Articles Posted in Insurance

investigationnursinghomesnbc2019-300x262Profit-hungry nursing home operators persist in throwing out vulnerable seniors and disabled patients from needed care, too often because the facilities find they can get higher-paying patients to fill their already costly beds.

Thousands of complaints about potentially improper discharges or transfers from nursing homes and assisted living facilities dominate the work of ombudsmen, whose work is federally required, and state supported, an NBC News investigation found.

The broadcast journalists reported:

vcuhospital-300x200A  Virginia hospital has found an eyebrow-raising solution to some of  its struggles with elderly, poor, and sick patients who take up beds and medical resources that might generate more revenue and less headache for the institution: Administrators hired a law firm and turned to the courts to strip legal control over the frail seniors from their loved ones.

Over families’ objections, the seniors’ newly appointed guardians then allowed the patients to be moved out of the Virginia Commonwealth University Health System hospital in Richmond and into poorly rated nursing homes. As the Richmond Times-Dispatch reported:

“A yearlong investigation by the Richmond Times-Dispatch, which involved analyzing more than 250 court cases and interviewing more than two dozen people, revealed that VCU Health System has taken hundreds of low-income patients to court over the past decade to remove their rights to make decisions about their medical care. This process, which frees up hospital beds at VCU Health System and saves thousands in uncompensated costs, often results in sick, elderly or disabled patients being placed in poorly rated nursing homes, sometimes against the wishes of their own family members. In these cases, VCU Health asks the court to grant an attorney at the ThompsonMcMullan law firm the power to make critical medical and life decisions for its patients. The court orders the attorney to represent the best interests of those patients, but the law firm continues to look out for the hospital’s interests on dozens of guardianship cases each year.”

shooting-300x201When it comes to key health concerns of the American public, President Trump and his administration have offered evidence anew that whatever they say may not last to the next political moment, that inaction is its own powerful kind of action, and that what officials say they’re doing may be exactly the opposite.

This is not intended as partisan commentary. It reflects the turn of a few news cycles and how Trump and his officials have dealt with:

  • The outbreak of serious lung illnesses and deaths tied to vaping

blawhospitalcostgrafic-300x174Tthe Trump Administration deserves credit for doing something right on hospital prices — but with what likely will be ineffective results.

The president and Alex Azar, the head of the sprawling Health and Human Services agency, have rolled out delayed new federal rules that will order hospitals, starting in 2021, to make public the discounted prices they negotiate with insurance companies and require insurers to allow patients to get advance estimates of their out-of-pocket costs before they see a doctor or go to the hospital.

Trump explained why, as reported by the New York Times, saying: “For decades, hospitals, insurance companies, lobbyists and special interests have hidden prices from consumers, so they could drive up costs for you, and you had no idea what was happening. You’d get bills that were unbelievable, and you’d have no idea why.”

bardbaby-240x300It’s the price and cost problem, stupid. That’s a fictitious but new tattoo that voters might want politicians to take up as they consider the many major problems with the American health care system, especially as yet more medical billing outrages surface.

Marshall Allen, a reporter for ProPublica, the Pulitzer Prize-winning investigative site, posted about a doozy: It’s about almost $1 million in charges that a hospital group sought to saddle a new mom with, even as she wrestled with pregnancy complications and an ailing premature baby.

That mom also happened to be an emergency room nurse. And the chain that flubbed her medical bill was her own employer: Dignity hospitals. That’s a Christian medical enterprise that describes itself as the fifth largest health system in the nation and has as its motto, “Hello, human kindness.” As Allen reported, it’s worth noting this, too, about Dignity:

Extreme sports may be to blame. Or it might be a falling tree, an error with a surgery, or an auto wreck.

As the title of the tough, direct, and new HBO documentary makes clear, “Any One of Us” might suffer from a calamitous spinal cord injury (SCI). The 1-hour and 25-minute work by first-time director Fernando Villena focuses on pro mountain biker Paul Basagoitia but is carried by a “chorus” of 17 women and men who all have had significant injuries to their spinal cords.

cardformedicare-300x188Americans in coming weeks will make important decisions on the national and personal level about how best to safeguard themselves and their loved ones with a crucial component of the U.S. health care system: their insurance coverage.

Though the exact timing of the open enrollment season varies by geography and plan, it’s that key time for millions who get their coverage via Medicare and may wish to make changes. These are important weeks, too, for many who obtain health insurance under the Affordable Care Act, aka Obamacare. Many workers are hearing a lot from their human resources folks about their employer-provided plans.

It’s clear from the political polling and the sometimes-dreary Democratic presidential debates that there’s huge interest and lots of devil in the details about Americans’ health insurance options.

cashrain-300x225Politicians almost by reflex decry the skyrocketing cost of U.S. health care by blaming much of it on waste, fraud, abuse. They, alas, really may be on to something, newly published research shows.

Health care experts, including a medical leader of health insurer Humana, “combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy,” leading them to some jaw-dropping calculations about how well spent is the $3.5 trillion or so that Americans drop on health care, the New York Times reported.

Answer: Really badly. The researchers, in their published work, estimated that 20%-25% of American health care spending is wasteful. That turns into giant sums, fast, as the newspaper reported, including:

costemployerinsurance2019-300x169Millions of Americans may sigh at Bertha, Barney, or Betty, or whatever they’ve nicknamed the beat-up family vehicle parked out front: “Wouldn’t it be great, if only we could afford a nicer, newer model?”

A big obstacle to that wish, however, may be the increasingly costly and unaffordable health insurance they get at their workplace. New research finds that the annual premium for family coverage  — forked over mostly by companies but also by workers — now averages $20,576, according to an annual survey by the nonprofit, independent Kaiser Family Foundation.

Drew Altman, chief executive of the group, commented to the Wall Street Journal about the spiking burden of workplace coverage: “It’s a milestone. It’s the cost of buying an economy car, just buying it every year.”

bernie-225x300Critics have attacked Sen. Bernie Sanders for his proposal to wipe out $81 billion in medical debt, including by changing rules around debt collection and bankruptcy. He also called for “replacing the giant credit reporting agencies with a ‘public credit registry’ that would ignore medical debt when calculating credit scores,” reported the New York Times.

Well, there he goes again, with interesting but hard to execute ideas, critics replied to Sanders’ medical debt idea, dissecting it to pieces.

But dig into some of the news articles and important realities flare up. Even his critics concede that medical debt has become a nightmare for too many Americans, contributing in unacceptable fashion to family stress and anxiety and, more importantly, adding to the nightmare of medical bankruptcy.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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