FAIR Health

The Latest News about FAIR Health Initiatives

 

 A selection of prominent media outlets referencing our data and tools.

 

2017
      June
    • Fair Health elects new director to board
      June 22, 2017
      hrmronline.com
      Fair Health, a non-profit organization that provides cost information to the healthcare industry and consumers, has elected James Roosevelt, Jr. to its board of directors.

      Currently counsel at Verrill Dana in Boston, Roosevelt has previously served for more than 10 years as the president and CEO of Tufts Health Plan.

      Former chair of America's Health Insurance Plans, Roosevelt currently chairs the organization's policy and regulatory committee. Previously, he chaired the Massachusetts Hospital Association and the Massachusetts Association of Health Plans; he also served on the board of the American Hospital Association and is a past president of the American Health Lawyers Association. In 2008, President-Elect Barack Obama appointed Roosevelt to his transition team to co-chair a review of the Social Security Administration.

      Read full article here.
       
    • Medical responses to opioid addiction vary by state, analysis finds
      June 22, 2017
      salon.com
      Opioid-related diagnoses are discovered to be treated very differently depending on where they are diagnosed

      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Read full article here.
       
    • FAIR Health adds former Tufts Health Plan CEO to board: 4 things to know
      June 21, 2017
      beckershospitalreview.com
      New York City-based FAIR Health, a healthcare data analytics and consumer education firm, appointed James Roosevelt Jr. to its board of directors.

      Here are four things to know about Mr. Roosevelt.

      1. Mr. Roosevelt serves as counsel at Verrill Dana in Boston.

      2. He previously helmed Boston-based Tufts Health Plan as president and CEO for more than 10 years.

      Read full article here.
       
    • FAIR Health Elects James Roosevelt, Jr. to Board of Directors
      June 20, 2017
      CNBC.com
      NEW YORK, June 20, 2017 /PRNewswire-USNewswire/ -- FAIR Health, Inc. announced today that it has elected James Roosevelt, Jr. to its Board of Directors. Currently Counsel at Verrill Dana LLP in Boston, Mr. Roosevelt brings to FAIR Health decades of experience as a distinguished business and civic leader with expertise in many aspects of the national healthcare system.

      "We welcome Mr. Roosevelt to the FAIR Health Board," said Stephen A. Warnke, Chairman of FAIR Health's Board of Directors. "At a time of unprecedented strain on our healthcare system, Jim's understanding of the issues that affect health plan members, professional and institutional providers, insurers, policy makers, researchers and others adds a uniquely broad-based perspective to inform FAIR Health's core mission of helping all of these stakeholders navigate the challenges of the healthcare sector."

      Read full article here.
       
    • Peeling Back the Curtain on Regional Variation in the Opioid Crisis. MedicalResearch.com Interview with: Robin Gelburd, JD President FAIR Health
      June 19, 2017
      medicalresearch.com
      MedicalResearch.com: What is the background for this study?

      Response: The opioid crisis is affecting the entire nation, but not in the same way in every location. Although a number of studies have been conducted on geographic variations in the opioid epidemic, there remains a need for more information on the regional level. To help meet that need, FAIR Health consulted its database of more than 23 billion privately billed healthcare claims, the largest such repository in the country. Focusing on the most recent complete ten-year period (2007-2016), FAIR Health examined claims data from rural and urban settings, the country’s five most populous cities (Chicago, Houston, Los Angeles, New York and Philadelphia) and the states where those cities are located.

      When the term “opioid-related diagnoses” is used in this study, it refers to opioid abuse, opioid dependence, heroin overdose and opioid overdose (i.e., overdose of opioids excluding heroin).

      Read full article here.
       
    • Marshall offers baseline concussion tests for children playing sports
      June 18, 2017
      wvgazettemail.com
      With more elementary and middle school students getting involved in sports, the risk of concussion is higher than ever.

      A new initiative from Marshall University’s Sports Medicine Institute hopes to help parents make smarter decisions about when to let their children keep playing after receiving a concussion.

      “Before we clear them to return to playing their sport, we want to make sure they have returned to as close to their normal cognitive level as possible,” said Tom Belmaggio, coordinator of Marshall’s Sports Medicine Institute. “This testing makes that possible."

      Read full article here.
       
    • Coping with opioid crisis varies wildly form state to state
      June 17, 2017
      dailynews.com
      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Medical responses to opioid-related diagnoses appear to differ among the five states examined by Fair Health, a nonprofit that provides cost information to the health industry and consumers. To draw that conclusion, researchers analyzed the health insurance billing codes associated with those diagnoses.

      Read full article here.
       
    • Opioid abuse and dependence diagnoses
      June 15, 2017
      crainsnewyork.com
      This issue of Pulse Extra examines opioid-related insurance claims using data from FAIR Health with about 23 billion medical and dental claims from 150 million privately insured individuals. In a recent white paper, the nonprofit explored regional variation in opioid-related claims in five states: Illinois, Texas, California, New York and Pennsylvania. Overall, it noted claims for opioid abuse and dependence "were more concentrated among middle-aged people in rural than urban settings, where they were spread more broadly among young and middle-aged people."

      Below, we look at differences in opioid-related claims in New York City, the suburbs and the rest of the state

      Read full article here.
       
    • Opioid-related treatment approaches vary by region
      June 14, 2017
      behavioral.net
      Research published this week by FAIR Health, a national, independent not-for-profit that analyzes commercial insurance claims, indicates treatment approaches for opioid-related diagnoses widely vary by geographic location.

      In is third whitepaper on the nation’s opioid epidemic, FAIR Health analyzed privately billed healthcare claims to study the nation’s top five cities by population (Chicago, Houston, Los Angeles, New York and Philadelphia) and their respective states over the period from 2007 to 2016.

      Read full article here.
       
    • Analysis: Peering Into the Nation’s Opioid Crisis Through a Regional Lens
      June 14, 2017
      realclearhealth.com
      The opioid crisis is national in scale, but it varies greatly at the regional level. Drawing on our national database of 23 billion private health care claims, we recently explored the regional variation in the opioid crisis during the ten-year period 2007-2016 in a new white paper. Preceded by reports on national trends in opioid-related diagnoses and on the epidemic’s impact on the health care system, this report is important because it suggests the need for policy flexibility in dealing with the varying regional manifestations of the opioid crisis.

      Read full article here.
       
    • Opioid epidemic hits nearly all age groups in both rural and urban US areas
      June 14, 2017
      healthmedicinet.com
      In rural areas around the country, in the period 2007 to 2016, private insurance claim lines with opioid abuse and dependence diagnoses were found in every age group from 13- 18 years to over 80 years, and in urban areas, in every age group from 13-18 years to 71-80 years. Those findings were based on data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. As detailed in the third in a series of FAIR Health white papers on the nation’s opioid epidemic, Peeling Back the Curtain on Regional Variation in the Opioid Crisis: Spotlight on Five Key Urban Centers and Their Respective States, claim lines with opioid abuse and dependence diagnoses were more concentrated among middle-aged people in rural than urban settings, where they were spread more broadly among young and middle-aged people.

      Read full article here.
       
    • Studies find medical treatment for opioid addiction varies widely between states
      June 14, 2017
      medcitynews.com
      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Medical responses to opioid-related diagnoses appear to differ among the five states examined by Fair Health, a nonprofit that provides cost information to the health industry and consumers. To draw that conclusion, researchers analyzed the health insurance billing codes associated with those diagnoses.

      Read full article here.
       
    • Report: SoCal Claims With Opioid Diagnosis Outpace Remainder of State
      June 14, 2017
      workcompcentral.com
      Private insurance claim lines with an opioid dependence diagnosis increased more than 24,000% from 2007 to 2016 in California, with an even greater increase of almost 32,000% in Southern California, according to a new study from FAIR Health.

      Read full article here.
       
    • Opioid epidemic affects most age groups, areas in U.S.
      June 13, 2017
      upi.com
      June 13 (UPI) -- A new report finds that the opioid epidemic does not discriminate by age or areas of the country with impacts on nearly all age groups, regions of the country.

      The report by FAIR Health, a national, non-profit organization that tracks healthcare costs and health insurance information, shows that from 2007 to 2016, private insurance claim lines for opioid abuse or dependence diagnoses were seen in every age group from 13- to 18-year-olds to people over age 80 in rural areas. In urban areas, opioid diagnoses were seen in every age group from people 13 to 18 to those between 71 and 80 years of age.

      Read full article here.
       
    • How Should Opioid Addiction Be Treated?
      June 13, 2017
      drugtopics.modernmedicine.com
      As the opioid crisis worsens, debates rage about the best methods to combat it.

      The kind of treatment you receive if you are addicted to opioids depends on where you live, a new study found. But all treatment options are not created equal.

      Fair Health, an organization that tracks health information, analyzed health insurance claims relating to opioid addiction from five states between 2007 and 2016, and found that each state tends to treat opioid addiction differently. In California, for example, the most commonly used procedure codes attached to claims were related to drug tests and outpatient services. New York listed methadone administration as its most common code, while Texas’ top five codes all involved lab tests.

      Read full article here.
       
    • Medical responses to opioid addiction vary by state
      June 13, 2017
      cityandstateny.com
      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Read full article here.
       
    • Dental Association urges men to look after their teeth
      June 13, 2017
      ctpost.com
      During National Men’s Health Month, the Connecticut State Dental Association is encouraging men to pay close attention to their oral health.
      “During men’s health month, we urge men to focus on their well-being, including their oral health,” said Dr. Gary Linker, CSDA President in a news release.
      Men’s Health Month is a national health education program created to heighten the awareness of preventable health problems and encourage the detection and treatment of disease among men and boys.

      Read full article here.
       
    • Opioid Epidemic Hits Nearly All Age Groups in Both Rural And Urban US Areas
      June 13, 2017
      sciencenewsline.com
      In rural areas around the country, in the period 2007 to 2016, private insurance claim lines with opioid abuse and dependence diagnoses were found in every age group from 13- 18 years to over 80 years, and in urban areas, in every age group from 13-18 years to 71-80 years. Those findings were based on data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. As detailed in the third in a series of FAIR Health white papers on the nation's opioid epidemic, Peeling Back the Curtain on Regional Variation in the Opioid Crisis: Spotlight on Five Key Urban Centers and Their Respective States, claim lines with opioid abuse and dependence diagnoses were more concentrated among middle-aged people in rural than urban settings, where they were spread more broadly among young and middle-aged people.

      Read full article here.
       
    • Queens has third-biggest rise in opioid claims in NY
      June 13, 2017
      crainsnewyork.com
      New York City accounts for a relatively small share of the private insurance claims filed for the treatment of opioid abuse or dependence in the state in recent years. But the city is home to two of the 10 New York areas that have seen the biggest rise in such claims between 2007 and 2016, according to a new report by FAIR Health, a national nonprofit with a database of billions of commercial health insurance claims.

      Queens was No. 3 in the top 10, behind Binghamton and Rochester. The borough saw a nearly 11,000% increase in opioid abuse and dependence claims between 2007 and 2016, and a 1,658% rise between 2014 and 2016.

      Read full article here.
       
    • Medical responses to opioid addiction vary by state, analysis finds
      June 13, 2017
      miamiherald.com
      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Medical responses to opioid-related diagnoses appear to differ among the five states examined by Fair Health, a nonprofit that provides cost information to the health industry and consumers. To draw that conclusion, researchers analyzed the health insurance billing codes associated with those diagnoses.

      Read full article here.
       
    • Opioid addiction treatment varies by state: 7 things to know
      June 12, 2017
      beckershospitalreview.com
      Medical interventions for opioid-related diagnosis vary by state, according to a new white paper released by Fair Health, a nonprofit provider of health industry cost information.

      To assess the regional variations in opioid misuse and addiction treatment, Fair Health researchers analyzed data on privately billed health claims compiled in the nonprofit's database for patients from the country's five most populous cities — Chicago, Houston, Los Angeles, New York and Philadelphia — and their respective states, according to the report.

      Here are seven things to know.

      Read full article here.
       
    • Study: The Drug Crisis Is Not Discriminating By Age Or Region
      June 12, 2017
      dailycaller.com
      Americans of all ages are suffering from drug addiction, and insurance claims for opioid abuse and dependence are increasing in both urban and rural areas across the country.

      An analysis of private insurance claims between 2007 and 2016 reveals opioid abuse exists among all Americans, from those as young as 13 to individuals more than 80 years old. Previous analyses suggest the crisis is far worse for Americans living in sparsely populated areas. Specific demographic trends vary from urban metropolises to more rural areas, but opioid abuse is not unique to any age, gender or region, FAIR Health reported Monday.

      Read full article here.
       
    • Medical responses to opioid addiction vary by state, analysis finds
      June 12, 2017
      fiercehealthcare.com
      This article originally appeared in Kaiser Health News.

      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Read full article here.
       
    • Southern California Surge in Opioid-Related Diagnoses 31,897% over Ten Years
      June 12, 2017
      smobserved.com
      Epidemic Hits Nearly All Age Groups in Both Rural and Urban US Areas

      In rural areas around the country, in the period 2007 to 2016, private insurance claim lines with opioid abuse and dependence diagnoses were found in every age group from 13-18 years to over 80 years, and in urban areas, in every age group from 13-18 years to 71-80 years.

      Those findings were based on data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. As detailed in the third in a series of FAIR Health white papers on the nation's opioid epidemic, Peeling Back the Curtain on Regional Variation in the Opioid Crisis: Spotlight on Five Key Urban Centers and Their Respective States, claim lines with opioid abuse and dependence diagnoses were more concentrated among middle-aged people in rural than urban settings, where they were spread more broadly among young and middle-aged people.

      Read full article here.
       
    • Medical responses to opioid addiction vary by state, analysis finds
      June 12, 2017
      MSN.com
      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Read full article here.
       
    • Medical responses to opioid addiction vary by state, analysis finds
      June 12, 2017
      KHN.org
      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Read full article here.
       
    • Medical responses to opioid addiction vary by state, analysis finds
      June 12, 2017
      usatoday.com
      Location, location, location. That mantra may apply even when it comes to how opioid addiction is treated.

      Specifically, patients with private insurance who are diagnosed with opioid dependency or abuse may get different medical services depending on where they live, a white paper to be released in the upcoming week by a national databank indicates.

      Read full article here.
       
    • 5 Ways to Cut Healthcare Costs if Your Deductible Is Too High
      June 5, 2017
      fool.com
      How can you cut healthcare costs if your deductible is too high? Follow these five tips to make your care more affordable.

      Health insurance deductibles are rising in 2017, with average deductible costs expected to top $6,000 for those with coverage through the Obamacare marketplaces and $1,500 for those with employer plans. Paying thousands before insurance starts picking up the tab is enough to strain any budget -- especially if you have multiple family members who need medical services and have individual deductibles to meet.

      Going to the doctor for annual exams and health problems is not an optional expense, so finding a way to keep costs down is vital. Here are five ways to make your medical service as affordable as possible -- even if you are stuck with a high-deductible plan.

      Read full article here.
       
    • Ban Checking In Youth Hockey, Says NHL Great Eric Lindros
      June 1, 2017
      vocativ.com
      Eric Lindros made his NHL debut as a 19-year-old with the Philadelphia Flyers in 1992 and immediately became the sport’s most prolifically precocious scorer. In his first two seasons, he scored 85 goals in 126 games, a per-game rate that bested the output of the legendary Wayne Gretzky at that age (albeit only at the third decimal place).

      In that second season, I had the pleasure of seeing him play a road game in Hartford in which he scored two goals and added two assists—in the first period. By his third season, Lindros was league MVP. As historically productive as Lindros was, however, he had trouble staying on the ice. He suffered at least six concussions between 1998 and 2000, effectively derailing his career.

      Read full article here.
       
    • FAIR Health to expand allowed amount resources, Payscout acquires HealPay & more — 11 RCM key notes
      June 1, 2017
      beckershospitalreview.com
      Here are 11 recent updates on revenue cycle management companies.

      11. New York City-based FAIR Health, a healthcare data analytics and consumer education firm, is expanding its allowed amount resources this summer.

      Read full article here.
       
    • Dental Coverage for Retirees
      June 1, 2017
      huffingtonpost.com
      Getting dental care is at least as important when you’re older as when you’re younger, and maybe more so. Past dental problems may require additional treatment over time, such as when a filling becomes broken or chipped. Risks for tooth loss as a result of tooth decay and gum disease grow with age, because of many factors. For example, you may have decreased saliva production (dry mouth) from medications taken to treat medical conditions. And, chronic diseases such as diabetes may increase the risk of gum disease. Cognitive or physical limits may make routine brushing and flossing harder, which can get in the way of keeping your teeth healthy. Dental insurance can help make sure you can afford the dental care you need as you get older. If you’re working, you may get dental coverage through your employer. But, once you retire, getting dental coverage may not be as easy.

      Read full article here.
       

    • May
    • FAIR Health to extend allowed amount medical benchmarks: 3 things to know
      May 25, 2017
      beckershospitalreview.com
      FAIR Health, a healthcare data analytics and consumer education firm, is expanding its allowed amount resources this summer.

      Here are three things to know.

      1. Allowed amounts are the maximum a health plan will pay for a covered service.

      2. The organization will create a suite of products comprising allowed amounts for HCPCS, dental, outpatient and anesthesia procedures based on its claims database. FAIR Health's current FH Allowed Medical Benchmarks includes allowed amounts benchmarks for more than 11,000 CPT codes by local market area.

      Read full article here.
       
    • How Can Data Help Us Understand the Growing Opioid Crisis in Ohio?
      May 24, 2017
      bold.global
      From 2007 to 2014, private insurance claim lines with opioid-related diagnoses increased 770 percent in Ohio. The diagnoses were opioid abuse, opioid dependence, heroin overdose and overdose of opioids excluding heroin. Of five of the major cities in the state — Cincinnati, Cleveland, Columbus, Dayton and Toledo — Toledo had the largest increase, at 1,022 percent.

      In this article, we report the findings in terms of “claim lines,” which are the individual services or procedures listed on an insurance claim. “Percent of claim lines” is the percent of all claim lines associated with a specific group of diagnosis codes in a defined time period.

      Read full article here.
       
    • Here's How Much A Medical Birth Costs, Because Your Wallet Is Worried
      May 23, 2017
      romper.com
      When you're expecting, it's completely normal to feel nervous, whether you're thinking about your labor or the inevitable sleepless nights ahead. Here in the United States, expectant moms often have to worry about medical costs, too, especially as healthcare premiums and deductibles increase. If you're trying to plan ahead and calculate your delivery bill, you'll want to know how much a medical birth costs on average at an American hospital.

      Read full article here.

       
    • 57 RCM service expansions so far in 2017
      May 23, 2017
      beckershospitalreview.com
      Fifty-seven companies extended their revenue cycle management portfolios with healthcare vendors and providers so far in 2017.

      33. FAIR Health, a healthcare data analytics and consumer education firm, is expanding its claims database.

      36. FAIR Health unveiled a healthcare pricing resource aimed at providing transparency for costs of common procedures and conditions.

      Read full article here.
       
    • Seguros dentales que salvarán tu sonrisa
      May 16, 2017
      msn.com
      Para muchas personas, desembolsar el dinero para tratar un dolor de dientes puede ser tan doloroso como el diente mismo. Eso se debe a que cerca del 40% de los estadounidenses no tienen un seguro dental, y la mayoría de las personas que lo tienen pierden la cobertura una vez que se jubilan.

      Pero ignorar los problemas dentales u omitir el cuidado preventivo puede hacerte daño. Por ejemplo, algunos estudios sugieren que las infecciones crónicas de las encías están asociadas con un mayor riesgo de sufrir ataques cardíacos.

      Read full article here.
       
    • Opioid epidemic evident in rising insurance claims
      May 14, 2017
      crainscleveland.com
      As the country grapples with the sweeping opioid epidemic, one study offers a different lens through which to view the crisis: private insurance claims.

      In Ohio, private insurance claims that reflected an opioid-dependence diagnosis grew 770% between 2007 and 2014. And in Cleveland, 680%, according to a recently released analysis from FAIR Health, a national nonprofit working toward transparency for health care costs and health insurance information. recent data available.

      Read full article here.
       
    • Florida responds to urgent opioid crisis
      May 11, 2017
      behavioral.net
      Last week, Gov. Rick Scott declared the opioid crisis in Florida a public health emergency. His executive order allows the state to pre-emptively access the first half of a $54 million federal grant that otherwise would not be available until July 1.

      Many in the Florida treatment community thought the move should have happened sooner because the state is seeing such an alarming rise in overdoses.

      In 2015, more than 3,900 deaths in Florida were attributed to opioids, and according to its bureau of vital statistics, in the first six months of 2016 alone, there were 2,664 opioid-related deaths recorded—the most recent data available.

      Read full article here.

       
    • How you can better understand your medical bills so you're not overcharged
      May 11, 2017
      news5cleveland.com
      Patients in our area and around the country are paying too much for their medical bills.

      Billing errors, overcharges and double-billing are racking up thousands in unsubstantiated costs.

      A local case
      "I get that bill again and my heart rate goes up and I'm like, 'you've got to be kidding me,'" said Cindy Crock of Massillon. "Why won't somebody fix this?"

      Read full article here.
       
    • Here's What It Costs to Actually Become a Mother
      May 8, 2017
      fortune.com
      This story originally appeared on money.com.

      Children are priceless, but in the United States, giving birth to one is far from free. When American mothers take their newborns home from the hospital, big bills can follow.

      The average doctor charges for a vaginal delivery with no complications in the U.S. is $3,035, according to data from FAIR Health, a health care nonprofit that keeps a national database of insurance claims. That includes the cost of routine care before and after the birth (but not tests like ultra sounds or amnio). If you want an epidural (which, let's be real, many women do), that's another $2,132 on average. Prices vary considerably depending on where you live. The average cost of a C-Section nationwide is $3,382, plus $1,646 for an epidural, FAIR Health found.

      Read full article here.
       
    • Here's What It Costs to Actually Become a Mother
      May 6, 2017
      money.com
      Children are priceless, but in the United States, giving birth to one is far from free. When American mothers take their newborns home from the hospital, big bills can follow.

      The average doctor charges for a vaginal delivery with no complications in the U.S. is $3,035, according to data from FAIR Health, a health care nonprofit that keeps a national database of insurance claims. That includes the cost of routine care before and after the birth (but not tests like ultra sounds or amnio). If you want an epidural (which, let's be real, many women do), that's another $2,132 on average. Prices vary considerably depending on where you live. The average cost of a C-Section nationwide is $3,382, plus $1,646 for an epidural, FAIR Health found.

      Read full article here.
       
    • Out-of-Pocket X-Ray, CT Scan Costs Vary Widely – News
      May 4, 2017
      thefloridaoracle.com
      SUNDAY, May 15, 2016 (HealthDay News) — The out-of-pocket price for a standard chest X-ray, CT scan or ultrasound can vary by hundreds of dollars, depending on where the imaging is done, new research reveals.

      And uninsured patients trying to get the cost in advance may face an uphill battle, investigators caution, with hospitals slower to respond than stand-alone imaging centers.

      How slow? Calls made to six hospitals and five private imaging centers in the Philadelphia region got answers from half of the hospitals within five to 10 minutes, researchers said. But one-third of the hospitals took between 10 and 15 minutes, while the rest took even longer.

      Read full article here.
       

    • April
    • Concussion protocol key
      April 30, 2017
      leadertelegram.com
      It’s an issue that’s steadily becoming an epidemic in athletics.

      A study by FAIR Health, a nonprofit organization that strives for transparency in health care costs and insurance, found that concussion diagnoses for people under the age of 22 rose 500 percent from 2010 to 2014.

      Read full article here.
       
    • Unlocking Medicare Data Can Enlist Needed Foot Soldiers In The March To Sound Health Care Reform
      April 26, 2017
      forbes.com
      As debate over the Affordable Care Act (ACA) and reforming federal health insurance law feverishly continues in Washington, one thing both sides of the aisle should agree on is the need for greater transparency about health care costs, quality and outcomes. A distinctive private-public partnership is poised to shine a spotlight on what sometimes can seem like a “black box” to patients, providers and insurers working within the system. Through the Qualified Entity Certification Program (QECP), the innovative spirit of the private sector can be brought to bear on questions of intense national importance at this crucial moment.

      Read full article here.
       
    • Obesity in Kids Quadruples Risk of Type 2 Diabetes, Study Finds
      April 26, 2017
      ajmc.com
      A study of English children found that obesity quadruples the risk of developing type 2 diabetes (T2D), adding to the recent evidence that diabetes incidence is rising among youth as the obesity epidemic worsens.

      The study from King’s College of London, appearing in the Journal of the Endocrine Society, examined data from nearly 370,000 children aged 2 to 15 years, whose body mass index (BMI) was measured between 1994 to 2013. During the study period, 654 children in the study developed diabetes, with incidence of T2D rising from 6.4 cases per 100,000 during the early part of the study (1994-1998) to 33.2 per 100,000 during the last 4 years of the study (2009-2013).

      Read full article here.
       
    • Report: FAIR Health most 'reliable' database for benchmarking out-of-network physician rates
      April 21, 2017
      beckershospitalreview.com
      A new study found FAIR Health outperformed other national databases as a reliable source for out-of-network physician rate benchmarking.

      Physicians for Fair Coverage, an alliance of multispecialty groups promoting cost transparency, commissioned the study to address balance billing issues related to insurers' increasingly narrow physician networks. The alliance tapped independent researches from NORC at the University of Chicago — a social research organization — to analyze four national and 15 state databases.

      The researchers evaluated the databases on comprehensiveness, validity and availability, among other characteristics. The researchers also considered how independent the databases were and how much it cost to access their data.

      Read full article here.
       
    • Study: FAIR Health maintains top claims database
      April 21, 2017
      politico.com
      FAIR Health has the most comprehensive paid claims database and is the best resource for settling disputes over out-of-network bills, according to a study by researchers at the University of Chicago being released today. The analysis looked at five different claims databases, including the insurer-aligned Health Care Cost Institute and Blue Health Intelligence. But it found that FAIR Health, a nonprofit group that seeks to improve transparency in the health care system, has the “largest and most geographically widespread database.” The study was paid for by Physicians for Fair Coverage, an alliance of specialty physician groups.

      Read full article here.
       
    • New study supports national database for out-of-network reimbursement
      April 21, 2017
      njbiz.com
      How to reimburse surprise bills has been one of the most contentious points in the out-of-network debate in Trenton in the past year.

      Oscillating between arbitration and capping rates at 250 percent of Medicare, legislators have been unable to find a solution that makes all stakeholders happy.

      Sen. Joe Vitale, chair of the Senate health committee, said recently that arbitration was the fairest option.

      Read full article here.
    • Independent Research Funded by Physicians for Fair Coverage Shows That FAIR Health is a Useful Source of Data for Out-of-Network Physician Charge Benchmarking
      April 21, 2017
      prnewswire.com
      WASHINGTON, April 21, 2017 /PRNewswire-USNewswire/ -- In a new analysis funded by Physicians for Fair Coverage, researchers at NORC at the University of Chicago, an independent research organization, today announced results of a study that found the FAIR Health database currently offers advantages over other national datasets and state All Payers Claims Data (APCDs) for the purpose of identifying a standard benchmark for out-of-network physician rates for medical services. This research relied on publicly available information related to relevant data sources as well as qualitative discussions with data stakeholders.

      Read full article here.
    • Report: Ohio Insurance Claims for Opioid-Related Cases Spike
      April 20, 2017
      newsmax.com
      Insurance claims for opioid abuse, opioid dependence, heroin overdose and overdose of opioids jumped 770 percent in Ohio from 2007 to 2014, according to an analysis by FAIR Health, a national, independent, nonprofit organization aiming to bringing transparency to healthcare costs and health insurance information.

      Toledo had the largest increase, at 1,022 percent.
      The opioid epidemic has hit Ohio hard. According to the state's Department of Health, the number of opioid-related deaths skyrocketed by 775 percent from 2003 to 2015, numbers that include deaths involving prescription opioids, heroin and fentanyl.

      Read full article here.
       
    • Heroin Overdose Insurance Claims Jump 1,078 Percent In Opioid-Plagued Ohio
      April 19, 2017
      dailycaller.com
      Insurance claims for heroin overdoses and dependence are surging in Ohio, one of the states hit hardest by rising rates of opioid abuse and overdose deaths, according to a Wednesday report.

      Private claims for diagnoses including opioid abuse, opioid dependence, heroin overdose and overdose of opioids excluding heroin rose by 770 percent across Ohio between 2007 and 2014. Increases were seen throughout the state, however, Ohio’s five major cities were responsible for the majority of claims made over that period. The analysis by FAIR Health, a national nonprofit advocating healthcare transparency, revealed the largest statewide increase was for heroin overdose claims, which surged by 1,078 percent between 2007 and 2014.

      Read full article here.
       
    • Why Healthcare Is Sick
      April 17, 2017
      wnyc.org
      Elisabeth Rosenthal, a former ER physician, veteran health reporter and current editor-in-chief of Kaiser Health News, joins us to discuss her book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. Rosenthal reveals how the current medical system values profits over patients, and why politicians have little say in reducing costs. She also offers advice to consumers so that they can better navigate the system.

      Listen to the full interview here.

       
    • The Opioid Crisis in Illinois: The View from Private Claims Data
      April 14, 2017
      bold.global
      Abuse of opioids is on the rise. The widespread abuse of heroin and opioid prescription painkillers over the years is often dubbed “The Opioid Crisis.” The epidemic is disproportionately affecting white, middle-class people in non-urban settings, but are we seeing a rise in the abuse of these drugs in U.S. cities?

      Using private insurance claim lines, or individual services or procedures listed on an insurance claim, FAIR Health found an increase in claim lines with opioid abuse and dependence diagnoses in Illinois of 329 percent from 2007 to 2014. Within Chicago alone, the increase was 382 percent, compared to 322 percent for the rest of the state.

      Read full article here.

       
    • Private insurers see surge in opioid-related claims
      April 14, 2017
      mydaytondailynews.com
      Private insurance claims related to heroin overdoses alone jumped 400 percent in one year.

      New health insurance data puts to rest any notion that addiction to opioids like heroin primarily affects the poor.
      In a single year, the number of private health insurance claims related to heroin overdoses in Dayton skyrocketed by more than 400 percent, underscoring the drug’s impact on the affluent and middle-income households that tend to have those policies.

      Read full article here.

       
    • Cuomo Pledges $200 Million To Fight Addiction Amid Opioid Epidemic
      April 10, 2017
      dailycaller.com
      Officials in New York are pledging $200 million to fight opioid addiction running rampant in the state, including with 24-hour treatment centers and a high school for recovering addicts.

      Gov. Andrew Cuomo wants to dedicate the money to combating the opioid epidemic, which claimed 2,431 lives in 2015 in the state. His budget calls for a recovery high school and a number of 24/7 treatment centers, though it is so far vague on specific implementation of such funds, reports WHEC.

      Read full article here.
       
    • The Growing Opioid Crisis: Spotlight on New York Private Claims Data
      April 10, 2017
      realclearhealth.com
      From 2007 to 2014, private insurance claim lines with opioid abuse and dependence diagnoses increased 487 percent in New York State. The greatest increase occurred in the New York City suburbs (Nassau, Rockland, Suffolk and Westchester), where the rise was 1,459 percent—compared to 324 percent for New York City and 310 percent for the rest of the state.

      These dramatic trends were identified when we investigated recent opioid-related data from New York State in our FAIR Health database of over 23 billion privately billed healthcare claims, the largest such repository in the country.*

      Read full article here.
       
    • Lawmaker proposes bill to prevent concussions in youth baseball
      April 9, 2017
      sports.timesunion.com
      Legislation would require children 13 years and younger to wear a helmet with a chin strap, would ban head-first slides

      Major League ballplayers returned to the diamond last week for the first games of the 2017 MLB season.
      But as aspiring Major Leaguers take the field, a state lawmaker wants to modify a few rules of the game for youngsters.
      Assemblyman Michael Benedetto, D-Bronx, is sponsoring legislation that would require children to wear a helmet with a chin strip when they play organized baseball and would prohibit head-first sliding by children 13 years old or younger. The bill does not have a Senate sponsor.

      Read full article here.
       
    • Study: Private insurance claim lines related to opioids rose 1,459% in NYC suburbs
      April 6, 2017
      beckershospitalreview.com
      FAIR Health, a nonprofit healthcare data analytics and consumer education firm, recently used its national database to examine private insurance claims in New York state between 2007 and 2014. What the firm found was a substantial increase in such claims in New York City, the city's suburbs and the rest of the state.

      Here are three study findings.

      1. FAIR Health found private insurance claim lines with opioid abuse and dependence diagnoses increased during the study time period by 1,459 percent in the New York City suburbs of Nassau, Rockland, Suffolk and Westchester counties, according to a news release from the firm.

      Read full article here.
       
    • Insurance Claims For Opioids Skyrocket 1,459 Percent In NY Suburbs
      April 6, 2017
      dailycaller.com
      Private insurance claims for opioid abuse and dependence are skyrocketing in the suburbs of New York, far outpacing claims in New York City and the rest of the state.

      Private claims shot up an alarming 1,459 percent between 2007 and 2014 across Nassau, Rockland, Suffolk and Westchester counties, which represents roughly 21 percent of the state population. An analysis by FAIR Health, a national non-profit advocating healthcare transparency, found the rate of private opioid abuse claims nearly tripled the overall rate across the state, which increased by 487 percent over the same time period.

      Read full article here.
       
    • Health Care Reform on Hold: Now What?
      April 6, 2017
      realclearhealth.com
      The American Health Care Act (AHCA) was pulled from the House floor before an expected vote and efforts to repeal or reform the Affordable Care Act, or “Obamacare,” could be suspended for some time. The future of health care law reform efforts remains uncertain—but confusion is nothing new to Americans navigating the complexities of health care delivery and payment. No matter the outcome last month, Americans were still going to wake up this morning with complicated decisions to make about their health care. As we move forward, continuing to make these difficult decisions, individuals and policymakers will grapple with managing and navigating intricate inter-related health care delivery and payment systems. These policy decisions should be taken seriously as they affect individuals, families, and the health and wealth of our nation.

      Read full article here.
       
    • Private insurers in New York see surge in claims related to opioid addiction
      April 5, 2017
      modernhealthcare.com
      Data obtained by Crain's reveal alarming regional trends in opioid abuse and dependence in New York.

      Private insurance claims for emergency room visits, substance use treatment and other services related to opioid addiction surged in New York state between 2007 and 2014, well before the latest coverage mandates took effect, new data show.

      During that period, the number of claims related to opioid abuse and dependence—two similar but distinct diagnoses—increased 487%, with the sharpest increase taking place between 2011 and 2014, according to a report provided to Crain's by the health care transparency group Fair Health, which has the largest private health claims database in the country.

      Read full article here.
       
    • Private insurers in the state see surge in claims related to opioid addiction
      April 5, 2017
      crainsnewyork.com
      Data obtained by Crain's reveal alarming regional trends in opioid abuse and dependence in New York.

      Private insurance claims for emergency room visits, substance use treatment and other services related to opioid addiction surged in New York state between 2007 and 2014, well before the latest coverage mandates took effect, new data show.

      During that period, the number of claims related to opioid abuse and dependence—two similar but distinct diagnoses—increased 487%, with the sharpest increase taking place between 2011 and 2014, according to a report provided to Crain's by the health care transparency group Fair Health, which has the largest private health claims database in the country.

      Read full article here.
       
    • Alternative Places of Service: An Era of Rapid Growth
      April 4, 2017
      sipconline.net
      Where once consumers would have gone to a doctor’s offce or hospital, they are increasingly seeking healthcare from alternative places of service. They may visit a retail clinic, an urgent care center or an ambulatory surgery center (ASC), or they may receive care at home or via telehealth. Understanding the growth in consumer choices in settings for care and the trends in costs associated with them can inform nearly every aspect of the design of health coverage, including the structure of benefts plans, formation and selection of networks and the use of communications to drive member behavior. As organizations that carry the risks of their members’ healthcare, self-insurers may want to explore how these alternative places of service can keep costs down while ensuring that members get the care they need.

      Read full article here.
       

    • March
    • 15 RCM companies with service expansions in March
      March 31, 2017
      beckershospitalreview.com
      Here are 15 companies that extended their revenue cycle management portfolios for healthcare vendors and providers in March.

      11. FAIR Health, a healthcare data analytics and consumer education firm, is expanding its claims database.

      14. FAIR Health unveiled a healthcare pricing resource aimed at providing transparency for costs of common procedures and conditions.

      Read full article here.
       
    • Bundled Payments And Episodes Of Care: What's Next
      March 30, 2017
      forbes.com
      The change in presidential administration has caused some confusion about the future of Medicare’s bundled payment initiatives. Before becoming secretary of health and human services (HHS), Tom Price spoke out against Medicare’s mandatory bundled payment initiatives. Furthermore, it was reported that he was likely to “pull the plug” on a mandatory five-year pilot, scheduled for launch on July 1, to hold hospitals in 98 markets financially accountable for the cost and quality of care associated with bypass surgery and heart attacks. But, in February, an HHS spokesman said the launch would go forward as scheduled.

      Read full article here.
       
    • Negotiating Your Medical Bills
      March 30, 2017
      wnyc.org
      Diane Spicer, supervising attorney of Community Health Advocates at the Community Service Society, joins us to guide listeners on understanding their medical bills and how to negotiate medical expenses.

      Spicer advises to first make sure that your insurance company was correct in its billing statement prior to negotiating. Check out fairhealth.org for a compilation of what the average rates are for medical services. Then, check to see who is sending the bill.

      Read full article here.
       
    • Insurance Claims For Opioid Abuse Up 329 Percent In Chicago
      March 29, 2017
      dailycaller.com
      Private insurance claims related to opioid abuse are skyrocketing in Illinois.

      Claims for opioid abuse and dependence diagnoses increased by 329 percent in Illinois from 2007 to 2014 alone, according to data released Wednesday by Fair Health. In fact, opioid-related claims jumped by 382 percent in Chicago alone.

      While Chicago’s figures present a stark contrast between that of the rest of the state, the reality is not as severe as the numbers portray. The city’s claims did increase at a faster rate than the state of Illinois, but, based on population, the city’s proportion of opioid-related claims is much smaller than the state’s.

      Read full article here.
       
    • Here's a measure of the opioid problem in Chicago and Illinois
      March 29, 2017
      chicagobusiness.com
      We already know that opioid abuse presents a spiraling crisis across the U.S. Now, newly available data from private insurance claims shows just how much prescription pain reliever and heroin abuse has impacted Chicago and all of Illinois.

      Private insurance claims related to opioid abuse and dependence diagnoses increased 329 percent in Illinois between 2007 and 2014, according to data from Fair Health, a New York-based nonprofit that seeks to increase transparency in health care costs.

      In Chicago alone, such claims increased 382 percent over the seven-year period.

      Read full article here.
       
    • 9 RCM companies with recent service expansions
      March 27, 2017
      beckershospitalreview.com
      Here are nine companies that extended their revenue cycle management portfolios for healthcare vendors and providers so far in March.

      5. FAIR Health, a healthcare data analytics and consumer education firm, is expanding its claims database.

      8. FAIR Health unveiled a healthcare pricing resource aimed at providing transparency for costs of common procedures and conditions.

      Read full article here.
       
    • Nation's Largest Private Healthcare Database Acquires All Medicare Claims Data
      March 27, 2017
      pharmacychoice.com
      By a News Reporter-Staff News Editor at Managed Care Weekly Digest Newswire/ FAIR Health announced that as a result of its designation last year by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity (QE), it is adding four full years of Medicare claims data to its database of more than 23 billion private healthcare claims. FAIR Health is one of only four organizations certified by CMS under its Qualified Entity Certification Program (QECP) to receive Medicare Part A (hospital and facility services), Part B (medical services) and Part D (prescription drug services) claims data for all 50 states and the District of Columbia. To date, FAIR Health has received from CMS 100 percent of claims for Parts A and B services rendered nationwide from January 2013 through September 2016, and all Part D claims from 2013 through 2015. FAIR Health expects to receive the balance of the data by April 2017, giving the organization all Parts A, B and D claims from 2013 through 2016. Moving forward, FAIR Health is scheduled to receive Parts A and B data quarterly and Part D data annually (see also FAIR Health).

      Read full article here.
       
    • 5 Ways To Handle A Surprise Medical Bill
      March 24, 2017
      moneyunder30.com
      Even when you have insurance, you’re not always covered.

      An unexpected surgery, outpatient procedure, or ER visit may come with unforeseen medical bills. Nearly a third of Americans have gotten a medical bill they didn’t expect. For 43 million Americans in 2014, these and other bills led to medical debt reported to the credit bureaus, according to the Consumer Financial Protection Bureau.

      How do you deal with a surprise medical bill you didn’t expect (and might not even understand)?

      Read full article here.
       
    • Skyrocketing healthcare costs: Do your research
      March 22, 2017
      abcactionnews.com
      ST. PETERSBURG, Fla. - Healthcare costs continue to soar nationwide, including in Tampa Bay. As our nation’s leaders debate over the Affordable Care Act, one big concern is that prices could go up for the procedures you need.

      Read full article here.
       
    • Entrevista con la Robin Gelburd (Estados Unidos): Diabetes tipo 2 y obesidad infantil
      March 22, 2017
      infobioquimica.com
      En esta entrevista nos habla sobre el aumento marcado de diabetes tipo 2 en la población pediátrica.

      Robin Gelburd es Presidente de FAIR Health, organización sin fines de lucro con la misión de aportar transparencia a los costos de atención médica y reembolso de seguros, en los Estados Unidos.
      Ha sido Asesor General de una fundación dedicada a la investigación médica y presidenta de una coalición estatal para el adelanto de la investigación en salud.
      En esta entrevista nos habla sobre el aumento marcado de diabetes tipo 2 en la población pediátrica.

      Read full article here.
       
    • 7 RCM keynotes
      March 22, 2017
      beckershospitalreview.com
      Here are seven recent updates on revenue cycle management companies.
      5. FAIR Health adds 4 years of Medicare claims data
      FAIR Health, a healthcare data analytics and consumer education firm, is expanding its claims database.

      Read full article here.
       
    • Nation's largest private health care database acquires all Medicare claims data
      March 17, 2017
      eurekalert.org
      New York, NY--March 15, 2017--FAIR Health announced today that as a result of its designation last year by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity (QE), it is adding four full years of Medicare claims data to its database of more than 23 billion private healthcare claims. FAIR Health is one of only four organizations certified by CMS under its Qualified Entity Certification Program (QECP) to receive Medicare Part A (hospital and facility services), Part B (medical services) and Part D (prescription drug services) claims data for all 50 states and the District of Columbia. To date, FAIR Health has received from CMS 100 percent of claims for Parts A and B services rendered nationwide from January 2013 through September 2016, and all Part D claims from 2013 through 2015. FAIR Health expects to receive the balance of the data by April 2017, giving the organization all Parts A, B and D claims from 2013 through 2016. Moving forward, FAIR Health is scheduled to receive Parts A and B data quarterly and Part D data annually.

      Read full article here.
       
    • New healthcare pricing resource quantifies costs of complete episodes of care
      March 17, 2017
      insurancenewsnet.com
      By a News Reporter-Staff News Editor at Insurance Weekly News -- New York, NY--FAIR Health announced the availability of its FH® Episodes of Care Benchmarks product--an innovative resource that sheds new light on the costs related to the full range of services associated with common procedures and conditions.

      This new dataset offers both benchmark charges and allowed costs, specific to 493 regions across the country, for procedures related to defined episodes. The benchmarks are based on market-level data from privately billed healthcare claims contributed to FAIR Health by insurers and claims administrators; they represent the claims experience of more than 150 million individuals nationwide.

      Read full article here.
       
    • FAIR Health adds 4 years of Medicare claims data
      March 16, 2017
      beckershospitalreview.com
      FAIR Health, a healthcare data analytics and consumer education firm, is expanding its database of private claims.
      Here are five things to know.

      1. The firm's database will soon have an additional four years of national Medicare claims data, according to a news release.

      2. The addition will include all Medicare Parts A, B and D claims data from 2013 through 2016.

      Read full article here.
       
    • Claims data vendor adds 4 years of Medicare billing info
      March 15, 2017
      healthdatamanagement.com
      FAIR Health, which operates the largest repository holding private health care and dental claims, totaling some 23 billion records, now is adding four recent years of Medicare claims data to its holdings.

      Last year, the Centers for Medicare and Medicaid Services designated FAIR Health as a qualified entity to receive Medicare data. Now, the company is one of four vendors certified by CMS to receive claims for Medicare Parts A, B and D that the agency receives from across the nation.

      Read full article here.
       
    • FAIR Health Acquires Medicare Parts A, B, D Data
      March 15, 2017
      workcompcentral.com
      FAIR Health has acquired four years of Medicare claim data, the health care data organization announced in a press release Wednesday.

      The nonprofit has been approved to receive Medicare Part A, Part B and Part D claims data for all 50 states and Washington, D.C. The data concerns the experience of 55 million people receiving Medicare Parts A and B coverage

      Read full article here.
       
    • Nation's Largest Private Healthcare Database Acquires All Medicare Claims Data
      March 15, 2017
      newyork.citybizlist.com
      FAIR Health announced today that as a result of its designation last year by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity (QE), it is adding four full years of Medicare claims data to its database of more than 23 billion private healthcare claims. FAIR Health is one of only four organizations certified by CMS under its Qualified Entity Certification Program (QECP) to receive Medicare Part A (hospital and facility services), Part B (medical services) and Part D (prescription drug services) claims data for all 50 states and the District of Columbia. To date, FAIR Health has received from CMS 100 percent of claims for Parts A and B services rendered nationwide from January 2013 through September 2016, and all Part D claims from 2013 through 2015. FAIR Health expects to receive the balance of the data by April 2017, giving the organization all Parts A, B and D claims from 2013 through 2016. Moving forward, FAIR Health is scheduled to receive Parts A and B data quarterly and Part D data annually.

      Read full article here.
       
    • Connecticut sees sharp increase in overdose deaths of young women
      March 15, 2017
      theday.com
      The number of women, especially young women, who died of overdoses was substantially higher last year than in the year before, leading at least one organization in the region to seek a new way to target the problem.

      A deeper look at data the state Office of the Chief Medical Examiner released last month reveals sharp increases in the number of young women who died of overdoses in 2016 versus the year before.

      Notably, there was a 385.7 percent increase — from seven to 34 — in the number of women aged 25 to 34 who died of fentanyl-related overdoses. That’s compared to a 134.8 percent increase among men the same age.

      Read full article here.
       
    • 4 RCM companies with recent service expansions
      March 14, 2017
      beckershospitalreview.com
      Here are four companies that extended their revenue cycle management portfolios for healthcare vendors and providers so far in March.

      1. Columbia, S.C.-based Palmetto Health will expand its Cerner Millennium Revenue Cycle platform across four of its acute care facilities.

      2. Medical and radiation oncology consulting firm Revenue Cycle plans to merge with Coding Strategies, a healthcare coding and compliance education and consulting firm.

      3. FAIR Health, a healthcare data analytics and consumer education firm, unveiled a healthcare pricing resource aimed at providing transparency for costs of common procedures and conditions.

      Read full article here.
       
    • Five Ways to be a Savvy Medical Tourist and Enjoy a Vacation
      March 10, 2017
      sanjuanweeklypr.com
      Let’s get this out of the way: I’m not in the business of giving medical advice. I can’t say if traveling abroad for dental work — or a hip replacement or open-heart surgery — is wise, safe or worthwhile for you. Only your dentist or doctor can and, unfortunately for my bank account, I’m neither. What I am is a working parent who would rather spend my savings on a vacation than on a root canal. Call me crazy. So when costly dental work became unavoidable, I was willing to consider getting it done overseas and letting the savings from lower-cost care pay for a week on a tropical Thai island. My conclusion? Medical tourism is not for everyone, but it’s not as crazy as it sounds. I would do it again.

      Read full article here.
       
    • Five Ways to be a Savvy Medical Tourist and Enjoy a Vacation
      March 8, 2017
      nytimes.com
      Let’s get this out of the way: I’m not in the business of giving medical advice. I can’t say if traveling abroad for dental work — or a hip replacement or open-heart surgery — is wise, safe or worthwhile for you. Only your dentist or doctor can and, unfortunately for my bank account, I’m neither. What I am is a working parent who would rather spend my savings on a vacation than on a root canal. Call me crazy. So when costly dental work became unavoidable, I was willing to consider getting it done overseas and letting the savings from lower-cost care pay for a week on a tropical Thai island. My conclusion? Medical tourism is not for everyone, but it’s not as crazy as it sounds. I would do it again.

      Read full article here.
       
    • Hospital Impact: Benchmarks for episodes of care create opportunities for providers
      March 7, 2017
      fiercehealthcare.com
      For years, people have talked about defining medical treatments as comprehensive episodes of care as a way to base reimbursement on value rather than on volume. As long ago as the early 1990s, Medicare sponsored (PDF) a pilot program in which it paid a single, negotiated amount for an episode of coronary artery bypass graft surgery (CABG). Yet episodes of care remain somewhat underused by medical administrators and practice managers—despite the benefits they may offer.

      Read full article here.
       
    • Tips for Researching & Evaluating Dental Insurance Plans
      March 7, 2017
      advisoryhq.com
      If our top dental insurance picks don’t fit the bill, you may be inclined to perform your own research. When trying to compare dental insurance plans, there are a few expert tips that can make the search for the best dental plans a painless, productive process.

      Research Your Area
      Before finding dental insurance plans, it may be helpful to understand the cost of procedures. Using the FAIR Health Consumer Cost Lookup or a Dental Cost Estimator can provide region-specific estimates on procedural costs.
      Looking at the cost of dental procedures can provide guidance when searching for dental insurance quotes. The best dental insurance for you may be comprehensive or simply for preventative procedures, depending upon average out-of-pocket cost.

      Read full article here.
       
    • FAIR Health launches healthcare pricing guide: 7 things to know
      March 6, 2017
      beckershospitalreview.com
      FAIR Health, a healthcare data analytics and consumer education firm, unveiled a healthcare pricing resource aimed at providing transparency for costs of common procedures and conditions.

      Here are seven things to know.

      1. The resource is called FH Episodes of Care Benchmarks.

      Read full article here.
       
    • Virginia physician practice taps McKesson for RCM, Parasail Health releases financing app & more — 6 RCM key notes
      March 6, 2017
      beckershospitalreview.com
      Here are six recent updates on revenue cycle management companies.

      1. Parasail Health, a patient financing provider, released a financing app for medical bills.

      2. Revenue cycle management company Syncordia Technologies and Healthcare Solutions unveiled a new software as a solutions offering.

      Read full article here.
       

    • February
    • DrExit: Costs of A Hospital Monopoly in One Underserved County
      February 28, 2017
      thehealthcareblog.com
      There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance, and government.  It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs, and ultimately reduce care quality as a result.  Lawmakers should focus on this “first pillar” of cost control as they go back to the drawing board.

      In 2010, there were 66 hospital mergers in this country. Since the Affordable Care Act went into effect the rate of hospital consolidation has increased by 70 percent. By creating incentives for physicians and health providers to coordinate under accountable care organizations (ACOs), the ACA hindered the ability of regulators to block hospital mergers while incentivizing hospital consolidation.

      Read full article here.
       
    • 5 Quick Tips on How to Budget for Healthcare Costs
      February 22, 2017
      bold.global
      It always makes sense to plan for the costs that may be coming your way — and how to pay for them. Why not make a budget to plan for your healthcare costs?
      One reason people may hesitate is that healthcare is less predictable than other costs, such as groceries and utilities. You can’t know ahead of time whether someone in your family will break a leg or whether a chronic illness will worsen. But, if you have health insurance, the costs can be somewhat more predictable.

      Tip #1: Fixed Cost
      You know what your premium will be — or your share of the premium, if your employer contributes part. That’s the charge (often monthly) for maintaining your health insurance. If you get health insurance through your job, you may have this charge automatically deducted from your paycheck. That’s the fixed cost aspect of your healthcare budget.

      Read full article here.
       
    • How obesity and related conditions are skyrocketing
      February 16, 2017
      contemporarypediatrics.modernmedicine.com
      Children are struggling with obesity more than ever before, and a new study has the numbers to prove it.
      According to a new report from the not-for-profit FAIR Health, both obesity and diabetes mellitus are increasing in the pediatric population, putting kids at risk for a host of other obesity-related conditions.

      FAIR Health researchers reviewed 5 years of health insurance claims data from 2011 to 2015 to identify trends in obesity and diabetes among the nation’s insured children and adolescents. The organization found that both obesity and diabetes claims increased annually during the study period. Diabetes diagnoses more than doubled in individuals from birth to age 22 years over the study period, increasing a total of 109%.

      Read full article here.
       
    • Dental Insurance That Will Save Your Smile
      February 10, 2017
      finance.yahoo.com

      For many people, doling out the cash to get a toothache treated can hurt almost as much as the tooth itself. That’s because about 40 percent of Americans lack dental insurance, and most who have a dental plan lose that coverage once they retire.
      But ignoring dental problems or skipping preventive care can harm you. For instance, some studies suggest that chronic gum infection is associated with an increased risk for heart attack.
      Read full article here

    • Individual Dental Insurance: 2017 Guide to the Best Dental Insurance Plans for Individuals
      February 9, 2017
      advisoryhq.com

      You bite down into your delicious dinner and…ouch. An unexpected ache emerges in the back of your jaw. And if you don’t have the proper dental insurance for individuals, that pain can spread to your wallet.
      A sudden toothache and your ensuing visit to a dentist can drain your bank account if you lack individual full coverage dental insurance. Even a simple cavity can be costly, while more complicated dental work like a root canal carries an even heftier price tag. Individual dental insurance could be one of the most underrated medical investments a person can make—and can save you beaucoup bucks.

      Read full article here
    • Out-of-Network Billing: ‘Surprise Billing’ Or ‘Surprise Gaps in Insurance Coverage’?
      February 9, 2017
      anesthesiologynews.com

      This is a familiar story: A patient with health insurance has an accident and seeks care at a hospital. She receives care in the ER and undergoes an operation. The health care team provides the necessary care, regardless of her health insurance policy. After discharge from the hospital, she receives an unexpected bill from the ER, surgeon and anesthesiologist. Her family wonders why she received separate bills from her providers, because she has health insurance that she thought covered emergency treatment.

      Read full article here
    • Want to stretch your healthcare dollars? Learn about flexible spending plans
      February 8, 2017
      thehill.com
      Saving money for healthcare expenses is a simple idea. But, there are ways to save money that, although a little more complex, give you more money to save. That’s the idea behind flexible spending plans.
      Read full article here
    • 3 Ways Physicians Can Address Patients’ Financial Worries
      February 2, 2017
      fiercehealthcare.com
      Just as doctors talk to patients about the pros and cons of treatment options, they need to be prepared to discuss the costs of care from tests to prescription medications.
      When patients are hit with unexpected medical bills, they may become worried about the expense and stop making appointments, taking medications or following treatment plans, according to Managed Healthcare Executive.
      Read full article here
    • Do physicians dismiss patients’ financial concerns?
      February 1, 2017
      managedhealthcareexecutive.modernmedicine.com
      Root of the problem
      One reason physicians don’t discuss out-of-pocket costs as much as they should is because they’re busy, says Ubel. But focusing on treating a condition without discussing costs can have serious implications. Take diabetes, for example, he says. If a physician wants his or her patient to try a new medication to lower their blood sugar, and the physician hasn’t taken the time to screen for the patient’s financial concerns, the patient may stop taking the medication or not fill the prescription.
      Read full article here

    • January
    • CT Viewpoints: ‘Driver’s Ed’ needed for understanding Connecticut health insurance
      January 31, 2017
      ctviewpoints.org

      Before receiving a driver’s license, those who undergo this rite of passage must first receive driver’s education that prepares them for the challenges of the road. Yet there is no similar educational prerequisite that prepares healthcare consumers for using health coverage before receiving their health insurance ID cards. Just as an uneducated driver is more likely to be involved in a mishap on the road, a healthcare consumer who does not understand health insurance is at greater risk for adverse financial and/or clinical consequences when navigating the complex and evolving healthcare landscape.
      Read full article here 

    • Opioid Crisis Brings Paradigm Shift
      January 30, 2017
      behavioral.net
      The increasing rate of opioid addiction might be grabbing the headlines lately, but it is not news to addiction treatment professionals. Clearly, the significantly increased attention is bound to bring changes, challenges and opportunities as various stakeholders look for ways to address the crisis
      Read full article here 
    • ‘Driver’s ed’ needed for understanding health insurance
      January 30, 2017
      nhregister.com
      Before receiving a driver's license, those who undergo this rite of passage must first receive driver's education that prepares them for the challenges of the road. Yet there is no similar educational prerequisite that prepares healthcare consumers for using health coverage before receiving their health insurance ID cards. Just as an uneducated driver is more likely to be involved in a mishap on the road, a healthcare consumer who does not understand health insurance is at greater risk for adverse financial and/or clinical consequences when navigating the complex and evolving healthcare landscape.
      Read full article here 
    • Why Millennials Need to Think About Health Insurance Differently
      January 27, 2017
      thebalance.com
      Millennials do a lot of things differently from the older generations. And health care is no exception.
      As a general rule, millennials are more cost-conscious, meaning they’re more likely to inquire about the cost of treatments and coverage before receiving them.
      Read full article here 
    • 8 ways consumers can control their personal healthcare costs
      January 26, 2017
      thehill.com

      Everyone talks about how healthcare costs are rising. But there are ways for you to control your healthcare costs. Here are eight such ways.
      1. Prevent illness
      Living a healthy lifestyle is good for both your health and your wallet. That includes adopting a good diet and exercise regimen, and, if you smoke, quitting. It also includes taking advantage of free preventive services. Under current law, most health insurers are required to cover certain preventive services, such as cancer screenings and immunizations, for free.

      Read full article here.

    • How price transparency will improve health care
      January 24, 2017
      tennessean.com

      Do you want to buy a car only knowing the first month’s payment? Would you shop at a store that would not give you the full price of your purchase until the bill arrived in the mail?

      Americans are doing this every day when it comes to spending on health care. Since the passage of the Affordable Care Act in 2010 the focus has been on access to health care. Access to health care is in the revitalization process across the nation, but is access the only problem Americans face when it comes to health care?

      Read full article here.

    • Health claims on the rise for kids’ with Type 2 diabetes, obesity-related conditions
      January 24, 2017
      post-gazette.com

      It’s no secret that American children have gotten fatter in recent decades.

      Now a new study joins earlier research showing the consequences: A sharp rise in insurance claims for youth with Type 2 diabetes, high blood pressure and other conditions more often associated with older adults.

      Read full article here.

    • Health claims on the rise for kids with Type 2 diabetes
      January 23, 2017
      startribune.com

      It's no secret that American children have gotten fatter in recent decades.

      Now a new study joins earlier research showing the consequences: a sharp rise in insurance claims for youth with Type 2 diabetes, high blood pressure and other conditions more often associated with older adults.

      Read full article here.

    • Obesity and Type 2 Diabetes Claims Rise Sharply in Pediatric Population
      January 23, 2017
      medicalresearch.com
      MedicalResearch.com: What is the background for this study? What are the main findings?

      Response: For more than 20 years, an epidemic of obesity has been contributing to increasing rates of type 2 diabetes in the United States. During at least part of that period, both conditions have been found to be rising in young people as well as adults. Using our FAIR Health database of billions of privately billed healthcare claims, we sought to ascertain recent trends in obesity and obesity-related conditions (including type 2 diabetes) in the national, privately insured, pediatric population, which we defined as spanning the ages from 0 to 22 years. Our study period was the years 2011 to 2015.

      Read full article here.

       
    • Diabetes, Obesity-Linked Disorders Double in Kids
      January 20, 2017
      medscape.com
      The number of children and adolescents diagnosed with type 2 diabetes more than doubled in recent years, and the increase appears to be coincident with a rise in obesity rates and other obesity-related conditions, according to an analysis of private insurance claims data.

      "States varied in the prevalence of claims associated with pediatric type 2 diabetes and in the prevalence of nondiabetic, obesity-related, pediatric diagnoses — but there appeared to be a relationship between the two," the study authors write.

      Read full article here.
       
    • Type 2 diabetes among youth doubles over 5 years, troubling for later cancer risk
      January 19, 2017
      blog.aicr.org
      Among kids, teens and young adults, private insurance claims for type 2 diabetes more than doubled from 2011 to 2015, according to a new paper from an organization that analyzes healthcare costs and insurance. Obesity claims also increased during this same time period.

      The report from FAIR Health adds to the concerning data on obesity and diabetes among youth. While obesity among children has leveled off in recent years, the increase over the past several decades now means more than one in three children and adolescents are overweight or obese.

      Read full article here.
       
    • More Needs to be Done to Address the Severity of Concussions
      January 19, 2017
      psychologytoday.com
      Despite the fact that all 50 states and the District of Columbia have enacted state legislatures to address youth sports-related concussions since 2007, the prevalence and potential repercussions of these kinds of head injuries is more concerning than ever before.

      Since their brains and bodies are still developing, young athletes are more susceptible to concussions and the adverse effects associated with them. In fact, well over half of emergency room visits for children (ages 8 to 13) are tied to sports-related concussions, with each incident exposing the child to potential brain injury or damage.

      Read full article here.
       
    • Brace Yourself: A Guide to Orthodontia Reimbursement
      January 18, 2017
      dentistrytoday.com
      Those of us who wore braces when we were younger can thank our orthodontists for the straight teeth we have now. And, the growing number of people who have had their teeth straightened as adults are also indebted to their orthodontists. But today’s families may hesitate before getting necessary treatment because of the costs and the complications involving insurance and payment.

      Many dental plans cover orthodontics, but the coverage often differs from other dental services. Patients will usually pay a higher share of the cost, coverage may be limited to children, and there is often a lifetime maximum. Helping the families you treat understand the details of their plan and their payment options now can help them get ready for the time when they may need orthodontic care.

      Read full article here.
       
    • Surprised by a medical bill? Here's what to do
      January 17, 2017
      cnn.com
      In 2013, Kelly A. Kyanko gave birth to her second son. During labor, her doctors became aware of "a very small complication," she said -- nothing too concerning, but doctors wanted a pediatrician in the room during the delivery.

      "I'm not exactly going to say 'no' to that, right? Obviously I was in a lot of pain and it was a very stressful time so I wasn't in any position to be saying yes or no to the doctors around me and what they thought was best," said Kyanko, herself a doctor and an assistant professor at New York University School of Medicine.

      Read full article here.
       
    • Study: Sharp Spike in Obesity-Linked Diagnosis Among Kids, Teens
      January 17, 2017
      newsmax.com
      Kids and teens have gotten heavier over the last decade, noted by a sharp rise in health insurance claims over the last five years filed on behalf of young people who have high blood pressure, Type 2 diabetes, sleep apnea and other conditions associated with older adults, a new study finds.

      FAIR Health analyzed data from a large national database of health claims paid by about 60 insurers from 2011 to 2015 and found the following:
      • The percentage of infants and toddlers to adults with claims of obesity-related diagnosis increased annually in all age groups.

      Read full article here.
       
    • Study: Sharp Spike in Obesity-Linked Diagnosis Among Kids, Teens
      January 17, 2017
      healthmedicinet.com
      Kids and teens have gotten heavier over the last decade, noted by a sharp rise in health insurance claims over the last five years filed on behalf of young people who have high blood pressure, Type 2 diabetes, sleep apnea and other conditions associated with older adults, a new study finds.

      FAIR Health analyzed data from a large national database of health claims paid by about 60 insurers from 2011 to 2015 and found the following:

      Read full article here.
       
    • Obesity Claims For Youth Are Rising Dramatically
      January 16, 2017
      dailycaller.com
      Youth insurance claims for obesity increased 154 percent between 2011 and 2014, according to a recent study from FAIR Health.

      For the past twenty years, a wave of obesity has swept across the U.S. In point of fact, the prevalence of obesity in adults 18 and older was under 18 percent in all but two states as recently as 1994. Twenty years later, in 2014, no state had less than 18 percent prevalence. Across all age groups, the percent of insurance claims with an obesity diagnosis increased from 2011 to 2015. The greatest increase — 154 percent — occurred in those aged between 19 and 22 years.

      Read full article here.
       
    • Insurance claims and obese children
      January 16, 2017
      kimt.com
      ROCKWELL, IOWA –  Health insurance companies are seeing an uptick in the number of claims being filed, but who they’re being filed for and why may surprise you.

      Childhood obesity is not a new problem, especially in the United States, but the number of children developing obesity-related conditions is a growing trend.

      According to a study done by non-profit Fair Health, insurance claims for type 2 diabetes among people younger than 23 years old more than doubled between 2011 and 2015.

      Read full article here.
       
    • Insurance Claims With Pediatric Type 2 Diabetes More Than Doubled from 2011 to 2015
      January 15, 2017
      medindia.net
      Type 2 diabetes is more commonly associated with adults. However, its frequency has markedly increased in the pediatric age group.

      Private health insurance claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population (ages 0 to 22 years) from 2011 to 2015, increasing 109%, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information.

      Read full article here.
       
    • Diabetes Among Kids Growing Alarmingly, Warns Study of 2011 vs 2015
      January 14, 2017
      microfinancemonitor.com
      Based on private health insurance claims with a type 2 diabetes diagnosis, a study said the incidence of the disease has more than doubled in the pediatric population or children aged 0 to 22 years.

      Between 2011 and 2015, diabetes among children and yougnsters increased 109 percent, according to data from FAIR Health, a nonprofit dedicated to bringing transparency to healthcare costs and health insurance information in the US.

      In a new FAIR Health white paper, Obesity and Type 2 Diabetes as documented in private claims runs counter to the common appellation of “adult-onset diabetes” for type 2 diabetes.

      Read full article here.
       
    • The growing incidence of obesity and Type 2 diabetes in young people
      January 13, 2017
      origin-nyi.thehill.com
      As the new year begins, many people make resolutions, often having to do with weight. In a country where 71 percent of adults age 20 years and over are overweight or obese, according to the Centers for Disease Control and Prevention (CDC), it is no wonder that adults are resolving to eat more healthfully, exercise more and lose weight. But, as adults strive to adopt healthier habits, it is important for them not to forget their children. Children too have been increasing in weight. Indeed, as revealed in a new white paper from FAIR Health, Obesity and Type 2 Diabetes as Documented in Private Claims Data: Spotlight on This Growing Issue among the Nation’s Youth, over the years from 2011 to 2015 obesity became a more serious problem for the nation’s young people, as did type 2 diabetes, to which obesity contributes.

      Read full article here.
       
    • Insurance claims for youth with type 2 diabetes doubled from 2011 to 2015, study finds
      January 13, 2017
      beckershospitalreview.com
      Youth health insurance claims for conditions more often seen in older adults — like high blood pressure, type 2 diabetes and sleep apnea — are climbing, a study by Fair Health found.

      Fair Health analyzed health insurance claims from more than 60 insurers covering about 150 million people from 2011 to 2015. The study focused on claims for youth diagnosed with obesity or type 2 diabetes and claims associated with those patients, excluding claims submitted by government payers like Medicaid.

      The CDC estimates only 0.25 percent of individuals under the age of 20 have type 1 or type 2 diabetes.

      Here are four findings from the study.

      Read full article here.
    • Vermont among lowest for pediatric type 2 diabetes
      January 13, 2017
      vermontbiz.com
      Vermont Business Magazine Tightly related to obesity, pediatric type 2 diabetes diagnoses have climbed rapidly in the US. But Vermont and New Hampshire continue to be among the states with the lowest rates in the nation. Private health insurance claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population (ages 0 to 22 years) from 2011 to 2015, increasing 109 percent, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. Boys were diagnosed with type 2 more than girls, while girls have a higher incidence of obesity.

      This finding, reported in the new FAIR Health white paper, Obesity and Type 2 Diabetes as Documented in Private Claims Data: Spotlight on This Growing Issue among the Nation's Youth, runs counter to the common appellation of "adult-onset diabetes" for type 2 diabetes.

      Read full article here.
       
    • White paper: Diabetes diagnoses doubles across pediatric population
      January 13, 2017
      drugstorenews.com
      NEW YORK  — Private health insurance claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population (ages 0 to 22 years) from 2011 to 2015, increasing 109%, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information.

      This finding, reported in the new FAIR Health white paper, runs counter to the common appellation of "adult-onset diabetes" for type 2 diabetes.

      Read full article here.
       
    • US Childhood Type 2 Diabetes Rises 109% Between 2011 and 2015
      January 13, 2017
      nutritioninsight.com
      13 Jan 2017 --- Type 2 diabetes diagnosis has more than doubled in the pediatric population (ages 0 to 22 years) from 2011 to 2015, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information.

      The upsurge in diagnoses represents a 109 percent increase.

      The finding, reported in the new FAIR Health white paper, Obesity and Type 2 Diabetes as Documented in Private Claims Data: Spotlight on This Growing Issue among the Nation's Youth, runs counter to the common appellation of "adult-onset diabetes" for type 2 diabetes.

      Read full article here.
       
    • Sharp Increase Of Type 2 Diabetes Seen Among US Youth Population
      January 13, 2017
      eurasiareview.com
      Private health insurance claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population (ages 0 to 22 years) from 2011 to 2015, increasing 109 percent, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information.

      This finding, reported in the new FAIR Health white paper, Obesity and Type 2 Diabetes as Documented in Private Claims Data: Spotlight on This Growing Issue among the Nation’s Youth, runs counter to the common appellation of “adult-onset diabetes” for type 2 diabetes.

      Read full article here.
       
    • Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions
      January 12, 2017
      khn.org
      It’s no secret that American children have gotten fatter in recent decades.

      Now a new study joins earlier research showing the consequences: A sharp rise in insurance claims for youth with Type 2 diabetes, high blood pressure and other conditions more often associated with older adults.

      Claims for Type 2 diabetes — formerly known as “adult-onset” diabetes — among young people aged 0 to 22 years old more than doubled between 2011 and 2015, according to an analysis of a large national database of claims paid by about 60 insurers.

      Read full article here.
       
    • Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions
      January 12, 2017
      managedhealthcareconnect.com
      It’s no secret that American children have gotten fatter in recent decades.

      Now a new study joins earlier research showing the consequences: A sharp rise in insurance claims for youth with Type 2 diabetes, high blood pressure and other conditions more often associated with older adults.

      Claims for Type 2 diabetes — formerly known as “adult-onset” diabetes — among young people aged 0 to 22 years old more than doubled between 2011 and 2015, according to an analysis of a large national database of claims paid by about 60 insurers.

      Read full article here.
       
    • Obesity-Linked Diagnoses On The Rise Among Kids And Teens
      January 12, 2017
      npr.org
      It's no secret that American children have gotten heavier in recent decades.

      Now an analysis released Thursday by the nonprofit Fair Health, a national clearinghouse for claims data, joins earlier research showing the consequences of that extra weight. The study found a sharp rise in health insurance claims filed on behalf of young people who have high blood pressure, Type 2 diabetes, sleep apnea and other conditions more typically associated with older adults.

      Read full article here.
       
    • Hospital Impact: States use claims data to experiment with healthcare improvement efforts
      January 11, 2017
      fiercehealthcare.com
      In the wake of the recent presidential election, questions have been raised about what will happen to federal healthcare law and policy. As relevant as those questions may be, they shroud the importance of what is already happening at the state level. In essence, there are 50 living laboratories around the country, trying out new legislation, regulations, policies and initiatives in the hope of improving both the cost-effectiveness and quality of healthcare.

      To inform their efforts, states benefit from access to privately billed healthcare claims data from an independent, neutral source. Robust, reliable, geographically specific, regularly updated data can support a wide range of state health programs and initiatives.

      Read full article here.
       
    • New Technology Unveiled At CES 2017 Can Help Spot Concussions In Just 30 Seconds
      January 5, 2017
      ibtimes.com
      Concussions continue to plague sports of all kinds, with occasionally tragic outcomes. A new piece of technology, unveiled at CES 2017, may be the key to catching concussions that would otherwise go undetected.

      The Reflexion Edge, from the Reflexion Interactive Technologies, aims to shed light on some of the darker areas of concussion protocol that leaves mild concussions often undiagnosed—leaving an athlete exposed to potentially devastating, compounding effects down the line.

      Read full article here.
       
    • Many states aren't doing enough to address the severity of concussions
      January 5, 2017
      thehill.com
      Despite the fact that all 50 states and the District of Columbia have enacted state legislatures to address youth sports-related concussions since 2007, the prevalence and potential repercussions of these kinds of head injuries is more concerning than ever before.

      Since their brains and bodies are still developing, young athletes are more susceptible to concussions and the adverse effects associated with them. In fact, well over half of emergency room visits for children (ages 8 to 13) are tied to sports-related concussions, with each incident exposing the child to potential brain injury or damage.

      Read full article here.
       
    • Men Nearly Three Times as Likely to Be Diagnosed With Oral Cancer As Women
      January 5, 2017
      edgemedianetwork.com
      Privately billed insurance claim lines related to oral cancer diagnoses rose 61 percent from 2011 to 2015, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. As shown in the infographic below, the greatest increase occurred in throat cancer (malignant neoplasm of the nasopharynx, hypopharynx and oropharynx) and the second greatest in tongue cancer (malignant neoplasm of the tongue).

      Read full article here.
       
    • Experimental treatments and clinical trials — how to get accepted into one
      January 3, 2017
      thehill.com
      Most health plans only cover treatments they think are medically proven to work. But, medicine is always changing. Opinions can differ about whether there is enough evidence to support a treatment. In such a case, an insurer may say no to paying for a treatment that it calls “experimental,” even though your doctor thinks the treatment is well supported. That can leave you with a big bill — unless you successfully appeal the insurer’s decision.

      Read full article here.
       


Archive
      2016
      December
    • 58 RCM product launches in 2016
      December 30, 2016
      beckershospitalreview.com
      Here are companies that debuted revenue cycle management products for healthcare vendors and providers in 2016.

      25. FAIR Health launched a mobile app aimed at promoting healthcare literacy among Connecticut patients.

      Read full article here.
       
    • How to avoid and handle surprise medical bills
      December 23, 2016
      thehill.com
      Surprise bills are never a welcome surprise. Typically, they arrive after you arranged care from a doctor and a hospital that were both in your health plan’s network, but then you were unexpectedly treated by one or more other providers who, unbeknownst to you, were outside that network.

      When these out-of-network providers send you a bill for their services, you may have to pay the full amount out of pocket or, if your health plan covers out-of-network care, to pay the balance of the bill that your insurance fails to cover. And the balance bill generally requires you to pay more than the out-of-pocket amount you would have owed if you had been treated by an in-network provider.

      Read full article here.
    • Cost transparency coming into sharper focus
      December 22, 2016
      hartfordbusiness.com
      Q&A talks with Robin Gelburd, founding president of FAIR Health, a New York-based nonprofit that aims to advance healthcare cost transparency.

      Q: With a grant from the Connecticut Health Foundation, FAIR Health (FH) in September launched a free mobile app called FH Cost Lookup CT, which allows consumers to view zip-code specific pricing data for a wide array of medical billing codes. What sorts of health consumers benefit the most from such an app and why?
      A: Research continues to show that most Americans, particularly Hispanic consumers and the newly insured, lack the necessary understanding of health insurance to make informed decisions when selecting a plan, provider or treatment. Yet, consumers are also responsible for an increasing portion of health costs.

      Read full article here.
       
    • The High Cost of Coping
      December 21, 2016
      time.com
      Anxiety. Depression. Eating Disorders. Phobias. Every year tens of millions of Americans face a mental health challenge-often at great expense. Here's how to ease the financial strain.

      For five years, Christine Byrd figured her teenage daughter was going through a phase when she became withdrawn from friends and family and brushed off meals at home. It was only when Pepper Snider turned 17 that she was diagnosed with anorexia, triggering five years of intensive treatment, including thrice-weekly therapy, residential care, and hospital stays. The total of $55,000 she spent out of pocket has left Byrd, 56 and widowed, with no retirement savings and five-figure credit card debt that she’s slowly paying off. “It was a long journey,” says Byrd of her now-28-year-old daughter’s recovery. “But it was worth it to see her get back on track.”

      Read full article here.
       
    • A Comprehensive Guide to the Best Mental Health Resources
      December 21, 2016
      time.com
      How to find help treating—and paying for—your condition.

      When you or your family members have a mental health disorder that requires professional help—often at great expense—you’ll need to navigate a maze of treatment options, professional designations, insurance claims (and possibly appeals), and more. To get the help you need at a price you can afford, take advantage of the many useful resources out there — from nonprofit advocacy groups to commercial services that can be worth the cost.

      Read full article here.
       
    • Understanding your explanation of benefits
      December 15, 2016
      thehill.com
      If like millions of Americans, you have a health plan, you have probably received an Explanation of Benefits (EOB) from your insurer. Many people do not understand this form, and because it includes a notice that it is not a bill, they discard it. But if you do not pay attention to your EOBs, you may not get the maximum value of the health benefits you are entitled to receive.

      Read full article here.
       
    • Woman Shocked by Bill at Freestanding ER
      December 14, 2016
      nbcmiami.com
      Rachael Stamatyades knew something wasn't right.

      "I woke up in the middle of the night and it was really bad," she said.

      A sore throat - so painful - she went to the closest emergency room, where she says a doctor quickly made a diagnosis.

      "He said, 'Oh, it looks like strep.' And I said, 'Are you gonna do a swab?' And he said, 'No. If it looks like a duck and sounds like a duck, it's a duck,'" Rachael said.

      Read full article here.
       
    • 'Surprise Billing' Called Rare in Florida Emergency Medicine
      December 12, 2016
      sunshinestatenews.com
      The Florida College of Emergency Physicians (FCEP) and its national counterparts today urged state and national policymakers to investigate the reimbursement practices of insurance companies, especially when patients go out of network for emergency medical care.

      “We are urging Sen. Bill Nelson to investigate fully what is happening in his own state before calling for an inquiry into ‘surprise bills’ by emergency physicians,” said Jay Falk, MD, president of FCEP.  “Our report shows that less than 4 percent of privately insured patients in Florida actually received balance bills ('surprise' bills' more formal name).  We are calling for an examination of what insurers are offering their patients under high-deductible plans."

      Read full article here.
       
    • American healthcare's one constant in a sea of change: Emergency medicine
      December 9, 2016
      beckershospitalreview.com
      In these post-election days of uncertainty, when the words "repeal and/or replace" are echoed in many circles, there are a few issues meriting clarification and particular emphasis.

      First, emergency physicians have championed the issue of patient access for decades. The American College of Emergency Physicians (ACEP), emergency medicine's largest professional association began in 1968, with patient access as a primary mission to American society. This issue is of central importance, as our population continues to age, coincidental with the increasing age of emergency department patients, however there are substantial risks in this environment for adults as well for children. A just released Children's Health Fund report1 noted that "approximately 28% of children in the U.S. still do not have full access to essential health services."

      Read full article here.
       
    • Muchos estadounidenses prescinden del dentista debido al costo
      December 7, 2016
      salud.univision.com
      Los investigadores afirman que el hallazgo resalta la necesidad de reformar el seguro dental

      MARTES, 6 de diciembre de 2016 (HealthDay News) -- Los estadounidenses son mucho más propensos a prescindir de la atención dental necesaria debido al costo que de cualquier otro tipo de atención de la salud, informan unos investigadores.

      Los adultos en edad laboral son particularmente vulnerables, según el estudio. Alrededor de un 13 por ciento reportaron prescindir de la atención dental debido al costo.

      Read full article here.
       
    • Many Americans Skip the Dentist Due to Cost
      December 6, 2016
      health.com
      Researchers say finding highlights need to overhaul dental insurance
      TUESDAY, Dec. 6, 2016 (HealthDay News) -- Americans are more likely to skip needed dental care because of cost than any other type of health care, researchers report.

      Working-age adults are particularly vulnerable, the study found. Some 13 percent reported forgoing dental care because of cost.

      That's nearly double the proportion of seniors and triple the percentage of children for whom cost poses a barrier to dental care, the study showed.

      Read full article here.
       
    • Many Americans Skip the Dentist Due to Cost
      December 6, 2016
      health.usnews.com
      TUESDAY, Dec. 6, 2016 (HealthDay News) -- Americans are more likely to skip needed dental care because of cost than any other type of health care, researchers report.

      Working-age adults are particularly vulnerable, the study found. Some 13 percent reported forgoing dental care because of cost.

      That's nearly double the proportion of seniors and triple the percentage of children for whom cost poses a barrier to dental care, the study showed.

      Read full article here.
       
    • 5 enduring healthcare insurance tips for consumers
      December 6, 2016
      thehill.com
      In a time of flux in healthcare policy at the federal and state levels, consumers need guidance in steering through the complexities of the healthcare system.

      The new presidential administration may bring changes in the new year, but changes also may come from your own healthcare plan as the new plan year begins. It is important to check your plan documents for changes in your copays, deductibles and network participation of doctors and hospitals.

      Read full article here.
       
    • Five Key Things Healthcare Consumers Must Know
      December 5, 2016
      dailycaller.com
      With the costs of healthcare rising under Obamacare, consumers need to keep a few things in mind when navigating the complexities of the healthcare system.

      Robin Gelburd, president of FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance, provides five key things for consumers to keep in mind when considering healthcare plans.

      Read full article here.
       
    • Accolades Recognize Preeminence of FAIR Health Consumer Website
      December 4, 2016
      health-plan-news.com
      FAIR Health’s consumer website marked another year as the preeminent site for consumers to access accurate, actionable healthcare cost estimates and health insurance information. In a time of flux in healthcare policy at the federal and state levels, the site continues to serve as a lighthouse to consumers at sea among high-deductible health plans, narrow networks and other potentially confusing aspects of the healthcare marketplace. To that end, FAIR Health offers five tips for consumers below.

      Read full article here.
       
    • Latinos usan mal la sala de emergencias
      December 1, 2016
      salud.univision.com
      Una encuesta realizada por la organización FAIR Health encontró que los latinos usan mal la sala de emergencia al hacerse atender por afecciones que no son realmente graves.

      Parece ser que los latinos tienen casi el doble de probabilidad que el resto de la población en general de ir a la sala de emergencias (ER) por incidentes no urgentes (39 por ciento vs. 21 por ciento).

      Read full article here.
       

    • November
    • How to decide on the best times, and lengths, for open enrollment
      November 29, 2016
      benefitnews.com
      This is the second article in a 10-part series on successful open enrollment.

      When it comes to selecting an open enrollment window, timing is crucial.
      Putting benefits selection at the end of the year may make sense to many employers, whose fiscal years often end in December, but between the holidays and end-of-year deadlines, employees may have too much on their plates to devote the proper time to choosing the plan that’s best for them.

      For many organizations, the fall can be the best time for open enrollment. One big reason is the media attention given to the benefit-plan selection process in the months of October and November, says Robin Gelburd, founding president of FAIR Health, a national, independent organization with the mission of bringing transparency to healthcare costs and health insurance information.

      Read full article here.
       
    • Six Updates To Open For The Holidays
      November 28, 2016
      tcbmag.com
      From skepticism over hospital consolidation to optimism over telemedicine, here’s what’s on the minds of employers as we say goodbye to 2016.

      With the holiday season here, it’s time for one of the many annual arguments in the Burda household: Lots of little presents or one big present? I’m a lots-of-little-presents kind of guy, so in keeping with that spirit, I’m using this month’s space to give you as many updates as can fit on the page. Here goes:

      Read full article here.
       
    • 5 Things Young Fit Guys Need to Know About the Scary Rise in Mouth Cancer
      November 28, 2016
      mensfitness.com
      Worldwide rates of oral cancer are skyrocketing. Here's how you can reduce your risk.

      New research from Cancer Research UK show that rates of oral cancer have jumped by 68 percent in the UK over the last 20 years. And, according to a report from FAIR Health, an independent nonprofit which combined data from more than 21 billion privately billed medical and dental claims, the situation is perhaps even more dire for men in the U.S. Between 2011 to 2015, claims of oral cancer surged 61 percent.

      Read full article here.
       
    • Oral cancer on the rise in US
      November 28, 2016
      dental-tribune.com
      NEW YORK, USA: According to the latest figures published by a nonprofit health care transparency organization, claims related to oral cancer diagnosis in the U.S. have risen by over 60 percent since 2011. The data also showed that men were diagnosed with the disease three times more often than women were.

      FAIR Health, a U.S. nonprofit organization dedicated to bringing transparency to health care costs and health insurance information, analyzed data on privately billed medical and dental insurance claim lines related to oral cancer diagnoses from 2011 to 2015 and found that the overall number of claims rose by 61 percent over the period. The greatest increase was in malignant neoplasm of the nasopharynx, hypopharynx and oropharynx, and the second greatest in malignant neoplasm of the tongue.

      Read full article here.
       
    • An employee’s guide to preventative and wellness services
      November 22, 2016
      benefitnews.com
      Employees are probably used to going to a doctor when they feel sick. But, to prevent illness, it is also important to seek healthcare when they feel well. With preventive services, such as vaccines and cancer screenings, people can avoid certain diseases and catch others in their early stages, before they have a chance to cause much harm. With wellness services, such as weight management, stress reduction and physical fitness training, employees can adopt a lifestyle that can keep you in good health, with less chance of getting sick.

      Read full article here.
       
    • Out-of-Network Doctors Causing ER Bills to Go Up
      November 20, 2016
      abcnews.go.com
      For patients treated at in-network hospitals, their bills could rise if they are treated by doctors who are not in their network.

      Click here for the full video.
       
    • Changing sexual habits leads to startling rise in oral cancer in men
      November 19, 2016
      biotechin.asia
      There has been a startling rise in reported oral cancer cases in US, says a new study, in the past few years. New study shows oral cancer cases have significantly increased in the US in past years. FAIR Health, a non-profit organization, released data that shows 61 percent increase from 2011 to 2015 in oral cancer cases.

      Read full article here.
       
    • Surgeon General's first-ever addiction report calls for care coordination
      November 17, 2016
      healthcaredive.com
      Dive Brief:
      • U.S. Surgeon General Dr. Vivek Murthy issued a landmark report Thursday on drug and alcohol misuse in the country. This is the first time a Surgeon General report has been dedicated to this issue.
      • Addiction is "one of America's most pressing public health concerns," Murthy says. "The way we address this crisis is a test for America."
      • Approximately 21 million people in the U.S. are suffering from substance misuse disorders, but only 1 in 10 receive treatment, according to the announcement.
      Read full article here.
       
    • Study: Nearly 1 in 4 patients unknowingly treated by out-of-network ER doc
      November 17, 2016
      fiercehealthcare.com
      Nearly a quarter of patients who receive emergency care at an in-network hospital are surprised to learn that they were treated by an out-of-network physician, according to a new study. And they may be even more surprised once they receive their bill.

      In the study, published in the New England Journal of Medicine, researchers analyzed claims data from a large commercial insurer. Of the 99 percent of ED visits by patients younger than 65 between January 2014 and September 2015 that occurred at in-network facilities, 22 percent of them involved out-of-network physicians.

      Read full article here.
       
    • Surprise doctor bills from ER care can add angst to injury
      November 17, 2016
      discover-usa.net
      Cooper and fellow Yale researcher Fiona Scott Morton analyzed insurance claims for more than 2 million ER visits around the country.

      Almost one-quarter of the patients who went to ERs within their health insurance networks were treated by an out-of-network doctor and ended up with unexpected expenses, the study found.

      Patients might be liable for an average balance of around $622, the researchers estimated.

      The Fair Health claims database was developed after United Healthcare was successfully sued by the State of NY for fraudulently calculating and significantly underpaying doctors for out-of-network medical services, using the Ingenix database.

      Read full article here.
       
    • The ins and outs of free preventive care
      November 15, 2016
      thehill.com
      Although the law may change as a result of the recent presidential election, for right now a tremendous health benefit is available: free preventive care services.

      The Affordable Care Act (ACA) requires most health plans to cover certain preventive services at no cost to you. (The exceptions are older plans that predated the ACA and have not changed since).

      As discussed in our new FH Health Insurance 101 article, “Preventive and Wellness Services: Coverage and Costs,” as long as you receive the specified preventive services from an in-network provider, you don’t have to pay a copay or coinsurance, and there will be no charge even if you have not met your deductible.
      Preventive services make sense because they can protect your health. Some services, such as immunizations, can stop disease from happening.

      Read full article here.
       
    • How to make the most of open enrollment
      November 15, 2016
      benefitnews.com
      It’s fall again, and that means it’s open enrollment time. Employers can help employees with the challenges of selecting a health plan by giving them a how-to guide with questions and answers.

      The basics
      This is the season when many employers give employees a chance to pick a health insurance plan for the coming year, or reconsider the plan you already have. It’s also the time when the federal and state health insurance exchanges allow employees to select a private plan, an option that can be especially attractive if your employer doesn’t offer health coverage.

      Read full article here.
       
    • Steer Your Patients to Clear, Unbiased Data and Resources
      November 15, 2016
      dentistrytoday.com
      Dental costs and insurance are a mystery to many consumers. You can help demystify them by making your patients aware of our free, award-winning consumer website, fairhealthconsumer.org, which can play a useful role in your own communications with your patients.

      Lack of Knowledge about Dental Costs

      Even for the 64% of Americans who have dental insurance, there is often confusion as to what services are covered and how much the insurer will pay. For those who do not have dental benefits, lack of knowledge of the costs of care, and fear of high prices, may keep many from seeking the dental care they need.

      Read full article here.
       
    • Cost estimators take mystery out of health care costs
      November 13, 2016
      thetimes-tribune.com
      American consumers can drive a hard bargain when shopping for big-ticket items such as cars, appliances and home improvement. Yet, few price out an increasingly expensive item: health care.

      Some health care providers and insurers are trying to change that.

      Read full article here.
       
    • Claims Related to Oral Cancer Diagnoses Rise 61 Percent since 2011
      November 7, 2016
      dailynational.com
      Privately billed insurance claim lines related to oral cancer diagnoses rose 61 percent from 2011 to 2015, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. As shown in the infographic below, the greatest increase occurred in throat cancer (malignant neoplasm of the nasopharynx, hypopharynx and oropharynx) and the second greatest in tongue cancer (malignant neoplasm of the tongue).

      Read full article here.
       
    • Fair Health website awarded best cost estimator by Kiplinger
      November 4, 2016
      beckershospitalreview.com
      Kiplinger awarded Fair Health a place on its Personal Finance 2016 Best List in the category of Best Websites and Tools to Save on Your Health.

      Fair Health provides healthcare cost estimates for services in more than 490 geographic regions across the U.S. Cost estimates are powered by Fair Health's database of more than 21 billion claims for privately billed medical and dental procedures.

      Read full article here.
       
    • ED Nurses Fight Opioid Epidemic
      November 2, 2016
      nursing.advanceweb.com
      As nurses, we witness the national opioid epidemic daily. The rise in opioid abuse is skyrocketing and our hospital resources are stretched. Yet, when armed with the right resources we are uniquely positioned to combat the problem and its consequences.

      Two specific initiatives within the emergency department could have a profound effect on opioid abusers if widely implemented: greater availability of naloxone coupled with more patient and family education, and strict adherence to prescription guidelines.

      Read full article here.
       
    • Oral Cancer diagnoses claims rise 61% over 4 years
      November 1, 2016
      managedhealthcareconnect.com
      Recent data released by FAIR Health showed that between 2011 and 2015, privately billed insurance claim lines related to oral cancer diagnoses increased by  61%, with the largest increases reported among throat cancer and tongue cancer diagnoses.

       “Oral cancer is a serious and growing public health problem,” Robin Gelburd, JD, president of Fair Health, said in a statement. “We hope that our data help inform the national conversation on this topic.”

      Read full article here.
       
    • Michael Douglas, Val Kilmer, and the alarming rise of oral cancers in men
      November 1, 2016
      philly.com
      Val Kilmer, who played “Batman” and the author in the one-man show “Citizen Twain,” was revealed this week to have oral cancer -- and the news was spread by fellow oral cancer survivor Michael Douglas.

      At an event in London, Douglas said that Kilmer is “dealing with exactly what I had,” and that “things don’t look too good for him.”

      But Kilmer's friends maintain that he’s doing well and getting back to work after recovering from the disease.

      The more hopeful prognosis likely matters to a lot of people at a time when oral cancer is on the rise in American men. Health insurance claims for the condition jumped 61 percent from 2011 to 2015, according to a report by FAIR Health, an independent nonprofit. The most dramatic increases were seen in throat and tongue cancer, which were three times more common in men as in women during that same period.

      Read full article here.
       
    • Best Websites and Tools to Save on Your Health, 2016
      November 1, 2016
      kiplinger.com
      Keys to finding less-expensive pharmaceuticals and cutting costs for health care.

      The picks below are part of Kiplinger’s Personal Finance’s annual Best List, a roundup of the best values in all the areas we cover – from funds, stocks and ETFs to credit cards and bank accounts to cars, college, kid stuff, phone plans, travel and health. Discover all our Best List picks here.

      At FAIR Health’s Consumer Cost Lookup, you can see the estimated charges (based on costs for your ZIP code) for thousands of medical and dental procedures.

      Read full article here.
       

    • October
    • Health Insurance Claims for Oral Cancer Soar
      October 31, 2016
      managedcaremag.com
      From 2011 to 2015, claims for the condition jumped 61% for everybody, with men representing the lion’s share of the increase, according to a study by the not-for-profit FAIR Health as reported in Dentistry Today. This, while the historically typical cause for the disease—smoking—has gone down. (Alcohol consumption is also a common cause.) Researchers link the current situation to the spread of HPV, which can affect the mouth, throat, tongue and tonsils.

      Read full article here.
       
    • Oral cancer rates going up for U.S. men; link to HPV is eyed
      October 28, 2016
      philly.com
      Oral cancer is on the rise in American men, with health insurance claims for the condition jumping 61 percent from 2011 to 2015, according to a new analysis.

      The most dramatic increases were in throat cancer and tongue cancer, and the data show that claims were nearly three times as common in men as in women during that same period with a split of 74 percent to 26 percent.

      The startling numbers - published in a report by FAIR Health, an independent nonprofit - are based on a database of more than 21 billion privately billed medical and dental claims.

      Read full article here.
       
    • Oral Cancer Diagnoses Jump 61% From 2011 to 2015
      October 26, 2016
      dentistrytoday.com
      Privately billed insurance claims related to oral cancer diagnoses rose 61% from 2011 to 2015, according to data on 21 million privately billed medical and dental claims examined by FAIR Health. The greatest increase involved throat cancer (malignant neoplasm of the nasopharynx, hypopharynx, and oropharynx). The second greatest was in tongue cancer (malignant neoplasm of the tongue).

      “Oral cancer is a serious and growing public health problem,” said FAIR Health president Robin Gelburd. “We hope that our data help inform the national conversation on this topic.”

      Read full article here.

       
    • Startling Increase in Oral Cancers
      October 26, 2016
      lifezette.com
      We don’t often hear about certain types of cancers, but this may be changing. Privately billed insurance claims from FAIR Health, a national nonprofit organization dedicated to bringing transparency to health care costs and health insurance information, show an alarming rise in the number of people diagnosed with oral cancers — among men particularly.

      Read full article here.
       
    • Oral cancer claims up 61% since 2011: 3 quick facts
      October 26, 2016
      beckershospitalreview.com
      Privately billed insurance claims related to oral cancer diagnoses rose 61 percent from 2011 to 2015, according to data from FAIR Health.

      Below are three statistics.

      1. Privately billed claims related to oral cancer rose from 302,477 in 2011 to 486,328 in 2015.

      Read full article here.
       
    • Trending News Today: Oral Cancer Incidence on the Rise
      October 26, 2016
      specialtypharmacytimes.com
      A new study has been launched to test a dietary supplement called lunasin and its potential effects on amyotrophic lateral sclerosis (ALS), according to NPR. The study came from an unusual case, in which an ALS patient taking lunasin had his speech go back to normal, swallowing back to normal, and is no longer using his feeding tube. Furthermore, his therapists reported that he was significantly stronger. This occurred after 6-months of taking lunasin. With this new study, researchers are taking a nontraditional approach. Instead of using a comparison group in which patients take a placebo, researchers matched each patient with 3 to 5 people whose disease was on a similar course. Since the supplement is already on the market, researchers were able to skip safety testing. There are 50 volunteers included in the study, and most of the data was gathered virtually through the PatientsLikeMe website, where patients post their weekly assessments. Even if the dietary supplement is found to not be beneficial, the approach will provide people with the outcomes quickly and won’t waste their time and money if lunasin fails, reported NPR

      Read full article here.
       
    • REPORT: Oral Cancer Insurance Claims Up 61 Percent Since 2011
      October 26, 2016
      dailycaller.com
      Privately held insurance claims related to oral cancer are up 61 percent since 2011, an increase that is likely linked to human papillomavirus (HPV), according to a new data from FAIR Health.

      The largest increases in claims arose in throat and tongue cancers. Males appear to be disproportionately impacted by oral forms of cancer, as men claim it three times as often as women from 2011 to 2015, according to Fair Health. Forms of oral cancer are the eighth most common cancer affecting men, and they have a drastically high death rate.

      Read full article here.

       
    • The startling rise in oral cancer in men, and what it says about our changing sexual habits
      October 25, 2016
      washingtonpost.com
      Oral cancer is on the rise in American men — jumping 61 percent from 2011 to 2015, according to a new analysis of insurance claims.

      The most dramatic increases were in throat cancer and tongue cancer, and the data shows that claims were nearly three times as common in men as in women during that same period with a split of 74 percent to 26 percent.

      The startling numbers — published in a report on Tuesday by FAIR Health an independent nonprofit — are based on a database of more than 21 billion privately billed medical and dental claims. They illustrate both the cascading impact of human papillomavirus (HPV) in the United States and our changing sexual practices.

      Read full article here.
       
    • New FAIR Health App: Find CT Medical and Dental Costs, Plan Your Cost of Care
      October 25, 2016
      csms.org
      CSMS Affinity Partner FAIR Health has launched a free mobile app that enables both insured and uninsured healthcare consumers to estimate the costs of medical and dental services received in Connecticut. The app also has cost information for the neighboring states of New York, Massachusetts, and Rhode Island.

      Read full article here.
       
    • Changing sexual habits may be responsible for startling rise in oral cancer in men
      October 25, 2016
      miamiherald.com
      Oral cancer is on the rise in American men — jumping 61 percent from 2011 to 2015, according to a new analysis of insurance claims.

      The most dramatic increases were in throat cancer and tongue cancer, and the data shows that claims were nearly three times as common in men as in women during that same period with a split of 74 percent to 26 percent.

      The startling numbers — published in a report on Tuesday by FAIR Health an independent nonprofit — are based on a database of more than 21 billion privately billed medical and dental claims. They illustrate both the cascading impact of human papillomavirus (HPV) in the United States and our changing sexual practices.

      Read full article here.

       
    • The startling rise in oral cancer in men, and what it says about our changing sexual habits
      October 25, 2016
      sfgate.com
      Oral cancer is on the rise in American men — jumping 61 percent from 2011 to 2015, according to a new analysis of insurance claims.

      The most dramatic increases were in throat cancer and tongue cancer, and the data shows that claims were nearly three times as common in men as in women during that same period with a split of 74 percent to 26 percent.

      The startling numbers — published in a report on Tuesday by FAIR Health an independent nonprofit — are based on a database of more than 21 billion privately billed medical and dental claims. They illustrate both the cascading impact of human papillomavirus (HPV) in the United States and our changing sexual practices.

      Read full article here.

       
    • The startling rise in oral cancer in men, and what it says about our changing sexual habits
      October 25, 2016
      chron.com
      Oral cancer is on the rise in American men — jumping 61 percent from 2011 to 2015, according to a new analysis of insurance claims.

      The most dramatic increases were in throat cancer and tongue cancer, and the data shows that claims were nearly three times as common in men as in women during that same period with a split of 74 percent to 26 percent.

      The startling numbers — published in a report on Tuesday by FAIR Health an independent nonprofit — are based on a database of more than 21 billion privately billed medical and dental claims. They illustrate both the cascading impact of human papillomavirus (HPV) in the United States and our changing sexual practices.

      Read full article here.

       
    • What you need to know for the 2017 Obamacare open enrollment
      October 25, 2016
      ctmirror.org
      If you buy health insurance on your own, or plan to, your chance to sign up for 2017 coverage starts next week. This year’s open enrollment period is coming after several months of turmoil for the state’s health insurance exchange, including the departure of two insurance companies, big price hikes and a major change in the availability of insurance agents and brokers who have helped many people pick health plans in the past.

      Here’s what you need to know about the open enrollment period, in two parts: What’s new this year and, for those new to the process, the basics on buying insurance.

      Read full article here.
       
    • Consumers Hungry for Health Insurance Information as Early as High School
      October 24, 2016
      pharmacychoice.com
      By a News Reporter-Staff News Editor at Managed Care Weekly Digest Seventy-six percent of respondents felt the best life stage for consumers to gain an understanding of health insurance was before or during high school or college, according to a national survey commissioned by FAIR Health and conducted by ORC International. Of the respondents favoring insurance education for students, 41 percent felt the education should begin before or during high school. The full survey findings are available in a new report, Healthcare and Health Insurance Choices: How Consumers Decide, with key results highlighted in the infographic below (see also FAIR Health).

      Read full article here.
       
    • Soaring opioid treatment costs create headache for comp sector
      October 24, 2016
      businessinsurance.com
      Workers compensation experts say they’re seeing escalating costs for treating opioid addiction in the United States and predict the current addiction climate will get a lot worse before it gets better.

      “These are clean-up costs … We’ve created a mess over the past 20 years that we now have to fix,” said Mark Pew, senior vice president at Prium, a Duluth, Georgia-based medical cost management firm. “It’s the new normal.”

      Read full article here.
       
    • Consumers are hungry for health insurance info [infographic]
      October 18, 2016
      benefitspro.com
      The cost of health care may prompt some consumers to accept significant inconvenience, to new research.

      A 2016 FAIR Health-ORC Survey Report of 1,006 U.S. adults, ages 18 and older, the survey provides a nuanced window into consumers' attitudes and practices related to those areas.

      Read full article here.
       
    • Consumers are hungry for health insurance info [infographic]
      October 15, 2016
      lifehealthpro.com
      The cost of healthcare may prompt some consumers to accept significant inconvenience, to new research.

      A 2016 FAIR Health-ORC Survey Report of 1,006 U.S. adults, ages 18 and older, the survey provides a nuanced window into consumers' attitudes and practices related to those areas. The research was supported by the New York State Health Foundation (NYSHealth), which is dedicated to expand health insurance coverage, increase access to high-quality healthcare services and improve public and community health.

      Read full article here.
       
    • Six ways health plans address consumer pain points
      October 13, 2016
      managedhealthcareexecutive.modernmedicine.com
      By the time federal open enrollment begins November 1, Horizon Blue Cross Blue Shield of New Jersey intends to have what one executive describes as a “much simpler” consumer website so individuals know immediately where to find information. The insurer also is providing more bill payment options, and conducting major outreach to individual members. That outreach focuses on its plans’ broad value—including wellness products, telemedicine, prenatal care and free basic preventive services.

      Spurred on by the Affordable Care Act's emphasis on the individual market, Horizon is also pursuing targeted initiatives, such as the launch of a dedicated Hispanic enrollment and service center and mall kiosks with bilingual agents and Spanish-language materials. This is part of an ongoing marketing partnership with HolaDoctor. The upshot? Nearly 400% growth since 2013 to 30,000-plus Hispanic members—about 15% of the previously uninsured people who joined Horizon for 2016.

      Read full article here.
       
    • SALUD: Nueva aplicación para estimar los costos médicos
      October 13, 2016
      identidadlatina.com
      FAIR Health, una organización sin fines de lucro nacional e independiente, ha lanzado una aplicación móvil gratuita sobre cobertura de salud para residentes de Connecticut. Disponible en inglés y español,FH® Cost Lookup CT puede descargarse de la tienda de aplicaciones de iTunes y de Google Play. Los consumidores de atención de salud de Connecticut, lo mismo los asegurados que los no asegurados, pueden utilizar la aplicación para estimar los costos de los servicios médicos y dentales de su área; la aplicación también explica información básica esencial sobre cómo planificar, calcular el presupuesto y obtener la atención de salud.

      Read full article here.
       
    • Survey unveils strong appetite for health insurance information—As early as high school
      October 12, 2016
      beckershospitalreview.com
      Most people learn what they know about health insurance on the job, when they use their employers' health plans.

      But, in a nationwide consumer survey conducted this year for FAIR Health by ORC International,1 76 percent of respondents felt that was too late. In their view, people should begin understanding health insurance plans before or during high school or college. Forty-one percent thought the skill should begin to be acquired in high school or earlier. The full survey report, Healthcare and Health Insurance Choices: How Consumers Decide, is being released this month, along with the infographic below.

      Read full article here.
       
    • 11 Tips For Saving On Health Care Costs All Year Long
      October 11, 2016
      forbes.com
      Earlier this month, the Kaiser Family Foundation and Health Research & Educational Trust released the results of their 2016 Employer Health Survey. Some news was promising: increases in the cost of health insurance premiums have started to slow down. This year’s average increase was 3%. That’s less than last year’s 4%. Of course, whenever we’re talking about health care costs, the news is never all good. Premiums may be increasing at a slower rate, but deductibles are going up. In the past year, employers reported that deductibles rose 12%. This year, for the first time, more than half (51%) of all insured employees have deductibles of over $1,000.

      Read full article here.
       
    • Physical therapy practice posts fees
      October 11, 2016
      democratandchronicle.com
      Anyone who provides your health sooner or later will need care.

      Ever wonder if your doctor, nurse or therapist becomes frustrated when they ask how much a service will cost get answered with a shrug?

      “You try to find out these prices ahead of time and you can’t,” said Nancy Alexander, whose quest for an upfront price on an MRI a couple of years ago ended up changing how she practices physical therapy.

      Read full article here.
       
    • One in Four Americans, Fearing Insurance Gaps, Reported Medical Conditions Got Worse After They Delayed Emergency Care
      October 11, 2016
      CNBC.com
      WASHINGTON, Oct. 11, 2016 /PRNewswire-USNewswire/ -- Nearly one in four Americans (registered voters) reported their medical conditions got worse after they delayed visiting an emergency department, because they feared their health insurance companies would not cover the costs, according to a new poll by Morning Consult.

      "As a physician, it greatly concerns me that people are waiting until their medical conditions deteriorate to seek emergency care, which can have lifelong consequences," said Dr. Jay Kaplan, president of the American College of Emergency Physicians (ACEP). "Insurance companies are misleading patients by selling so-called 'affordable' policies that cover very little until large deductibles are met, and the companies are blaming medical providers for charges. Many people don't realize this until they need medical care, and then they are shocked at how little their insurance pays."

      Read full article here.
       
    • Americans are avoiding the ER and becoming sicker while paying more for insurance
      October 11, 2016
      modernhealthcare.com
      About 1 in 4 Americans says his or her medical conditions has worsened after postponing emergency room treatment, according to a survey released Tuesday.

      The poll, commissioned by the American College of Emergency Physicians, found Americans delay visiting an ER because they don't think their health insurance will cover the costs.

      At the same time, more than 50% of respondents are paying more for their insurance compared to last year, while another 20% said they are paying “much more.”

      Read full article here.
       
    • Recent studies find concussion diagnoses have spiked
      October 10, 2016
      watertowndailytimes.com
      A new report by the Blue Cross Blue Shield Association shows that concussion diagnosis rates have skyrocketed since 2010. Total concussion diagnoses across the U.S. increased by 43 percent between 2010 and 2015. Juveniles between the ages of 10 and 19 years saw both the highest increase in diagnoses and number of concussions. This age range experienced over five times as many concussions as all other age ranges combined.

      Blue Cross Blue Shield cites media attention and state by state legislation regarding traumatic brain injuries for the increase in diagnoses, not an increase in concussions themselves.

      Read full article here.
       
    • IBA South: Louisiana has more opioid prescriptions than residents, pushing insurance costs higher
      October 6, 2016
      ibamag.com
      High workers’ compensation rates in Louisiana may be exacerbated by ongoing opioid abuse, as new information suggests that state is one of eight that has more opioid prescriptions than it does residents.

      According to new information published by Workers’ Compensation Research Institute and IT company IMS Health, Louisiana has the sixth highest prescription-per-capita rate at 1.03 pain-killer prescriptions written per resident in 2015.

      Read full article here.
       
    • Recent studies find concussion diagnoses have spiked
      October 5, 2016
      mpcourier.com
      A new report by the Blue Cross Blue Shield Association shows that concussion diagnosis rates have skyrocketed since 2010. Total concussion diagnoses across the U.S. increased by 43 percent between 2010 and 2015. Juveniles between the ages of 10 and 19 years saw both the highest increase in diagnoses and number of concussions. This age range experienced over five times as many concussions as all other age ranges combined.

      Read full article here.

       
    • AMCP Foundation's Symposium Gathers Diverse Stakeholders to Address Issues of Opioid Misuse and Abuse
      October 5, 2016
      pharmacytimes.com
      National Harbor, Md., Oct. 5, 2016 — Improvements to opioid prescribing, increasing the use of naloxone to reverse opioid overdose and expanding the use of medication-assisted treatment (MAT) for opioid-use disorders were among the many suggestions to come out of the Academy of Managed Care Pharmacy (AMCP) Foundation 6th Annual Research Symposium, “Balancing Access and Use of Opioid Therapy.”

      More than 125 participants attended the full-day event on Oct. 3 to discuss how health plans, providers, advocacy groups, payers and other stakeholders can work together to ensure that patients have appropriate access to opioid pain therapies, while preventing their abuse.

      Read full article here.
       
    • AMCP Foundation's Symposium Gathers Diverse Stakeholders to Address Issues of Opioid Misuse and Abuse
      October 5, 2016
      cnbc.com
      Improvements to opioid prescribing, increasing the use of naloxone to reverse opioid overdose and expanding the use of medication-assisted treatment (MAT) for opioid-use disorders were among the many suggestions to come out of the Academy of Managed Care Pharmacy (AMCP) Foundation 6th Annual Research Symposium, "Balancing Access and Use of Opioid Therapy."

      Read full article here.
    • How to Pick the Best Health Care Plan During Open Enrollment
      October 4, 2016
      time.com
      As health care gets more costly, your open-enrollment decisions become ever more critical. Workers at large companies will pay 5% more, on average, on insurance premiums in 2017, says the National Business Group on Health (NBGH).

      Read full article here.

    • September
    • 6 Things Obamacare Plans Won’t Cover
      September 29, 2016
      investopedia.com
      While the Affordable Care Act greatly expanded Americans’ access to health insurance, there are still many things Obamacare plans won’t cover. All plans offered through the government’s health insurance marketplace are required to to accept individuals with preexisting health conditions and to offer a set of essential health benefits. These include emergency services, hospitalizations, pregnancy care and behavioral health treatment, among other things.

      But certain services that might seem essential to you may not be considered essential by law or by your insurance company. Why? “These plans were designed by Congress,” explains David Reid, CEO of EaseCentral, an HR benefits software company, and 30-plus year health-industry veteran and benefits expert. The Affordable Care Act determined the essential health benefits list – what insurers had to cover – so that plans would be consistent across carriers and consumers would know they were comparing apples to apples, and not be deceived by the fine print when shopping around. Unfortunately, as so often happens, the minimum became the maximum: If the ACA didn't specify a service had to be included, the insurer's marketplace plan often wouldn't offer it. "The objective is good, but the result isn't what everyone expected,” he says.

      Read full article here.
       
    • Some treatment costs higher for worker's comp claims
      September 28, 2016
      fox13news.com
      (FOX 13) - The cost of a CT scan has a local tech for a music and entertainment company stunned.

      “That's bull; that really is. It’s unjustifiable! I'm sorry it's wrong! I figured just a medical bill, it would be maybe a thousand, and sure enough, it’s $17,862,” says Roger Demaris.

      He slipped while moving equipment. Brandon Regional treated the injury, and did the CT scan as a precaution since it was a head injury. Because he was hurt on the job, Demaris took the hospital bill to his boss at Coldman Music.

      Read full article here.
       
    • When covering painkiller crisis, don’t blame the victims
      September 26, 2016
      poynter.org
      The screen shows a woman kicking and screaming. She yells “Oh my god” over and over before crumpling to the ground.

      The camera shifts to follow a body as it’s loaded into a coroner’s van. Though the woman is now off-screen, her piercing screams can still be heard.

      Every day, 78 Americans die from an opioid overdose.

      Read full article here.
       
    • The opioid epidemic is skyrocketing private insurance costs
      September 26, 2016
      statnews.com
      The opioid epidemic has caused thousands of deaths, broken apart countless families, and endangered untold babies and children. It’s also taking a heavy economic toll.

      Private insurance is footing a large part of the bill for the opioid epidemic. But much of the existing information on private insurance costs has been limited, either because it didn’t include a large enough sample of private insurers or because it didn’t delve deeply enough into the specific services and price tags.

      Read full article here.
       
    • Coaches, programs adjust as concussion diagnoses spike
      September 22, 2016
      mydaytondailynews.com
      BUTLER COUNTY — At a time when athletes are bigger, stronger and faster than decades ago, precautions are being implemented to reduce the risks of concussions.

      Concussion diagnoses in children and young adults under age 22 rose 500 percent from 2010 to 2014, according to a new study published by FAIR Health, a national, independent, nonprofit organization who says its “mission is to bring transparency to healthcare costs and health insurance information.”

      Read full article here.
       
    • Your Deadly Medicine Cabinet
      September 21, 2016
      lifezette.com
      Check it, clear it, lock it up — or move it to a better place

      With prescription drug addiction more of a problem even than illegal drug use, could your medicine cabinet be connected to criminal activity?

      Cynthia MacGregor, a freelance writer in Palm Springs, Florida, didn’t think much about a drop-in guest at her Friday night poker game — until he made multiple trips to the bathroom.

      Read full article here.
       
    • Study raises new questions about fetal ultrasounds
      September 20, 2016
      foxnews.com
      A new study suggesting that first-trimester fetal ultrasound may contribute to the severity of autism symptoms heightens a dilemma facing obstetricians: How to halt the widespread overuse of fetal ultrasound without scaring women away from this important medical procedure.

      The study, published Sept. 1 in the journal Autism Research, is the latest in a series of highly limited studies that raise questions about the safety of fetal ultrasound. Some research is based on animal studies—fetal chicks and rats, for instance—that may not be relevant to humans. The latest study, based on the medical histories of 2,644 families with autistic children, relies on parents’ reports of their ultrasound experiences rather than actual records.

      Read full article here.
       
    • President Declares This Prescription Opioid and Heroin Epidemic Awareness Week
      September 20, 2016
      HHNmag.com
      The White House is asking for increased attention to the nation’s opioid epidemic, at the same time that more staggering statistics were just released on the toll that heroin and prescription painkillers are taking on society.

      On Friday, President Obama declared these seven days Prescription Opioid and Heroin Epidemic Awareness Week, starting Sunday and running through Sept. 24. Prescription painkillers alone have killed more than 165,000 Americans since 1999, and the nation’s top official wants the U.S. to take this week to remember those lost to overdoses, and support survivors who are still fighting addiction.

      Read full article here.
       
    • Study Raises New Questions About Fetal Ultrasounds
      September 19, 2016
      WSJ.com
      A new study suggesting that first-trimester fetal ultrasound may contribute to the severity of autism symptoms heightens a dilemma facing obstetricians: How to halt the widespread overuse of fetal ultrasound without scaring women away from this important medical procedure.

      The study, published Sept. 1 in the journal Autism Research, is the latest in a series of highly limited studies that raise questions about the safety of fetal ultrasound. Some research is based on animal studies—fetal chicks and rats, for instance—that may not be relevant to humans. The latest study, based on the medical histories of 2,644 families with autistic children, relies on parents’ reports of their ultrasound experiences rather than actual records.

      Read full article here.
       
    • Health spending related to opioid treatment rose more than 1,300 percent
      September 18, 2016
      fosters.com
      The nation’s ongoing opioid problem comes with staggering physical and emotional costs to patients and families. But the dollar cost to the health system has been harder to peg. Now a new report shows a more than 1,300 percent rise in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.

      From 2011 to 2015, insurers’ payments to hospitals, laboratories, treatment centers and other medical providers for these patients grew from $32 million to $446 million — a 1,375 percent increase.

      Read full article here.
       
    • Opioid use decreases in US states that legalize medical marijuana - study
      September 18, 2016
      RT.com
      New research shows a decline in the use of opioid painkillers in US states that allow people to treat pain with medical marijuana, affirming the fears of Big Pharma who have been vigorously seeking to frustrate efforts to legalize the herb.

      Columbia University researchers examined data from 1999 to 2013 and found an association between a state legalizing medical marijuana and a reduction in testing positive for opioids after dying in a car accident, particularly among drivers aged 21 to 40.

      Read full article here.
       
    • Opioid epidemic boosts costs for health insurers
      September 16, 2016
      LVB.com
      In a four-year period, health insurers' spending on patients addicted to opioid painkillers has increased more than 1,000 percent, revealing the impact of the opioid crisis on the health care system.

      Between payments to hospitals, laboratories, treatment centers and other medical providers for opioid-dependent patients – or patients addicted to prescription medication or heroin – health insurers in the U.S. spent $446 million in 2015.

      In 2011, health insurer payments for opioid-dependent patients totaled $32 million, according to a white paper released by Fair Health Inc., a New York-based nonprofit that provides cost data to the health care industry and consumers.

      Read full article here.
       
    • Opiate addiction treatment costs have increased 1,000 percent in last 5 years
      September 16, 2016
      WCPO.com
      CINCINNATI -- Stephanie Isaac was 22 years old when she started using drugs, and it was only a matter of time before she started using heroin.

      Isaac, now 35, has been clean for several years, but she needed help getting there.

      “I couldn't do it on my own,” Isaac said. “I was forced to do it. I caught a charge, and I went to jail and I was sent to treatment.”

      Read full article here.
       
    • New App Aims to Bring Price Transparency to Medical, Dental Procedures
      September 15, 2016
      DMDtoday.com
      A new, free mobile app has been released to help improve patients’ healthcare insurance literacy in the State of Connecticut. The company releasing the app, FAIR Health, says their goal is to provide more transparency in both dental and medical costs, and to increase Connecticut residents’ engagement in their own healthcare.

      FAIR Health is a non-profit corporation that aims to boost patient understanding of the costs associated with healthcare.

      Read full article here.
       
    • Opioid Addiction Treatment: Can Managed Care make an Impact?
      September 15, 2016
      managedhealthcareconnect.com
      In an open letter recently sent to all physicians, US Surgeon General, Vivek Murthy, MD, pleaded for help with solving America’s opioid crisis. He wrote that since 1999, overdose deaths from opioids have quadrupled and prescriptions for the pain management drugs are so prevalent that every American adult could have a bottle.

      In 2012, health care providers wrote 259 million prescriptions for opioid pain medications, according to Centers for Disease Control and Prevention (CDC) data. Opioid abuse is being called a national epidemic, and experts say it will take multiple stakeholders, including managed care organizations, to curb its effects and reverse the growing trend of misuse.

      Read full article here.
       
    • Opioid epidemic boosts costs for health insurers
      September 15, 2016
      CPBJ.com
      In a four-year period, health insurers' spending on patients addicted to opioid painkillers has increased more than 1,000 percent, revealing the impact of the opioid crisis on the health care system.

      Between payments to hospitals, laboratories, treatment centers and other medical providers for opioid-dependent patients – or patients addicted to prescription medication or heroin – health insurers in the U.S. spent $446 million in 2015.

      Read full article here.
       
    • Study Reveals Major Spike in Number of Young Concussion Victims
      September 15, 2016
      virginiabeach.legalexaminer.com
      According to a study conducted by the independent, nonprofit organization Fair Health, the number of concussion diagnoses in children and teens under the age of 22 increased by an incredible 500 percent between the year of 2010 through 2014.

      National statistics reveal that between one to two million of concussions received by children and teens every year are recreation and sports related. Anywhere between 500,000 to one million of these injuries go untreated.

      Read full article here.
       
    • Opioid treatment costs rose more than 1,300 percent over 4 years
      September 15, 2016
      bendbulletin.com
      The nation’s ongoing opioid problem comes with staggering physical and emotional costs to patients and families. But the dollar cost to the health system has been harder to peg. Now a new report shows a more than 1,300 percent rise in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.

      From 2011 to 2015, insurers’ payments to hospitals, laboratories, treatment centers and other medical providers for these patients grew from $32 million to $446 million — a 1,375 percent increase.

      Read full article here.
       
    • Study: Insurer spending on opioids rose 1,375 percent over four years
      September 15, 2016
      benefitspro.com
      The surging death toll from opioids has focused considerable attention on both heroin abuse and the role played by prescription drugs and those that use and prescribe them.

      But what’s the cost to the health care system of this epidemic?

      Read full article here.
       
    • Report: Medical Costs Associated With Opioid Misuse up 1,000% Since 2011
      September 14, 2016
      workcompcentral.com
      The medical costs associated with opioid abuse and dependence diagnoses increased by more than 1,000% between 2011 and 2015, according to a new study from Fair Health, a national nonprofit that analyzes health care costs.

      Read full article here.
       
    • Cost of Opioid Misuse Treatment Services Increased 1,000% In Past Few Years
      September 14, 2016
      wcinsights.com
      FAIR Health, a nonprofit agency whose mission is to provide transparency on healthcare and health insurance costs and information, released a whitepaper that details the startling rise of costs related to opioid misuse and dependence over the past five years.

      Between 2011 and 2015, professional charges for services provided to opioid abusive or dependent patients for by 1,000 percent. In four years. Professional charges totaled $71.66 million in 2011 to 721.80 million in 2015. And the allowed amounts for these services (the maximum that an insurer will pay) went from $32.42 million in 2011 to $445.74 million in 2015. That’s an increase of 1,375 percent.

      Read full article here.
       
    • 7 recent RCM product launches
      September 14, 2016
      beckershospitalreview.com
      Here are companies that debuted revenue cycle management products for healthcare providers in the last month.

      1. Windham Brannon, an audit and accounting firm, will provide advisory and financial assistance to rural hospitals through its revenue cycle consortium.

      2. Fiserv, a financial services technology provider, introduced a payment platform designed to help utility, insurance, lending, healthcare and telecommunication companies customize billing and payment options for customers.

      3. FAIR Health launched a mobile app aimed at promoting healthcare literacy among Connecticut patients.

      Read full article here.
       
    • REPORT: Opioid addiction is costing more than just lives
      September 13, 2016
      WLNS.com
      LANSING, MI (WLNS) – 6 News has brought you dozens of reports on just how serious of an epidemic opioid drugs, like heroin, have gotten in our state.

      Jackson County has been dealing with a record number of overdoses this year and the deadly problem just isn’t going away.

      A report released today by a group called Fair Health shows that the addiction is costing more than just lives.

      Read full article here.
       
    • Claims study quantifies growing impact of opioid crisis
      September 13, 2016
      behavioral.net
      Intuitively, most industry observers know more people are receiving treatment for opioid addiction today than just a few years ago. This week, FAIR Health, a not-for-profit, independent data organization, released a new report that has quantified the magnitude of the trend.

      And it’s staggering.

      Commercial health insurers paid treatment centers, hospitals, labs and other medical providers $445.7 million to treat plan members’ opioid dependence and abuse in 2015. By comparison, 2011 payments totaled just $32.4 million, demonstrating a 1,375% spending increase over five years.

      Read full article here.
       
    • 5 study findings on health spending related to opioid addiction treatment
      September 13, 2016
      beckershospitalreview.com
      FAIR Health has put a dollar amount on the impact of the epidemic of opioid abuse, involving both prescription pain relievers and heroin.

      In its new white paper, the national, independent, nonprofit organization looks at the increasing healthcare costs and demand for specific services attributable to the epidemic. FAIR Health analyzed data from its database of more than 21 billion privately billed healthcare claims to identify trends and patterns in these costs and services.

      Here are five study findings:

      Read full article here.
       
    • Opioid epidemic expert: Payers can do 'quite a bit' to curb costly crisis
      September 13, 2016
      fiercehealthcare.com
      As the cost of opioid abuse disorders continues to climb for payers, one expert tells FierceHealthPayer insurers have a major role to play in mitigating the crisis.

      Healthcare spending among private insurers for opioid-related diagnoses increased more than 1,000 percent between 2011 and 2015, according to a new white paper from the nonprofit databank FAIR Health.

      Read full article here.
       
    • Health Plans’ Spending on Opioid Abuse Soars 1,375%
      September 13, 2016
      managedcaremag.com
      Health insurers saw an incredible increase of 1,375% in spending on patients with opioid dependence during a four-year period, according to a study by Fair Health, a not-for-profit data collector that provides cost transparency information.

      Health insurers’ payments to treatment centers, hospitals, labs, and providers grew from $32 million in 2011 to $446 million in 2015, according to the report.

      Read full article here.
       
    • Opioid Misuse Treatment Spending Increases by more than 1300%
      September 13, 2016
      managedhealthcareconnect.com
      According to a recently released report by FAIR Health, health spending for opioid dependence treatment increased by more than 1300% between 2011 and 2015.

      “Since its inception around the beginning of the 21st century, the current epidemic of opioid abuse, dependence and overdoses has taken many lives, caused widespread suffering at every level of society and resulted in high economic costs,” FAIR Health researchers wrote in the recently released white paper.

      Read full article here.
       
    • Charges and Allowed Amounts for Services for Patients with Opioid Abuse or Dependence Diagnoses Rose over 1,000 Percent since 2011
      September 13, 2016
      sports.yahoo.com
      NEW YORK, Sept. 13, 2016 /PRNewswire-USNewswire/ -- National aggregated professional charges for services for patients with opioid abuse or dependence diagnoses rose by more than 1,000 percent from 2011 to 2015, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. As detailed in FAIR Health's new white paper, The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services, and in the infographic below, imputed allowed amounts for such services grew by an even greater rate, 1,375 percent, during the same period.

      Read full article here.
       
    • Opioid epidemic: Treatment costs surge 1,300 percent in 4 years, study finds
      September 13, 2016
      RT.com
      The US healthcare system is grappling with an opioid epidemic that is decimating some communities. While Congress has yet to further fund treatment, the private healthcare sector has been struggling with the associated costs.

      Most Americans believe that opioids are the biggest drug problem facing the country, and health insurers are likely to agree, based on the findings of Fair Health’s white papers. Their report found claims related to opioid dependence have increased 3,203 percent from 2007 to 2014 – and that’s just the tip of the iceberg.

      Read full article here.
       
    • Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent
      September 13, 2016
      healthleadersmedia.com
      The report gives some examples of the changes, however. For example, one billing code for a test on opiate use commonly brought in a $31 payment from insurers prior to the change. The two billing codes that replaced it now are commonly paid at $78 and $156.

      The new billing codes may reflect new technology in testing, said Gelburd. She said some observers speculate that the rapid increase in lab spending might reflect that, with more patients in therapy, the tests are being used to ensure they are taking their proper medications and not abusing narcotics.

      Read full article here.
       
    • Opioid-related spending by health insurers spikes more than 1300 percent
      September 13, 2016
      healthcarefinancenews.com
      From 2011 to 2015, insurers' payments to hospitals, laboratories, treatment centers, other providers grew from $32 million to $446 million.

      The nation's ongoing opioid problem comes with staggering physical and emotional costs to patients and families. But the dollar cost to the health system has been harder to peg. Now a new report shows a more than 1,300 percent rise in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.

      Read full article here.
       
    • Costs soar for fighting opioid abuse
      September 12, 2016
      WashingtonExaminer.com
      The opioid epidemic is costing the healthcare industry, with spending on fighting opioid abuse and dependence rising by 3,200 percent in recent years.

      A series of reports published Monday found that spending on opioid abuse rose from $71 million in 2011 to $721.8 million in 2015. The spending encompasses the charges that providers billed for services and procedures to insurers.

      Read full article here.
       
    • Study: Health spending related to opioid treatment rose more than 1,300 percent over 4 years
      September 12, 2016
      arcamax.com
      The nation's ongoing opioid problem comes with staggering physical and emotional costs to patients and families. But the dollar cost to the health system has been harder to peg. Now a new report shows a more than 1,300 percent rise in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.

      From 2011 to 2015, insurers' payments to hospitals, laboratories, treatment centers and other medical providers for these patients grew from $32 million to $446 million -- a 1,375 percent increase.

      Read full article here.
       
    • Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent
      September 12, 2016
      KHN.org
      The nation’s ongoing opioid problem comes with staggering physical and emotional costs to patients and families. But the dollar cost to the health system has been harder to peg. Now a new report shows a more than 1,300 percent rise in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.

      From 2011 to 2015, insurers’ payments to hospitals, laboratories, treatment centers and other medical providers for these patients grew from $32 million to $446 million — a 1,375 percent increase.

      Read full article here.
       
    • Insurance Data Show A Surge In Spending On Opioid Treatment And Testing
      September 12, 2016
      NPR.org
      The nation's opioid problem comes with staggering physical and emotional costs to patients and families. But the financial burden on the health system has been harder to peg.

      A report set to be released Tuesday shows a more than thirteenfold increase in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.

      Read full article here.
       
    • A new app helps consumers compare reimbursement for medical procedures online
      September 12, 2016
      internethealthmanagement.com
      An East Coast non-profit healthcare organization wants patients to know before they go online to book a medical or dental procedure —at least in Connecticut, New York and select other states.

      Fair Health Inc., a not-for-profit consumer healthcare research organization based in New York, has developed and released a free Apple iOS and Android app that gives Connecticut residents access to web tools for estimating how much health insurers most often reimburse for a test or procedure. The app also provides resources and articles about health insurance to help guide consumers through buying insurance In Connecticut and Rhode Island, Massachusetts and New York.

      Read full article here.
       
    • The FH Cost Lookup CT App Compares Costs Of Medical Services
      September 8, 2016
      trendhunter.com
      New York-based non-profit organization Fair Health has launched an innovative and highly informative healthcare app, dubbed FH Cost Lookup CT, that is designed to make it easier than ever for people in Connecticut to receive transparent and revealing information about the price of different medical services in their area.

      This healthcare app allows users to access a range of content about the complicated world of health insurance, and offers estimates on insurance reimbursements for different medical procedures and tests.

      Read full article here.
       
    • FAIR Health launches CT consumer healthcare mobile app
      September 7, 2016
      hartfordbusiness.com
      A national independent nonprofit announced Tuesday that it has launched a free mobile app to help improve health insurance literacy, promote transparency in medical and dental costs and increase healthcare engagement among Connecticut residents.

      Fair Health launched the app, the FH Cost Lookup CT. The app, funded by a grant from the Connecticut Health Foundation (CT Health), can be downloaded from the iTunes App Store or Google Play and is available in English and Spanish.

      Read full article here.
       
    • Price transparency, healthcare engagement, insurance literacy: 3 notes on FAIR Health's new app
      September 7, 2016
      beckersasc.com
      Connecticut-based FAIR Health recently launched FH Cost Lookup CT to improve insurance literacy, promote transparency in medical and dental costs and increase healthcare engagement for state residents, Healthcare Finance reports.

      Here's what you should know.

      1. The app will help insured and uninsured consumers estimate costs of procedures in Connecticut, New York, Massachusetts and Rhode Island.

      Read full article here.
       
    • The makeup of the millennial patient — 18 things to know
      September 7, 2016
      beckershospitalreview.com
      Born between 1982 and 2022, millennials are changing the platform of healthcare. They are not just the largest U.S. generation, but also possess a great purchasing power.

      Here are key takeaways about the millennial patient.

      Connecting with a millennial patient

      Read full article here.
       
    • Connecticut posts free health literacy and price transparency app
      September 7, 2016
      healthcareitnews.com
      FAIR Health has launched a free mobile app it says can help improve health insurance literacy, promote transparency in medical and dental costs, and increase healthcare engagement among Connecticut residents.

      Available in both English and Spanish, the FH Cost Lookup CT app includes a feature that enables both insured and uninsured consumers to estimate the region-specific costs of medical and dental procedures received in Connecticut, as well as in the neighboring states of New York, Massachusetts and Rhode Island.

      Read full article here.
       
    • Opioid Epidemic Prompts More Finger Pointing at Pharma
      September 7, 2016
      pharmexec.com
      One issue that Democrats and Republicans agree on is that too many Americans are dying or becoming addicted to powerful prescription pain medications, and that the government, the medical profession and the pharmaceutical industry need new strategies to halt the spread of opioid abuse across the nation. States are suing pharma companies for misleading promotional messages, while members of Congress complain
      about high prices for antidotes and for safer formulations. Politicians of all stripes demand limits on opioid prescribing and dispensing and more treatment for addicts.

      An estimated 19,000 Americans died last year from prescription opioid overdoses, and thousands end up in emergency rooms every day, largely related to over-use and abuse of extended release/long-acting (ER/LA) pain medications. While these drugs provide much-needed relief to individuals suffering from chronic pain, they also can provide a big “high” when crushed so they can be inhaled or injected. Huge sales increases over the past decade indicate opioid use far greater than what is needed for legitimate patient treatment.

      Read full article here.
       
    • FAIR Health introduces app to increase health literacy
      September 7, 2016
      clinical-innovation.com
      Low healthcare literacy leads to confusion for both patients and physicians when trying to achieve the best care possible. FAIR Health has designed an app to help users tackle the difficult decisions in regards to health insurance.

      Meant to increase understanding of medical and dental costs and improve healthcare engagement, the FH Cost Lookup CT app was developed in response to changes for consumers the Connecticut health system was expanded.

      Read full article here.
       
    • Fair Health's new cost transparency app provides clarity to Connecticut residents in English, Spanish
      September 6, 2016
      mobihealthnews.com
      The problem of bias is one of the potential pitfalls of creating a healthcare price transparency tool. If the tool is offered by an insurer or a hospital, consumers might not trust that the data is fair and accurate, rather than intended to drive them to a particular provider.

      Fair Health, which recently launched a new consumer-facing app in the state of Connecticut, has an advantage in this area. The nonprofit organization was founded as part of a settlement between the New York Attorney General's office and the state's health insurance industry, and its whole mission is to provide a nonbiased dataset for governments, researchers, insurers, and the public.

      Read full article here.
       
    • You Can Negotiate Costs with Doctors? A New Mobile App to Improve Health Insurance Literacy
      September 6, 2016
      CTHealth.org
      “Negotiate the price? I didn’t know that. They never told me that. Can we do that?”

      Those were the reactions from focus group participants to the question:
      “Can patients negotiate costs with their doctors for care that they receive out of network, or for which they lack insurance coverage?”

      A national, independent, nonprofit organization, FAIR Health, conducted two focus groups in Hartford with the Hispanic Health Council for our “Engage Health CT” initiative, a project supported by a grant from the Connecticut Health Foundation.

      Read full article here.
       
    • Connecticut's FAIR health app aims to improve price transparency, health insurance literacy
      September 6, 2016
      healthcarefinancenews.com
      FAIR Health, a nonprofit cost transparency and health research company, has launched a free mobile app it says can help improve health insurance literacy, promote transparency in medical and dental costs, and increase healthcare engagement among Connecticut residents.

      The "FH Cost Lookup CT" was funded by a grant from the Connecticut Health Foundation. It comes at a time when changes to the Connecticut health system increasingly require consumers to make complex decisions based on costs associated with their medical and dental care.

      Read full article here.
       
    • FAIR Health Launches Connecticut Consumer Healthcare Mobile App
      September 6, 2016
      finance.yahoo.com
      NEW YORK, Sept. 6, 2016 /PRNewswire-USNewswire/ -- FAIR Health, a leading national independent nonprofit organization that advances system-wide healthcare cost transparency through consumer resources, data products and health services research support, announced today that it has launched a free mobile app to help improve health insurance literacy, promote transparency in medical and dental costs and increase healthcare engagement among Connecticut residents.

      Funded by a grant from the Connecticut Health Foundation (CT Health), the FH® Cost Lookup CT mobile app becomes available at a time when changes to the Connecticut health system increasingly require consumers to make complex decisions based on costs associated with their medical and dental care. Those changes include the expansion of coverage through Access Health CT, the state's health insurance exchange; the proliferation of health plans with increased member cost-sharing requirements and narrow networks; and the overall drive toward value in healthcare.

      Read full article here.
       

    • August
    • PriceCheck: Not All Health Care Transparency Tools Are Alike
      August 31, 2016
      health.wusf.usf.edu
      Transparency is the new buzzword in health care with consumer demand fueling changes to state laws and giving birth to websites that publish prices for medical procedures.

      WUSF partnered with WLRN in Miami to launch their own database called PriceCheck. But we're not the only game in town.

      A Google search for the term “medical prices” turns up several tools you can use to look up healthcare costs.

      Read full article here.
       
    • 8 ways to help kids and teens avoid sports injuries this fall
      August 30, 2016
      LancasterOnline.com
      Summer is winding down, and that means kids are heading back to school — and back to sports.

      Sports offer a number of great benefits, from staying fit and promoting leadership and teamwork to even improving academic performance.

      But sports also carry risks.

      More than 60 million children ages 6 to 18 participate in organized athletics, according to SafeKids.org. And more than 2.6 million are seen in emergency rooms each year for injuries related to sports and recreation.

      Read full article here.
       
    • Insured Woman Gets $18,000 Bill for Using an In-Network Doctor
      August 30, 2016
      time.com
      “I’ve always paid my bills. I had excellent credit.”

      That’s Nancy Gomez speaking with CBS Los Angeles about her ordeal. She’s a Californian with PPO insurance — and thousands of dollars in medical debt.

      Though Gomez is fully insured, she says she received an $18,000 bill for a treatment with an Encino pain specialist in her network, CBS reports. Gomez, who went in for an epidural nerve block, received the bill a few weeks later.

      Read full article here.
       
    • Insured woman gets $18K bill for using an in-network doctor
      August 29, 2016
      Aol.com
      "I've always paid my bills. I had excellent credit."

      That's Nancy Gomez speaking with CBS Los Angeles about her ordeal. She's a Californian with PPO insurance — and thousands of dollars in medical debt.

      Though Gomez is fully insured, she says she received an $18,000 bill for a treatment with an Encino pain specialist in her network, CBS reports. Gomez, who went in for an epidural nerve block, received the bill a few weeks later.

      Read full article here.
       
    • Bureaucracy in Workers’ Compensation
      August 25, 2016
      safetynational.com
      Workers’ compensation is one of the most highly-regulated lines of insurance. This session at WCI’s 2016 Workers’ Compensation Educational Conference reviewed how these state variations are impacting employers today and some of the solutions being considered to reduce this seemingly excessive bureaucracy plaguing the system.

      Speakers included:
      • Todd Brown, Practice Leader Compliance and Regulatory, Medata
      • Francine Johnson, Senior Director of State Programs and Product Strategy, FairHealth
      • Jon Wroten, Senior Vice President, Regulatory Compliance Quality, Sedgwick
      • Mark Walls, Vice President – Communications and Strategic Analysis, Safety National
      Read full article here.
       
    • The opioid epidemic: How bad is it and who does it hurt?
      August 21, 2016
      dailykos.com
      Last week I introduced you all to a friend of mine whose son has been struggling with heroin addiction for 12 years. It began with a car crash that caused traumatic brain injury. He began using heroin after taking opioid pain relievers as directed by his physicians. His story is not atypical as 79 percent of heroin users first abused opioid pain relievers.

      The discussion that followed in the comments brought to the surface the other stakeholders that must be included in any discussion of opioid analgesics—the patients to whom the drugs were sold in the first place. Before the widespread use of opioid analgesics, patients with chronic pain were treated with non-opioid medications and various other therapies dependent upon the cause of the pain. Sadly, these treatments did not always provide the relief that patients needed and, frankly, deserved, so the introduction of an opioid analgesic that was marketed  in the early 1990s as safe and less addictive than prior versions was a boon to them. As well as for the doctors who had struggled unsuccessfully to alleviate their pain.

      Read full article here.
       
    • How the Opioid crisis Is affecting the healthcare system
      August 18, 2016
      TheHill.com
      Following the release of our FAIR Health white paper, The Opioid Crisis among the Privately Insured: The Opioid Abuse Epidemic as Documented in Private Claims Data, on Aug. 1, and the publication that day of the featured article in Kaiser Health News entitled, “Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds,” the public response has been overwhelming. Our investigation into opioid abuse among privately insured individuals evidently struck a nerve, particularly with its central finding: that claim lines with an opioid dependence diagnosis rose 3,203 percent from 2007 to 2014. Headlines about the opioid crisis have continued to multiply since then: On Aug. 12, the Centers for Disease Control and Prevention (CDC) reported that the overall incidence of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome that occurs in newborns and is caused primarily by exposure to opioids in the womb, had increased almost 300 percent from 1999 to 2013 in the states included in the CDC report.

      Read full article here.
       
    • Scientists Find Much Safer Alternative To Morphine
      August 18, 2016
      dailycaller.com
      Scientists discovered a new drug that could replace morphine and doesn’t have the potentially lethal side effects.

      Researchers at the University of California at San Francisco (UCSF) discovered “PZM21” has the same pain relieving qualities of morphine, without the medical risks, and it is potentially non-addictive, The Daily Mail reported Wednesday.

      Read full article here.
       
    • From Patient To Consumer: Reimagining Health Care From A Consumer Perspective
      August 18, 2016
      huffingtonpost.com
      Navigating our health care system is no easy task. For decades, consumers have been forced to contend with a fragmented health system that makes decision making an all-consuming challenge. Whether it’s choosing a provider, knowing where to get information about cost or quality of doctors, or understanding a dictionary of complex health care terms, many consumers often feel left to fend for themselves in a system that is working against them.

      For many individuals, it’s hard to know where to start. A recent state analysis by Rice University in Texas found that 42 percent of consumers who bought their own insurance felt like they lacked a clear understanding of their health insurance plans. Nearly a quarter of those surveyed who had employer-sponsored coverage still struggled with understanding their benefits.

      Read full article here.
       
    • All Payer Claims Databases: The Post-Gobeille landscape
      August 12, 2016
      thehill.com
      On July 21, 2016, the Department of Labor (DOL) issued proposed regulations that would expand reporting requirements for employee benefit plans governed by ERISA. Although the changes sought by DOL are significant, they do not address a serious issue that the Supreme Court’s decision in Gobeille v. Liberty Mutual Ins. Co. created for many states. In Gobeille, the Court held that state laws creating All Payer Claims Databases (APCDs) cannot mandate the disclosure of ERISA plans’ claims and other information. This decision presents an obstacle to the burgeoning movement to create state APCDs—repositories of healthcare claims data intended to help advance policy making and analysis.

      The potential benefits of APCDs are many. Making the treatment history of almost all residents of a large number of states, perhaps eventually the entire United States, accessible to researchers and policy makers affords an enormous opportunity to improve healthcare policy, economics, treatment and, ultimately, Americans’ personal health.

      Read full article here.
       
    • Healthcare Services Rendered to Privately Insured Patients with a Diagnosis of Opioid Dependence Increase 3,200 Percent since 2007
      August 11, 2016
      insurancenewsnet.com
      By a News Reporter-Staff News Editor at Insurance Weekly News -- Private health insurance claim lines with an opioid dependence diagnosis rose 3,203 percent from 2007 to 2014 in the United States, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. Claim lines with a pregnancy drug dependence diagnosis, which could be attributable to opioids or other drugs, rose 511 percent.

      Read full article here.
       
    • So Why is Naloxone Getting So Expensive?
      August 9, 2016
      prium-evidencebased.blogspot.com
      Last week, I posted a piece on the public health debate around naloxone.  Since then, I've received a stream of new and interesting data to share.  

      First, a report showing that naloxone scripts led to fewer ED visits... of the 2,000 patients in this study focused in safety-net clinics around San Francisco, those receiving naloxone along with long-term opioid prescriptions had 47% fewer visits to the emergency department.  That appears to be compelling evidence to suggest co-prescribing naloxone makes sense (though the focus on the safety net clinic population begs the question of how translatable the conclusions might be to other populations).

      Read full article here.
       
    • PERSONNEL MATTERS: Huge increase seen in opioid dependence-related claims
      August 8, 2016
      tirebusiness.com
      CHICAGO (Aug. 8, 2016) — The number of claims made to private health insurers that include a diagnosis of opioid dependence rose by more than 3,200 percent in the past decade, according to a report released Aug. 2.

      The nonprofit group FAIR Health used data gleaned from ICD-9 diagnostic codes used for insurance claim forms. Researchers found adults between ages 19 and 35 were by far the most diagnosed age group, accounting for 69 percent of claim lines for opioid dependence during the study period. The same age group composed the majority, or 78 percent, of heroin overdoses.

      Read full article here.
       
    • Desperate to detox: Addiction services are swamped, and police are changing tack as the opioid crisis deepens
      August 8, 2016
      usatoday.com
      Getting hit in the face was all part of Laurie Polatas’ plan. She was desperate to get her daughter Michelle out of a seemingly endless cycle of opioid drug addiction, sex trafficking and crime.

      Laurie's plan was to offer Michelle money and ask her to meet in a McDonald's parking lot. Laurie had police wait nearby, hoping she could coax her daughter into doing something to warrant an arrest, land her in jail and get her off the streets. Michelle came, and punched Laurie in the head as soon as she spotted law enforcement.

      Read full article here.
       
    • Robin Gelburd, FAIR Health, Discusses Surprise Medical Bills
      August 5, 2016
      Healthcare Consumerism Radio
      Joining our hosts on HealthCare Consumerism Radio is Robin Gelburd, president of FAIR Health.

      Consumers are frequently exposed to surprise balance bills when they unwittingly receive out-of-network services at in-network facilities. Consumers also receive sizable bills in the wake of receiving emergency care at a facility outside of their plan’s network.

      In order to address this growing concern—sometimes causing consumers to go into medical bankruptcy—state legislatures are designing legislation that holds a consumer harmless to in-network payment amounts and offers various approaches to how providers should be paid for such services. New York and Connecticut are examples of two such states that have moved in this direction. Other states are contemplating their own creative solutions to this pressing problem and are being watched with keen interest by stakeholders and policymakers.

      Click here  for the full audio
       
    • Insurance claims related to opioid dependence have risen by 3200%, US study finds
      August 5, 2016
      BMJ.com
      Private health insurance claims for opioid dependence in the United States rose more than 3200% from 2007 to 2014, an analysis of privately billed healthcare claims has shown.1 The study was conducted by FAIR Health, a New York City based non-profit corporation that maintains a database of over 20 billion privately billed healthcare claims and provides healthcare cost data and analysis to government agencies, insurers, providers, and consumers.

      Read full article here.
       
    • Opioid crisis plagues privately insured
      August 5, 2016
      behavioral.net
      A new study that analyzed claims from a large database of employer-sponsored health insurance plans found a striking 3,000% increase in opioid dependence between 2007 and 2014. It’s yet more evidence of the opioid crisis and its prevalence in middle-class demographic groups.

      The findings can also be seen as a significant big-picture indicator, considering that private health insurance plans historically have covered 70% or more of the adult population, according to the Census Bureau.

      Read full article here.
       
    • Skyrocketing Number of Privately Insured are Dependent on Opioids: Study
      August 5, 2016
      hhnmag.com
      Research by nonprofit group also finds that ages 19-35 disproportionately affected by wave of addiction.

      The number of privately insured individuals addicted to opioids has skyrocketed in recent years, according to new research released this week.

      Between 2007 and 2014, insurers reported an astonishing 3,203 percent uptick in the number of individuals classified as dependent on prescription painkillers and heroin. The data — gathered by health care transparency advocate Fair Health from billions of insurance claims — lends further credence to the assertion that this epidemic of addiction knows no stereotypes

      Read full article here.
       
    • Opioid dependency increased by over 3,000% between 2007 and 2014
      August 4, 2016
      norcal.news
      A new report by researchers from FAIR Health has come up with an alarming finding. According to the report, reliance on opioid has increased by over 3,000% between 2007 and 2014. Another concerning fact in the report appears to be a rise in heroin overdoses by 510% between 2009 and 2014. FAIR Health is a nonprofit organization which works with an aim to bring transparency to healthcare.

      Andrew Kolodny, senior scientist at the Heller School for Social Policy and Management at Brandeis University, said that 3,000% rise is big difference. The report added that opioid abuse has also jumped up by 317% between 2007 and 2014. The researchers said the rate of increase in heroin overdoses is much precipitous than surge in opioid abuse.

      Read full article here.
       
    • Medical Services For Opioid Dependency Up 3,000 Percent Over Last Decade
      August 3, 2016
      dailycaller.com
      A new report shows the rate of medical services for opioid dependency has risen by more than 3,000 percent between 2007 and 2014, while services for opioid abuse have risen by more than 300 percent.

      Researchers from FAIR Health, a “nonprofit organization dedicated to bringing transparency to healthcare,” found medical services for opioid dependency has risen by 3,303 percent in seven years, and services for opioid abuse rose by 317 percent during that time. Researchers also found that heroin overdoses have risen by 510 percent between 2009 and 2014, which researchers say is “much steeper than the growth in overdoses” from prescription opioids.

      Read full article here.
       
    • Mobile health app for CT Hispanics aims to aid healthcare decisions
      August 3, 2016
      hartfordbusiness.com
      Hispanic consumers in Connecticut later this summer will be able to access a Connecticut-specific mobile app in English and Spanish designed to improve health insurance literacy, consumer engagement in health care, and medical and dental cost transparency.

      Released by the independent nonprofit organization Fair Health and funded by a grant from the Connecticut Health Foundation, the free app will enable consumers to estimate the costs of medical and dental procedures received in Connecticut, as well as in New York, Massachusetts and Rhode Island, according to a news release from Fair Health. The app also will provide educational materials that explain the fundamentals of health coverage, identify specific healthcare issues in the state and include links to state-specific healthcare

      Read full article here.
       
    • Opioid-Related Insurance Claims Rise 3,000 Percent
      August 3, 2016
      doctorslounge.com
      The number of private health insurance claims for Americans addicted to opioids and heroin rose 3,203 percent from 2007 to 2014, according to a Fair Health report.

      WEDNESDAY, Aug. 3, 2016 (HealthDay News) -- The number of private health insurance claims for Americans addicted to opioids and heroin rose 3,203 percent from 2007 to 2014, according to a Fair Health report.

      Fair Health is a nonprofit group concerned with transparency in health care costs and health insurance information.

      Read full article here.

       
    • Opioid Dependence Claims Up 3200% Among Private Insurers, Report Finds
      August 3, 2016
      AJMC.com
      The opioid crisis is swamping private insurers, who have seen claims for abuse and dependence skyrocket among enrollees who are mostly white young adults. Women have now overtaken men in misusing the drug, according to a new report.

      Data from FAIR Health, culled from more than 20 billion private insurance claims going back to 2002, show that claims for opioid dependence rose 3203% from 2007 to 2014, with claims for opioid abuse rising 317% in that same period. While it is known that the current opioid and heroin epidemic is hitting much harder among suburban whites than prior spikes in abuse, the report spells out the role that private insurance plays in this crisis.

      Read full article here.
       
    • Opioid crisis shocker: Medical services for dependence diagnoses spike at over 3,000 percent
      August 3, 2016
      foxnews.com
      The current opioid crisis in the United States is one issue that unites Americans across the political spectrum.

      On July 22, the bipartisan Comprehensive Addiction and Recovery Act of 2016 (CARA) was enacted. The law authorizes the federal government to strengthen opioid addiction prevention, treatment and recovery and expand access to the opioid overdose-reversal drug naloxone.

      Read full article here.
       
    • One Statistic Illustrates the Grim Reality of Opioid Abuse — And It's Just the Beginning
      August 3, 2016
      mic.com
      Opioids have become a deadly epidemic in the U.S. — and a new study begins to show just how dire the situation has become. According to a new paper by FAIR Health, there's been an over 3,000% increase in opioid dependency between 2007 and 2014 among the privately insured.

      To conduct their study, researchers pooled insurance records for some 150 million patients, tracking certain "diagnosis codes" that reflected opioid dependency — a condition marked by "by symptoms such as increased tolerance, withdrawal or unsuccessful attempts to quit," according to CNN.

      Read full article here.
       
    • Opioid Dependence Claims Up by More Than 3,000% Since 2007
      August 3, 2016
      APTA.org
      A new report on the opioid crisis—this one focused on private insurance data--presents yet another litany of chilling statistics on the reach of the epidemic, this time including a startling 3,203% increase in claims related to opioid dependence from 2007 to 2014.

      The latest report, conducted by the nonprofit FAIR Health, is the result of an analysis of the organization's collection of more than 20 billion privately billed health care claims. Like previous research, the FAIR Health report points to a public health crisis that has ballooned rapidly, and is affecting certain age groups and regions disproportionately.

      Read full article here.
       
    • Opioid health services increased 3,000 percent
      August 3, 2016
      benefitspro.com
      How much is opioid addiction costing the United States?

      A new study from Fair Health Inc., a New York City-based nonprofit organization dedicated to bringing transparency to health care, finds that medical services for privately insured patients dealing with opioid dependence increased 3,000 percent from 2007 to 2014. Specifically, medical services performed on such patients increased to 7 million from 217,000.

      Read full article here.

       
    • Morning Briefing: Warning over "opioid crisis" of privately insured
      August 2, 2016
      ibamag.com
      Warning over “opioid crisis” of privately insured
      The number of people hooked on prescription drugs and heroin saw a sharp increase while overdoses hit a record high in the years from 2007 to 2014.

      Analysis by non-profit Fair Health found that there was a more than 3000 per cent rise in claims on private health insurance during the 7-year period and the report warns that the US in “in the midst of an epidemic of opioid dependence, abuse and overdose.”

      Read full article here.
       
    • Opioid dependence leads to 3,000% rise in medical services
      August 2, 2016
      CNN.com
      In one of the first looks at privately insured patients with opioid problems, researchers paint a grim picture: Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.

      The study considers a huge cohort of people who have either job-based insurance or buy coverage on their own. Its findings illustrate that the opioid problem is "in the general mainstream," said Robin Gelburd, president of Fair Health, a nonprofit databank corporation focused on health care cost transparency and insurance information. "Is the health system preparing for this tsunami of services?" she said.

      Read full article here.
       
    • Private insurers see 3,200% increase in claims related to opioid dependence
      August 2, 2016
      modernhealthcare.com
      The number of claims made to private health insurers that include a diagnosis of opioid dependence rose by more than 3,200% in the past decade, according to a report released Tuesday.

      The not-for-profit group FAIR Health used data gleaned from ICD-9 diagnostic codes used for insurance claim forms. Researchers found adults between ages 19 and 35 were by far the most diagnosed age group, accounting for 69% of claim lines for opioid dependence during the study period. The same age group composed the majority, or 78%, of heroin overdoses.

      Read full article here.
       
    • Un nuevo portal en internet te ayuda a buscar el mejor seguro médico
      August 2, 2016
      univision.com
      El sitio Fairhealth en internet es una nueva herramienta para ayudar a conseguir el seguro médico más adecuado y a bajos a costos, además de brindarle información sobre doctores de especialidades.

      Read full article here.
       
    • Opioid crisis: Dependence diagnoses spike for privately insured
      August 1, 2016
      fiercehealthcare.com
      The rise of the opioid abuse crisis has led to a sharp uptick in the number of opioid dependence diagnoses in recent years among the privately insured, according to a white paper from FAIR Health.

      FAIR Health, a non-profit databank focused on healthcare transparency, examined its database of more than 20 billion privately billed health claims and found that between 2007 and 2014, opioid dependence diagnoses rocketed up 3,203 percent. The diagnoses “overwhelmingly” occurred among 19-35 year olds.

      Read full article here.
       
    • Opioid-related insurance claims rose more than 3,000 percent 2007 to 2014
      August 1, 2016
      CNBC.com
      Health insurance claims for people hooked on prescription painkillers and heroin skyrocketed as the number of Americans who fatally overdosed on those opioids hit record highs, a new analysis reveals.

      The number of private health insurance claims related to opioid dependence diagnosis soared by 3,204 percent from 2007 to 2014, the analysis found.

      Read full article here.
       
    • 6 statistics about the national opioid epidemic
      August 1, 2016
      beckershospitalreview.com
      New York-based Fair Health recently conducted a study on national opioid practices.

      The nonprofit data bank analyzed anonymous claims data — provided by insurers — that contained information for 150 million patients. Researchers pinpointed diagnosis codes relating to opioid dependency and abuse, adverse events as a result of heroin use and other issues related to opiate abuse.
       
      Here are six things to know about the study's findings:

      Read full article here.
       
    • Medical services for people with opioid dependence jumps 3,203%, study finds
      August 1, 2016
      beckershospitalreview.com
      The United States is experiencing an epidemic of opioid dependence, abuse and overdose, which has resulted in an overwhelming amount of medical services, according to a study by FAIR Health.

      For the study, FAIR Health, a national, independent, nonprofit organization, examined its database of more than 20 billion privately billed healthcare claims to identify trends and patterns in the opioid epidemic among privately insured Americans.

      Read full article here.
       
    • Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds
      August 1, 2016
      PBS.org
      In one of the first looks at privately insured patients with opioid problems, researchers paint a grim picture: Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.

      The study considers a huge cohort of people who have either job-based insurance or buy coverage on their own. Its findings illustrate that the opioid problem is “in the general mainstream,” said Robin Gelburd, president of Fair Health, a nonprofit databank corporation focused on health care cost transparency and insurance information. “Is the health system preparing for this tsunami of services?” she said.

      Read full article here.
       
    • Many More People Seek Medical Help For Opioid Abuse
      August 1, 2016
      NPR.org
      Health care claims for people with opioid dependence diagnoses rose more than 3,000 percent between 2007 and 2014, according to an analysis of insurance records.

      The findings illustrate that the opioid problem is "in the general mainstream," says Robin Gelburd, president of Fair Health, a nonprofit that analyzes health care costs and conducted the study.

      Read full article here.
       
    • 3,000% jump in claims: The toll heroin, painkillers take on insurers
      August 1, 2016
      finance.yahoo.com
      Health insurance claims for people hooked on prescription painkillers and heroin skyrocketed as the number of Americans who fatally overdosed on those opioids hit record highs, a new analysis reveals.

      The number of private health insurance claims related to opioid dependence diagnosis soared by 3,204 percent from 2007 to 2014, the analysis found.

      The same analysis by Fair Health also found other disturbingly sharp spikes upward in the number of private insurance claims related to opioid abuse, drug dependence by pregnant women and heroin overdoses since 2011.

      Read full article here.
       
    • New insurance data analysis shows how large the opioid epidemic is
      August 1, 2016
      healthcaredive.com
      Dive Brief:
      • Medical services or procedures listed on an insurance claim among the U.S. privately-insured population with an opioid dependence diagnosis increased 3,203% from 2007 to 2014, according to a recent Fair Health white paper.
      • During the same time period, opioid misuse increased by 317% and heroin overdoses increased by 530%.
      • According to the CDC, opioids in 2014 contributed to 28,647 deaths in the U.S.

      Read full article here.
       
    • Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds
      August 1, 2016
      KHN.org
      In one of the first looks at privately insured patients with opioid problems, researchers paint a grim picture: Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.

      The study considers a huge cohort of people who have either job-based insurance or buy coverage on their own. Its findings illustrate that the opioid problem is “in the general mainstream,” said Robin Gelburd, president of Fair Health, a nonprofit databank corporation focused on health care cost transparency and insurance information. “Is the health system preparing for this tsunami of services?” she said.

      Read full article here.
       

    • July
    • Is Marketing Perpetuating Latino Health Care Disparities?
      July 31, 2016
      ama.org
      Race and health care practices should be mutually exclusive phenomena, yet in the United States, Latinos continue to be less likely than their non-Latino peers to have health insurance or a regular doctor. Are health care marketers allowing this demographic to slip through their fingers?

      Read full article here.

       
    • Compare Medical Costs
      July 29, 2016
      pubs.AARP.org
      Get your medical and dental costs under control by comparing prices with online tools from reputable organizations. HealthcareBlueBook.com, NewChoiceHealth.com and FairHealthConsumer.org list the typical costs that providers charge for many medical procedures, including prices for imaging services such as MRIs, X-rays and CT scans. They also can help you estimate the costs you may be asked to pay-with or without insurance.

      Read full article here.
       
    • Real Life: Paying For Healthcare
      July 28, 2016
      blog.pokitdok.com
      The ways we are paying for healthcare is changing, and the tectonic shift is causing some pretty significant issues. High-deductible health plans (HDHPs), which put a greater burden of financial responsibility on patients, and the sheer difficulty of paying a medical bill each play a part in this change.

      So, why are healthcare payments changing and how should hospitals adapt to this new normal? This post explores what has been, what is, what will be, and who stands to pay the price.

      Read full article here.
       
    • Study links concussions to structural changes in the brain
      July 25, 2016
      si.com
      A new study has found that concussions can have long-term effects on the structure of the brain. Even after clinical symptoms dissipate, structural changes can still be found, according to the study out of the Medical College of Wisconsin. This study was presented at the American Academy of Neurology’s Sports Concussion Conference earlier this month. While the structural effects on the brain after suffering a concussion were known previously, this study’s focus was to give a clearer time frame for the duration of those effects. Researchers found that six months after the initial injury, an individual’s white matter still shows signs of microstructural brain damage.

      Read full article here.
       
    • Youth Concussions: A Matter of National Concern
      July 20, 2016
      dailynational.com
      A widely publicized new study in the journal Pediatrics has reignited concern about concussions in children and young adults. According to what the study authors call “the most accurate and precise estimate to date,” between 1 and 2 million concussions related to sports and recreation occur annually in Americans 18 or younger, and between 500,000 and 1 million of those concussions go untreated. That this form of traumatic brain injury, which can have long-term clinical repercussions, is so common in our youth raises many questions for anyone concerned with the nation’s health. We at FAIR Health decided to answer some of those questions by researching our database of over 20 billion privately billed healthcare claims, the largest such repository in the country.

      Read full article here.
    • How Much Does it Cost to give birth in the United States?
      July 19, 2016
      app.fortunechina.com
      Read full article here.
       
    • Client Alert: Florida: What the New Balance Billing Law Means for Physicians
      July 18, 2016
      jdsupra.com
      This year two bills became law in Florida that are intended to equip Floridians with tools to make health care decisions based on cost and to protect them from significant unanticipated medical bills.  The first (HB1175) requires hospitals and ambulatory surgery centers to post publicly the average price they are paid for certain procedures, as well as information about their financial assistance policies and collection procedures.  The second (HB221) expands the existing Florida balance billing prohibition and limits physicians and other providers and facilities in the amount that they can bill PPO patients for their services in certain scenarios.  Physicians should be aware of both laws, but their billing staff needs to understand the intricacies of the expanded balance billing law, which became law on July 1, 2016, to mitigate a drop in physician income.

      Read full article here.
       
    • How to Slash Dental Bills (and Keep Your Teeth)
      July 14, 2016
      msn.com
      Keeping your teeth and gums healthy isn’t just a question of vanity. Sure, fresh breath and a sexy smile are great social assets. But oral health also has a lot to do with overall wellness.

      According to the Mayo Clinic, dental disease may be linked to health issues such as premature birth and low birth weight, cardiovascular disease, diabetes, endocarditis (infection of the inner lining of the heart), osteoporosis and even Alzheimer’s.

      Read full article here.
       
    • Study shows concussions up 500% in youth sports
      July 13, 2016
      si.com
      The concussion issues in sports have been a huge topic for years, especially in the NFL. A new study published by FAIR Health suggests that the issues have continued to become a huge concern across a range of youth sports in the United States for boys and girls.

      FAIR Health’s study concluded that concussion diagnoses for people under the age of 22 rose 500% from 2010 to ‘14. FAIR Health is a not-for-profit whose “mission is to bring transparency to healthcare costs and health insurance information.” This study, the company said in a release, was conducted “based on healthcare insurance claims 2007–15, ages 0–22 years.”

      Read full article here.
       
    • Health Buzz: Youth Concussion Rates On the Rise
      July 11, 2016
      health.usnews.com
      Children and young adults are being diagnosed with concussions at an increasingly high rate, up 500 percent from 2010 to 2014, according to new data from FAIR Health, an independent, national nonprofit.

      Concussions are a type of traumatic brain injury that cause the head and brain to quickly moving back and forth, potentially leading to cell damage and chemical changes. Across the United States, approximately 175,000 children receive emergency room treatment every year due to sports-related activities, according to the Centers for Disease Control and Prevention.

      Read full article here.
       
    • Data suggest increase in reported youth concussions; upwards of 500 percent since 2010
      July 11, 2016
      foxnews.com
      Two new data sets suggest youth concussions may be more common than previously thought.

      Findings announced Sunday at the American Orthopaedic Society for Sports Medicine found a 60 percent increase in concussion incidence among people ages 5 to 24 from 2007 to 2014. Researchers at the University of California San Francisco Medical Center analyzed administrative health records of more than 8.8 million members belonging to a large private payer insurance group to draw their conclusions. Alan L. Zhang, assistant sports medicine professor in residence, said in a news release that his team’s study was the first to consider concussion diagnosis trends across such a wide age group.

      Read full article here.
       
    • Surprise Medical Bills Fuel Fight Between Providers, Insurers
      July 8, 2016
      WSJ.com
      ‘Narrow network’ plans can deliver shocks when patients inadvertently go outside them for treatment

      The growth of insurance plans built around small networks of health-care providers is fueling new fights over surprise medical bills, when patients inadvertently get care from out-of-network doctors.

      Providers and insurers are blaming each other for sticking patients with higher bills in such cases, and nearly two dozen states have passed or are considering legislation to protect consumers.

      Read full article here.
       
    • Youth Concussions: A Matter of National Concern
      July 8, 2016
      huffingtonpost.com
      A widely publicized new study in the journal Pediatrics has reignited concern about concussions in children and young adults. According to what the study authors call “the most accurate and precise estimate to date,” between 1 and 2 million concussions related to sports and recreation occur annually in Americans 18 or younger, and between 500,000 and 1 million of those concussions go untreated. That this form of traumatic brain injury, which can have long-term clinical repercussions, is so common in our youth raises many questions for anyone concerned with the nation’s health. We at FAIR Health decided to answer some of those questions by researching our database of over 20 billion privately billed healthcare claims, the largest such repository in the country.

      Read full article here.
       
    • Connecticut taps Fair Health for benchmarking out-of-network ER reimbursement rates
      July 6, 2016
      hartfordbusiness.com
      The state of Connecticut, as part of a new consumer protection law, has designated FAIR Health Inc.'s database as the official benchmarking database for determining reimbursement for emergency services received out of network, according to a FAIR Health news release today.

      Fair Health is a national independent nonprofit that advances systemwide healthcare cost transparency through consumer resources, data products and health services research support.

      Read full article here.
       
    • CMS finalizes new rules for QES on sale and sharing on Medicare Claims Data
      July 5, 2016
      hipaajournal.com
      The Centers for Medicare and Medicaid Services (CMS) has finalized a new set of Rules for qualified entities that will allow the sharing or sale of Medicare claims data to healthcare providers, employers, and other entities.

      The rule changes will help to ensure that healthcare organizations, employers, and other organizations have access to the data they need to make informed decisions about the provision of care to patients. With access to all Medicare and private sector claims data, it is hoped that the quality of care provided to patients will be improved.

      Read full article here.

       
    • The fascinating facts about immigrants and health insurance
      July 1, 2016
      foxnews.com
      Immigration has been much in the news lately, with the Supreme Court deadlock blocking President Obama’s immigration reform program, California’s move to try to extend participation in their state health exchange to undocumented immigrants, and the continuing prominence of immigration as both a presidential election issue and a source of international turmoil.

      One aspect often lost in the headlines is just how challenging it can be for immigrants, both documented and undocumented, to get health insurance in the United States. 

      Read full article here.
       

    • June
    • Providers urged to use claims data to help drive LTC business plans
      June 30, 2016
      new.newsedge.com
      Skilled nursing providers should examine healthcare claims data to find regional or state trends that may change their business plan, an expert said Tuesday.

      In a general sense, we're seeing tremendous changes that are happening in the way people are seeking their care, said Robin Gelburd, JD, of FAIR Health, a nonprofit focused on healthcare claims and insurance transparency. Her presentation at the LTPAC conference, titled Precursors to LTPAC: How Healthcare Claims Data Can Help Drive Strategic Decision Making examined diagnosis and other demographics related to how people seek care.

      Read full article here.

       
    • 5 Facts About Urgent Care Clinics
      June 30, 2016
      AJMC.com
      Convenience has become important in healthcare, whether it is increased use of technology or where someone gets care. Difficulty making appointments has led to people not visiting the doctor or just going to the emergency room, and now they are using urgent care clinics, as well.  

      In the last 5 years urgent care has seen a rise in popularity. Here are 5 facts about urgent care clinics.

      Read full article here.

       
    • Check your health coverage with an explanation of benefits, or EOB
      June 30, 2016
      canmua.net
      Your EOB is the only way to know which medical services your health insurance plan covered, and you’ll need it if you were denied coverage or want to negotiate your bill.
      After a hospital stay or outpatient visit, you may get several bills and at least one statement that says “not a bill.” This is your explanation of benefits, or EOB.

      At first sight, it might look like a bunch of numbers and nonsense to you, and you may even be tempted to throw it away. Don’t. For each medical bill you receive, you should receive an explanation from your insurer, though sometimes more than one medical bill is reflected on an EOB. Your EOB is the only way to know which medical services your health insurance plan covered, and you’ll need it if you were denied coverage or want to negotiate your bill.

      Read full article here.
       
    • Request Your Medical Records Before You Pay That Hospital Bill
      June 29, 2016
      nasdaq.com
      It’s your right to access all of your hospital records — and the best reason to have them might be financial.

      If you’re hit with a huge medical bill that you think is erroneous or fraudulent, these records can prove you right or wrong. They’re the best account of what actually happened, more reliable than your memory or the doctor’s. In fact, hospital bills are often based on these records, and sometimes nothing else.

      Read full article here.
       
    • Providers urged to use claims data to help drive LTC business plans
      June 28, 2016
      McKnights.com
      Skilled nursing providers should examine healthcare claims data to find regional or state trends that may change their business plan, an expert said Tuesday.

      “In a general sense, we're seeing tremendous changes that are happening in the way people are seeking their care,” said Robin Gelburd, JD, of FAIR Health, a nonprofit focused on healthcare claims and insurance transparency. Her presentation at the LTPAC conference, titled “Precursors to LTPAC: How Healthcare Claims Data Can Help Drive Strategic Decision Making” examined diagnosis and other demographics related to how people seek care.

      Read full article here.
       
    • Finding a primary care physician is an important step for millennials
      June 13, 2016
      Medicalxpress.com
      According to a recent survey by FAIR Health, a nonprofit organization that gathers information on health data, more than 50 percent of millennials use means such as retail clinics, urgent care centers or emergency rooms for nonemergency medical care.

      University of Alabama at Birmingham School of Medicine Associate Dean of Rural and Primary Care William Curry, M.D., says convenience is the main factor.

      Read full article here.
       
    • At Health Datapalooza: Transforming Claims Data in to Quality and Cost Part I
      June 6, 2016
      RCMAnswers.net
      “Claims data is incredibly noisy and unless you really understand what the is question that you are trying to answer, there is a high likelihood that the data that you pull to answer the problem is going to be the wrong data,” Ariel Bayewitz, Vice President of Provider Analytics at Anthem, unequivocally told the audience.  Despite the onerous task of working with claims data, the Health Datapalooza panelists presented  their organization’s success turning this messy data into actionable and reliable information for the end user whether consumers, providers, payers and health systems. Here is a synopsis of challenges each organization or corporation is trying to meet with their clients and the benefits they were able to deliver. The panel moderator was Francois de Brantes of HCI3 and distinguished panelists included:

      Read full article here.
       
    • How to Keep Your Dental Costs Low
      June 1, 2016
      Nerdwallet.com
      Avoiding dental care because of the cost can backfire, resulting in a big bill and lot of pain later.

      Between 40% and 60% of Americans don’t go to the dentist as often as they should, according to the Centers for Disease Control and Prevention. Although many cite anxiety or fear, cost is the largest reason: The CDC reports that while 10% of Americans forgo dental care due to fear or anxiety, 42% do so because of cost.

      You don’t have to be one of them. There are several ways to save money on dental care, and some may surprise you.

      Read full article here.
       

    • May
    • How To Engage Millennials In Health Insurance
      May 31, 2016
      Insurancenewsnet.com
      Significant changes in health insurance enrollment, such as public and private exchanges and new benefit designs, including high-deductible plans and narrow networks, are requiring individuals to take on greater personal responsibility for selecting the most suitable plan and managing their own benefits and costs - often through Internet portals. Individuals must become betterinformed health care consumers who are skilled at using the latest technology to navigate the system and get the most out of their health coverage.

      The size, diversity and buying power of the population segment known as millennials or Generation Y (ages 18-34) make them an important group to study. According to the Pew Center, this generation constitutes the largest segment of the U.S. workforce and has surpassed baby boomers as the largest living generation.

      Read full article here.
       
    • Troubleshooters: Tips on preventing pricey medical procedures
      May 14, 2016
      6abc.com
      The Action News Troubleshooters receive many, many complaints about medical bills, and many of you tell us those bills are simply too high. We've discovered that asking the right question could save you hundreds, even thousands of dollars.

      Bob Dolente works on his feet, so he can't afford to be in pain.

      Dolente tells us, "Sciatica pain is very painful. You can't stand, and you can't put no pressure on your legs."

      Read full article here.
       
    • Survey: Patients With Skimpy Health Insurance Policies Put Off Care
      May 9, 2016
      WPR.org
      Poll of ER Docs Shows 62 Percent Think Coverage Is Less Than Adequate

      A poll commissioned by the American College of Emergency Physicians shows many emergency room patients delay care because of high out-of-pocket medical costs.

      Dr. Lisa Maurer, an ER doctor at Wheaton Franciscan in Milwaukee said she's observed it first-hand. Many insured patients don’t understand their policies and get sticker shock when they have up-front costs, Maurer said, which hurts both the patient and the provider.

      Read full article here.
       
    • Here’s What It Costs to Actually Become a Mother
      May 6, 2016
      Time.com
      The price tag for childbirth can be painful.

      Children are priceless, but in the United States, giving birth to one is far from free. When American mothers take their newborns home from the hospital, big bills can follow.

      The average doctor charges for a vaginal delivery with no complications in the U.S. is $3,035, according to data from FAIR Health, a health care nonprofit that keeps a national database of insurance claims. That includes the cost of routine care before and after the birth (but not tests like ultra sounds or amnio). If you want an epidural (which, let’s be real, many women do), that’s another $2,132 on average. Prices vary considerably depending on where you live. The average cost of a C-Section nationwide is $3,382, plus $1,646 for an epidural, FAIR Health found.

      Read full article here.
       
    • Need a new knee? Better shop around.
      May 5, 2016
      MarketWatch.com
      Medical care is a lot like real estate: the price we pay often comes down to location, location, location.

      In South Carolina, the going rate for a knee replacement is nearly $14,000 more than the national average of $33,000, whereas in Pennsylvania it’s nearly $4,000 less, according to a recent study from researchers at the Health Care Cost Institute and the Carlson School of Management, University of Minnesota, published in Health Affairs. These prices come from a national database of commercial insurance claims and include the total amount received by the medical provider from the insurance company and the patient.

      Read full article here.
       

    • April
    • 50 Benefit Technology Innovators
      April 21, 2016
      benefitnews.com
      The Dig|Benefits Technology Innovator Awards recognize 50 visionaries who are driving technology innovation, overcoming organizational and technology barriers, deploying leading-edge technology, and shaping benefit technology regulation and policy. The awards were open to benefit plan sponsors, benefit technology company executives, benefit advisers, brokers and consultants and others on the leading-edge of technology development, adoption and deployment.

      To select the winners, the editors asked readers for nominations, consulted with industry experts and called on their own industry knowledge. They selected individuals who are making breakthroughs in digital benefits platforms, health insurance alternatives, private exchanges, retirement and robo-advising, financial wellness tools, digital health and wellness tools, advancesin digital employee engagement platforms, and benefits and workplace analytics.

      Read full article here.
       
    • FAIR Health database tops 20 billion in private insurance claims
      April 13, 2016
      beckershospitalreview.com
      The FAIR Health database has stored more than of 20 billion medical and dental claims submitted through private insurance.

      Below are four things to know about the FAIR Health database.

      1. FAIR Health was created as way to encourage price transparency between payers, providers and consumers.

      Read full article here.
       

    • March
    • Costs Should Be Part of the Equation
      March 29, 2016
      informedmedicaldecisions.org
      I have excellent health insurance, but like millions of Americans, I have a high-deductible health plan. As more and more employers move to this model, it is important that we, as consumers of health care, consider the costs of care as part of our treatment decision-making process. In what other buying decision would we ignore costs? Could you imagine comparing dishwashers or car models without looking at the price tag? Why would health care be any different? To illustrate this point, consider my own cautionary tale.

      I was recently confronted with a health issue and was offered several treatment options: watchful waiting, medicines, or an outpatient procedure. The symptoms were bothersome enough that I did not wish to wait and I was concerned about the side effects of the medicines. In a shared-decision-making process with my doctor, I decided to move forward with the procedure. Thankfully it went according to plan, and I was very pleased with the care I received. But then I got the bill: almost $2,000, including office visits, imaging, sedation, and pathology.

      Read full article here.
       
    • How to reduce the cost of dental care
      March 28, 2016
      washingtonpost.com
      Doling out the cash to get a toothache treated can hurt almost as much as the tooth itself. That’s because about 40 percent of people in the United States have no dental benefits. And most who are insured lose their coverage once they retire.

      But ignoring dental problems or skipping preventive care can harm you. Some studies suggest that chronic gum infection is associated with an increased risk for heart attack. So how can you maintain oral health without wrecking your budget? Consumer Reports’ experts recommend these steps:

      Read full article here.
       
    • 5 key factors of dental savings plans in retirement
      March 11, 2016
      bankrate.com
      For those crossing into retirement, a cutoff from dental benefits can be a rude awakening.

      While many employers provide employees with insurance that covers dental costs, that coverage often comes to an abrupt end when an employee retires. Medicare doesn't cover most routine dental services. Some Medicare Advantage plans provide limited dental benefits, but costs can still add up.

      Read full article here.
       
    • How Millennials Are Impacting Healthcare IT
      March 10, 2016
      hitechanswers.net
      Millennials between the ages of 18 and 24 have been changing the norms as consumers. Nearly all business sectors have been affected by millennials because they are not sticking to traditional consumer trends. Below I highlighted 5 ways in which millennials are changing the world of healthcare:

      1). Millennials are more likely to use telehealth
      According to a Harris Poll survey, Millennials between the ages of 18 and 34 are most likely (74%) to be interested in telehealth compared to only 41% of individuals age 65 and above. A separate joint survey between Salesforce and Harris Poll found 61% of millennials would support the use of telehealth to eliminate in-person visits.

      Read full article here.
       
    • How Much Does a Root Canal Cost?
      March 10, 2016
      nerdwallet.com
      Most people don’t like going to the dentist. If you’re heading in for a root canal, you could be feeling double the dread if you don’t know how much it will cost.

      It’s understandable to worry about whether you can afford a root canal, but this isn’t a procedure to skip because of cost. You might be able to pass on some dental work, but a root canal is usually advised when the root of a tooth is infected and there’s a risk that the infection could spread to other parts of the face and neck.

      Read full article here.
       
    • Young people file more kidney dialysis claims [infographic]
      March 10, 2016
      lifehealthpro.com
      Fair Health is seeing a sharp increase in the chances that privately insured, working-age adults will file claims for kidney dialysis.

      The rate of increase seems to be higher for younger insureds than for older insureds, analysts at the group say.

      Read full article here.
       

    • February
    • 10 Years Watching the New York Health System: The Good and the Bad
      February 29, 2016
      huffingtonpost.com
      After 10 rewarding years, I step down this week as President of the New York State Health Foundation and join the faculty at New York University. In other places, I have reflected on my experiences running the Foundation, but here I thought I would reflect on the ups and downs of health care and public health in New York State.

      As president of a foundation helping to support medical care innovation, healthy living, better health policy, and more attention to the real health needs of New Yorkers, I have had the privilege of watching our health system evolve and try to improve. Some of what I observe, I am super-impressed with. Other aspects of what has happened over 10 years, I find disappointing.

      Read full article here.
       
    • 7 Expert Tips for Negotiating Your Medical Bills
      February 29, 2016
      everup.com
      You head to the dentist for a root canal; or stop in for an X-ray of the ankle that’s been bothering you since you ran a marathon last week; have an accident that results in an impromptu hospital stay. The common denominator? You (and your bank account) wait in fear for the bill to hit your mailbox, when you’ll grimace, bow your head in financial heartbreak, and stock up on Ramen to sustain you through the next two months while you pay it off.

      “If you’ve received a medical bill recently, then what I’m about to say likely won’t come as a surprise—in the United States, we spend a lot on healthcare,” said Nicole Lapin, New York Times best-selling author of Rich Bitch, Accredited Investment Fiduciary (AIF®), and the money saving correspondent for The Wendy Williams Show. “In fact, we spend more than twice as much per capita on healthcare than the average developed country does, at an average of $8,508 per person per year. (FYI: That adds up to $2.8 trillion total, or a staggering 18 percent of GDP.)

      Read full article here.
       
    • Take a bite out of dental bills
      February 25, 2016
      cnbc.com
      Baby boomers beware: A major retirement expense may be hiding in your mouth.

      A majority of those age 50 to 64 either believe that — or are unsure whether — a Medicare health insurance plan will cover routine dental care, according to a recent survey by advocacy group Oral Health America (OHA). (To download the study, click here.)

      Read full article here.

       
    • Cutting medical costs isn’t as hard as you think
      February 25, 2016
      fox4kc.com
      KANSAS CITY, Mo. -- Medical procedures are expensive, and if you don’t do your research, you could end up owing the hospital tens of thousands of dollars.

      But there are several things you can do to avoid going into debt the next time you go in for a test or surgery.  Many experts suggest before going in for any procedure, you should first cost compare.

      Read full article here.
       
    • 7 Ways To Save At The Dentist
      February 24, 2016
      huffingtonpost.com
      Dental care is important to your overall health as well as your smile. Failure to take care of your teeth and visit a dentist regularly can lead to gum disease and allow bacteria an efficient path into your bloodstream, potentially contributing to the risk of heart attacks, strokes, and diabetes. Unfortunately, too many Americans are not visiting a dentist as often as they should -- and, according to a 2012 study from the Centers for Disease Control and Prevention (CDC), one of the primary factors is cost.

      Dental insurance is not covered in many health insurance plans, nor is adult dental health covered under the Affordable Care Act. Separate dental insurance is available, but it can be out of reach for many families who require subsidies just to maintain health insurance, let alone dental coverage.

      Read full article here.
       
    • Making medical bills more affordable
      February 24, 2016
      koat.com
      ALBUQUERQUE, N.M. —We've all received them, and often, they're not so easy to understand. But when you get a medical bill you can't pay, there are simple steps you can take to make it more affordable.

      At a time when medical costs keep rising -- higher deductibles, steep out of pocket costs -- paying those bills has never been so difficult. And understanding them -- well, not even health care professionals can always decipher their meaning.

      Read full article here.
       
    • Emergency physicians seek solutions to fair treatment
      February 23, 2016
      orlandosentinel.com
      Florida's legislators have recently expressed a legitimate concern raised by residents regarding what has been referred to as "surprise bills" they receive after getting needed health care. In most cases, the "surprise" results from a misunderstanding of what is covered in their insurance plans and how large their out-of-pocket deductible is, even in the case of a medical emergency.

      Sometimes patients receive "surprise bills" when an emergency provider is not a participant in their insurance company's plan, a so-called out-of-network provider. When medical emergencies happen, there is no time, and there should be no reason to check one's insurance information.

      Read full article here.
       
    • Troubleshooters: Cracking Medical Codes
      February 22, 2016
      6abc.com
      LANSDALE, Pa. (WPVI) -- The cost of healthcare is becoming an ever bigger burden on consumers. Many are getting socked with expensive medical bills they never anticipated. But there are ways to figure out pricing and to shop around for the medical service you need.

      There are 10,000 medical procedure codes and that isn't counting anesthesia codes or codes for things like durable medical equipment. And it's these codes that dictate what patients have to pay.

      Read full article here.
       
    • Save At The Dentist
      February 18, 2016
      kob.com
      Dental care is important to your overall health as well as your smile. Failure to take care of your teeth and visit a dentist regularly can lead to gum disease and allow bacteria an efficient path into your bloodstream, potentially contributing to the risk of heart attacks, strokes, and diabetes. Unfortunately, too many Americans are not visiting a dentist as often as they should � and, according to a 2012 study from the Centers for Disease Control and Prevention (CDC), one of the primary factors is cost.

      Dental insurance is not covered in many health insurance plans, nor is adult dental health covered under the Affordable Care Act. Separate dental insurance is available, but it can be out of reach for many families who require subsidies just to maintain health insurance, let alone dental coverage.

      Read full article here.
       
    • Most Parents Incorrect on Child's First Dental Visit
      February 15, 2016
      fairfielddentalassociates.com
      As part of our series for National Children’s Dental Health Month, Fairfield Dental Associates is sharing information, research and new stats on ways to protect children’s teeth. A new East Coast survey has found nearly half of all U.S. consumers do not know when a child should first see the dentist. This is alarming as dental decay can set in early. According to responses gathered from over 1,000 respondents, nearly 40 percent of parents think the first dental check-up should occur after a child’s second birthday - which is a year too late. The FAIR Health’s consumer survey also found that some parents thought first dental visits could be delayed until the age of three which is way too long to wait.

      Read full article here.
       
    • 5 Ways to Save Money at the Dentist
      February 9, 2016
      parade.com
      Today was part one of a multi-part dental treatment for two molars that need their fillings replaced. Going to the dentist isn’t one of my favorite activities, but saving money at the dentist is. And that’s why I love my new dentist.

      After taking into consideration my existing dental insurance, the dentist gave me an estimate for my work. Though my insurance is covering one-third of the price, the dentist recognized that the remaining two-thirds was a pretty penny and offered me two payment options. I could break up my payments over four installments. Or, if I could afford to pay the whole fee at once, she’d knock 5 percent off the total. I went for the second option.

      Read full article here.
       

    • January
    • New Fair Health Survey Finds Blacks & Millennials Among Those Most Likely to Find Deals for Dentist
      January 27, 2016
      newsinblack.com
      A person’s oral hygiene habits can be linked back to how much money they make — at least that’s one of the somewhat unsurprising findings of a recent survey released by medical and dental data distributor Fair Health. According to dental news site Drbicuspid.com, the survey, entitled “Consumer Attitudes: Dental Treatment and Insurance,” was based on more than 1,000 U.S. adults and found a variety of different correlations among different demographics and their dental determinations.

      One of the big points is the fact that people who live in households that make less than $35,000 are more likely to rely on an emergency department for treating their teeth than consumers from higher-income households. While it makes sense logically, it’s not a good trend for any of the parties involved.

      Read full article here.
       
    • Planning to Pay Medical Debt With a Credit Card? Weigh Your Options First
      January 27, 2016
      creditkarma.com
      Thinking of paying that big medical bill with a credit card? You may want to think twice.

      Paying off medical debt with a credit card can be a bad idea unless you're trying to earn credit card rewards and can pay the balance in the same billing cycle, says Bruce McClary, a spokesman for the National Foundation for Credit Counseling (NFCC).

      Read full article here.
       
    • Checking Up On Health: Health Care News and Views Compiled by Benita Dodd
      January 26, 2016
      georgiapolicy.org
      The Legislature’s back in session; the presidential candidates’ ranks are thinning and you’re probably wondering whether there’s anything worthwhile amid the rhetoric.

      Governor Nathan Deal has made it quite clear that Medicaid expansion is not on his agenda, and it’s a wise move. First, why would you spend scarce state dollars on able-bodied individuals? Second, why would you force low-income Georgians into a program that is dogged by poor outcomes and low physician participation? Third, as I wrote recently in a commentary, there are opportunities in Georgia to expand health care options without expanding Medicaid.

      Read full article here.
       
    • Detangling the Medical Insurance Morass
      January 22, 2016
      lifezette.com
      How to save money, understand your bills, find the right doctors — and stay sane

      The labyrinth of medical bills can be ruthless no matter how careful you are.

      Outside of bankruptcy, it’s estimated that about 56 million adults — about 20 percent of the population — struggle to pay health-related bills. The cost of medical care was rated a top issue in 2015, according to a November Gallup Poll. As of 2013, nearly 2 million people had filed bankruptcy because of unpaid medical bills. This outpaces credit card bills and mortgages as the No.1 leading cause of bankruptcy in the United States.

      Read full article here.
       
    • One in Five Consumers Rarely or Never See the Dentist
      January 20, 2016
      dentistrytoday.com
      Nationwide, 20% of consumers in the United States say they never visit the dentist or only do so when there is an urgent need, according to a survey from FAIR Health. This increases to 30% for households with annual incomes less than $35,000 and falls to less than 10% for households with incomes higher than $100,000.

      African-Americans, Latinos, low-income households, and adults with a high school diploma or less visited the dentist less frequently than other racial, ethnic, or socioeconomic groups. Also, African-Americans and Latinos are more likely to report that a member of their household visited an emergency room for oral healthcare in the past 5 years.

      Read full article here.
       
    • Research Shows Too Many Americans Don't See the Dentist
      January 20, 2016
      fairfielddentalassociates.com
      Thirty percent of Americans never see the dentist, according to a new survey conducted by FAIR Health. The survey was conducted last year by ORC International's Telephone CARAVAN®. The combined sample consisted of 1,028 U.S.-based adults.  Fairfield Dental Associates found this statistic to be very alarming, especially with recent research that shows periodontal disease can lead to other life-threatening conditions. It is especially a concern with children who do not receive proper dental care. Twenty percent of consumers surveyed said they never saw the dentist or only did when their teeth required urgent care. One-third of the households that didn’t see the dentist had annual incomes of less than $35,000. Ten percent of households earning $100,000 or more also didn’t see the dentist.

      Read full article here.
       
    • Survey: Income influences where consumers receive dental care
      January 19, 2016
      drbicuspid.com
      The likelihood of an individual visiting the dentist is related to his or her household income, according to a new consumer survey released January 19 by Fair Health.

      Based on the survey of more than 1,000 U.S. adults, consumers from households with an income of less than $35,000 are more likely to rely on an emergency department for oral healthcare, compared with consumers from higher-income households.

      Read full article here.
       
    • Florida’s Insurance Consumer Advocate Hosts Forum on FAIR Health Database
      January 19, 2016
      capitalsoup.com
      Florida’s Insurance Consumer Advocate, Sha’Ron James, invites the public and industry stakeholders to participate in a forum focused on informing consumer decisions in healthcare.  The high cost of healthcare continues to be an issue for Florida’s families and the financial impact of one medical event can be a devastating blow to a family’s financial future.  Currently, there are several proposals before the Legislature and other policy options that have been discussed that take consumers out of the billing equation and empowers the consumer with the information they need to make informed medical decisions.

      Read full article here.
       
    • Ahorros para que la visita al dentista no te robe la sonrisa
      January 15, 2016
      laopinion.com
      Cómo reducir costos, aprovechar al máximo tu seguro y encontrar la mejor atención para tus dientes
      Pagar un montón de dinero para recibir tratamiento por un dolor de muelas puede doler casi tanto como la muela misma. Esto se debe a que aproximadamente el 40% de la gente en Estados Unidos no cuenta con beneficios para servicios dentales. Y la mayoría de las personas que sí están aseguradas pierden su cobertura al momento de retirarse.

      Pero ignorar los problemas odontológicos u omitir el cuidado preventivo puede perjudicarte. Algunos estudios sugieren que la infección crónica de las encías está asociada con un mayor riesgo de ataque al corazón. Entonces, ¿cómo puedes mantener saludable tu boca sin arruinarte el presupuesto? Nuestros expertos recomiendan los siguientes 10 pasos:

      Read full article here.
       
    • Choosing Doctors and Health Plans
      January 14, 2016
      TheIHCC.com
      Consumers' Healthcare Decision-making Varies Across Age, Gender and Socio-economic Status

      Read full article here.
       
    • $64,000 air-ambulance bill puzzles Scottsdale woman
      January 13, 2016
      azcentral.com
      With her husband's life fading from a stab wound to the head, Laura Brown's only thought was how quickly she could get to his side.
      She was in Scottsdale. He was at a Yuma hospital.

      On the road to Yuma, she got a call. Her husband, Bruce, was being flown by medical helicopter to St. Joseph’s Hospital and Medical Center in Phoenix. His brain stem had been severed. A day later, he was pronounced dead.

      Read full article here.
       

      2015
      December
    • ER Docs Say Rule Change Could Raise Patients' Out-Of-Network Bills
      December 28, 2015
      npr.org
      Two professional organizations representing emergency doctors warn that a federal rule released in November could lead to higher out-of-pocket costs for consumers when they need emergency care outside their health plan's network of providers.

      But consumer advocates and health policy analysts say the groups' proposed solution doesn't adequately protect consumers.

      Read full article here.
       
    • Benefits Options Are More Foreign to Some Workers
      December 28, 2015
      workforce.com
      Non-English speakers have difficulty choosing benefits. That’s why offering information in other languages can cut costs and strengthen engagement.
      Remember how complicated it was to understand your health care benefits when you got your first real job? Now imagine trying to figure it out if all the information was in another language. That is exactly what happens to millions of Spanish-speaking workers and their families in the United States, and it’s costing them — and their employers — a lot of money.
       
      In 2013, 21 percent of U.S. households (about 62 million people) reported speaking a language other than English at home, and Spanish was by far the most common at 62 percent. That same year, there were roughly 11 million Latino immigrants working in the United States.

      Read full article here.
       
    • The top changes MCOs should expect in 2016
      December 21, 2015
      managedhealthcareexecutive.modernmedicine.com
      As the U.S. healthcare system’s historical transformation continues in 2016, we will see an increased focus on consumerism, cost transparency and value-based reimbursement. These developments will create both opportunities and challenges for all managed care stakeholders. Here is a preview of industry changes to expect in the coming year:

      Patient out-of-pocket costs will likely increase

      Healthcare costs continue to outpace inflation, creating greater incentives for insurers to offer plans with high-deductibles and narrow networks. These plan designs are offered typically at lower premiums but require much higher consumer cost-sharing levels. According to a PwC’s 2014 Touchstone Survey, 44% of employers across all industries were considering limiting their offerings to high-deductible plans within the next three years. Indeed, today many of the health plans with the lowest premiums on public and private changes have high deductibles. A 2015 Robert Wood Johnson report showed that 41% of provider networks available through silver plans on the Affordable Care Act marketplace are “small” or “extra small.”

      Read full article here.
       
    • Dental Insurance That Will Save Your Smile
      December 16, 2015
      consumerreports.org
      10 ways to cut costs and find the best care for your teeth

      Doling out the cash to get a toothache treated can hurt almost as much as the tooth itself. That’s because about 40 percent of people in the U.S. have no dental insurance. And most who have dental plans lose their coverage once they retire.

      But ignoring dental problems or skipping preventive care can harm you. Some studies suggest that chronic gum infection is associated with an increased risk for heart attack. So how can you maintain oral health without wrecking your budget? Our experts recommend these 10 steps:

      Read full article here.
       
    • Consumer Attitudes About Oral Health
      December 14, 2015
      theihcc.com
      A recent consumer survey conducted by ORC International for FAIR Health, an independent, non-profit organization focused on health care cost transparency and health literacy, showcases consumer attitudes about dental care and insurance. The survey found that many Americans do not visit the dentist regularly and are confused about when young children should visit the dentist for their first oral exam. Furthermore, the survey reveals that a significant number of people are turning to the hospital emergency departments for dental treatment.

      The results of this opinion poll underscore the need for more consumer education about oral health and further exploration of other factors, such as cost and access to oral health care services that may possibly serve as a barrier to dental care.

      Read full article here.
       
    • How to Fix Tooth Decay Without a Drill — and Save Money
      December 10, 2015
      time.com
      "It’s unnecessary for patients to have fillings because they’re not required in many cases of dental decay."

      Afraid of the dentist? Don’t be. Even if you have tooth decay, you might not need a filling. A new study published in Community Dentistry and Oral Epidemiology finds that treating early decay without a drill can be even more effective in the long run. And it’s cheaper, too.

      Read full article here.
       
    • 4 Times It Pays to Talk Back to Your Dentist
      December 10, 2015
      time.com
      Tooth care can be costly, even if you're insured. Know when to ask questions.

      Dental work isn’t as costly as other health care, but the bills may leave a bad taste in your mouth. Most plans cover all preventive care, but patients usually pay 20% to 40% on basic work like fillings and extractions and half on major procedures (dentures, crowns), says the National Association of Dental Plans. The most common plans have low yearly payout caps—typically around $1,500. And for some, all costs are out of pocket: Only 60% of Americans have dental coverage, the NADP says.

      Read full article here.
       
    • App Brings Health Insurance Literacy to Hispanic Population.
      December 2, 2015
      fiercehealthpayer.com
      Health insurance and mobile engagement: What's working, what's new and what's next [Special Report]
      Even as consumers become more engaged, health literacy presents a considerable barrier to improving how the system works and keeping costs down. In fact, numerous studies reveal that individuals still struggle to understand basic health insurance terms and plan features, Robin Gelburd (right), president of the national nonprofit organization FAIR Health, tells FierceHealthPayer in an exclusive interview.

      Read full article here.
       
    • In the Dark about Health Care Prices and Insurance? Mobile Apps Can Shine a Light
      December 1, 2015
      theihcc.com
      Millions of Americans have embraced mobile devices to shop for retail products, such as shoes and electronics. Some tech-savvy consumers are beginning to look for the same convenience when shopping for health care services as well.

      Read full article here.
       

    • November
    • FAIR Health, Inc. Awarded Grant to Introduce Mobile App to Latino Health Care Consumers in Connecticut
      November 19, 2015
      tribunact.com
      FAIR Health, Inc., a New York City based not-for-profit corporation whose mission is to bring transparency to health care costs and health insurance information, recently received a 15-month $120,000 grant from the Connecticut Health Foundation (CT Health). The grant will enable FAIR Health to offer a consumer decision support tool to Latinos in Connecticut. Specifically, FAIR Health will translate its nationally recognized mobile app into Spanish and add state-specific cost data.

      Read full article here.
      Read full Spanish article here.
       
    • Healthcare Consumerism: Embrace it or Step Aside
      November 6, 2015
      ManagedHealthcareExecutive.com
      Today’s consumers have high expectations when making a retail purchase. These same demands apply when purchasing health insurance and getting medical care. Health plans that don’t meet customers’ expectations may be left out in the cold.

      The trend—dubbed healthcare consumerism—marks a shift toward greater consumer choice and responsibility. “With that comes increased consumer cost sharing,” says Robin Gelburd, president, FAIR Health, New York, New York. “Whether enrolling in a plan, selecting a provider, paying for benefits, or deciding where to receive healthcare services, consumers are expected to take an active role in managing their healthcare and benefits.”

      Read full article here.
       
    • Survey: Insurance Premiums Influence Young Shoppers
      November 6, 2015
      Health Insurance Underwriter
      When choosing a health plan, the cost of insurance premiums is the top concern for younger healthcare shoppers (under age 45), while in-network access to their doctors ranks higher with older consumers (age 45 and over), according to a 2015 FAIR Health survey of more than 1,000 adults in the United States.

      Read full article here.
       
    • Ten ways plans must change to meet consumer demands
      November 3, 2015
      ManagedHealthcareExecutive..com
      Today’s consumers have high expectations when making a retail purchase. These same demands apply when purchasing health insurance and getting medical care. Health plans that don’t meet customers’ expectations may be left out in the cold. The trend—dubbed healthcare consumerism—marks a shift toward greater consumer choice and responsibility.

      As healthcare consumerism gains momentums, health plans need to change their offerings to keep up with consumer demands.

      “They have ... to come to grips with the fact that the market was moving toward health saving accounts and high deductible health plans, and consequently lower premiums,” says Douglas Field, chief executive officer, The Institute for HealthCare Consumerism, Alpharetta, Georgia. “And because most plans don’t know how to act as retail businesses, they [are] pressured to become more consumer facing—especially in light of [Affordable Care Act] ACA adding a lot of individuals to the market.”  

      Read full article here.
       

    • October
    • Transparency Without Clarity Is Like a Sink Full of Dirty Dishes
      October 29, 2015
      LifeHealthPro.com
      Robin Gelburd, president of FAIR Health, a national independent non-profit organization joins us on this episode of ShiftShapers to discuss a study and some interesting and effective work around the broad subject of pricing and transparency.

      They have recently released a must-read survey for anyone in the benefits field titled “Understanding Consumer Health Insurance Preferences.” Robin discusses the findings and why she believes that transparency without clarity is like a sink full of dishes.

      We will explore some of the most interesting findings of the study, such as how and why certain constituencies access care in different locales. We also explore common misconceptions consumers have about pricing and what they find most important when choosing a healthcare plan. You won’t want to miss this informative episode.

      Read full article here.
       
    • Workers Can’t Stand Choosing Benefits, but Spanish Speakers Just Can’t Understand Them
      October 27, 2015
      Workforce.com
      Remember how complicated it was to understand your health care benefits when you got your first real job? Now imagine trying to figure it out if all the information was in another language. That is exactly what happens to millions of Spanish-speaking workers and their families in the United States, and it’s costing them — and their employers — a lot of money.

      In 2013, 21 percent of U.S. households (about 62 million people) reported speaking a language other than English at home, and Spanish was by far the most common at 62 percent. That same year, there were roughly 11 million Latino immigrants working in the United States.

      Read full article here.
       
    • Spanish-Language Mobile App Helps To Extend Health Coverage Safety Net
      October 15, 2015
      HealthAffairs.org
      Sweeping reforms to the US health care system now require consumers to understand complex health plans, become more aware of the costs of their care, and make related decisions independently. This presents a challenge for all health care consumers; the new demands are especially daunting for those who do not speak English.

      In June 2015, the New York Community Trust (the Trust) awarded a grant to FAIR Health—an independent, national, nonprofit organization that offers consumer engagement tools powered by its vast database of health insurance claims—to develop, promote, and distribute a Spanish-language mobile phone app to help New York City’s Latinos become more engaged and better informed health care consumers. The newly released app, FH®CCSalud (Calculadora de Costa Salud), provides information in Spanish about how health insurance coverage works and enables users to look up quickly and easily the costs of thousands of medical and dental procedures by geographic area. (Consumers anywhere can download the free app at iTunes or Google Play.)

      Read full article here.
       
    • It Pays to Shop Around for Health Care, Study Finds
      October 8, 2015
      CBSNews.com
      CBS News discusses Cost Transparency - click here.
       
    • How to Save Money on Dental Procedures
      October 7, 2015
      ABCNews.go.com

      Watch the Good Morning America segment: How to Save Money on Dental Procedures
       

    • ED Use Increases Among Newly Insured
      October 6, 2015
      ManagedHealthcareExecutive.ModernMedicine.com
      Healthcare leaders are realizing that the Affordable Care Act (ACA) did not solve the problem of unnecessary, preventable emergency department (ED) visits. In fact, some experts say the move toward universal healthcare has increased the likelihood that patients are comings to EDs when a primary-care physician would suffice.

      “For many new to healthcare insurance, it is like giving someone keys to a new car and now they need drivers’ education,” says Robin Gelburd, president of FAIR Health, a nonprofit organization that provides comprehensive data about healthcare costs in the United States. “But it also provides a real opportunity for health plans and system providers to educate the public.”

      Read full article here.
       
    • How to Choose the Right Health Plan This Year
      October 6, 2015
      Time.com
      Employer coverage is getting more restrictive. Here's how to make a smart choice this open enrollment season.

      As health care costs continue to outpace inflation, companies are finding additional ways to have employees bear more financial responsibility for their coverage. Among the changes you could see during open enrollment this year: Your employer might be offering a slimmer list of in-network doctors, making you pay extra for your spouse’s coverage, or pushing you into a high-deductible plan.

      As a result, the insurance you chose last year may no longer be the best deal. Use these strategies to compare your options.

      Read full article here.
       
    • Smart Ways to Pay Less for Dental Care
      October 6, 2015
      Kiplinger.com
      Sure, dental insurance is cheap. The most popular kind of group plan costs just $32 a month, on average, and three-fourths of employers help pay the tab, according to the National Association of Dental Plans (NADP). That cuts the average employee premium down to about half the original cost—or even less. But you get what you pay for. The coverage is awful.

      As you choose benefits during open enrollment, it’s worth checking up on the coverage in your dental plan. If you anticipate needing an expensive procedure next year that your plan won’t pay for, you may be able to put money aside tax-free in a flexible spending account (if your employer offers one) or a health savings account (if you have a high-deductible health plan).

      Read full article here.
       

    • September
    • For Narrow Networks, Fresh Scrutiny: Can They Pass the Adequacy Test?
      September 30, 2015
      ManagedCareMag.com
      State legislators and insurance regulators are refereeing the latest power struggle between providers and insurers—the design of provider networks.

      Insurers are narrowing networks to better control costs; creating “high quality” networks to include providers that rank well on quality metrics; and introducing tiered networks in which consumers pay more for high-cost providers. These changes may please the providers who are fortunate enough to be chosen for the networks, but are threatening to those left out, such as higher-cost academic medical centers or specialty providers such as children’s hospitals or cancer centers. 

      Read full article here.
       
    • Patient Tools Help With Shared Decision-making
      September 30, 2015
      AAFP.org
      September 28, 2015 03:54 pm Michael Laff Washington, D.C. – The physician may know the science of a patient's health condition inside and out, but the physician can't make difficult treatment decisions alone. Patients need to understand the risks and potential alternatives to prescribed care or treatment so they can make informed contributions to decisions about their health.

      A panel of health analysts recently discussed tools that can assistant in this process during an event (www.youtube.com) hosted here by the Alliance for Health Reform.

      Read full article here.
       
    • Tools for Patients: Data, Technology, and Communication in Patient-Centered Care
      September 30, 2015
      AllHealth.org
      This briefing, the third in a series on creating a more consumer-friendly and patient-centered health care system, delved into the issues that patients face as they make decisions about their health care. It explored questions such as: What does it mean for patients to be engaged in their care? What information and tools are available to empower patients to make treatment decisions and manage their care? What are the respective roles of technology, the doctor-patient relationship, and the health care system as a whole in helping patients navigate their care?

      Read full article here.
       
    • Tips to Save on Dental Care
      September 30, 2015
      WFMZ.com
      ALLENTOWN, Pa. - If you've been to the dentist lately, you know it can be expensive and these days dental care is one of the most common exclusions from health insurance plans and Medicare. 

      Sometimes the sticker price can make people avoid the dentist. Even with dental coverage, you can spend thousands for things like braces, crowns and implants. But there are some tips on how to save money at the dentist's office. 

      Did you know some dental offices offer their own plans and there are a few other ways to save money?

      Read full article here.
       
    • Health Care Prices Vary Wildly: What Can You Do?
      September 21, 2015
      USAToday.com
      It’s a frustrating reality of the medical marketplace: Prices are all over the map.

      If you need an angioplasty to treat heart disease in Birmingham, Ala., it will cost about $15,500. But the identical procedure in Sacramento will cost four times as much.

      And even within the same Boston-area market, the price of removing a common type of skin cancer can vary by hundreds of dollars depending on which hospital you go to.

      Read full article here.
       
    • Websites Help You Find Out How Much A Medical Procedure Will Cost
      September 17, 2015
      ABC15.com
      Before you leave the doctor’s office, you know you're going to get a hefty bill. I found a way for you to plan and save.

      The two sites are called Healthcarebluebook.com and Fairhealthconsumer.org.

      Read full article here.
       
    • 6 Basic Bills You Should Always Negotiate
      September 9, 2015
      ReviewJournal.com
      Does the thought of haggling over your monthly bills make you break out in a cold sweat? You're not alone because most people don't like trying to talk their way into a lower price. A 2013 Consumer Reports survey found that less than half of consumers had tried negotiating a better deal on everyday goods and services in the past three years. But if you can get over your fear of negotiating, you'll see the payoff in your pocketbook — especially when it comes to bills that you pay regularly or even occasionally.

      Tai McNeely, a money-saving expert and founder of the His & Her Money blog, said she frequently negotiates with service providers to get a better rate. She's successful nine out of 10 times. "I don't have a problem with calling and asking for a discount because they budget for this stuff," she said. "If you don't use it, someone else will."

      Read full article here.
       
    • Obamacare Q&A: How To Price Shop for Medical Treatment
      September 3, 2015
      FresnoBee.com
      Whether you get your health insurance from your employer, Covered California or the open market, more of you are picking – or being forced into – high-deductible plans.

      Although these plans come with relatively cheap premiums, you must spend thousands of dollars out of pocket before your coverage kicks in.

      Read full article here.
       
    • Tips on How To Lower Your Medical Bills
      September 3, 2015
      WKTV.com
      NBC NEWS - When it comes to "bill shock," a surprise medical expense can be particularly damaging.

      Medical bills can be a big problem for your finances.

      One in three consumers has trouble paying medical bills - and one in five has an unpaid medical debt on his or her credit report.

      Read full article here.
       

    • August
    • How to Drill Down on Dental Costs: Save on Your Next Trip to the Dentist
      August 27, 2015
      TheStreet.com
      NEW YORK (MainStreet) -- Finances may play a bigger role than fear when it comes to avoiding the dentist's chair. Under the Affordable Care Act, dental coverage is required for children but not for adults, and according to the CDC, 45 million Americans do not have dental insurance. Working adults are visiting the dentist at the lowest rate since 1996, when the American Dental Association began tracking dental care utilization, while dental visits for children continue to climb.

      "There are a lot of patients that for many reasons, whether it's fear or finances, say I'm just not going to see the dentist right now," says Dr. Mark Wolff, professor and chairman of NYU's Department of Cariology and Comprehensive Care and associate dean for predoctoral clinical education. He warns that this can be a formula for financial disaster. "When you have bleeding, when you have swelling, when you have pain in a tooth, there is guaranteed nothing cheap about what's about to happen," he says. Delaying treatment can ultimately lead to a gaping hole in your budget as a condition worsens over time and becomes more expensive to handle.

      Read full article here.
       
    • Healthcare 2015: Why Millennials Avoid Seeing Doctors And What This Means For Rising Healthcare Costs
      August 27, 2015
      IBTimes.com
      When her stomach began to hurt a few weeks ago, Emily Torres, 25, put off calling the doctor. She wanted to see if the ache would subside on its own. Besides, because she didn’t have a regular physician, she wasn’t quite sure whom to see. Finally, after four days of pain, she did some research, made a phone call and eventually saw an internist. By then, her stomachache had dissipated.

      Torres' delay in seeing a doctor hardly differentiates her from her peers. In fact, it makes her the norm. Millennials, the generation between the ages of 18 and 34, do not visit doctors the way other age groups typically do, a growing body of evidence shows. Not only do they forgo healthcare in favor of other priorities, when they do need medical attention, they turn to Google and WebMD before visiting actual doctors, whom they are less like to visit repeatedly or regularly. These habits, doctors and public health experts say, could not only jeopardize young people’s health but also potentially increase healthcare costs over the long run.

      Read full article here.
       
    • Cost Transparency and Consumer Health Insurance Preferences
      August 19, 2015
      TheIHCC.com
      As the U.S. health care system undergoes significant change, consumers must adapt by taking greater responsibility for their health care decisions, including choosing health insurance plans and managing medical expenses. A 2015 survey sponsored by FAIR Health, a national nonprofit organization dedicated to advancing transparency in health care costs and providing educational material on health insurance coverage, sheds light on the need for individuals to gain a better understanding of their health insurance benefits and their out-of-pocket expenses for health care services.

      The survey of U.S. consumers spans five main areas: individuals’ use of emergency department (ED) services for non-emergent care; their use of online tools for selecting a health plan; their selection of physicians; comparison shopping for health care; and their experience with medical bills. The survey’s results provide insights that can help to inform consumer education and engagement strategies. A detailed report analyzing the survey’s findings, “Understanding Consumer Health Insurance Preferences,” is available for download on FAIR Health's website.

      Read full article here.
       
    • Health Care Shopping Patterns Point to Employee Education Needs
      August 18, 2015
      EBN.BenefitNews.com
      Despite some progress in making employees smarter consumers of health care, pockets of resistance remain, sometimes in surprising places. A recent survey of more than one thousand American adults by FAIR Health showed considerable insensitivity to the cost of physician-provided medical services, among other things.

      “Even though this is the age of big data and smartphones, not all consumers are taking full advantage of easily accessible information that can inform critical decisions about their health care,” the report concludes. “While many tools and resources exist today… more work is needed to raise consumer awareness about their availability and value.”

      Read full article here.
       
    • Having Health Insurance Is One Thing, Understanding It Another
      August 17, 2015
      CTMirror.org
      It’s no secret that health care and insurance are complex. But just how complicated are they to navigate?

      Take scheduling a doctor visit to have a rash checked out. Finding out what it will cost requires answering a series of questions: Is the doctor in your insurer’s network? Is the facility? What’s your copay for the visit? If you have a yearly deductible, how much of it have you already fulfilled? If the rash requires a procedure to treat it, will that require seeing a different doctor? If so, is that doctor in your insurer’s network?

      Read full article here.
       
    • The Cloak Over Health Care Costs: Why Is It So Tough To Get Prices for Procedures?
      August 11, 2015
      BankRate.com
      Now that we're in the age of health insurance reform, you might expect that figuring out prices for specific services would be a cakewalk, right?

      Not necessarily. In many cases, a patient won't know the actual cost of care until after that care is delivered, which can lead to surprise medical bills and unwanted debt that can affect your credit score. Check your credit score for free at myBankrate.

      Though you can take proactive measures to ward off high health care costs, "price transparency" remains an elusive goal as the U.S. health care system continues its extreme makeover.

      Read full article here.
       
    • Tips On Saving at the Dentist
      August 11, 2015
      ABC11.com
      HOUSTON -- Heading to the dentist can be a real pain in the mouth and a pain on your wallet. But there are some ways to help save money on your next visit.

      Fear causes many people to avoid the dentist at all costs, but that's one of the worst things you can do when it comes to saving money.

      "Anything that's diagnosed as an issue or problem in the mouth is not going to get better with time," said Grant Sadler, CEO of GMS Dental Centers. "It's only going to get worse, and getting worse means getting more expensive."

      Read full article here.
       
    • Millennials and Healthcare: 25 Things to Know
      August 4, 2015
      BeckersHospitalReview.com
      There is a lot of talk about the impact the aging baby boomer population is going to have on the healthcare industry, but many trends are being driven by another sect of the population: millennials.

      Millennials are defined as individuals ages 18 to 24 or 18 to 34, depending on the source. Having lived with the Internet and near instant access to a wealth of information, many millennials approach healthcare — either as employees or consumers — with different expectations and skill sets than previous generations. And although baby boomers are often considered the "largest generation" in number, millennials actually outnumber the boomers by 7.7 million.

      Highlighted below are 25 things to know about this generation and its effect on healthcare costs and trends.

      Read full article here.
       

    • July
    • Narrow Network Evolution Could Benefit Chiropractic, Telemedicine
      July 30, 2015
      HealthLeadersMedia.com
      Aetna's complaint in the lawsuit accuses the doctor of pricing gouging for out-of-network services: "After Aetna properly paid Defendant the fair value for his services and the accepted rate for similar services in the community by providers in Defendant's area of practice, Defendant sought to exploit and to gouge [the patient] by billing the member for the difference between his charges and what Aetna paid to him—a practice commonly referred to as 'balance billing'."

      The patient was billed $10,635, according to Aetna's complaint.

      The defendant in the case, Sanjay Bhagat, MD, says the lawsuit was dismissed. He declined to comment about details of the case.

      Read full article here.
       
    • How To Negotiate Your Hospital Bills
      July 29, 2015
      FoxNews.com
      Opening a huge medical bill after a hospital stay can be enough to make you sick all over again.

      Just ask Todd Fassler, of San Diego, who made headlines this month when he was bitten by a rattlesnake and charged $153,000 for a four-day hospitalization. A freak occurrence isn’t the only way to end up with a huge medical expense, though. Those with chronic illnesses face large costs over and over. Of all new cancer drugs approved in 2014, none cost less than $120,000 a year, according to the Mayo Clinic Proceedings, prompting a petition signed by 117 oncologists to lower costs.

      Read full article here.
       
    • Analysis: Women Having More Ultrasounds During Pregnancies
      July 23, 2015
      NationalPartnership.org
      There has been a steep increase in the rate at which U.S. women receive fetal ultrasounds, even though medical experts caution that recurrent scans during low-risk pregnancies are not medically justified, according to an analysis, the Wall Street Journal reports.

      Background 

      Several medical societies in a joint statement released May 2014 recommended that women with low-risk pregnancies have between one and two ultrasounds. According to the Journal, experts currently recommend that women with low-risk pregnancies have an ultrasound at 12 weeks' gestation and another at 20 weeks' gestation. Low-risk pregnancies make up about 80% of cases. 

      Read full article here.
       
    • Fetal Ultrasound Usage Grows, Without Compelling Medical Need: Report
      July 22, 2015
      DOTmed.com
      Fetal ultrasounds are surging in popularity and usage, and some experts are advising that scans of pregnant women may be becoming too frequent. 

      The latest report on the issue features a new study of data analyzed by FAIR health, nonprofit insurance claims aggregator, for the Wall Street Journal. It shows just how fast these scans' popularity has grown, and raises concerns about their overuse. 

      Read full article here.
       
    • WSJ Analysis Highlights Excessive Prenatal Ultrasound Use
      July 22, 2015
      AuntMinnie.com
      An analysis of fetal ultrasound use commissioned by the Wall Street Journal found that an average of more than five fetal ultrasound procedures were performed per delivery in the U.S. in 2014, up 92% from 2004.

      Read full article here.
       
    • How Much Is That Procedure? Patients Advised To Ask Questions, Shop Around
      July 22, 2015
      KenoshaNews.com
      When you walk into a coffee shop, you can see exactly how much a large coffee costs, and that’s for a purchase of less than five bucks. But when you walk into a hospital, there are no signs to explain the prices — and those are for purchases that often run into the tens of thousands of dollars.

      “You would never go to the car dealer and say, ‘I’ll take the black one,’ while having no idea how much the car costs, and then three months later you get a bunch of illegible bills in the mail and that’s when you find out the leather seats cost you a thousand extra bucks,” said Rick Anderson, CEO of Smart Choice MRI.

      Read full article here.
       
    • Few Comparison Shop For Dental Care, Poll Finds
      July 22, 2015
      DentalVisionPlans.com
      Whether it stems from their antipathy for the dentist chair or a desire to rein in health care spending, as numerous reports indicate that costs are on the rise, dental care is something that consumers aren't taking as seriously as they ought to, the results of a newly released survey suggest.

      Thanks to the Internet and social media consumers today have a variety of means to go to in order to find out how much they'll spend for various purchases, be them household items or forms of entertainment. Based on a recent poll conducted by nonprofit corporation FAIR Health, for instance, nearly 6 in 10 millennials use the Internet to compare and contrast prices for home electronics. Additionally more than one-third – 35 percent – comparison shop online before buying a new or used car.

      Read full article here.
       
    • Five Factors That Influence Health Plan Selection
      July 21, 2015
      ManagedHealthcareExecutive.ModernMedicine.com
      A recent survey by FAIR Health, an independent, not-for-profit dedicated to healthcare cost and insurance transparency, indicates the top factors that influence consumers' health plan selection. The survey, of more than 1,000 adults, was conducted in March, 2015.

      Read full article here.
       
    • What To Do When Your Doctor Leaves Your Health Plan
      July 20, 2015
      Health.USNews.com
      When you have a good relationship with your doctor, it's almost like magic – especially if you've ever had a doctor you've disliked. After all, a good doctor-patient relationship can do wonders for the quality of your health care. You're more likely to be open and candid, and the doctor is more likely to listen closely and provide better care.

      That's why it can be so disappointing to find that your doctor is no longer in your network, meaning your health insurance company no longer covers your visits, or covers them at a lower level. Although most people would love to stick with a trusted provider, out-of-network doctors' fees are often too steep to pay out of pocket. For example, a 45-minute visit to a doctor you've already seen can cost $300 if you're paying cash, according to Fair Health Consumer, a website that helps patients estimate health costs.

      Read full article here.
       
    • WSJ: Fetal Ultrasound Procedures Are Often Not Medically Justified
      July 20, 2015
      FierceMedicalDevices.com
      As fetal-ultrasound procedures continue to increase in the U.S., medical experts are cautioning against running frequent scans with the devices.

      The use of the most common fetal-ultrasound procedures averaged 5.2 per delivery in 2014, up 92% from 2004, according to an analysis of data compiled for The Wall Street Journal by nonprofit insurance claims aggregator FAIR Health. But some experts in the field are saying the scans aren't medically justified, especially in light of the upswing in procedures with the devices.

      Read full article here.
       
    • Telehealth App Launches Radar Mapping to Help Patients Find Closest Doctor
      July 20, 2015
      HITConsultant.net
      HealthiestYou, a Scottsdale, Arizona-based telehealth company focused on engagement and utilization has announced the launch of “radar mapping” – a new way for consumers find the closest care facility from their mobile device.

      The “radar” feature is the first app of its kind to provide a comprehensive, interactive list of all health options, such as doctors, E.R., urgent care and pharmacy locations, customized to members’ health insurance plans. It shows members the providers that are within close proximity to their current location, and displays detailed contact information, education and credentials, as well as consumer reviews.

      Read full article here.
       
    • Why You Should See a Dentist Before You Retire
      July 20, 2015
      Time.com
      Most seniors pay for dental care out of pocket.

      If you plan to retire soon, add this item to your to-do list: a visit to the dentist before your dental insurance disappears.

      Retirees transitioning to Medicare are often surprised to learn that the program does not cover routine dental care or more complex procedures.

      Read full article here.
       
    • Pregnant Women Get More Ultrasounds, Without Clear Medical Need
      July 20, 2015
      WSJ.com
      During her pregnancy, Milena Mrosovsky estimates she underwent a dozen fetal ultrasounds. “I was just happy to get my pictures,” she says of the scan images, “and keep them in my little album.”

      Her experience isn’t uncommon. American women have been getting fetal ultrasound scans at sharply higher rates than before, and parents have turned the images of their unborn into fixtures of social media.

      In 2014, usage in the U.S. of the most common fetal-ultrasound procedures averaged 5.2 per delivery, up 92% from 2004, according to an analysis of data compiled for The Wall Street Journal by FAIR Health Inc., a nonprofit aggregator of insurance claims. Some women report getting scans at every doctor visit during pregnancy.

      Read full article here.
       
    • Consumer Preferences: Spotlight on Health Insurance Cost, Physician Access and Network Size
      July 9, 2015
      TheIHCC.com
      As health plans and benefits advisors plan for this fall’s enrollment period, the results of a recent FAIR Health consumer survey shed light on what is most important to plan members when they select health insurance or choose a doctor.

      The survey results are particularly timely because insurers, employers and public/private exchanges increasingly offer health plans that require greater cost-sharing and benefits management responsibilities on the part of plan members, thereby making plan and provider selection decisions potentially more complicated.

      Read full article here.
       

    • June
    • The Rise of Health Care Consumerism- and the Informed Consumer
      June 18, 2015
      The Institute for Healthcare Consumerism Blog
      According to 2015 FAIR Health survey estimates, half of U.S. consumers consider their out-of-pocket medical costs higher than they expected. A third of those surveyed felt that costs were much higher than anticipated.

      Unexpected medical expenses are particularly troubling when consumers make good faith efforts to minimize costs by obtaining services within their insurance plans’ networks – only to receive “surprise bills” from providers they did not realize were out-of-network. Concern over the disparity between anticipated and actual costs is helping lead the way to a national dialogue, and, in some instances, to state-based legislative reform.

      Questions about unexpected medical bills are not new, so what is driving the momentum today for consumer protections? Changes in how and where health care is delivered, the increase in access to private insurance through public exchanges, the expansion of members’ responsibilities for managing their coverage and the lack of health care literacy among consumers are among the many factors combining to create a need to set ground rules for a new era of health care consumerism.

      Addressing this need, New York State recently enacted a law providing some of the nation’s most comprehensive health care cost transparency protections to help consumers avoid surprise medical bills and better manage their out-of-pocket medical expenses. Other states, including Texas, California, New Jersey, Connecticut, Oregon and Colorado are considering legislative proposals to address these consumer concerns.

      Read the full article here.

       
    • 7 things for ASC leaders to know for Monday — June 8, 2015
      June 10, 2015
      BeckersASC.com
      Here are seven news updates for ambulatory surgery center leaders to know for June 8, 2015.

      Children's Hospital in LA opens outpatient center in Encino
      Children's Hospital Los Angeles opened its new outpatient care center on June 2, 2015 with Robert Adler, MD, as chief medical officer. The outpatient center consists of seven exam rooms in its 3,000 square foot center. Richard D. Cordova, FACHE, president and CEO of Children's Hospital Los Angeles, believes that the center will serve as a vital investment in the center's ability to help families in the San Fernando Valley.

      GOP open to extending PPACA subsidies
      Working groups in the Senate and the House are devising plans to extend Patient Protection Affordable Care Act subsidies if the Supreme Court rules subsidies are unconstitutional in the King v. Burwell. House conservatives have hinted they will support a temporary extension of PPACA subsidies. Read the full report on Becker's ASC Review

      FAIR Health launches ASC benchmarks tool
      FAIR Health, an independent non-profit company, has launched its FH Ambulatory Surgery Center Benchmarks module. The new module was developed with more than 5 million claims for services performed in ASCs. It also includes more than 2,500 procedure codes.

      Read full article here.
       
    • FAIR Health Launches ASC Benchmarks Tool: 5 Key Insights
      June 10, 2015
      BeckersASC.com
      FAIR Health, an independent non-profit company, has launched its FH Ambulatory Surgery Center Benchmarks module. Here are five insights.

      1. The new module was developed with more than five million claims for services performed in ASCs. IT also includes more than 2,500 procedure codes.

      Read full article here.
       
    • 14 ASCs Taking on Price Transparency
      June 10, 2015
      BeckersASC.com
      Healthcare is moving toward greater transparency in pricing, and these 14 ambulatory surgery centers have embraced the push.

      If you would like to recommend another surgery center for this list, contact Anuja Vaidya at avaidya@beckershealthcare.com.

      Banner Desert Surgery Center (Mesa, Ariz.). The surgery center's website lists the direct pay prices and the discounted uninsured self-pay prices for the most common procedures provided by the center, including ophthalmology and ENT procedures. The direct pay price is based upon the current charge master pricing for the procedure and it does not include fees charged by physicians working at the center.

      The surgery center is a part of Phoenix-based Banner Health. It is licensed and accredited, like all Banner Surgery Centers.

      Read full article here.
       
    • Millennial Engagement A Cornerstone for Health Care Consumerism
      June 4, 2015
      TheIHCC.com
      Significant changes in health insurance enrollment, such as public and private exchanges, and new benefit designs, including high-deductible plans and narrow networks, are requiring individuals to take on greater personal responsibility for selecting the most suitable plan and managing their own benefits and costs – often through Internet portals. Individuals must become better informed health care consumers who are skilled at using the latest technology to navigate the system and get the most out of their health coverage.

      The size, diversity and buying power of the population segment known as Millennials or Generation Y (ages 18-34) make them an important group to study. According to the Pew Center, this generation constitutes the largest segment of the U.S. workforce and later in 2015 will pass Baby Boomers as the largest living generation. By engaging Millennials, health care sector leaders can plan a future when individual consumers can manage their own health insurance purchases, provider choices, benefits and expenditures simply and cost-effectively.

      Read full article here.
       
    • Strategy for a Transparent, Accessible, and Sustainable National Claims Database
      June 2, 2015
      AJMC.com
      A recent American Journal of Managed Care article identifying “barriers” to creating a national health-care claims database offered an unduly discouraging perspective. Focusing on a selective research organization, it overlooked, and to some extent mistakenly portrayed, what has already been accomplished in “Big Data” for the healthcare sector. The experience of FAIR Health, Inc, in creating, operating, and expanding its national health-care claims database offers a more positive account. FAIR Health’s database already provides data to researchers as well as to payers, providers, government agencies, and policy makers. It also offers significant ongoing service to consumers in the form of a free online search tool to find the estimated cost of healthcare services and procedures in their own area using ordinary, consumer-friendly language, both in English and Spanish (and not solely arcane codes, as was mistakenly referenced in the recent article). In establishing its database and making it broadly available, FAIR Health has found solutions to problematic barriers and has identified operational requirements and features essential to a successful database.

      Read full article here.
       

    • May
    • Survey Reveals Consumer Dependence on ER Services for Non-Emergent Care
      May 26, 2015
      TheIHCC.com
      More than 14.1 million people nationwide have signed up for health insurance since enrollment under the Affordable Care Act opened in October 2013, and, in the same period, an additional 2.3 million young people have gained insurance through their parents’ health care coverage. Overall, the national uninsured rate is estimated to have dropped 7.1 percent in a year and a half.

      It is critically important that these newly-insured individuals, as well as those already insured, understand their insurance benefits and their own payment responsibilities. Informed and careful use of health care services will benefit not only consumers’ own wallets, it also will support effectiveness and efficiency in the national health care sector to the benefit of all.

      Read full article here.
       
    • How Millennials Can Get The Best Deals On Health Insurance
      May 26, 2015
      Debt.com
      Think of the last time you bought a camera, laptop, or video game. You didn’t just stroll into Best Buy and purchase the first model you saw, right?

      Unfortunately, many millennials are doing this — not with electronics, but with their health insurance. A new study by nonprofit FAIR Health found that only 19 percent of millennials compare the prices of health and dental insurance online before they buy. But compare that to the 59 percent of them who use the Internet to compare prices of consumer electronics, and 35 percent who price-check online for automobiles before they buy.

      Read full article here.
       
    • New York Law Sets Standard for Transparency
      May 22, 2015
      ManagedHealthcareExecutive.ModernMedicine.com
      A new healthcare cost transparency law in New York State aims to protect consumers from health plan cost issues that have challenged even the savviest consumers. The law, which other states are watching closely, requires insurers to publish clear information about plan rules for apples-to-apples comparsions.

      Plan documents must provide detailed explanations and examples of reimbursement calculations that will enable consumers to compare the benefits of various plan options and, once enrolled, make better informed treatment decisions.

      Read full article here.
       
    • Yes, You Can Negotiate Your Medical Bills
      May 21, 2015
      Finance.Yahoo.com
      You can negotiate car prices, mattress prices, and even your taxes, but did you know that you can negotiate your medical bills? Instead of panicking next time you get a medical bill, follow these steps to lower your payment and get out of medical debt sooner.

      1. Move quickly.
      While it can be tempting to simply hide your bills in a drawer instead of facing the amount owed, that gets you nowhere. Plus, you risk having your bill handed over to collections, which can take a big toll on your credit score. The faster you move, the more negotiating power you’ll have. After all, medical providers want their money ASAP.

      Read full article here.
       
    • How to Manage High Medical Bills
      May 21, 2015
      NYTimes.com
      Just because you have health insurance doesn’t necessarily mean you can afford all your medical bills, especially if you have a high deductible. So sometimes, it pays to negotiate.

      A Commonwealth Fund study released this week found that nearly a quarter of working-age Americans who had health insurance in 2014 were “underinsured.” The report cited rising deductibles — the amount you must pay for care before insurance coverage begins — as a growing factor.

      Read full article here.
       
    • Survey: Only 19% of Millennials Price Check Medical Care Online
      May 20, 2015
      BeckersHospitalReview.com
      Millennials ages 18 to 34 are the generation most associated with price checking and comparison shopping online. In fact, 59 percent price checked electronics online, and 35 percent comparison shopped for cars online, according to a recent survey from FAIR Health, a nonprofit aiming to improve the transparency of healthcare costs and health insurance information.

      However, the survey of 1,000 U.S. adults found millennials are less likely to price check and comparison shop online for medical and dental care: Just 19 percent of respondents ages 18 to 34 reported this behavior in the past year.

      Read full article here.
       
    • Bitten By High Dental Costs
      May 11, 2015
      LATimes.com
      Taking care of your teeth doesn't come cheap.

      Just ask Holly Kabrin. She expects to spend at least $1,000 to have her daughter's wisdom teeth removed. And she's still making payments on a $600 bill from a dental crown she got last year.

      Read full article here.
       
    • Emergency Room Use Varies by Income, Education and Race
      May 6, 2015
      SHRM.org
      Employees’ likelihood of using the emergency room (ER) for nonemergency care varies significantly along generational and socioeconomic lines as well as by race, according to the results of a recent FAIR Health survey.

      These disparities come at a time when there is a national spotlight on reducing health care costs. Workers are facing increased out-of-pocket expenses as employers look for ways to control health care premiums with high-deductible plans.

      Read full article here.
       

    • April
    • How to Minimize Dental Expenses
      April 28, 2015
      www.BBB.org
      We talked recently about the burdens of medical debt, and gave you our best suggestions for how to negotiate those expenses. But one pain point of medical debt that doesn’t get enough coverage (sorry for the puns) is the cost of dental care. These costs can certainly be burdensome, especially when we have other debts to pay. What makes matters even worse is that when money gets tight it can become tempting to avoid dental care altogether, which could lead to an even more expensive issue down the line. And any procedure, even the routine ones, can be quite pricey. So today, we are going to take a look at how you can minimize dental expenses while still getting the care you need. And if you do have to take on significant dental costs, we will show you how to manage that, too.

      Read full article here.
       
    • Transparency: How Healthcare Cost Competes With Real Value
      April 22, 2015
      HealthcareSuccess.com
      The popular buzz-phrase in contemporary healthcare—price transparency—is a relatively new dynamic in the competitive equation for providers and marketing professionals. And it cuts in two directions. On one hand, price transparency—and knowing the cost of medical procedures in advance—is a major plus for public awareness. On the other hand, price is not the only consideration for truly wise (and informed) shoppers.

      The Internet, healthcare reform and other social dynamics have been transforming the everyday patient into informed consumers. And nobody on the care continuum—especially the patient—likes the sticker shock experience of being blown away by a huge bill from the hospital or provider months after the fact. Increasingly, informed consumers and employers shop hard for value in healthcare.

      Read full article here.
       
    • Money Monday: Negotiating Medical Debt
      April 21, 2015
      KFVS12.com
      (KFVS) - Medical debt is the single biggest reason people file for personal bankruptcy, but it's possible to lower your medical debt through negotiating.

      In a perfect world, financial experts say do your negotiating before a medical procedure.

      This means you have to be honest about your financial situation and go into that discussion armed with an understanding of what the procedure should cost.

      Knowing the “reasonable customary charge” gives you a starting point.

      You can find those charges for a range of procedures at fairhealthconsumer.org.

      Read full article here.
       
    • Retailing Health Care
      April 20, 2015
      RetailLeader.com
      "When a mother can take a sick child to an urgent care or retail clinic, get in that day, wait less time and get the same diagnosis for the same cost or less, she's going to do that every time," notes Jeff Pepperworth, president of Inmar Healthcare Network, which provides management services to retail pharmacies. "Accessibility is a large component of growth in retail clinics."

      The range of services accessed at retail clinics has expanded recently. According to FAIR Health, a nonprofit organization that tracks health care insurance claims, the most common insurance code now being billed by retail clinics is the 15-minute office visit.

      Read full article here.
       
    • Strategy for a Transparent, Accessible, and Sustainable National Claims Database
      April 15, 2015
      AJMC.com
      A recent American Journal of Managed Care article1identifying “barriers” to creating a national health-care claims database offered an unduly discouraging perspective. Focusing on a selective research organization, it overlooked, and to some extent mistakenly portrayed, what has already been accomplished in “Big Data” for the healthcare sector. The experience of FAIR Health, Inc, in creating, operating, and expanding its national health-care claims database offers a more positive account. FAIR Health’s database already provides data to researchers as well as to payers, providers, government agencies, and policy makers. It also offers significant ongoing service to consumers in the form of a free online search tool to find the estimated cost of healthcare services and procedures in their own area using ordinary, consumer-friendly language, both in English and Spanish (and not solely arcane codes, as was mistakenly referenced in the recent article). In estab-lishing its database and making it broadly available, FAIR Health has found solutions to problematic barriers and has identified operational requirements and features essential to a successful database.

      Read full article here.
       
    • New State Law Eliminates Surprise Medical Bills
      April 15, 2015
      BizJournals.com
      Advocates are cheering a new state law will help New Yorkers avoid surprise bills and unexpected expenses for medical procedures.

      The Emergency Services and Surprise Bills law, which goes into effect March 31, expands transparency and protects consumers who receive care from out-of-network physicians while at a participating hospital or ambulatory surgery center; as well as for emergency services. It also contains protections for those who must go out of network for a specialist or procedure not available within their insurer’s network.

      Read full article here.
       
    • Shopping for Health Care: Patient Advocates Say Do Your Homework, then Haggle
      April 15, 2015
      SCPR.org
      Last week, I shared some tips on how to get affordable health care from David Newman, executive director of the Health Care Costs Institute in Washington, D.C.

      As promised, I'm back with more tips. This batch comes from patient advocates – people who fight high costs and unfair bills for a living.

      Read full article here.
       
    • Taking Advantage of Health Care Transparency Trends
      April 2, 2015
      LifeHealthPro.com
      Advisors work hard helping their business clients to deal with the complexity and expense of health care insurance benefits as well as with the needs and expectations of their employees. They recognize that their clients’ satisfaction with advisory services will be greatly influenced by employees’ experience with the plan chosen by their employer.

      When a plan exposes employees to unexpected out-of-pocket health care costs, the surprise bills can color employees’ perception about their benefits and lead to complaints that may impact the brokers’ relationships with their clients. By keeping up with, and taking advantage of, developments in transparency in health care costs and insurance, advisors can better serve their clients, improve enrollee experience and promote greater member satisfaction.

      Read full article here.
       
    • NY Healthcare Transparency Law Enacted
      April 2, 2015
      Christopher Cheney, for HealthLeaders Media
      This week, the Empire State is taking a bold step toward boosting consumerism in the healthcare industry, with enactment of a new transparency law that sets responsibilities for providers, payers, and patients.
      New Yorkers know how to cut a deal.

      Ambitious healthcare transparency legislation approved approved a year ago in Albany goes into force this week. The "Emergency Medical Services and Surprise Bills" law features consumer protections for out-of-network care, a pricing benchmark for healthcare services based on nearly 2 million NY insurance claims, and an independent dispute resolution process for providers and payers to arbitrate contested billings.  FAIR Health Inc., a not-for-profit corporation founded in 2009 to build a national database of insurance claim information and serve as a resource for the healthcare industry, is providing the data for setting the new transparency law's pricing benchmark. 

      Read full article here.

       

    • March
    • The Transparency Train Is Leaving the Station
      March 31, 2015
      LifeHealth.com
      The national health care cost transparency movement is well underway. A proactive approach to helping employers and their workforce board the transparency train can help brokers and other advisers differentiate their practice and ensure that their business will move forward as new consumer-focused health care cost transparency initiatives unfold.

      We are already seeing the ripple effect of the cost transparency transformation. Health care utilization is changing, with more consumers deciding to receive care at alternative facilities such as urgent care centers, retail health clinics and ambulatory surgery centers. More employers are selecting narrow and tiered networks and high-deductible plans that require employees to roll up their sleeves to try and understand the implications of these new plan designs.

      Read full article here.
       
    • Rising Healthcare Costs are Pressuring Patients
      March 30, 2015
      LATimes.com
      Coping with ever-increasing medical bills is frustrating — and getting more so.

      A recent survey by private health insurance exchange EHealth highlights the pressure Americans are feeling. It found that more than 6 in 10 people say they're more worried about the financial effect of expensive medical emergencies and paying for healthcare than about funding retirement or covering their kids' education.

      People who get health insurance through work and on their own have seen their costs rise dramatically over the last decade.

      Read full article here.
       
    • NYS Law, in Effect April 1, Eliminates Surprise Medical Bills
      March 26, 2015
      BizJournals.com

      Robin Gelburd, president of FAIR Health, said there are hundreds of “Chad’s” out there who struggle to do the right thing and be responsible, only to be stuck later when the bill arrives.

      She points to a classic example: A pregnant woman specifically picks a hospital that’s part of her insurer’s network, then ends up needing an epidural that’s performed by an anesthesiologist who’s out-of-network but working at the hospital.


      Read full article here.
       

    • State’s Health Bill Will End Surprises on April Fools’ Day
      March 26, 2015
      EBA.BenefitNews.com
      There will be fewer surprises on April Fools’ Day. The New York State Budget Bill that generally takes effect April 1 and creates new consumer protections includes some of the nation’s most comprehensive health care cost transparency requirements. The law addresses surprise balance bills, emergency care costs, dispute resolution and network adequacy. Several states are monitoring the New York bill and considering similar legislation.

      The health care reimbursement system can be difficult to understand. Prior to the implementation of this law, even the most diligent patients who do their homework and check to see if their providers are in-network often face surprise expenses.

      Read full article here.
       
    • Angelina Jolie’s Preventative Surgery: What Women Need to Know to Beat Ovarian Cancer Risk
      March 24, 2015
      NYDailyNews.com
      Angelina Jolie’s brave decision to remove her ovaries and fallopian tubes in her continued quest to reduce her risk of cancer is being hailed as an inspiration for women. But it isn’t for everyone.

      The Oscar-winning actress revealed in her op-ed in The New York Times that she took the drastic step so her children will never have to say, “Mom died of ovarian cancer.”

      Read full article here.
       
    • Medical Patients Dealing with Surprise Bills
      March 23, 2015
      RecordOnline.com
      When Rob Sethre went in for a cardiac ablation procedure at a New Jersey hospital last year, he signed a lot of insurance forms. The 55-year-old Warwick resident had researched his insurance coverage in advance, and was heartened when the hospital told him his deductible would be his only expense.

      That’s why he was surprised when, a few weeks later, he received a bill for $4,140 from an anesthesiologist. While Sethre’s doctor was in-network, and so was the hospital, the anesthesiologist was not. But no one shared that information with Sethre.

      Read full article here.
       
    • 5 Top Consumer Health Cost Nightmares
      March 23, 2015
      LifeHealthPro.com
      Once marketers had to use surveys, focus groups and educated guessing to figure out what was scaring consumers.

      Today, they have search results.

      Google, for example, has gotten public health researchers' attention with a flu tracker based on results for flu-related terms.

      Now FAIR Health, a health cost data transparency organization created through a New York state settlement, is analyzing the traffic going through its Consumer Cost Lookup tool to detect trends in which health cost services are worrying consumers.

      Read full article here.

    • You CAN and SHOULD Negotiate Your Medical Bills
      March 20, 2015
      NicoleLapin.com
      If you’ve received a medical bill recently, then what I’m about to say likely won’t come as a surprise: in the United States, we spend A LOT on healthcare. In fact, we spend more than twice as much per capita on healthcare than the average developed country does, at an average of $8,508 per person per year. (FYI: That adds up to $2.8 trillion total, or a staggering 18% of GDP.)

      Actually paying those bills? That’s another story. It’s not a pretty picture: 1 in 5 Americans is contacted by bill collectors about medical debt. Medical debt accounts for $1 out of every $3 owed in collection accounts, far more than all other debt in collections.

      Read full article here.
       
    • From Transparency to Clarity
      March 12, 2015
      ManagedHealthcareExecutive.ModernMedicine.com
      Everywhere we turn, we hear about the importance of transparency in healthcare. In light of the Affordable Care Act’s (ACA) disclosure rules and with the spotlight squarely placed on the industry, health plans and hospital systems, clinicians, policymakers, industry leaders and media outlets are all touting the benefits of accessible, reliable healthcare data. But while transparency is an important goal, it is only the first step toward driving improvement in our healthcare system. To see real change, we also need clarity.

      What is the difference between transparency and clarity? Think of the pile of dirty dishes in your kitchen after a holiday meal. You can see that they need to be cleaned, dried and put away, but how do you start to make sense out of the chaotic mess? Now, picture those same dishes clean, with the glasses and silverware neatly arrayed on a beautifully set table. That’s clarity. Clarity means taking data elements and making them actionable by adding the context necessary to inform sound decision-making for all stakeholders—payors, plan sponsors, purchasers, researchers, practitioners and consumers.

      Read full article here.
       
    • How To Pay For Your Dental Work
      March 12, 2015
      Finance.Yahoo.com
      Dentistry can be expensive, especially when you need to have major work done. Yet only about 50 percent of Americans have private dental insurance to defray the cost, according to a September 2013 report by the Government Accountability Office. An additional 13 percent have coverage through Medicaid or the State Children’s Health Insurance Program. An estimated 76 million Americans have no dental insurance.

      For those with insurance, the amount covered has barely budged over the past several decades. According to the GAO study, the median maximum benefit was $1,500 in 2008 (the last year for which figures are available), about what it has been for the past 30 years. (The Patient Protection and Affordable Care Act eliminated the annual limit for people younger than 19 in most plans, but it still applies to everyone else.)

      Read full article here.
       
    • Some Women Paying Extra to Screen for Breast Cancer
      March 10, 2015
      ReadingEagle.com
      Under health care reform, insurance plans are supposed to cover preventive services such as mammogram screenings at no additional cost.

      But some women in Berks County have received a radiology bill for this screening, a fact that has one Cumru Township insurance agent fuming.

      "They're all supposed to cover these mammograms," said Jay Mahoney, an agent with Gallen Insurance, which sells health, home, auto and business insurance. Mahoney, who on behalf of clients has dealt with St. Joseph Medical Center and Reading Hospital on this billing issue, added, "It's mandated by the federal government." 

      Read full article here.
       
    • The Cost of an Ankle
      March 9, 2015
      NPAlliance.org
      A colleague recently asked if I could offer advice for their friend with ankle trouble. The friend was in need of ankle surgery, but the price tag seemed steep. I had to admit, it’s very hard to compare prices in health care.

      There is a website that gives you a rough idea of the fair price in your area. It has some prices but not others. The prices vary depending on what insurance you have: www.fairhealthconsumer.org.

      Read full article here.
       
    • Now You Can Finally Figure Out How Much Your Medical Bills Should Be
      March 2, 2015
      HuffingtonPost.com
      Buying health care in America is like shopping blindfolded at Macy’s and getting the bill months after you leave the store, economist Uwe Reinhardt likes to say.

      A tool that went online Wednesday is supposed to give patients a small peek at the products and prices before they open their wallets.

      Read full article here.
       

    • February
    • Retail Clinics Fight Tetanus Vaccination Gap
      February 19, 2015
      LifeHealthPro.com
      The retail walk-in clinics in drug stores, discount stores and supermarkets are starting to get a reputation as the place to go to get a quick flu shot, and they are also building a clientele in the tetanus shot market.

      About 0.6 percent of the clinics' 15 million 2013 billings were for tetanus vaccine, according to data from Fair Health, a health care cost transparency organization formed in connection with a settlement New York state negotiated with health insurers in 2009.

      The percentage of the retail clinics' billings connected with tetanus shots was up from 0.2 percent in 2010.

      Read full article here.
       
    • Even Insured Consumers Get Hit With Unexpectedly Large Medical Bills
      February 18, 2015
      KaiserHealthNews.org
      After Pam Durocher was diagnosed with breast cancer, she searched her insurer’s website for a participating surgeon to do the reconstructive surgery.

      Having done her homework, she was stunned to get a $10,000 bill from the surgeon.

      “I panicked when I got that bill,” said the 60-year-old retired civil servant who lives near Roseville, Calif.

      Like Durocher, many consumers who take pains to research which doctors and hospitals participate in their plans can still end up with huge bills.

      Sometimes, that’s because they got incorrect or incomplete information from their insurer or health-care provider. Sometimes, it’s because a physician has multiple offices, and not all are in network, as in Durocher’s case. Sometimes, it’s because a participating hospital relies on out-of-network doctors, including emergency room physicians, anesthesiologists and radiologists.

      Read full article here.
       
    • Reforming Reimbursement
      February 9, 2015
      ManagedHealthcareExecutive.ModernMedicine.com
      As the healthcare industry undergoes unprecedented change, particularly in regard to payment reform, payers recognize a growing need for more comprehensive payment methodologies that adequately represent the true market cost of health services today.

      Providers who have traditionally based their payment methodologies on a multiple of Medicare’s fee schedule are beginning to recognize inherent limitations in a Medicare-based schedule that can affect their bottom line. Luckily, many limitations can be addressed by integrating independent, market-based data into a payment schedule.

      Read full article here.
       
    • 6 Ways I Became a More Frugal Medical Consumer
      February 3, 2015
      CreditCardGuide.com
      My husband and I have a high-deductible health insurance plan through his job, but that hasn’t stopped us from going to the doctor for any ache, pain or other problem.
      That strategy used to work fine when we had more generous health insurance plans through previous jobs, but with this high-deductible plan, our approach is breaking our budget.

      We’re not alone. A 2014 survey of 400 large employers by the National Business Group on Health, a nonprofit health policy group that represents large employers’ interests, found that more employers are trying to cut costs by offering high deductible health plans.

      Read full article here.
       
    • Blue Cross Pricing Tool Could Shake Up Medical Industry
      February 2, 2015
      NewsObserver.com
      Cary radiologist Stephen Loehr likes to think he runs a lean operation at his 14-employee outpatient practice, Triangle Vascular Associates. But pricing his services against other doctors and medical facilities has mostly come down to guesswork.

      Until now.

      A new online database from Blue Cross and Blue Shield allows Loehr to demonstrate to his patients that he is a financial bargain. His typical reimbursement from Blue Cross for an angioplasty for vein blockage performed at his Cary facility: $2,494.

      Read full article here.


    • January
    • Could This Pricing Tool For Consumers Disrupt Healthcare?
      January 20, 2015
      Forbes.com
      Of all the white hot healthcare topics heading into 2015, none is hotter ‒ or more galvanizing inside the industry ‒ than healthcare pricing. I’m not referring to the cost of insurance coverage (like premiums, deductibles and co‒pays), but the actual cost of healthcare delivery. The kind of pricing that Elisabeth Rosenthal over at the New York Times has covered extensively with her series ‒ Paying Til It Hurts. The kind that Steven Brill is eager to showcase on 60 Minutes. The kind that I highlighted last year with a $292,000 bill that was all math and no accounting.

      So what and where is this pricing tool? It was unveiled with relatively little fanfare last week by Blue Cross Blue Shield of North Carolina. Why is this disruptive? Because it’s an online tool that the general public can use to compare in-network pricing for specific procedures by provider and location. As an example of what it looks like, here are the in-network costs for a “knee replacement” through two of their more popular plans in a 25 mile radius of Cary, North Carolina.

      Read full article here.
       
    • Comparing Healthcare Costs? Here's Where to Start
      January 16, 2015
      Cheapism.com
      The open enrollment period for purchasing health insurance under the Affordable Care Act began on Nov. 15, 2014, and consumers have until Feb. 1 to enroll. For those who are already covered, there are new prices and plan options. For those who aren't, this is an opportunity to sign on.

      Massachusetts, the first state to mandate universal coverage, is a bellwether once again in requiring insurers to provide information on the cost of specific procedures at hospitals, imaging centers, and doctors' offices. The rest of the country can turn to web-based comparison tools designed to help find the best prices for health insurance, hospitals, doctors, and prescription drugs. Take note, however -- many of these tools are still barebones and none are polished and complete.

      Read full article here.
       
    • The Vocabulary of Change
      January 8, 2015
      HFMA Hudson Valley NY

      Seismic progress has been made in the national healthcare cost transparency movement over the past five years—akin to the evolution from the horse and buggy days to the recent news that the space probe Philae had landed on a comet 300 million miles from Earth. While the mode of transportation is critically important, the destination is what matters most. Visionary leaders today are harnessing the latest sophisticated data management technology and innovative analytic capabilities to transport stakeholders to a place where informed decisions about healthcare policy, process, risk, cost and availability can be made with the collaboration and concurrence of all affected parties.

      Kick-starting the transparency engine
      Five years ago—and, actually, long before that—it was generally understood that the healthcare system was broken. All stakeholders, including consumers, employers and unions, government entities, insurers, practitioners and hospitals had their own wish lists and sets of expectations of what the system should deliver. Against this backdrop, healthcare expenditures continued to escalate, and the proportion of costsharing shifted to the consumer grew steadily. Questions also continued to plague policymakers as to whether increasing costs in the healthcare system yielded a concomitant improvement in treatment outcomes. It became apparent that to gain a firm understanding of healthcare trends and practice patterns and to support compromise and collaboration, there was a need for an independent, agreed-upon source of cost and utilization information that could generate clear benchmarks and “apples to apples” comparisons—a unifying healthcare data vocabulary, if you will.

      Read full article here.
       

    • Gain Narrow Network Buy-In
      January 7, 2015
      ManagedHealthcareExecutive.ModernMedicine.com
      As health plans and purchasers struggle to keep premiums low and quality high, many are turning toward narrower networks. However, limited networks have sparked concern among consumers, plan sponsors and policy makers who worry that they will unduly limit patients’ access to care and lead to increased patient use of out-of-network providers with higher out-of-pocket costs. New York has passed a new law to protect consumers from unexpected out-of-network costs and many states are considering tougher standards for network adequacy.

      When plan members face unexpectedly high costs or receive a bill for services they thought were covered, it affects how they value their benefits and, in the case of employer-sponsored plans, the sponsor’s overall satisfaction with the plan. In addition, insurers may find themselves spending valuable time and resources dealing with frustrated members or time-consuming appeals. For narrow networks to work, they must work for everyone--plans, purchasers, plan sponsors, participants and providers. That means delivering access to timely, accurate and user-friendly information to ensure that plan members get the most out of their provider network.

      Read full article here.
       
    • Greg Feltenberger: Deciphering Health Care Price Tags
      January 7, 2015
      IdahoStatesman.com
      When you visit the doctor, you pay your copay and/or coinsurance. Then, after the visit, you receive the "this is not a bill" explanation of benefits (EOB) - where you learn more about what was paid, what wasn't paid and how much you may eventually owe.

      But while most of us know the process, it's often difficult to understand for various reasons - the most common reason could be that our health care system is incredibly complex. In addition, treating the human body isn't like running a diagnostic on your car and replacing faulty parts.

      Health care costs and where each dollar is spent are confusing mysteries. Prices for services are inconsistent (not standard) among different physicians of the same specialty in the same geographic area and between different care locations (e.g., ambulatory surgery centers, aka ASCs, versus hospitals).

      Read full article here.
       
    • How to Stretch Your Health-Care Dollars
      January 5, 2015
      WSJ.com
      A new year is here, and with it new opportunities to rein in a major slice of the household budget: health care.

      Yes, it’s complex. But being proactive can pay off, experts say.

      “The big change in the last couple years is clearly you can shop for health care and reduce your financial exposure, but you have to be willing to shop,” says John Santa, medical director for Consumer Reports Health.

      This is the last Health Costs column, so I want to share some of the best strategies for maximizing health care at the lowest out-of-pocket cost. 

      Read full article here.
       
    • Q&A: Christopher F. Koller
      January 2, 2015
      As the country’s first state health insurance commissioner, an adjunct professor in the School of Public Health at Brown University, and the current president of the Milbank Memorial Fund, Christopher F. Koller is a nationally recognized health state policy innovator. Under Mr. Koller’s leadership from 2005 to 2013, the Rhode Island Office of the Health Insurance Commissioner received widespread attention for its rate review process and its efforts to use insurance regulation to promote payment reform, revitalize primary care and transform the delivery system. Prior to that role, Mr. Koller served as the first CEO of the Neighborhood Health Plan of Rhode Island; he was also the founding chair of the Association of Community Affiliated Plans. In addition, Mr. Koller was a member of the Institute of Medicine’s Committee on Essential Health Benefits and currently serves in a range of national and state health policy advisory capacities. In a recent conversation with FAIR Health Access, Mr. Koller spoke about the efforts he made to help reform healthcare in Rhode Island, state efforts at health reform, as well as potential solutions for improving primary care and healthcare quality and delivery overall.

      BA: Your career in healthcare has been marked by significant “firsts.” You were the first CEO of the Neighborhood Health Plan in Rhode Island, the first health insurance commissioner of Rhode Island and, indeed, the country. To what extent did the lack of precedent in those respective roles allow you the opportunity to innovate more freely in those capacities? What inspired your unique approach to regulation?

      CK: I have never thought of myself as an innovator, although the lack of precedent in both roles probably scared me less than it might have other people. Risks around programs and policies were ones that I was willing to take. In both cases, there certainly was an open slate which enabled me to try new things and obtain feedback. As health insurance commissioner, I made some missteps and some of our initiatives, well-intentioned as they may have been, in retrospect, were not as effective as planned. Still, we learned from those experiences and went on.

      Our unique approach was mainly inspired by the broad statute that created the Office of the Health Insurance Commissioner. Normally, commercial health insurance regulation follows two standards: to guard the solvency of insurers and to protect the interest of consumers. However, when the Rhode Island legislature developed the role of health insurance commissioner, they gave the position two additional responsibilities: to ensure the fair treatment of providers and to direct health plans towards policies that improve the entire healthcare system. When I started as health insurance commissioner, our lawyer would remind me that the Office’s obligation to direct health plans was a “shall” not a “may.” Our Office, however, could interpret how we would fulfill that obligation. In many cases, insurers knew that in a better world they would be paying more for primary care and less for other types of care, or implementing innovative types of payment reform, but they just needed support to do what was in the public interest.

      BA: What led you to pursue a career in the healthcare sector? What do you consider to be your most significant accomplishments? What were some defining challenges that you faced?

      CK: I began working at a hospital consulting firm when I was in college; I could never find anything that interested me more than the healthcare field.  I believed that pursuing a career in healthcare would allow me to become involved in socially important, intellectually challenging issues—and it has. I am proud of the work we did at Neighborhood Health Plan—it is a community health center-based Medicaid health plan. We expanded the program, gave low-income individuals greater access to healthcare and arranged ways for payors and providers to help improve the system.

      As health insurance commissioner, a significant achievement was using the rate review process to incentivize health plans to spend more on primary care. International data clearly show that high-performing healthcare systems spend more money on primary care. The U.S. spends about five to six percent of our healthcare dollars on primary care compared to 20 percent internationally. In Rhode Island, the policies of our office increased primary care spending to ten and a half percent of all healthcare spending by commercial insurers in the state; Rhode Island residents will reap the benefits of that in the future.

      One of the most challenging moments I faced in my career was the year that the Office of the Health Insurance Commissioner was defunded. I remember receiving a call from a legislator who told me that the office was eliminated and would be merged into the larger department of business regulation. However, there was sufficient public outcry, and within a week, the funds were restored. That was very gratifying.

      BA: How has your experience in healthcare and as an insurance commissioner informed your current role as president of the Milbank Memorial Fund?

      CK: The Milbank Memorial Fund has identified three major priorities for the next three years: we will respond to the needs of state policymakers using evidence and experience to improve the health of populations, help states build health policymaking skills and enhance the impact of the Milbank Quarterly. The first two priorities correspond directly to my experience in state policymaking. The states are where the action is, yet most state leaders lack the resources to accomplish the work they need to do. Good leadership is not simply being good at one’s job, but building public consensus and support for initiatives.

      The Fund continues to emphasize the importance of primary care and examine issues related to population health—a population-based approach, as opposed to individual patient care. In that regard, it is important to consider the impact of social determinants of health. As a nation, we spend far too much money on medical care, and we often confuse health with healthcare.  Research—much of it published in the Milbank Quarterly—has demonstrated that the best way to improve the lifespan of our population is not through medical care, but by improving diet, exercise, education, relationships, the environment and other upstream factors. The issues of equity and justice also are important given the health disparities between income levels.

      BA: Recently, the Milbank Memorial Fund released a report entitled, Aligning Payors and Practices to Transform Primary Care: A report from the multi-state collaborative. What actions do you think are the most critical to improving primary care? What lessons can be learned from these efforts – such as the Rhode Island Chronic Care Sustainability Initiative (CSI-RI), which you launched as health insurance commissioner, to create a patient-centered and value-based primary care system?

      The most significant lessons that can be learned from these efforts include focusing on primary care, aligning incentive payments and payment mechanisms across payors, and considering what is being paid for—what constitutes good primary care. Only states can align payments because they have special antitrust exemptions that allow them to bring together different payors and primary care physicians to coordinate payment models if it is in the public interest. Improving primary care also will involve developing standards for high-quality primary care. The Fund is actively working with many states to help them develop and sustain their all-payor primary care transition initiatives. It is a high priority for us, and one we care about deeply.

      BA: As implementation of the ACA continues, what ongoing challenges to improving healthcare quality, availability and affordability need to be addressed? What solutions should we be focusing on to address these issues? What role do you think consumer engagement can—and should—play in these efforts?

      CK: Of the three—quality, access and affordability—affordability of healthcare will be the toughest to address. There is a debate around the role of consumerism and the role of public collective action to improve affordability; both approaches have merits.
      Despite its limitations, only government can ensure access to healthcare. There has to be a role for government to define policy priorities, develop solutions and protect the public interest just as it is doing through the ACA.  Healthcare is also a commodity, however.  Its consumers need to be involved and the obvious way to engage them is to align their interests economically. A significant portion of healthcare costs has shifted to consumers but they often do not understand the cost implications of their choices. Learning to manage a $2,500 deductible on one’s own may not necessarily slow down cost trends, but it still has to be part of the discussion. Research shows that cost sharing curtails needed care as well as inappropriate care, so patient engagement is necessary, but not sufficient, to address the affordability issue.

      BA: The national dialogue continues to focus on rising healthcare costs. What are some of the most significant challenges to tackling the issue of prices and spending? What nearer-term solutions should we be focusing on to address this issue? Is price transparency part of the remedy?

      CK: I would frame this as an ongoing debate over the best way to allocate limited resources. The two extremes for addressing this issue are: a central planning version publicly funded by the state, and handing vouchers to consumers and letting them make decisions about care. The U.S. solution lies somewhere in between and will have to allow for differences from state to state. People who have worked in healthcare longer than I have say they have never seen a time of so much experimentation and discussion around these issues.

      As we have discussed consumers also will have to be involved in some way.  Price transparency is definitely part of the remedy, but it is not the whole piece. In Rhode Island, we focused our transparency efforts on public education and changing provider and payor negotiating behavior, rather than making consumers wiser shoppers.  Evidence and logic say that giving people a health savings account (HSA) and price information shifts costs but may not  bring down cost trends. Actuarially, most of the healthcare costs are driven by five percent of the people who account for 50 percent of the costs, and next year’s “five percenters” are not this year’s.  Transparent pricing is not going to prevent them from getting sick and incurring those costs, or being price sensitive when they do. Rather, they need more supports like sophisticated care coordination and disease prevention mechanisms. That said, price transparency in healthcare services is valuable for public accountability; few things work better when they are kept out of the public view.

      Regardless of the paths taken, provider payment reform will be central to addressing healthcare prices and spending. Doctors have to be paid differently—on a population basis rather than on a per-procedure basis. Solutions also will involve revaluing certain medical services to correspond more with the evidence and placing greater emphasis on the entities that can advance population health, such as good primary care.  Transparency can only help those efforts.

      BA: FAIR Health has led efforts to bring price transparency to the healthcare sector and has become a leading source of independent and objective price information. What broader role do you think FAIR Health will come to play as the healthcare landscape continues to evolve?

      CK: I am proud to be associated with FAIR Health because it has been so successful in serving as a trusted reference for out-of-network pricing. But it is also important to understand that charge, price and cost are three different economic terms. We do not really understand what costs are: a service can seem cheap or expensive depending on how costs are allocated. As a society, we need to consider the role of price transparency as opposed to charge transparency, and the role of public organizations, trusted community-wide efforts, national nonprofit resources like FAIR Health and private initiatives in making that price information more readily accessible to different stakeholders—consumers, providers, researchers and others. Those of us who have pushed for making price information public have encountered resistance. If price transparency is part of the future of healthcare, trusted price information from organizations like FAIR Health will be a public good. This role will require a lot of public policy support, because price information is currently considered to be proprietary. Whether and how to make prices transparent is a matter of public policy, and FAIR Health will be critical to that conversation.

      2014
      December
    • IHC Radio Interview: Robin Gelburd, FAIR Health, Discusses Next Steps for Price Transparency
      December 1, 2014
      TheIHCC.com, HealthCare Consumerism Radio
      In this segment, the hosts talk with Robin Gelburd, president of FAIR Health, a national independent, not-for-profit corporation whose mission is to bring transparency to health costs and health insurance information through comprehensive data products, consumer resources and research tools. At the fifth anniversary of FAIR Health, Robin and the hosts discuss the next steps in the push for price transparency in health care.

      Listen to full interview here.
       
    • Coalition Comes Together to Protect Consumers Against Unfair Health Insurance Payment Practices
      December 1, 2014
      NewJerseyNewsRoom.com
      A coalition of physicians, hospitals and other healthcare providers is calling on the legislature to make health insurance policies easier for consumers to understand and use.

      “With many consumers unaware of the benefits associated with their health insurance policies, we are turning to the legislature to demand more transparency from insurers about how they pay for out-of-network services,” said Neil Eicher, Vice President of Government Relations & Policy for the New Jersey Hospital Association. “Health insurance companies are obligated to inform their beneficiaries and the providers who serve them about who is in their networks, and what the cost-sharing obligations will be for the patient.”

      Read full article here.
       

    • November
    • The $20,000 Tick Bite
      November 26, 2014
      Finance.Yahoo.com
      After three years of suffering with pain so intense he couldn’t work, and undergoing three back surgeries, Gary Duncan, then 47 and living in Claremont, Calif., received a diagnosis of Lyme disease. To see doctors who specialized in Lyme, he and his wife, Holly, went out of their insurance plan’s network. They thought their preferred provider organization limited their out-of-pocket costs to $10,000 a year, which they were willing to spend to make Gary well. They didn't know they were on their way to a $20,000 tick bite.

      They knew that every time an out-of-­network doctor sent them a bill, their insurance would cover 60 percent. What they didn’t understand was that meant 60 percent of what their insurer deemed a “usual, customary, and reasonable,” or UCR, charge, which was often much less than the providers’ actual fees. So when a doctor charged them, say, $1,000, and the plan determined the UCR charge was $800, the plan paid only 60 percent of $800, or $480—not 60 percent of $1,000. Plus the plan had a $3,500 deductible. By the end of the year, the couple had paid more than $20,000 out of pocket.

      Read full article here.
       
    • FAIR Health Selected to Provide Data Validation Services for Minnesota
      November 24, 2014
      EnhancedOnlineNews.com
      The Minnesota Department of Health (MDH) has selected FAIR Health — the leading independent nonprofit data company that supplies the U.S. healthcare system with critical data, related tools and education — to provide External Data Validation for the State’s All Payer Claims Database (APCD). The result of a competitive bidding process, FAIR Health’s selection provides further evidence of the value customers place on the unique protocols and analytics FAIR Health employs to support data integrity.

      Robin Gelburd, FAIR Health’s President, stated, “We are gratified to be chosen by Minnesota to help the State ensure the quality of its APCD. This selection is the highest form of endorsement for FAIR Health’s own national database of private claims information. FAIR Health is honored to be entrusted with the validation of the data that can inform the State’s healthcare policy decisions.”

      Read full article here.
       
    • Patients Struggle to Understand and Control Health Care Costs
      November 21, 2014
      KAIT8.com
      Open enrollment is underway for many across the Carolinas. It is the annual opportunity, whether through your employer, or a federal health care exchange, to sign up for medical insurance. Many will be looking at increases in premiums and would like to find a way to save some money. It's not easily done because the health care economic model is much different than the one we use in just about every other aspect of our lives.

      Think about it, when you buy a car, a television or head to the grocery story, one of the overriding factors in making a purchase is cost.

      Read full article here.
       
    • The High Price of Being an Uninformed Patient
      November 11, 2014
      The Wall Street Journal
      SHERYL GARRETT: We may invest considerable energy in evaluating and selecting the best medical insurance for our budget and anticipated needs, keeping in mind that insurance is purchased to cover the risks you can’t afford to bear yourself. Considering all of the options and features available in medical insurance contracts, this task is not an easy one.  Even if we’ve read the policy, we often don’t really have a clue how our insurance coverage actually works and what is covered until we have a claim.  Also, selecting the right insurance isn’t the only financially impactful decision you’ll make regarding your medical care.

      Read full article here.
       
    • Medical Procedure Payments Are Not All Equal, Shop To Net Savings
      November 5, 2014
      MainStreet.com
      Ensuring that you are paying a fair amount for your next medical procedure can be tricky. Consumers are paying about 683% more for similar medical services at different facilities in the same city, according to the 2011 Healthcare Transparency Index Study. Spending for healthcare is taking up a large amount of consumers’ budgets even though the rise in premiums has been steady, a Kaiser Family Foundation survey found.

      Before undergoing a treatment and being hit with a large bill, consumers can research doctors and hospitals and estimate their out-of-pocket health care costs.

      Read full article here.
       

    • October
    • Five Years Later, FAIR Health Continues to Help Shape the Healthcare Landscape
      October 29, 2014
      BioPortfolio.com
      FAIR Health, the independent nonprofit that provides trusted healthcare data to the U.S. healthcare sector and leads the national conversation on transparency and clarity in healthcare costs and insurance, celebrated its fifth anniversary yesterday. From a newly launched nonprofit, focused initially on providing benchmark charge data to health insurers and consumers, FAIR Health has emerged as a national company with hundreds of industry licensees, thousands of providers using its data, and thousands of visitors to its consumer website. FAIR Health also maintains the largest private healthcare claims database owned by an independent organization and offers an expanding portfolio of data products and tools that meet the needs of all healthcare stakeholders.

      Read full release here.
       
    • Can We Control Healthcare Costs Without Price Caps?
      October 16, 2014
      BeckersHospitalReview.com
      Capping healthcare provider payments based on Medicare reimbursement rates isn't necessarily an adequate solution to charge variations and ballooning care costs, Robin Gelburd, president of FAIR Health, an independent nonprofit that advocates for healthcare transparency, writes in Health Affairs.
       
      Ms. Gelburd writes in response to another Health Affairs piece by Jonathan Skinner, PhD, a professor at Dartmouth; Elliott Fisher, MD, director of the Dartmouth Institute for Health Policy and Clinical Practice; and James Weinstein, DO, president and CEO of Lebanon, N.H.-based Dartmouth-Hitchcock health system. Drs. Skinner, Fisher and Weinstein wrote limiting prices to 125 percent of what Medicare pays would eliminate the most extreme charge variations and protect consumers from excessive healthcare provider market power.

      Read full article here.

    • The Need For A Comprehensive, Current, And Market-Representative Health Care Cost Benchmark
      October 9, 2014
      HealthAffairs.org
      A recent post from Jonathan Skinner and colleagues on Health Affairs Blog posited an interesting solution to ever-increasing health care costs, suggesting that imposing price caps on all medical services, equal to 125 percent of the Medicare payment, would serve to eliminate wide variations in quoted prices for health care services.
       
      While the overall idea of controlling costs through the establishment of a mutually agreed-upon and accessible benchmark is a sound one, the use of Medicare reimbursement levels as a ceiling for this purpose would present a number of challenges. For example, Medicare does not assign a value to all codes; a separate system would be needed to price services not addressed by Medicare’s fee schedule.
       
      Read full article here.
       
    • High Deductibles Have Patients Clamoring for Cost Clarity
      October 7, 2014
      Crain's New York Business
      Cheryl Blum, a mother of four, is no stranger to discussing the cost of her medical choices with her doctor. After her primary care physician referred her to a specialist for a colonoscopy, Ms. Blum used her insurance plan’s online cost estimator to find a doctor who could do the procedure for less.
       
      “I was very honest with the office manager and said, ‘It’s nothing personal, but the other facility has fees that are $300 to $400 below yours,’” she said.
       
      Ms. Blum is the embodiment of the new, informed patient. As workers shoulder a bigger portion of ever-rising health costs, providers and insurers are finally opening up about prices. Employers hope that if health care operates more like a retail business—with transparent pricing—patients will then be able to shop for the best-quality care at the lowest cost.

      Read full article here.

    • Study: Medical Price Comparison Tools Save Money, Boost Care
      October 1, 2014
      FoxBusiness.com
      Shopping around has its benefits, even in the healthcare market. A new report from UnitedHealthCare, the Minnetonka, Minn.-based healthcare insurer, shows using an online medical price comparison tool saves consumers’ money and at the same time gives them better quality of care.
       
      Comparing more than 425,000 users and nonusers of  UnitedHealthCare’s online service myHealthcare Cost Estimator http://www.welcometomyuhc.com/hcce-review/index2.html, the insurer found of those who used the tool, 7% are more likely to choose a high-quality primary care doctor and 9% are more likely to select a high quality orthopedist. UnitedHealthCare uses a proprietary analysis of care quality and cost efficiency to designate a doctor as high-quality.
       
      Read full article here.
       

    • September
    • How Do You Pay for Value-Based Care?
      September 30, 2014
      BenefitsPro.com
      As the notion of value-based payment has taken hold in the health care market – the concept that health care providers should be paid according to the quality of care they offer, as opposed to today’s “fee-for-service” payment method – insurers, from the Centers for Medicare & Medicaid Services to commercial payers, have had to define and measure quality and value in health care.
       
      And how those quality metrics are defined and collected, and how the payment measures are structured, vary from payer to payer – and even within different insurance organizations – as they experiment with various models to test what’s most effective.

      Read full article here.

    • Even With In-Network Hospital, Insurance May Not Cover ER Physicians
      September 23, 2014
      TampaBay.com
      When her husband, Charles, showed signs of heart trouble in January, Donna Baker didn't hesitate to drive him to the emergency department at nearby Mease Countryside Hospital.
       
      Only later did the Bakers learn that while Mease Countryside is part of their health insurance network, the physician who treated him there is not. The ER doctors are employed by a separate company that doesn't accept their United HealthCare plan.
       
      The result? The Bakers got stuck with a $1,235 doctor's bill.

      Read full article here.
       
    • Website Tracks Consumers' Online Searches on Dental Treatment
      September 23, 2014
      ADA.org
      The terms "adult cleaning" and "root canal on a molar tooth" were the top two most frequently searched terms about dental services on FAIR Health, a website that provides cost information on medical and dental treatment. 
       
      Consumers can access FAIR Health's free database of billions of billed medical and dental services so they can estimate and plan their medical and dental expenditures. FAIR Health's consumer website, FH Consumer Cost Lookup, also offers educational articles and videos about the health care insurance reimbursement system. 

      Read full article here.
       
    • FAIR Health Expands Information Available on its Consumer Website Through Addition of Cost Estimates for HCPCS Codes
      September 11, 2014
      International Business Times
      FAIR Health, the leading independent data company that serves the healthcare system through data tools and educational resources, today announced the introduction of cost information for medical supplies, equipment and services such as ambulance transportation to the estimates of professional fees available through its consumer website. FAIR Health is adding to its Consumer Cost Lookup tool the charges for a subset of Healthcare Common Procedure Coding System (HCPCS) codes that providers and insurers use to represent such services and equipment. Available to consumers at no charge through www.fairhealthconsumer.org, FAIR Health’s award-winning website, this new feature enables consumers to obtain a more comprehensive estimate of their healthcare expenses in their own geographic area.
       
      “The integration of cost estimates for items and services billed by HCPCS codes was the natural next step in advancing the consumer experience on the website,” said Robin Gelburd, president of FAIR Health. “Making these data accessible puts consumers in an even stronger position to plan and manage the costs associated with their care by giving them a more complete picture of those costs.”

      Read full article here.
       

    • August
    • 5 Ways to Avoid Surprise Medical Bills
      August 19, 2014
      MainStreet.com
      More than one in four Americans say they are struggling to pay health care costs or can not afford to pay them at all, especially when they are hit with a bill they did not anticipate.
       
      The study from the Centers for Disease Control and Prevention also found that one in five families was paying medical bills over time.
       
      Consumers are often also billed for additional services they did not receive or are not aware that the decisions their health professional made will cost them extra.

      Read full article here.
       

    • July
    • FAIR Health Releases the Most Searched Dental Services by Healthcare Consumers
      July 22, 2014
      DentalProductsReport.com
      FAIR Health is an independent data company that serves the healthcare system through data tools and education. As a nonprofit organization, FAIR Health’s mission is to bring fairness and transparency to health insurance information and healthcare costs by acting as a neutral party that translates the data they collect into resources that help support all parties.
       
      In their most recent endeavor, FAIR Health has attempted to bring integrity to the data regarding the dental services that consumers are most in need of cost information. In their most recent release, FAIR Health shared the top fifteen most searched dental services by healthcare consumers that are most frequently looking for cost information. The results of this data also depicts the changes in the most searched dental services from 2013 and 2014.

      Read full article here.
       
    • Ever Wonder What Dental Services Consumers Search For? FAIR Health Offers an Analysis
      July 14, 2014
      DentistryIQ.com
      Prophylaxis. Root canal. Periodic evaluation, or porcelain/ceramic crowns. While these are basically part of a second language to dental professionals, consumers want to know more about what procedures are available to them, and how much these services are going to cost them.
       
      Compiling that information in one central location is FAIR Health, a data company that serves the health-care system through data tools and education. That's a fancy way of saying they keep track of what consumers are searching for regarding their oral and systemic health, and are sharing their insightful findings with health-care professionals to guide them in their marketing and promotions.

      Read full article here.
       
    • How Patient Needs for Price Data are Changing
      July 10, 2014
      HealthDataManagement.com
      FAIR Health, which operates a database of 17 billion medical and dental claims, has unveiled the top 15 medical and dental services for which consumers have searched for cost information.
       
      The searches were done on the vendor's free FH Consumer Cost Lookup Web site. The data covers the first two quarters of 2013 and 2014, giving a glimpse at changes in consumer interests in the cost of care and insights for stakeholders to respond to shifts in delivery and reimbursement, according to the vendor. 

      Read full article here.
       
    • FAIR Health Cost Lookup Tool
      July 7, 2014
      OnSiteClinics.com
      The Agency for Healthcare Research and Quality announced this spring that it is designating FAIR Health’s Cost Lookup Tool one of its QualityTools.

      Read full article here.


    • June
    • Price Transparency Comes to the Forefront
      June 19, 2014
      ManagedHealthcareExecutive.com
      The Health Care Cost Institute (HCCI) has developed a partnership with Aetna, Humana and UnitedHealthcare to provide a free online tool that will offer consumers comprehensive information on price and quality of health services.
       
      The new tool will aggregate pricing data from commercial plans, as well as Medicare Advantage and Medicaid plans, if the states agree, says David Newman, executive director, HCCI. HCCI will create and administer the information portal, which is expected to be available in early 2015.

      Read full article here.
       

    • May
    • Three Advantages to Leveraging Claims Data to Forecast Healthcare Industry Trends
      May 29, 2014
      MedCityNews.com
      As the ACA continues to drive rapid transformation throughout the healthcare industry, new decision risks are emerging for all of the stakeholders in this complex market. As industry players struggle to quantify the effects of current reforms on their business models, it is becoming evident that high-quality, unbiased claims data are a critical tool. Specifically, pharmaceutical companies rely heavily on trend forecasting to ensure they are prepared for shifting market forces that ultimately affect their sales, production and profit. External, private healthcare claims data can shed light on the underlying reasons for changing product demand, allowing companies to take a more proactive approach and retain their competitive advantage.

      Read full article here.

    • Towards Affordable Care: Policies To Reduce Price Variability
      May 21, 2014
      Innovations.AHRQ.gov
      Hospital pricing for elective procedures can vary significantly across facilities within a given market area, and differences are typically unrelated to variations in quality of care. Under most benefit plans, insured consumers lack incentive to choose hospitals offering a lower price for these services. In addition, prices charged for general hospital care often differ based on patients’ insurance status.

      Read full article here.

    • What are the Ingredients in Your Health Care Cost Estimation Tool?
      May 19, 2014
      TheIHCC.com
      By Robin Gelburd, President, FAIR Health, Inc.

      Employers are increasingly hearing about the importance of offering employees tools to help them factor cost into their health care decisions. Such tools are especially relevant as many more employers shift their employees to high deductible health plans or plans with more extensive cost-sharing provisions. Further, employees purchasing insurance offered through the ACA-created health exchanges are often in plans that feature narrow networks with a limited selection of providers, or closed network plans that do not reimburse for out-of-network coverage, and therefore, are facing the decision of whether to go out-of-network to see their preferred physicians. 
       
      The call for price transparency in health care services becomes even more urgent in light of recent economic data demonstrating that, after an extended retrenchment, health care consumers in the United States are seeking care again. As employees re-engage with the health care delivery system with health plans that involve new cost-sharing models, employers can offer an important service by linking employees to accurate, user-friendly tools for understanding the financial implications of alternative care decisions. 
       
      Read full article here.
       

    • April
    • Look Beyond Medicare Data When Shopping for Healthcare
      April 29, 2014
      Reuters.com
      The recent release of Medicare billing records for doctors across the United States brought hope that consumers would get what they need to comparison-shop for healthcare.
       
      Although that did not turn out to be true, you do have other places to look.
       
      Experts say there are limits to how much can be learned from data tracking 880,000 doctors billing about $77 billion to the federal healthcare program for the elderly for some 6,000 types of procedures.

      Read full article here
       
    • Robin Gelburd Live on HCI
      April 25, 2014
      TheHCInsider.com (Aired February 26, 2014)

      Discussion topics:
      1. How does FAIR Health help consumers make sense of healthcare costs?
      2. How can cost-transparency tools help educate and empower the healthcare consumer?
      3. What do you think are the biggest healthcare data challenges we will face over the next three years?

      Listen to full interview here.

    • 5 Hidden Costs of Hospital Visits
      April 9, 2014
      Money.USNews.com
      When Ritter Elizabeth Hoy, 33, went to an emergency room in Oxford, Ohio, last summer, she spent approximately six hours undergoing tests until she was sent home with some codeine for her pain and no diagnosis. The following day, very much in pain, Hoy found another hospital, where the physician took an X-ray – something the ER doctor didn’t do the day before – and concluded Hoy had two broken ribs.
       
      "It was my own stupid fault," says Hoy, who had attempted to move a refrigerator on her own in her apartment.
       
      Not long afterward, Hoy, a marketing professional, became sick again – this time, from her hospital bills. The first emergency room visit cost four times more than the second and didn’t even conclude that she had broken ribs.

      Read full article here.
       

    • March
    • How to Estimate Out-of-Pocket Medical Expenses
      March 21, 2014
      NYSUT United
      People often pay a $15 or $20 co-pay for services billed by participating providers, but may incur substantial out-of-pocket expenses for non-participating providers or out-of-network services.

      Real full article here.
       
    • Big Things in Patient Engagement: Context and Transparency
      March 18, 2014
      HL7Standards.com
      While there were over 38,000 attendees at HIMSS14, and there were some 95,000 tweets, so I was able to see a lot of what stood out from my armchair by some very diligent tweeting, which appears to be growing exponentially around Health IT.

      Read full article here.


    • February
    • The Best iPhone Apps for Health Insurance
      February 11, 2014
      AppPicker.com
      If you are looking for health insurance, whether it be for you or your family, then check out our list of the best health insurance apps for your iPhone.

      Read full article here.
       
    • FAIR Health Sheds the Light on Costs
      February 11, 2014
      Healthcare IT News
      Most healthcare stakeholders and observers would probably agree that the way healthcare costs are determined and communicated is, to put it mildly, a bit nonsensical.
       
      One of the biggest issues is that, unlike with most other economic activities, patients, who are the actual consumers of healthcare services, usually have little to no idea of the cost of what they’re buying.

      Read full article here.
       
    • In Southwest Georgia, The Affordable Care Act Is Having Trouble Living Up To Its Name
      February 4, 2014
      Kaiser Health News
      ALBANY, Ga. — If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month. If he lived in Beverly Hills, he would pay $1,405.
       
      But Mullins, who builds custom swimming pools, lives in Southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.

      Read full article here.
       

    • January
    • Interview with Robin Gelburd, FAIR Health, On Transparency and Consumer Decision Support
      January 31, 2014
      TheIHCC.com
      The hosts are joined by Robin Gelburd, President, FAIR Health, in a discussion on how the evolving health care landscape has made cost a more relevant issue in consumers' decisions about their health care. We have recently seen a wide variety of efforts to make health care costs more transparent to patients. Unfortunately, transparency is not enough. Consumers need clarity, or the context and educational information that helps them to understand how to apply available information to health care decision-making.
       
      Listen to full interview here.
       
    • The Importance of Data and Education to Manage Health Plans
      January 10, 2014
      Benefits Magazine
      Benefit plan sponsors are being buffeted by the sea change surrounding health reform. Many questions remain regarding the form the private insurance system will take once the reforms have been implemented. However, for multiemployer health plans, the main goal of offering health benefits remains the same: to provide affordable health care coverage that maintains the health and quality of life of participants.
       
      Read full article here.
       

      2013
      December
    • Money Power: Fix your finances with cool web tools, apps
      December 30, 2013
      TulsaWorld.com
      These sites can help you make smarter decisions about budgeting, investing and taxes. All of them are free unless otherwise noted, and some come with mobile applications.
       
      Read full article here.
       
    • 6 Health Insurance Options for College Students
      December 16, 2013
      FoxBusiness.com
      Each year, college students face a critical test that they probably don't hear about in any classroom: having the right health insurance to cover the costs of ailments and emergencies that may arise while they're in school.
       
      Read full article here.
       
    • 8 Smart Online Tools to Manage Your Finances
      December 4, 2013
      Kiplinger.com
      If you ask an expert to identify great personal finance Web tools, chances are that popular sites such as Mint.com, Manilla.com and Credit.com will be on the list. But the realm of online resources extends well beyond those familiar names. We dug deeper for useful tools that address a range of personal finance concerns. All of them are free unless otherwise noted, and some come with mobile applications.
       
      Read full article here.
       

    • November
    • 4 Ways to Save on Healthcare Costs
      November 27, 2013
      Yahoo! Finance
      Once upon a time, many of us had a health insurance plan that gave us most of what we needed for a $10 or $20 co-pay. That’s no longer true: many of us now are on insurance plans with a high deductible, a high co-pay, out of network, out of pocket — or paying a percentage of whatever costs we incur.
       
      Read full article here.
       
    • How to Avoid Getting Ripped Off Using Online Tools
      November 27, 2013
      CNBC.com
      Often, the best way to avoid a rip-off is to know what others are paying for things. What did the guy sitting next to me on the plane pay for his ticket? How much did the neighbor pay for his kid's wedding? That emergency dental procedure? The water pump replacement on her late-model foreign car?
       
      Read full article here.
       
    • 3 Things to Consider About the Fees in Your Dental Practice
      November 22, 2013
      Practicemanagement.dentalproductsreport.com
      Let’s face it. No one likes to talk about how much something is going to cost, and there are times that we all really want something … until we see the price tag. 
       
      Dental team members and dental patients feel the exact same way. Those veneers or implants sound great … until the price tag is revealed. So how do you move past “sticker shock” when it comes to your patients? How are the best ways for you to know if you’re charging what you should be charging for a procedure? Here are some ideas…
       
      Read full article here.
       
    • 7 Ways to Pay Less at the Doctor
      November 20, 2013
      Grandparents.com
      You see your doctor for 15 minutes and the bill is $150. Even more confusing, your friend sees her doctor for the same reason across the country—or across the street—and is charged a different rate. So is the person who is sitting next to you in the waiting room. What’s up with that?
       
      Read full article here.
       
    • Cost transparency tools grow in scope
      November 1, 2013
      ebn.benefitnews.com
      A growing range of cost transparency tools are reinventing the ways that employees understand health care's real expenses and make better decisions. But how much data can they handle and still remain engaged in the process?
       
      Read full article here.
       

    • October
    • The 5 Things You Should Know When Your Healthcare Claim Is "Denied"
      October 28, 2013
      Forbes.com
      I am often asked to comment on a range of medical treatments – from new drugs to medical devices and procedures. Investors will inquire about a new treatment or procedure to gauge the likelihood of a product’s success, or to understand if there is a market for a particular treatment. But recently, and with greater frequency, I have been getting calls from individuals detailing obstacles they face to receiving medical treatment. Many of these calls concern costly and essential treatments or procedures, and with growing frequency, these callers have been denied reimbursement by their insurance companies.
       
      Read full article here.
       
    • 6 Things You Must Know About Obamacare and Health Insurance
      October 2, 2013
      Mainstreet.com
      At least one good thing has come from the Affordable Care Act. In spite of all the political posturing, Obamacare is causing a lot of people to ask questions about health insurance. The uninsured and self-employed have particular questions, as do young adults facing their first policy purchase. And annual enrollment for employer-sponsored health insurance is looming for millions of Americans who purchase their health insurance at work.
       
      Read full article here.
       

    • September
    • Will Obamacare Make You Blow Your Budget?
      September 24, 2013
      Mainstreet.com
      Two in five Americans, or some 40%, are spending more money on health care now than last year and are concerned how the new Affordable Care Act will affect their finances.
       
      Only 8% of Americans say they are spending less money now on health care, according to a new Bankrate.com report.
       
      Consumers are questioning how the Affordable Care Act, also known as Obamacare, will affect their current health coverage. 28% say this is what they would most like to know about the new law, followed closely by the 24% who want to know how it will affect their household budgets. Another 23% are most curious about whether the Affordable Care Act is really going to happen, and 15% say their top question is simply what Obamacare is.
       
      Read full article here.
       
    • The Importance of Data Analytics for Self-Insurers
      September 18, 2013
      The Self-Insurer
      Rising health costs in the United States have increased the financial burden of healthcare coverage for all parties – especially employers and employees. To combat this continuing trend, everyone must be more strategic about how they manage healthcare costs.
       
      Many employers see the Patient Protection and Affordable Care Act’s (ACA) exemptions for self-insurers as an opportunity to take greater control of the cost of their employee health benefits. Even while changes continue to be made to the ACA, meaning that the ultimate impact of “the decision to self-insure” remains unclear, many employers are revisiting the option to self-insure.  According to research by the Employee Benefit Research Institute, one fact remains clear:  self-insurance is an increasingly popular option for employers in an era of high and escalating premiums.
       
      With this trend comes premium relief – but also increased risk for predicting and managing employee health costs. In order to fully comprehend these costs – and strategize accordingly – employers need access to regional market information on benefits utilization and health risks. These data can help self-insured organizations better understand, and mitigate, short- and long-term risk through smart plan design and clear, actionable benefits communication. 
       
      Read full article here.
       
    • Addressing Patient Financial Stress Reaps Benefits
      September 17, 2013
      Physician's Money Digest
      A recent commentary in the Journal of the American Medical Association recommends that physicians pay almost as much attention to patients’ financial health as they do to their medical health. The commentary goes so far as to suggest that all patients be screened for financial stress.
       
      Robin Gelburd, president of FAIR Health, a not-for-profit organization focused on bringing current and reliable health care cost information to all parties within the health care system, isn’t surprised by the recommendation.
       
      Read full article here.
       
    • What You'll Really Pay for Health Care
      September 12, 2013
      MarketWatch
      Imagine if your auto insurance worked the way your health insurance does. For years, you probably would have paid a fixed monthly premium plus, say, $20 every time you took your car to the body shop, regardless of whether you got an oil change or your entire engine replaced. 
       
      Now, your plan has switched, and in addition to premium payments you’re responsible for the first few thousand dollars of bodywork each year. And here’s an extra wrinkle: The mechanic won’t tell you how much you owe until after your car has been serviced.
       
      That pretty much sums up the state of affairs with health insurance today for millions of people in the U.S. What people pay for health care can be all over the map depending on their health care provider, facility and plan type. A study released last week by the Center for Studying Health System Change found that hospital prices for privately insured patients vary widely even within individual communities; and the study also noted that these prices can be tough to obtain in advance. “It’s very hard to find out how much you’re on the hook for until you get the bill,” said Katy Kozhimannil, assistant professor at the University of Minnesota School of Public Health.
       
      Read full article here.
       
    • 8 Tips to Help 40-Somethings Manage Their Healthcare Costs
      September 7, 2013
      Dailyfinance.com
      As we enter our 40s, our physical condition tends to start deteriorating -- at least a little -- no matter how well we take care of ourselves. You may find yourself suddenly needing reading glasses, for example, or taking medications to tame your high blood pressure.
       
      These issues, and ones down the line, can end up costing us a lot of money, so it's worth putting a little time into thinking about how to secure good care for yourself while not spending more than you need to. You may end up saving money -- and perhaps even extending your life.
       
      Read full article here.
       
    • Cutting the Cost of Dental Care
      September 3, 2013
      LA Times
      When Patricia Torres learned she needed a root canal, she wasn't concerned. After all, she had dental insurance. Then the bill arrived.
       
      "I was completely shocked and surprised because the bill came in for $750," says the 38-year-old stay-at-home mother from Woodland Hills. Her insurance covered only 50% of the price.
       
      Torres' surprise at the size of her bill didn't surprise Jeff Album, vice president of public and government affairs with Delta Dental of California, which sells dental benefits. "The average person doesn't know how dental insurance works and shows up at the doctor's office and discovers that with advanced treatment, there is a cost to bear."
       
      Dental insurance differs from medical benefits in a number of ways, he said.
       
      First, it's specifically designed to encourage preventive treatment. That's why most dental plans pay 100% for preventive services, such as cleanings, X-rays and checkups. Basic restorative services such as fillings and periodontal cleanings are generally covered at 80%, and you'll commonly get just 50% reimbursement for procedures such as implants and crowns.
       
      Read the full article here.
       

    • August
    • How to Find Out How Much Your Medical Procedure Should Cost
      August 29, 2013
      Fox Business
      When it comes to medical procedures and treatment, it pays to shop around.
       
      According to a recent study by the Centers for Medicare & Medicaid Services, there are “significant” variations across the country and even within communities of what medical providers charge for common inpatient and outpatient services. As health-care costs continue to tick up as wages remain stagnant, patients have to be their own advocate to find the best care for the right price. Thankfully, the internet has made it a lot easier to review doctors and prices.
       
      Having the knowledge of how much a particular procedure should cost will enable you to negotiate a fair price and avoid excessive health-care bills.

      Read full article here.

       


    • July
    • Helping Consumers Navigate Claims Data
      July 12, 2013
      Healthcare Informatics
      If the age of medical cost transparency is in fact upon us, then perhaps Oct. 27, 2009 might be cited as one of the key dates for this burgeoning movement. It was on that date that an organization by the name of Fair Health was created.
       
      Fair Health is a non-profit organization developed in large part to the efforts of then-New York State Attorney General, Andrew Cuomo (now Governor of N.Y.). Cuomo, who was investigating how out-of-network claims were being priced, settled with the various insurance companies out of court. From that settlement, the insurance companies agreed to establish a non-profit organization that would feature an independent database of healthcare charge information.
       
      Read full article here.
       
    • 5 ways IT helps make sense of costs
      July 10, 2013
      Healthcare IT News
      Most healthcare stakeholders and observers can agree that the way healthcare costs are determined and communicated is, to put it mildly, a bit nonsensical. One of the biggest problems is that patients – the actual consumers of healthcare services – usually know nothing about the cost of what they’re buying.
       
      Enter FAIR Health, a non-profit organization that emerged in 2009 as part of a legal settlement between the state of New York and the insurance industry. The lawsuit stemmed from then Attorney General Andrew Cuomo’s contention that there was a conflict of interest involved in insurance companies setting out-of-network costs of healthcare services using data owned and managed exclusively by the insurance industry.
       
      Read full article here.
       
    • How to Dispute Credit Card Charges and Other Billing Errors
      July 2, 2013
      Real Simple
      Chances are, you don't stop to study sales receipts or read bills thoroughly before paying them. Hey, you're busy! But the people who prepare your bills are busy, too, and they can make mistakes. Case in point: Up to 40 percent of medical bills may contain errors, according to Stephen Parente, a professor of health finance at the University of Minnesota, in Minneapolis. That's why it's worth taking a few valuable seconds to scan your bills. Here's the scoop.
       
      Read full article here.
       

    • June
    • Federal Gov't, Private Groups Step Up Efforts To Boost Online Health Care Cost Transparency
      June 17, 2013
      iHealthBeat
      The federal government and private groups increasingly are making health care cost information available online.
       
      In an iHealthBeat Special Report by Rachel Dornhelm, experts discussed how such efforts are affecting health care costs.
       
      The Special Report includes comments from:
       
      • Victoria Bogatyrenko, vice president of product and innovation at United HealthCare;
      • Niall Brennan, director of CMS' Office of Information Products and Data Analytics;
      • Robin Gelburd, president of FAIR Health;
      • Jerry Kominski, director of the University of California-Los Angeles' Center for Health Policy Research; and
      • Jeffrey Rice, CEO of the Healthcare Blue Book (Dornhelm, iHealthBeat, 6/12).

      The complete transcript of this Special Report is available as a PDF.
       
      Read article online here.
       

    • May
    • Seven Must-Knows about Dental Plans
      May 31, 2013
      Voluntary Benefits Magazine
      Recent debate on expanding access to healthcare, improving health outcomes and reducing the cost of medical care has dominated the public’s attention regarding our nation’s healthcare system. As a result, discussions about other vital but often-undervalued benefits – including dental insurance – have typically taken a backseat, both in terms of media interest and consumer education.Recently, however, there has been a surge of attention to the effect the Affordable Care Act (ACA) will have on dental insurance plans. According to a Pew Center on the States report, approximately 5.3 million children are expected to gain dental coverage after 2014 as part of the ACA. The Act includes a plan for pediatric dental insurance plans that will be sold through insurance exchanges, both packaged with comprehensive medical plans and as stand-alone plans. This marks a major shift from the way dental insurance is currently sold. For the first time, there is a need for pediatric-only plans.
       
      Dental plan options, whether through stand-alone plans or medical-dental packages, will vary by state when the exchanges begin enrollment this fall. However, the consumer/employee is the ultimate decision maker and will require education and a clear presentation of the options to make informed choices.
       
      Fortunately, there is time for Americans to consider their dental plan options. In order to do so, every party – brokers and advisors, employers and their employees – must understand what information they need to provide or obtain.
       
      Read full article here.
       
    • Let's go shopping for surgery: New government data shines light on health care cost variations
      May 8, 2013
      Marketplace
      Let’s say you needed a pacemaker and you went to Uniontown hospital in Uniontown, Pennsylvania, the charge might be $20,000. If you went to Phoenixville Hospital near Philadelphia, the charge might have been $211,000. Hospitals list radically different charges “because they can,” says Gerard Anderson , director of the Johns Hopkins Center for Hospital Finance and Management. “Nobody’s been looking at their charges over the last 30 years.”In the past, hospitals have kept their charges hidden, according to Peter Ubel, professor of Business Administration and Medicine, at Duke University. “If I’m negotiating prices with insurers, I don’t want people to know about it.”
       
      Read full article here.
       

    • March
    • New Tools Make it Easier to Find Prices for Medical Procedures
      March 26, 2013
      LA Times
      Eve tried to get a firm price tag before going to the doctor or the hospital? Good luck. Historically, the search for healthcare prices has been an exercise in futility.
       
      But that's starting to change. With healthcare costs rising and consumers on the hook for a growing share of their medical bills, doctors, hospitals and health insurers are feeling the pressure to make healthcare prices more readily available.
       
      Read full article here.
       
    • Data for All, and All for Data
      March 7, 2013
      Advance for Health Information Professionals
      The competitive and rapidly evolving nature of today's healthcare system has dramatically increased the need for solid, actionable data throughout the healthcare sector. This development has placed greater strain on information systems as hospitals, physician practices, health departments and health insurance companies maintain and share health records to improve the quality of care patients receive.  But individual patient information isn't the only data with which the healthcare system should be concerned.
       
      Read full article here.
       

    • February
    • Transparency In Health Costs for Consumers Has Arrived
      February 21, 2013
      Health Thought Leadership Blog
      February marks the Annual National Wise Health Care Consumer Month. FAIR Health, Inc., the subject of this post and podcast, is joined by the American Institute for Preventative Medicine (AIPM) in helping to educate people on ways to be smarter and healthier consumers.
       
      FAIR Health, Inc., is a national, independent not-for-profit corporation whose mission brings transparency to health costs and health insurance information through comprehensive data products and consumer resources. FAIR Health uses its database containing billions of billed medical and dental services to power a free Website that enables consumers to estimate and plan their medical and dental expenditures.
       
      View the blog post and listen to the podcast here.
       
    • Report Faults High Fees for Out-of-Network Care
      February 5, 2013
      NYTimes.com
      Just over a year ago, Angel Gonzalez, 36, awoke with searing chest pain at 2 a.m. A friend drove him to the closest emergency room. Though he was living on $18,000 a year as a graduate student, Mr. Gonzalez had good insurance and the hospital, St. Charles in Port Jefferson, N.Y., was in his network. But the surgeon who came in to remove Mr. Gonzalez’s gallbladder that Sunday night was not.
       
      He billed Mr. Gonzalez $30,000, and an assistant billed an additional $30,000. Mr. Gonzalez’s policy covered out-of-network providers, but at a rate it considered appropriate: $2,000. “I was on the hook for more than I made in a year,” Mr. Gonzalez said.
       
      A health insurance industry report to be released on Friday highlights the exorbitant fees charged by some doctors to out-of-network patients like Mr. Gonzalez. The report, by America’s Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates.
       
      Insurers hope to spotlight a vexing problem that they say the Affordable Care Act does little to address. “When you’re out of network, it’s a blank check,” said Karen Ignagni, president and chief executive of AHIP. “The consumer is vulnerable to ‘anything goes.’ ”
       
      “Unless we deal with cost, we won’t have affordability,” she added. “And unless we have affordability, we won’t have people participating” under the Affordable Care Act.
       
      Read the full article here.
       
    • The Health Insurance Out-of-Network Bite
      February 5, 2013
      Bankrate.com
      Stepping outside your health insurance company's preferred providers list could take a toll on your bank account. Though there are certain circumstances where an insurance company will pay all or a portion of out-of-network costs, policyholders need to tread carefully. You can easily find yourself on the hook for massive bills. Here's what you need to know.
       
      How health care networks work
      Doctors, hospitals and other health care providers "give health insurance companies discounts on care in order to increase their volume by attracting plan members," explains health care economist Adam C. Powell, president of the consulting firm Payer+Provider Syndicate, in Boston. "When a health plan member goes out of network, the health insurance company is typically stuck paying retail prices rather than wholesale prices."
       
      And those higher prices can be passed along to the patient. 
       
      Robin Gelburd, president of Fair Health Inc., a New York-based nonprofit dedicated to increasing the amount of transparency in health insurance, adds that insurance networks can be complicated. There may be multiple payment tiers or fee structures that can make it difficult for policyholders to understand their costs. Also, hospitals or other health care facilities may be included in an insurance company's network, but specific physicians, specialists or labs may not be.
       
      Read the full article here.
       

    • January
    • Q&A: Stephen Warnke, Esq.
      January 29, 2013
      As the founding Chair of FAIR Health, Stephen Warnke has been at the helm of its Board of Directors even before the organization was officially established in 2009. As Co-Chair of the Health Care Group at Ropes and Gray, LLC, Stephen and his firm represent a wide range of healthcare stakeholders. Mr. Warnke recently spoke with FAIR Health Access about the rewards and challenges of being a healthcare lawyer, the changing conversation in healthcare, and FAIR Health’s role in bringing cost transparency to an ever-evolving healthcare industry.
       
      BA: How did healthcare become the focus of your work as an attorney?
       
      SW: I’ve been a healthcare lawyer in New York since 1991, and previously worked in the administration of then-Mayor David Dinkins on Medicaid and drug abuse issues. What drew me to the healthcare bar was that it’s an area of private practice in which I, as a lawyer, can be intimately involved in matters of pressing policy significance, representing private clients but doing so in a way that advances the public good. The healthcare industry is in a state of perpetual flux and perpetual crisis, so there is never a moment when you can profess to have complete command of all the technical details. The challenge for lawyers who represent healthcare clients is therefore constantly evolving, and of course, always fascinating.
       
      BA: You were asked to serve as Chair of FAIR Health following the settlement between then-Attorney General Cuomo and the insurance companies in New York State. What were your thoughts about a settlement agreement that provided for the establishment of a new organization rather than a settlement agreement that simply provided for the payment of a specific sum?
       
      SW: The Cuomo Settlement Agreement was farseeing in several respects. First of all, the Attorney General understood that to capitalize and make possible the kind of venture that he had in mind for FAIR Health would require a substantial commitment of upfront dollars. By settling with over 12 insurers, both regional and national, he was able to raise the funds dedicated to that important mission. Second, he recognized that the organization responsible for validating and publishing healthcare pricing data should be completely disinterested and mission-driven -- not a subsidiary of any sector of the industry with a stake in the pricing data but also not pursuing profit or any narrow, parochial set of interests. And so, the second innovation of the settlement agreement was to provide for the launch of a new business that would function as the successor to Ingenix but be neutral, dispassionate, and committed to charitable purposes. Third, the Attorney General recognized that there was substantial complexity to taking over the Ingenix benchmarking business lock, stock, and barrel, and doing so in a way that preserved Ingenix’s role in disseminating data releases in a timely manner for use in adjudicating and paying out-of-network claims. So, he recognized that was an important commercial function but nonetheless a commercial function that could be effectively discharged by a mission-driven non-profit.
       
      BA: Looking back on how far FAIR Health has come since its founding in 2009, is it what you had imagined it would be?
       
      SW: It is remarkable how far FAIR Health has come, but I’m not that surprised given the talent that we’ve been lucky to recruit – from president Robin Gelburd and on through the ranks of what has become an extraordinary organization. FAIR Health’s progress is deeply gratifying but it’s a testament to what energetic, well-led, and dedicated people can do.
       
      BA: The FAIR Health Board members are drawn from many different corners of the healthcare industry. How does that impact Board dynamics and deliberations?
       
      SW: FAIR Health has a small but hardworking and diverse Board with individuals who have worked with major health plans, consumer organizations, physician organizations, and hospital systems. We all understand, however, that when we deliberate as a Board our overarching obligation is to promote the mission of FAIR Health. So, we bring our varying perspectives and experiences to the common activity of using our asset – a vast reservoir of claims data – to promote accessibility and transparency in the healthcare arena.
       
      BA: How is the conversation in the healthcare industry changing? What is FAIR Health’s role in this change?
       
      SW: With the enactment of the Affordable Care Act, there are two imperatives in healthcare that must be managed well in order to promote positive change. One is to expand access to care for populations that previously have had to rely on emergency rooms and have been without comprehensive health benefits. The other is to control costs. The risk certainly exists that, as more people gain access to health insurance, our society will spend an even higher percentage of our gross domestic product on healthcare. By contributing objective, reliable data to the national conversation on healthcare spending, FAIR Health informs the dialogue on how to ensure high quality care at an affordable price. FAIR Health will play, I believe, a key role in assisting both industry participants and policymakers to figure out how to price care in ways that depart from the traditional fee-for-service paradigm through episode of care payments, through bundled payments, and other mechanisms that are likely to prove much more effective in delivering quality while controlling cost.
       
      BA: Why is cost transparency so important in the healthcare industry?
       
      SW: There’s virtually universal consensus in the industry that payment has to reward efficiency and quality. FAIR Health’s data repository – its ability to show costs of various care interventions on a micro basis, not just by region but by zip code – will be extraordinarily useful as we seek to match payment to performance. FAIR Health’s neutrality and agnostic posture afford access for all healthcare stakeholders – from consumers to providers to payors – to data that are free from any bias, thus fostering informed public debate and innovation.
       
      Read Stephen Warnke's bio here.
       
    • 6 Ways to Negotiate Lower Doctor Bills
      January 17, 2013
      Forbes.com
      For the past couple of years, I’ve been putting off getting a bone-density scan, despite my doctor’s urgings. I have made efforts to bolster my bones (vitamin D, calcium, strength-training exercises) and haven’t broken any since my last scan six years ago, so I figured I didn’t need a new test. And I’ve been hesitant for another reason: Money.
       
      Read full article here

       


      2012
      December
    • Q&A: Options For Patients Who Get Out-Of-Network Care
      December 26, 2012
      Kaiser Health News
      Consumer columnist Michelle Andrews answers a reader's question about handling an out-of-network bill from a provider the patient didn't choose.
       
      Watch the segment here.
       
    • Consumer - Driven Health Plans and the Growing Role for Agents
      December 4, 2012
      Health Insurance Underwriter

      View on pages 18-21 here.


    • November
    • A Call For Clarity In Health Care: The FAIR Health NPIC Database
      November 29, 2012
      Health Affairs Blog
      By all accounts, health care in America has been ailing for several decades. Americans have struggled with acquiring and maintaining adequate health insurance as costs have steadily increased. While the increased insurance coverage provided under the Affordable Care Act (ACA) will help individuals access and pay for health care services, the ACA’s impact on cost, which will be shifted but not eliminated, seems likely to be less substantial. Developing new approaches to rein in spending and improve the value of care delivery remains a critical challenge for all of the diverse players in the health care arena.
       
      Read the full post here.
       
      Robin Gelburd, A Call For Clarity In Health Care: The FAIR Health NPIC Database, Health Affairs Blog, November 28, 2012. http://healthaffairs.org/blog/2012/11/28/a-call-for-clarity-in-health-care-the-fair-health-npic-database/print/. Copyright ©2010Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.
       
    • 10 Ways to Save at the Dentist
      November 12, 2012
      Shine from Yahoo!
      Dreading a trip to the dentist? While it's not the most exciting place to visit, our number one reason for skipping dental care, is actually cost - whether you're insured or not - according to the American Dental Association. For example, average out-of-pocket expenses for a simple filling, according to the Consumer Reports National Research Center, is $141 dollars for those with insurance and double for those without.
       
      Here are ten ways you can lower your dental costs, saving hundred of dollars a year on procedures.
       
      Bartering
      Many freelancers and small business owners have scored free dental care by offering a service or product of equal or greater value to their dentist. For example, at the annual O+ Festival in Kingston, New York, artists and medical professionals exchange the art of medicine for the medicine of art.
       
      Patients shouldn't be shy about asking a dentist to barter. In addition to artwork, you may be able to convince your dentist to swap services for big-ticket appliances, remodeling work or website development - all ways to help them with their business.
       
      Read full article here.
       

    • October
    • Healthcare Price Lists: A Short (but Useful) Guide
      October 16, 2012
      WiseBread.com
      Consumers are taking on more and more responsibility for controlling their own healthcare costs. Many people have high-deductible health plans or consumer-directed health plans that come with high deductibles and high out-of-pocket expense caps, ranging from $1,250 (self-only) to $12,500 (family) in 2013. (See also: The Types of Insurance Plans)
       
      According to a survey by the Kaiser Family Foundation and the Health Education Research Trust, 19% of people with employer-sponsored plans have an HDHP with a savings option (HDHP/SO). That percentage is expected to grow as more employers shift to these plans or expand offerings to include them in benefit packages. You may be one of those people, or you may want to control expenses even if you are not directly responsible for paying medical bills.
       
      See the full article here.
       
    • Measuring the Cost of 'free'
      October 1, 2012
      Employee Benefit News
      Although eight new prevention-related health care services for women included in the Patient Protection and Affordable Care Act are now available at no cost to female patients, insurance brokers and industry experts are left wondering about the real price tag.
       
      Tanya Boyd, owner of Sunnyvale, Texas-based Tanya Boyd & Associates, believes the Department of Health and Human Services and the Obama administration should not tout the word "free" when talking about health care coverage. "It is completely misleading," she says.
       
      Free is more of a fallacy and should be replaced with the more appropriate word "covered," when talking about health care services covered for women, adds Reid Rasmussen, owner of McKinney, Texas-based Benefit Brainstorm. "While many call these 'free' services, there is still a cost that's being shared by Americans who are buying insurance," he says.
       
      Read the full article here.
       

    • August
    • Special Report: Why a Hospital Bill Costs What It Costs
      August 24, 2012
      RD.com
      While the value of a house is based on an assessment, and the cost for an antique is determined by an appraisal, a full explanation of medical costs is hard to come by. After we asked 18 health-industry sources, we learned that no one seems to know the whole story. But one point was clear: Paying attention to the billing process may save you money.
       
      Here, four eye-opening facts about medical bills—and how to use that knowledge to save money on your health care.
       
      Read full article here.
       
    • FAIR Health database of claims opens to researchers
      August 8, 2012
      American Medical News
      The health insurance claims database created as part of settlements between the New York State Attorney General’s Office and major health insurers in 2009 now is accessible to academic researchers, opening a new window into the way privately insured people use health care.
       
      FAIR Health Inc., a nonprofit entity created as part of an agreement between the largest health insurance companies and the office of then-Attorney General Andrew Cuomo, opened up its database for academic research with a new set of research-friendly tools announced July 17.
       
      See full article here.
       
    • Their Cost = Our Information
      August 6, 2012
      Democrat and Chronicle
      FAIR Health is a web resource that aims to provide information about how much you can expect to pay for health care. It provides price information, but doesn’t get at cost — the amount the hospital, doctor or other provider racks up in delivering the care you are paying for. Your price and their cost are not the same.
       
      Yet, we hear ad nauseum about bending the cost curve. But it’s more like the price curve. We can’t bend the cost curve until we know the cost. Yuri Geller didn’t bend a spoon in your kitchen drawer. It had to be in front of him for that trick to work.
       
      Read full article here.
       
    • Robin Gelburd's interview with Global HR News
      August 2, 2012
      GlobalBusinessNews.net

      Listen to Robin's interview here.


    • July
    • Cost Transparency Becomes Critical
      July 19, 2012
      Managed Healthcare Executive
      The stars may be aligning to shine a light on a need for healthcare cost transparency. The Patient Protection and Affordable Care Act (PPACA), health insurance exchanges and a trend toward higher-deductible plans all depend, to some degree, on consumers being able to compare healthcare costs.
       
      “Our healthcare system has always been unusual in that consumers have not had the resources to understand the cost of the services they receive, yet typically are asked to finance at least some part of that care,” says Robin Gelburd, president of FAIR Health, Inc., which provides healthcare charge information. “While making the decision to seek medical care is clearly different from most other purchasing decisions, it is not reasonable to suggest that cost should play no role in such decisions.”
       
      The number of employers offering various forms of high-deductible health plans has increased, and is expected to continue to do so, which ties healthcare spending decisions more directly to costs. Gelburd says the trend toward high-deductible and higher co-pay plans will make consumers take more interest in the cost of care they receive.
       
      Read full article here.
       

    • June
    • Decoding Your Medical Bill
      June 28, 2012
      NYTimes.com
      This week’s Your Money column looks at how difficult it’s become for consumers to figure out how much they actually owe on their medical bills, and what the charges are based on to begin with.
       
      I spoke with Jean Poole, a medical billing advocate, who talked about the 96 hours of detective work that was involved in untangling a 68-year-old man’s medical bills after a long hospital stay — and he was insured. Ultimately, she was able to uncover more than $22,000 in charges that he did not owe.
       
      It’s hard to shop around for good medical care because there’s so little pricing information available.  President Obama’s Affordable Care Act, the health care overhaul law passed in 2010, tries to make some improvements (though the Supreme Court is expected to rule whether all or some of the law is constitutional this month).
       
      But while the law’s changes help you shop around for insurance policies — specifically through its new one-stop-shop HealthCare.gov Web site, which lists all of your insurance options in one place — it’s still too soon to tell how effective the law will be for anyone comparing medical services.
       
      Read full article here.
       
    • That CT scan costs how much?
      June 8, 2012
      ConsumerReports.org
      If gas stations worked like health care, you wouldn’t find out until the pump switched off whether you paid $3 or $30 a gallon. If clothes shopping worked like health care, you might pay $80 for a pair of jeans at your local boutique and $400 for the identical pair at the nearest department store—and the clothes wouldn’t have price tags on them.
       
      “Why can’t you or I as a consumer ask what it’s going to cost and be met with something other than a blank stare?” asks Will Fox, a principal with Milliman, a national health actuarial consulting firm. The answer, he says, is that neither providers nor health insurers really want consumers to have that information.
       
      Read full article here.
       
    • Transparency crucial to empowering health care consumers
      June 1, 2012
      BryceWilliams.wordpress.com
      Knowledge is power — the power to think, to act, to buy, or even to not do any of the above. Our nation’s health insurers and health care providers need to figure out how to put power back into the hands of consumers. Consumers today have too many constraints when it comes to accessing decision-critical information about the cost of health care. That’s a hard pill to swallow when there’s so much at stake.
       
      A recent post on The Health Care Blog featured a fascinating yet not unsurprising finding: The cost for appendectomies can vary by more than $100,000 between health plans and hospitals.
       
      Dr. Renee Hsia of UCSF was asked what appendectomies cost by a friend who had to pony up over $50,000 in co-pays for one. Dr. Hsia’s research, which looked at pricing variability across the state of California and was published in the Archives of Internal Medicine,  found that an appendectomy could run from $1,529 to $182,955 — varying as much as $7,504 to $171,696 within one hospital.
       
      Read the full article here
       

    • May
    • The Patient as Customer
      May 25, 2012
      Charlotte Observer
      When buying a new car or TV, most consumers shop around and compare prices.  But when it comes to medical care, cost is often an afterthought.
       
      “People have a tendency to put more thought into buying a pair of jeans than they do about getting the right knee replacement,” said Jarvis Leigh, a vice president with Aetna insurance company.
       
      Part of the reason is that most people have health insurance, provided by an employer or the federal government, that covers most of their medical bills. As more people are uninsured and as patients with insurance face higher deductibles and co-pays, there is a greater incentive to find out the cost in advance of treatment.
       
      Read full article here.
       

    • April
    • Insurers Alter Cost Formula, and Patients Pay More
      April 23, 2012
      NewYorkTimes.com
      Despite a landmark settlement that was expected to increase coverage for out-of-network care, the nation’s largest health insurers have been switching to a new payment method that in most cases significantly increases the cost to the patient.
       
      The settlement, reached in 2009, followed New York State’s accusation that the companies  manipulated data they used to price such care, shortchanging the nation’s patients by hundreds of millions of dollars. 
       
      The agreement required the companies to finance an objective database of doctors’ fees that patients and insurers nationally could rely on. Gov. Andrew M. Cuomo, then the attorney general, said it would increase reimbursements by as much as 28 percent. 
       
      It has not turned out that way. Though the settlement required the companies to underwrite the new database with $95 million, it did not obligate them to use it. So by the time the database was finally up and running last year, the same companies, across the country, were rapidly shifting to another calculation method, based on Medicare rates, that usually reduces reimbursement substantially.  
       
      “It’s deplorable,” said Chad Glaser, a sales manager for a seafood company near Buffalo, who learned that he was facing hundreds of dollars more in out-of-pocket costs for his son’s checkups with a specialist who had performed a lifesaving liver transplant. “I could get balance-billed hundreds of thousands of dollars, and I have no protection.”

      Read full article here.
       
    • Out-of-Network Costs up As insurers Tie Payment to Medicare
      April 19, 2012
      USA Today
      When Sharon Smith chose an out-of-network specialist to perform a complicated jaw surgery on her teenage son last May, she knew it would cost her more. But she was not expecting $15,000.  Consumers have long complained about the cost of going outside their health plan's network, but Smith encountered a new twist: A growing number of insurers have changed the way they calculate reimbursements to shift more of the expense to patients.
       
      Read full article here.
       
    • Health Insurance Navigator
      April 19, 2012
      Web MD Blog
      In 2011, nearly 30 million Americans were enrolled in a high-deductible health plan with at least a $1,000 deductible for individuals and $2,000 for families, according to the Employee Benefit Research Institute. That’s almost double the number of people who had this type of coverage just six years ago.
       
      Read full article here.
       
    • Healthcare Pricing Still a Struggle for Consumers
      April 19, 2012
      LATimes.com
      Californians are still struggling to get straight answers about the cost of common medical procedures despite state efforts aimed at lifting the veil on medical pricing.
       
      As consumers shoulder a larger share of their healthcare costs, the ability to comparison shop is key to keeping that care affordable. Medical costs borne by U.S. employees have more than doubled since 2002 to more than $8,000 a year, while the median household income has dropped 4%.
       
      Read full article here.
       
    • Out-Of Network Care is Expensive But a Couple of New Options Help
      April 19, 2012
      KaiserHealthNews.org
      Financially, it's always been risky to get health care from a hospital or doctor that's outside your health plan's network. Without the protection of guaranteed rates negotiated by your health plan, you may end up owing much more, including any billed amounts not paid by your plan. Out-of-network cost sharing is usually higher, too.
       
      Read full article here.
       
    • Smart Shopping Can Relieve Pain From Dentists Charges
      April 19, 2012
      KaiserHealthNews.org
      If you need dental work, chances are you’ll pay a big chunk of the bill out of your own pocket, even if you have dental insurance. Dental coverage often maxes out at just a few thousand dollars a year or less and typically covers only half of the cost of major procedures like crowns and root canals.
       
      Read full article here.
       
    • Health Care Website Compares Medicare to ‘Usual’ Rates
      April 2, 2012
      BuffaloNews.com
      The independent nonprofit health care pricing service, created two years ago by then-Attorney General Andrew M. Cuomo after a probe of health insurance practices, has added a new service allowing consumers to compare Medicare fees to “usual-and-customary” rates.
       
      New York-based Fair Health said it has launched a free, Web-based tool that offers a side-by-side comparison of the two common types of health insurance reimbursement. That tool, FH Medicare Compare, is designed to give consumers a better understanding of their out-of-pocket medical costs, so they can make more informed decisions about their care. It’s now available at the Fair Health consumer website, at www.fairhealthconsumer.org
       
      Read full article here.
       

    • January
    • Tips for keeping dental care costs down
      January 21, 2012
      ConsumerReports.org
      The biggest reason for delaying dental care is cost, according to our new survey that asked readers to describe the dental health and cosmetic treatments they received in the last five years.  

      Read full article here.

    • Managing a Deductible
      January 19, 2012
      Wall Street Journal
      As the end of open-enrollment season approaches, many Americans with workplace health insurance are facing the likelihood of bigger deductibles next year. 

      Read full article here.

    • WISH-TV (CBS) – Indianapolis - TV News Spot
      January 18, 2012
      WISH TV
      Healthcare Costs: Way to Take Control of Your Money
      Air date:  January 11, 2012

      Click here: WISH TV


      2011
      December
    • Window to the Marketplace
      December 9, 2011
      Managed Healthcare Executive
      What was referred to as a "black box" in February 2008 today has become an open window to the healthcare marketplace. The industry's privately owned database of usual-and-customary (UC) charge information is now a transparent, public information source called FAIR Health.
       
      Read full article here.
       

    • August
    • Happy 65th Birthday: What Now?
      August 28, 2011
      New York State Bar Association Journal
      Individuals age 65 or older are eligible to apply for and receive Medicare benefits. To understand how Medicare will affect you, you need to understand the various components of the Medicare program.  

      Read full article here.
       
      Reprinted with permission from: New York State Bar Association Journal, July/August 2011, Vol. 83, No. 6, published by the New York State Bar Association, One Elk Street, Albany, NY 12207.
       
    • Health care costs estimates on Web
      August 4, 2011
      PittsburghPost-Gazette.com
      A nonprofit consumer group has launched a website to help patients get cost estimates for several medical procedures, as well as estimates of what they can expect insurers to reimburse for out-of-network care.

      Read full article here.

    • Radio Interview with FAIR Health President Robin Gelburd
      August 4, 2011
      KDKA 1020AM, Pittsburgh PA

      Listen to full interview here.

    • Website shows cost of dental services to patients, insurers
      August 3, 2011
      ADA News
      A website is available that helps patients and insurance companies estimate how much dental services will cost.
       
      Read full article here.
       
    • Online tool to help consumers estimate medical costs
      August 3, 2011
      amednews.com
      The FAIR Health online medical cost lookup tool established as part of multiple insurers' settlements with former New York Attorney General Andrew Cuomo is set to launch in August.  

      Read full article here.


    • July
    • The Age of Consumerism: FAIR Health to provide average procedure costs
      July 1, 2011
      Colorado Medicine
      Beginning this summer, patients will be able to look up average physician charges for procedures by zip codes.
       
      Read full article here.
       

    • May
    • Understanding Out-of-Network Costs
      May 19, 2011
      AARP New York, May 6, 2011
      New Yorkers who are confused or unaware of out-of-network health care costs now have somewhere to go for help: FAIR Health.
       
      Read full article here.
       

    • April
    • Price check on health care
      April 11, 2011
      Albany Times Union
      Consumers now have access to database that includes average cost of health care services in America.
       
      In the Capital Region, a basic root canal costs about $800 and a simple tooth extraction costs about $175. Until this month, the typical patient didn't know that.
       
      Read full article here.
       
    • FAIR Health Inc. to offer health cost clarity
      April 11, 2011
      Rochester Democrat & Chronicle
      A new nonprofit health company with upstate roots is offering consumers a rare window into how health costs are determined, how they differ from region to region and what methodologies are used to set them.
       
      Read full article here.
       
    • Site helps consumers predict out-of-network health costs
      April 7, 2011
      Buffalo News
      Consumers in New York State and nationwide have a new ally to help predict how much they will have to pay for medical and dental care outside their insurers' approved providers.  They can now go to www.fairhealthconsumer.org to find out how much a dental service or procedure typically costs in their ZIP code, how much is typically covered by insurance plans, and how much they'll have to pay themselves -- all before they even go to the dentist.
       
      Read full article here.
       
    • Increased Price Transparency in Health Care — Challenges
      April 7, 2011
      The New England Journal of Medicine
      Slowing the growth of health care costs is critical to the long-term fiscal stability of the United States and is the direct or indirect focus of most U.S. health policy initiatives today.  One tactic for reducing spending is to increase price transparency in health care — to publish the prices that providers charge or those that a patient would pay for medical care — with the aim of lowering prices overall.
       
      Read full article here.
       

    • March
    • Consumer Report - Help Navigating the Health Care Labyrinth
      March 2, 2011
      New York Public Radio
      Whatever happens to health care reform, private insurance will continue to play a central role in American health care. And while some 75 percent of Americans with private insurance like their plans, according to one recent survey, hundreds of thousands of frustrated people call insurance regulators every year looking for help. Including me.
       
      Read full article here.
       

    • February
    • FAIR Health Launches Rate-Comparison Products; Hopes to Woo Ingenix Customers
      February 11, 2011
      Health Plan Week
      FAIR Health, Inc. — the not-for-profit entity created in response to questionable rate-setting practices allegedly used by some health insurers in New York — has launched its first two benchmark data products, HPW has learned. But while the 16-month-old public entity has been able to meet aggressive product-development timelines, its biggest challenge likely will be credibility, industry observers tell HPW. Moreover, some health plans and employers have already found alternatives for determining rates for out-of-network providers.

      Read full article here.
       

    • January
    • New Database For Out-of-Network Claims Coming Soon
      January 26, 2011
      American Medical News
      Physicians are likely to know by this summer how their out-of-network pay will be affected by the organization that was designed to replace UnitedHealth Group-owned Ingenix as the arbiter of "usual, customary and reasonable" payment rates.
       
      The new FAIR Health database, created under agreements with the New York attorney general's office, is set to launch by late January. Payments based on the new figures could be sent to physicians by the summer. In late March, the office plans to unveil a consumer site that will publish typical charges for a given service.
       
      Read full article here.
       

      2010
      July
    • If You Build It, Will They Come? New UCR Database to Be Operational in Early 2011
      July 1, 2010
      Health Plan Week
      A rule that will require health insurers to maintain a medical loss ratio (MLR) of 80% for their individual and small-group products already has caused some health plans to restructure they way they pay brokers and agents. Other insurers have decided to scale back or exit the individual market. One health plan has said it will close its doors at the end of the year due in large part to the new rule, according to interviews and documents obtained by HPW. Other regulations, such as the exclusion of lifetime and annual benefit limits, also could have a negative impact on the individual and small-group markets.

      Read full article here.
       

      2009
      October
    • New Database to Help Set Payouts by Health Insurers
      October 28, 2009
      The New York Times
      Andrew M. Cuomo, the New