Categories
Potpourri

Pharmaceutical Companies ARE Looking Out For You!

From AP:

The chairman of the Federal Trade Commission says eliminating lucrative patent settlements between brand-name and generic drug companies would save consumers $3.5 billion annually.

The FTC has waged a years long campaign against so-called “pay-to-delay” settlements, in which a branded drug company rewards a generic competitor for keeping cheaper versions of its drugs off the market.

While the FTC calls the deals anticompetitive, they have been upheld by courts.

In a speech in Washington, FTC Commissioner Jon Leibowitz calls on Congress to pass a bill banning the settlements. He says it could save consumers $35 billion over 10 years, about $12 billion of which would go to the government.

Categories
Potpourri

Health Care System Problems, One More Time….

http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners.

62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness.

Overall, 78% of the people with a medically-related bankruptcy had health insurance.

Categories
Living Donor Protections

Pre-Existing Condition Patient Protection Act of 2009

U.S. Senator John Rockefeller (D-WV) and Representative Joe Courtney (D- CT) have introduced legislation to prohibit pre-existing condition exclusions in group health plans and in health insurance coverage for groups and individuals. For living organ donors, this is important news, because health insurance plans can and do consider living donation to be an “pre-existing condition” that may impact a donor’s ability to secure health insurance and the cost of premiums.

Called the Pre-Existing Condition Patient Protection Act of 2009, the legislation is being supported by a who’s who list of organ-transplant-related non-profits: The National Kidney Foundation, The American Society of Transplant Surgeons, NATCO – the Organization for Transplant Professionals, and the United Network for Organ Sharing (UNOS).

To get informed, check out govtrack.us, where you can read the full text of the bill, track its movement through the House and Senate and read the floor speeches made about it. Here are the links directly to the House and Senate versions:

House of Representatives H.R. 1558

U.S. Senate S. 623

If you wish to write your Congressional representatives, you can look them up at www.senate.gov and writerep.house.gov/writerep/welcome.shtml, both of which offer convenient email forms as well as mail and fax information.

For those who want to support the legislation, here’s a sample letter:

(Date)
The Honorable (add Senator’s full name)
U.S. Senate
Washington, DC

Re: Preexisting Condition Patient Protection Act of 2009

Dear Senator (add Senator’s name)

(I or your organization) request that you support the Act introduced by Congressman Joe Courtney, and Senator John Rockefeller titled “Preexisting Condition Patient Protection Act of 2009?. This Act will prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets, including live organ donation. It will eliminate the real fear of losing access to affordable private health care insurance when becoming a live organ donor.

Pre-existing condition exclusions dramatically increase the cost of health insurance for these altruistic live donors, or have the impact of rendering the person uninsurable altogether.

It is time that the federal government prohibits private health insurers and self-insured health plans from treating live organ donors as having a pre-existing condition. Removing live organ donation as a pre-existing condition is a necessary component of health care reform.

(you or your organizations name here) appreciate(s) your consideration of this request to support this Act that will prohibit live organ donation from being considered a preexisting conditions. Thank you.

Sincerely,
Name
Title
Organization
Address

Categories
Potpourri

What Health Insurance Crisis?

Parapalegic Man Dumped in L.A. Gutter Sues Hospital

Gabino Olvera, 42, sued the Hollywood Presbyterian Medical Center for negligence after it discharged him in February 2007, took him across town in a van and left him in a soiled hospital gown without a wheelchair in the heart of the city’s homeless area.

Witnesses who came to Olvera’s aid said they saw him dragging himself on the ground with hospital papers and documents clenched in his teeth while the driver sat in her van and applied makeup before driving off.

The incident was captured by security cameras at a nearby homeless shelter.

Not only does this infuriate me on a basic level, it also brings to mind a recent incident of my own.

Last month I had my yearly GYN exam. My insurance card is generally in my purse, and I always bring my checkbook for my co-pay, a holdover from when doctor’s office didn’t take debit/credit cards. When I checked in, they asked for my card, which mysteriously wasn’t in my wallet (I suspect I was looking up something on the insurance company’s website, which would require my ID number). When I revealed I didn’t have the precious little piece of plastic, the receptionist immediately kicked in to panic mode – I could see it in her eyes.

“The information is the same as last year.” I said, trying to be helpful.

“But you haven’t been here in a year.”

Bear in mind that my state of mind has been highly fragmented since about – oh – Thanksgiving due to family emergencies, being the owner of an ecommerce biz (can we say holiday retail shopping season??), Folly’s cancer, a 1968 blue toilet sitting in my guest bedroom, etc., but this struck me as one of the most absurd statements I’d heard in my life. Of COURSE it has been a year…..

“That would be because I only have to be here once a year.” I said.

She muttered agreement but I could tell her thoughts were decidedly elsewhere. Gone was her sense of customer service, replaced by this frantic scrambling; I’m certain I’m not the only person who’s ever shown up without their insurance card, so what is the problem? Plus, I’ve been seeing this same doctor for ten years; it’s not as if they don’t know where I live.

“Well, you’re going to have to leave some sort of payment.” she said.

“All right.”

“Or you can reschedule.”

“It takes me six weeks to get in here for my annual exam. I’m not rescheduling.”

“And you need to get us a copy of your card. Can you bring it over or fax it to us?”

“I can fax it to you.”

“Okay, today? Tomorrow? Cuz we need to have it.”

Oh my God.

“I will get it to you.”

While waiting to be called in, I filled out a questionaire regarding ovarian and breast cancer in my family. They’ve discovered a nifty gene that greatly predisposes women to either affliction and identifying that gene allows women to make certain decisions regarding their health care. A local hospital is testing women and gathering all relevant data related to the matter.

Naturally, the test is about $3000. Even more expectedly, insurance companies don’t cover it. Frankly, it’s not in their best interest to know if you’re suseptible to breast or ovarian cancer, and they don’t care if preventative double masectomies might save a woman’s life. It’s far more profitable for them if you get the disease and they provide you with their maximum 10 grand a year in treatment. If you die, so what? That just really isn’t their – or their stockholders’ – problem.

Yes, I qualified for inclusion in the study.

Here’s the TMI portion of the program – I have a tipped uterus. Basically this means that my doctor has a helluva time checking for all the bits and pieces and she’s inclined to send me to get a fucking ultrasound. Last year I blew her off, so this year she gave me a bit of flack for it and made me promise to go. I was too tired to argue, so I made the appt.

Did I mention that my fucking insurance doesn’t pay for the ultrasounds either? (see my post last April on my $300 deductible)

Checking out, I informed the woman about the missing insurance card.

“I have a check,” I say, fully prepared to leave my co-pay, as usual.

“How about a credit card, so that when we get your insurance card, we can just charge your co-pay?”

Yeah sure, whatever. So I give her my debit card and tell her how much my co-pay is.

That night I tell my S.O. how irritating it was to be treated like I was going to scam them out of their money because I forgot my insurance card.

The next day I fax them a copy of my insurance card.

Then the weekend passes.

On Monday morning, I attempt to call and ensure they actually RECEIVED the fax. But typical of contemporary medical practices, my doctor is in but one office of their organization, so the number goes to a phone tree then hits a woman at the administrative portion of the company who has no idea what I’m talking about. She transfers me to the ‘woman who deals with the faxes’ who then hims and haws, puts me on hold, then shuffles more paper around and finally tells me she can’t find my file, so she’ll have to call me back, maybe tomorrow.

Okay.

I hang up and head up to the shower. When I emerge from the shower, clean, pink and barely toweled off, I’m beseiged by a very pissed off S.O. who is demanding to know WHY my doctor’s office has charged us $125.

I don’t know about you, but I do not have an extra $125 laying about in my checking account, so this was potentially a disaster. He happened to log in to the online banking and see the charge; otherwise I can guarantee we would’ve had things bouncing around like jack russell terriers on cocaine and incurring untold hundreds in overdraft fees ($32 per, you know. Fucking banks). Apparently before my S.O. decided to take his exasperation out on me, he called the aforementioned number and eventually got some woman in billing who told him that it’d be 30 to 45 days before the charge would be reversed.

Infuriated (at him and them), I throw on some clothes and drive over to the doctor’s office; wet hair, sub-freezing temperatures and all. I find the ‘check-out’ woman (different than when I was there the prior week, and not the same woman who ‘couldn’t find my file’ on the phone), who calmly tells me she never got the fax. I give her a copy of the damned card, and she IMMEDIATELY reverses the charges. What the hell was so difficult that the chick on the phone wouldn’t provide that as an option?

Here’s the tie-in:

1. This homeless gentleman received the treatment he did because he had no insurance. If you think this is an isolated incident or that it can’t happen to you, see above. The moment I couldn’t display my insurance card, I was treated like a grifter who had wandered in off the streets to con the doctor’s office out of a hundred bucks worth of medical procedure. Imagine how much this guy’s ER visit cost, so they’re even less happy to see his indigent ass.

2. My doctor belongs to a practice (and in this case, they’re a microcosm of EVERY practice out there) that encompasses multiple offices and specialties. They’ve grown so big that the people who deal with the adminstrative portion of the business have NO contact with the actual patients (aka consumers) other than a number on a file or maybe a disembodied voice on the phone. In other words, they don’t CARE. You’re not human, you’re just an account.

3. It was easier for the woman at the desk to charge my debit card $125 than it was for to pick up the phone and inquire about the faxed insurance card. Picking up the phone would’ve meant a little more time out of her day, whereas charging my card ‘solves’ the problem for her. She can close the file, send it off to Admin and move on to another task. Calling me might actually require keeping my file open until she received the fax, la la la, and the most important thing is not customer service, but making her job easier.

A simple resolution to the task at hand – I’m sure that’s all the woman driving the van from Hollywood Presbyterian wanted. It’s not her fault the guy’s homeless, a parapalegic, or that he has no insurance, right? Her job was simply to get him out of the hospital’s sight. What he does from there?

Well, that’s his problem.