Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] The hospital that will remain nameless

One person’s journey through an unhealthy health care system.  Definitely not patient centered. Have had similar insurance problems, mostly because of errors in the insurance company erring in my personal identifiers.

From the 19 February 2015 item  By LISA SUENNEN at The Health Care Blog

Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.

I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly.

And from one of the comments…

William Palmer MD says:

You sound true and authentic to me too. I am embarrassed as to how often we do screw up. The only excuse I think is that we have so much internal and external regulation that we become nervous nellies, unable to relax and enjoy what we are doing. You should go to a Pharmacy and Therapeutics meeting in a hospital and listen to the barrage of complaints from everyone to everyone. Wrong dose, wrong timing, wrong drug, wrong patient. I have walked out of these meetings because of the hostility. We would all do better if we could start some little village clinic in the Congo, without the interminable watching from a thousand eyes.

February 22, 2015 Posted by | health care | , , , , , , , , | Leave a comment

Psychiatrist appointments hard to get, even for insured, study shows — ScienceDaily

Psychiatrist appointments hard to get, even for insured, study shows — ScienceDaily.

Obtaining access to private outpatient psychiatric care in the Boston, Chicago and Houston metropolitan areas is difficult, even for those with private insurance or those willing to pay out of pocket. Researchers, who posed on the phone as patients seeking appointments with individual psychiatrists, encountered numerous obstacles, including unreturned calls, and met with success only 26 percent of the time.

October 17, 2014 Posted by | health care, Psychiatry, Psychology | , , , | Leave a comment

[Report] Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

From the 1 January 2014 report at Health Affairs

Abstract

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power.

This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care.

High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins.

Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates.

Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

 

 

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February 5, 2014 Posted by | health care | , , , , , , | Leave a comment

Health Law Helper – Affordable Care Act Interactive Tool

Health Law Helper – Affordable Care Act Interactive Tool.

From the Consumer Reports Web site

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Related Affordable Care Act (Obamacare) Resources 

Information about the Act (Obamacare)

Other pages at HHS.gov/healthcare (US Dept of Health and Human Services)

  • Live Chat courtesy of  the US Department of Health and Human Services (HHS)
  • Prevention and Wellness with information on how many insurers are required to cover certain preventive services at no cost to you.

October 1, 2013 Posted by | health care | , , , , | 1 Comment

November is Long-Term Care Awareness Month

English: Nursing and Residential Care Home, Wi...

English: Nursing and Residential Care Home, Withington This is Clyde Court, on Lapwing Lane. (Photo credit: Wikipedia)

 

From a recent USA.gov email

 

When planning ahead in these uncertain financial times, it’s important to think about long-term care for yourself and your loved ones. Long-term care (LTC) is a range of services and supports you may need to meet your health or personal needs over a long period of time. These services might include emergency response systems, senior centers, assisted living, nursing homes, transportation services, and many more.

Most long-term care assists people with activities of daily living like dressing, bathing and using the bathroom. Other common long-term care services include helping with housework, cooking, shopping, or even managing money. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. And it’s not just for seniors—if you have a significant health challenge, you may need long-term care at any age.

While there are a variety of ways to pay for long-term care, it is important to think ahead about how you will fund the care you may need. Generally, Medicare doesn’t pay for long-term care, but only for a medically necessary skilled nursing facility or home health care. Long-term care insurance may be an option to help you and your family prepare ahead of time for the potential need for long-term care. There are a variety of plans available that vary in cost depending on what services you want covered and the age you begin coverage. Before you choose a plan you should take into account where and what kind of care you might need.

Be sure to take some time this month to check out your options and plan ahead, so you can rest assured that you and your family get the care you need. And if you’re a caregiver now for a family member with health challenges, find more resources and support from USA.gov.

 

Related resources

 

 

 

November 8, 2012 Posted by | health care | , , , , , , | Leave a comment

Is the Fact that I Am a Woman Considered a Pre-Existing Condition?

 

By MAGGIE MAHAR at the 8 August post at The Health Care Blog

The male body has long been considered the “standard” for health care coverage. Having a woman’s body is seen as an expensive anomaly, and women pay dearly for being different.

When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women. Some argue that this is fair: after all, a woman could become pregnant, and labor and delivery are costly.

But the truth is that, even when maternity benefits are excluded, one-third of all health plans charge women at least 30 percent more, according to a report released just last month by the National Women’s Law Center.

In 36 states, “92 percent of best-selling plans charge 40-year-old women more than 40-year-old men,” the Center reports, and “only 3 percent of these plans cover maternity services … One plan in South Dakota charges a woman $1252.80 more a year than a 40-year-old man for the same coverage.”

Today, less than half of American women can obtain affordable insurance through a job, which explains why millions buy their own insurance in the individual market. In that market, just 14 states ban gender rating:  California, Colorado, Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, New Jersey, New York, North Dakota, Oregon, Vermont, and Washington….

 

Insurers explain that women cost them more, even if policies don’t cover maternity, because “they are more likely to visit doctors, get regular check-ups, take prescription drugs, and have certain chronic illnesses.”

In other words, women are penalized for taking care of themselves, As for those “female chronic ailments,” men also are more vulnerable to certain diseases – including many caused by smoking (23 percent percent smoke vs. 17 percent of women)…

If a woman is raped she, too, risks being shunned. When Christina Turner was attacked by strangers, doctors advised that she take HIV medication “just in case.” Insurers then refused to cover her because the HIV drugs “raise too many health questions.” They told her they would reconsider her in three years if she could prove she did not have AIDS.

Turner went without insurance for three years. Other rape victims report being denied because they suffered from post-traumatic stress syndrome.

These are the most shocking cases. Other rules discriminate against millions of women for a long list of commonplace reasons:

  • If a woman has survived breast cancer, this is a pre-existing condition.
  • If she is pregnant when she applies, this also is considered a pre-existing condition, just like cancer. Most likely, she will be turned down.
  • If she is of child-bearing age and has children, this may well viewed as a pre-existing condition, leading to higher premiums.
  • On the other hand, if she is infertile, this too, can be labeled a pre-existing condition.

Not long ago, House Minority Speaker Nancy Pelosi summed up the hurdles: “If you’re a woman, it’s a pre-existing condition.”

“In most markets if you are a non-smoking female you will pay more than a smoking male of the same age because you possess ovaries and not testes.”..

 

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August 9, 2012 Posted by | Public Health | , , , | Leave a comment

Health Insurance: Those Who Are Covered, Recover

 

From the 7 August 2012 article at Science News Daily

Underinsured CVD patients die sooner than patients with private insurance, irrespective of race…

Insurance status is a better predictor of survival after a serious cardiac event than race, and may help explain racial disparities in health outcomes for cardiovascular disease. A new study by Derek Ng, from the Johns Hopkins Bloomberg School of Public Health in the US, and his team shows that race is not linked to an increased risk of death but being underinsured is a strong predictor of death among those admitted into hospital with a serious cardiac event. Their work appears online in the Journal of General Internal Medicine, published by Springer…

g and colleagues looked at whether the risk of early death was associated with insurance status or race. They took into account the potential effects of neighborhood socioeconomic status and disease severity. They analyzed data from a sample of patients admitted to one of three Maryland hospitals for three specific cardiovascular events: 4,908 with acute myocardial infarction (or heart attack); 6,758 with coronary atherosclerosis (or furring up of the arteries); and 1,293 with stroke.

They found that underinsured patients died sooner than patients with private insurance, whereas the survival rates were comparable between whites and blacks. More specifically, underinsured patients had a 31 percent higher risk of early death after a heart attack and a 50 percent higher risk after atherosclerosis. This survival effect was independent of race, neighborhood socioeconomic status and disease severity.

The authors conclude: “Among those admitted to the hospital with an acute cardiovascular event, there was an increased risk of mortality among subjects who were underinsured compared to those who had private insurance. Given the recent changes in health insurance and healthcare reform, these results underscore the need to closely investigate the factors relating to health insurance that may explain these disparities. Indeed, targeting these factors may relieve the burden of mortality disproportionally affecting those who are underinsured.”

 

August 8, 2012 Posted by | health care | , , , , | Leave a comment

American Medical Association (AMA) news: Appealing denied claims seems to work, GAO report says :: April 11, 2011 … American Medical News

amednews: Appealing denied claims seems to work, GAO report says :: April 11, 2011 … American Medical News

Yes, this is old news, but thought it would be worth posting…

The government is looking for a way to track and report denial rates to consumers as part of health insurance exchanges.

By EMILY BERRY, amednews staff. Posted April 11, 2011.

  • A government review of the rates at which insurers decline to write policies and reject claims for payment found that when physicians and patients appealed denied claims, those appeals were “frequently” successful, with 39% to 59% resulting in a reversal.

The Government Accountability Office report, released March 16, also found that many health insurance claims denials stem from miscodings, incomplete information or other paperwork errors, pointing to the need for further automation of claims processing.

The report examined what the GAO called “application denials” — declining to write a policy for someone — as well as “coverage denials” — deciding not to pay a claim. The Patient Protection and Affordable Care Act called on the GAO to examine both. The Dept. of Health and Human Services, which has started tracking application denials, plans to track and publish rates of coverage denials as part of the health insurance exchanges that will be part of the health reform law, according to the report.

Until HHS tracks application and coverage denials in a comprehensive way, there is limited information available about both. The GAO noted that the American Medical Association helped the authors interpret and understand the limitations of denial data available.

Rejected applications, denied claims

The GAO examined application denial data in the individual insurance market, collected by the HHS during the first quarter of 2010 and from six states that already track denials.

Researchers found that the rate at which insurers declined to offer an applicant coverage averaged 19%, but rates varied widely……

February 13, 2012 Posted by | health care | , , , , , , | Leave a comment

Department of Health and Human Services Updates HealthCare.gov Insurance Finder

HealthCare.gov

Take health care into your own hands

 

From the press release

HealthCare.gov Insurance Finder Gets Better for Consumers

On Monday, November 15, 2010, the Department of Health and Human Services updated the HealthCare.gov Insurance Finder with more information on private insurance plans.

Created under the Affordable Care Act, www.HealthCare.gov was launched July 1, 2010, and is the first website of its kind to bring information about private and public health coverage options into one place to make it easy for consumers to learn about and compare their insurance choices.

HealthCare.gov and its Insurance Finder are critical new tools for consumers, making the health insurance market more transparent than it has ever been.

On October 1, the Insurance Finder added price estimates for private insurance policies for individuals and families, allowing consumers to easily compare health insurance plans – putting consumers, not their insurance companies, in charge and taking much of the guesswork and confusion out of buying insurance.

Insurance companies are also required to include two notable metrics never before made public:

  • The percentage of people who applied for insurance and were denied coverage.
  • The percentage of applicants who were charged higher premiums because of their health status.

Significant Increase in Options for Consumers to Compare & in Number of Health Insurance Companies in Finder

Today’s update represents a significant increase in the number of private insurance plans and the number of issuers represented:

  • On October 1, there were 4,400 plans for individuals and families listed in the Finder, and today’s update brings that number to over 8,500.
  • On October 1, there were 230 health insurance companies the individual and family market represented in the HealthCare.gov Insurance Finder, and today’s update brings the number of health insurance companies in the Finder to 299.

This update to HealthCare.gov further enhances the ability of Americans to find health care coverage that meets their needs and get the best value for their money.  And it represents a significant expansion in the transparency that HealthCare.gov is bringing to the insurance marketplace – transparency that leads to more competition between insurers and better value for consumers.

Posted: November 15, 2010

November 28, 2011 Posted by | Consumer Health, Public Health | , , , | Leave a comment

A Consumer Advocacy Group Focuses on Insurance Issues and Consumer Rights

[via Resource Shelf]

Have insurance related questions?
Whether they are related to health insurance, auto insurance, or other policies, United Policy Holders just might have the information needed to help make informed decisions.

United Policyholders was founded in 1991 as non-profit tax-exempt organization dedicated to educating the public on insurance issues and consumer rights.

Much of their work centers on natural disasters. Their first major project was a firestorm in California.
Their publications (generally free) include: Tips for Flood Claimants, Tips for Fire Claimants, Tips for Earthquake Claimants, Tips for DisabilityClaimants, Hiring an Attorney; Why, When and How, and a half hour videotapetitled; Ten Steps…Settling Your Insurance Claim.

Web pages include State by State Help, Newsletters, and Buying Tips.

August 6, 2010 Posted by | Health News Items | , | Leave a comment

   

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