Texas Republicans want to deny STD and HIV screenings under ACA

In an article in Politico by Alice Miranda Ollstein called Obamacare back in court as Texans challenge coverage for STDs and HIV care,” yet one more try to gut certain preceived, unsavory provisions will be headed toward the Supreme Court. A few paragraphs are below, with a link to the article at the end:

“This challenge, filed in March of 2020 by a group of Texas residents and employers and backed by former Trump officials, argues that the ACA’s preventive care mandates violate the Religious Freedom Restoration Act and that forcing people to pay for plans that cover STD screenings and HIV prevention drugs will ‘facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use….’

‘Ending the requirement that preventive services be free to patients will have negative health and financial consequences for millions,’ warned Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation.

The Biden administration is arguing that the case should be thrown out because the Texans do not have legal standing because they aren’t being harmed by their insurance covering preventive services — a line of argument that has been successful in past defenses of the Affordable Care Act.

They also argue that there’s a clear government interest in preventing the spread of HIV and STDs for the health of the population at large which justifies the policy.”

The Religious Freedom Restoration Act has been used like a hammer since it came about to legislate some version of morality that suits a strident set of religious folks. Since many teens are going to have sex whether their minister or parents tell them not to and often it will be unprotected sex, having preventive coverage against STDs and HIV is important. And, with prostitution being the oldest profession and drug use more rampant now that drug companies have hooked people on pain-killers which are more expensive than heroin, exposure exists even to the teen and adult children of the most pious of us.

I have used this example before, but a pretty devout friend noted church parents would be astounded at the level of unleashed promiscuity that goes on even at the most ardent of religious colleges. College students are going to have sex. And, my guess is they will like it and want more. Further, I do not think whether their plan covers STD or HIV prevention will be too much of a factor in that decision. If Rx is a factor, it will likely be around a Plan B pill or daily birth control.

If certain ministers and priests are so concerned with sexual promiscuity, then they may want to govern some of their fellow ministers and priests about their sexual misconduct. While I fully recognize that the significant majority of religious leaders do not do these things, predatory sexual behavior is not good form for a religious leader.

Let’s protect people with health care preventive options. Health care is a private matter and is no business of a minister or even the parents, once the child is legally an adult.

https://www.yahoo.com/entertainment/obamacare-back-court-texans-challenge-110000749.html

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Navigating medical customer service – a reprise

The following was written a few years ago, but I thought I would repost this as it might help some. By the way, some of these suggestions might serve you well in other customer service experiences with banks, retail, supplies, etc.

Before I share a few observations and experiences, let me first note that too many Customer Service Representatives (CSRs) are likely understaffed and undertrained to do the jobs they are asked to do. The healthcare system in the US is complex with a lot of moving parts, including consolidated entities on the provider side and insurer side. In other words, there are plenty of opportunities for the system to fail the customer, provider and insurer.

Through all of this, the patient has to be the navigator of his or her customer service experience. Otherwise, the patients may not realize they are not being treated fairly. As evidence that I am not personalizing this more than I am, let me mention two things.

First, I have a friend who runs a successful business advocating for insured patients. Her firm is hired by companies to help their employees and retirees navigate the healthcare insurance system. In essence, they advocate to get the insurers to pay for what they say they will in plan documents. No more, no less.

Second, as a retired benefits manager and consultant, I am familiar with the complexities, but there are people who know them far better than I. So, what concerns me is people who get maltreated  by the system and don’t know they can push back or don’t feel comfortable in so doing. The various acronyms, footnotes, poor communications, entities and touch points are confusing.

Rather than lament issues, let me offer a few tips to help in the navigation.

– If you need a pre-authorization for a surgery or procedure, start at least a week before or as soon as you can. Ask what they need and make sure they know who to call. An increasing number of providers are putting the burden more on patients to get the process started.

– On any call or reach-out, save emails or notifications, write down notes, names, dates and phone numbers – there are many, especially with centralized functions for smaller doctor offices. Recently, I was given multiple numbers to call (and addresses) from each party.

– Read your EOBs – Explanation of Benefits – including the footnotes as to why something was unpaid or pending. There may be an action needed on your part. If you have a non-ACA, non-Medicare or non-employer plan, there may be a need for medical information to confirm this is not a pre-existing condition.

– If you feel uncomfortable with asking questions of your doctor or insurer, write the questions down or include someone to advocate for you. Don’t be afraid to ask what someone said as it can be confusing or the person may not be the best communicator. And, if it is a major surgery or procedure, it is more than OK to seek a second-opinion.

– Follow-up. This is critical. Hand-offs are made to do things and the receiving entity may not confirm it has the ball. As a result, while you are waiting, nothing is happening. If medical records need to be there in 30 or 60 days, follow-up 10 – 15 days before those deadlines.

– Finally, be as diplomatic and polite as you can, but sometimes it is hard. So, be prepared to say something like, “I am sorry to be a pain, but this is frustrating.” Also, if urgency is needed, please share that need. Some readlng this may note there are websites to facilitate this process, but too often, the website does not do what you think it is doing. It may just be recording a query and not codifying an action. You may be surprised how frequentIy I have to read to the CSR what another part of the company sent me.

Again, there are many fine people in these positions who want to get things right for the patient. It is often said, good people make up for a bad structure.  Yet, it should not be as hard as it is. Until it is made easier, you must be the navigator of your customer service.

Please feel free to share your ideas and reactions.

*Note: If you simply cannot pay hospital bill after the above gets resolved, hospitals have processes in place to request an abatement to some or all of the bill. Usually, a weblink or phone number on the bill can be found. The process is not too unwieldy, given its nature. Sometimes the answer is no, but it is not uncommon for them to cut something out of the bill. Given some of the numbers are multiple tens of thousands, anything helps.

The pandemic risk is exponential, not arithmetic

I read today in The Charlotte Observer the president called the North Carolina governor asking for full opening of the Republican National Convention (RNC) with no social distancing or masks required. Think about this. He has the nomination. He just needs the delegates to vote on it. Yet, he is advocating the gathering of Republicans which heighten the risk by people who believe him when he says these protocols are not needed.

Pandemics work exponentially, not arithmetically. Let’s just say 0.5% of the people at the RNC get infected. That is 250 people who expose people serving food, ushering, securing, guiding them around Charlotte. That is 250 people who take the risk back to their communities to expose their families, friends and communities. On February 28, a night the president still called the Coronavirus a hoax, we had the first recorded American death due to COVID-19. We now are passed 105,000 on May 31, three months later. The question to ask is it worth 250 people infected in late August, that will cause a much large number of deaths come the day of the election?

I want Trump supporters to realize the risk the president is placing on the Republican party and others just so he can hear applause at the RNC. Yet, many citizens are smarter than this president and other politicians. While masks being worn by Democrats and Independents exceed 80%, 58% of Republicans are wearing masks, which means more are than are not. So, if this convention occurs without limits, will they come? If they do have the RNC, just maybe only the delegates and a few supporters actually show up; that would help the exposure immensely, but not rid ourselves of it.

Let me update a few ratios in closing. As of today, the US has 5% of the global population and 28% of the COVID-19 deaths. Thinking we solved this problem is a huge mistake in overconfidence and is yet more evidence of misinformation to gloss over the problem. Those US deaths tally 105,000 and counting as of May 31. Remember, we just crossed 100,000 last week. The summer weather will help, but we must keep our social distancing, keep good hand washing hygiene, wear masks in stores, in spite of what some influencers may tell you. It is only your and your family’s health we are talking about.

Medical errors are a problem – here are some thoughts on how to reduce them

Earlier this week, a US health news piece entitled “In a review of 337,000 patient cases, this was the no 1 most common preventative medical error” by Meera Jagannathan was made available on msn.com. This article echoes the findings of two pieces I have referenced previously, the first, a book called “Internal Bleeding: the truth behind American medicine’s terrible epidemic of medical mistakes,” written in 2004 by two internists Dr. Robert Wachter and Dr. Kaveh Shojania. The second was the Leapfrog Study which looked at deaths caused by medical errors toward the turn of the century. A link to the recent article is below.

The article reveals the results of four medical studies that analyzed medical death rates from 2000 – 2008. Of the just over 251,000 medical deaths, 9.5% of the deaths could be attributed to medical error. In other words, 1 out of 10 deaths could have been avoided as they resulted from a medical error.

The article focuses on nine things that should be done to reduce medical mistakes. I will just list them, but please click on the article link below.

  1. Make sure you fully understand the procedure and why it is necessary.
  2. Brief the doctors on your allergies, health conditions and medicines.
  3. Don’t assume every provider has access to your records.
  4. Bring a friend or family member if the patient is not good with asking questions about what is happening.
  5. Keep close track of your medicines and results.
  6. Make sure the doctors and nurses wash their hands.
  7. Research wisely.
  8. Don’t be afraid to speak.
  9.  Ask providers what they are doing to prevent  mistakes.

The Leapfrog study noted three things to reduce deaths due to medical errors.

  1. Have complex surgeries performed in centers of excellence where they have done multiple hundreds or thousands of the procedure.
  2. While dated, poor handwriting of prescriptions or instructions caused mistakes. Most hospitals now have electronic orders, but be sure you understand what is being asked or prescribed.
  3. Make sure there are doctors on site and not just residents in intensive care units.

I wrote earlier about the book “Internal Bleeding,” so I provided a link below. Reviewing that summary and comparing to the above, here are a few more thoughts from that post as well as a few others thrown in.

  • write a summary of your and your family medical history
  • write down what your symptoms are – people see the white coat and forget.
  • if you are not sick or injured, the hospital is the last place you should be; some hospitals incent ER doctors to admit patients; ask questions about this.
  • know your environment; if you have bladder or some other cancer it may be environmental not familial. Bladder cancer is a bellweather environmental caused cancer.
  • ask for other pain medications beside opioids; they should be only used for severe pain and for short durations.
  • introduce yourself to all providers; make sure they know who you are.
  • Complete the prescription regimen and don’t stop when you are feeling better.

Medical professionals do not want medical errors either. So, help them help you. And, if you have trouble advocating for yourself, take a trusted person with you.

https://www.msn.com/en-us/health/health-news/in-a-review-of-337000-patient-cases-this-was-the-no-1-most-common-preventable-medical-error/ar-AAEGPVF?ocid=spartandhp

https://musingsofanoldfart.wordpress.com/2012/07/28/internal-bleeding-be-your-own-health-care-advocate/