Articles Posted in Insurance

devito-300x169As tens of millions of Americans struggle with workplace medical insurance that provides them with little benefit when they most need it, consumers may wonder just how naïve their employers may be in overlooking industry SPIFFs, SPIVs, and other little-discussed payments that jack up costs and may reduce benefits.

Before any confusion arises, don’t think about health insurance in high-minded terms, and, instead, as just another business transaction — maybe what occurs at the cheesy used car dealership in the neighborhood (ala actor Danny DeVito in “Matilda,” as shown above). There, customers have gotten savvy about bonuses (Sales Promotion Incentive Funds or Sales Promotion Incentives) ladled on salesmen to get them to move vehicles out of showrooms, asap.

Pro Publica, a Pulitzer Prize-winning investigative site, deserves credit for digging in to the medical insurance business to show how similar incentive programs proliferate in brokerages that purportedly help companies of all sizes figure how to cover their employees’ health needs.

fentanylA steady flow of news reports shows how our nation’s opioid crisis can be fairly blamed on just about every actor in the medical field that should have known better: Big Pharma, doctors, hospitals, and regulators. It’s been a toxic mix of incompetence, indifference and out-and-out  deceptive conduct that produced the epidemic that now claims tens of thousands of American lives each year.

Take, for instance, the drug fentanyl, a lab-created painkiller 100 times more powerful than morphine. How did it escape the confines of legitimate prescription pain control to become a killer street drug? The Washington Post reports, based on research from Johns Hopkins experts, on how doctors, hospitals, and the federal Food and Drug Administration bungled a plan to safeguard the administration of this highly potent drug that had obvious abuse potential from the day it came onto the market.

Meantime, two other news organizations — the Pulitzer Prize-winning investigative website Pro Publica and the online health site Stat — have pried loose disturbing, sealed court testimony, showing how a wealthy, philanthropic family approved a lethal deceit about the potency of OxyContin, a billion-dollar opioid pushed relentlessly by Purdue, the Big Pharma firm they owned.

mdepressionRoughly 1 in 7 moms, who, during or after pregnancy, suffer debilitating depression — losses of energy or concentration, changes in sleeping and eating patterns, feelings of worthlessness or suicidal thoughts — now may get counseling that has proven helpful to women and their babies.

Preventive health experts have called on medical providers to guide women to this specialized care that could benefit 180,000 to 800,000 mothers each year. Because this treatment has been put forward this way, women also can get help affording it. As the New York Times reported, the recommendation for maternal depression counseling, by the United States Preventive Services Task Force, means insurers must cover the services — with no co-payments — under the Affordable Care Act.

Experts told the newspaper the USPSTF action was an important step on perinatal depression, noting:

commonwealth-underinsured-300x216Republicans got their heads handed to them in the midterms because they bungled a decade of efforts to eliminate public options on health insurance, the House minority leader has conceded. But he and other lawmakers, as well as corporate bosses, may face greater political fallout for failing to deal with a bigger health coverage nightmare for  Americans: workplace insurance plans.

More than half of Americans 65 or younger — 150 million-plus — get employer health insurance, while just a quarter of us buy plans on individual markets or get covered by Medicaid, reported the nonpartisan, respected Commonwealth Fund.

Republicans, in control of the House and Senate and now the White House, have ripped at the Affordable Care Act since its passage — although Obamacare has expanded and improved options for those uncovered on the job, including protections for preexisting conditions. Lawmakers in the meantime largely have left alone employer plans.

hospitalprices-300x162Patients and reformers attacking skyrocketing health care costs may want to focus less on doctors and more on big, shiny hospitals, where in just five years prices soared by 42 percent for inpatient care versus the still sizable 18 percent price hikes that MDs scored.

Those findings are part of a new study that examined medical costs based on actual payments, focusing on common procedures like deliveries of babies (vaginal and cesarean), colonoscopies, and knee replacements.  “Hospital prices grew much faster than physician prices for inpatient and outpatient hospital-based care in the period 2007–14 … The same pattern was present for all four of our procedures,” wrote the researchers from Yale, MIT, and Carnegie Mellon. They found that hospital costs also spiked for outpatient care, increasing 25 percent, versus 6 percent for doctors.

This meant that for a knee replacement costing $30,000 or so, the doctors’ mean price was almost $4,900, while the hospital price was almost $25,000. For a $13,000 C-section, the doctor’s mean price was $4,600, while the figure for hospitals was $8,300. These numbers were derived from analyzing hundreds of thousands of procedures.

HepatitisCInvestigators have teased out yet another damaging thread in the villainous web of harms of the opioid crisis. A spike in hepatitis C infections is a costly, long-term, and major health consequence of the hype and disastrous reformulation of OxyContin, the powerful painkiller made by Purdue Pharmaceuticals owned by the wealthy Sackler family.

Purdue, in the 1990s, promoted and sold OxyContin to doctors and hospitals in a relentless campaign that stressed how this drug was supposedly safer and longer acting, releasing its potent effects over as long as a 12-hour span instead of requiring many pills that needed to be taken more often.

Although those claims of the drug’s benefits were dubious to start, patients — especially those abusing the highly addictive prescription medication — found they could get around OxyContin’s delayed release, getting an immediate jolt or walloping high, by crushing their pills. They then snorted Oxy as a powder or mixed it with a liquid and injected it.

With the nation fast graying, a long-term care crisis looms, and too many Americans may not realize that not only will nursing home care be tough to find and afford, it also may be less than ideal. But what happens if seniors themselves — especially the frail old — are asked how care-giving services might best serve them, so they not only can stay in their homes but also enjoy their lives more?

That’s the experimental approach taken by a health care team in Denver, working in the long-titled program, “Community Aging in Place — Advancing Better Living for Elders.” CAPABLE staff intervene with the aged, asking them how, even with disability and debilitation, to improve their lives. The program offers them six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1,300.

cbpbust-300x200If  anyone around doubts still the threat that the opioid crisis poses to the nation, a drug bust involving a vegetable truck in Arizona should provide powerful persuasion: Federal agents, suspicious about the vehicle’s floor, loosed a drug-sniffing dog, resulting in the seizure of not just 395 pounds of methamphetamines but also 254 pounds of fentanyl.

Fentanyl is a synthetic opioid, a lab-created super drug that experts say is 50 times stronger than heroin and up to 100 times more potent than morphine. It packs a wallop for users in tiny grains or flecks.

The record-setting seizure at the Arizona border stop amounted to 144 or so kilograms of fentanyl, with drug enforcement officials estimating that just 1 kilogram of fentanyl can produce 1 million fatal doses. That means just this one bust had the potential to cause 144 million deaths.

The Trump Administration has put out its latest prescription to try to slash out-of-control prescription drug prices: Officials want to call medication “rebates” what they say they’ve really become — “kickbacks” — and crack down on the crazy rise of profit-reaping middlemen in the drug business.

Alex Azar, secretary of the Health and Human Services Department, announced that Uncle Sam, via the giant Medicare and Medicaid plans, hopes to fix big flaws in the drug industry by barring prescription medication discounting to PBMs (prescription benefit managers). The discounts still would be available to patient-consumers. But eliminating them for PBMs could be a major step in cutting drug costs, not the least because this step could give parties in this medical “supply chain” more transparency on what products cost.

headmri-300x300When patients experience bad headaches, severe chest pain, back or neck aches, or even when kids come in with gut pain that likely is appendicitis, doctors too readily push them into and through what may be hospitals’ over-sized cash-generating machines. It’s past time to end wasteful use of high-powered imaging systems, experts from the Mayo Clinic and Stanford University say.

Drs. Ohad Oren, Electron Kebebew, and John Ioannidis have called out their medical colleagues in an opinion piece published in the medical journal JAMA over excess computed tomography (CT) and magnetic resonance imaging (MRI), saying conditions can’t justify why Americans undergo these costly scans at many times the rate, for example, that Finns do.

Research shows diagnoses don’t improve with many more MRIs and CTs. Instead, they may lead to yet more costly, invasive, and unnecessary tests and procedures, some of which can harm patients.

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