Mass. Consumers Struggle To Get Info On The Varying Prices For Health Care Services
Massachusetts' consumers say it isn't easy to find out what a procedure will cost ahead of time, even though the state has a law requiring that information be available. face challenges in determining medical services pricing, Kaiser Health News also reports on how some business leaders and lawmakers want to reexamine the out-of-pocket spending limits for families set by the health law.
Kaiser Health News:
How Much Is That Eye Exam? Study Probes The Elusive Quest For Health Care Prices
Let’s say you’re having trouble reading this. The words are a little fuzzy. You might need glasses or a new prescription. So you call to make an appointment for an eye exam and ask how much the visit will cost. You’re going to pay for the appointment because your insurance plan has a deductible that you haven’t met. Seems like a simple question, but be prepared: There’s a good chance you won’t get a simple answer. (Bebinger, 8/14)
Kaiser Health News:
Business Leaders, GOP Question HHS’ Change On Families’ Out-Of-Pocket Limits
One of the health law’s key protections was to cap how much consumers can be required to pay out of pocket for medical care each year. Now some employers say the administration is unfairly changing the rules that determine how those limits are applied, and they’re worried it will cost them more. (Andrews, 8/14)
Meanwhile, other news outlets look into in- and out-of-network billing transparency as well as the practice of "balance billing" -
Surprise! When Your Hospital Is In-Network, But Your Doc Isn't
Patients who have insurance and go to in-network hospitals may still wind up with unexpected bills. It happens when doctors are out of network and don't take a patient's insurance. In those instances, patients may owe the balance between what the provider charges and what the insurance plan is willing to pay. It's often referred to as surprise billing, a form of balance billing, and it's a situation that Michael Trost of Dingmans Ferry, Pa. encountered this past spring. An unanticipated trip to an in-network hospital and the subsequent surgery from an out-of-network doctor resulted in a surprise bill of $32,325. (Gordon, 8/13)
Advocates, CMS Warn Providers About Continuing Medicare 'Balance Billing'
CMS recently issued a report on the practice of "balance billing" -- under which health care providers charge qualified Medicare beneficiaries (QMBs) a share of the cost of care, such as copayments. That practice is illegal, CMS officials said. Seniors and people with disabilities are considered QMBs if their incomes are less than federal poverty level and they have limited assets. States are required through Medicaid to cover some of the QMBs' Medicare Part B premiums and the per-service cost-sharing, such as copayments. (Gorn, 8/13)