Behind the scenes at a health insurer: How the money is made, or why the Medical Loss Ratio matters

Behind the scenes at a health insurer: How the money is made, or why the Medical Loss Ratio matters

A contributor to one of my online communities, Scott Haas, wrote this to the group the other day in the context of what happens behind the scenes in health insurance. His note primarily concerns the Medical Loss Ratio formula and the way it was changed by the Affordable Care Act — and the role of […]

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 […]

‘Hospitals’ confusing online price lists give patients a headache’: Us, on CBS News

‘Hospitals’ confusing online price lists give patients a headache’: Us, on CBS News

We were featured on CBS Evening News on Jan. 21, 2019, talking about the new Medicare ruling that hospitals need to publicize their list prices starting Jan. 1, 2019. Here’s the CBS Evening News version, “Hospitals’ confusing online price lists give patients a headache,” with correspondent Anna Werner. Here’s the CBS This Morning version, “Are […]

Medicare head asks Twitter to help enforce price transparency policy

Medicare head asks Twitter to help enforce price transparency policy

Seema Verma, the head of the Centers for Medicare and Medicaid services, called on Twitter a few days ago to help her enforce a new rule on health price transparency. The rule requires hospitals to post their list prices online. It went into effect on Jan. 1, and there was scant information about how it […]

Medicaid patients suffer as layers of private companies profit: The Los Angeles Times

Filed Under: Costs, Health plans, Patients

Medicaid patients suffer as layers of private companies profit: The Los Angeles Times

“Marcela Villa isn’t a big name in healthcare — but she played a crucial role in the lives of thousands of Medicaid patients in California,” Chad Terhune, lately of Kaiser Health News, writes over at The Los AngelesTimes. “Her official title: denial nurse. Each week, dozens of requests for treatment landed on her desk after […]

Lax oversight leaves surgery center regulators and patients in the dark: Kaiser Health News

Lax oversight leaves surgery center regulators and patients in the dark: Kaiser Health News

“The first man died in April 2014. Another died later that month. Then on July 18 of that year, a woman was rushed to a hospital where she was told she was lucky to be alive,” Christina Jewett, Kaiser Health News and Mark Alesia, USA Today Network, write in an investigative piece on regulation at […]

Hey there, U.S. House of Representatives!

Hey there, U.S. House of Representatives!

We’re always interested in seeing who’s visiting and what they’re doing. On a lazy July Friday afternoon, it was the U.S. House of Representatives, where someone spent 10 minutes perusing our front page. These screenshots are from the analytics service Clicky, which will tell us — depending on how your internet is configured — who […]

Balance billing by providers — state consumer protections: The Commonwealth Fund

Balance billing by providers — state consumer protections: The Commonwealth Fund

“Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing,” Kevin Lucia, Jack Hoadley and Ashley Williams wrote in a balance billing paper for the Commonwealth Fund in June 2017, analyzing the fragmented state-by-state situation for consumer protections. “However, […]

Drug copay assistance keeps patients alive and prices, premiums high: USA Today

Drug copay assistance keeps patients alive and prices, premiums high: USA Today

“Leonard Rodgers, 80, Tempe, Arizona, gets help with the cost of his expensive prescriptions from non-profit Good Days,” Jayne O’Donnell, David Robinson, Ken Alltucker and Liz Freeman write over at the USA TODAY Network. “He talks about how he would be bankrupt in a few months if it wasn’t for the financial assistance. Copayment assistance […]

NOLA.com | The Times-Picayune, WVUE-Fox 8, ClearHealthCosts named Peabody Award finalists

NOLA.com | The Times-Picayune, WVUE-Fox 8, ClearHealthCosts named Peabody Award finalists

“‘Cracking the Code: The Real Cost of Health Care,’ a joint project of NOLA.com | The Times-Picayune, WVUE-Fox 8 and ClearHealthCosts, was nominated Tuesday (April 10) for a 2018 Peabody Award, handed out annually to honor the best in TV, radio and digital media,” Mike Scott writes over at NOLA.com. “The series was one of […]