Axios Vitals: Out-of-network problems

Plus, America's lackluster booster rollout | Tuesday, November 16, 2021

Open in app View in browser   Presented By UnitedHealth Group   Axios Vitals By Tina Reed ·Nov 16, 2021 Good morning, Vitals readers. Today's newsletter is 842 words or a 3-minute read.     1 big thing: Out-of-network bills Cindy Beckwith has undergone two open-heart surgeries and continues chemotherapy treatments. Photo: Cindy Beckwith   Cindy Beckwith has learned to live with two things that aren't going away soon: a rare cancer and medical bills stemming from the out-of-network care it required, Axios' Bob Herman writes. Why it matters: People who have health insurance but get sick with rare diseases that require out-of-network care face potentially unlimited costs. Details: Beckwith, 57, of Bolton, Connecticut, was diagnosed with pulmonary artery sarcoma, a rare tumor on a main artery. She also has fibromuscular dysplasia, a rare blood vessel condition. She has ConnectiCare health insurance, which she gets through her husband's employer. Her local doctors suggested she see specialists at the University of Pennsylvania Health System because her conditions were so uncommon, but the system was out-of-network. The bill showed charges of $270,000, just for services received in 2019. Beckwith and the hospital settled on $20,138.40. Penn Medicine "insisted" she pay a minimum of $441 per month until 2023, she said. Beckwith and her husband have already paid more than $11,000. The big picture: Federal regulations cap how much people pay out of pocket for in-network care, but no such limit exists for out-of-network care. The other side: A ConnectiCare spokesperson said the insurer does "not speak about our members' private health information." A Penn Medicine spokesperson said in a statement the system "has a longstanding commitment to work with patients to help them understand the costs associated with their care, including out-of-pocket costs." The resolution: After Axios submitted a HIPAA authorization waiver, signed by Beckwith, Penn Medicine called her to say they'd knocked $4,000 off her remaining balance. This is part of Axios' new series, Billed and Confused. Have you been hit with an unexpected medical bill? Maybe the experience left you feeling puzzled or upset? Email bob@axios.com, so we can dig into what's happening.     2. America's lackluster booster rollout Illustration: Maura Losch/Axios   The Biden administration is expected to begin the process of expanding the booster authorization to all adults as early as this week, according to a source familiar with internal planning, Axios' Caitlin Owens writes. Why it matters: America's booster campaign got off to an underwhelming start, potentially leaving millions of vulnerable people at risk as the holidays approach. The big picture: The pandemic still isn't over, and the data is clear that vaccine effectiveness has waned over time and with the rise of Delta — but also that a booster dose restores protection against the virus to remarkable levels. "As every month goes by, the immunity wanes more and more. So as time goes by, you're going to see more vaccinated people" becoming more vulnerable to the virus, NIAID director Anthony Fauci told Axios. Between the lines: Despite disagreement among experts about exactly who needs a booster, there's broad consensus that older people and at least some with underlying health conditions should get an additional dose around six months after their first series. State of play: The Biden administration's original plan was to recommend most adults get a booster eight months after their initial round. However, the FDA and CDC ultimately recommended the shots for more limited groups. But some cities and states have made boosters available to all adults. What we're watching: If eligibility is expanded nationwide — and thus simplified — booster uptake could increase. "In my opinion boosters are ultimately going to become a part of the standard regimen and not just a bonus," Fauci said.     3. Pfizer agrees to share recipe for COVID-19 pill Photo illustration: Pavlo Gonchar/SOPA Images/LightRocket via Getty Images   Pfizer has agreed to a licensing deal with the U.N.'s Medicines Patent Pool for its COVID-19 pill — roughly a month after Merck said it licensed its COVID pill with the MPP, Bob writes. Why it matters: These antiviral pills showed promising results in reducing the severity of infection and preventing death among the unvaccinated. Pfizer's licensing agreement, combined with Merck's, will allow generic drug companies to cheaply produce the pills for more than 100 low- and middle-income countries. Details: Pfizer's agreement will cover 95 countries. Merck's agreement covered 105. "Pfizer will not receive royalties on sales in low-income countries and will further waive royalties on sales in all countries covered by the agreement" until the World Health Organization no longer classifies the pandemic as a "public health emergency," Pfizer said in a press release. Yes, but: While antivirals are considered to be a major tool to end the pandemic, vaccines remain the most effective way to prevent serious illness and death.     A message from UnitedHealth Group Health care's $320 billion opportunity     The U.S. health system could save $320 billion over the next decade by treating common conditions in a primary care setting instead of the emergency department. See how UnitedHealth Group is helping people access high-quality, affordable health care that meets their unique needs.     4. 1 big number 70%: That's how many U.S. adults are concerned about another pandemic happening in their lifetime, a poll released this morning by intelligence company Morning Consult found. Just under half (47%) think the country will be prepared to handle the public health impact of another health crisis like COVID-19, according to the poll of 2,200 adults taken between Nov. 3 and Nov. 5.     5. Catch up quick In a sudden move, Al Sandrock, the man behind Biogen's Aduhelm, to retire. (STAT+) California orders Amazon to pay $500,000 over concealed COVID cases claim. (Axios) FDA updates COVID-19 test policies. (Associated Press) Bird flu outbreaks reported in Europe and Asia. (Axios) A second HIV patient may have been "cured" of infection without stem cell treatment, in extremely rare case. (CNN)     A message from UnitedHealth Group Helping older Americans access care at home     UnitedHealth Group is working to expand access to convenient, high-quality, home-based care for seniors. See how we're helping to close gaps in care by providing more than 1.7 million seniors access to free, in-home primary care this year.   Like this email style and format? Learn more about Axios HQ. It'll help you deliver employee communications more effectively.   Axios thanks our partners for supporting our newsletters. If you're interested in advertising, learn more here. Sponsorship has no influence on editorial content. Axios, 3100 Clarendon B‌lvd, Suite 1300, Arlington VA 22201   You received this email because you signed up for newsletters from Axios. Change your preferences or unsubscribe here.   Was this email forwarded to you? Sign up now to get Axios in your inbox.   Follow Axios on social media: