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Insurance Coverage

All articles tagged with #insurance coverage

Preapproved Breast MRI Ends Up in a Surprise Bill for a High-Risk Woman
health13 hours ago

Preapproved Breast MRI Ends Up in a Surprise Bill for a High-Risk Woman

A high‑risk woman was preapproved for an annual breast MRI, intended as preventive care, but she still received about $1,200 in charges after the scan; federal guidelines treat preventive breast MRIs differently based on whether a mammogram is abnormal, and self‑insured employer plans aren’t always bound by state rules, leaving patients to navigate deductibles and cost-sharing. The piece highlights gaps between preventive‑care recommendations and actual coverage and suggests checking state rules, using patient navigators, shopping around for pricing, and timing scans near the deductible year to minimize costs.

via KFF Health News|
#breast-cancer#health#insurance-coverage
Bridging the Gap to Clinical Trials: Access, Costs, and Change
health4 days ago

Bridging the Gap to Clinical Trials: Access, Costs, and Change

Many patients want to join clinical trials, but recruitment is hampered by geographic, time, and cost barriers, plus limited provider referrals and difficult trial searches. While ACA-mandated coverage helps with routine trial costs, incidental expenses and out-of-network issues can block participation. Policymakers and advocacy groups are pushing to streamline rules, fund travel/childcare support, and explore decentralized trials to expand access; patients should ask about trials, use search tools, and seek navigator help to identify feasible options.

via CNN|
#clinical-trials#health#healthcare-costs
Elective egg freezing: pricey, uneven coverage, and tax considerations
healthcare12 days ago

Elective egg freezing: pricey, uneven coverage, and tax considerations

Elective egg freezing remains expensive and poorly covered by insurance, with a single cycle averaging about $16,000 and total costs potentially reaching $47,000 when multiple cycles, storage, and implantation are included. Workplace benefits are the main source of coverage today, but many plans cap benefits and broad coverage is rare; only a minority of insurers and states provide comprehensive protections. If an employer pays for the benefit, it is typically treated as earned income and taxed, potentially increasing the tax bill, while medical-related preservation may be deductible.

via CNBC|
#egg-freezing-costs#healthcare#insurance-coverage
AOC's Egg Freezing Sparks a New York Insurance-coverage Push
health13 days ago

AOC's Egg Freezing Sparks a New York Insurance-coverage Push

Rep. Alexandria Ocasio-Cortez revealed she is freezing her eggs and paying thousands out of pocket, highlighting the lack of insurance coverage for the procedure. A proposed New York bill (S4497/A7339) would require such coverage and is the first of its kind, but has stalled in the Assembly after passing the Senate twice. The piece notes egg-freezing costs, the growing but uneven adoption of coverage by employers, and alternatives like Cofertility, while stressing the personal and policy dimensions of access to fertility preservation.

via Gothamist|
#alexandria-ocasio-cortez#egg-freezing#health
Young Americans Battle Insurance Hurdles as Colon Cancer Rates Rise
health5 months ago

Young Americans Battle Insurance Hurdles as Colon Cancer Rates Rise

Colon cancer rates are rising among people in their 20s and 30s in the US, but adults under 45 often struggle to get insurance coverage for colonoscopies since the ACA mainly covers preventive screenings for those 45 and older. Diagnostic colonoscopies can be denied or costlier, leading to delays and out-of-pocket expenses (one case cited around $2,000). Doctors note referral loops and misattributions of symptoms contribute to late evaluations. Some experts suggest stool tests like Cologuard to expedite access, while the debate about lowering screening age continues due to capacity and disparities. Researchers also advocate broader study of cancer causes (the exposome) to inform policy and screening strategies.

via The Guardian|
#affordable-care-act#colon-cancer#colonoscopy
Insurance hurdles threaten to sideline WBC stars
sports6 months ago

Insurance hurdles threaten to sideline WBC stars

Insurance constraints for the World Baseball Classic are sidelining several star players, with eight to ten Puerto Rican teammates potentially blocked from coverage and Team Puerto Rico weighing withdrawal; Francisco Lindor is among those denied due to elbow surgeries, as insurers tighten criteria after injuries in 2023. Rosters loom, and MLB/MLBPA are lobbying to loosen rules, while an age cap of 37 excludes some veterans and teams may have to absorb risk if players lack coverage.

via The New York Times|
#francisco-lindor#insurance-coverage#mlb-underwriting
Oral GLP-1 Pill Arrives, but Injections Still Lead the Weight-Loss Market
health7 months ago

Oral GLP-1 Pill Arrives, but Injections Still Lead the Weight-Loss Market

Wisconsin physician Dr. Srividya Kidambi explains that the FDA-approved oral GLP-1 pill (semaglutide tied to SNAC) offers a cheaper, potentially easier alternative to injections like Wegovy, but must be taken fasting with a small amount of water and carries similar GI side effects. Insurance coverage for obesity remains inconsistent, supply shortages persist, and experts say the pill will complement rather than replace injections as the GLP-1 market is projected to grow dramatically into 2035.

via WPR|
#glp-1#health#insurance-coverage
Debate Intensifies Over Obamacare and Healthcare Subsidies
health10 months ago

Debate Intensifies Over Obamacare and Healthcare Subsidies

Many Americans face rising health insurance premiums, with costs increasing significantly since 2010, despite the ACA's success in reducing the uninsured rate. The law focused on expanding coverage rather than controlling costs, which continue to grow due to systemic issues like provider pricing and lack of comprehensive reform. Political disagreements hinder effective solutions, leaving many Americans struggling with affordability and underinsurance, highlighting the need for more substantial health care reforms.

via vox.com|
#aca#health#health-care-costs
CDC Updates COVID Vaccine Guidelines and Recommendations
health10 months ago

CDC Updates COVID Vaccine Guidelines and Recommendations

Most Americans with health insurance will still get COVID-19 vaccines at no cost, despite CDC's new recommendation requiring shared clinical decision-making, which introduces some ambiguity about coverage obligations. Major insurers have committed to covering recommended vaccines at no cost through 2026, but some insurers may argue they are not required to cover vaccines not explicitly recommended by the CDC, especially under shared decision-making guidelines. Medicaid will continue to cover vaccines at no cost, but changes are expected for other vaccines like MMRV for children.

via CNN|
#cdc#covid-19-vaccines#health
The Hidden Body Part That Regulates Vital Functions and Is Hard to Treat
health10 months ago

The Hidden Body Part That Regulates Vital Functions and Is Hard to Treat

Women, and some men, face significant challenges in accessing pelvic floor therapy due to insurance restrictions, high costs, and systemic undervaluation of this essential treatment, which is crucial for addressing issues like pelvic pain, prolapse, and sexual dysfunction. Patients often experience delays, inadequate coverage, and emotional distress, highlighting the need for systemic healthcare reforms to improve access and recognition of pelvic health.

via Slate|
#health#insurance-coverage#medical-access