Patients often win if they appeal a denied health claim

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The health law set national rules for appealing a denied claim, and advocates say consumers should take advantage of them

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By Pauline Bartolone, Capital Public Radio

APR 14, 2014

This KHN story was produced in collaboration with NPR

SACRAMENTO, Calif. — Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.

To help make sure a patient’s claims aren’t improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.

For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea.  Continue reading

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Focus one exchange enrollment overlooks millions who bought private insurance

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ACA health reform logoBy Annie Feidt, APRN

Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is exceedingly complicated.

The Obama administration is tracking the number of plans purchased on the federal website healthcare.gov and on the state marketplaces, and this month reported that It had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid since October.

But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers — and that number could be substantial. Continue reading

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Health news headlines — April 15th

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When naming unwise treatments, doctors overlook lucrative procedures

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Twenty-dollar bill in a pill bottleBy Jordan Rau
KHN Staff Writer

APR 14, 2014

This KHN story was produced in collaboration with the 

 

When America’s joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes.

The American Academy of Orthopaedic Surgeons discouraged patients with joint pain from taking two types of dietary supplements, wearing custom shoe inserts or overusing wrist splints after carpal tunnel surgery.

The surgeons also condemned an infrequently performed procedure where doctors wash a pained knee joint with saline.

“They could have chosen many surgical procedures that are commonly done, where evidence has shown over the years that they don’t work or where they’re being done with no evidence,” said Dr. James Rickert, an assistant professor of orthopedic surgery at Indiana University. “They chose stuff of no material consequence that nobody really does.” Continue reading

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Q: Do I face a penalty if my kids’ CHIP coverage starts in April?

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Cute Baby Boy Isolated on WhiteBy Michelle Andrews

Q. I understand that I won’t have to pay a penalty for not having insurance because I signed up for coverage before the end of open enrollment.

But what about my kids? Their CHIP coverage didn’t start until April.  Continue reading

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Health news headlines — April 14th

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Doctors who shun insurance, offering care for cash

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200px-Flag-map_of_TexasBy Alexa Ura, The Texas Tribune
APR 11, 2014

This story was produced in partnership with 

LAREDO — For 12 hours a day, the waiting room at Dr. Gustavo Villarreal’s family practice is often packed with patients, people who will pay a flat $50 fee for the convenience — or necessity — of a walk-in, quick-turn doctor’s visit.

Villarreal’s practice, which does not accept any form of health insurance, has thrived despite its location in a city where nearly one-third of the population lives below the federal poverty line. Continue reading

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Health news headlines — April 12th

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Measles update: WA case count grows to 12, extending to third county

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Kitsap County resident confirmed with measles; exposure likely in San Juan County

 

From the Washington State Department of Health:

Alert IconApril 11, 2014 - Measles continues to spread in Washington as cases in San Juan County have extended to a Kitsap County resident. A man in his 40s from Kitsap visited several places in Friday Harbor, including a restaurant where a contagious San Juan County man was at the same time.

San Juan County’s case count is now five, and Kitsap County has one. In Whatcom County, the case count remains at six.  Continue reading

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State exchange directors offer enrollment snapshots

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 Washington MapRichard K. Onizuka from the Washington Health Benefit Exchange reports that 136,497 of Washington state’s 146,000 new enrollees have already paid their premiums. Almost twice as many people, 268,000, gained Medicaid coverage, he added, and 8,000 people signed up on March 31.

 

By Lisa Gillespie
APRIL 11TH, 2014,

The Obama administration is touting the success of the health law’s open enrollment, which signed up  at least 7.5 million Americans for health coverage through the online insurance marketplaces.

But the experience varied according to states and Families USA brought together five state exchange directors Thursday to talk about what they’ve seen so far. These states – Kentucky, New York, Washington, California and Connecticut — all had functioning exchanges and pursued that health law’s Medicaid expansion.  Continue reading

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