Category Archives: insurance

Find out why your health insurer denied your claim

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What’s a Claim File? Why Should I Request One?

A claim file is a collection of the information your insurer used to decide whether it would pay for your medical treatment or services. Most people in the U.S. facing a denial have the right to request their claim file from their insurer. It can include internal correspondence, recordings of phone calls, case notes, medical records and other relevant information.

Information in your claim file can be critical when appealing denials. Some patients told us they received case notes showing that their insurer’s decision was the outcome of cost-cutting programs. Others have gotten denials overturned by obtaining recordings of phone calls where company staff introduced errors into their cases.

https://projects.propublica.org/claimfile/

It Pays to Shop Around for Health Care

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There is a wide variation in health care costs, whether it’s imaging, prescription costs or even routine care.

For example, an MRI scan of the lumbar spine (low back area) costs around $277 at our facility versus $767 at Bayhealth (that’s almost 3 times more!)

Take a look at Delaware’s ‘CostAware’ for more pricing information. You’ll be surprised at the differences (not unusual for hospital facilities to be 3 to 6 times more than outpatient centers!)

https://costaware.dhss.delaware.gov: It Pays to Shop Around for Health Care
https://dhin-hccd-portal.medicasoft.us/public/view?v=CostAwareImagingbyProviderOrganization_17283331733160%2FImagingbyProviderOrganization&embed=true

Why would they do this 🤬

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This program should be expanded and not eliminated!

“Senate and House Republicans told Peter Sullivan of Axios that if they regain control of the government, they will work to get rid of the provision in the Inflation Reduction Act that permits the government to negotiate with pharmaceutical companies over drug prices.

Negotiations on the first ten drugs, completed in August, will lower the cost of those drugs enough to save taxpayers $6 billion a year, while those enrolled in Medicare will save $1.5 billion in out-of-pocket expenses.”

https://heathercoxrichardson.substack.com/p/september-18-2024

Important: Compare the Candidates on Health Care Policy

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The general election campaign has commenced, spotlighting President Biden and former President Trump as the presumptive nominees for their respective parties and the currently viable contenders for the presidency. While this is not an election like in the past where health care reform is a central issue being debated, health care is an important issue for voters and Biden and Trump have sharply divergent records and positions. This side-by-side analysis serves as a quick resource for understanding each candidate’s record as president, positions, public statements, and proposed policies. It will be continuously updated as new information and policy details emerge throughout the campaign.

https://www.kff.org/compare-2024-candidates-health-care-policy/

The US Healthcare System: How Did We Get Here and What Will It Take To Get Out’

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Highly Recommended: Excellent must-read slide deck from Professor Richard Wender

the-us-healthcare-system-wender-1Download

Why Medicare Advantage is not an Advantage

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Prior authorization issues and the quest for profits are major issues with many Medicare Advantage plans, as outlined in this article.

“Traditional Medicare rarely requires so-called prior authorization for services. But virtually all Medicare Advantage plans invoke it before agreeing to cover certain services, particularly those carrying high price tags, such as chemotherapy, hospital stays, nursing home care and home health.

“Most people come across this at some point if they stay in a Medicare Advantage plan,” said Jeannie Fuglesten Biniek, associate director of the program on Medicare policy at KFF, the nonprofit health policy research organization. After years of steep growth, more than half of Medicare beneficiaries are now enrolled in Advantage plans, which are administered by private insurance companies.”