Could we be at the edge of health care’s tipping point? Care And Cost

Could we be at the edge of health care’s tipping point? Care And Cost

“Health care wonks play a game where they wonder whether health care really is changing in ways that are palpably better for everyone,” Brian Klepper writes over at careandcost.com and the Valid Points Newsletter. “Everyone, that is, except for the senior executives of the drug and device firms, electronic health record companies, major health plans […]

Barriers to care experienced by women in the United States: The Henry J. Kaiser Family Foundation

Barriers to care experienced by women in the United States: The Henry J. Kaiser Family Foundation

“This Visualizing Health Policy infographic looks at barriers to care experienced by women in the United States. Women incur greater health care costs than men, particularly during the reproductive years,” The Henry J. Kaiser Family Foundation says on its website. “Despite a lower uninsured rate than men (11% vs 14%), women are more likely to […]

How much does an emergency room visit cost? Or how to successfully argue a bill

How much does an emergency room visit cost? Or how to successfully argue a bill

His kid was treated at the emergency room at Children’s Medical Center – Plano, Tex., he told us when he shared his experience on our website. The charge was $1,770; insurance paid nothing, and he was asked to pay $1,501.24. His remark: ‘Waited six hours. Very expensive treatment for a kid’s tummyache.” I asked him […]

A missed opportunity for the malpractice system to improve health care: The New York Times

A missed opportunity for the malpractice system to improve health care: The New York Times

“The American medical malpractice system is doing almost nothing to improve the quality of health care, research suggests,” Aaron E. Carroll writes over at The New York Times. “What may be more concerning is that there is very little discussion, much less action, about changing this. Despite worries among doctors that they are at financial […]

Medical coding and billing: The inside story of how the sausage is made

Medical coding and billing: The inside story of how the sausage is made

Medical coding and billing seems impenetrable — those strings of numbers on  a bill that purport to show what was done, and what was spent. Sometimes it looks as if chimpanzees are typing in random strings of numbers. The bills and explanations arrive months if not years after the event. The numbers are unfamiliar. Memories […]

Insurance company cites ClearHealthCosts as a good source of pricing information

Insurance company cites ClearHealthCosts as a good source of pricing information

Headscratchers: Blue Cross Blue Shield of Texas and Blue Cross Blue Shield of Illinois refer their insured people to us to save money on health care. In a piece titled “Be the 1 in 5 who’s saving money,” the piece posted on these two sites explains how to save — by using, among other tools, […]

Claims denials and appeals in ACA marketplace plans: Kaiser Family Foundation

Claims denials and appeals in ACA marketplace plans: Kaiser Family Foundation

“In this report, we analyze transparency data released by the Centers for Medicare and Medicaid Services (CMS) to examine claims denials and appeals among issuers offering individual market coverage on healthcare.gov from 2015-2017,” Karen Pollitz, Cynthia Cox and Rachel Fehr write for the Kaiser Family Foundation, in a startling analysis of federal data that reveals […]

Do PBMs Delay Drugs and Drive Up Drug Prices? – The Atlantic

Do PBMs Delay Drugs and Drive Up Drug Prices? – The Atlantic

“Lynn Lear finished her final round of chemotherapy for breast cancer in December. To help keep the cancer from coming back, Lear’s doctor told her about a new medication she could take called Nerlynx. Lear, who is 46, wanted to do everything she could to remain healthy, so she asked her doctor to order the […]

Ohio insurers deny 20% of Obamacare claims: cleveland.com

Ohio insurers deny 20% of Obamacare claims: cleveland.com

“As many as one out of five in-network claims made for Ohio patients with Obamacare are denied, according to research by the Kaiser Family Foundation,” Ginger Christ writes over at cleveland.com. “When a health insurance claim is denied, that leaves patients or providers to cover the cost, leading to unexpected medical bills for patients or […]