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Kaiser Health News reported on some challenges that primary care providers are facing when they treat mental health issues. Apparently, in the 1980s, many insurers issued policies to separate mental health treatment from treatment of more traditional medical concerns by separating out the network of providers who could be reimbursed for mental health treatment. Since then, it appears the separation has grown. The original reasoning might have made sense: steering patients towards specialists, who might have been able to offer higher quality at lower costs. However, the insurers' rationale might have ignored patients' preferences. Apparently, "primary care physicians handled nearly 40% of all visits for depression or anxiety and prescribed half of all antidepressants and anti-anxiety medications." Given how frequently primary care physicians treat mental health issues, it seems that separating the provider networks would pose significant burdens on patients.

Kaiser Health News reported on some challenges that primary care providers are facing when they treat mental health issues. Apparently, in the 1980s, many insurers issued policies to separate mental health treatment from treatment of more traditional medical concerns by separating out the network of providers who could be reimbursed for mental health treatment. Since then, it appears the separation has grown. The original reasoning might have made sense: steering patients towards specialists, who might have been able to offer higher quality at lower costs. However, the insurers' rationale might have ignored patients' preferences. Apparently, "primary care physicians handled nearly 40% of all visits for depression or anxiety and prescribed half of all antidepressants and anti-anxiety medications." Given how frequently primary care physicians treat mental health issues, it seems that separating the provider networks would pose significant burdens on patients.

The article discusses how insurers will deny mental health claims from primary care physicians, which resulted in some billing their treatment under different procedure codes. Overall, the current policy of separating provider networks (even though many patients consult primary care physicians about mental health issues) seems short-sighted: insurers might be able to save on some claims in the short-run, but the policy likely drives up costs for providers who must then track more administrative rules or drives up costs in general as patients need to see more providers resulting in more visits.

Kaiser Health News published a piece on how a slight difference in how a procedure was billed made a significant financial difference for the patient. As background, the Affordable Care Act mandated that certain preventative care procedures (e.g. routine check-ups) would not cost insured patients anything out-of-pocket with the hope that more people would undergo preventative care and avoid more costly care. A screening colonoscopy is an example of such preventative care procedures. However, diagnostic colonoscopies -- which might be prescribed to determine if a patient has colon cancer -- can still be billed as non-preventative care, thereby costing some patients. Presumably, healthcare providers get paid much more for diagnostic colonoscopies than they do for screening colonoscopies, tempting many to bill for the more profitable procedure. In turn, Medicare has clarified that the removal of a polyp (relevant to the patient's colonoscopy described in the article) does not warrant changing a screening colonoscopy to a diagnostic one. However, it seems like some providers persist in the more lucrative billing. In this particular piece, the patient expected her colonoscopy to be a screening procedure and therefore not to cost her anything. She was billed over $2,000, and the provider persisted in billing her procedure as diagnostic rather than as screening (even when a representative from the insurance company was present). After being contacted by Kaiser Health News, the provider admitted making a mistake and re-submitted the procedure as a screening colonoscopy.

Kaiser Health News published a piece on how a slight difference in how a procedure was billed made a significant financial difference for the patient. As background, the Affordable Care Act mandated that certain preventative care procedures (e.g. routine check-ups) would not cost insured patients anything out-of-pocket with the hope that more people would undergo preventative care and avoid more costly care. A screening colonoscopy is an example of such preventative care procedures. However, diagnostic colonoscopies -- which might be prescribed to determine if a patient has colon cancer -- can still be billed as non-preventative care, thereby costing some patients. Presumably, healthcare providers get paid much more for diagnostic colonoscopies than they do for screening colonoscopies, tempting many to bill for the more profitable procedure. In turn, Medicare has clarified that the removal of a polyp (relevant to the patient's colonoscopy described in the article) does not warrant changing a screening colonoscopy to a diagnostic one. However, it seems like some providers persist in the more lucrative billing. In this particular piece, the patient expected her colonoscopy to be a screening procedure and therefore not to cost her anything. She was billed over $2,000, and the provider persisted in billing her procedure as diagnostic rather than as screening (even when a representative from the insurance company was present). After being contacted by Kaiser Health News, the provider admitted making a mistake and re-submitted the procedure as a screening colonoscopy.

While this case was resolved in favor of the patient, it is unfortunate that the provider admitted to making a mistake only after media's involvement. There must be many, many other cases in which media does not get involved, and patients might have little practical recourse when providers insist they are correct.

Kaiser Health News published a piece about the upcoming potential decrease in affordability of health insurance plans. Last year, Congress passed the American Rescue Plan Act, which subsidized health insurance premiums for plans offered through insurance exchanges set up by the Affordable Care Act, reducing those premiums on average by about 23%. Perhaps unsurprisingly, enrollment in such plans increased. Congress has not yet renewed the subsidies, and the current governor of California has proposed using some of its surplus to offset the loss of subsidies for Californians if Congress does not act.

Kaiser Health News published a piece about the upcoming potential decrease in affordability of health insurance plans. Last year, Congress passed the American Rescue Plan Act, which subsidized health insurance premiums for plans offered through insurance exchanges set up by the Affordable Care Act, reducing those premiums on average by about 23%. Perhaps unsurprisingly, enrollment in such plans increased. Congress has not yet renewed the subsidies, and the current governor of California has proposed using some of its surplus to offset the loss of subsidies for Californians if Congress does not act.

After a cursory reading, one might think this article is about the importance of government subsidies to boost enrollment. However, such efforts seem to ignore the underlying cause of the rising premiums. That is, governments might be willing to spend millions and billions on subsidizing insurance premiums, perhaps without spending corresponding amounts on slowing the rise in healthcare costs. Both efforts might be needed: subsidies for short-term relief and cost management for help ensure that governments (and patients) do not simply keep paying higher and higher amounts that might have been avoided through a more systems-oriented solution.

The New York Times published an article about a patient who got surgery and was surprised by how large the bill was: over $200,000 when she was told that it would have been less than $1,400. In this case, the patient relied on the hospital's estimate, and the hospital subsequently stated that it misread her insurance card. The issue is that the services provided were considered out-of-network, meaning that the insurer would not really be involved and the patient would be liable for much more of the bill. Apparently, the hospital believed that the patient should pay the entire bill, even though she relied on information from the hospital. The hospital system went as far as suing her. The Colorado Supreme Court ruled in the patient's favor, about eight years after her surgery.

The New York Times published an article about a patient who got surgery and was surprised by how large the bill was: over $200,000 when she was told that it would have been less than $1,400. In this case, the patient relied on the hospital's estimate, and the hospital subsequently stated that it misread her insurance card. The issue is that the services provided were considered out-of-network, meaning that the insurer would not really be involved and the patient would be liable for much more of the bill. Apparently, the hospital believed that the patient should pay the entire bill, even though she relied on information from the hospital. The hospital system went as far as suing her. The Colorado Supreme Court ruled in the patient's favor, about eight years after her surgery.

The emotional toll and the cost in time and money seem like they would have been overwhelming. In other industries, it seems like service providers tend to bear most of the additional cost if they grossly underestimate a job. It is unclear why the hospital system believed it was entitled to the full amount given its mistake, and strategically, why they thought they would be able to meaningfully recover enough of the charge to make the negative press worthwhile.

Kaiser Health News reported on efforts in Massachusetts to block the expansion proposed by the largest healthcare provider in the state. The healthcare provider is a non-profit institution who reported $442 million in operating income last year, and the proposed expansion was found to be expected to nearly double that figure. Growth in the state's healthcare spending exceeded the target set by the state's health policy commission, and prices from the healthcare provider that proposed the expansion "far exceeded those of other hospital systems."

Kaiser Health News reported on efforts in Massachusetts to block the expansion proposed by the largest healthcare provider in the state. The healthcare provider is a non-profit institution who reported $442 million in operating income last year, and the proposed expansion was found to be expected to nearly double that figure. Growth in the state's healthcare spending exceeded the target set by the state's health policy commission, and prices from the healthcare provider that proposed the expansion "far exceeded those of other hospital systems."

The healthcare institution has been able to command such a premium in pricing in part because of its size. The institution was formed as the merger of two prominent Boston hospitals, whose merge likely should have been blocked to prevent consolidation in the market. Now the state seems to be mitigating its earlier permissiveness by blocking further expansion.