Entries for February 2008

Healthcare bills have always been baffling. Indeed, it's hard to think of a less aptly named document than your insurer's "Explanation of Benefits." Now there's even more reason to worry you're being overcharged. According to an investigation by New York Attorney General Andrew Cuomo, insurers have been systematically low-balling their reimbursements to some physicians and hospitals—leaving consumers to pick up too much of the tab.

The investigation focuses on services by doctors, hospitals, and other providers who are outside the health plan's approved network. About three quarters of people are in health plans that allow them to use such out-of-network services, usually with the proviso that they're responsible for about 20 percent of the bill. But here's the catch: If the provider's bill exceeds what is "reasonable and customary" for similar services in that geographic area, the insurer won't pay the whole bill, leaving the consumer on the hook for not only his or her 20 percent share but also for any amount above that reasonable and customary level.

As if healthcare spending weren't already a train wreck in the making, it's projected to nearly double by 2017, the Centers for Medicare and Medicaid Services announced today. That means it'll reach a whopping $4.3 trillion and account for 19.5 percent of our gross domestic product, up from 16.3 percent now.

Meanwhile, in a parallel universe called Campaign Land, the candidates for president propose expanding coverage to some or all of the 47 million who are uninsured. Democrats Hillary Clinton and Barack Obama in particular are talking up huge new programs that they claim would accomplish the laudable goal of making healthcare coverage universal. John McCain's plan is less far reaching, but he, too, proposes improving access to affordable healthcare.

It's tough enough for rape victims to come forward. Now there's another reason for them to think twice about reporting the crime: They may get stuck with a hefty bill for the rape kit used to collect evidence against their attacker.

Talk about adding insult to injury. In a story last week in the Raleigh News & Observer, reporter Mandy Locke described the situation in North Carolina, where "the vast majority of the 3,000 or so emergency room patients examined for sexual assaults each year shoulder some of the cost of a rape kit test." A state victims compensation fund intended to help cover the bills is woefully underfunded and had capped payouts for the $1,600 test at $1,000. Since Locke's story ran, "The cap has been lifted," says North Carolina Department of Crime Control and Public Safety spokesperson Patty McQuillan, though she noted that the legislature would still have to provide the additional funds.

Cancer screening is no fun, and every year around the time of my annual mammogram my emotions follow a now predictable path. For the week or so beforehand, I'm petrified at odd moments, sure that my good luck has run out. Then there's the inevitable unpleasantness of the exam itself—enough said about THAT—followed by relief that I've cheated cancer one more time. This lasts about two days, at which point low-level worry sets in again.

With all the emotional anxiety that accompanies these tests, is it any wonder that people avoid them if they can come up with an excuse? Lacking health insurance—as 47 million Americans do—may seem like a passable justification. So might being on Medicaid and having access to few providers who will take your coverage. But a new study by the American Cancer Society makes the case for screening even under challenging circumstances.

Anyone who's ever investigated buying an individual health insurance policy won't be surprised to hear that the vast majority of people say "no thanks" to such coverage, even when they can't buy insurance through an employer. A new analysis, released Monday by the Kaiser Family Foundation, found that this is not only true for lower-income people—those who earned up to 250 percent of the poverty level, or about $47,000 for a family of four—but also for those who made much more.

The percentage buying coverage did rise as incomes grew, but even at four times the poverty level (roughly $38,000 for an individual or $75,000 for a family of four) only about a quarter of people who didn't have other insurance options bought individual policies.

Whether and how the next president will find a way to cover the 47 million people who lack health insurance will be on many voters' minds as they head to the polls on Tuesday. If this is your top-priority issue, you could drive yourself crazy trying to pick apart the differences between the Clinton and Obama plans. Ditto the offerings on the Republican side. That's because they're much more alike, within each party, than they are different. But there are significant differences between Democrats and Republicans in how their respective candidates would address the problem, reflecting the two parties' very different political philosophies. Focus on those instead, and your choice is much clearer. Then pick the candidate in that party that you like best.

On the Democratic side, both Hillary Clinton and Barack Obama want to get everyone covered by expanding public programs and private insurance options and subsidizing the cost for people who can't afford it. The main difference between their plans is that Clinton would require everyone to have health insurance, while Obama would mandate coverage only for children.

Doctors aren't thrilled about the growing crop of websites that invite patients to post online, Zagat-style ratings and comments about their physicians. Nobody likes having his performance judged, and the anonymity of the Internet encourages the sort of no-holds-barred criticism that can feel—and may be—unfair. But the American Medical Association's stance against them seems shortsighted. Instead of trying to discourage people from logging on and registering their opinions, doctors would be better served using the sites to learn what their patients think.

Sure, the information is subjective, but why should consumers rule it out on that basis? It's sorely needed. Patients are paying more for their health coverage all the time, and they want value for their money. But it's not easy to comparison shop for doctors. It's hard to find out what the fee will be until after the fact, and good luck locating data that help you evaluate whether Doctor A is more nimble with a scalpel than Doctor B. Everyone agrees that we need more reliable tools to help patients evaluate clinical competence and improve pricing "transparency." A doctor's clinical skill, after all, is the most critical measure of his or her abilities. But communication skills and accessibility matter, too, and who better to give you the lowdown on those details than other patients?