Insurers, Patients Wrestle With Payment, Care Issues And Strategies
News outlets report on a variety of issues reflecting the insurance hassles patients sometimes face and the efforts by insurance companies to find profits in better-coordinated care.
Health News Florida: Experts Split On Insurance Hassles
When Jack Gilliam walked into the emergency room at Florida Hospital, he had a tight chest, neck and jawline and a warning from his doctors that he would probably need a heart catheterization, an invasive chest X-ray that tests blood flow. ... His insurer, United Healthcare, wouldn't pay for the $25,000 procedure unless he failed a chemical stress-test. ... Some doctors and health advocates say such scenarios are increasingly common as insurance companies implement new tactics to limit payment and care. Yet opinions and data are so mixed, getting a clear picture of what's happening is tough, if not impossible (Davis, 9/23).
Bloomberg/BusinessWeek: Insurance Companies Seek Profits In-Network
Insurers have spent more than $5 billion in recent years buying up doctor practices and clinics to create networks that might help them woo new customers. The companies are betting they can cut spending by keeping patients healthier with better-coordinated treatment and by ensuring that physicians across the country use the most effective approach for any given condition (Weschler, 9/22).
In related news, WBUR's CommonHealth blog draws similarities between the health care challenges faced by the United States and China.
WBUR's CommonHealth blog: China And The U.S. Face Similar Health Care Challenges
The two countries are expanding insurance coverage and each is worried about rising costs. On costs, where patients go for care makes a big difference in China as it does in the US. A key challenge is how to persuade patients they don’t need to go to a hospital, especially high end hospitals, for routine care (Bebinger, 9/25).