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Health Insurers Highlight Excessive Out-of-Network Charges
Some California physicians providing out-of-network medical care bill patients at rates far beyond what Medicare allows, a new report from a health insurance trade group shows.The national survey released Friday by America's Health Insurance Plans is part of the industry's effort to show that some medical providers are overcharging consumers and unnecessarily raising healthcare costs. Some critics fault insurers for all too often paying these excessive charges for out-of-network care and then passing along those increased costs in the form of higher premiums for employers and consumers.
In California, the report shows, a pathologist billed $8,100 for a tissue exam in 2011, compared with the Medicare fee of $128.46. Another California doctor billed $30,000 for a gallbladder removal using a laparoscope while the Medicare rate was $778.16, according the industry group.
Read the full story: http://lat.ms/WZ25ZT
Source: Los Angeles Times
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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For Neuromuscular Disease Community, an Era of Opportunities and Threats
March 17th 2025Robert Califf, MD, former commissioner of the FDA, delivered a keynote address at the 2025 Muscular Dystrophy Association Clinical & Scientific Conference that highlighted the enormous opportunities for progress in neuromuscular disease care amid a changing policy environment.
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The Impact of Cost Sharing on High-Value Care
March 14th 2025Michael Chernew, PhD, professor of health care policy and director of the Healthcare Markets and Regulation Lab, Harvard Medical School, shares how cost-sharing policies shape access to critical health care services and influence value-based insurance design.
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Oz Confirmation Hearing Probes Vision for Medicaid but Coalesces Around Well-Being
March 14th 2025Mehmet Oz, MD, the nominee to lead CMS under the Trump administration, testified in a confirmation hearing before the Senate Finance Committee, where he found common ground on improving outcomes through healthier lifestyle choices but encountered repeated questions on potential Medicaid cuts.
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