At the wrong hospital, you’re 3 times more likely to die: New York Times

Filed Under: Costs, Patients, Providers

Summary: “Not all hospitals are created equal, and the differences in quality can be a matter of life or death,” Reed Abelson writes over at The New York Times. “In the first comprehensive study comparing how well individual hospitals treated a variety of medical conditions, researchers found that patients at the worst American hospitals were […]

Millions have pre-existing conditions that would make them uninsurable: Kaiser Foundation

Summary: “A new Kaiser Family Foundation analysis finds that 52 million adults under 65 – or 27 percent of that population — have pre-existing health conditions that would likely make them uninsurable if they applied for health coverage under medical underwriting practices that existed in most states before insurance regulation changes made by the Affordable […]

Escalator clauses examined as an underlying factor: Risk Managers

Filed Under: Costs

Summary: “Are escalator clauses, common to most Managed Care Contracts, the driving force behind trend factors?” Bill Rusteberg writes over at, his blog. Bill’s a broker in Texas, and a man with an encyclopedic knowledge of health care. “An actuary’s primer I stumbled upon while reading incredibly boring stuff (my answer to sleeping pills) […]

The share of health costs paid out of pocket worldwide: The Data Blog

Filed Under: Costs

Summary: “In many low and middle income countries, out-of-pocket healthcare expenditures are high, and can be a significant financial risk to the poor. Universal health coverage (UHC) is about people having access to needed health care without suffering undue financial hardship,” a blog post on the World Bank’s Data Blog says. This map screenshot is […]

10 steps for appealing a claim or bill: Part 2 of our series on billing

Filed Under: Costs, Health plans, Patients

Summary: So you got a huge bill, and you’re sure there’s been a mistake, either in the bill or the insurer’s processing of a claim. You want to appeal, because it’s a lot of money. Here’s a step-by-step course of action. We cannot guarantee that you will win, but at least you will have tried. Read […]

Blondie and the (Medical Billing Error) Beast, Part 3: APPEAL WON!

Filed Under: Costs, Health plans, Patients

Summary: “More than a month after my last update detailing Blondie’s labrum tear surgery final claims appeal filing, I received this note from her mother,” writes Mandi Bishop over at, in the third and final part of a series on challenging medical bill denials.  “Dear Mandi and Mike, I just wanted to let you know […]

A.C.A. repeal without replacement could spur insurer exodus

Summary: “The incoming Donald Trump administration and Republicans in Congress reportedly are rushing to repeal most of the Affordable Care Act within days of taking office, with a possible delay of a year or two while they craft a replacement package,” Harris Meyer writes over at Modern Healthcare. “They’re also discussing quick administrative moves to unravel the […]

I read 7 Republican Obamacare replacement plans. Here’s what I learned: Sarah Kliff, Vox

Filed Under: Costs

Summary: “If there’s one thing Republicans have been clear about for the past six years, it is that the top of their agenda includes repealing Obamacare,” writes Sarah Kliff over at Vox. “But Obamacare repeal would leave an estimated 22 million Americans without coverage and wreak havoc on the individual insurance market. It’s becoming increasingly […]

What’s next for the ACA? A roundup of early predictions

Summary: No one really knows what will happen when Donald Trump takes office, in light of his pledge to repeal the Affordable Care Act. Nothing is as simple as it sounds ever in life; also, Trump will have to contend with the fact that many parts of the A.C.A. were wildly popular with insurance companies, […]

Our pledge to you in the wake of the election

Filed Under: Costs

Summary: Now that we have some distance from Donald Trump’s election victory on Tuesday, we can look to what’s ahead and where we fit in. Trump has been quoted as saying that he will repeal the entire Affordable Care Act, and also that he would repeal only parts of it. Not much is certain at this […]