Tag: Health Care

Messing Up Your Insurance Paperwork – Hazards of

It Shouldn’t Be This Easy to Lose Your Health Insurance
By Danielle Ofri
Dr. Ofri is a primary care doctor in New York City.

“I’m sorry, Dr. Ofri,” the representative said, rechecking her records, “but you didn’t enroll this year.”

Could that be? Could I have somehow forgotten? Or missed the notification? “But don’t worry,” she said. “We’ve put you on the basic plan.”

“OK,” I said, starting to relax and thinking out loud. “I guess my kids will get to meet some new doctors.”

But the representative did not match my tone. “I’m sorry, but the basic plan is just for the employee,” she said, “not your family.”

That’s when a coil of disbelief clamped my heart to a standstill. My spouse and children would be left without health insurance? The panicked questions quickly percolated: What about their ongoing medical treatments? What about their medications? What if someone got hit by a car, or got cancer? There’s hardly a more devastating feeling for a parent than to realize that you haven’t adequately provided for your family.

from the comments:

In 2015, I was sued for the first time in my life–for failing to pay for routine blood tests. I was sued for $600, then assigned $300 in court fees. I called the insurance company: aren’t these test covered by my very high (yet these days “normal”) monthly premium ? Yes, but I had failed to tell them my new group number, assigned by them. I was bemused. If you assigned it, don’t you have it? Yes, they said, but you had to confirm it. I spent hours on the phone to get someone with authority to reverse the $600 charges. They did, only after I explained I would sit on the phone (I was hung up on multiple times) until I cost them more than $600. I was given a “confirmation” code. It was a lie–the person who gave it was not “authorized” to cancel my charges. I got a lawyer–he said pay, for the law is on their side, and it is only $600. I did, but was deeply horrified to be in a system that is rigged to allow legal robbery for obscenely flimsy reasons. All said, this doctor is not alone, and all of this must stop. We must have sane, not-for-profit medicine. I am aware too this happens to the poor all the time. No wonder the inchoate rage.

As a psychologist I can attest to this phenomenon from the other side. I’ve had patient’s claims rejected for the flimsiest reasons. Each time, I was told that they acknowledged their mistake and would happily resubmit the claim, only to have it rejected for the next flimsy reason: diagnosis code 300.4 vs 300.40, no license number on the invoice (right there in the letterhead), no NPI number (not required), etc. I’ve spent hours on the phone advocating for my patients to get reimbursed, usually to no avail. And each time, the insurance corporation gets to hang onto the patient’s money a little longer and earn interest for another month.

I’m a physician too.
I lost my health insurance when I was 36 weeks pregnant over 36 cents.
At the time, I was working as a contractor. I foolishly bought my insurance through the ACA exchange to support it as a new government program. $3,500 deductible had been met. One day, I went online to pay my premium and my account was gone.
When I called, they said my payment from the previous month was short 36 cents (I switched the cents on the check.)
“If you had bought your insurance directly through the insurance company, we would have just let you pay the 36 cents and re-instated your policy.”
“But because you used the ACA, it only gives 30 days for payment, and if you don’t pay within the 30 days, the policy is terminated.”
No amount of begging, crying or calling changed this situation.

See also:
Fighting the Insurance Company – Example of

Kaiser Permanente Strike

75,000 Kaiser Permanente workers walk off the job. It’s the largest health care worker strike in US history
On Wednesday, more than 75,000 unionized employees of Kaiser Permanente, one of the nation’s largest not-for-profit health providers, walked off the job, marking the largest health care worker strike in US history.

The striking employees, who work across California, Colorado, Washington, Virginia, Oregon and Washington, DC, are represented by a coalition of unions that comprise 40% of Kaiser Permanente’s total staff. The vast majority of the striking workers are in West Coast states. The strike began at 6 am local time, and will run through Saturday morning.

Losing Your Job Because You’re Sick Then Losing Your Insurance Because You’re Unemployed

There are plenty of cases in this book where you find just frustration with the way our health care system works or does not work. You know, one interesting story you tell is of a woman who comes into the emergency room. This is not during the COVID days. She comes into the emergency room, and she wants chemotherapy treatments, and she knows she has cancer. And in fact, she has detailed instructions from the oncologist who has been treating her. Why was she coming to the emergency room?

NAHVI: Well, she came to the emergency room because her oncologist had stopped treating her. So what her story was – she was a young lady. She was diagnosed with cancer. And then she started getting treatment for her cancer with an oncologist at a private – not-for-profit but private institution. And then what happened was that because of her chemotherapy and her cancer treatments, she took too many sick days from her job. So she ended up losing her job. Then she lost her health insurance because of losing her job.

So her chemo – her oncologist wasn’t able to see her anymore because she didn’t have insurance anymore. So he or she referred this patient to our hospital, which was a public hospital where I was working at the time. She didn’t understand that she had to go see an oncologist. So she just came to the emergency room. And I thought there was a misunderstanding.

I saw her, and I said, you know, I’m an ER doctor. I – if I could treat you, I absolutely would. I just don’t have these tools. I don’t have that capability. And then we ended up kind of going from there. But that’s how she ended up in the emergency room with me.

DAVIES: But it’s interesting – I mean, it would take her, I think she said, weeks or months to get an appointment with an oncologist. And she knew that if you come to the ER, they have to treat you, right? I mean, so she figured, hey, you can’t send me away.

NAHVI: That was what she told us, yes. She said that she was familiar, that there was some law out there, that if you are uninsured under any circumstances, you come to an emergency room, we have to treat you. And she’s right. Except the caveat to that, which kind of is what made me so uncomfortable at that time, was that she had a great understanding of the situation, except that what we have to do in the ER is stabilize you, not necessarily treat you. So you have to be evaluated by law. And whatever we can do to stabilize you, we have to do.

In the eyes of this legislation, she was stable. So she had cancer, and she was dying, but she was dying slowly. She wasn’t dying quickly. So she was technically stable. And it became this kind of horrible thing that I had to explain to her that, yes, you’re protected by this law and yes, you have cancer and yes, you’re dying, but I can’t help you.

An ER doc reflects on life, death and uncertainty in the early days of COVID-19
Fresh Air

Insulin – Unaffordable to Many in US

A study in the Annals of Internal Medicine found that in 2021, nearly 1 in 5 adults in the U.S. with diabetes either skipped, delayed or used less insulin than was needed to save money. That comes out to roughly 1.3 million adults, or 16.5% of those who need insulin.

“In the ICU, I have cared for patients who have life-threatening complications of diabetes because they couldn’t afford this life-saving drug,” said the study’s lead author, Dr. Adam Gaffney, a critical care physician at the Cambridge Health Alliance in Massachusetts.

“Universal access to insulin, without cost barriers, is urgently needed,” he said.

Starting Jan. 1, the Inflation Reduction Act, signed into law by President Joe Biden in August, will cap the monthly cost of insulin at $35 for seniors on Medicare. The bill, however, will leave out millions of Americans with private health insurance as well as those who are uninsured.

Nearly 1 in 5 U.S. adults with diabetes ration insulin to save money, study finds

Young adults and the uninsured — those who will be left out of the Inflation Reduction Act’s monthly insulin cap — were the most likely to ration their medication.
Berkeley Lovelace Jr.

County General on Saturday Night

I put down her chart. He was right. A bullet through the abdomen wasn’t the worst case. It was nothing. Something that would wait till morning. There were people who were worse, people who had been run over by cars or stabbed in gang fights, people with multiple gunshot wounds, people who wouldn’t survive if they didn’t get immediate attention. And this was the judgment residents had to develop in a MASH unit like this.

As we walked away, he said, “You’ll get used to it. You’ll learn to do it.”

I thought, No, I won’t.

I was wrong. I very quickly saw more than I ever imagined, and came to realize that doctors are basically biological repairmen, especially in inner-city hospitals on violence-riddled Saturday nights. On my first night at County General, I treated a guy with a penis the size of a football. It turned out he’d been shot in the ass, and the bullet had exited through his penis. After a few Saturdays, though, I learned that two things could be predicted with 100 percent accuracy: If you asked anyone with a knife wound what happened, they’d say, “I don’t know.” And if a person had something stuck up their butt—which in my experience included lightbulbs, broomsticks, and grapefruits—they’d explain, “It was an accident. I sat on it.”

Pinsky, Drew. Cracked: Life on the Edge in a Rehab Clinic

50 Years of the War on Drugs

Hinton has lived his whole life under the drug war. He said Brownsville needed help coping with cocaine, heroin and drug-related crime that took root here in the 1970s and 1980s.

His own family was scarred by addiction.

“I’ve known my mom to be a drug user my whole entire life,” Hinton said. “She chose to run the streets and left me with my great-grandmother.”

Four years ago, his mom overdosed and died after taking prescription painkillers, part of the opioid epidemic that has killed hundreds of thousands of Americans.

Hinton said her death sealed his belief that tough drug war policies and aggressive police tactics would never make his family or his community safer.

Brian Mann
Morning Edition

Go Fund Me as Health Care Finance


‘Why Is It So Expensive?’
We Asked People From Around the
World What They Think of U.S. Health Care.
Video by Chai Dingari, Adam Westbrook and Brendan Miller

From the comments:

One day I had a serious hemorrhage and was taken to a nearby public trauma hospital via an ambulance. As the doctor was frantically trying to stop the bleeding in the emergency room, I kept rambling incoherently (under powerful anesthetic) to confirm that the hospital was “in network” – the healthcare workers reassured me “you are fine.”

When my friend fell and couldn’t get up she insisted that no one call an ambulance. She called her brother and waited – in excruciating pain – but she was more afraid of the cost of the ambulance.

I worked for a major medical company (Think of big health insurer they are all the same) when Obama care came around. Did we worry? Nope, because their profit was built in. healthcare companies just wanted to “reject” preexisting conditions . We knew, all the health plans would go up…listening to our “elected officials”, us lemmings in the office KNEW IT WAS A LIE… everyone knew the cost of insurance would GO UP.

We had unpaid claims that sat in our database FOR YEARS, never paying them because in a decade…that 50k is cheaper to process and it would just stay in a “round robin” appeals process that goes on forever. (literally we had claims that SAT unpaid for a decade or more because paying a 50k or 1 million dollar claims/debt from 10 years ago is cheaper, we talked about it openly)… All our executives made huge paychecks, huge paydays….. Its ridiculous. Meanwhile the rules are made by companies to pay as little as possible…I loved working for an insurance company, I had the Cadillac of Cadillac of insurance…. Literally it was the only redeeming quality .

Goldman Sachs and Chris Rock on Health Care Profitability

Goldman Sachs analysts attempted to address a touchy subject for biotech companies, especially those involved in the pioneering “gene therapy” treatment: cures could be bad for business in the long run.

“Is curing patients a sustainable business model?” analysts ask in an April 10 report entitled “The Genome Revolution.”

“The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies,” analyst Salveen Richter wrote in the note to clients Tuesday. “While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”

Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’
Tae Kim

Nothing’s been cured in my lifetime. Nothing. The last thing they cured was polio and that was during the first season of “I Love Lucy.”

At least they’re still working on AIDS. They won’t cure it, but they will figure out a way for you to live with it. They won’t fix it, they’ll just patch it up. Their hope is that one day someone will say, “How come you weren’t at work yesterday?”
“My AIDS is acting up. You know when the weather gets like this, my AIDS just pop up. But I got me some Robitussin and I’m fine now.”

They don’t want to cure anything because the money is in the medicine. It’s like anything else. You think Cadillac can’t make a car that lasts a lifetime? Sure they can. But there’s no money in that.

“We need people to come back. We’ll make a car that lasts seven years. After that, shit’s gonna fall off.”

Diseases are just piling up. People still get cancer, sickle cell, tuberculosis, Jerry’s kids still limping around.

Cure some shit. Get rid of it.

Rock This!
Chris Rock
April 19, 2000

The Algorithm Did It

Stanford Hospital staff protesting the decision by higher ups to give vaccines to admins at home from r/pics

“There is an enormous demonstration going on at Stanford Hospital right now carried out by staff, who are protesting the decision by higher ups to give vaccines to some administrators and physicians who are at home and not in contact with patients INSTEAD of frontline workers.” Twitter

Only Seven of Stanford’s First 5,000 Vaccines Were Designated for Medical Residents. Stanford Medicine officials relied on a faulty algorithm to determine who should get vaccinated first, and it prioritized some high-ranking doctors over patient-facing medical residents.

Algorithm issue my ass.

You prioritized age, and in so seniority, and didn’t prioritize Frontline work, and depriotize those working from home.

It doesn’t matter if you asked a computer to then run the numbers, you set the rules.

The sentence should be “Hospital administration did not prioritize front line workers but instead accounted for seniority in distributing the vaccine. As a result only 7 of the first 5,000 vaccines for staff will go to Frontline workers. These results were accepted without further scrutiny or adjustments by the administrators incharge of doing so.”

“The algorithm did it” is increasingly an excuse used for shitty management decisions.

Yup. Algorithms are created by people. The correct phrasing is “the algorithm was written to do it.”

Decision Making Software

She doesn’t remember exactly when she realized that some eligibility decisions were being made by algorithms. But when that transition first started happening, it was rarely obvious. Once, she was representing an elderly, disabled client who had inexplicably been cut off from her Medicaid-funded home health-care assistance. “We couldn’t find out why,” Gilman remembers. “She was getting sicker, and normally if you get sicker, you get more hours, not less.”

Not until they were standing in the courtroom in the middle of a hearing did the witness representing the state reveal that the government had just adopted a new algorithm. The witness, a nurse, couldn’t explain anything about it. “Of course not—they bought it off the shelf,” Gilman says. “She’s a nurse, not a computer scientist. She couldn’t answer what factors go into it. How is it weighted? What are the outcomes that you’re looking for? So there I am with my student attorney, who’s in my clinic with me, and it’s like, ‘Oh, am I going to cross-examine an algorithm?’”

The coming war on the hidden algorithms that trap people in poverty
A growing group of lawyers are uncovering, navigating, and fighting the automated systems that deny the poor housing, jobs, and basic services.
Karen Hao
MIT Technology Review

Cost of Health Care in the US – Some People’s Experiences

Trump Took Credit for Making Insulin “So Cheap It’s Like Water.” Tell That to People Paying For It. from politics

With good insurance my insulin, pump, and glucometer supplies cost over 650 per month.

Pretty much. I didn’t mind my insurance at my old job. Never went to the doctor either. When I *did* end up having to have stomach surgery, I quickly learned to hate my insurance company. Tried to tell me hernia repair was fucking elective.

Yeah that’s ridiculous. A similar thing happened when my wife had appendicitis. They said it was going to burst and as such would have to remove it. Insurance tried to tell her it was elective so they wouldn’t be covering the $77,000 hospital stay. Very crazy.

I’m a teacher and my insurance SUCKS! I had to pay 10k out of pocket 2 yrs in a row for random medical issues. We have a lot of teachers that are much better off on their spouse’s plan. I’d love to see what a good plan looks like

It costs $6 for a 3 month supply of insulin, here in Australia. That’s what’s cheaper than water is Trump, not $300 a week 

There are people from the United States in Southern California that open up pharmacies in Tijuana Mexico specifically for the diabetic market in San Diego. In Mexico, they can sell all types of insulins for pennies on the dollar. Less than what a copay is in the United States with excellent insurance. People drive down there and buy insulin, from a pharmacy owned by someone that lives in the US, for cheaper than what they can get it in the US for. It’s stupid.
… Decent plans disappeared long before the aca. They were well on their way out in The late 90s and early 00s (prolly even before that). I owned a business around 2004, and the overhead for employees to get healthcare was so astronomical, that it’s literally the only reason why we kept everyone as private contractors.

I had the gall bladder removed about four years ago. Still paying off the 20k portion of my bill. It was more (45k) before I fought them over “choosing” out of network doctors when the hospital emergency room I went to was in network.