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Doctors at Your Service: An Appraisal of Direct Patient Contracting Practices

…emphasis on preventive care would deliver more gratifying outcomes for both patients and physicians. Equally enticing are the improved work-life balance and potentially higher compensation compared to traditional insurance reimbursement. At the same time, if I and my peers shun traditional medical practices in large numbers, it could exacerbate the existing primary care workforce shortage and inequities in the system….

Georgetown Experts Help States Weigh Solutions to Protect Consumers from Unexpected Medical Bills

…testimony on the issue of balance billing as they weigh how best to tackle this issue. The Pennsylvania Insurance Department held a hearing to gather information about the prevalence and severity of balance billing in the state and to discuss how to deal with it. Led by Commissioner Miller, the Insurance Department Panel heard testimony from approximately 20 speakers, including…

No QHPs Comparable to CHIP, Says (Delayed) HHS Certification

…are generally more comprehensive for “child-specific” services (such as dental, vision, and habilitation services) and for children with special health care needs as compared to those offered by QHPs.” The table beginning on page 4 summarizes information on 1) actuarial value – or the percentage of costs paid by the QHP or CHIP – and 2) the combined out-of-pocket cost…

Filing Fee and External Appeals

…charge a fee for appealing. The federal process for external appeals that is available to states without their own process does not require a fee. As implementation of this rule continues, states with filing fees associated with their external appeals process should reconsider. Exercising a right to externally appeal should not come at any cost to a consumer.    …

Feds Propose Changes – and an Expanded Role – for Marketplace Navigators

The federal agency responsible for administering the Affordable Care Act’s health insurance marketplaces, the Centers for Medicare and Medicaid Services (CMS), has released new proposed rules to govern health insurance companies and the marketplaces beginning in 2017. The rules cover a wide range of subjects, from the regulation of premium rates, to benefit design and provider networks. However, because we…

Paying for Miracles – The High Cost of Cures

…it became available in 2013, he was prescribed Sovaldi, the infamously costly medication. After the 12-week therapy, the disease that had defined and repressed his life vanished. He was cured. Yet the ability to cure comes with a cost. For Sovaldi, it’s $84,000. As more “miracle” drugs become available, the issue of who pays for such cures – and how…

State Efforts to Reduce Consumers’ Cost-Sharing for Prescription Drugs

…same time, insurance companies are shifting drug costs onto consumers, largely through changes in their drug formulary designs. Although many insurers have long had tiered formularies that offer low cost-sharing for generic drugs and higher cost-sharing for brand-name drugs, the practice has expanded in recent years, with insurers adding an upper tier to their formularies. These so-called specialty tiers have…

Shop to Renew During Open Enrollment

…silver-level plan. Savings. A recent report about shoppers and switchers from the 2015 open enrollment season shows that people that switched health plans in the same metal tier saved an average of $33 per month or nearly $400 for the year compared to what they would have paid if they stayed in the same plan. People that switched insurance companies…

Health Care Cost Considerations in Medical Education

…record database with over 5 million anonymous entries, students can examine and compare both treatments prescribed for each patient and their associated payments. Analyzing the dataset has revealed that the cost of C-sections and hip replacements contrast widely across the state of New York. Many factors including geographic location, the number of inpatient nights and the rate of preventable complications…

Open Enrollment Begins, Kinks in the Cost Calculator Tool on Healthcare.gov and Other OE News

…users will have to opt-in to use the tool. Users can also leave comments about their experience with the tool directly on the website. While healthcare.gov has access to over 90 percent of insurer data about providers, some provider data is still missing or inaccurate. Under this scenario, the provider tool will inform the user that “no data from insurance…

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.