By Julie Appleby, Kaiser Health News
Marcia Perez of Palo Alto may live 2,000 miles Nancy Pippenger in Indiana, but the two women have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.
“To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”
“They said, ‘We take the old plan, but not the new one,’” says Perez, who is an attorney in Palo Alto.
In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.
Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions across the country start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect. Continue reading
An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. Incidents such as these have raised the issue of how well law enforcement officers are trained to deal with people with severe mental illness. (Diane Block/KQED)
By Stephanie O’Neill
Debbie is a Ventura County mother of a 23-year-old son diagnosed with bipolar disorder. At times his condition becomes so severe that he gets delusional and requires hospitalization.
“They weren’t threatening; they didn’t scare him. It stayed really, really calm.”
“He doesn’t understand that he’s ill and that he needs help,” Debbie says. “He thinks he’s fine.”
Debbie, who asked that her last name be withheld for privacy reasons, says when that happens, she calls the sheriff’s department for help — as she did earlier this year. Their response, she says, was heartening.
“The police officers … were so great, because they kept telling him, ‘You’re not in trouble, we’re here to help you,’ ” she says. “So they weren’t threatening; they didn’t scare him. It stayed really, really calm.” Continue reading
Back MRI costs vary widely, even within the same city. (Cory Doctorow/Flickr)
In June, KQED launched PriceCheck, our crowdsourcing project on health costs. We’re working in collaboration with KPCC, public media in Los Angeles, and ClearHealthCosts.com, a New York City startup looking at health costs.
Just in San Francisco, back MRIs range in price from $575 to $6,221.
We’re asking you, the members of our community, to share what you’ve paid. We started with mammograms. We have both cash or “self-pay” prices in our database. We also have crowdsourced prices. The range we’ve found, even in close geographic areas, is startling.
Here’s one example: ClearHealthCosts collected self-pay prices at various centers in the Bay Area and Southern California. If a woman walks into the NorCal Imaging Center in Walnut Creek, a screening mammogram will cost her $125, if she pays out of pocket. Continue reading
Screenshot from CoveredCA.com, the website of Covered California.
Former foster youth lined up at Covered California’s last board meeting to complain about the hoops they have to jump through to enroll in Medi-Cal, the state’s health plan for the poor.
“Navigating adulthood is challenging enough, let alone trying to find insurance to cover your medical needs,” said Vanessa Hernandez, who spent 14 years in foster care. She says her younger brother tried twice to sign up online before he gave up.
“Currently the process is very unclear, it’s hard to navigate, and it’s not very accessible,” she said. Continue reading
The San Francisco Board of Supervisors approved a November ballot measure to tax soda and sugary drinks Tuesday afternoon, but not with the unanimous vote they were looking for.
If passed by a two-thirds majority of San Francisco voters, the new legislation will tax soda and other sugar-sweetened beverages at two cents per ounce and direct the revenue to the city’s public health and recreation and parks departments and the school district.
The board voted 6-4 this afternoon to place the initiative by supervisors Scott Wiener and Eric Mar before voters, with supervisors Jane Kim, Katy Tang, Norman Yee and London Breed voting against it. Continue reading
By April Laissle
California is well behind almost every other state when it comes to caring for its kids, according to an annual report from the Annie E. Casey Foundation and its Oakland-based partner, Children Now.
The report looks at four indicators of children’s well-being: family stability, economic stability, health, and education. This year, California inched up one spot to 40th overall, but ranked 26th in the health category.
Some of that progress is due to the expansion of health insurance under the Affordable Care Act, though advocates say there is still work to be done.
“We have increased the number of children now that are on Medi-Cal,” said Jessica Mindnich, research director at Children Now. “But do these kids actually have access to doctors and to dentists? Are they able to get in in a timely manner?” Continue reading
Aerial view of the California Health Care Facility in Stockton. (Photo: California Department of Correction and Rehabilitation)
By Julie Small
The federal receiver who manages medical care in California prisons reopened admissions Monday at a Stockton facility for the state’s sickest inmates. The receiver’s decision ends a temporary court-ordered suspension at Stockton’s California Health Care Facility.
“We are going to slowly begin admitting medical patients.”
In early 2014 the federal overseer of medical care in California prisons suspended all transfers to the $800 million prison medical complex because of unsanitary conditions. Receiver Clark Kelso found doctors and nurses at the facility lacked essential supplies, such as bandages and catheters for incontinent inmates. He also found that staff was too small to provide around-the-clock care to the hundreds of inmates at the prison with complex medical conditions.
Spokeswoman Joyce Hayhoe said Monday that after a series of improvements, the Stockton prison may accept inmates again. Continue reading
Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)
One month, three months, even five months.
That’s how long some Northern California Kaiser patients wait to see an individual therapist — according to many Kaiser patients and therapists.
KQED’s Jon Brooks has reported extensively on this issue over the last two months. He talked to close to two dozen therapists and patients who said that they were experiencing long wait times. One therapist whose specialty is geriatric care told him that she had written to her superiors saying, “I can’t tell a patient that has six months to live that I’ll see them in five months.” Continue reading
By David Gorn, California Healthline
State officials on Friday said they have not determined whether or not to offer applied behavior analysis (ABA therapy) as a Medi-Cal benefit to children with autism.
Federal officials earlier this month issued guidance on the subject, saying it is covered for Medicaid beneficiaries under age 21 as part of the Early and Periodic Screening, Diagnosis and Treatment program.
“Under the Medicaid state plan, services to address [autism spectrum disorder] may be covered under several different … benefit categories,” the CMS guidance said. For children, it said, “states must cover services that could otherwise be covered at state option under these categories consistent with the provisions … for Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). Continue reading
By Lynne Shallcross
We are wrapping up the first phase of our PriceCheck project. The goal is to shine a light on costs of common health care procedures in California. We’re starting with screening mammograms, and already we’ve found that the cash price (for people who are uninsured or have gone out of network) varies from a low of $60 at the H. Claude Hudson Comprehensive Health Center in Los Angeles, a county-run clinic, to $801 at U.C. San Francisco on the high end.
Together with KPCC in Los Angeles and ClearHealthCosts.com, we’re also asking you, the members of our community, to share what you’ve been charged — and what your provider has been paid — for common health procedures.
In order to do that, you need to get familiar with your insurance company’s “explanation of benefits” or EOB. That’s the form your insurer sends to explain what was paid, to whom, at what level and why.
Here’s a typical EOB, that we’ve marked with some explanations below:
An explanation of benefits from Anthem Blue Cross.