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 […]

A behind-the-scenes look at how contracts are made in health care

Filed Under: Costs, Health plans, Patients

A behind-the-scenes look at how contracts are made in health care

“An Open Letter to My Patients Who Have Insurance Coverage Through EMI” is the headline of the blog post, by Randy G. Delcore, M.D., medical director, Cedar Orthopaedic Surgery Specialty Clinic, on the  Cedar Orthopaedic Surgery Center web site, describing to patients the end of a contract with an insurer. The blog post ends with […]

Patients want to shop for care, but have a hard time finding good tools: NPR

Filed Under: Costs, Health plans, Patients

Summary: “Kate and Scott Savett were trying to be responsible when they needed some medical care… Scott, 43, is a chemist and designs software for labs; Kate, 37, works in life insurance,” wrote Elana Gordon, at our partner WHYY public radio in Philadelphia, a bit ago. “They buy their health insurance through Scott’s job, and […]

What your doctor wishes you knew about insurance: Guest post

Filed Under: Costs, Health plans, Patients

What your doctor wishes you knew about insurance: Guest post

Guest post by Dina D. Strachan, M.D. If one were to survey the public, it is not obvious whether being sick would rank as more frustrating than dealing with health insurance —- especially in these times of health reform and uncertainty. Doctors also sometimes find dealing with health insurance difficult —- especially when their patients […]

Blondie and the beast: Medical coding errors (Part I)

Summary: “When Maria spoke to the collections agency about the latest bill she’d received for her daughter’s surgery, the woman on the other end of the phone was encouraging: ‘You only owe $10,000. It WAS $44,000. You should be happy!’ Mandi Bishop writes over at Tincture. “Only $10,000. For a surgery that should not have […]

Why we don’t wear hearing aids: Our series on the cost of hearing aids

Filed Under: Costs, Health plans, Patients

Katherine Bouton, a former editor at The New York Times, is the author of “Shouting Won’t Help: Why I  — and 50 Million Other Americans — Can’t Hear You.” This was originally posted on her Psychology Today blog, “What I  Hear,” and is reposted with permission as the first part of our new series, “How […]

What it means to you: Oct. 1 and buying health insurance, an overview

You may have been hoping you could ignore the topic of health insurance, but Oct. 1 is almost here, and with it the new health insurance landscape brought by the Affordable Care Act. And we’re going to help you navigate through it. Here is an outline of what we’ll write about, basically a handbook on […]