Managed-care plans, which reap billions in taxpayer dollars to coordinate care for low-income Americans on Medicaid, outsource crucial treatment decisions to subcontractors that aren’t directly accountable to the government. In California, health officials say one firm improperly withheld or delayed care for hundreds of people.
The money was paid on behalf of more than 400,000 people who may have been ineligible for the public program, a state audit found. One had been dead for four years before payments stopped.
Insurance companies profit from government contracts but are subject to little oversight of how they spend the money or care for patients. The expansion of Medicaid under the Affordable Care Act has only exacerbated the problem.
Amid the buzz over apps and electronic medical records rescuing modern medicine, California’s Medicaid program still clings to 1970s-era technology. A reboot may cost half a billion dollars.
A Health Affairs study quantifies the financial effects of such mergers on consumers and their insurers. The hospital industry and doctor practices say the consolidation leads to better coordination of care.
El hospital St. David’s Medical Center, en Austin, Texas, bajó una cuenta médica drásticamente. ¿Por qué fue tan alta en principio? ¿Qué pasa con las cuentas sorpresa?
“I don’t feel any consumer should have to go through this,” says Drew Calver, who faced a life-changing surprise bill from an Austin hospital after a heart attack last year. After attention as a “Bill of the Month” patient, he paid the hospital $332. But he worries about other patients with surprise bills.
Un maestro de Austin, Texas, quien sufrió un ataque cardíaco, tuvo que vivir una odisea cuando recibió una cuenta astronómica.
A Texas teacher, 44, faces a “balance bill” of almost twice his annual salary for a heart attack he never expected to have.
The state’s third-largest insurer faces anger from customers in the individual market who unexpectedly lost their insurance despite paying premiums faithfully. In its recently filed lawsuit, the company blamed a contractor for “egregious” billing problems.