Medicaid Insurers’ Contracts on the Line in Tight Governor’s Race
The Democratic candidate for governor says he would make Iowa the second state to drop private Medicaid management companies, which he calls “a disaster.”
Insurers
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Trump’s Personnel Agency Says It Will Remove Some Identifying Info as It Sweeps Up Medical Records
The Office of Personnel Management said it will “pseudonymize” medical records it collects on more than 8 million people — federal workers and retirees, and their family members. Democrats and employee unions say the agency’s move is an overreach.
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She Struggled To Get a Lifesaving Drug Even After Insurers Vowed To Help
Margaret Hvatum ended up in the hospital after her insurer denied coverage of a medicine she relies on to boost her immune system. Hvatum got entangled in the preapproval process, which the insurance industry has vowed to improve.
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Long-Awaited Rule Aims To Boost ACA Choices While Embracing Higher Deductibles
The Trump administration finalized a rule that embraces new types of Obamacare coverage, including 30% higher out-of-pocket costs for some plans, and a more novel approach that allows insurers to offer coverage without set networks of doctors and hospitals.
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Millions of Kids Could Lose Insurance as GOP Healthcare Cuts Start To Bite
Big cuts to healthcare programs in the 2025 GOP budget law are creating an affordability crunch for many Americans: Higher health insurance premiums. Confusion about who Medicaid will cover under the new rules. 51Ƶ Health News chief Washington correspondent Julie Rovner explains how the changes could leave nearly 2 million children uninsured.
By Julie Rovner -
Baffling. Frustrating. Frightening. What It’s Like To Be Sued Over Medical Debt.
Patients’ experiences encapsulate breakdowns in a healthcare system that traps patients in debt. The industry’s key players blame one another.
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Even Patients Are Shocked by the Prices Their Insurers Will Pay — And It Costs All of Us
Health care prices are on the rise, and patients are flummoxed that even insurance companies aren’t doing more to control costs.
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They Need a Ventilator To Stay Alive. Getting One Can Be a Nightmare.
Few nursing homes are set up to care for people needing help breathing with a ventilator because of ALS or other infirmities. Insurers often resist paying for ventilators at home, and innovative programs are now endangered by Medicaid cuts.
By Jordan Rau This Health Economist Wants Your Medical Bills
Season 14, Episode 3A longtime health economist sets her sights on lowering Americans’ insurance premiums.
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So Your Insurance Dropped Your Doctor. Now What?
Patients sometimes find themselves scrambling for affordable care when a contract dispute causes a hospital — and most of the doctors and other clinicians who work there — to be dropped from an insurance network. Here are six things to know if that happens to you.
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As Insurers Struggle With GLP-1 Drug Costs, Some Seek To Wean Patients Off
Conventional wisdom says GLP-1 drugs must be taken indefinitely to maintain weight loss. But a growing number of researchers, payers, and providers are challenging that consensus and exploring whether — and how — to taper patients off expensive GLP-1 drugs.
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When Hospitals and Insurers Fight, Patients Get Caught in the Middle
About 90,000 people spent months in limbo as central Missouri’s major, and often only, provider fought over insurance contracts. Patients getting caught in the crossfire of disputes has become a familiar complication, as about 8% of hospitals have left an insurer network since 2021. Trump administration policies could accelerate the trend.
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Insurers and Customers Brace for Double Whammy to Obamacare Premiums
Consumers face both rising premiums and falling subsidies next year in Obamacare plans, with insurers seeking increases to cover not only rising costs but also some policy changes advanced by President Donald Trump and the GOP.
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5 Takeaways From Health Insurers’ New Pledge To Improve Prior Authorization
Dozens of health insurance companies pledged on Monday to improve prior authorization, a process often used to deny care. The announcement comes months after the killing of UnitedHealthcare executive Brian Thompson, whose death in December sparked widespread criticism about insurance denials.
By Lauren Sausser and Phil Galewitz -
Their Physical Therapy Coverage Ran Out Before They Could Walk Again
Health plans limit physical or occupational therapy sessions to as few as 20 a year, no matter the patient’s infirmities. The limits persist despite federal rules banning insurers from setting annual dollar limits on the care they will provide.
By Jordan Rau -
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The Medicare Advantage Influence Machine
New court filings and lobbying reports reveal an industry drive to tamp down critics — and retain billions of dollars in overcharges.
By Fred Schulte and Holly K. Hacker -
Perspective
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.
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The Colonoscopies Were Free. But the ‘Surgical Trays’ Came With $600 Price Tags.
Health providers may bill however they choose — including in ways that could leave patients with unexpected bills for “free” care. Routine preventive care saddled an Illinois couple with his-and-her bills for “surgical trays.”
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When a Quick Telehealth Visit Yields Multiple Surprises Beyond a Big Bill
For the patient, it was a quick and inexpensive virtual appointment. Why it cost 10 times what she expected became a mystery.
By Darius Tahir