Insurers Alter Cost Formula, and Patients Pay More
By NINA BERNSTEIN
Despite a landmark settlement that was expected to increase coverage for out-of-network care, the nation’s largest health insurers have been switching to a new payment method that in most cases significantly increases the cost to the patient.
The settlement, reached in 2009, followed New York State’s accusation that the companies manipulated data they used to price such care, shortchanging the nation’s patients by hundreds of millions of dollars.
The agreement required the companies to finance an objective database of doctors’ fees that patients and insurers nationally could rely on. Gov. Andrew M. Cuomo, then the attorney general, said it would increase reimbursements by as much as 28 percent.
It has not turned out that way. Though the settlement required the companies to underwrite the new database with $95 million, it did not obligate them to use it. So by the time the database was finally up and running last year, the same companies, across the country, were rapidly shifting to another calculation method, based on Medicare rates, that usually reduces reimbursement substantially.
The Confusion of Hospital Pricing
By RONI CARYN RABINWesley Bedrosian
When Augie Hong awoke with severe abdominal pain nearly two years ago, he went to the hospital emergency room closest to his home in San Francisco. The diagnosis was acute appendicitis, and doctors removed his inflamed appendix.
Mr. Hong had health insurance, so he wasn’t too worried about paying. Then the bills started to arrive.
“That’s when I got nervous,” said Mr. Hong, 36, who has insurance through his job at an investment firm.
In all, Mr. Hong was charged $59,283, including $5,264 for the doctors. According to the Healthcare Blue Book, that amount is six times the fair price for an appendectomy in Northern California, which is $8,309 (including a four-day admission) for the hospital and an additional $1,325 for the doctor. Even after Mr. Hong’s insurer paid the hospital $31,409 and Mr. Hong paid the doctors $4,034, the bills kept coming.
A new study suggests that Mr. Hong’s experience is not unusual. Hospital charges are all over the map: according to the report published Monday in the Archives of Internal Medicine, fees for a routine appendectomy in California can range from $1,500 to — in one extreme case — $182,955. Researchers found wide variations in charges even among appendectomy patients treated at the same hospital.
http://well.blogs.nytimes.com/2012/04/23/the-confusion-of-hospital-pricing/?pagemode=print
For removal of appendix, hide walletStudy finds 'madness' pricing with a huge swing in patients' bills, from $1,500 to $180,000.By LINDSEY TANNER/The Associated Press CHICAGO — What do hospitals charge to remove an appendix? The startling answer is that it could be the same as the price of a refrigerator -- or a house http://www.printthis.clickability.com/pt/cpt?expire=&title=For+removal+of+appendix%2C+hide+wallet&urlID=476786211&action=cpt&partnerID=561087&cid=148611025&fb=Y&url=http%3A%2F%2Fwww.pressherald.com%2Fnews%2Ffor-removal-of-appendix-hide-wallet_2012-04-24.html |
California's working poor would lose a lot if health reform law dies
A bill to create a federally funded Basic Health Plan for about 720,000 low-income residents would go for naught if the Supreme Court tosses out the law.
David Lazarus
April 24, 2012
If the healthcare reform law is thrown out by theU.S. Supreme Court — as many fear could happen based on the comments of conservative justices — more than 700,000 low-income Californians could lose a once-in-a-lifetime chance to obtain affordable health insurance.
At stake is what's known as a Basic Health Plan. This is a system provided for by the reform law, fully funded by the federal government, that would extend coverage to people who may not be able to afford conventional insurance policies but don't qualify for Medi-Cal.
At stake is what's known as a Basic Health Plan. This is a system provided for by the reform law, fully funded by the federal government, that would extend coverage to people who may not be able to afford conventional insurance policies but don't qualify for Medi-Cal.
Doctors falling short helping seniors to avoid medical problems, poll finds — Health — Bangor Daily News — BDN Maine
By Judith Graham, Kaiser Health News
Posted April 24, 2012, at 8:41 a.m.
Posted April 24, 2012, at 8:41 a.m.
Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new surveyfrom the John A. Hartford Foundation.
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