Pharmacy benefit managers have curtailed in-person audits of pharmacy claims during the pandemic, switching to virtual audits done by computer. That has markedly increased the number of claims they can review — and the chances for payment denials — squeezing pharmacies and bringing in more cash for the benefit companies.
A Trump administration rule mandating that hospitals disclose true prices on their websites took effect this year. But compliance is spotty and even when the data is public, it’s hard to find and understand.
In his campaign, President Joe Biden promised to undo policies, particularly health policies, implemented by former President Donald Trump. Yet, despite immense executive power, reversing four years of action takes time and resources.
Under a rule that kicked in Jan. 1, hospitals are required to make public the prices they negotiate with insurers. That’s a lot more information than was previously required, which was only the posting of “chargemasters” — the hospital-generated list prices that few consumers or health plans actually pay.
A provision the Trump administration tucked into its final rule on health plan price transparency requires telling consumers what they will pay out-of-pocket for drugs and showing them what the plan paid.
A routine doctor’s visit for a sore throat brought more than $28,000 in charges for one New York City woman in our latest “Bill of the Month” installment.
In our ongoing, crowdsourced investigation with NPR and CBS, we’ve armed future health system pilgrims with the tools they need to avoid exorbitant medical bills and fight back against unfair charges. Here’s a look back at 2019’s stories.
Consumers are admonished to be “smart shoppers,” but that’s difficult if health care prices are clear as mud. When Sarah Macsalka’s son needed stitches, she did her best to avoid the ER and still ended up with a $3,000 bill.
Health care is still a top issue in the Democratic primary debate for president, but the candidates’ complicated plans may be doing more to confuse than to educate voters. Margot Sanger-Katz of The New York Times, Caitlin Owens of Axios and Julie Appleby of Kaiser Health News join KHN’s Julie Rovner to discuss this and more health news. Also, for extra credit, the panelists recommend their favorite health policy stories of the week.
The final directive drew swift responses from the hospital and insurance industries. The Trump administration also released a proposed rule that would require health insurers to spell out for all services beforehand just how much patients may owe for their out-of-pocket costs.