Congress has no solution for out-of-network ambulance rides; teenagers going to an emergency department in a mental health crisis don't receive necessary follow-up care; Medicaid explores nutritional benefits of food as medicine spending in some states.
Insured Americans Are Getting Hit With Out-of-network Ambulance Bills
Most insured individuals who take an emergency ambulance ride will not be covered for that expense, according to STAT. In 2022, ambulance rides, which can cost hundreds of dollars, were excluded from the federal law that banned most types of surprise medical bills. Despite nearly 85% of all emergency ambulance rides being out-of-network, no progress has been made by Congress to resolve the issue.
Many Teenagers Not Receiving Care After Going to the ED for Mental Health Crisis
Receiving follow-up care for mental health crisis has been known to reduce suicide risk, yet nearly half of all adolescents who go to the emergency department (ED) for a mental health crisis do not get follow-up care. A study published in Pediatrics, reported by CNN, said that 31.2% saw a mental health provider within 7 days of the ED visit and 55.8% had one within 30 days. The lack of care was most prevalent among Black children in comparison with White children.
US Allowing More Medicaid Funds to Go Towards Healthy Nutrition in Some States
The Biden administration has begun approving state requests to allow Medicaid funds to pay for healthy meals and nutritional counseling, according to The Wall Street Journal. Growing research has supported better nutrition as a way to improve health and reduce medical costs, especially among low-income individuals. Allowing Medicaid to include the idea of food as medicine aims to improve health for low-income individuals, by emphasizing the importance of eating nutritious, and oftentimes pricey, foods.
Neonatology Pricing and Network Participation Under State Balance Billing Regulations
October 2nd 2025This national study of neonatology services found no clear evidence that state surprise billing regulations influenced prices or provider network participation for the commercially insured.
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AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
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October 2nd 2025To mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The October issue features a conversation with Ge Bai, PhD, CPA, professor of accounting at Johns Hopkins Carey Business School and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
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Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
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