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Shocking, Sad, and Strange – True Stories of Insurance Scams and Malfeasance

Patient Dumping of Psychiatric Patients

Homeless Woman with a CatRawson-Neal Psychiatric Hospital in Las Vegas, a state run hospital, is being sued in a class action suit led by the ACLU for “patient dumping”. They are accused of “dumping” over 1500 psychiatric patients. The accusation is that the staff would medicate or sedate indigent patients, give them a bag of sandwiches, and one days worth of meds and put them on a bus headed to California – Sacramento, Los Angeles, and San Francisco . Evidently this Nevada State public psychiatric hospital did not like the odds of reimbursement so they disposed of their patients.

The state web site says that Rawson-Neal: “Provides acute psychiatric inpatient treatment for adults with serious mental disorders. A multi-disciplinary assessment is the basis of each individual treatment plan. The hospital provides intensive and comprehensive treatment and after care recommendations.” The after care recommendations must read “Upon arrival in San Francisco walk to the Tenderloin district to locate a homeless shelter and soup kitchen. Good luck with your Schizophrenia and don’t come back to Vegas.”

When you gamble in Vegas you know the odds are in favor of the house. Casinos will evict you at will if they don’t want your business or they dislike your behavior. But we expect a lot more from health care professionals. Who would have thought that a public psychiatric hospital would treat ill people as disposable? The stigma of mental illness is enormous and sadly it can extend to health care workers. Are there any other categories of illness where people are treated so abysmally as those with mental illness? Can you imagine taking someone who needs dialysis down to the bus station and giving them a ticket to L.A. and a sandwich??

Fortunately with the ACA we have true parity of care for mental illness. But you have to get enrolled for the coverage. The expansion of Medicaid will help many of these patients if they can be reached, enrolled, and encouraged to seek treatment. Hopefully an effort will be made to enroll the most needy, vulnerable, homeless and ill citizens. Everyone need to learn about the prostate cancer symptoms as well.

Ten Essential Benefits

The ACA defines certain categories of benefits as “Essential Health Benefits.” There are ten Essential Benefits in every policy:

Ambulatory patient services – this means outpatient care. Care at your doctor’s office or an outpatient surgical center. Just like now, different insurance carriers will have different networks. Make sure your doctor is in the network before changing your insurance coverage.

Emergency services – The purpose of the emergency room is for serious symptoms such as heart attack or serious and urgent conditions such as accidents. This Best Truck Accident Lawyer Kansas can help you get the insurance which will get you treatment for less. For non emergency but urgent conditions look for the nearest Urgent Care Clinic. They cost much less – sometimes just a copay. The wait is much shorter. I have never waited more than 20 mins at an Urgent Care Clinic. Food poisoning, a painful earache, a broken toe – I go to Urgent Care. If the medical staff thinks you need the ER they call for an ambulance quickly.

Hospitalization – You will pay some percentage of your hospitalization such as 20% or 30%. Check your out of pocket maximum to calculate your total exposure.

Maternity and newborn care – Prenatal care and Postnatal care is classified as preventive and is no cost. The law requires insurers to cover child birth and newborn infant care generally at the coinsurance rate. This is great for families – women and infants. For example in Texas none of the individual plans cover maternity. I spent hours trying to find a plan in Texas for my daughter in law which covered maternity. This will no longer be a problem. However there won’t be plans without maternity coverage so everyone is paying for this. If you are a fifty year old single male there will be maternity on your policy.

Mental health and substance abuse disorder services, including behavioral health treatment – every plan should offer mental health parity now. That means patients with a biological mental illness or mental disorder can have unlimited visits to their psychiatrist. Mental illness is treated as any other medical condition. If you have a brief medication management appointment than your cost might only be a copay. Becca Leitman Therapy is covered generally at the coinsurance rate – 80% after deductible for example. The plans are intended to cover mental problems. It won’t cover couples counseling or life style coaches. For insurance to cover therapy you need some sort of diagnostic code of a psychiatric condition.

Prescription drugs – all plans must have prescription coverage which covers at least one drug in every class and category of medication. According to Orchard, most healthy people only use generics or an occasional brand name drug. However, just as now, if you have a serious chronic condition make sure your medications are covered on your plan. Also drug costs will be counted toward your out of pocket maximum. That is a good change.

Rehabilitative services and devices – Physical therapy, speech therapy, and cardiac therapy are examples of these services.

Laboratory services – A covered test ordered for Preventive Care is no cost to you. However a test ordered for diagnostic care will cost you, generally coinsurance. It is all about how your doctor or medical clinic code your service to the insurance company. A Colonoscopy coded as Preventive is paid at 100%. A Colonoscopy coded as diagnostic will apply to your deductible and coinsurance.

Preventive services and chronic disease management – The U.S. Preventive Services Task Force has a list of 50 services which are now covered at NO COST to you. This is a huge benefit for everyone. For detailed information see below:

Pediatric services, including oral and vision care – Under the law children under the age of 19 have dental care and vision care. Every insured child can have two dental cleanings plus other dental services.

See the full list of preventative care benefits provided to you by your insurance now at HealthCare.Gov.

We are the Champions!

That is Taima, the Seahawk Mascot. Taima is always the first person (?) umm creature out of the tunnel to start the game. Taima has been the team mascot since 2007. His handler, David Knutson of Spokane has 30 years of experience with birds of prey. Taima rode in the airplane with the team, and had his own hotel room in New York.

The Seahawks and Taima

Taima’s trainer and handler David Knutson “It’s just crazy. Seahawks fans are so loud, false starts for other teams are common. However, for one Seahawk, having a false start is not an option. Taima is the official mascot for the Seattle Seahawks, his name means “Thunder.””One hawk and he’s Seattle’s own,” Knutson said.

“He lives here with us in Spokane and we go to all the home games and training camp and some of the other events with the Seahawks. .”Before each game, Taima waits in the tunnel with the players for his cue to fly. “We never know if he’s going to do it, you can’t force him to do it,” Knutson said. “He’s not drugged, he doesn’t have his wings clipped, he could fly away whenever he wants.”

“Fans erupt after Taima makes his debut and anxiously await their chance to meet him in person. Everybody knows his name, everybody wants to get a picture with him, and every year it seems there’s a new picture to take and it seems right now, it’s to kiss the top of his head or the side of his face,” Knutson said.

Falconry is an ancient practice going back to 2000 BC. It was a popular sport among the nobles of medieval Europe. Efforts of the North American Falconers Association to conserve raptors have been successful. The Peregrine Falcon was on the endangered species list in 1970 due to DDT. There are now over 3000 breeding pairs in North America.

We have an amazing mascot for our amazing team. Go Hawks!
Below are two great pictures of the Superbowl fireworks off the Space Needle.

The Space Needle with Fireworks Fireworks by the Space Needle

 
 
 
 
 
 
 
 
 

HHS Strengthens Patients Rights

There was a press release today from the Department of Health and Human Services. As part of their ongoing efforts to empower patients they have taken action to give you direct access to your laboratory results. These new changes allow a patient to obtain their test results directly from the laboratory in addition to obtaining results from your doctor.

Under the HIPPA Privacy Rule patients or their personal representatives can obtain a copy of a patient’s protected health information. It is likely that you will be required to put your request in writing and pay for the costs of copying, mailing, or electronic media such as a flash drive. Copies must be given to the patient within 30 days of her request.

Affordable dental insurance for individuals!

Delta Dental Banner

Delta Dental ThumbnailDELTA DENTAL individual and family plans combine innovation, excellence, and affordability. Many of my business clients have Delta Dental small group plans. Now I can offer my individual and family clients the dental insurance most preferred by Dentists in Washington State.
Click on the link to enroll online. It is easy to use. Enter your zip code. When you come to a section labeled Broker or Producer click on the drop down box and click on my name.

Delta Dental Link for easy, online application.

Ladies, have you had a Mammogram this year? A free mammogram?

October is National Breast Cancer Awareness Month. Breast cancer is the second leading cause of cancer death for women in the United States, after lung cancer.

All women are at risk for breast cancer. A woman in the United States has a 1 in 8 chance of developing invasive breast cancer in her lifetime. Men can also get breast cancer, though this is rare.

The health care law already requires most health plans to cover certain recommended preventive services at no out-of-pocket cost. This means that women can get free annual mammograms, and those who are at increased risk of developing breast cancer can get genetic counseling at no additional cost. Many of us, probably most of us have lost family or a friend to breast cancer. This feature of the ACA (Affordable Care Act) can save lives.

Please forward this email to a woman in your life.

22 Preventive Services covered at 100%

The ACA (Affordable Care Act has 22 covered services specifically for women. There are also of course a lot of Preventive Services for men. In the spirit of Breast Cancer Awareness month I offer you this list.

22 Preventive Service for Women, including Pregnant Women, covered at 100%.

Anemia screening on a routine basis for pregnant women
Bacteriuria urinary tract or other infection screening for pregnant women
BRCA counseling about genetic testing for women at higher risk
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for women at higher risk
Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and other women at higher risk
Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
Domestic and interpersonal violence screening and counseling for all women*
Folic Acid supplements for women who may become pregnant
Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
Gonorrhea screening for all women at higher risk
Hepatitis B screening for pregnant women at their first prenatal visit
Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*
Osteoporosis screening for women over age 60 depending on risk factors
Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
Sexually Transmitted Infections (STI) counseling for sexually active women*
Syphilis screening for all pregnant women or other women at increased risk
Well-woman visits to obtain recommended preventive services*

For more information you can visit the Health Resources and Services Administration’s page on Women’s Preventivite Services Guidelines page hosted by the U.S. Department of Health and Human Services or the Preventative Care Benefits page from HealthCare.Gov.

 

Vol. 8 October 10th, 2013

Health-Care Dates to Remember:

March 31, 2014

The Washington Health Benefit Exchange, aka www.WAHealthPlanFinder.org, is the place to sign up for Medicaid and Subsidized Insurance for low income families. The end of the open enrollment is March 31st, 2014.

Regular individual and family enrollments continue year round. We have a good choice of insurance carriers available. Please send me your friends.

November 15, 2014

The start of open enrollment for policies effective January 1st, 2015. This is also a time to switch plans or switch carriers. The open enrollment ends January 15, 2015.

To date over 270,000 people have enrolled through the Wash Exchange. The site however can be cumbersome and uncooperative – however it has been gradually improving.

Recently I helped three clients purchase individual insurance. Three intelligent, fun guys. Some aspects of my work are great. One of them is computer literate and technology savvy. He had spent 8 hours on the www.WAHealthPlanFinder.org web site. 8 hours! We had coffee, talked for an hour or so and he came to a decision.

Anther client, a smart guy with a PhD, was also frustrated with the site. Eventually he called me for help. He purchased a policy on paper….which was easy for both of us. Quick and simple.

I am sure there are many success stories – 270,000 of them I guess. But it is not always easy or quick to use the exchange site.

Groups policies renew annually at the month of their renewal date, as they always have.

 

Live Nation, The Exchange, & Mick Jagger

Rolling Stones Concert StageThe largest producer of popular musical events in the world is Live Nation. (who knew?) They produce 150 events in Washington State each year and around the world. You can get more information on them and the events they host on  CheapoTicketing.

Washington Health Plan Exchange has launched an outreach effort with Live Nation. www.livenation.com. It is youth oriented and much hipper than Ticketmaster.

Mick JaggerOutreach will take place through Live Nation websites, print and radio ads, and social media. This is a new and different platform to educate young adults.
Enrolling healthy young adults is critical to make the ACA a success. It is critical to keep the premiums down. These individual products are all one community pool for experience (claims). We needt as many young people as possible to enroll. That is the main factor to keep the rates low. If you know someone, especially someone young who is uninsured please forward this newsletter to them.

Live Nation PosterIf the average age in the pool next fall is in the forties or higher than the annual renewal rates will be much higher. And no one wants that! So encourage young people in your life to enroll and to check out Live Nation in a few weeks.

I am a Beatles fan myself but thought some of you would enjoy this picture of Mick from the Live Nation web site plus some music as a reward for reading to the end. He looks doe eyed and sweet in this video montage to Satisfaction.

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Thank you for coming!  Please email ann@assurehealthinsurance.com for more information while we update our website.