How Profit Pressures Can Crush Everything Good About Efforts to Improve Healthcare

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A key District court decision against United Behavioral Health (UBH), a subsidiary of the country’s largest insurer United Healthcare and the country’s largest behavioral health provider, noted that UBH created internal policies that illegally denied treatment to thousands of patients, and put profits over patients. The case will now move into the remedy phase where penalties will be determined. United Health Group is expected to appeal.

If we continue to put profit over health, the U.S. health system will continue its slide towards becoming a second rate health system that delivers quality care only to those with the highest income. The only way out is through the consumer.  Washington is too embroiled in a political tug of war, insurance and health providers only see financial pressures growing due to rising costs and an ageing population, and medical records providers try to hold on to their market share by blocking the data sharing that is critical to achieving quality outcomes.

Blood Pressure Drug Recall

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The recent recall of drug pressure medication Losartin (25mg, 50mg, and 100 mgs) is part of a larger investigation by the U.S. Food and Drug Administration (FDA) into multiple generic high blood pressure medications. Losartin is part of a class of drugs called angiotensin II receptor blockers (ARB).

The FDA has been working with multiple drug manufacturers to identify and correct multiple impurities in this class of drugs. The complete list of Losartin products in this recent recall is available from the FDA.

The current recommendation for patients taking and ARB drug is to contact their pharmacist or physician to discuss whether a replacement is necessary. Not all ARB drugs contain impurities.

Only You Are Your Best Advocate 

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As a patient in the U.S. health care system you will face many obstacles to getting safe, quality, and affordable health care. To overcome them, you must advocate for yourself and lead your health care team. You’ll get a big assist from many primary and specialty care practices transitioning into medical homes and providing patient-centered care.

You are the core of your health. You make the most of the choices that impact your health. You certainly feel or suspect that something may be wrong long before anyone else. You decide when and how to engage with the health care system.

The crucial steps when advocating for yourself are:

Continue reading “Only You Are Your Best Advocate “

Is Doctors Lying to Patients Ever OK?

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We all know the healthcare system is difficult at best and more likely just broken. A recent Medscape poll of 286 physicians and 362 RNs and APRNs reported that at least some physicians felt it was OK to lie to patients about a medical error (17%), prognosis (14%), and to get treatment (24%).

There’s more information about lying to patients in this report from Medscape.

While it’s understandable that any clinician might lie if they felt they were helping a patient, doesn’t that reinforce a dangerous presumption that doctors know better than patients what’s in the patient’s interest?

Two questions that need to be asked in future polls are “how do patients feel about doctors and nurses lying to them,” and “how will we activate patients to contribute to their care teams if we don’t trust them with the truth?”

Free Patient Navigation for Medicare Beneficiaries

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Making your way through complex medical systems, doctors appointments, and treatments can be overwhelming. Medicare beneficiaries can get free help with care coordination, medication management, explanation of a diagnosis or treatment, and connections to resources through the Medicare Quality Improvement Organization. Just complete the brief form on their home page. If you need additional assistance finding help for your health care journey, complete the contact form at aPatientsPlace.com.

New Medicare Cards

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medicare recently sent 61 million new Medicare cards to members. If you have not received a new card take these steps:

1. Call 1-800-Medicare. they will verify your identity and address, and help you get a new card.

2. Log into your Medicare.gov account to retrieve your new Medicare number or print your official card.

3. Ask your primary care practice or medical provider. they may be able to look up your Medicare number for you.

Here’s the link to Medicare’s new card web page if you want more information. If you need additional help fill out and submit the contact form.

11 Essential Tips for Consumers to Get High Quality Healthcare

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1. Be involved in all parts of your healthcare.

2. Ask questions whenever you are unsure of anything related to your healthcare.

3. Find out how much you will be expected to pay before appointments, tests, and treatments are started.

4. Request copies of your test results, doctor’s notes, and medical record when you check in for any appointment, test or treatment.

5. Always find out how much successful experience your health providers have at diagnosing and treating your specific condition.

6. Keep and organize copies of your medical records, test results, and interactions with all of your health providers.

7. Learn as much as you can about your illness and providers from trustworthy sources.

8. Contact your insurance provider as much as is needed to understand your coverage, your insurance provider’s guidelines, and your financial responsibilities.

9. Negotiate fees with doctors and treatment providers whenever possible.

10. Review your bills for mistakes, or have someone do it for you; its free.

11. Consult an experienced specialist after a serious diagnosis.

Get free help navigating your health insurance, appealing insurance denials, and accessing care through the Patient Advocate Foundation, or call 800-532-5274. Go to https://apatientsplace.com/help-guidance/ for hundreds of links to free help with your healthcare.

The White House, HHS, and CMS Are To Slow Ensuring Patient Access to Medical Records

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Pretty much everyone agrees that helping patients understand and engage in their own health, well being, and health care is an important part of a safe, cost-effective, and high performing U.S. health system.

It makes no sense that despite the evidence that patients are still facing significant barriers to getting their own medical information., leading health care organizations, including the White House, U.S. Department of Health and Human Services (HHS), The Centers for Medicare and Medicaid Service (CMS), and leading payers sit on their hands when providers do not remove barriers and provide patients easy and affordable access to their own medical information.

The solutions are not hard or technological. Today, with only a few exceptions, medical records are kept electronically, and the cost to transmit data is almost nothing.

Access would be opened and barriers lowered if these leading organizations would simply publicizing organizations not complying, reducing reimbursement payments, and assessing penalties for non-compliance.

Unfortunately for every American, the White House, Congress, HHS, CMS, and large commercial health insurance companies, have not taken much leadership in solving this long-standing problem. Sure, they’ll offer hundreds of millions of taxpayer dollars for health providers to convert to electronic medical records, and even announce new initiatives with great names, like “MyHealthEData,” intended to “trigger innovation, advance research to cure disease, and provide evidence-based treatment guidelines.” God forbid they actually helped Americans get the cost and medical information they must have to manage their own health.

Fortunately, even without leadership form these healthcare powers, some consumer driven organization like Apple or Amazon will eventually figure out how to give control of our medical records back to consumers and monetize providing consumers a simple, secure, and unobstructed digital service for collecting, storing, retrieving, and distributing their own health records.

Help with Unexpected and Expensive Medical Bills

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Take these steps when you get an unexpected or expensive medical bill.

  1. Contact the sender and request an itemized bill.
  2. Contact your insurance provider and find out if the sender is in your network. Ask your health insurance provider to explain your bill(s).
  3. If the bill is from a recent trip to a hospital emergency department contact your state health insurance department to find out the state laws against balance billing. Here’s the link to a list of state insurance regulators from the National Association of Insurance Commissioners: http://www.insurance.naic.org/state_web_map.htm

Many more options for handling unexpected and expensive medical bills are detailed in Lower Your Healthcare Bills and Medical Bill Financial Help.

These options include;

  1. Finding mistakes.
  2. Disputing the charges.
  3. Applying for charitable care.
  4. Appealing for insurance coverage.
  5. Negotiating payment discounts and plans.
  6. Public Funding

There are also free medical bill review and advocacy services available.

Medical bill review company CoPatient put together a step-by-step medical bill payment guide that’s very easy to use. You can also get free help from aPatientsPlace.com experts.