47 mins Ago
Family Receives $3,700 Surprise Bill After Son’s Birth
In 2017, not long after giving birth to her first child, Susan found out that she carries a genetic mutation that increases her lifetime risk of breast cancer to 72 percent. Women who have the BRCA2 gene have a handful of treatment options. Some opt for a preventative double mastectomy. Susan wanted to continue to […]
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When the pain in Diane Conine’s stomach was so unbearable that she was throwing up and her urine was filled with blood, her daughter drove her to the emergency room. She had already been to an urgent care center, where she was told she had a bladder infection, according to the Albany Herald. Conine spent […]
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Priscilla Maldonado thought she was having a healthy baby boy after an uneventful pregnancy. But when she gave birth to her son, Ja’bari Gray, at Methodist Hospital in San Antonio on New Years Day, doctors quickly realized that something was wrong, according to News 4 San Antonio. Gray was born without skin from his neck […]
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Stephanie Sena was in the hospital being treated for sepsis and preparing to have half her foot amputated when her doctor came to her room and told her that she needed to prepay nearly $2,000 for the surgery. Sena was no stranger to amputations. She had previously lost three toes to neuropathy in her foot, […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of clarity throughout the process of accessing care and other roadblocks when it comes to getting 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. […]
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Robin Agar, a Delaware resident who runs a charity that benefits cancer patients, suffers from rheumatoid arthritis. Last year, her doctor prescribed the drug Xeljanz. The process for Agar to receive her medication, which Tarbell detailed, turned into a case study of the issues consumers can face when dealing with Pharmacy Benefit Managers (PBMs). Instead […]
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As consumers grapple with high out of pocket costs, surprise bills, and skimpy coverage, a recent survey from Morning Consult and Business Insider examined how costs affect consumers’ behavior. Nearly 6 in 10 respondents reported that they have delayed or gone without medical or dental care due to cost. Thirty-one percent of respondents said they […]
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In an effort to bring awareness to the medical debt affecting Americans, including thousands of Tennessee consumers, Nashville’s NewsChannel 5 donated $15,000 to an organization that used it to eliminate $1.8 million in medical debt for more than 600 Tennesseans. Consumers for Quality Care has previously highlighted the possible consequences of this kind of medical […]
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When Lynn Lear completed her final round of chemotherapy for breast cancer last December, her doctor prescribed a drug called Nerlynx. Lear agreed to the medication, wanting to do everything she could to remain healthy after her battle with cancer. However, the prescription for the specialty drug could not be filled at her neighborhood pharmacy. […]
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Photo by Heidi de Marco/KHN Consumers for Quality Care’s most recent survey findings shed light on consumers’ feelings toward America’s health care system. Benefits Pro highlighted the findings and noted that consumers are looking for greater predictability around health care costs and more quality coverage. The research found that consumers are more concerned with health […]
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Four months before the due date, Lauren Dill lost her son, Simon Augustus. She suffered what is referred to as a “silent” miscarriage. Dill was induced and spent nine hours in labor. She told CBS News that she would never forget what her midwife said to her – “here is a perfect little baby without […]
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Michael Okoye, an exchange student, was injured while playing basketball for his school, Cape Fear Christian Academy in North Carolina. Okoye was excelling in basketball and colleges were starting to take notice, CBS 17 reports. But that changed when Okoye was injured playing in a tournament at school. “The point guard from the other team, […]
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Consumers are often blind-sided by the higher medical bills that can result from overnight hospital stays that are classified as “observations,” the Post-Gazette reports. Hospitals and insurance companies determine the classification, which denotes whether they believe patients require an inpatient hospital stay or outpatient monitoring. Small wonder it’s confusing: For the same care, the same […]
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Jamie Hansen’s 15 year-old son, Ryan, was ten hours away at a Canadian summer camp when he texted complaining of hip pain and trouble breathing. At first, Jamie dismissed her son’s complaints, thinking it was just nerves. After a few days, his condition continued to worsen and Jamie drove up to get him, Stateline, an […]
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Esteban Serrano was playing soccer with friends when he twisted his knee. As a prolific soccer player, Serrano had been injured before. He left the field to ice his knee and when it did not improve he decided it was time to visit the doctor, Kaiser Health News reports. Serrano made an appointment at Rothman […]
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A recent hearing on surprise bills in the House Education & Labor Committee’s Health, Employment, Labor, and Pensions Subcommittee featured a resounding message: consumers should be protected from unexpected medical bills. The hearing comes at a time when surprise billing has been increasingly in the public spotlight. NPR, which reported on the hearing, has partnered […]
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In 2016, Charley Butler was diagnosed with testicular cancer and he believed that his health insurance would help cover the cost of his care. Butler had previously been contacted by a broker for National Brokers of America Inc. and signed up for an 11-month insurance plan, Los Angeles Times reports. Butler said that the plan […]
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Physicians who work with transplant recipients are highlighting a coverage gap that makes it harder for some to get the drugs they need to avoid organ rejection and stay alive, The New York Times reports. The drugs are vital for patients like 72-year-old Claudia McGinness, who underwent a double-lung transplant in 2008 after idiopathic pulmonary […]
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24-year-old Landon Freeman has autism, bipolar disorder and obsessive-compulsive disorder. His parents took him to the Novant Health emergency room in the beginning of January after he attempted to run away from home. It was Landon’s fifth hospital visit since Thanksgiving, but it has become his longest, WFAE reports. Landon has remained in the emergency […]
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A recent survey from Gallup and West Health estimates that Americans borrowed $88 billion to pay for health care-related expenses in 2018, The New York Times reported. The survey’s authors said that while the data was complex, one conclusion was clear: “High health care costs had created significant anxiety.” The survey adds to recent research […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of clarity throughout the process of accessing care and other roadblocks when it comes to getting 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. […]
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Claudia Knafo tried to comparison shop. When she knew she needed spinal surgery in 2012, she consulted multiple surgeons. Ultimately, she selected one whose website indicated her insurance was accepted, Vox reports. At an appointment, the surgeon’s office photocopied her insurance card. Thankfully, Knafo’s surgery went well and she recovered easily. All seemed to have […]
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Americans are paying the price for getting sick or hurt, according to new research. A recent survey, published in the American Journal of Public Health, found that nearly 60 percent of people who have filed for personal bankruptcy reported that a medical expense “very much” or “somewhat” contributed to their financial situation, according to The […]
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James Henderson, a 74-year-old Missouri man who was critically injured and lost his wife in a 47-car pileup, is now battling his insurance company. Henderson has been in the intensive care unit at CenterPoint Medical Center since the mid-February crash, Stamford Advocate reports. Henderson’s family says that five of his doctors have suggested he be […]
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With medical debt the leading cause of bankruptcy in the country, a new video report from CBS News highlights how a loophole leaves consumers with surprise medical bills that they shouldn’t receive. Close to 65 percent of emergency departments around the country are staffed by outside companies, according to CBS News. For consumers, this arrangement […]
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Debbie Moehnke was already in a Vancouver, Wash., medical clinic when she had a massive heart attack. She had made the appointment because her feet were extremely swollen, her husband Larry tells Time. As she waited, she began to feel like she couldn’t breathe. Moehnke was rushed, by ambulance, from the clinic to a local […]
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Photo by Heidi de Marco/KHN In New Hampshire, some residents are anxiously preparing for the state’s Medicaid work requirements to take effect this June. The change, which will impact 50,000 residents, requires that New Hampshirites work at least 100 hours to qualify for Medicaid or risk losing coverage as soon as August. The change could […]
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In an op-ed published in the Baltimore Sun, Dr. Barbara McAneny, president of the American Medical Association, outlines the dangers of insurance prior authorizations. Prior authorizations can delay consumers’ care. Those delays can mean added pain and frustration for patients already facing difficult diseases. For some, like Colin Haller, it can feel like an avoidable […]
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After Nicole Briggs woke up one night with intense stomach pain and drove herself to a freestanding ER, she was told that she had appendicitis and needed surgery. As she rushed to nearby Swedish Medical Center, she called to make sure that the hospital would be in her insurance network, NBC reports. Even when the […]
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Insurance companies and hospitals are fighting against a recent proposal to increase transparency for consumers, according to The Wall Street Journal. The proposed rule, which Consumers for Quality Care has previously reported on, would make the negotiated payment rates between insurers and providers public. The idea of increasing transparency has been lauded by consumer advocates […]
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Critics in Arizona, including Democratic lawmakers and physicians, are warning consumers about the risks associated with short-term limited-duration insurance plans (STLDI), reports The Arizona Mirror. They warn that the plans often contain coverage gaps that can result in hefty bills for consumers. “It’s ‘buyer beware,’” Dr. Paul Kozak, an emergency room physician said to the […]
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When David Sprecher’s wife, Tyna, was having issues breathing following pneumonia treatment, he brought her to a local emergency room. He believed did everything right, choosing an in-network hospital, Deaconness, according to The Spokesman-Review. Sprecher says that at every turn of Tyna’s care they asked the physicians and nurses if insurance would cover the expenses. […]
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As surprise medical bills cause headaches for consumers around the country, some states have ramped up efforts to protect consumers. Consumers for Quality Care has reported on changes lawmakers are pursuing in Arizona, California, and other states to address the practice of balance and surprise billing. Now, lawmakers in Washington and Nevada are addressing the […]
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In February 2018, Jill Williams brought her 25-year old son, Austin, to the Sutter Roseville emergency room. Austin, who has schizophrenia, was agitated, not speaking, and unable to walk. Around 11 p.m., Williams left the hospital to get some sleep. She asked the hospital to inform her when Austin was going to be discharged so […]
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Brian Brubaker’s daughter, Emily, faces years of expensive dental work. She was born with a rare condition called ectodermal dysplasia, which affects hair, skin, and teeth. Because of the condition, Emily has no adult teeth and will have to have them surgically replaced. Children born with ectodermal dysplasia are among the four percent of individuals […]
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Hospitals often blame maternity deaths on factors beyond their control but data suggests they may be at fault, according to a recent analysis from USA Today. The analysis examined billing data from nearly 7 million births across 13 states and found complications at more than 1,000 hospitals. Roughly one in eight hospitals have complication rates […]
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As consumers seek lower-cost alternatives to ACA plans, many have turned to alternatives like short-term limited duration policies or Christian-sharing ministries. These plans carry risks and could leave consumers paying more, not less, according to NPR and Kaiser Health News. These risky plans are presented as alternatives for consumers who cannot afford the premiums of […]
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Washington’s state legislature is considering a proposal to help alleviate the burden of balance billing, Public News Service reports. Balance billing, a kind of surprise medical billing, occurs when patients receive care from an out-of-network provider at an in-network facility. Consumers often end up with balance bills after an emergency situation. Dr. Nathan Schlicher, a […]
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Consumers may finally get some insight into negotiated payment rates but even greater transparency could still be necessary. The federal government is considering a new rule to publish the negotiated payment rates between providers and insurance companies. According to The Wall Street Journal, the change would expose the true cost of care for consumers. If […]
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A Northern California federal judge has issued a “scathing ruling” that a subsidiary of insurance giant UnitedHealth Group implemented internal policies that discriminated against patients with mental health and substance abuse issues, according to The New York Times. In his decision, U.S. Chief Magistrate Judge Joseph C. Spero said that United Behavioral Health, a unit […]
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Consumers often face surprise medical bills after receiving care from an out-of-network provider at an in-network facility. Even when consumers are vigilant, they can end up with surprise bills. This was true for Khrystyna Greene, who went to a free-standing emergency room in San Antonio to get care for her son who had fallen and […]
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Cancer patients are facing delays in receiving care and access to critical oncology drugs as a result of pharmaceutical benefit managers (PBMs) practices. These delays, oncologists warn, are putting their lives at risk, Medscape reports. “[A] patient had metastatic kidney cancer, and his oncologist was seeking to treat him with sunitinib malate (Sutent, Pfizer), a […]
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Consumers find themselves in the middle of a fight between insurers and providers, according to a new lawsuit. According to CNN, the suit alleges that Anthem is paying consumers directly, in an effort to pressure providers to join its network. The insurer sent more than $1.3 million in money owed to out-of-network providers to consumers. […]
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In 2016, Elizabeth Perez went to hotel in Broward County, Florida for a free allergy test she had seen advertised online. The advertisement was from Primera Medical Group, based in Atlanta, Georgia. Perez said the techs drew blood and performed a skin allergy test. She expected to get her results in the mail, according to […]
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Consumers are not appealing insurance denials and when they do, the denials are often being upheld. A recent study from the Kaiser Family Foundation found that consumers enrolled in ACA health care plans usually do not appeal their denials, Becker’s Hospital Review reports. The study analyzed 230 million claims submitted to 130 insurers in 2017 […]
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Photo by Heidi de Marco/KHN Consumers are being warned that short-term limited-duration insurance plans may not provide them the coverage they need. The Kentucky Department of Insurance’s website has published an alert warning consumers about short-term limited-duration health plans, Insider Louisville reports. The alert includes a question and answer section that provides information about the […]
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Photo by Heidi de Marco/KHN A breast cancer survivor is fighting for coverage for herself and thousands of other women after her insurance company denied a routine follow-up test, ABC7 reports. Alice Anselmo is lucky to be cancer free. She was shocked, however, when her insurer, Aetna, said it would not cover her breast MRI. […]
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Ohio Attorney General David Yost announced that the state would seek a $16 million repayment from OptumRx, a pharmacy benefit manager (PBM) owned by UnitedHealth. OptumRx, which served as the middleman for Ohio’s Bureau of Workers’ Compensation, allegedly overcharged the bureau since 2015, the Columbus Dispatch reports. Yost’s decision to seek repayments from OptumRx comes […]
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A Pennsylvania woman received a medical bill of more than $16,000 after her short-term limited-duration insurance plan failed to cover her fully, Lancaster Online reports. Pennsylvania Insurance Commissioner Jessica Altman highlighted the consumer’s story at a recent U.S. House subcommittee hearing. The woman who fainted hit her head, Altman said, and the plan paid $200 […]
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Since Carol Marley was diagnosed with cancer, her most “gnawing, ever present concern” has been something she never anticipated. It’s not chemo or fear of the unknown, according to NPR. Instead, it’s the bills. She wasn’t prepared for the confusing medical bills and hours on the phone with her insurance and providers. “I have faith […]
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According to recent CQC research, more than 60 percent of survey respondents say it’s too difficult to know how much they are going to have to pay for health care. Texas lawmakers have introduced legislation that seeks to alleviate some of that confusion by clarifying freestanding emergency room billing practices, KXAN reports. House Bill 2041, […]
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When Melissa Welch-Latronica was pulled over by police, she handed over her driver’s license and waited. She did not feel anxious until she saw a second squad car pull up behind the car that had pulled her over, she told Chicago Tribune. She had a clean record and was confused as to what was taking […]
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A new law in Arizona addresses balance billing, a practice that leaves consumers with surprise medical bills, AZ Family reports. SB 1441 aims at reducing the burden that surprise bills put on patients. After a consumer receives a balance bill, the consumer, their insurer and the provider are required to have a conference call with […]
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After numerous reports highlighting balance billing issues at Zuckerberg San Francisco General Hospital, state officials are taking action to better protect consumers. State representatives have introduced legislation to end the practice of balance billing, which leaves consumers with costly bills like the woman who received a $20,000 bill after a minor bike crash. The new […]
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Emergency patients might have a harder time getting admitted to the hospital than they anticipate. A new study examined over a million Medicare cases and found that hospitals often make $700 more on elective admissions than on emergency department cases, according to the Washington Post. This financial incentive means that elective patients often take priority […]
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A new study found that some Colorado residents have skipped care due to fear of the costs, 9news reports. The study by the Colorado Consumer Health Initiative examined the frequency and impact of health care costs on the state’s residents. It found that 34 percent of privately insured Coloradans received a surprise medical bill in […]
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A Pennsylvania couple has paid a medical bill “in protest” after spending seven months trying to get the bill corrected, The Inquirer reports. Dave Southard got his first colonoscopy at age 64. Colonoscopies are supposed to be fully covered for consumers between 50 and 75 years old who have private insurance. After Southard received a […]
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When Jeannette Parker saw a skinny and sick-looking stray kitten outside of Florida’s Everglades National Park, she decided to feed it some tuna she had in her car. The kitten bit her finger and broke the skin. Parker cleaned the wound, but she began to worry about rabies due to warnings in the area, NPR […]
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As consumers face rising premiums, high deductibles, and surprise bills, state lawmakers and national stakeholders are fighting to control health care costs for consumers. The Center for American Progress reports that only six states currently have comprehensive protections against surprise bills. In Georgia, legislators are working on a bill to address surprise medical bills, according […]
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As the average cost of employer sponsored health care plans has tripled over the last two decades, ProPublica and NPR are examining the impact insurance brokers have had on these prices. The system of payments to brokers incentivizes them to push employers toward more costly plans. Employers often turn to health insurance brokers to help […]
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Anthem’s controversial emergency department policy added confusion to the nation’s already confusing health care system. The policy, which CQC has previously reported on, allowed Anthem to retroactively deny coverage for consumers’ ER visits if the insurer determines the situation was not actually an emergency. While Anthem said the policy was designed to reduce unnecessary ER […]
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Florida-based Simple Health Plans and its CEO Steve Dorfman are at the center of an FTC suit that alleges they tricked consumers into thinking they were buying comprehensive health coverage, CBS reports. Consumers believed their policies provided ample coverage. Instead, they received huge medical bills. One victim, Julia Wilber, went to the emergency room after […]
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Consumers trying to avoid seeking treatment from out-of-network providers to prevent surprise bills often turn to their health plan’s provider directories. But a recent article from Fierce Healthcare highlights issues with ensuring provider directories are accurate – and how it hurts consumers when they are not. Provider directories – or the list of in-network physicians– […]
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Recently divorced and facing financial trouble, Joseph Pero was in a self-described “dark place” in 2017. Then, he did the unthinkable and pointed a handgun at his own heart. Thankfully, he missed. Instead, the bullet hit his lungs and fractured six ribs. In that moment, Pero realized that he wanted to live. The Los Angeles […]
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In a recent op-ed published in Newsweek, Vidor Friedman, President of the American College of Emergency Physicians, pushed back against a controversial ER policy, which he calls “disturbing.” The policy, which CQC has previously reported on, retroactively denies emergency room coverage if the insurer believes that the patient should have sought a lower degree of […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of clarity throughout the process of accessing care and other roadblocks when it comes to getting 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. […]
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New Hampshire resident Donna Backman was selected to be Sen. Maggie Hassan’s (D-NH) guest for the State of the Union address earlier this month. Sen. Hassan invited Backman to help bring awareness to the issue of surprise billing, The Eagle-Tribune reports. “I asked her if she wanted to come down and be my guest because […]
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A recent New York Times article highlights the negative consequences of large-scale health care mergers, such as hospital mergers. The increasing occurrences of mergers and consolidation have previously been scrutinized for increasing consumer costs. But now evidence suggests that hospital mergers lead to worse health outcomes as well. Markets for both hospitals and physicians have […]
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The Colorado State Legislature recently introduced legislation to protect consumers from surprise medical bills, FOX reports. Surprise billing, a practice where consumers are charged for receiving care from out-of-network practitioners at in-network facilities, is increasingly common for consumers. Recent CQC research found that 74 percent of consumers are frustrated by unexpected hospital bills and fees. […]
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When Luke Drager wiped out while skim-boarding in Hilton Head, his parents took him to Hilton Head Hospital’s emergency room because they feared he had broken his ankle. At the hospital, the family was given a cost estimate of about $770 for Luke’s X-rays. Months later, the Dragers were shocked when they received a hospital […]
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Over a 9-year period, Colorado consumers could have saved $11.5 billion if hospitals contained costs and profit margins, The Associated Press reports. According to a new state report, hospitals charged patients with private insurance more, even as revenues increased. In 2009, Medicare and Medicaid in Colorado paid 78 cents and 54 cents, respectively, for every […]
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Consumers in Georgia believe they were misled by Anthem, according to local NBC station 11Alive. John Marks, a retiree who has survived both cancer and a heart attack, is careful each year when he chooses his insurance plan. He knows how vital his medical care is and would never want to jeopardize it. He has […]
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State regulators do not have the authority or capacity to regulate the marketing of potentially risky short-term insurance plans, according to Modern Healthcare. The article cites a new study from the Georgetown Center on Health Insurance Reforms, which examines states’ ability to regulate the marketing of these plans after a HHS regulation expanded the plans’ […]
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When Paul Sweatman’s left ankle swelled to three times its normal size in 2017, his first stop was an urgent care clinic. The urgent care said that the case was more complex than they were able to handle and sent him to Atlanta Medical Center. The hospital’s staff discussed the possibility of amputation. Fortunately, they […]
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A new study from Health Affairs highlights the impact that hospital prices have on the nation’s health care spending, Modern Healthcare reports. The study found that increasing hospital prices are the largest driver of national health care spending inflation. The prices increased 42 percent over a seven-year period, from 2007 to 2014. In comparison, physician […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of clarity throughout the process of accessing care and other roadblocks when it comes to getting 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. […]
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When David Lerman’s insurance changed to Anthem Blue Cross of California this year, he did not realize that the insurer was in a dispute with the largest medical provider in the community, Sutter Health. The insurer and provider, which operates 24 hospitals and roughly 5,000 physicians in Northern California, are battling over the cost of […]
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The new federal rule that requires hospitals to post list prices online was meant to help consumers comparison shop. Now, a California Healthline investigation examines how this new policy is bringing to light huge hospital price fluctuations. California Healthline looked at the chargemasters, which enumerate a hospital’s list prices, of four large hospitals in the […]
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Feeling burdened by high medical costs, more and more consumers are turning to crowdsourcing on the Internet. Over the summer, Consumer for Quality Care reported on this trend, which shows a third of all GoFundMe donations now made are to defray medical costs. GoFundMe’s CEO Rob Solomon recently spoke to CBS News about the phenomenon. […]
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Matt Gleason got a flu shot when his employer offered them for free in the office, but he fainted five minutes after receiving his shot. Gleason has a history of fainting and came to quickly, but his coworker had already called 911, Kaiser Health News reports. After five minutes, he began vomiting and agreed to […]
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When Sterling Slade got in a motorcycle accident last April, he was taken by ambulance to Intermountain Medical Center. Unconscious and fighting a catastrophic brain injury, Slade had no say in which hospital he was taken to, KUTV reports. Thanks to the medical staff at Intermountain Medical Center, he is alive today. A few months […]
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While consumers increasingly are facing expensive balance billing and surprise bills and many rural hospitals are closing, some Texas hospitals are bringing in huge profits, The Dallas Morning News reports. All D-FW hospitals combined had an average profit margin of 12.7 percent. That surpassed margins in many other regions, including Minneapolis (4.3 percent), Detroit (5.5 […]
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American health care consumers are frequently frustrated by unexpected costs, a lack of clarity throughout the process of accessing care and other roadblocks when it comes to getting 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. […]
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Photo by Heidi de Marco/KHN As of January 1, hospitals are required to post list prices online, although it is not immediately clear how helpful the new postings will be for consumers. Kaiser Health News reports that while hospitals are posting the information, it is still far from clear how much consumers will actually need […]
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Short-term health insurance plans have become increasingly popular as a result of rising premiums and recent actions by the Trump Administration. As Kaiser Health News reports: Driven by rising premiums for Affordable Care Act plans, interest in short-term insurance is growing, boosted by Trump administration actions to ease Obama-era restrictions and possibly make federal subsidies […]
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One Virginia couple is doing all they can to keep up with their medical bills, which includes taking on five jobs between the two of them. Unfortunately, Tiffany Cano says it is still not enough. Tiffany and her husband, Robert, have racked up more than $12,000 in medical debt since their son, Brody, was born […]
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New Mexico’s Office of Superintendent of Insurance (OSI) is making changes to help consumers who are facing surprise bills, KRQE writes. The office reports that it has added new management and is considering introducing legislation to streamline resolutions for consumers facing surprise bills. New Mexico’s Superintendent of Insurance, John Franchini, says he knows that surprise […]
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In October 2017, Vox’s Sarah Kliff began her emergency room bill project. Over the subsequent 15 months, she has received and reviewed 1,182 consumer emergency room bills from all 50 states and D.C., she reports. The goal was to gain a better understanding of the unpredictability and costliness of ER bills, specifically looking at the […]
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When Sarah Witter fell skiing and could not get back up, she knew that she had suffered a serious fall. What she did not know – or even anticipate – was the aftermath that the fall would create, Kaiser Health News reports. At the hospital, x-rays showed that Witter had broken two major bones in […]
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Keisheya Spencer says she never expected to have to fight her insurance company to cover a wheelchair for her son with Cerebral palsy, Keyshawn Griffin. Spencer says that her insurer, Blue Cross Blue Shield, used to cover most of what Keyshawn needed. Then a few months ago, it began to push back, CBS reports. Since […]
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A new story from Kaiser Health News highlights how a health provider’s price for medical implants is heavily dependent on who is paying. When Kim Daniels had reconstructive surgery following the double mastectomy she had after undergoing cancer treatment, the implants she selected cost her insurance, PennCare, $7,000. Such a high charge for the exact […]
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In 2019, it will be more important than ever for consumers to educate themselves about their insurance plans and specifically their network of providers. While the news that more health insurance plans are available for 2019 suggests that consumer choice is on the rise, a new report from Avalere suggests that may not be 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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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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