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KFF Health News published an investigation detailing a patient's frustrating experience in getting a medical bill resolved. Despite obtaining prior authorization and checking that her providers were in-network, the patient still received a bill for almost $140,000. The payer denied the claim as insufficiently detailed, and the patient estimates that she spent over twelve hours following up with the hospital to get an appropriate bill. Apart from the time spent resolving the issue, having such a large bill must exact a psychological toll.

KFF Health News published an investigation detailing a patient's frustrating experience in getting a medical bill resolved. Despite obtaining prior authorization and checking that her providers were in-network, the patient still received a bill for almost $140,000. The payer denied the claim as insufficiently detailed, and the patient estimates that she spent over twelve hours following up with the hospital to get an appropriate bill. Apart from the time spent resolving the issue, having such a large bill must exact a psychological toll.

In this case, the provider seems to be mostly at fault, in that the hospital eventually did generate a bill that was accepted by the insurer. It is a little unclear whether the insurer's required level of detail for the bill is reasonable, but the requirement for an itemized bill appears to be an industry response to providers who might have overcharged as a general practice. Caught in the crossfire are the patients who face large bills, are unsure what to do, and are concerned about facing collections or bad credit reports. Perhaps there should be a clear industry standard for medical claims, and more of the onus should be on providers to meet that standard (or they forgo payment), instead of relying on patients to move the process along.

Kaiser Health News published a piece on how many patients with temporomandibular joint disorders (TMJ) pay for treatment out-of-pocket. The article highlights challenges that these patients face, starting with disagreement from medical providers about the most effective treatment for the condition. Beyond that, medical insurers apparently deny some treatment as dental work, while dental insurance view treatment as medical. Even when medical insurance does cover some treatment, the article reports that they might cover the more expensive surgical options but not cover the work of some specialists in this area.

Kaiser Health News published a piece on how many patients with temporomandibular joint disorders (TMJ) pay for treatment out-of-pocket. The article highlights challenges that these patients face, starting with disagreement from medical providers about the most effective treatment for the condition. Beyond that, medical insurers apparently deny some treatment as dental work, while dental insurance view treatment as medical. Even when medical insurance does cover some treatment, the article reports that they might cover the more expensive surgical options but not cover the work of some specialists in this area.

The article reports that the specialty of "orofacial pain" was established in 2020, perhaps explaining the reluctance of some insurers to cover their work. Some who were interviewed point out the irony that insurers are willing to cover more expensive treatment options that are less effective, rather than less invasive options that are supposedly more effective. Understandably, insurers want to avoid paying for ineffective treatment, but as the field of medicine progresses, keeping up with new procedures is likely a challenge.

The Supreme Court recently overturned a precedent that established what is known as the Chevron deference doctrine, which held that federal regulatory agencies have broad powers to interpret legislation, including specifying details not delineated in legislation. With the precedent overturned, KFF Family News points out that many facets of health policy might be reshaped. For example, the No Surprises Act, which tries to protect patients from unexpected medical bills, may need to be refined to be more explicit, or current regulation might need to be rolled back.

The Supreme Court recently overturned a precedent that established what is known as the Chevron deference doctrine, which held that federal regulatory agencies have broad powers to interpret legislation, including specifying details not delineated in legislation. With the precedent overturned, KFF Family News points out that many facets of health policy might be reshaped. For example, the No Surprises Act, which tries to protect patients from unexpected medical bills, may need to be refined to be more explicit, or current regulation might need to be rolled back.

Since the Supreme Court ruled that the judicial branch will exercise more oversight of federal regulation, policy can be awkward as different judges can rule differently on the same policy issue: "'You could have eight or nine of 11 different views of the courts,' said William Buzbee, a professor at Georgetown Law." It seems likely that many different parties will challenge various policies, potentially causing years -- if not decades -- of regulatory turmoil in health care and other industries.

Unpaid medical debt often gets sent to collections -- similar to other forms of unpaid debt. If collectors assess the probability of being able to recover the debt as low, they frequently mark down the value of the debt so that it might become considered paid in full, even if only a fraction is paid. KFF Health News reported on Los Angeles County and Cook County (in Illinois) as deciding on setting aside money to wipe out unpaid medical debt of their residents.

Unpaid medical debt often gets sent to collections -- similar to other forms of unpaid debt. If collectors assess the probability of being able to recover the debt as low, they frequently mark down the value of the debt so that it might become considered paid in full, even if only a fraction is paid. KFF Health News reported on Los Angeles County and Cook County (in Illinois) as deciding on setting aside money to wipe out unpaid medical debt of their residents.

On paper, the counties seem to be getting good value: Los Angeles County plans on spending $5 million to wipe out $500 million of debt (a ratio of one cent for one dollar) for 150,000 residents. At a similar ratio, Cook County is reported to have spent $12 million to eliminate $1 billion in debt in 2022. While the debt relief will certainly help those who were indebted, taxpayers can reasonably ask whether that money could have been better spent to help avoid the medical debt in the first place. For example, the article mentions that most of the affected patients likely qualified for financial aid from hospitals, but might not have known about such programs. However, it is unclear what the return on investment would be for the longer term fixes. Managing the tradeoffs between short-term relief with more systemic fixes can indeed be challenging.

Medicaid is meant to provider health insurance to those who cannot afford it in the US. Unfortunately, enrollment in Medicaid does not actually mean that a person will receive adequate medical care, since many healthcare providers do not accept Medicaid insurance because of its low reimbursement rates. KFF Health News reported on California's plans to increase those rates, and the subsequent attempt by the governor to divert funding away from the state's Medicaid insurance, Medi-Cal.

Medicaid is meant to provider health insurance to those who cannot afford it in the US. Unfortunately, enrollment in Medicaid does not actually mean that a person will receive adequate medical care, since many healthcare providers do not accept Medicaid insurance because of its low reimbursement rates. KFF Health News reported on California's plans to increase those rates, and the subsequent attempt by the governor to divert funding away from the state's Medicaid insurance, Medi-Cal.

A couple of years ago, the governor of California expected a state budget surplus so large that "No other state in American history has ever experienced a surplus as large as this". Unfortunately, that surplus did not last, and the state faced (or is expected to face) large deficits in subsequent years. In response, the governor desires to use funding from a tax on managed-care plans to cover the state's budget shortfall. Some in the healthcare industry have worked on a possible voter initiative to try to reserve funds from this tax for Medi-Cal. Even with such a restriction, however, it is unclear whether the state legislature would simply reduce funding for Medi-Cal from the general budget in future years.

Regardless of how this particular challenge plays out, the governor's proposal illustrates some of the challenges for funding health care for those who cannot afford it. Despite meaning well, it is not surprising that when faced with a significant budget shortfall, the state de-prioritizes this constituency. However, one problem is that legislatures frequently encounter budget restrictions, so Medicaid continues to be underfunded by various states.