Focus

Insurance Focused on Virtual Visits? The Pros and Cons of a New Twist in Health Plans

At the height of the covid-19 pandemic, people often relied on telemedicine for doctor visits. Now, insurers are betting that some patients liked it enough to embrace new types of health coverage that encourages video visits — or outright insists on them. Priority Health in Michigan, for example, offers coverage requiring online visits first for nonemergency primary care. Harvard Pilgrim Health...

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PMH Isn’t Code-able – A Cautionary Tale

Before our discussion of the term past medical history (PMH), let’s briefly reflect on the risk adjusted payment paradigm, or MRA as it’s known in Medicare Advantage circles. CMS bases the bulk of the capitation payment made to MA plans on the health status of the patient, as reflected by the conditions reported by a healthcare provider. CMS guidelines state that the ICD-10-CM codes for these...

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The Director of Florida’s Program for Brain Damaged Infants Has Resigned

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox. Series: Birth Rights - Investigating Florida’s NICA Program On the eve of what was expected to be a contentious board of directors meeting, the head of Florida’s compensation program for brain-damaged children abruptly resigned. Kenney Shipley, who...

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Telemedicine Abortions Offer Cheaper Options but May Also Undermine Critical Clinics

Allison Hansen had just gone through a breakup with her boyfriend last year when she discovered she was pregnant. She already had an 8-year-old son and did not want another child. Hansen called the Planned Parenthood facility near her home in Savannah, Georgia, to inquire about abortion services and was told the procedure would cost $500 and require four to six hours at the clinic. Hansen didn’t...

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Audit Confirms That a Program for Brain-Damaged Kids Arbitrarily Denied Claims and Overspent on Perks

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox. Series: Birth Rights Investigating Florida’s NICA Program Florida’s embattled compensation program for children who suffer brain damage at birth arbitrarily denied claims, failed to adequately describe rights and benefits in a parents’ handbook, and...

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Injuries Mount as Sales Reps for Device Makers Cozy Up to Surgeons, Even in Operating Rooms

Cristina Martinez’s spinal operation in Houston was expected to be routine. But after destabilizing her spine, the surgeon discovered the implant he was ready to put in her back was larger than he wanted to use — and the device company’s sales rep didn’t have a smaller size on hand, according to a report he filed about the operation. Dr. Ra’Kerry Rahman went ahead with the operation, and...

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