Patient and Consumer Protections

Prior Authorization

NEW & NOTEWORTHY

TrumpRx: What’s the Value for Customers?

In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.

Claims Denials and Appeals in ACA Marketplace Plans in 2024

This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.

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  • No Surprises Act Implementation: What to Expect in 2022

    Issue Brief

    The “No Surprises Act,” which establishes new federal protections against most surprise out-of-network medical bills when a patient receives out-of-network services during an emergency visit or from a provider at an in-network hospital without advance notice, will take effect next month. A new KFF brief outlines what to expect in 2022.

  • Few Adults Are Aware of Hospital Price Transparency Requirements

    Issue Brief

    This data note for the Peterson-KFF Health System Tracker shows that few Americans realize that starting this year hospitals are required to post prices of common health services on their websites in a format patients can access and use.

  • Ground Ambulance Rides and Potential for Surprise Billing

    Issue Brief

    This analysis for the Peterson-KFF Health System Tracker finds that half of emergency ground ambulance rides result in an out-of-network charge for people with private health insurance, potentially leaving patients at risk of getting a surprise bill.

  • COVID-19 Test Prices and Payment Policy

    Issue Brief

    This analysis examines list prices for COVID-19 testing at the largest hospitals in every state and finds they range widely from $20 to $850. Federal law now requires private insurers to cover COVID-19 tests at no cost to the patient and provides funding for people without health insurance.