Danilo Manimtim and his wife Marilou both had cataract surgery in Fresno, California in late 2021 and early 2022, respectively. Manimtim, a retired orthopedic surgeon, calculated that since he had met his deductible, his cost-sharing would amount to about $750. He sought care at an outpatient department of a local hospital. As I’ve often said, if you are physically capable of walking, never, ever seek any kind of care at a hospital. Manimtim failed to realize that his health plan, the California Public Employees’ Retirement System (CalPERS) health plan, uses an innovative system known as reference pricing. Anthem Blue Cross managed the plan for CalPERS.
Category: Devon Herrick
Have a Chronic Disease? There’s a Smartphone App for That
An article in the San Francisco Chronical that was republished in Kaiser Heath News looked at tech firms that monitor chronic conditions remotely. The firms offer both digital or human health coaches to help patients better manage their care. There are approximately 50 different firms designed to help patients adhere to treatment programs or deal with chronic conditions.
Doctors Hate Insurance Companies Meddling with Patient Care
A survey found that nearly 90% of doctors believe barriers erected by health insurance plans have negatively impacted patient care. The survey also found that doctors are so fed up that two-thirds would not recommend a career in medicine while nearly half (48%) are considering leaving medicine for another career. The survey was 600 physicians with practices in primary care.
FTC to Fight Drug Rebates and Fees that Reduce Competition
On June 16, 2022 the U.S. Federal Trade Commission (FTC) issued a policy statement on drug rebates and fees paid by drug makers. The rebates and fee are paid to Pharmacy Benefit Managers (PBMs) sometimes in return for excluding cheaper alternatives on a drug plan formulary. The way it works is a drug maker will jack up the price of a given drug (like insulin) but give a steep discount to the PBM in return for guarantees that the plan will not include generic versions that cost far lesson the formulary.