Insurers Stiff Providers and Patients
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A Good Day To Advocate for Better Healthcare
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Anime for Universal Healthcare
My wife and I occasionally watch anime - cartoons. These are often from Asia. We stumbled upon one called Parallel World Pharmacy. I’m sharing this because the message of this series is that medicine and healthcare should be affordable and available to everyone. They also point out that society needs to make sure there is sufficient affordable daycare to help all families. Here is the official description:
“When pharmacologist Kanji Yakutani dies, he probably wasn’t thinking he’d be reincarnated as a boy apprentice in a medieval world. The distinguished medical researcher finds himself now surrounded by quack medicines swindling the common good. With his past experience and a new set of supernatural powers, he’ll go from cutting-edge medical technology to now reforming healthcare for all!”
Parkinson’s & Deep Brain Stimulation
More than 10 million people globally live with Parkinson’s disease, for which there is currently no cure. Deep brain stimulation (DBS) is a surgical treatment that helps alleviate some movement symptoms of the condition. People with Parkinson’s can still encounter movement issues when using current DBS.
Good News! Researchers from the University of California, San Francisco found that adaptive deep brain stimulation that uses AI can reduce the time a person experiences their most bothersome Parkinson’s disease-related symptom by around 50%. (Medical News Today)
The study was recently published in the journal Nature Medicine.
An adaptive DBS continuously monitors a brain signal that best tracks a patient’s symptoms. When the algorithm detects a change in the brain signal, it adjusts stimulation intensity in real-time. This means the device will deliver the correct amount of stimulation that the patient needs to adequately control their symptoms.
To implement adaptive DBS, the authors developed a data-driven analysis pipeline that identifies brain signals that indicate changes in symptoms, as well as the adaptive DBS algorithms embedded within the research device.
So Cool.
Cybersecurity and Medicine
When medical computer systems are attacked, everyone suffers. Patients can be left with insufficient care at critical moments. Doctors may be unable to get patient history or test/lab/imaging results. Pharmacies can’t verify and process prescriptions. Payments can become non-existent and insurers may be unable to authorize payments/treatments. Just a nightmare.
Cyberattacks against the U.S. health care sector more than doubled between 2022 and 2023, according to the Cyber Threat Intelligence Integration Center.
In February, a devastating attack on Change Healthcare, a company that processes health care payments, wreaked havoc across the U.S.
In May, a ransomware attack hit Ascension, a Catholic health system with 140 hospitals in at least 10 states. Doctors and nurses working at Ascension reported medication errors and delays in lab results that harmed patient care.
The Biden administration announced some protections meant to tighten cybersecurity in healthcare. The announcement included a plan for tech companies Google and Microsoft to offer various cybersecurity services for free or at discounted prices, to hospitals that otherwise could not pay for the latest and best cyber-defenses.
The government’s announcement contains also a number of valuable services. It also includes, access to the HHS tools and IT recommendations site and is valuable. If you are in the field have a look - or make sure the IT department looks. They cover a wide range of best practices to protect systems.
These will help, but there is something else that will help and it has to do with the way the US has chosen to store data.
The credit card in your wallet likely has a chip, that is used to authorize purchases and can save a tremendous amount of information. It was invented in France in 1998 for the Carte Vitale, the French Health insurance card. Patient medical records are all there on the card. That means that if there is a cyber attack the doctor or pharmacist can still access the patient’s medical records and know what appropriate doses are, whether there are allergies to medications, and what treatments have or have not worked so far. The patient’s data. of course, is backed up elsewhere when modified.
While we are on the software subject let me point out that the format for medical records are common in many countries but not here. When there is universal health insurance it is to everyone’s benefit to be able to share data.
We have had electronic records for more than a decade and the government paid doctors to transfer paper files to electronic form but we did not demand a common format, because we chose to allow industry to seek proprietary advantage with private formats.
Specifically, there are no standards for semantic interoperability of health care data; there are only syntactic standards. This means that while data may be packaged in a standard format it lacks definition, or linkage to a common shared dictionary. Our national implementation did not have a national interoperability goal.
Anyway, if we had Universal Healthcare, we could all have a smart health insurance card, use common electronic health records and many of the healthcare cybersecurity issues we face would be by the wayside.
Here is a link to a recent NPR story on healthcare and cybersecurity.
Insurance Interference in Care
A recent investigation into mental healthcare by Politico revealed insurance company behavior that is driving psychologists out of networks. I have friends who have left the profession in the last few years because they experienced this behavior first hand.
The techniques included keeping reimbursement rates very low, cutting paid session time to 45 minutes, hounding providers for an end date of treatment, and of course denying care claiming that symptoms were not sufficiently severe to warrant treatment. Much of this for patients that were suicidal. Psychologists whose claims were denied were left on hold with customer service for hours. One estimated that he placed over 20 calls to try and be reimbursed and could have earned about $5000 in the time he wasted with the insurance company.
Anneliese Hanson, a former Cigna manager and therapist, worked in their behavioral health department and said that customer service problems can be traced, in part, to a decision several years ago to outsource these calls to the Philippines and that overseas employees lack access to the full claims system and often are unfamiliar with complex medical terminology in English. She quit Cigna and returned to private practice and then they put her on hold for 2 hours when she tried to get her claims paid.
“The idea is if you make it so frustrating for providers to follow up on claim denials, they’re just going to give up and the insurance company is not going to have to pay out,” Hanson said.
It couldn’t be clearer that insurance companies want to acquire the patient’s premiums and not make the payments.
Guess what legislation covers mental health care. You already know and they can do it in a patient centered way making sure providers are paid for needed care. It is a national health insurance trust. Let’s let our elected representatives know.
Action
Use RESISTBOT via [Apple Messages / WHATSAPP / MESSENGER] or by texting SIGN PZYIGT to 50409 on your cell phone to send this message.
“I am your constituent and I want you to know that insurance companies claim to cover mental health care but are shortchanging patients and providers alike.
They deny claims for treatment, make providers wait hours to talk to customer service to try to get reimbursed, cut the allowable the treatment time, and seek to cut off treatment. They even do this for patients who are suicidal. As a result providers are leaving the insurance company’s networks and leaving so many patients without care. Here is a reference to the ProPublica/NPR report for your legislative staff to review.
https://www.propublica.org/article/cigna-medical-director-doctor-patient-preapproval-denials-insurance
HR 3421, the vastly improved Medicare for All Act covers such services - check Title 2, a), section 5 on page 11. Here is the text for you https://www.congress.gov/118/bills/hr3421/BILLS-118hr3421ih.pdf
We sent you to Congress to fix problems. I don’t want you to put a band aid on this wound with some obtuse rule for insurance companies that they will weasel around and continue to cheat patients and providers. I want you to pass universal healthcare for all of us and make sure all of us can get the treatment we deserve, not the runaround from insurance companies.”
Find My Elected Officials
Contact State and Federal Representatives - phone and email
Healthcare Advocacy (Us) Website
Our Newsletter resources including reproductive healthcare - Healthcare Advocacy Reading List
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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