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KFF Health News published an article on yet another way in which patients can end up in medical debt. Like some other stories, patients mentioned in this article seem to have signed forms that they did not fully understand and opted for an out-of-network provider. One element of this story not frequently highlighted in other medical debt stories is that insurers sent reimbursement checks to the patients, who were then supposed to sign them over to the provider. In some cases, patients admitted to keeping the checks. In at least one case, a patient declared that she handed over the checks, but is still being sued.

KFF Health News published an article on yet another way in which patients can end up in medical debt. Like some other stories, patients mentioned in this article seem to have signed forms that they did not fully understand and opted for an out-of-network provider. One element of this story not frequently highlighted in other medical debt stories is that insurers sent reimbursement checks to the patients, who were then supposed to sign them over to the provider. In some cases, patients admitted to keeping the checks. In at least one case, a patient declared that she handed over the checks, but is still being sued.

Part of the confusion appears to stem from a lack of upfront clarity of pricing and of how much out-of-network insurers would pay. An exacerbating factor appears "onerous repayment terms." Some of these pain points might be streamlined by, for example, having the insurer pay the provider directly, even for out-of-network patients. Perhaps, though, insurers do so in order to minimize the likelihood that they will be contacted for any outstanding balance; or perhaps they do so to give providers an added incentive to join their networks. To reduce confusion, state governments could perhaps standardize and simplify patient forms, similar to how some states streamline mortgage applications.

KFF Health News published an article explaining how drug prices can rapidly increase. Featured in the article is a drug company that does not actually develop its own drugs. Instead, the company buys drugs developed elsewhere and markets them and raises their prices.

KFF Health News published an article explaining how drug prices can rapidly increase. Featured in the article is a drug company that does not actually develop its own drugs. Instead, the company buys drugs developed elsewhere and markets them and raises their prices.

The article opens with the example of a different company that developed a promising drug, which might have had a negative side effect. Investors found the company unattractive, and the company was sold. The featured company eventually bought the company, raising the price roughly tenfold (after subsequent studies seemed to rule out the side effect). Obviously, not every acquirer can raise prices as much, and it appears that part of the featured company's strategy is to streamline the process for the patient, whether by negotiating with insurance carriers for coverage or by employing nurses to talk with each patient.

Ultimately, a major issue in drug development is the cost to develop and test a drug. If, for example, the original company could weather the initial negative news of the side effect by not having to spend as much on drug testing, perhaps it would have been able to sell the drug for longer at the original price. Hence, while people want to know that the drugs they take are safe (requiring expensive and extensive testing), that cost might hinder competition and eventually allow companies to charge more for their products.

Selecting a doctor from an insurance directory can be a difficult task. Many times, directories lack the information that one might want in selecting a provider. Kaiser Health News published a piece that opened with a vignette of a patient encountering incorrect information on an insurer's provider directory. The one piece of information that people would most expect an insurer's provider directory to get right is whether that provider accepts the insurer's plans. Yet, an insurance agent observed "The thing that shocked me was how many offices told my clients, 'We have never heard of this company." When asked for comment, the insurer wrote that their network "meets or exceeds regulatory standards." It is unclear whether those standards would have been met if the directory were completely accurate.

Selecting a doctor from an insurance directory can be a difficult task. Many times, directories lack the information that one might want in selecting a provider. Kaiser Health News published a piece that opened with a vignette of a patient encountering incorrect information on an insurer's provider directory. The one piece of information that people would most expect an insurer's provider directory to get right is whether that provider accepts the insurer's plans. Yet, an insurance agent observed "The thing that shocked me was how many offices told my clients, 'We have never heard of this company." When asked for comment, the insurer wrote that their network "meets or exceeds regulatory standards." It is unclear whether those standards would have been met if the directory were completely accurate.

The inability for an insurer to secure enough providers may sometimes be a reflection that that insurer is not offering competitive enough rates. Since network adequacy is a concern and patients should not have to call providers' offices to sort out network status, the government should probably impose stiffer penalties for incorrect network status information. Insurers might protest about the additional cost of keeping their directories up-to-date, and perhaps this would be an opportunity for a marketplace (perhaps sponsored by the federal government) to offer each provider a single account to easily specify contact information and whether he or she accepts a variety of insurance plans. That information could then be made publicly available so that others can streamline certain functions such as identifying a suitable insurance plan for those who already have specific providers in mind.

With mental health issues on the rise, Kaiser Health News published a piece on the use of technology to help facilitate mental health treatment through telemedicine visits. Not surprisingly, reimbursement for telemedicine visits increased during the pandemic. Additionally, the article profiled some individual cases in which technology solved a real problem, whether that be access to a rural area or overcoming an individual's hurdles to getting ready and going out for treatment.

With mental health issues on the rise, Kaiser Health News published a piece on the use of technology to help facilitate mental health treatment through telemedicine visits. Not surprisingly, reimbursement for telemedicine visits increased during the pandemic. Additionally, the article profiled some individual cases in which technology solved a real problem, whether that be access to a rural area or overcoming an individual's hurdles to getting ready and going out for treatment.

While much of medical treatment cannot yet be conducted remotely, telemedicine does seem like one promising way of streamlining health care, which will be an increasingly important issue in light of the projected upcoming shortage of qualified providers. Mental health care seems to particularly suited for remote visits.

Adding to the area highlighted in last week's blog post, ProPublica published a look into one major insurer's way of handling prior authorization requests. We tend to think of automation positively, but what about when it can be used to create much more hassle for patients and doctors? The picture that ProPublica's article paints is that the insurer's doctors use software to reject prior authorization requests in bulk, in some instances averaging less than two seconds per case. It appears that the researchers for the article obtained an internal spreadsheet that documented how many claims were denied per doctor in a two-month time span. A former executive at the insurer was quoted as describing a strategy of denying all requests and seeing which rejections were contested.

Adding to the area highlighted in last week's blog post, ProPublica published a look into one major insurer's way of handling prior authorization requests. We tend to think of automation positively, but what about when it can be used to create much more hassle for patients and doctors? The picture that ProPublica's article paints is that the insurer's doctors use software to reject prior authorization requests in bulk, in some instances averaging less than two seconds per case. It appears that the researchers for the article obtained an internal spreadsheet that documented how many claims were denied per doctor in a two-month time span. A former executive at the insurer was quoted as describing a strategy of denying all requests and seeing which rejections were contested.

One core issue with the system is the asymmetry of the costs and rewards: rejecting a prior authorization request costs the insurer very little, but can cost the provider much time and can cost the patient much money. If the rejection is not contested, insurers likely save money (at least in the short-term), and if a rejection is contested, they likely do not pay any out-of-pocket penalty. Last week's post mentioned some potential fixes, such as publishing rejection rates or making the insurer (or medical directors) liable for the harm caused to patients because of the denied medical care. One could imagine setting up a state-level ombudsman to adjudicate disputes and requiring insurers to compensate providers for their time whenever a case is decided in the providers' favor.