the business of health care – Page 2 – watercress words by Dr Aletha

How to Understand, Manage, and Sometimes Fight Medical Bills

In this post I talk about my recent elective surgery and the shockingly high six-figure hospital bill. I offer a KFF Health News article detailing various patients’ exorbitant medical costs, emphasizing the importance of understanding medical bills, insurance coverage limitations, and potential avenues for reducing charges.

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

My Hospital Surgery Bill

Recently, I underwent an elective surgery to treat a painful but not life-threatening condition. It’s been a long time since I needed any type of surgery.

I received a message from the hospital about the projected cost of my procedure and one-night hospital stay. My husband has been in the hospital a few times over the past few years, so I knew to expect a large number. But I still gasped when I saw the 6-figure number following the dollar sign.

Now this is a non-life-saving, one-and-a-half-hour surgery, with a one-night stay in the hospital (sometimes a same-day surgery) that will “cost” my insurance companies and me over 100K! The only thought in my mind was “I’m so glad I have good insurance coverage.”

Of course, that astronomical number is nowhere close to what the insurance will actually pay, but that’s another issue. (see number 7 below) . But it caused me to notice this article from KFF Health News and pass it along to you.

Medical Bills Can Be Vexing and Perplexing. Here’s This Year’s Best Advice for Patients.

Emmarie Huetteman December 23, 2025

A Texas boy’s second dose of the MMRV vaccine cost over $1,400. A Pennsylvania woman’s long-acting birth control cost more than $14,000.

Treatment for a Florida Medicaid enrollee’s heart attack cost nearly $78,000 — about as much as surgery for an uninsured Montana woman’s broken arm.

In 2025, these patients were among the hundreds who asked KFF Health News to investigate their medical bills as part of its “Bill of the Month” series.

Insured and uninsured. Job-based and government-funded. Comprehensive and short-term. Part of a sharing ministry. So many people with different health insurance situations asked the same questions:

Why do I owe so much? And how am I going to afford it?

As millions of Americans grapple with the rising cost of health insurance next year, the “Bill of the Month” series is approaching its eighth anniversary. Our nationwide team of health reporters has analyzed almost $7 million in medical charges, more than $350,000 of that this year.

Of this year’s 12 featured patients, five had their bills mostly or fully forgiven soon after we contacted the provider and insurer for comment.

(You can read the 12 patients’ stories on the KFF website.)

Our mission, though, is to empower every patient with the information needed to understand, manage, and — if push comes to shove — fight their own medical bills. Here are our 10 takeaways from 2025.

1. Most insurance coverage doesn’t start immediately. Many new plans come with waiting periods, so it’s important to maintain continuous coverage until the new plan kicks in.

One exception: If you lose your job-based coverage, you have 60 days to opt into a COBRA policy. Once you pay, the coverage applies retroactively, even for care received while you were temporarily uninsured.

Photo by Andrea Piacquadio on Pexels.com

2. Check out your coverage before you check in. Some plans come with unexpected restrictions, potentially affecting coverage for care ranging from contraception to immunizations and cancer screenings.

Call your insurer — or, for job-based insurance, your human resources department or retiree benefits office — and ask whether there are exclusions for the care you need. Ask specifically about per-day or per-policy-period caps, and what you can expect to owe out-of-pocket.

3. “Covered” does not mean insurance will pay, let alone at in-network rates. Carefully read the fine print on network gap exceptions, prior authorizations, and other insurance approvals. The terms may be limited to certain doctors, services, and dates.

4. Get a cost estimate in writing for nonemergency procedures. If you object to the price, negotiate before undergoing care. And if you’re uninsured and receive a bill that’s $400 or more than the estimate, the federal Centers for Medicare & Medicaid Services has a formal dispute process.

5. Location matters. Prices can vary depending on where a patient receives care and where tests are performed. If you need blood work, ask your doctor to send the requisition to an in-network lab. A doctor’s office connected to a health system, for instance, may send samples to a hospital lab, which can mean higher charges.

using a syringe to obtain blood specimen from an individual — Photo by Pranidchakan Boonrom on Pexels.com

6. When admitted, contact the billing office early. If possible, when you or a loved one has been hospitalized, it can help to speak to a billing representative. Ask whether the patient has been fully admitted or is being kept under observation status, as well as whether the care has been determined to be “medically necessary.”

And while there may be no choice about taking an ambulance, if a transfer to another facility is recommended, you can ask whether the ambulance service is in-network.

7. Ask for a discount. Medical charges are almost always higher than what insurers would pay, because providers expect them to negotiate lower rates. You can, too. If you’re uninsured or underinsured, you may be eligible for a self-pay or charity care discount.

8. There’s help available for Medicaid patients. If you get a bill you don’t think you should owe, file a complaint with your state’s Medicaid program and, if you have one, your managed-care plan. Ask whether there is a caseworker who can advocate on your behalf. A legal aid clinic or consumer protection firm specializing in medical debt can also help file complaints and communicate with providers.

9. Your elected representatives can help, too. While a call from a state or federal lawmaker’s office may not get your bill forgiven, those officials often have an open line of communication with insurance companies, local hospitals, and other major providers — and advocating for you is their job.

10. When all else fails … you can write to “Bill of the Month”!

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House.

Do you have a confusing or outrageous medical bill you want to share? Tell us about it!KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Exploring the HEART of Health

By the way, my surgery and hospital stay went well, and I am recovering nicely.

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Dr. Aletha

Raymond and I on a recent vacation. My surgery should help me continue to enjoy traveling and fun with my family.

Expert Predictions about 2026 Health Policy

In this post I review some 2026 healthcare predictions for likely continuation of partisan gridlock, minimal congressional action, and increased focus on health care affordability amid midterm elections. Key issues to watch include ACA enrollment responses, Medicaid work requirements, rising insurance costs, and the impact of AI on consumer health care navigation.

As we anticipate 2026, here is a look at what the federal government may do with healthcare in the United States.

This is a reprint of an article first published on KFF and shared here by permission.

The author is Drew Altman, President and Chief Executive Officer of KFF, a position he has held for over 30 years, founding the KFF organization in the 1990s. He is a leading expert on national health policy issues and an innovator in health journalism and the nonprofit field.

(Note: I have edited this article for length and readability. I linked to the original content so you can read the full sections. The photos are for illustration and are not affiliated with the original article on KFF. AO)

Health Policy in 2026

from Drew Altman, December 8, 2025

Forecasting the year ahead in health policy is always treacherous because events intervene and screw up even the best predictions. But my working theory is that the sharp partisan divide in Congress, and even sharper disagreement on health care policy, can produce only small-ball actions on health next year.

So, what should you watch for that will really matter for people, policy, and politics?

Voter Reaction to the ACA in the Midterms

First and foremost is the role that health care affordability will play in the midterms. Assuming there is no deal on the enhanced ACA (Affordable Care Act) tax credits, spiking premium payments in the Marketplaces will become the national symbol for voters of concerns about their health care bills.

Democrats will prosecute the issue to the fullest, and Republicans will generally try to shift the subject and fight on other issues. Health care affordability will be in the spotlight, but how important it is as a vote-and-turnout driver remains to be determined.

Photo by Edmond Dantu00e8s on Pexels.com

How ACA Enrollment Might Change

Second, again assuming there’s no deal on the tax credits, we’ll see how enrollees actually respond in the Marketplaces. What share of the 24 million enrollees switch to cheaper high-deductible plans? What is the impact of doing that on their financial security and health-seeking behavior? What happens to older and sicker enrollees who need better, more comprehensive coverage? How many millions choose to be uninsured in 2026 and who are they?

Medicaid Work Requirements

Third, states that have expanded Medicaid will be gearing up for Medicaid work requirements, which kick in in 2027.

Red states may be looking for flexibility to implement the toughest possible requirements and reduce their Medicaid rolls and spending.

Blue states will be looking for nooks and crannies in the law and the rules to lessen the impact in the hopes that Democrats seize control again in 2028 and reverse the requirements.

Having implemented state welfare work requirements myself, I know there is always some ability to shade implementation depending on the goals of a state.

In our case in New Jersey, we had little interest in kicking people off welfare (and into homelessness or deep poverty, which we’d also have to address). We did have a big interest in providing job training, childcare, transportation, and a pathway to jobs.

More Expensive Health Insurance

Fourth, after years of moderate increases, health costs will increase more sharply again. Employer premium increases may not touch double digits but could come close.

The average cost of a family policy for employers could approach $30,000. Cost-sharing and deductibles will likely rise again after plateauing for several years.

Employers and public payers are increasingly skittish about the costs of GLP-1s for weight loss. It’s possible GLP-1s could turn from today’s dilemma to a technology-diffusion success story of sorts. (Glucagon-Like Peptide-1)

Costs are coming down, pills are on the horizon, and payers are developing more sensible guidelines for their initial and long-term use.

In a country where the dam breaks on every effective new medical technology and it’s rapidly disseminated at high costs, GLP-1s could emerge as a more balanced and sensible example of technology diffusion. Like most new medical technologies, it still increases costs.

Drug and Hospital Costs Increase

Fifth, the Trump administration has put pressure on drug prices through a variety of initiatives. Probably the most important is Medicare drug price negotiations, which began in the Biden years, but together they are putting pressure on drug prices.

Still, retail drug spending is only 9% of overall health spending (16% for employers) and there is growing awareness that hospitals gobble up the single largest share of the health care dollar.

Proposals to cap hospital prices or put hospitals on a budget seem to be coming back into fashion again but are non-starters with Republicans in charge, as of course is single payer.

For 2026, we can look generally for greater attention being paid to hospital prices and possibly greater action at the state level, where several states have established hospital cost targets with varying degrees of teeth.

Prior Authorization Review

Sixth, people (and providers) hate prior authorization review. Will the administration’s voluntary effort to work with industry to streamline and pare back prior authorization result in any concrete relief for patients when it kicks in this year?

MAHA and Vaccinations

Seventh, four in 10 Americans say they identify with the MAHA agenda. We’ll learn more in the coming year about which tenets of this loose movement have staying power. (Make America Healthy Again)

Everyone is for exercise and for healthier food for kids (although I do still miss those Hostess Cupcakes and Twinkies that I had as a kid).

But people who have serious illnesses may grow tired of the central MAHA notion that they are personally responsible for disease and may increasingly make the connection between their own need for medical care and cuts in Medicaid and ACA coverage.

President Trump and Secretary Kennedy at the MAHA commission meeting, public domain photo

There is some overlap between MAHA and the anti-vax movement. Another thing to watch: will vaccination rates continue to decline as the administration chips away at universal vaccination and trust in vaccines?

Patients Using AI for Health

Eighth, AI means a lot for physicians, researchers, hospitals, insurance companies, and investors, with profound implications in some areas of medicine, such as radiology. But when will AI start having real meaning for the things people care about most: their costs and their ability to navigate the health system? (AI-Artificial Intelligence)

The implications and practical applications for consumers receive far less attention, as generally does the relatively low level of trust in AI. Possibly, 2026 will be the year when attention shifts more seriously to the consumer side of AI in health.

Conclusion

All told, it will be a big year ahead in health policy. And this list only just scratches the surface. (Others include the CDC, NIH, FDA, and Medicare.)

But there probably won’t be a lot of significant action in Congress. Still, every incremental change is a big fight in health care, and hard won, and in a hyper-partisan Congress, 2026 will be no different.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

How health policies may affect you.

Based on what you know now, how likely are these predictions correct?

Which of these issues are most important to your healthcare?

How will you respond to health policy changes that affect you? What information do you need?

How do you and your family contribute to “making America healthy again”?

Cover Photo

The cover image was created by the AI feature of Jetpack. (affiliate link)

Exploring the HEART of Health

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