At the beginning of the coronavirus pandemic, insurers announced that they would cover all of the costs for COVID-19 treatment, but now, most insurers have reinstated co-pays and deductibles for COVID-19 patients, reports The Washington Post. Jamie Azar, who was hospitalized with COVID-19 in July, is facing thousands of dollars in co-pays, deductibles and out-of-network charges for her hospital and rehab stays for her treatment, with potentially thousands of dollars more in uncovered expenses as her recovery continues. The financial burden of COVID-19 is falling unevenly on patients across the country: health plan coverage varies widely across states, with only two states (Vermont and New Mexico) mandating complete insurer coverage of treatment. Azar—whose insurer reinstated patient cost-sharing on Jan. 31—now joins millions of other Americans with serious illnesses who face uncertain, confusing and expensive medical billing and insurance practices.
For years, Ely Bair dealt with migraine headaches, jaw pain and high blood pressure, until a dentist recommended surgery to realign his jaw to get to the root of his health problems, reports Kaiser Health News. Bair had his first of two surgeries in 2018 and his out-of-pocket costs were $3,000. However, before having his second surgery, he switched jobs but retained the same brand of healt insurance. His second surgery at the same hospital went well, but he was billed for $27,119. Even though he retained the same insurance company, his new plan had a $5,000 lifetime limit on coverage for his orthognathic surgery, which is not considered an essential health benefit in Washington. After working with a patient advocare, appealing to his insurer three times and filing a complaint with the state attorney general's office, Bair's bill was reduced to $7,164.
A recent poll by Consumers for Quality Care reveals that Montanans are concerned about the rising cost of healthcare and broadly support Medicaid expansion, reports the Missoula Current. The research shows that 63 percent of respondents agreed that Medicaid should be permanently expanded, with over half of both Republicans and Independents agreeing. In addition, more than 1 in 4 respondents have overdue or unpaid medical bills and worry about their ability to afford medical care. Furthermore, 68 percent of respondents have struggled to pay a medical bill at some point even while they had health insurance.
A new law in Illinois will advance health equity by lowering costs and improving access to care for low-income and uninsured residents, reports My Journal Courier. SB 1840 amends both the Illinois Community Benefits Act and the Hospital Uninsured Patient Discount Act to decrease the maximum amount collected by uninsured patients for services rendered by a hospital from 25 percent to 15 percent of a person’s income and lowering the cost threshold for all medically necessary healthcare services that make uninsured patients eligible for discounts from $300 to $150. Among numerous other stipulations, the legislation also requires nonprofit hospitals’ community benefits plans to describe activities the hospital is undertaking to address health equity, reduce health disparities and improve community health.
In response to increasing health disparities, which cost Maryland more than $1 billion per year in direct medical costs, the Maryland Health Equity Act is allocating $60 million to address health inequities across the state, reports State of Reform. The newly formed Health Equity Resource Community (HERC) Advisory Committee, consisting of state officials and health policy experts from across the state, will decide how best to use these funds. The committee will be meeting throughout August and will begin accepting grant applications for funds as early as October.
A report released last week by the Colorado Department of Health Care Policy and Financing (HCPF) found that Colorado hospitals have the highest profit margins in the country, leading to increased prices for payers and patients, reports AboutHealthTransparency.org. The department evaluated the Medicare Cost Report Data for Colorado’s hospitals from 2009 to 2018; however, it only included hospitals with 25 or more beds, excluding most rural hospitals. HCPF estimates that Colorado hospitals’ operating costs were $1.3 billion above the national median.
A recent survey of New Jersey voters by ALG Research and Bully Pulpit Interactive shows that New Jersey residents remain concerned about the rising cost of healthcare, particularly in the wake of the COVID pandemic, reports New Jersey Business Magazine. The findings reveal that 71 percent of respondents say that their healthcare costs are rising faster than income levels, and this number jumps to 80 percent among those who are struggling financially. Furthermore, nearly a quarter of all respondents have unpaid or overdue medical bills, though disparities in this data point exist – 35 percent of respondents of color say they currently have unpaid or overdue medical bills, while 43 percent of those struggling financially stated the same.
This summer, Connecticut launched a new Covered CT Program, which aims to reduce the number of residents who are uninsured by helping them afford insurance, reports Fox 61 News. The program is going to provide no-cost health coverage to up to 40,000 people in Connecticut when it’s fully implemented in 2022. In this new program, the state will pay the consumer portion of the monthly premium directly to insurance carriers and will also pay for the cost-sharing amounts that consumers normally would have to pay with a health insurance plan. Beginning in 2022, this program will also include coverage for visiting the dentist and non-emergency medical transportation to see providers.
Connecticut recently passed a bill that expands the types of entities to which billing and collection restrictions apply, placing further limitations on collection efforts by such entities and making several changes to Connecticut’s exiting laws concerning facility fees, reports the National Law Review. Among other changes, the new law prohibits hospitals, entities that are owned by or affiliated with a hospital and collection agents that receive referrals from hospitals or such other “affiliated with” or “owned by” entities from: reporting a patient to a credit rating agency for a period of one year beginning on the date that the patient first receives a bill for healthcare provided; initiating an action to foreclose a lien on a patient’s primary residence if the lien was filed to secure payment for healthcare providers; or applying to a court for an execution against a patient’s wages or otherwise seeking to garnish a patient’s wages, to collect payment for healthcare services, if such patient is eligible for the hospital bed fund.
An investigation by NC Public Radio and WRAL-TV found broad price differences for the same services, depending on insurance plan and hospital in the Triangle area. Following a Trump Administration rule that went into effect in January 2021, hospitals must now post detailed price and negotiated rate information online for 300 procedures. Across the Triangle's largest hospitals, the negotiated rate for a colonoscopy runs from $504 to $5,397. The investigation revealed that while hospitals in the Triangle are following the rules better than those in other parts of the nation, big information gaps still create blind spots for consumers who want to effectively shop for healthcare services. A separate report by Patient Advocate Rights randomly selected ten North Carolina hospitals and just one provided complete transparency as the mandate instructs. However, advocates note that even if every hospital complied fully, consumers would still need to understand the information provided to avoid surprise medical bills.