Care Is Significant Portion Of Health Care Spending For Consumers
4 months Ago

Hospital Care Is Significant Portion Of Health Care Spending For Consumers

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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Administration Scraps Medical Best Practice Guideline Website
5 months Ago

Administration Scraps Medical Best Practice Guideline Website

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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CMS Move Could Raise Drug Prices, Hurt Consumers
5 months Ago

CMS Move Could Raise Drug Prices, Hurt Consumers

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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Divorce Or Care? Family Considers Extreme Measures To Pay For Daughter’s Care
5 months Ago

Divorce Or Care? Family Considers Extreme Measures To Pay For Daughter’s Care

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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NYT Editorial Examines The State Of Medicaid Coverage In The US
5 months Ago

NYT Editorial Examines The State Of Medicaid Coverage In The US

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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Why Are ER Bills So High?
5 months Ago

Why Are ER Bills So High?

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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New Venture Could Benefit Consumers
5 months Ago

New Venture Could Benefit Consumers

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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Family Vacationing In US Receives $18K Hospital Bill For Child’s Nap, Formula
5 months Ago

Family Vacationing In US Receives $18K Hospital Bill For Child’s Nap, Formula

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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Consumers Face Consequences Of High Deductible Insurance Plans
6 months Ago

Consumers Face Consequences Of High Deductible Insurance Plans

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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Type I Diabetic Recounts Her Struggle With Insurance Coverage
6 months Ago

Type I Diabetic Recounts Her Struggle With Insurance Coverage

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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Cost Of Emergency Room Visits Doubles Over 8 Years
6 months Ago

Cost Of Emergency Room Visits Doubles Over 8 Years

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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New Missouri Law Aims To Protect Consumers
6 months Ago

New Missouri Law Aims To Protect Consumers

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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Man Diagnosed With ALS Fights Insurer To Get Bed He Needs
6 months Ago

Man Diagnosed With ALS Fights Insurer To Get Bed He Needs

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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Patient Advocates Question New Insurer Practices
6 months Ago

Patient Advocates Question New Insurer Practices

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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Mom With Breast Cancer Hurt By Short-Term Insurance
7 months Ago

Mom With Breast Cancer Hurt By Short-Term Insurance

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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Anthem Tells Woman Oncologist Is In Network, Then Reverses Course
7 months Ago

Anthem Tells Woman Oncologist Is In Network, Then Reverses Course

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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Man Receives Surprise Medical Bill After Being Attacked, Left Unconscious
7 months Ago

Man Receives Surprise Medical Bill After Being Attacked, Left Unconscious

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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Anthem Continues Harmful Denial Practices
7 months Ago

Anthem Continues Harmful Denial Practices

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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ALS Patients Lose Time Waiting For Insurer Approval
7 months Ago

ALS Patients Lose Time Waiting For Insurer Approval

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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Mom Denied New Liver Writes Plea to Insurer’s CEO
7 months Ago

Mom Denied New Liver Writes Plea to Insurer’s CEO

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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Surprise Medical Bills Continue to Plague Consumers
7 months Ago

Surprise Medical Bills Continue to Plague Consumers

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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Hospitals Make Big Profit Off Of Low Cost Items
7 months Ago

Hospitals Make Big Profit Off Of Low Cost Items

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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Hospitals Fight Anthem’s ER, Imaging Policies
7 months Ago

Hospitals Fight Anthem’s ER, Imaging Policies

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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Woman Charged More Than $5,000 For Basic First Aid Supplies
7 months Ago

Woman Charged More Than $5,000 For Basic First Aid Supplies

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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American College Of Emergency Physicians Starts New Campaign Against ER Rule
7 months Ago

American College Of Emergency Physicians Starts New Campaign Against ER Rule

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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Surprise Medical Bills Sent To Newborn Babies
7 months Ago

Surprise Medical Bills Sent To Newborn Babies

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 Argue ‘Step Therapy’ Harmful For Patients
8 months Ago

Doctors Argue ‘Step Therapy’ Harmful For Patients

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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Tennessee Man Fights Insurance Company For Prosthetic Arm
8 months Ago

Tennessee Man Fights Insurance Company For Prosthetic Arm

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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Lapses In Mental Health Parity Laws Hurt Consumers
8 months Ago

Lapses In Mental Health Parity Laws Hurt Consumers

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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Consumer Receives the Same Treatment at Two Hospitals, But One Costs 33 Times More
8 months Ago

Consumer Receives the Same Treatment at Two Hospitals, But One Costs 33 Times More

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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Senators Want Answers About  1400 Percent Increase in Price of Cancer Drug
8 months Ago

Senators Want Answers About 1400 Percent Increase in Price of Cancer Drug

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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Iowa Legislature Approves Bill That Could Jeopardize Health Consumers
9 months Ago

Iowa Legislature Approves Bill That Could Jeopardize Health Consumers

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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New Medicare Cards Aim To Reduce Identity Theft
9 months Ago

New Medicare Cards Aim To Reduce Identity Theft

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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UnitedHealthcare’s New, Harmful ER Policy
9 months Ago

UnitedHealthcare’s New, Harmful ER Policy

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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Two Studies Find Hospitals Upcharge Cancer Bills
9 months Ago

Two Studies Find Hospitals Upcharge Cancer Bills

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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Anthem Under Scrutiny For New Anesthesia Policy
10 months Ago

Anthem Under Scrutiny For New Anesthesia Policy

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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Hospital Offering Bank Loans On The Spot Could Put Consumers On The Hook For More Health Care-Related Costs
10 months Ago

Hospital Offering Bank Loans On The Spot Could Put Consumers On The Hook For More Health Care-Related Costs

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 Hosts Telebriefing on AHPs
10 months Ago

Consumers for Quality Care Hosts Telebriefing on AHPs

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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Idaho Consumers Could Be Stuck With Less Coverage If They Opt For New, Cheaper Blue Cross Plans
10 months Ago

Idaho Consumers Could Be Stuck With Less Coverage If They Opt For New, Cheaper Blue Cross Plans

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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Anthem Makes Some Changes To Harmful ER Policy; Doesn’t Go Far Enough
10 months Ago

Anthem Makes Some Changes To Harmful ER Policy; Doesn’t Go Far Enough

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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California Investigates Aetna’s Coverage Denial Practices
10 months Ago

California Investigates Aetna’s Coverage Denial Practices

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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Consumers Stuck With Big Bills After ER Trips
10 months Ago

Consumers Stuck With Big Bills After ER Trips

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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Consumers Hit By Surprise Medical Bills Often Can’t Pay
10 months Ago

Consumers Hit By Surprise Medical Bills Often Can’t Pay

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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Insurer Goes Against Doctor’s Recommendation, Denies Cancer Treatment Coverage
10 months Ago

Insurer Goes Against Doctor’s Recommendation, Denies Cancer Treatment Coverage

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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Cuts To Medicaid Transportation Services Put Consumers At Risk
10 months Ago

Cuts To Medicaid Transportation Services Put Consumers At Risk

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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Family Battles Insurer For Infant’s Life-Saving Procedure
10 months Ago

Family Battles Insurer For Infant’s Life-Saving Procedure

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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Consumers Feel The Pain Of Anthem’s New ER Policy
10 months Ago

Consumers Feel The Pain Of Anthem’s New ER Policy

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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Hospital Service Reductions Negatively Impact Rural Consumers
10 months Ago

Hospital Service Reductions Negatively Impact Rural Consumers

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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Consumers In Idaho Could Get Stuck With Bare Bones Plans
11 months Ago

Consumers In Idaho Could Get Stuck With Bare Bones Plans

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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Centene Sued Over Narrow Network Plans
11 months Ago

Centene Sued Over Narrow Network Plans

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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Aetna Agrees to Pay $17 Million Settlement for Revealing HIV Statuses of Thousands of Policy-holders
11 months Ago

Aetna Agrees to Pay $17 Million Settlement for Revealing HIV Statuses of Thousands of Policy-holders

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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Mental Health and Addiction Treatment Database Freeze Could Hurt Consumers
11 months Ago

Mental Health and Addiction Treatment Database Freeze Could Hurt Consumers

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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Allowing Medicaid Work Requirements Will Harm Most Vulnerable Americans
11 months Ago

Allowing Medicaid Work Requirements Will Harm Most Vulnerable Americans

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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Samantha Bee Highlights Failing Maternity Care
11 months Ago

Samantha Bee Highlights Failing Maternity Care

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. McCaskill Requests Information On Anthem’s ER Policy Change
11 months Ago

Sen. McCaskill Requests Information On Anthem’s ER Policy Change

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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Special Enrollment Periods Allow Some To Still Enroll In A 2018 Health Plan
12 months Ago

Special Enrollment Periods Allow Some To Still Enroll In A 2018 Health Plan

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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Consumers Battle Against Hospital-Owned Debt Collectors
12 months Ago

Consumers Battle Against Hospital-Owned Debt Collectors

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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CQC’s Christensen Discusses The Dismantling Of Massachusetts’ Health Care
12 months Ago

CQC’s Christensen Discusses The Dismantling Of Massachusetts’ Health Care

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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Insurer Under Fire For Rolling Back Coverage of HIV Prevention Medication
12 months Ago

Insurer Under Fire For Rolling Back Coverage of HIV Prevention Medication

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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Insurer Denies Teen’s Brain Surgery
12 months Ago

Insurer Denies Teen’s Brain Surgery

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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Consumers Are Paying More For ER Facility Fees
1 year Ago

Consumers Are Paying More For ER Facility Fees

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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Consumers Face High Costs From Overtreatment
1 year Ago

Consumers Face High Costs From Overtreatment

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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CQC Board Member Donna Christensen Speaks To Consumers About Open Enrollment
1 year Ago

CQC Board Member Donna Christensen Speaks To Consumers About Open Enrollment

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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States Allowed To Get Rid Of Consumer Medicaid Safety-Net Protection
1 year Ago

States Allowed To Get Rid Of Consumer Medicaid Safety-Net Protection

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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CA Fines Anthem $5 Million Over Consumer Grievances
1 year Ago

CA Fines Anthem $5 Million Over Consumer Grievances

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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Consumers Face Narrow Networks During Open Enrollment
1 year Ago

Consumers Face Narrow Networks During Open Enrollment

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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When Hospitals And Doctors Make Mistakes, Consumers Often Pay
1 year Ago

When Hospitals And Doctors Make Mistakes, Consumers Often Pay

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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Doctor Reveals Truth About Medical Preauthorization Process
1 year Ago

Doctor Reveals Truth About Medical Preauthorization Process

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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Half of Consumers Denied Insurance Coverage For Cholesterol Drug
1 year Ago

Half of Consumers Denied Insurance Coverage For Cholesterol Drug

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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Michigan Insurer Stops Coverage For Pain Therapy
1 year Ago

Michigan Insurer Stops Coverage For Pain Therapy

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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Anthem’s ER Policy “Completely Unfair To Patients”
1 year Ago

Anthem’s ER Policy “Completely Unfair To Patients”

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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CQC Highlights Additional Organizations That Oppose The Massachusetts Waiver
1 year Ago

CQC Highlights Additional Organizations That Oppose The Massachusetts Waiver

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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CQC Joins More than 400 Medical, Consumer and Patient Groups Asking CMS to “Stop the Waiver” in Massachusetts
1 year Ago

CQC Joins More than 400 Medical, Consumer and Patient Groups Asking CMS to “Stop the Waiver” in Massachusetts

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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New Project Asks Consumers To Share Their Stories
1 year Ago

New Project Asks Consumers To Share Their Stories

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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Discrepancy Between Insurer And Hospital Leaves Consumer With A $24K Bill
1 year Ago

Discrepancy Between Insurer And Hospital Leaves Consumer With A $24K Bill

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 With Brain Cancer Sent Denial Letter
1 year Ago

9-Month-Old With Brain Cancer Sent Denial Letter

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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Appalachia Residents Battle Lack Of Accessible Mental Health Care
1 year Ago

Appalachia Residents Battle Lack Of Accessible Mental Health Care

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 RI Encounter Barriers To Care
1 year Ago

Transgender Consumers In RI Encounter Barriers To Care

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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New Executive Order Could Hurt Consumers
1 year Ago

New Executive Order Could Hurt Consumers

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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Patient Groups Protest MA Waiver, Transportation Cuts
1 year Ago

Patient Groups Protest MA Waiver, Transportation Cuts

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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Massachusetts’ Waiver Request Could Harm Consumers
1 year Ago

Massachusetts’ Waiver Request Could Harm Consumers

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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Study Finds Mental Health Coverage Narrower Than Other Coverage
1 year Ago

Study Finds Mental Health Coverage Narrower Than Other Coverage

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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Insurer Denies Man’s Painkillers After Back Surgery
1 year Ago

Insurer Denies Man’s Painkillers After Back Surgery

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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Observational Status Creates Roadblocks To Recovery For Medicare Patients
1 year Ago

Observational Status Creates Roadblocks To Recovery For Medicare Patients

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 Future Of ACA Remains In Flux, Top Insurers Make $6 Billion
1 year Ago

As Future Of ACA Remains In Flux, Top Insurers Make $6 Billion

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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Narrow Network Plans Offer Less Mental Health Coverage
1 year Ago

Narrow Network Plans Offer Less Mental Health Coverage

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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Study Finds Most Emergency Room Visits Are Valid
1 year Ago

Study Finds Most Emergency Room Visits Are Valid

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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VA Insurers Accused Of Disobeying Law Over Cancer Treatment
1 year Ago

VA Insurers Accused Of Disobeying Law Over Cancer Treatment

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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Patients’ HIV Status Exposed By Aetna ‘Mistake’
1 year Ago

Patients’ HIV Status Exposed By Aetna ‘Mistake’

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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New Study Suggests Insurance Denials Could Be Making Patients Sicker
1 year Ago

New Study Suggests Insurance Denials Could Be Making Patients Sicker

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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Consumers In Indiana Hit By Anthem’s Emergency Room Coverage Cuts
1 year Ago

Consumers In Indiana Hit By Anthem’s Emergency Room Coverage Cuts

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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DOJ and Mylan Reach EpiPen Settlement That Could Benefit Consumers
1 year Ago

DOJ and Mylan Reach EpiPen Settlement That Could Benefit Consumers

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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Study: Poorer Patients May Be Hardest Hit By Observational Hospital Care
1 year Ago

Study: Poorer Patients May Be Hardest Hit By Observational Hospital Care

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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Consumers Get Left In The Dark On Pricing For New Hospital Procedures
1 year Ago

Consumers Get Left In The Dark On Pricing For New Hospital Procedures

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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Patient Groups File Civil Rights Complaint Over Hemophilia Coverage
1 year Ago

Patient Groups File Civil Rights Complaint Over Hemophilia Coverage

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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UnitedHealth Apologizes After Truvada Letter
1 year Ago

UnitedHealth Apologizes After Truvada Letter

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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Customer Told Insurance Would Not Cover His Surgery, Despite Pre-Approval And Payment
1 year Ago

Customer Told Insurance Would Not Cover His Surgery, Despite Pre-Approval And Payment

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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Veteran Winning The Battle Against Congestive Heart Failure, Losing Battle With His Insurer For Required Care
1 year Ago

Veteran Winning The Battle Against Congestive Heart Failure, Losing Battle With His Insurer For Required Care

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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Tips for Consumers Hit By Surprise Medical Bills
1 year Ago

Tips for Consumers Hit By Surprise Medical Bills

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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Patients Face Surprise Coverage Gaps And Increasingly Shoulder The Burden Of Health Care Costs
1 year Ago

Patients Face Surprise Coverage Gaps And Increasingly Shoulder The Burden Of Health Care Costs

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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New Study Highlights Problem Of Surprise Medical Bills For Consumers
1 year Ago

New Study Highlights Problem Of Surprise Medical Bills For Consumers

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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Narrow Networks Can Mean Less Access To Cancer Experts
1 year Ago

Narrow Networks Can Mean Less Access To Cancer Experts

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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Woman Wakes Up From Minor Surgery To Find Her Front Teeth Knocked Out
1 year Ago

Woman Wakes Up From Minor Surgery To Find Her Front Teeth Knocked Out

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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Consumers Sue After Being Denied Mental Health And Drug Treatments
1 year Ago

Consumers Sue After Being Denied Mental Health And Drug Treatments

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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Woman Thought Her Surgery Was Preapproved, It Wasn’t
1 year Ago

Woman Thought Her Surgery Was Preapproved, It Wasn’t

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 Struggle To Get Powerful, Life-Changing Cholesterol Medicine
1 year Ago

Patients Struggle To Get Powerful, Life-Changing Cholesterol Medicine

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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Consumer Group Skips CT Rate Request Hearing It Deems Futile
1 year Ago

Consumer Group Skips CT Rate Request Hearing It Deems Futile

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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Minnesota Woman Battles Insurer For Access To Life-Saving Medicine
1 year Ago

Minnesota Woman Battles Insurer For Access To Life-Saving Medicine

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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Aetna Denies Alaska Woman Life-Saving Surgery
1 year Ago

Aetna Denies Alaska Woman Life-Saving Surgery

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 Insurance Department Monitoring New BCBS ER Rules
1 year Ago

Georgia Insurance Department Monitoring New BCBS ER Rules

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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Consumers Get Short Shrift As Insurers See Huge Income
1 year Ago

Consumers Get Short Shrift As Insurers See Huge Income

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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Are Consumers Being Denied Mental Health Coverage?
1 year Ago

Are Consumers Being Denied Mental Health Coverage?

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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What Happens When An Insurer Denies Important Medication?
2 years Ago

What Happens When An Insurer Denies Important Medication?

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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Consumers In Georgia, Missouri, And Kentucky May Get Surprise Emergency Room Bills
2 years Ago

Consumers In Georgia, Missouri, And Kentucky May Get Surprise Emergency Room Bills

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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Surprise Medical Bills In New Jersey Are Another Chapter In A Growing Trend
2 years Ago

Surprise Medical Bills In New Jersey Are Another Chapter In A Growing Trend

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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Uninsured, Minorities Face Highest Emergency Room Bills
2 years Ago

Uninsured, Minorities Face Highest Emergency Room Bills

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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BCBS Illinois Faces State Review For First Time In Decades
2 years Ago

BCBS Illinois Faces State Review For First Time In Decades

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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BCBSNC Asks Consumers To Pay More After Announcing Big Profits And Million Dollar Bonuses
2 years Ago

BCBSNC Asks Consumers To Pay More After Announcing Big Profits And Million Dollar Bonuses

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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