Archive for the ‘Physician Recruitment’ Category

Some Healthcare Insurers Refuse to Sell Child-Only Policies

Monday, October 4th, 2010

Insurers who refuse to sell child-only policies are creating a political firestorm.  Some of the nation’s largest insurers are in open rebellion against a provision contained in the new healthcare reform law that is already in effect.  The shot across the White House’s bow is a decision by several insurers to stop selling child-only policies instead of complying with the law that blocks them from turning away kids with pre-existing conditions.  Anthem Blue Cross, Aetna, Inc., and others are refusing to sell the policies in states such as California, Illinois, Florida and Connecticut – even though the law requires that insurers cover children under 19 even if they have a history of illness.  Approximately 500,000 children nationally are impacted by this action.

The insurers claim that the new requirement will result in unforeseen costs related to covering eligible children.  The scenario they envision is that parents might buy policies for their children only after they get sick, creating a surplus of kids who suddenly need insurance coverage.  The decision by some of the big insurers to abandon this niche marketplace means that just a few firms will be forced to share what could be an enormous financial burden.  The good news is that relatively few child-only policies are sold.

The Obama administration immediately denounced the action.  White House Press Secretary Robert Gibbs told reporters “It’s obviously very unfortunate that insurance companies continue to make decisions on the backs of children and families that need their help.”

The stakes are especially high in California.  Legislation awaiting Governor Arnold Schwarzenegger’s approval would ban companies that refuse to sell child-only policies from selling insurance in the profitable individual market for five years.  Assemblyman Mike Feuer (D-Los Angeles), who wrote the bill, said “At a time when we are launching a national approach to ensure that all children have access to healthcare, Anthem’s actions represent a step backwards.  By threatening to drop child-only policies in California, the company jeopardizes the health of families and children.  I call on Anthem to reconsider its plan.”

Insurer Denies Teenage Girl Coverage Because She Was Diagnosed With an Overbite at Age 8

Thursday, July 15th, 2010

Insurance company cancelled teenager’s coverage because she was diagnosed with an overbite at age 8.  A suburban Chicago teenager had her healthcare coverage rescinded when her parents’ insurance company learned that she had been diagnosed with an overbite at age eight. An orthodontist and braces cured the overbite, but the insurer cancelled the girl’s coverage by claiming it was a pre-existing condition.  The girl’s parents fought back and – thanks to strong support from Illinois insurance regulators – the coverage has now been reinstated.

Thanks to healthcare reform legislation, this practice – known as rescission – will no longer be allowed as of late September except in cases where fraud is involved.  Illinois has one of the nation’s highest rescission rates with 12.9 for every 1,000 policies written.  The girl’s father, an attorney employed at a small firm, buys individual coverage for his family.  Insurance regulators say that rescission is most common in these circumstances.  People who are covered by company-sponsored programs rarely face rescission.  According to the girl’s father, “We didn’t try to hide anything.  Our orthodontist told us her mandibular hypoplasia was routine, and it was nothing the insurance company even asked us about on our application.  From our perspective, they didn’t even ask for the names of any of our children’s dentists or orthodontists.”

“There’s now a defined legal standard for when a rescission is appropriate,” said Michael McRaith, Illinois Insurance Director.  “In Illinois, our law was ambiguous, vague and left wide latitude and discretion with the insurance industry.”  The insurance industry defends rescissions as a necessary business practice when people misrepresented or lied about their medical histories on their applications.  Rescissions affect approximately seven percent of the population with private insurance who purchase individual policies.  Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a lobbying group, said “Rescissions are very rare.  They are only used as a last resort.”

Congressional Democrats take another view.  “It was viewed by Congress as the tip of the spear,” said Representative Jan Schakowsky (D-IL).  “It typifies the practices of the insurance industry to maximize their profits that were so clearly anti-consumer and harmful to people who were counting on their health insurance at the moment they needed it the most.”

Postpartum Depression Hits New Dads, Too

Monday, June 7th, 2010

As many as 10.4 percent in fathers of new babies suffer from postpartum depression.  It’s not only mothers of newborns who sometimes grapple with postpartum depression after childbirth.  Fathers of new babies also can suffer from the condition, according to a study from the Journal of the American Medical Association.  In fact, JAMA notes, approximately 10 percent of new fathers experience the condition.

“Other fathers felt happy and joyous,” said Joel Schwartzberg, who suffered postpartum depression after the birth of his son 10 years ago.  “Inside, I felt like my world had collapsed, and along with that, I felt a great and incredible sense of responsibility.  I thought I was the only person in the world who was a bad dad.  I thought I was deficient, that I was handicapped.  What I learned was that I was not alone by any stretch.  It helped me relax; it helped me not be so hard on myself.”  Eventually, Schwartzberg sought medical treatment for his postpartum depression.

The study, performed by researchers at Eastern Virginia Medical School in Norfolk, analyzed 43 studies involving 28,004 men and found that just 4.8 percent of men fit the diagnosis of depression under normal circumstances.  That number climbed to 10.4 percent in fathers of new babies; three months following birth, the study found that approximately one fourth of the men studied were depressed.  Sleep deprivation could be a root cause, says William Courtenay, a researcher, psychotherapist and founder of, who noted that men often act out through anger and irritability.  “A man who’s depressed can look like someone who’s stressed, angry, irritable and getting into conflict with others, or being withdrawn or drinking,” Courtenay said.  “We can also see classic signs of depression, a sense of worthlessness and helplessness and sad mood.”

“Also, he may be grieving because he no longer has his wife to himself,” said Jean Cirillo, PhD.  “He has to share her with the baby, and the baby’s needs get taken care of first. This can be hard for a man.”

Insurer Preauthorization Doesn’t Guarantee Payment for $148,000 Back Surgery

Thursday, September 10th, 2009

balancing-a-checkbook-paying-billsHere’s a story that illustrates one way that our healthcare delivery system is broken.  Michael Napientek has been through healthcare insurance hell – and survived the ordeal. Last fall, the doorman underwent back surgery after obtaining a preauthorization number for payment from his insurance company.  Napientek’s health insurance is provided by his wife Sandie’s employer, Accelerated Health Systems.  The policy is a self-insured plan funded by Accelerated Health Systems, and which is administered by Wausau, WI-based UMR, a UnitedHealthcare subsidiary.

Imagine the Napienteks’ surprise when bills totaling $148,000 started appearing in their mailbox.  The insurer was refusing to pay for the surgery, even though it had preauthorized the procedure.  Three appeals against the claim were denied on the grounds that Napientek had not exhausted all means of pain relief.  Sandie Napientek complained to a UMR representative and was told that preauthorization did not guarantee payment because they had not provided documents that proved the “appropriateness” of the surgery.

Frustrated, the Napienteks turned to the Chicago Tribune’s “What’s Your Problem?” columnist Jon Yates to see if he could intervene.  Yates contacted UMR, who referred him to United Healthcare.  The Napienteks’ next communication from UMR was a letter saying it would pay the entire $148,000.  According to the letter, UMR changed its mind “based on additional information submitted and the opinion of an independent physician.”

This story represents a classic example of an insurance company bureaucrat standing between the patient and his physician – after preapproved surgery had been performed.

Wanda Jones: Time to Reinvent Hospitals and Medical Office Buildings

Wednesday, September 9th, 2009

great_ormond_st_readyHospitals and medical office buildings must undergo a complete rethinking to move them functionally and architecturally from the 1970s to models that make sense for the 21st-century.  Wanda Jones, healthcare futurist and president of the New Century Healthcare Institute, believes that we need to reinvent hospital design and construct linear-spine facilities that provide patients with more personalized medicine.  This anticipates expansions, contractions, removal and replacement of patient towers by dividing the number of patient beds into two, three or four towers.  This way, they can be incrementally changed without interrupting the others and are readily adaptable to specific programs.

In a recent interview for the Alter+Care Podcasts on Healthcare, Wanda Jones discusses the paradigm shift in terms of new technologies that will make obsolete the knowledge base on which healthcare systems, hospitals and physicians have made money up until now.  Every surgical specialty will use robotics, and cures for cancer will be based on technology that has arisen out of the human genome project.  The New Century Healthcare Institute is a research-and-development and educational foundation devoted to population-based planning and adaptation of the healthcare system to future conditions.

Stimulus Bill Boosts Healthcare for the Uninsured and Underserved

Thursday, July 2nd, 2009

Tucked into the Obama Administration’s stimulus bill is $200 million to support student loan repayments for primary-care physicians, dentists and mental health specialists who devote two years to working at National Health Service Corps sites.  Approximately 3,300 awards are being made to individuals serving in health centers, rural health clinics and healthcare facilities that treat the uninsured and people living in under served areas.23285

Department of Health and Human Services Secretary Kathleen Sebelius, notes that the American Recovery and Reinvestment Act “has laid the foundation for health reform and is supporting our effort to give more people access to the quality, affordable healthcare they need.  National Health Service Corps has helped protect the health and well-being of millions of Americans.  Now, we are doubling the Corps and putting doctors and clinicians in the communities where they are desperately needed.”

The additional funding should double the number of corps members “and the number of patients they care for, and spark economic growth in communities hard hit by the economic turndown,” according to Mary Wakefield, administrator of the Health Resources and Services Administration, which manages the corps.