Health insurers process more than five billion payment claims annually, federal figures show. About 850 million are denied, according to health-policy nonprofit KFF. Less than 1% of patients appeal. Few people realize how worthwhile those labors can be: Up to three-quarters of claim appeals are granted, studies show. Patients who fight denied claims must marshal evidence from medical studies, navigate dense paperwork and spend hours on the phone during what is often one of the most difficult times of their lives.
Republican leaders on Tuesday downplayed the possibility of cuts to Medicaid benefits as they seek a reconciliation bill with up to $2 trillion in savings. Speaker Mike Johnson (R-La.) and Majority Leader Steve Scalise (R-La.) sought to reassure the public — and potential jittery members of their own caucus — that the Medicaid changes under discussion include work requirements and fraud reduction, not drastic cuts like lowering the federal match for Medicaid expansion states or instituting a per capita cap.
A bill that makes it harder for insurance companies to deny coverage for mental healthcare passed in the Colorado House on Monday. Under federal law, insurers are required to treat physical and mental health care in the same way, but state Sen. Judy Amabile, the sponsor of the bill, says that many insurers are refusing to cover mental health care based on what their definition of what's medically necessary. The Democrat from Boulder County's bill would establish a standard definition of medical necessity based on criteria developed by mental health professionals.
A free cruise turned into a financial nightmare for Mike Cameron, a Minnesota truck driver of 25 years, and his girlfriend, Tamra. The couple won a free cruise with Norwegian Cruise Line and were excited to celebrate Tamra's recent lung cancer recovery. The pair set sail for the week-long trip in early January, but shortly into the week, Cameron got sick. He said he went to the ship's medical center and was diagnosed with the flu. ... But when it came time to pay the bill, Cameron was shocked to learn that the total cost of his care was more than $47,000.
Trump said last month that he would not make cuts to the country's public health insurance program for low-income and disabled Americans. But the White House and Republicans in Congress are considering a menu of options that could add up to $2.3 trillion in potential cuts to Medicaid over the next decade.
States are absorbing substantial increases in healthcare costs for the poor, as they realize that the people remaining on Medicaid rolls after the COVID-19 pandemic are sicker than anticipated — and costlier to care for. In Pennsylvania, state budget makers recently unveiled the scale of that miscalculation, with Democratic Gov. Josh Shapiro proposing an increase of $2.5 billion in Medicaid spending in the next fiscal year. That amounts to a roughly 5% increase in overall state spending, mostly driven by the cost to care for unexpectedly sick people remaining on the state's Medicaid rolls.