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1 week Ago

California Investigates Aetna’s Coverage Denial Practices

California Investigates Aetna’s Coverage Denial Practices

Consumers Stuck With Big Bills After ER Trips
1 week Ago

Consumers Stuck With Big Bills After ER Trips

More and more consumers are finding themselves saddled with expensive emergency room bills as a result of Anthem’s decision to stop covering visits it deems to be non-emergencies.  That’s exactly what happened to Kimberly Fister-Mesch. According to Consumer Reports, Fister-Mesch woke up in the middle night with a severe headache. She took Motrin and Tylenol, […]

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Consumers Hit By Surprise Medical Bills Often Can’t Pay
2 weeks Ago

Consumers Hit By Surprise Medical Bills Often Can’t Pay

As consumers continue to receive surprise medical bills, they often do not have the money to pay, Fierce Healthcare reports. After arriving at an in-network hospital, consumers can be unknowingly treated by out-out-network physicians. That’s exactly what happened to Reid Rupp, who received a $17,000 bill from an out-of-network plastic surgeon after a medical emergency […]

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

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

A St. Louis man is fighting his insurance company after it went against his doctor’s treatment advice and denied his treatment for lung cancer, KMOV reports. After undergoing surgery to remove his left lung, David Starzyk’s doctor developed a treatment plan for his other lung. His doctors at Siteman Cancer Center made plans for radiation […]

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Cuts To Medicaid Transportation Services Put Consumers At Risk
3 weeks Ago

Cuts To Medicaid Transportation Services Put Consumers At Risk

Photo By Heidi de Marco/KHN The Trump administration recently announced changes to Medicaid’s non-emergency medical transportation (NEMT) services, allowing states to apply for waivers so they are no longer required to provide this key benefit. But, as Kaiser Health News reports, NEMT services have been an integral part of the Medicaid program since its inception […]

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Family Battles Insurer For Infant’s Life-Saving Procedure
3 weeks Ago

Family Battles Insurer For Infant’s Life-Saving Procedure

4-month old Jensen Kittle was born with Severe Combined Immunodeficiency (SCID), a life-threatening genetic disorder that leaves Jensen with virtually no immune system to battle every day germs. According to local CBS affiliate WRGB: “Without an immune system he has no ability to fight against the flu, the common cold, even wearing the wrong fragrance […]

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Consumers Feel The Pain Of Anthem’s New ER Policy
3 weeks Ago

Consumers Feel The Pain Of Anthem’s New ER Policy

As a part of Vox’s dive into emergency room billing, Sarah Kliff recently reported on how Anthem’s new emergency room policy – which essentially requires patients to diagnose themselves in order to ensure their condition is serious enough to be deemed an emergency by Anthem, and therefore covered by their insurance – is impacting consumers. […]

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Hospital Service Reductions Negatively Impact Rural Consumers
3 weeks Ago

Hospital Service Reductions Negatively Impact Rural Consumers

Photo By Heidi de Marco/KHN Hospital conglomerates are changing their business models, consolidating care at regional hospitals, and often cutting services at more remote facilities. As services are cut from these facilities, they become de facto outpatient clinics. Hospital executives argue that the changing medical landscape has made long inpatient stays more sparse and hospitals […]

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Consumers In Idaho Could Get Stuck With Bare Bones Plans
4 weeks Ago

Consumers In Idaho Could Get Stuck With Bare Bones Plans

Idaho has announced it will take formal steps to allow insurance companies to sell non-compliant plans on the state’s ACA market place, the Associated Press reports. The change means some consumers who opt for cheaper plans could end up with health insurance that doesn’t cover their needs. Under Idaho’s guidelines, insurers can offer plans that […]

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Centene Sued Over Narrow Network Plans
4 weeks Ago

Centene Sued Over Narrow Network Plans

A new lawsuit claims that health insurance company Centene Corporation provides plans that have less coverage than advertised. The lawsuit claims the insurance company’s slim coverage makes it difficult, if not impossible, for consumers to find adequate care, according to Bloomberg. The company misled customers about the number of doctors covered under its health plans, […]

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

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

Health insurance giant Aetna has agreed to a $17 million settlement after it breached consumers’ privacy in an incident that revealed the HIV statuses of thousands of policy-holders, according to The Associated Press. Consumers for Quality Care reported on the breach over the summer. Court documents say the Hartford, Connecticut-based company sent a mailing in […]

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Mental Health and Addiction Treatment Database Freeze Could Hurt Consumers
1 month Ago

Mental Health and Addiction Treatment Database Freeze Could Hurt Consumers

The Trump administration has frozen the National Registry of Evidence-based Programs and Practices (NREPP), a national database of mental health and substance abuse treatments and interventions, a move that could have negative consequences for consumers. Health professionals and community groups use the database to identify resources to help individuals in need of these services. According […]

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Allowing Medicaid Work Requirements Will Harm Most Vulnerable Americans
1 month Ago

Allowing Medicaid Work Requirements Will Harm Most Vulnerable Americans

Photo by Heidi de Marco/KHN The Trump administration announced it would allow states to implement work requirements for Medicaid recipients, the Washington Post reports. The change signifies a fundamental shift in the program’s policy. At the time of the announcement, 10 states had already requested federal permission to add work requirements to their Medicaid programs […]

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Samantha Bee Highlights Failing Maternity Care
1 month Ago

Samantha Bee Highlights Failing Maternity Care

Comedian Samantha Bee recently highlighted how American hospitals are failing on maternity care. In the segment, Bee focused on a number of stories that examine how the U.S. has the worst maternal mortality rate in the developed world. A 2015 statistic found that American women die in childbirth at twice the rate of women in […]

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

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

Sen. Claire McCaskill has requested information from insurance giant Anthem over a policy change that impacts Missouri consumers’ emergency room coverage, according to St. Louis Business Journal. As Consumers for Quality Care has previously reported, Anthem has told patients in a number of states that their ER visits may no longer be covered, if they […]

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

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

Despite the Affordable Care Act (ACA) open enrollment period ending on December 15, some consumers may still be eligible to enroll in a health plan for 2018. Most residents in states that established their own marketplaces have later deadlines, according to the Kaiser Family Foundation. State-based Marketplaces (SBMs) have flexibility to set their own dates […]

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Consumers Battle Against Hospital-Owned Debt Collectors
2 months Ago

Consumers Battle Against Hospital-Owned Debt Collectors

A Florida woman’s life was thrown into turmoil after she was hospitalized and received a massive bill that she couldn’t pay. According to Bloomberg: [Angelia] Fowler had been sick for months in November 2015 when her son finally took her to the emergency room with what turned out to be pneumonia. She spent much of […]

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

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

In a recent Medium column, Consumers for Quality Care board member Donna Christensen discusses the potential dismantling of Massachusetts’ health care system. The Commonwealth, once a national leader on health care, is on the verge of cutting thousands of vulnerable Massachusetts citizens’ coverage. The Massachusetts government recently submitted a waiver request (known as a 1115 […]

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

Insurer Under Fire For Rolling Back Coverage of HIV Prevention Medication

Photo by Heidi de Marco/KHN Recently, UnitedHealthcare has come under fire for rolling back coverage of Truvada, a pre-exposure prophylaxis (PrEP) medication.  When used correctly, the drug has at least a 92% success rate in preventing HIV transmission. The drug is normally expensive, and many patients use secondary insurance, such as copay cards or manufacturer […]

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Insurer Denies Teen’s Brain Surgery
2 months Ago

Insurer Denies Teen’s Brain Surgery

Cara Pressman, a 15-year-old with epilepsy, has some tough words for her insurance company after it denied her coverage of a minimally invasive brain surgery. One day when Cara was 9, she incessantly complained of a severe headache.  That night Cara had her first seizure.  When her parents came to her room she was covered […]

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Consumers Are Paying More For ER Facility Fees
3 months Ago

Consumers Are Paying More For ER Facility Fees

The latest installment of Vox’s series on hospital billing and prices examines the monopoly powers of emergency rooms and how consumers are hurt by facility fees. Nearly all emergency room bills include a facility fee, a charge that is applied just for seeking care. According to Vox: Emergency rooms argue that these fees are necessary […]

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Consumers Face High Costs From Overtreatment
3 months Ago

Consumers Face High Costs From Overtreatment

A new Pro Publica report examines how unnecessary procedures and overtreatment are contributing to skyrocketing costs of care. Some doctors and hospitals are performing redundant or unnecessary tests, scans, and procedures. Patients, often lacking knowledge and understanding of why these procedures are being recommend, authorize them. Later, these patients face extreme medical bills for the […]

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CQC Board Member Donna Christensen Speaks To Consumers About Open Enrollment
3 months Ago

CQC Board Member Donna Christensen Speaks To Consumers About Open Enrollment

Consumers for Quality Care board member and former Congresswoman Donna Christensen recently made a number of appearances to inform consumers on how to choose the best plan during open enrollment. Speaking on news networks in Charleston, W. Va.; Chicago; Portland, Oregon; and Seattle, Christensen educated consumers about potential changes and issues to be on the […]

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

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

The federal government has allowed Iowa to rollback its retroactive eligibility benefit, making it the fourth state to do so, Kaiser Health News reports. The benefit, which has been a feature of Medicaid for years, allowed for new enrollees’ medical bills to be paid retroactively up to 3 months. The other states include Arkansas, Indiana, […]

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CA Fines Anthem $5 Million Over Consumer Grievances
3 months Ago

CA Fines Anthem $5 Million Over Consumer Grievances

California’s managed care regulator has fined Anthem $5 million, alleging “systemic violations and a long history of flouting the law in regard to consumer complaints,” the Los Angeles Times reports. The fine adds to the $6 million which the insurer has been fined for similar reasons, since 2002. “Anthem Blue Cross’ failures to comply with […]

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Consumers Face Narrow Networks During Open Enrollment
3 months Ago

Consumers Face Narrow Networks During Open Enrollment

As consumers navigate open enrollment for ACA insurance plans, narrow networks continue to be a problem. In an interview with NPR’s Michael Martin, Kaiser Health News’ Julie Rovner explained how narrow networks came about and how they impact consumers: “[When insurers] were starting to put together their plans, they thought, how are we going to […]

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When Hospitals And Doctors Make Mistakes, Consumers Often Pay
3 months Ago

When Hospitals And Doctors Make Mistakes, Consumers Often Pay

A recent Chicago Tribune article examined the lack of accountability from hospitals and doctors related to complications.  These unforeseen costs can be extreme and often become the patient’s responsibility. Whether because of mistakes, infections or plain bad luck, those who go in don’t always come out better.  More than 400,000 Americans die annually in part […]

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Doctor Reveals Truth About Medical Preauthorization Process
3 months Ago

Doctor Reveals Truth About Medical Preauthorization Process

MedPage Today recently published an article by Dr. Milton Packer, describing a peculiar lunch he attended and the lesson he learned about consumer-unfriendly practices insurance companies employ in conducting preauthorization assessments for drugs and medical procedures. Dr. Packer was invited to give a presentation on heart failure to a group of doctors.  He noticed that […]

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Half of Consumers Denied Insurance Coverage For Cholesterol Drug
3 months Ago

Half of Consumers Denied Insurance Coverage For Cholesterol Drug

A recent study of US pharmacy claims found that less than half of patients prescribed a new cholesterol drug receive insurance coverage for the drug. The drug, a PCSK9 inhibitor, has been shown to give patients a 27 percent or lower chance of developing a heart attack, 22 percent lower chance of cardiovascular revascularization, and […]

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Michigan Insurer Stops Coverage For Pain Therapy
3 months Ago

Michigan Insurer Stops Coverage For Pain Therapy

Photo By Heidi de Marco/KHN Alex Ostrowski was just 12 when she suffered a life-threatening accident.  A boat ran over her Jet Ski and she ended up pinned between its propeller and the boat’s diving board. The propeller crushed her hip and pelvis and cut the entire left side of her body.  Miraculously, Ostrowski survived […]

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Anthem’s ER Policy “Completely Unfair To Patients”
3 months Ago

Anthem’s ER Policy “Completely Unfair To Patients”

Consumers in a few states are beginning to grapple with Anthem’s new Emergency Room policy to reject claims that are ultimately deemed as non-emergencies. One Kentucky woman suffered severe stomach pain and was stuck with a bill when the insurer decided she hadn’t been in an emergency situation. According to The Associated Press: Alison Wrenne […]

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CQC Highlights Additional Organizations That Oppose The Massachusetts Waiver
4 months Ago

CQC Highlights Additional Organizations That Oppose The Massachusetts Waiver

As Consumers For Quality Care previously reported, Massachusetts recently submitted a Medicaid 1115 waiver request to the Centers for Medicare & Medicaid Services (CMS) that would make substantial changes for current MassHealth recipients, cutting health care coverage for those who need it most. More than 400 groups submitted comments with serious concerns about the Massachusetts […]

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

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

By Heidi de Marco/KHN As Consumers For Quality Care previously reported, Massachusetts recently submitted a Medicaid 1115 waiver request to the Centers for Medicare & Medicaid Services (CMS) that would make substantial changes for current MassHealth recipients, cutting health care coverage for those who need it most. More than 400 groups submitted comments with serious […]

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New Project Asks Consumers To Share Their Stories
4 months Ago

New Project Asks Consumers To Share Their Stories

Photo by Heidi de Marco/KHN As extreme hospital and insurer bills continue to be a phenomenon in American healthcare, Vox’s Sarah Kliff has launched a new project, which aims at bringing transparency to high hospital bills and to tackle the question of “why these prices are such a problem for the American health care system.” […]

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

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

Photo by Heidi de Marco/KHN Three year-old Elodie Fowler went to Lucile Packard Children’s Hospital for an MRI. She has a rare genetic condition and her doctors wanted to have a better understanding of what was causing swelling in the right-side body and digestion issues, Vox reports. The scan only took about 30 minutes. When […]

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9-Month-Old With Brain Cancer Sent Denial Letter
4 months Ago

9-Month-Old With Brain Cancer Sent Denial Letter

9-month-old Connor Richardson is battling brain cancer and his insurance company. Recently, Connor and his parents received a letter informing them the insurer would not cover an experimental but necessary cancer treatment. According to The Daily Beast: Connor was only seven months old when he had an uncharacteristic bout of crying through the night. His […]

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Appalachia Residents Battle Lack Of Accessible Mental Health Care
4 months Ago

Appalachia Residents Battle Lack Of Accessible Mental Health Care

A new article from Kaiser Health News highlights the lack options for mental health treatment in Appalachia, and the measures many consumers and physicians take in order to meet the community’s need. In at least one county in West Virginia, there are no psychiatrists. The lack of available care options means that many individuals have […]

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Transgender Consumers In RI Encounter Barriers To Care
4 months Ago

Transgender Consumers In RI Encounter Barriers To Care

Transgender consumers in Rhode Island were recently polled on a range of issues by the National Center For Transgender Equality.  RI Future highlighted the survey’s findings, including issues with health care coverage and mental health.  The survey found that many respondents reported harassment, coverage denial, and distress because of their gender identity. According to RI […]

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New Executive Order Could Hurt Consumers
4 months Ago

New Executive Order Could Hurt Consumers

In the wake of the failed ACA repeal and replace, President Trump has signed an executive order on health care, which could have a negative impact on consumers. Former CMS Director Andy Slavitt has argued the move would eliminate protections for pre-existing condition protections and make the individual exchanges a high-risk pool. The White House […]

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Patient Groups Protest MA Waiver, Transportation Cuts
5 months Ago

Patient Groups Protest MA Waiver, Transportation Cuts

Numerous patient and advocacy groups have spoken out against Massachusetts’ proposed Medicaid waiver request, which would take away transportation benefits for many MassHealth beneficiaries. The waiver would eliminate transportation services for non-disabled adults in non-emergency situations, The Republican reports. Massachusetts claims the change would save $5 Million in 2020 – a small fraction of the […]

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Massachusetts’ Waiver Request Could Harm Consumers
5 months Ago

Massachusetts’ Waiver Request Could Harm Consumers

The Commonwealth of Massachusetts is asking the federal government to be allowed to make cuts to Medicaid, curtail access to long-term and in-home health care supports, and limit drug coverage.  According to Modern Healthcare: The state has asked for permission to move childless, non-disabled adults with incomes above the federal poverty level into subsidized commercial […]

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Study Finds Mental Health Coverage Narrower Than Other Coverage
5 months Ago

Study Finds Mental Health Coverage Narrower Than Other Coverage

Consumers who are looking to get mental health treatment while being insured by a narrow network plan may have a difficult time finding a doctor in their network. A new study published in Health Affairs has found disparities between coverage for mental health and medical/surgical coverage in narrow network plans. Kaiser Health News reports that […]

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Insurer Denies Man’s Painkillers After Back Surgery
5 months Ago

Insurer Denies Man’s Painkillers After Back Surgery

Joe Stanziano had recently undergone his fourth back surgery in five years, when his doctor prescribed an opioid to aid his recovery.  As recovery progressed, his doctor decided to start tapering off the pain meds by prescribing a lower dose. Stanziano’s insurer denied coverage of the medication. PAMED recently reported Stanziano’s experience to highlight the […]

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Observational Status Creates Roadblocks To Recovery For Medicare Patients
5 months Ago

Observational Status Creates Roadblocks To Recovery For Medicare Patients

Many senior citizens believe that their insurance would cover costs related to a fall or accident; but a hidden policy – called observational care – may jeopardize their care, Reader’s Digest reports. Elisa Roland chronicles the obstacles in getting her mother adequate care, after she suffered a fall and could not walk.  Before the accident, […]

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

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

As debate over the affordable care act continues many questions remain about the future of our health care system.  However, one thing is certain, America’s health insurance companies are doing very well: Combined, the nation’s top six health insurers reported $6 billion in adjusted profits for the second quarter. That’s up more about 29 percent […]

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Narrow Network Plans Offer Less Mental Health Coverage
5 months Ago

Narrow Network Plans Offer Less Mental Health Coverage

A recent study found that narrow-network plans offer even more limited mental health care, Reuters reports. Narrow-network plans were created to bring lower-cost health insurance plans to ACA markets. These plans generally limit coverage to fewer than 25 percent of providers in a given market. The study found that while narrow-network plans cover 24 percent […]

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Study Finds Most Emergency Room Visits Are Valid
6 months Ago

Study Finds Most Emergency Room Visits Are Valid

Consumers are almost always justified in visiting the emergency room despite recent cutbacks from insurers. A new study from the University of California at San Francisco has found that only 3.3 percent of ER visits are considered avoidable, Axios reports. The study found 3 major conclusions: The definition of “avoidable” is what splits most parties. […]

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VA Insurers Accused Of Disobeying Law Over Cancer Treatment
6 months Ago

VA Insurers Accused Of Disobeying Law Over Cancer Treatment

Photo by Heidi de Marco/KHN Despite state law, consumers in Virginia may have difficulty getting proton therapy, a treatment for cancer, covered. The parent company of Virginia’s only proton therapy center has issued a statement accusing insurers of violating a state law, which exists to give people access to the therapy, the Daily Press reports. […]

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Patients’ HIV Status Exposed By Aetna ‘Mistake’
6 months Ago

Patients’ HIV Status Exposed By Aetna ‘Mistake’

Aetna has come under fire after exposing some costumers’ HIV status.  The insurer sent letters to consumers, which contained information about changes in access to HIV medications. According to the Washington Post, the envelopes’ clear window made the contents of the letters visible without opening the mail. For some of these customers, a plastic window […]

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New Study Suggests Insurance Denials Could Be Making Patients Sicker
6 months Ago

New Study Suggests Insurance Denials Could Be Making Patients Sicker

A new study by the Doctors-Patient Rights Project (DPRP), found that over 50 million Americans are lacking access to health treatments, despite having insurance.  Specifically, the study looked at insurance denials and their long-term effects on patients.  According to the study, one third of patients who experienced insurance denials have had their health adversely effected […]

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

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

Indiana residents covered by Anthem will soon have to think twice before visiting the emergency room.  The insurer will notify customers that their ER visits might not be covered by their insurance, Fox 59 reports. Last week, Consumers For Quality Care sent a letter to the Indiana Insurance Commissioner that urged him to reject the […]

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DOJ and Mylan Reach EpiPen Settlement That Could Benefit Consumers
6 months Ago

DOJ and Mylan Reach EpiPen Settlement That Could Benefit Consumers

Almost a year after Mylan Pharmaceuticals was the subject of an outpouring of public disapproval; the Justice Department has reached a settlement with the company. The settlement includes reimbursements to Medicaid programs in every state, which will make the programs more solvent for consumers. Mylan was accused of overcharging the government for the emergency allergy […]

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

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

A new study published in the American Journal of Medicine suggests that poorer patients are spending more for hospital care.  While Medicare patients pay a fixed amount for inpatient treatment, the charges incurred when patients are not sick enough for inpatient care can be higher. Reuters reports: [P]eople who aren’t sick enough for an inpatient […]

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

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

Photo by Heidi de Marco/KHN Hospitals’ public announcements of their newest and most innovative surgeries, procedures and technologies are less than helpful to consumers, Axios reports. Hospitals will often issue press releases or mass e-mails announcing these services. These blasts can go on to be picked up by local news stations or other services. This past […]

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Patient Groups File Civil Rights Complaint Over Hemophilia Coverage
6 months Ago

Patient Groups File Civil Rights Complaint Over Hemophilia Coverage

Patients groups representing individuals with hemophilia have filed a civil rights complaint in Iowa that accuses health insurer Wellmark of engaging in discrimination, Washington Examiner reports. National Hemophilia Foundation, The Hemophilia Federation of America, and Hemophilia of Iowa allege that Wellmark exited the ACA market in Iowa to avoid paying for patients with hemophilia, including […]

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UnitedHealth Apologizes After Truvada Letter
6 months Ago

UnitedHealth Apologizes After Truvada Letter

An insurer is changing a company policy regarding Truvada, an HIV medication, after pushback from activists, NBC reports. UnitedHealth recently came under fire after a denial letter for the medication was circulated online.  In the rejection letter, the insurer cited the patient’s “high risk homosexual behavior” as its reason for the denial. The letter came […]

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

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

Chet Hartley, a retired law enforcement officer, was in for a shock when he received a letter from his insurer saying they would not cover his surgery, months after it had taken place.  KUTV explains, the letter said the surgery would not be covered, despite the fact that Hartley received pre-approval and had already paid […]

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

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

Matthew Nunley, a veteran, is facing the battle of his life. He has been diagnosed with congestive heart failure and is battling Anthem to cover the device keeping him alive, reports WDRB. Nunley’s diagnoses came in November 2016, after he got the flu. Doctors told Nunley it was a one-in-10,000 chance a virus would attack […]

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Tips for Consumers Hit By Surprise Medical Bills
7 months Ago

Tips for Consumers Hit By Surprise Medical Bills

As surprise medical bills continue to be a concern for consumers, more people are taking notice. A recent Yale study highlighted the growing phenomenon. Now, Huffington Post offers a first-person example of how to deal with the common issues that result in unexpectedly expensive hospital bills and discusses strategies for consumers to fight back. These […]

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

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

As health care costs continue to rise in the United States, patients are increasingly being stuck with a larger and larger portion of the bill. According to the Kaiser Family Foundation, the average deductible among covered workers with a deductible has gone up nearly $1,000 in just ten years: Writing in The Huffington Post, Dr. […]

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New Study Highlights Problem Of Surprise Medical Bills For Consumers
7 months Ago

New Study Highlights Problem Of Surprise Medical Bills For Consumers

In another chapter of an ongoing trend, consumers across the country have been facing steep medical bills after hospital visits they thought were in their insurance network. One California woman, Debra Brown, was shocked to get $500 out-of-network hospital bill from a doctor who she said never identified himself and only briefly touched her injured […]

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Narrow Networks Can Mean Less Access To Cancer Experts
7 months Ago

Narrow Networks Can Mean Less Access To Cancer Experts

Customers that have narrow network health plans probably can’t see top cancer experts. According to HealthDay: Less-expensive “narrow network” health plans are much less likely to cover treatment by doctors at centers affiliated with the U.S. National Cancer Institute, said study lead author Laura Yasaitis. The information comes from a recent study by the University […]

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

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

Gail Tapp, woke up from a minor surgery at Forth Worth’s USMD Hospital to find that her front teeth had been knocked out, CBS DFW reports. Tapp said doctors at USMD Hospital in Fort Worth told her husband they had accidentally knocked out three teeth while removing her breathing tube after routine bladder surgery. The […]

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Consumers Sue After Being Denied Mental Health And Drug Treatments
7 months Ago

Consumers Sue After Being Denied Mental Health And Drug Treatments

Blue Shield of California is facing a class-action lawsuit that claims the insurer improperly denied outpatient and residential care for patients, Kaiser Health News reports. The suit was filed on behalf of two parents who say their children were denied coverage to treatment for mental health and substance abuse issues. The suit also claims that […]

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Woman Thought Her Surgery Was Preapproved, It Wasn’t
8 months Ago

Woman Thought Her Surgery Was Preapproved, It Wasn’t

A Utah insurance company, Select Health, has come under scrutiny for refusing to pay for a surgery after preapproving the procedure, KUTV reports. Kristine LaMay submitted a pre-approval for her knee-replacement surgery. After she gained approval from her insurance company, she received the surgery. Now, the insurance company is saying it won’t pay. [N]early a […]

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Patients Struggle To Get Powerful, Life-Changing Cholesterol Medicine
8 months Ago

Patients Struggle To Get Powerful, Life-Changing Cholesterol Medicine

Patients who need cholesterol drugs are having a very difficult time getting them. The Wall Street Journal reports: Some doctors believe PCSK9 inhibitors could be a lifesaving solution for millions of heart-disease patients and could transform treatment for the most difficult cases—patients with FH, as well as those with a history of heart disease or […]

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Consumer Group Skips CT Rate Request Hearing It Deems Futile
8 months Ago

Consumer Group Skips CT Rate Request Hearing It Deems Futile

Photo by Heidi de Marco A prominent consumer advocacy organization in Connecticut elected to skip public health insurance rate request hearings hosted by the state Insurance Department. The Universal Health Care Foundation of Connecticut explained their non-attendance was intended as a protest to the timing and format of the meetings. The group complained the meetings […]

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Minnesota Woman Battles Insurer For Access To Life-Saving Medicine
8 months Ago

Minnesota Woman Battles Insurer For Access To Life-Saving Medicine

Minneapolis’ City Pages recently reported one woman’s battle to get her medication covered by her insurer, Blue Cross Blue Shield of Minnesota. The experience, she says, leaves her furious. I am furious. Furious that my insurance company preferred to pass me between divisions, departments, and parent companies rather than take responsibility for dealing with my […]

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Aetna Denies Alaska Woman Life-Saving Surgery
8 months Ago

Aetna Denies Alaska Woman Life-Saving Surgery

Photo by Heidi de Marco An Alaska woman is battling her insurance company to receive a life-saving surgery, the Alaska Dispatch News details. Barbara Ross, who supports a family of ten, has a hereditary lymphedema, which causes her body to retain fluid under the skin. After an injury, her condition worsened. She lost the ability […]

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Georgia Insurance Department Monitoring New BCBS ER Rules
8 months Ago

Georgia Insurance Department Monitoring New BCBS ER Rules

Georgia’s Insurance Department announced it would monitor a new Blue Cross Blue Shield policy that seeks to limit coverage for certain types of emergency room visits. According to Georgia Health News: The state insurance department says it will monitor the new emergency room policy of Blue Cross and Blue Shield of Georgia “to make sure […]

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Consumers Get Short Shrift As Insurers See Huge Income
8 months Ago

Consumers Get Short Shrift As Insurers See Huge Income

For consumers, there seems to be an ever-expanding list of negative headlines. Consumers have seen big premium increases on the ACA exchanges. Networks have narrowed leaving families and individuals with little choice in their health care. Services that some consumers have taken for granted, like heading to the Emergency Room in case of an emergency, […]

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Are Consumers Being Denied Mental Health Coverage?
8 months Ago

Are Consumers Being Denied Mental Health Coverage?

Photo by Heidi de Marco/KHN The Boston Globe recently reported on a growing trend of insurance companies refusing to cover mental health programs. Wilderness Therapy, a form of behavioral therapy, is increasingly accepted by mental health professionals to treat behavioral, substance abuse and mental health issues in teenagers. The programs use many of the same tactics […]

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What Happens When An Insurer Denies Important Medication?
9 months Ago

What Happens When An Insurer Denies Important Medication?

A new report from CNN highlights a young man’s story of being denied a life-saving medicine by his insurance company. He filed a lawsuit in 2015 and the suit’s trial is set for this summer. In November 2014, Gillen Washington, a Northern Arizona University student, went into his clinic. It should have been a routine […]

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

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

Anthem Blue Cross Blue Shield sent letters to customers in three states that warned some emergency room visits wouldn’t be covered. In Georgia, Missouri, and Kentucky, plans will no longer pay for visits that Anthem deems are no longer necessary. Emergency room physicians are upset about the letters. Dr. Becky Parker, president of the American […]

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

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

A recent investigative article from the New Jersey Star-Ledger details one woman’s struggle with a growing trend: unexpected, out-of-network hospital billings. Margo Anderson of New Jersey had a medical emergency and took care to go to a hospital that was considered “Tier 1” for her health plan. In other words, she went to a hospital […]

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Uninsured, Minorities Face Highest Emergency Room Bills
9 months Ago

Uninsured, Minorities Face Highest Emergency Room Bills

A new study from the Journal of the American Medical Association found that uninsured individuals and minority groups are often the highest billed emergency room patients. As Vox reports:   Welcome to the arcane and arbitrary world of billing practices at US hospitals today, as detailed in a new JAMA Internal Medicine study. The researchers, […]

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BCBS Illinois Faces State Review For First Time In Decades
9 months Ago

BCBS Illinois Faces State Review For First Time In Decades

The state of Illinois is conducting a “market conduct exam” of Blue Cross Blue Shield for the first time in 27 years. The reviews examine how insurers pay claims and handle customer complaints among other things. According to the Chicago Tribune:   Blue Cross and Blue Shield of Illinois confirmed the review this week, in […]

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

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

Last month, Blue Cross Blue Shield of North Carolina filed a request to raise premiums by 23 percent in 2018. Its customers have faced double digit increases for years:   “Steep rate increases have been a consistent feature of Blue Cross’s ACA coverage in North Carolina, and Thursday’s announcement follows a 24.3 percent rate increase […]

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