Articles Posted in Insurance

files-150x150A laptop and a cardboard box. These two items could be major tools in improving regular folks’ health throughout this year — and beyond — if they get launched on important tasks, pronto.

What needs to happen is for patients to be hyperconscious, persistent, and skeptical enough to start gathering vital records about themselves and their medical care. The documents they should have handy include all their medical records, as well as a file of any bills, insurance statements, and correspondence with providers about their treatment.

It might seem like a lot of bumpf. But consider, with patience: Doctors value the material so much that they make it their prime order of business in taking on a patient’s care to look fast and first at the individual’s health record.

cardmedicare-300x194Editor’s note: The blog will shift in ’23 to more episodic publication.

Just a reminder: 2023 will begin what could be consequential changes in aspects of older Americans, notably those age 65-plus and covered by Medicare.

As part of law of the Inflation Reduction Act passed by Democrats in the Congress and pushed by the Biden Administration, diabetics on original Medicare will see their cost for lifesaving insulin capped at $35-a-month under Part-D prescription drug plans. As the official Medicare site reports:

cash-150x150Editor’s note: The blog will shift in the days ahead to more episodic publishing.

Members of Congress raced at the year’s end to avoid the consequences of a brutal snowstorm battering huge swaths of the country. Before hitting the holiday exits, lawmakers approved a whopping $1.7 trillion bill to fund the federal government through the fiscal year and until next fall, spending giants sums on guns over butter.

Those who drill down on military budgets will be better positioned to determine the wisdom of the $858 billion appropriation by Congress for the Pentagon. The 4,000-plus pages that detail the measure’s allocations included $772 billion for domestic spending, including, of note for those focused on health care, items such as:

voting-150x150Voters from coast to coast made decisions last week not just about which candidates to favor but also about an array of health-related concerns from abortion to health insurance expansion to legalized ways to get high.

Women’s reproductive rights: a big deal

A major motivator in the 2022 midterm elections was the U.S. Supreme Court’s decision to abolish the constitutional right to abortion and leave it to the states to decide women’s reproductive health rights.

charitycarehospitalskff-300x209Already sick, injured, and debilitated by age and other circumstance, U.S. patient-consumers get battered with misleading information from shady firms about insurance coverage under the Medicare program and with too little word from hospitals about too spare charitable care that could help the beleaguered with bankrupting medical bills.

Democratic investigators for the U.S. Senate Finance Committee have ripped outfits hustling private Medicare plans to seniors, saying that companies have, among other sketchy practices uncovered, “posed as the Internal Revenue Service and other government agencies, misled customers about the size of their networks, and preyed on vulnerable people with dementia and cognitive impairment,” the New York Times reported.

The investigators said they have cataloged dubious behaviors by vendors in 14 states of Medicare Advantage programs. The newspaper earlier has reported those health plans have become a highly lucrative line of business for insurers. They overstate how sick their patients are to put a bigger bite on taxpayers’ financial support of health coverage for those 65 and older, with Advantage plans enrolling a huge chunk of seniors now.

cvsad-150x150Well, hear, hear! A much delayed, but important health care reform has gotten off to a rocking start. Consumers with moderate hearing loss now can buy hearing aids with greater convenience and less cost  — over the counter and without prescriptions.

New devices, new makers, and new retailers have raced in to tap a big need and potentially lucrative market, due to regulatory changes finally put in effect by the federal Food and Drug Administration, as the Wall Street Journal reported:

“Retail chains such as Walgreens, CVS, Walmart and Best Buy carry [hearing aids now], and they are also available on Amazon.”

colonoscopynatinstitute-300x292Colorectal cancer remains  the third most commonly diagnosed form of cancer  in this country. It kills tens of thousands of Americans annually. Although detection of the illness is declining overall, and especially among older adults, specialists have expressed growing concern about its rising rates in younger patients. This has prompted experts to push for more screenings to discover this cancer earlier.

But a new, decade-long European study involving 80,000 participants has given experts in the field at least a pause and may be forcing a more nuanced consideration of colonoscopies — long considered a pricey, inconvenient, intrusive, but “gold standard” test in the battle against colorectal cancer.

The study offered a brusque reminder, especially to regular folks, that testing and early detection of serious illnesses do not automatically result in optimal outcomes that improve or extend lives. As Stat, the science and medical news site reported:

coinstack-150x150The Biden Administration has tackled the “family glitch” in Obamacare, issuing new eligibility rules that will open up more affordable health insurance for many more poor, working poor, and middle-class Americans who otherwise might struggle to pay for coverage, even as provided by their employers.

This change in health care regulation is taking effect, even as tens of millions of people roll into an important period to protect their well-being — the annual “open enrollment” months for health coverage under the Affordable Care Act, by many employers, as well as for those eligible for Medicare.

The Treasury Department’s new regulations on the “family glitch” affects as many as 5 million people, more than half of them children, according to the nonpartisan, independent Commonwealth Fund. Here is how the Associated Press described what federal regulators are doing to make health coverage more affordable to many more people under the Affordable Care Act or Obamacare:

sidesleep-300x155With millions of patients struggling with long delays in getting replacements for night-breathing devices recalled by their manufacturer over the machines’ potential health risks, a seasoned health journalist has reported an intriguing, personal counterpoint on the growing prevalence of the problem of sleep apnea and its routine, costly, inconvenient care.

Jay Hancock, who has been a senior correspondent for the independent, nonpartisan Kaiser Health News service (KHN) for a decade and has reported on health care, business, finance, and the U.S. State Department for the Baltimore Sun and the Virginian Pilot, penned his piece in admitted self-interest. That’s because he suffered bouts of drowsiness during the day and his wife told him he snored.

He decided to undergo exams to see if he had sleep disorders. Tests gave him a diagnosis of moderate apnea. Because of his journalistic background, he wrote that he decided he needed to learn more, reporting:

medadvantagesuitsnyt-300x239The nation’s biggest health insurers are gaming a giant program to provide health coverage to seniors, exploiting the privatization of Medicare Advantage plans to rake in profits with schemes that have drawn fire from federal prosecutors.

The sustained, costly campaign by insurers to maximize their profits not only leaves older, vulnerable patients at risk of reduced care, it also imperils the overall health of the entire Medicare system, the New York Times  found in its investigation, reporting this [see chart above, courtesy the newspaper]:

“Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost. If trends hold, by next year, more than half of Medicare recipients will be in a private plan. But a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits. As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

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