Category: Health Industry

When Copay Assistance Backfires on Patients

Drugmakers offer copay assistance programs to patients, but insurers are tapping into those funds, not counting the amounts toward patient deductibles. That leads to unexpected charges. But the practice is under growing scrutiny.

How Your In-Network Health Coverage Can Vanish Before You Know It

One of the most unfair aspects of medical insurance is this: Patients can change insurance only during end-of-year enrollment periods or at the time of “qualifying life events.” But insurers’ contracts with doctors, hospitals, and pharmaceutical companies can change abruptly at any time.

KFF Health News’ ‘What the Health?’: Maybe It’s a Health Care Election After All

Health care wasn’t expected to be a major theme for this year’s elections. But as President Joe Biden and former President Donald Trump secured their respective party nominations this week, the future of both Medicare and the Affordable Care Act appears to be up for debate. Meanwhile, the cyberattack of the UnitedHealth Group subsidiary Change Healthcare continues to do damage to the companies’ finances with no quick end in sight. Margot Sanger-Katz of The New York Times, Anna Edney of Bloomberg News, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News’ Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Kelly Henning of Bloomberg Philanthropies about a new, four-part documentary series on the history of public health, “The Invisible Shield.” Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too.

Exclusive: Social Security Chief Vows to Fix ‘Cruel-Hearted’ Overpayment Clawbacks

New Social Security Commissioner Martin O’Malley is promising to change how the agency reclaims billions of dollars it wrongly pays to beneficiaries, saying the existing process is “cruel-hearted and mindless.”

Concerns Grow Over Quality of Care as Investor Groups Buy Not-for-Profit Nursing Homes

For-profit groups own more than 70% of U.S. nursing homes. Industry leaders and researchers wonder whether corporations and investors can succeed where not-for-profit organizations have struggled. Or, will quality of care suffer in the name of making money?

A New $16,000 Postpartum Depression Drug Is Here. How Will Insurers Handle It?

A pill form of an effective drug for postpartum depression hit the market in December, but most insurers do not yet have a policy on when or whether they will pay for it. The hurdles to obtain its predecessor medication have advocates worried.

Biden Team, UnitedHealth Struggle to Restore Paralyzed Billing Systems After Cyberattack

The cyberattack on a unit of UnitedHealth Group’s Optum division is the worst on the health care industry in U.S. history, hospitals say. Providers struggling to get paid for care say the response by the insurer and the Biden administration has been inadequate.

VIP Health System for Top US Officials Risked Jeopardizing Care for Soldiers

The historically troubled White House Medical Unit is just one part of a government health system that gives VIP care to top officials, military officers, military retirees, and families. Pentagon investigators say some were prioritized over rank-and-file soldiers.

Whistleblower Accuses Aledade, Largest US Independent Primary Care Network, of Medicare Fraud

A recently unsealed lawsuit alleges Aledade Inc. developed billing software that boosted revenues by making patients appear sicker than they were.

Statistical Models vs. Front-Line Workers: Who Knows Best How to Spend Opioid Settlement Cash?

A mathematical model designed to direct spending of opioid settlement funds is at the center of a debate over whether to invest in technology to guide long-term decisions or focus on the immediate needs of people in addiction.