Insurance and Providers Battle - Patients Suffer
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A Good Day To Advocate for Better Healthcare
If there are subjects you’d like to see or improvements made, please let me know using the comment button below. One item in work is how some medical networks are choosing to not accept patients from Medicare Advantage plans because these commercial insurers are driving down what they will pay providers to keep their profits up. More on this later.
Videos of these newsletters appear on Youtube on this channel. Let me know what you think.
Medical Abortion is Safe - Of Course
The Food and Drug Administration was correct when it deemed the drug safe to prescribe to patients in a virtual appointment? A study published Thursday in Nature Medicine looks at abortion pills prescribed via telehealth and provides more support for the FDA's assessment that medication abortion is safe and effective. The researchers found that the medication was effective – it ended the pregnancy without any additional follow-up care for 97.7% of patients. It was also found to be safe – 99.7% of abortions were not followed by any serious adverse events. (NPR)
What a surprise - NOT.
Insurance & Provider Giants Battle - Patients Lose
I received a note from a friend of mine that his health insurance company may no longer have a contract with his healthcare provider network. It has taken a while to make sure that he finally has the right doctor with the right care for his serious condition and he is right to be concerned.
The University of California Health System and Anthem Blue Cross have been at odds over whether to continue their contract. UC Health is a preferred Blue Cross provider. UC Health accused Anthem of not negotiating in good faith, while Anthem leaders retorted that UC Health had demanded too much and rebuffed the insurer’s request for administrative efficiencies.
In fact, roughly 8 million Anthem members in California were at risk of losing in-network access to UC Health’s vast network of prestigious hospitals and medical facilities, which could have left them with much higher out-of-pocket expenses. While not all patients were made aware of the situation, Anthem notified some enrollees they would be reassigned to new primary care doctors if no deal were reached.
Imagine having to find a new doctor in the midst of cancer treatment or if your critical surgery or cancer treatment is now your financial responsibility.
A few days ago a settlement was reached but the trauma inflicted on those patients in the midst of treatment for life threatening conditions is just cruel.
As mergers occur in the health industry, patients are left with fewer choices. Any time there are disputes, disruptions are felt more widely. And such fights rarely result in lower costs for consumers.
A KFF analysis found widespread evidence that consolidation of health providers leads to higher health care prices for private insurance. The same brief from 2020 found some evidence suggesting that large, consolidated insurance companies are able to obtain lower prices from providers, but that has not necessarily led to lower premiums for patients. An analysis of premiums in California found that between 2010 and 2018 “health insurance premiums for job-based coverage increased more than twice the rate of growth for wages
Did you catch that? Providers want more, insurance companies want more, consumers pay more.
You already know the answer. If we had a single insurance trust to which every provider network was linked the problem goes away.
ACTION
Massive insurance companies fighting with massive provider networks and patients are made to suffer and pay more. Universal Healthcare means everyone covered, cradle to grave for hundreds of billions of dollars less than we spend now.
Let Congress know they can fix this. Their contact info is in the Resources section.
Use Resistbot to send the email below by texting SIGN PIUZAK to 50409.
“I am your constituent and I just learned that 8 million patients were put at risk of having to find new doctors, some in the middle of treatment for serious issues like cancer because insurance giant Blue Cross and University of California Health did not want to come to terms. 8 million people at risk that is about 25% of the state.
If we had Universal Healthcare like HR 3421 then all of us would have insurance and Global Budgets outlined in the bill would insure that providers costs are fairly covered so this kind of mistreatment of patients would disappear. I strongly urge you to pass universal healthcare. Every one of your constituents needs it.”
Extra Credit Action
We have covered Medicare Advantage (commercial insurance - not Medicare) cheating over and over. Physicians for a National Health Plan estimates their level of fraud to be between $88 billion and $120 billion yearly.
An important letter calling out corporate profiteering in Medicare is currently circulating in Congress, and we need YOUR U.S. House Representative and your U.S. Senators to sign on!
Introduced by Sen. Elizabeth Warren and Reps. Pramila Jayapal, Rosa DeLauro, and Jan Schakowsky, this letter demands crucial reforms that would crack down on the worst behavior of insurance corporations, and expresses support for much-needed improvements to Traditional Medicare.
You can encourage your legislators to put their constituents first, and to sign this letter in support of a truly public Medicare program. Click on this PNHP link to send the letter.
RESOURCES
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
By phone: (202) 224-3121
By email: democracy.io
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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Thank you, Alan!
We just received notice that Legacy Health and Regence MedAdvantage have so far failed to reach agreement on continuing their contract so that we will not have access to the network of doctors closest to us and who know us best. Legacy’s letter to us puts us in the middle of the conflict between these two companies. That should never happen.
When people sign onto a Medicare program, including Medicare “Advantage,” they are a member of that program for a full year. The decision to choose that insurance involves making sure that all of your doctors and local health facilities are in network, otherwise you can face out of network, higher costs at your time of need.
But the way the calamity of our healthcare system is structured today, the responsible parties point fingers at each other, and hospitals and healthcare facilities are understaffed while dedicated medical professionals labor under relentless workloads. In this underfunded and understaffed system that is profit-based, monies are siphoned off to top executives and investors, so everyone suffers, including patients.
Medicare was established as a safety net providing medical care to elderly and disabled people. Because of political opposition gained through corruption, it is underfunded, so it underpays medical providers and their healthcare settings. When I was a provider who accepted Medicare I was overwhelmed by more people than I could treat. People who can pay a little more for access to medical care are offered the privatized Medicare "Advantage" system organized under huge insurance companies. These companies pay providers a bit more while the Medicare safety net is kept uncompetitive.
Universal healthcare is the way to go, to take the corruption out of the system and adequately monitor expenses so people don’t profit from others’ difficulties. it is time that we mount the political will to make this happen!