Letters to the Editor is a periodic characteristic. We welcome all feedback and can publish a range. We edit for size and readability and require full names.
Envy for-profit US healthcare? Check out this MD whose spouse is a medical billing skilled who spent over a yr difficult an egregious billing error. After all of it they nonetheless paid $1200. These are resourceful educated individuals who received taken for a trip. https://t.co/fnlUz3KTJb
— Raghu Venugopal MD (@raghu_venugopal) October 26, 2022
— Dr. Raghu Venugopal, Toronto
A Plea for Sane Prices
I simply learn your story concerning the emergency room billing for a process that was not achieved (“A Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband’s ER Bill,” Oct. 25). We too had an identical expertise with an emergency room and a damaged arm that was coded at a Level 5, and it was a easy break. No surgical procedure wanted, and it took them solely 10 minutes to set and wrap the damaged arm however charged us over $9,000. I disputed the costs, and it took six months to get them to cut back the invoice however they by no means admitted that they coded a easy break incorrectly to jack up the value of the invoice. If it had been a Level 5 subject, we’d not have sat within the ready room for six hours earlier than being seen. It was a horrible expertise, and I believe ERs all around the nation are doing this to make up for the non-payers they deal with daily. It is theft.
— Terrence Campbell, Pocatello, Idaho
It can be nice if the vaulted @KHNews would clearly distinguish between the ED professional payment billing & hospital expenses as it’s not solely clear right here w/ in community svs.—Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband’s ER Bill https://t.co/jRFAYb5F0P
— Ed Gaines (@EdGainesIII) October 25, 2022
— Ed Gaines, Greensboro, North Carolina
As you stated, CPT codes ought to at all times be examined. This case might be greater than “just an error.” As a retired orthopedic surgeon, chief of surgical procedure, and chief of employees at a North Carolina hospital, I’ve seen care similar to this coded precisely like this with the rationale that, “Hey, this was a fractured humerus and it was manipulated and splinted.” 24505 is appropriate IF that’s the definitive therapy, which it was not right here. Even code 24500 would point out definitive therapy with out manipulation. This was simply momentary care till definitive care could possibly be achieved later. It needs to be billed as a go to and a splint. The go to for this, if it was an remoted drawback (no different damage or issues), would qualify solely as a Level 2 go to. That incessantly will get upcoded as effectively by including a whole lot of non-pertinent household, medical, and social historical past and a whole bodily examination (seven techniques at the least) and a complete lot of non-pertinent “medical decision making.” All of that ought to be documented within the medical information even when the hospital stonewalls on the CPT codes.
Look intently at medical information and you can find frequent upcoding, in case you are acquainted with the necessities for various ranges of therapy.
— Dr. Charles Beemer, Arvada, Colorado
Never attribute to Baumol’s value illness that which is satisfactorily defined by malice. https://t.co/RbKOlBgCmp
— Shashank Bhat (@shashank_ps) October 26, 2022
— Shashank Bhat, San Francisco
Various years in the past, I used to be billed utilizing a code that described a therapy that was not carried out. In related trend, I talked with my insurance coverage firm, which principally stated it didn’t care whether or not the therapy came about or not as all it required was for a legitimate code to seem. I additionally contacted the Virginia Bureau of Insurance, which approves the varied insurance policies, and it stated it had no jurisdiction over claims. I made a decision to let the hospital sue me for the disputed quantity and defended myself in district court docket. Despite their legal professional and 4 “witnesses,” the case was thrown out as a result of the hospital was each unwilling and unable to justify the costs to the satisfaction of the decide. They didn’t need anyone in energy to testify due to the questions they’d have been requested, so that they left it to individuals who have been utterly clueless. The takeaways from this have been:
- Hospitals make up the numbers and depart them grossly inflated to allow them to declare that they’re giving freely care after they give reductions on the made-up numbers.
- Hospitals flip staff into separate billing entities to allow them to double-charge.
- Hospitals open services similar to bodily remedy in hospital areas as a result of insurance coverage firms can pay greater quantities when therapy is carried out in a hospital surroundings.
- Insurance firms and state insurance coverage companies don’t act as gatekeepers to guard their purchasers/taxpayers.
- The insurance coverage firms and the suppliers have a shared curiosity within the highest attainable ticket costs and outrageous expenses as a result of the suppliers get to assert how beneficiant they’re with “unremunerated care,” and if the costs have been inexpensive then they might not justify the excessive costs for insurance coverage premiums and the allowed administration/revenue share of 20% can be primarily based on a much smaller quantity.
In every other trade, this may have resulted in a number of antitrust fits. U.S. well being care is a tragic instance of presidency, well being care trade, and insurers all coming collectively towards the pursuits of customers. After this court docket case, I wished to type a nonprofit to systematically problem each outrageous cost towards individuals who, in contrast to myself, didn’t imagine or know easy methods to defend themselves. If hospitals and different suppliers have been pressured to go to court docket to justify their expenses on a scientific foundation, pricing sanity would finally prevail.
— Philip Solomon, Richmond, Virginia
The apparent resolution to prosecute the hospital for fraud adopted by a civil swimsuit”A hospital charged almost $7,000 for a process that was by no means carried out” https://t.co/wPNNZ5cZey
— Barry Ritholtz (@ritholtz) October 31, 2022
— Barry Ritholtz, New York City
Patients as Watchdogs
Thank you for the article on Lupron Depot injections (Bill of the Month: “$38,398 for a Single Shot of a Very Old Cancer Drug,” Oct. 26). Last yr, I used to be identified with prostate most cancers, although my case will not be wherever as extreme as that skilled by Mr. Hinds.
Last month my urologist scheduled an MRI replace for me at a facility owned by Northside Hospital Atlanta. At the suggestion of my beloved spouse, I known as my insurance coverage firm, UnitedHealthcare, to verify the process was lined. Fortunately, it was. That being stated, the agent from UnitedHealthcare talked about that Northside Hospital’s payment was “quite a bit higher than the average for your area.” It was. Before insurance coverage, the cost for an MRI at Northside was $6,291. I canceled the appointment at Northside and had the MRI achieved by a free-standing facility. Their cost, earlier than insurance coverage, was $1,234.
Every single encounter that I’ve with the well being care system entails fixed vigilance towards price-gouging. When I’ve a process, I’ve to guarantee that the power is in-network,. that every doctor is in-network, that any attending specialist similar to an anesthesiologist or radiologist is in-network (and their base-facility as effectively). If I’ve a blood check, I’ve to double-check if the fee is included in a process or whether it is separate. If it’s a separate payment, I’ve to make sure that the evaluation can be lined, and, if it’s not, that it’s not achieved via a hospital-owned facility however as a substitute via a free-standing operation.
I’ve a number of ongoing situations along with my prostate most cancers — Dupuytren’s contracture, a uncommon bleeding dysfunction just like thrombocytopenia, and arthritis. Needless to say, navigating our byzantine, inefficient, and profit-driven well being care system is a complete nightmare.
Health care within the United States has grow to be so exceedingly outrageous. I can’t perceive why it’s not a difficulty that surfaces throughout election years or one thing that Congress is keen to deal with.
Again, thanks on your wonderful reporting.
— Karl D. Lehman, Atlanta
Why capitalism with out guardrails is a pipedream. Own the patent, management the pricing, and that is the outcome: $38,398 for a Single Shot of a Very Old Cancer Drug https://t.co/BLes77QN7F through @khnews
— Brian Murphy (@NorwoodCDI) October 26, 2022
— Brian Murphy, Austin, Texas
I used to be a medical stop-loss underwriter and marketer for over 30 years. Most bigger (firm plans for 100-plus staff) are self-funded, which means the service — as on this case, UnitedHealthcare — is supplying the executive capabilities and community entry for a payment, whereas utilizing the employer’s cash to pay claims.
Every administrator on the market expenses a case administration payment, both as a stand-alone cost or buried of their charges. Either manner, all of them tout how they’re searching for each the employer and the affected person.
Even if this plan was absolutely insured, wouldn’t it have been in one of the best curiosity of all events after they grew to become conscious of the affected person’s therapy (perhaps after the primary fee) to succeed in out to the affected person and allow them to know there are different options?
The query in these instances is who’s minding the shop for each the affected person and the employer. The employer, the insurer, and the affected person might have all saved some huge cash and ache, if somebody from case administration had truly questioned the primary set of expenses.
— Fred Burkacki, Sarasota, Florida
I did just a few rounds of Lupron in my 20s for extreme #endometriosis, and I needed to battle my insurance coverage firm to get authorised. Now, that is how a lot it prices for some folks. https://t.co/UlB1TTtW40 #healthcare #prostatecancer
— Amanda Oglesby 🌊 (@OglesbyAPP) October 26, 2022
— Amanda Oglesby, Neptune, New Jersey
‘Bill of the Month’ Pays Off
I obtained a $1,075 refund on a colonoscopy invoice I paid months earlier after listening to the KHN-NPR “Bill of the Month” section “Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?” (May 31) and discovering out the process needs to be lined beneath routine well being care protection. Thank you!
— Cynthia McBride, University Place, Washington
We have to shut authorized loopholes to guarantee that most cancers diagnostic procedures have the identical insurance coverage protection as screening. Colonoscopies should be absolutely lined whether or not a polyp is discovered or not #ACA #colorectalcancer #CancerScreening https://t.co/slE6p3FvHe
— Erica Warner, ScD (@ewarner_12) May 31, 2022
— Erica Warner, Boston
Removing Barriers to Benefits
In the story “People With Long Covid Face Barriers to Government Disability Benefits” (Nov. 9), you said: “Many people with long covid don’t have the financial resources to hire a lawyer.” This is wrong. When making use of for incapacity, you don’t want monetary assets. There are regulation corporations focusing on incapacity claims and won’t cost you till you win your declare. And, based on federal regulation, these regulation corporations can cost solely a sure share of the again pay you’ll get as soon as the declare has been gained. Also, should you lose the declare, and the regulation agency has appealed as many occasions as attainable, you don’t owe something. Please don’t make it harder for individuals who are disabled with misinformation.
— Lorrie Crabtree, Los Angeles
People unable to work as a result of Long Covid are dealing with obstacles to acquiring authorities incapacity advantages.https://t.co/zWQfW5CkOS
— Ron Chusid (@RonChusid) November 10, 2022
— Ron Chusid, Muskegon, Michigan
Vaccine Injuries Deserve Attention, Too
I learn your long-covid article with curiosity as a result of lots of the obstacles and a number of the signs confronted by folks with lengthy covid are just like these skilled by folks with vaccine accidents. I’m actually involved about how there’s even much less consideration and assist for individuals who suffered hostile vaccine reactions.
Long covid and vaccine accidents are each problems with justice, mercy, and human rights as a lot as they’re a spread of complicated medical situations.
It’s almost 20 months since somebody I do know sustained a critical hostile response, and it’s heartbreaking how arduous it has been for her to seek out medical doctors who will acknowledge what occurred and attempt to assist. There’s no medical or monetary assist from our authorities, and the Countermeasures Injury Compensation Program is actually a lifeless finish, whilst different nations similar to Thailand, Australia, and the United Kingdom have begun to acknowledge and financially assist individuals who sustained vaccine accidents.
I’ve contacted my congressional representatives dozens of occasions asking for assist and sharing analysis papers about vaccine accidents, however they’ve declined to reply in significant methods. Similarly, my state-level representatives ignore questions on our vaccine mandate, which stays in place for state staff, regardless of at the least one confirmed vaccine-caused fatality in a younger mom who fell beneath the state mandate in an effort to volunteer at college.
There have been just a few articles, similar to …
… however no new ones have come to my consideration lately, and it’s regarding that the media and our political and public well being leaders appear OK with leaving folks behind as collateral harm.
Please contemplate writing a companion piece to focus on this want and the shortage of a purposeful security web or merciful response. My hope is that if lengthy covid and vaccine accidents have been each studied vigorously, new understanding would result in therapeutics and coverings to assist these folks.
— Kathy Zelenka, Port Angeles, Washington
Given how lengthy it took Congress to finally approve “Agent Orange” and “Burn Pit” advantages for disabled veterans, it’s at the least a 15-20 yr time-frame and so they do not have the backing or societal standing that veterans do. https://t.co/idt6tSioHc
— Matthew Guldin (@MRG_1977) November 11, 2022
— Matthew Guldin, West Chester, Pennsylvania
More on Mammograms
The article “Despite Katie Couric’s Advice, Doctors Say Ultrasound Breast Exams May Not Be Needed” (Oct. 28) does a disservice to girls and might trigger hurt. An ultrasound is saving my life. I had two mammograms with ultrasounds this yr. Although the primary mammogram confirmed one cyst that was identified as “maybe benign,” I knew it wasn’t. Why? Because I might really feel the distinction. I insisted on a second, and positive sufficient a large-enough cyst that’s positively malignant was discovered. I had breast surgical procedure on Oct. 31, adopted by radiation therapy and, if wanted, chemotherapy later. This article will deprive different, much less aggressive and skilled girls who shouldn’t have well being care credentials or a radiologist for a husband to be harmed by being lulled into complacency.
— Digna Irizarry Cassens, Yucca Valley, California
Why do some girls with dense breasts get further screening whereas others don’t? @CNN explains. @IronwoodCancer https://t.co/uFZZKo6RO4
— Patricia Clark (@patriciaclarkmd) October 27, 2022
— Patricia Clark, Scottsdale, Arizona
Your article on breast most cancers screening uncared for to current the supplemental choice of Abbreviated Breast MRI (AB-MRI). The out-of-pocket value at many clinics ranges from $250 to $500. For a nationwide itemizing of clinics that supply this supplemental screening choice, please go to https://timetobeseen.org/self-pay-ab-mri. For advantages, simply Google “Abbreviated Breast MRI.”
— Elsie Spry, Wexford, Pennsylvania
Why didn’t extra #SeniorCitizens depart for safer havens throughout Hurricane Ian as really useful? @judith_graham rightfully means that studying why is crucial because the inhabitants of older folks grows and #NaturalDisasters grow to be extra frequent. https://t.co/7k8bvNQxug
— Donald H. Polite (@DonaldPolite) November 2, 2022
— Donald H. Polite, Milwaukee
Preparation Plans for Seniors: All for One and One for All
At least 120 folks died from Hurricane Ian, two-thirds of whom have been 60 or older. This is a tragedy amongst our most weak inhabitants that ought to have been prevented (“Hurricane Ian’s Deadly Impact on Florida Seniors Exposes Need for New Preparation Strategies,” Nov. 2).
Yes, coming collectively and creating preparedness plans is one strategy to shield seniors and keep away from these sorts of tragedies sooner or later, however since this isn’t a one-size-fits-all state of affairs, organizations that assist seniors throughout the nation should first look internally and be held accountable by ensuring their groups at all times have a plan in place and are ready to activate them at a second’s discover.
During Hurricane Ian, I noticed firsthand what can occur when teamwork and efficient planning come collectively efficiently to guard and put together seniors with power well being situations like power obstructive pulmonary illness who require supplemental oxygen to breathe.
Home respiratory care suppliers and residential oxygen suppliers labored tirelessly to make sure our sufferers obtained loads of provides to maintain them all through the storm, and when some sufferers confronted conditions the place their oxygen gear wasn’t working correctly inside their houses, employees members have been available to calmly discuss the affected person via fixing the issue. After the winds receded, cell vans have been rapidly stationed in protected areas for sufferers or their members of the family to entry the oxygen tanks and provides they wanted. If sufferers have been unable to make it to those areas, employees members have been dispatched to ship tanks to their houses personally and test in on the affected person.
Patients have been additionally tracked down at shelters, and a staff of volunteers was fashioned across the nation to seek out sufferers who couldn’t be reached by calling their emergency backup contacts, a good friend, or member of the family. Through these established techniques, we have been capable of stay in touch with all of our sufferers in Ian’s path to make sure their care was not impeded by the storm.
Organizations ought to at all times be prepared and held accountable for the seniors they look after in occasions of catastrophe. I do know my staff will probably be prepared. Will yours?
— Crispin Teufel, CEO of Lincare, Clearwater, Florida
Understanding the affect of #Climatechange on older folks is critically essential because the inhabitants expands and #naturaldisasters grow to be extra frequent and intense.https://t.co/RKB7pA28nr
— Ashley Moore, MS, BSN Health Policy (@MooreRNPolicy) November 2, 2022
— Ashley Moore, San Francisco
The Tall and the Short of BMI
I’m amazed that in your article about BMI (“BMI: The Mismeasure of Weight and the Mistreatment of Obesity,” Oct. 12) you by no means talked about something concerning the lack of top. If an individual goes from 5-foot-2 to 4-foot-10, the BMI modifications considerably.
— Sue Robinson, Hanover, Pennsylvania
I’ve been towards this since after gastric bypass surgical procedure I received all the way down to 164 kilos however at 5’7″ BMI nonetheless thought-about me chubby. How an overreliance on BMI can stand between sufferers and therapy https://t.co/OawzhO0aOk
— Steve Clark (@blindbites) October 10, 2022
— Steve Clark, Lee’s Summit, Missouri
Caring for Nurses’ Mental Health
During the pandemic, after I learn tales about how courageous and selfless well being care heroes have been preventing covid-19, I questioned who was caring for them and the way they have been processing these occasions. They put their very own lives on the road treating sufferers and serving their communities, however how have been these experiences affecting them? I’m a mom of a nurse who was on the entrance traces. I always anxious about her in addition to her psychological and bodily well-being (“Employers Are Concerned About Covering Workers’ Mental Health Needs, Survey Finds,” Oct. 27). I used to be decided to discover a strategy to honor and assist her and her colleagues across the nation.
I created a big collaborative artwork venture known as “The Together While Apart Project” that included the art work of 18 different artists from across the United States. It originated throughout the lockdown part of the pandemic, a time once we have been all bodily separated but joined by a collective mission to create one wonderful artwork set up to honor front-line employees, particularly nurses. Upon its completion, this collaboration was acknowledged by the Smithsonian Institute, Channel Kindness (a nonprofit co-founded by Lady Gaga) and NOAH (National Organization of Arts in Medicine). After touring across the Southeast to varied hospitals for the previous yr on momentary exhibit, the art work now hangs completely in the primary foyer on the University of Virginia Medical Center in Charlottesville, Virginia.
I wished to do one thing philanthropic with this artwork venture to honor and thank well being care heroes for his or her dedication over the previous two years. It was essential to discover a manner to assist assist them and to make sure they aren’t being forgotten. Using artwork venture as my platform, I partnered with the American Nurses Association and created a fundraiser. This marketing campaign raises cash for the ANA’s Well-Being Initiative packages, which assist nurses struggling from burnout and post-traumatic stress dysfunction and who desperately want psychological and bodily wellness care. Fighting covid has taken a serious toll on too many nurses. Some really feel dehumanized and should not receiving the day off or the psychological and bodily assets wanted to maintain them. Many are struggling in silence and have to decide on between caring for themselves or their sufferers. They shouldn’t need to make this alternative. Nurses are the lifeline in our communities and the spine of the well being care trade. When they undergo, all of us undergo. Whether they work in hospitals, medical doctors’ places of work, assisted dwelling services, clinics or colleges, each nurse has been negatively impacted ultimately by the pandemic. They are being requested to take action rather more than their jobs require along with experiencing higher well being dangers, much less pay, and longer hours. Nurses beneath 35 and people of coloration are struggling in bigger numbers.
The American Nurses Foundation provides many types of wellness care at no cost. They rely closely on donations to keep up the standard of their choices in addition to the power to supply companies to a rising variety of nurses. I’m an artist, not an expert fundraiser, and I’ve by no means raised cash earlier than. But I really feel so strongly about making certain that nurses obtain the assist and care they deserve, that I’m keen to do no matter it takes to advocate and elevate these well being care heroes.
The Together While Apart Project’s “Thank You Nurses Campaign” objective is $20,200, an quantity chosen to mirror the numbers 2020, the yr nurses grew to become each day heroes. So far, I’ve raised over $15,500 via presents in all quantities. For instance, a $20 donation offers a nurse with a free one-hour name with a psychological well being specialist. That $20 alone makes a giant distinction and might change the life of 1 nurse for the higher. The marketing campaign has offered sufficient funding (yr thus far) to allow 940 nurses to obtain free one-hour wellness calls with psychological well being specialists.
The on-line fundraiser could be discovered at https://givetonursing.networkforgood.com/projects/159204-together-while-apart-fundraiser.
— Deane Bowers, Seabrook Island, South Carolina
CEAPs, is it time to supply extra #mentalhealth companies? Nearly 1/2 of employers (w/ 200 employees) report a rising share of employees utilizing psychological well being companies. Yet 56% report they lack #behavioralhealth suppliers for workers to entry to well timed care. https://t.co/Vpkkwlq6C6
— EAPA (@EAPA) October 27, 2022
— Employee Assistance Professionals Association, Arlington, Virginia