Pharmacy benefit managers have curtailed in-person audits of pharmacy claims during the pandemic, switching to virtual audits done by computer. That has markedly increased the number of claims they can review — and the chances for payment denials — squeezing pharmacies and bringing in more cash for the benefit companies.
Health insurers could do more to encourage vaccination, including letting the unvaccinated foot their bills.
The Biden administration is weighing how to treat urgent care clinics as part of broad regulations banning surprise, out-of-network medical bills. At the heart of the matter: What counts as an emergency?
A bicyclist from California competed in a Pennsylvania race that could have landed him in this month’s Tokyo Olympics. Instead, a crash on the velodrome track landed him in two hospitals where his out-of-state, out-of-network surgeries garnered huge bills.
U.S. Rep. Sharice Davids (D-Kansas) introduced a bill to do away with a health insurance rule that dictates which parent’s plan becomes a new baby’s primary insurer. This could save some parents from unexpected, sometimes massive medical bills. Davids took up the issue after a KHN/NPR Bill of the Month story on one family’s unexpected $207,455 NICU bill.
Patients seem to like remote visits, and health care providers now depend on them. But outages, freezing and other glitches cost time and money, and compromise quality of care.
The makers of Aduhelm, a drug approved last month despite concerns raised by experts about its effectiveness, have launched a website and ads designed to urge people who are worried about their memory to ask doctors about testing. But some health advocates say it is misleading because some memory loss with aging is normal.
The landmark federal health law required most commercial health plans to cover a comprehensive list of birth control methods approved by the Food and Drug Administration free of charge to female patients. But health plans don’t have to cover every option, and newer methods are not included in the federal list of covered services.
A year and a half after Sutter Health agreed to a tentative settlement in a closely watched antitrust case, the San Francisco judge presiding over the case indicated she would sign off on the terms, pending agreement on another contentious issue: attorney fees.
A year and a half after Sutter Health agreed to a tentative settlement in a closely watched antitrust case, the San Francisco judge presiding over the case indicated she would sign off on the terms, pending agreement on another contentious issue: attorney fees.
