Monthly Archives

January 2017

Tooth infection suddenly kills Sacramento truck driver, 26

By | Staying Healthy

What started as a toothache led to this dad’s heartbreaking death.

BY SAMMY CAIOLA

Nataliya Kondratyuk 22, with her two daughters Maya Kondratyuk 11 months, left, and Vanessa Kondratyuk 2, at a relative’s home in Antelope on Tuesday, January 31, 2017. Nataliya’s husband Vadim Kondratyuk, 26, died recently of complications from a dental infection. Randall Benton

Nataliya Kondratyuk 22, with her two daughters Maya Kondratyuk 11 months, left, and Vanessa Kondratyuk 2, at a relative’s home in Antelope on Tuesday, January 31, 2017. Nataliya’s husband Vadim Kondratyuk, 26, died recently of complications from a dental infection. Randall Benton

Vadim Anatoliyevich Kondratyuk was just 26 and had two young children. He was driving a truck route from Truckee to New York last Tuesday when he started to feel pain in the lower left side of his mouth, said his wife, Nataliya Kondratyuk. He pulled over in Oklahoma to see a dentist, who diagnosed an infection and prescribed antibiotics.

The pain subsided at first but then worsened, and Vadim Kondratyuk called his wife several times while driving to complain about the tooth. He made his delivery in New York, but his mouth was uncomfortably swollen and he couldn’t make the long drive home alone. His brother flew to New York to escort him back to Antelope where Nataliya, 22, was anxiously waiting with their 2-year-old and their 11-month-old.

On the way, Kondratyuk’s breathing became labored and he grew pale, Nataliya said. His brother rushed him to a Utah hospital, where he was placed on oxygen and then flown to a larger facility in Salt Lake City. Doctors there prescribed stronger antibiotics and put him on dialysis, but the tooth infection had spread to his blood and lungs, she said. She flew to his bedside and was able to say goodbye before he died on Monday morning.

We have dental coverage starting at $15 a month per adult… visit Health Life Dental Insurance to see how affordable it is to keep a healthy smile.

 

By Executive Order: MINIMIZING THE ECONOMIC BURDEN OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT PENDING REPEAL

By | Health Insurance

Trump Executive OrderFor Immediate Release

January 20, 2017

EXECUTIVE ORDER

– – – – – – –

MINIMIZING THE ECONOMIC BURDEN OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT PENDING REPEAL

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

Section 1. It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act (Public Law 111-148), as amended (the “Act”). In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.

Sec. 2. To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.

Sec. 3. To the maximum extent permitted by law, the Secretary and the heads of all other executive departments and agencies with authorities and responsibilities under the Act, shall exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs.

Sec. 4. To the maximum extent permitted by law, the head of each department or agency with responsibilities relating to healthcare or health insurance shall encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.

Sec. 5. To the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions.

Sec. 6. (a) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

DONALD J. TRUMP

THE WHITE HOUSE,

January 20, 2017.

Trump order paves way for agencies to weaken health law

By | Health Reform

By David Morgan and Susan Cornwell | WASHINGTON

REUTERS/Carlos Barria

REUTERS/Carlos Barria

President Donald Trump is ordering federal agencies to undermine Obamacare through regulatory action, a move that could weaken enforcement of the requirement for Americans to buy health coverage and give insurers leeway to drop some benefits.

Trump’s first executive order, signed hours after taking office on Friday, directs the federal government to scale back regulations, taxes and penalties under President Barack Obama’s healthcare law, the Affordable Care Act (ACA).

Republican lawmakers, who are working on new legislation to repeal and replace Obamacare, praised the order as showing Trump’s commitment to gutting the program and lowering steep healthcare costs they blame on the law.

Trump did not specify which parts of the program would be affected by his order, and any changes are unlikely to affect the government-funded or subsidized insurance plans covering more than 20 million people in 2017.

Trump’s nominee to head the U.S. Department of Health and Human Services, Georgia Representative Tom Price, has said there was no plan for “pulling the rug out” on millions of Americans’ healthcare as a replacement is designed.

But the scope of Trump’s order drives home the uncertainties of that process, healthcare experts said.

“The order could affect virtually anything in the law, provided it is couched as a delay in implementing the law,” said Stuart Butler, a senior fellow at the Brookings Institution.

Trump’s administration could decide to delay or not enforce the individual mandate, a requirement that Americans buy health coverage if they do not already have benefits from their employer or the government, as well as a similar requirement for employers of a certain size to insure their workers, experts said.

Others say those changes, if not handled carefully, could force insurance premiums higher and make healthcare less affordable for Americans – outcomes that Trump and Republicans say they are trying to avoid.

“The administration has to run a really fine line here,” said Dan Mendelson, chief executive of the Washington-based consulting firm Avalere Health. “They’re not going on record as saying what they’re going to do at this point.”

The administration could also alter, or fail to enforce, requirements that insurers cover a basic set of health benefits in all of their plans, from maternity and newborn care to mental health services.

“This could be a signal to the insurance industry that they could offer new products that, for example, didn’t include maternity benefits, in order to attract more sales from people who would prefer a slimmer package,” said Joe Antos of the American Enterprise Institute think tank.

‘FLEXIBILITY’ URGED

Republican Lamar Alexander, chairman of the Senate Health Committee, said last week that Price, once confirmed, could relax requirements for U.S. states to get exemptions from the law, as well as make it easier for states to get waivers on the Medicaid health plan for low-income households.

“Allow states more flexibility to determine the essential health benefits … that’s probably the single most important step that could be taken to create a market where more insurers are likely to sell policies,” Alexander said.

His committee is one of several in the House and Senate working on repealing and replacing Obamacare.

Three of the largest health insurers – Aetna Inc, UnitedHealth Group Incand Humana Inc – have essentially pulled out of the market offering health insurance to individuals under Obamacare, citing financial losses for covering a population that was sicker than they had expected.

The remaining players include Anthem Inc, as well as insurers that specialize in administering lower-cost Medicaid plans, such as Molina Healthcare Inc.

Ana Gupte, a senior healthcare analyst at the investment bank Leerink Partners, said Trump’s executive order could reassure people in the market that Obamacare will be dismantled one way or another.

That could be positive for insurers who would no longer face the law’s health insurance tax, she said. But it could negatively impact acute-care hospitals that have seen more customers and insurers that sell policies to state Medicaid programs, which could shrink in size.

“It’s clear that Congress is looking to repeal the law and that it’s poised to happen with a replacement. This is one more avenue to make sure their agenda is executed,” Gupte said.

ACA Makes Prescriptions Unaffordable – Now What?

By | Health Insurance, Health Reform

Pharma CostsThis year the Affordable Care Act is finding new ways to make healthcare unaffordable for those who do not qualify for subsidies.

In addition to those huge premium increases, the Obamacare plans are clobbering policy holders by covering only generic and “Preferred Brand” medicine.  But wait – there’s more – these named medicines are only covered as a copay on Silver Level Plans and above.*

What a punishing combination – dramatically higher premiums + expensive non preferred medicine covered only after your huge (as high as $7,150 per insured) calendar year deductible is reached.

Here’s how it works – Obamacare plans group medicine into Tiers:

  • ACA (Preventive Drugs Not Subject to Deductible)
  • Tier 1 (Preferred Generics)
  • Tier 2 (Non-Preferred Generics)
  • Tier 3 (Preferred Brand)
  • Tier 4 (Non-Preferred Brand) NOTE:  Some gold plans have a 75-150 copay for non preferred
  • Tier 5 (Specialty)

Your cost share is based on the tier in which the medicine is assigned within the drug list – and it probably won’t surprise you that only 17.9% of the drugs prescribed are actually covered under the Standard Copay Amounts.

To help you understand the prescription drug benefits offered under Blue Cross and Blue Shield of Texas Click Here. These benefits are based on your purchasing medications from a  Preferred Pharmacy – the wrong location can mean higher prices.  To see the Preferred Pharmacy locations Click Here.

So what’s the best solution?

Opt out of Obamacare now (Here’s How)!  Get HUGE savings on Fixed Benefit or Short Term Major Medical, pay for your own medications using GoodRX or through a legitimate Canadian Mail Order Pharmacyand bank the difference!

Click here now to get a quote!  Or call us at 800-257-1723 or click here to book an appointment.

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*Some gold plans have a $75-$150 copay for Non-Preferred Brands.  However, under most plans you must meet your deductible (which could be as high as $7150) before non-preferred and specialty medications are covered .

Younger People Need Long Term Care Coverage

By | Life Insurance, Supplemental Coverage

Long Term Care ChartMost small business employees and owner benefit packages have a glaring coverage gap that is becoming increasingly harder to ignore as baby boomers become older and younger employees become caregivers. I’m referring to insurance that covers long-term care. This is coverage that helps small business employees and owners protect their retirement assets and shoulder their responsibilities as caregivers should they or a family member need extended long-term care services.

Health insurance covers medical services such as doctor visits, hospitalizations and prescriptions. Life insurance provides a death benefit. Disability insurance provides supplemental income when employees can’t work due to illness or injury. And retirement plans help employees build a nest egg. But none of these types of insurance covers the cost of services and support that people need when they can no longer care for themselves because of an accident, illness or cognitive disorder.

That’s where Long Term Care Coverage (available through the purchase of a Living Benefits Life Insurance Policy) fits in. The benefits from Living Benefits Life Insurance can be used by policyholders of all ages who are permanently or temporarily unable to perform at least two activities of daily living (eating, bathing, dressing, toileting, transferring and continence) or who suffer from a cognitive disability. If, for example, you are injured in an auto accident and need help with bathing and dressing, and perhaps need some home modifications, your Living Benefits coverage likely would pay for that.

Long-term care services can be expensive. The cost of long-term care continues to rise year over year in most care settings, according to Genworth’s 2016 annual Cost of Care Study. These costs are increasing, especially for services in the home, which is where most people choose to receive care. Nationally, the median monthly costs for the services of a homemaker or an in-home health aide for 44 hours a week are $3,813 and $3,861, respectively. The national median monthly cost of a private nursing home room is $7,698; assisted living, $3,628 per month; and adult day care services, $1,473 per month.

Contrary to what many believe, long-term care is not for just older people. In fact, our Beyond Dollars Study found that long-term care is increasingly being used for younger policyholders. The percentage of care for recipients 65 years of age and older fell from 81 percent in 2010, the first year of the study, to 60 percent in 2015. This means that 40 percent of people requiring long-term care services are under the age of 65. That same survey also found more long-term claims stem from accidents than from illnesses.

For more information about Living Benefits Life Insurance call us now at 800-257-1723 or click here to set an appointment.

Obamacare Plans Don’t Always Include Top Cancer Centers

By | Health Insurance, Health Reform
Patients always have the right to appeal an insurer's decision to turn down their request for care at a major cancer center. But the chances an appeal will be honored can vary widely by type of cancer and an individual's case. Roy Scott/Ikon Images/Getty Images

Patients always have the right to appeal an insurer’s decision to turn down their request for care at a major cancer center. But the chances an appeal will be honored can vary widely by type of cancer and an individual’s case.
Roy Scott/Ikon Images/Getty Images

Being told that you have cancer can be scary. Discovering that your health insurance plan doesn’t give you access to leading cancer centers may make the diagnosis even more daunting.

As insurers in the plans set up under the Affordable Care Act shrink their provider networks and slash the number of plans that offer out-of-network coverage, some consumers are learning that their treatment options can be limited.

One reader wrote to Kaiser Health News last month saying that she was dismayed to learn that none of the plans offered on the New York health insurance marketplace provides access to Memorial Sloan Kettering Cancer Center in New York City, where she is a patient.

Memorial Sloan Kettering is a well-regarded cancer center that is affiliated with two key organizations: the National Comprehensive Cancer Network and the National Cancer Institute. The cancer center participates in New York’s Essential Plan, which is available to lower income people on the state’s exchange, but doesn’t participate in any of the regular plans designated as bronze, silver, gold or platinum.

The National Comprehensive Cancer Network is an alliance of 27 cancer centers. Member physicians and researchers develop widely recognized clinical practice guidelines.

The National Cancer Institute recognizes many cancer centers for their scientific leadership and research. The 69 NCI-designated cancer centers can offer patients access to cutting-edge treatments and clinical trials. All 27 NCCN centers are also designated by the NCI.

It’s unclear the extent to which these cancer centers, which are often but not always affiliated with large academic institutions, are included in the provider networks of marketplace plans nationwide. A survey by Avalere Health in 2015 found that three-quarters of NCI-designated cancer centers said they participated in at least some exchange plans, and 13 percent said they were included in all exchange plans in their state. However, of the 25 percent of centers that didn’t participate in any exchanges, many were in states with large numbers of exchange enrollees, including Texas and New York, the survey reported.

Does it matter if someone with a cancer diagnosis gets treatment at one of these centers rather than at a community hospital or some other site? Research suggests that it may. A study found that adult patients between the ages of 22 and 65 who were newly diagnosed with one of several types of cancer — breast, colorectal, lung, pancreatic, gastric or bile duct — were 20 percent to 50 percent more likely to die from the disease if they were initially treated at a place other than an NCI-designated comprehensive cancer center.

The study, which analyzed the five-year survival rates of nearly 70,000 patients whose cancers were reported in the Los Angeles County cancer registry between 1998 and 2008, was published in the journal Cancer in 2015.

Researchers hypothesize that the cancer centers’ multidisciplinary approach to decision-making, supportive care and access to cutting-edge treatment, among other things, contribute to the superior outcomes at comprehensive cancer centers, said Dr. Julie Wolfson, a pediatric oncologist at the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham who was a co-author of the study.

“The goal is to find out what is different about these places and then disseminate that to other” treatment sites, Wolfson said.

Often there are factors aside from survival rates that contribute to a patient’s decision about where to go for care, said Dr. Robert Carlson, CEO of the National Comprehensive Cancer Network. Those factors can include support systems that patients already have in place and concerns about nonmedical costs, such as housing and transportation.

“Most patients, if offered the option to go to a major cancer center — especially if it involves traveling — will decline it,” Carlson said.

Some cancer centers aim to give patients access to both types of facilities. City of Hope cancer center’s main academic campus is in Duarte, Calif., in Los Angeles County. That’s the best site for patients when their cancers are rare or advanced, optimal treatment isn’t clear or they could participate in a clinical trial, said Dr. Harlan Levine, the chief executive of the City of Hope Medical Foundation. But the cancer center also owns a network of 14 community cancer clinics located in Southern California for patients who can be effectively treated in that setting, he said.

City of Hope participates in two plans that are offered on California’s exchange, Blue Shield and Anthem, and its physicians are in-network for the exchange’s Oscar health plan. But most people don’t check access to cancer care when they shop for a plan. “Cancer is an infrequent purchase from a marketing point of view,” Levine said. In many cases, patients don’t realize their lack of access until after their diagnosis, when it may be too late.

Cancer centers may try to work with patients to enable their treatment.

“We understand that each patient has a unique financial situation and we work with our patients, especially those in active treatment, to ensure they receive the care needed and that their treatment is uninterrupted,” said Ruth Landé, senior vice president for patient care revenue at Memorial Sloan Kettering. “We have patient financial services representatives available to assist patients who do not have health insurance or whose insurance may not cover all charges.”

Patients who believe that it’s critical to be treated at a cancer center that’s not in their insurance network do have some recourse.

When people receive a cancer diagnosis, it’s “overwhelming,” said Anna Howard, a principal for policy development at the American Cancer Society’s Cancer Action Network. “You may not be aware of the fact that if your insurance plan says you don’t have coverage at a cancer center you can file an appeal.”

Appealing the insurer’s decision doesn’t guarantee success, however.

“Anecdotally,” Howard said, “we hear that it depends on the specific individual and type of cancer.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110.

Surprise medical bills piling up for patients – supplemental coverage may assist in filling in these gaps

By | Supplemental Coverage

In February, Houston lawyer John Mastriani went to see an ophthalmologist after noticing a problem with his vision. The physician told Mastriani he’d suffered a detached retina and needed surgery as soon as possible.suprise-medical-bills-supplemental-insurance-may-help-min

Dr. Keith Bourgeois could do the operation, he said, but a company representative from Mastriani’s new Aetna insurance plan initially said the doctor wasn’t covered, even though his name was listed as in-network. Then, hours later, a different rep said he was.

The next morning, as Bourgeois prepared for surgery, he heard again from Aetna: Now they were saying he, in fact, wasn’t covered. By then it was too late; Bourgeois needed to operate right away to save Mastriani’s vision.

Within a few weeks, the bill came: Mastriani owed more than $5,000.

“This is how bad it is,” Bourgeois said. “It’s become so complicated, the insurance companies don’t even know their own coverage. That happens to us about once a week.”

It’s not just happening at his office. According to a recent report by the Texas Medical Association, which represents physicians, more and more patients are getting slapped with surprise medical bills each year in Texas and across the country. The group blames ever-growing deductibles and the rapid narrowing of insurance networks — the practice of covering only select doctors at certain hospitals — for the surge in billing surprises.

Worse in emergency rooms

In a recent survey of Texas physicians, 61 percent said they had found their name listed as in-network on insurance plans that no longer covered them; 56 percent said they found instances where they were not listed in a plan but should have been, according to the report.

“So even when patients do their due diligence, there’s still a chance that I’m not in that network anymore,” said Bourgeois, a Texas Medical Association board member.

The problem is especially pronounced at emergency rooms, according to research published last month in the New England Journal of Medicine. The study found that, nationally, one out of every five patients who went to a hospital covered by their plan received at least one bill from a doctor who wasn’t covered. On average, those patients had to shell out an extra $900; some paid thousands more.

There are no federal protections against such practices, the researchers wrote, and state regulators don’t do enough. The national study singled out McAllen, the Texas border town, as the worst in the country.

There, an astonishing 9 out of 10 emergency room visits resulted in surprise medical bills for patients who thought they were covered.

People assume that if a hospital is covered by their plan, the same will be true of any doctors they see there. But take Humana Health Plan of Texas for example: In about half of the Texas hospitals covered by the plan, the insurer has no contracts with emergency department physicians, the medical association report found. At those emergency facilities, Humana card holders are guaranteed to pay extra.

Market failures

Jamie Dudensing, CEO of the Texas Association of Health Plans, acknowledged that surprise billing — known in the industry as “balance billing” — is a growing problem. But she said Mastriani’s case is an outlier: The vast majority of surprise bills are the result of emergency room visits and are not the fault of insurance companies, but rather a market failure that must be addressed by lawmakers.

In short, Dudensing said, there’s no incentive for physicians to negotiate to ensure they’re covered by the same plans that cover emergency rooms where they practice. In Texas, providers actually are paid more if they’re out of network, she said.

“I truly believe this is not helping anyone for us to go around blaming each other,” she said. “I believe that most doctors are working very hard and doing the right thing and want to be in-network. Instead of going around blaming people, I’d rather have protections to ensure those outlying situations don’t happen to a consumer.”

‘Amazing, incredible nightmare’

Texas lawmakers have attempted to address the issue in recent years, drawing muted praise from consumer advocates who say much more is needed. Texas is the only state to actively collect data on surprise medical bills, and since 2009, patients in some instances have been allowed to petition the Texas Department of Insurance for help fighting unexpected medical bills. Through the first 10 months of this year, the agency has helped 1,363 patients, nearly 500 more than were helped two years ago, according to an agency spokesman.

The Texas Medical Association is calling on lawmakers in 2017 to increase state oversight and make it even easier for patients to seek mediation after a surprise bill. Dudensing, the Texas insurance industry representative, said she supports giving consumers more protections in addition to other reforms to ensure emergency rooms and physicians are covered by the same plans.

It will have been too late for Mastriani. Ten months later, he’s still fighting Aetna to pay up.

It helps that he’s a consumer protection lawyer. A few weeks ago, he sent the company a letter giving it 60 days to pay his bill before he sues under the Texas Deceptive Trade Practices Act.

An Aetna spokeswoman said the company is reviewing Mastriani’s appeal and couldn’t comment further on the matter.

“As a lawyer, I see stuff like this all the time,” Mastriani said. “This is the amazing, incredible nightmare.”

We can help

Want to avoid billing surprises?  Supplemental coverage may assist in filling these gaps.  Call us 800-257-1723 or click here now for an appointment.

 

2017 the Houston Chronicle