Yale-New Haven Hospital in Connecticut has agreed to pay $3.78 million to settle allegations that it overcharged Medicare for chemotherapy and blood transfusions. The settlement involved billing improprieties the hospital disclosed to federal investigator. According to the federal investigators, claims for services by the hospital's oncology infusion service were not adequately documented.
Going out of network for medical care is sometimes unavoidable for patients, but it can be a lot more expensive than dealing with doctors and hospitals in their health plan's network of providers. In 2007, three out of four workers were covered by health plans that provide both network and out-of-network options, according to a Kaiser Family Foundation survey.
Less than two years after UNC Health Care pledged to ease billing practices some found threatening, the system is again ramping up efforts to collect money from its patients. All hospital and physician clinics affiliated with the state-supported health system have begun asking patients to pay their share of the bill upfront. That includes $15 and $20 co-payments to see a doctor, as well as big-ticket services such as MRI scans, which under many insurance plans can run into the hundreds of dollars. UNC Health Care leaders say asking for such payments doesn't conflict with their commitment to be more friendly to patients.
Highmark Inc.'s recent decision to charge Medicare customers $25 co-payments on certain injected drugs--chemotherapy agents, immunosuppressants, anemia drugs--is becoming a financial burden to a number of customers who require such injections several times a week. A spokesman for Highmark said the new charges were needed to defray the rising cost of the injected drugs, which can run from $100 to $30,000 per dose, depending on the drug.
The Florida Senate has approved a bill that would eliminate special automatic cost-of-living increases in payments to hospitals, nursing homes, county health departments and intermediate care facilities for the developmentally disabled. Critics say the move may discourage some institutions from taking Medicaid patients as well as diminish care for those who are served by it.
The Georgia Senate has approved the Georgia Health Marketplace Act that would make less-expensive health plans available to people without coverage. The Georgia Act would create a Web site where consumers and business owners could shop for health insurance plans and compare deductibles, co-payment requirements, benefits and premiums. If consumers find a plan that fits their needs, they can purchase the policy with pre-tax dollars. The measure also would allow state residents to set up health savings accounts to pay for their medical expenses.