A report from HHS' Office of the Inspector General estimates that Colorado paid insurers at least $7.3 million, consisting of approximately $3.8 million in federal funds, for services for deceased Colorado residents.
Much of the dysfunction in healthcare stems from misaligned incentives and a lack of transparency. Insurers, in their effort to control costs, have prioritized short-term denials over long-term value and positive health outcomes, undermining their own credibility while failing to promote their own customers’ well-being.
Evers proposed to establish a government office that would be responsible for helping Wisconsinites appeal claims denied by health insurance companies.
If a certain company denies too many claims, Evers proposes to implement a new process to audit health insurance companies and make sure they are providing the best services to residents in need of care.
Falling reimbursement is just one of the challenges medical practices face today. Absent reform, the market for physician services could collapse—and consolidate power in the hands of a few huge hospitals, health systems, and vertically integrated insurers like UnitedHealth’s Optum. Such consolidation means that patients would have fewer choices in where they can seek care—and would likely pay higher prices.
The relationship between Connecticut hospitals and the Connecticut Medicaid program can sometimes sound like a bad marriage — “Can’t live with 'em but can’t live without 'em either!” The rhetoric can be heated at times, with alleged Medicaid underpayment being blamed for a myriad of problems in the health care system.