Month: January 2023

Mother-to-be Kathleen Founds made a routine doctor’s appointment to discuss the risks of antidepressants in pregnancy. After the visit, Founds, who relies on medication to quell the manic highs and despondent lows of bipolar disorder, learned the physician was out of network. She received a surprise bill for $650, launching her into a maze of claim forms and hours on the phone being routed from one office to the next to dispute the charges — insurance red tape that so … Continue reading “California Author Uses Dark Humor — And a Bear — To Highlight Flawed Health System”

California’s decision last month to cancel the results of a long-planned bidding competition among commercial health plans in its Medicaid program has some industry insiders and consumer advocates wondering whether the state can stand up to insurers and force improvements in care for millions of low-income beneficiaries. In a backroom agreement announced in the final days of 2022, Gov. Gavin Newsom’s administration, facing lawsuits, granted concessions that allowed major insurers to claw back business they would have lost had health … Continue reading “California’s Resolve Questioned After It Grants Medi-Cal Contract Concessions”

Today, KHN has released details of 90 previously secret government audits that reveal millions of dollars in overpayments to Medicare Advantage health plans for seniors. The audits, which cover billings from 2011 through 2013, are the most recent financial reviews available, even though enrollment in the health plans has exploded over the past decade to over 30 million and is expected to grow further. KHN has published the audit spreadsheets as the industry girds for a final regulation that could … Continue reading “Did Your Health Plan Rip Off Medicare?”