Tag: health insurance

A Hospital Charged $722.50 to Push Medicine Through an IV. Twice.

Claire Lang-Ree was in a lab coat taking a college chemistry class remotely in the kitchen of her Colorado Springs, Colorado, home when a profound pain twisted into her lower abdomen. She called her mom, Jen Lang-Ree, a nurse practitioner who worried it was appendicitis and found a nearby hospital in the family’s health insurance network.

After a long wait in the emergency room of Penrose Hospital, Claire received morphine and an anti-nausea medication delivered through an IV. She also underwent a CT scan of the abdomen and a series of tests.

Hospital staffers ruled out appendicitis and surmised Claire was suffering from a ruptured ovarian cyst, which can be a harmless part of the menstrual cycle but can also be problematic and painful. After a few days — and a chemistry exam taken through gritted teeth — the pain went away.

Then the bill came.

Patient: Claire Lang-Ree, a 21-year-old Stanford University student who was living in Colorado for a few months while taking classes remotely. She’s insured by Anthem Blue Cross through her mom’s work as a pediatric nurse practitioner in Northern California.

Total Bill: $18,735.93, including two $722.50 fees for a nurse to “push” drugs into her IV, a process that takes seconds. Anthem’s negotiated charges were $6,999 for the total treatment. Anthem paid $5,578.30, and the Lang-Rees owed $1,270 to the hospital, plus additional bills for radiologists and other care. (Claire also anted up a $150 copay at the ER.)

Read the full article from Kaiser Health News.

Enrollment Period for Marketplace Coverage Starts

“In accordance with the Executive Order signed by President Biden, the Centers for Medicare & Medicaid Services (CMS) is announcing that the Special Enrollment Period (SEP) for the Health Insurance Marketplace® will officially be available to consumers in the 36 states that use the HealthCare.gov platform on Monday, February 15, and will continue through Saturday, May 15. At least 13 States plus the District of Columbia, which operate their own Marketplace platforms, have decided to offer a similar opportunity.

“President Biden was clear: we need to strengthen the Affordable Care Act and give more Americans access to health care, especially during this pandemic, which has further demonstrated the importance of having the right coverage. This Special Enrollment Period will give Americans who need affordable, quality health insurance an opportunity to get covered, and we encourage folks to head to HealthCare.gov starting on Monday to explore their options,” said HHS Acting Secretary Norris Cochran.”

Read the full announcement from HHS.

Hospital Prices Just Got a Lot More Transparent. What Does This Mean for You?

“Hospitals face the new year with new requirements to post price information they have long sought to obscure: the actual prices negotiated with insurers and the discounts they offer their cash-paying customers.

The move is part of a larger push by the Trump administration to use price transparency to curtail prices and create better-informed consumers. Yet there is disagreement on whether it will do so.

As of Jan. 1, facilities must publicly post on their websites prices for every service, drug and supply they provide. Next year, under a separate rule, health insurers must take similar steps. A related effort to force drugmakers to list their prices in advertisements was struck down by the courts.”

Read the full article from KFN.

Washington Healthplanfinder Sees Surge in Customers as Final 2021 Deadline Approaches

OLYMPIA, Wash. – People statewide flocked to Washington Healthplanfinder this week to beat the Dec. 15 deadline for health coverage that would start the first of the year. With that date now passed, Washingtonians still seeking 2021 health coverage have until Jan 15, 2021 to shop on Washington Healthplanfinder for coverage that begins February 1.

“We were glad to see the large number of enrollees come in and secure coverage that starts Jan. 1,” said Chief Executive Officer Pam MacEwan. “This year, in response to the public health emergency, we are providing additional time for those who didn’t enroll prior to Dec. 15 to sign up for 2021 coverage over the next month.”

As of Dec. 16, about 210,000 Washingtonians have signed up for 2021 coverage, including almost 30,000 new customers. Among new customers, 41% have selected a Cascade Care plan. Cascade Care plans cover more services prior to meeting a deductible, including primary care visits, mental health services, and generic drugs. Customers who need to renew their plan for 2021 can sign in to their Washington Healthplanfinder account using the WaPlanfinder Mobile App or on WAHealthplanfinder.org and easily update and renew their coverage. Additionally, some customers may find that they qualify for free or low-cost coverage.

Washington Healthplanfinder offers a wide range of resources to help people navigate their coverage options – including in-person enrollment centers, virtual video or phone assistance, and the WAPlanfinder Mobile App. Anyone requiring help signing up for coverage through Washington Healthplanfinder may contact the Customer Support Center at 1-855-923-4633; TTY: 855-627-9604. They may also contact an Exchange certified Navigator, Broker, or Enrollment center who can answer insurance questions and help with enrollment. Free help from local experts is accessible via the WAPlanfinder Mobile App or by visiting www.wahealthplanfinder.org.

During the 2021 open enrollment period, the Customer Support Center is open 7:30 a.m. – 8:00 p.m. Monday – Friday. Additionally, extended hours scheduled:

December
• Thursday, December 24, 7:30 a.m. – 3:00 p.m.
• Thursday, December 31, 7:30 a.m. – 3:00 p.m.

January
• Saturday, January 9, 10:00 a.m. – 2:30 p.m.
• Thursday, January 14, 7:30 a.m. – 11:59 p.m.
• Friday, January 15, 7:30 a.m. – 11: 59 p.m.

Reminders: Enrollment is offered year-round on Washington Healthplanfinder to individuals and families through Washington Apple Health (Medicaid).

About Washington Healthplanfinder
Washington Healthplanfinder is an online marketplace for individuals and families in Washington to compare and enroll in health insurance coverage and gain access to tax credits, reduced cost sharing and public programs such as Medicaid. The next qualified health and dental plans open enrollment period for Washington Healthplanfinder from Nov. 1, 2020 to Jan. 15, 2021.

After Kid’s Minor Bike Accident, Major Bill Sets Legal Wheels in Motion

Adam Woodrum was out for a bike ride with his wife and kids on July 19 when his then 9-year-old son, Robert, crashed.

“He cut himself pretty bad, and I could tell right away he needed stitches,” said Woodrum.

Because they were on bikes, he called the fire department in Carson City, Nevada.

“They were great,” said Woodrum. “They took him on a stretcher to the ER.”

Robert received stitches and anesthesia at Carson Tahoe Regional Medical Center. He’s since recovered nicely.

Then the denial letter came.

The Patient: Robert Woodrum, covered under his mother’s health insurance plan from the Nevada Public Employees’ Benefits Program

Total Bill: $18,933.44, billed by the hospital

Service Provider: Carson Tahoe Regional Medical Center, part of not-for-profit Carson Tahoe Health

Medical Service: Stitches and anesthesia during an emergency department visit

What Gives: The Aug. 4 explanation of benefits (EOB) document said the Woodrum’s claim had been rejected and their patient responsibility would be the entire sum of $18,933.44.

Read the rest of the article from KHN

People on Medicare Can Choose Among 33 Medicare Advantage Plans and 30 Medicare Prescription Drug Part D Plans, on Average, During the 2021 Medicare Open Enrollment Period

With Medicare open enrollment underway, KFF has released new analyses that examine beneficiaries’ Medicare Advantage and Part D drug plan options for 2021.

The average person on Medicare will be able to choose among 33 Medicare Advantage plans during the open enrollment period that runs through Dec. 7, finds Medicare Advantage 2021 Spotlight: First Look. It also finds that:

  • The average beneficiary can choose from plans offered by eight firms in 2021, although enrollment typically has been concentrated in plans operated by a handful of insurers.
  • Among the majority of Medicare Advantage plans that cover prescription drugs, 54 percent will charge no premium (although beneficiaries will have to pay the Medicare Part B premium), similar to 2020. Ninety-six percent of beneficiaries have access to a Medicare Advantage drug plan with no monthly premium in 2021.
  • Medicare Advantage plans may offer supplemental benefits not available in traditional Medicare. Most plans have historically offered fitness, dental, vision, and hearing. For 2021 the vast majority are also offering telehealth (98%).

Visit KFF for more information

Apple Health and Medicaid

Medicaid and Apple Health

Within Washington State, Medicaid is known as Apple Health.  Washington Apple Health applications are available year round. Visit the Health Plan Finder or call 1-855-923-4633 to enroll.

Eligibility for Apple Health for Children:

  • Free or low-cost coverage is available
  • Children of public employees with access to health insurance coverage under the PEBB or SEBB programs are not eligible for Apple Health for Kids with premiums
  • Low-cost coverage (Apple Health with premiums) is only available to children who are uninsured.
  • Income requirements for free coverage:

Eligibility for Apple Health for Adults:

  • Are age 19 through 64.
  • Have annual household income at or below the Medicaid standard (see income chart below).*
  • Are a U.S. citizen or meet Medicaid immigration requirements. (Washington residents from the Republic of Palau, the Republic of the Marshall Islands and the Federated States of Micronesia)
  • Are not entitled to Medicare.

How to Apply for Medicaid

  1. Review adult and/or child income eligibility requirements.
  2. Read the Eligibility Overview to determine if Apple Health is the best fit for you and your family.
  3. Create an account on Washington Health Plan Finder.
  4. Collect and enter information into the Washington Health Plan Finder application, WAPlanfinder Mobile App, downloadable paper form, or call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633.
  5. Review the five different Integrated Health Care Plans that are responsible for Medicaid in Washington, not all of which may be available in your location.
  6. If you need further help, contact a free Health Plan Navigator.

Navigating through Apple Health

Apple Health (Medicaid) Eligibility Factors – A video dealing with income verification issues
Washington Apple Health for Children in Foster Care – All foster children and youth in Washington are given health care through Coordinated Care
Washington Apple Health (Medicaid) Eligibility – A video on how Apple Health determines income
Washington Apple Health (Medicaid) Eligibility – A video addressing citizenship, immigration, and Medicaid

MCOs Available Through Apple Health

Amerigroup Washington
Community Health Plan of Washington
Coordinated Care of Washington
Molina Healthcare of Washington
UnitedHealthcare Community Plan