Letters to the Editor is a periodic function. We welcome all feedback and can publish a range. We edit for size and readability and require full names.
Patients as Educators
I learn, with curiosity, your article concerning the difficulties that adults with Down syndrome face within the medical world (“People With Down Syndrome Are Living Longer, but the Health System Still Treats Many as Kids,” April 17). I’d add that this sort of factor is an issue for adults with developmental disabilities basically. As an autistic grownup, I can positively relate.
I’ve truly discovered myself generally having to teach medical doctors about my situation. It is as if they don’t count on to see developmental disabilities amongst their sufferers. While I’m able to advocate for myself, I’m very involved about those that can not. Another vital level that your article makes is the necessity for medical professionals to handle developmentally disabled adults immediately. They must also communicate to them as fellow adults and never as youngsters. While we might have a developmental incapacity, we’re additionally properly conscious of the truth that we’re adults.
Lastly, your article mentions the problem of getting assist for folks over age 30. This is an issue not just for these with Down syndrome however for folks with developmental disabilities basically. I’m 58 and was identified with autism at age 37. While I’ve benefited tremendously from the assistance I have acquired, I’ve additionally discovered it very irritating to be turned away from potential avenues of self-betterment simply due to once I was born. It isn’t too late!
Thank you very a lot for this well timed article about adults with developmental disabilities.
— Elizabeth Avery, Weymouth, Massachusetts
Our well being system is not ready to look after adults with developmental disabilities — People with Down Syndrome Are Living Longer, however the Health System Still Treats Many as Kids https://t.co/vjHxtM6JrK by way of @kffhealthnews
— Ellen Andrews (@cthealthnotes) April 17, 2023
— Ellen Andrews, Hamden, Connecticut
I needed to take a minute and thanks for the article that was additionally revealed on CNN about individuals who have Down syndrome who’re residing longer with out the medical neighborhood maintaining. My aunt has Downs and will probably be 71 this June!
She has endured so many ups and downs from the medical neighborhood since she was born within the Fifties to the place we at the moment are. Hearing tales of the previous, there are occasions I simply can’t consider she’s nonetheless alive. My dad and mom and different aunt assist look after her in a rural space in Wisconsin and it’s been extraordinarily troublesome for everybody as she has gotten older. I despatched this text on and so they felt heard, for the primary time.
I respect you for bringing consideration to this not solely as a niece who loves her aunt, but in addition as a particular training trainer!
— Jennifer Pearce, Excelsior, Minnesota
Reminder for everybody to test the names in your medical payments, this occurs lots. I simply had my son’s ER facility invoice are available with my identify because the affected person. Easy dispute for us, cleaned after a single letter. https://t.co/Sr2rdI6MFQ
— pj (@pjsantoro) March 31, 2023
— PJ Santoro, Los Angeles
When Is an Insurer Not an Insurer?
I write to handle what could also be an inaccuracy in your March 29 Bill of the Month report, “ER’s Error Lands a 4-Year-Old in Collections (For Care He Didn’t Receive),” which maybe isn’t too materials to your protection (though it could possibly be if the dispute endured). But I believe it’s vital for KFF Health News to symbolize it accurately since your newsroom and KFF are extremely regarded sources of data round well being care cost.
You repeatedly referred to UnitedHealthcare because the affected person’s “insurer.” To be an insurer, an entity should assume the monetary threat of a declare, and on condition that HCA Healthcare is the employer, that’s extremely possible. Most most likely HCA is self-funded, immediately assuming all monetary threat for its worker profit plan. UnitedHealthcare is probably going only a supplier of administrative companies to the employer and its lined workers, in what’s also known as an “ASO” association, that means administrative companies solely.
Why does this matter? Many causes, however first, UHC and related organizations like folks to consider them because the insurer as a result of it enhances model energy in increasing their very worthwhile position as an middleman in well being care transactions. In the “C suite,” nevertheless, well being plan executives and traders are completely happy to keep away from the monetary uncertainty of well being care utilization, as an alternative having fun with the predictability of administrative earnings, together with by the supply of Rx advantages. UHC is basically a really massive ASO, as is Cigna, CVS, Elevance (previously Anthem), and lots of the bigger Blue Cross and Blue Shield entities. These firms get to entry the shoppers’ funds to fund well being care in advancing their market-share enterprise targets.
Second, the opposite two key events in most three-way medical transactions, sufferers and suppliers, are fairly often unaware of this, which muddies the problems that come up in disputed claims, and broader well being care coverage. Self-funded advantages will not be analogous to insurance coverage in lots of vital respects, and the usage of the phrase “insurance” interchangeably has led to confusion and unintended coverage penalties. KFF Health News is properly positioned to appropriate this key misunderstanding. Your work on affected person billing dilemmas is a superb place to handle this. In the article about Sara McLin (if I’ve accurately surmised that UHC is the administrator and never the insurer), UHC may merely be recognized because the administrator. Most readers and NPR listeners would grasp that refined however vital distinction.
KFF supplies a superb, clear image of business employment-based well being care profit financing within the annual “Employer Health Benefits Survey.” As famous on this yr’s report, 65% of workers are contributors in self-funded plans. This quantity continues to extend.
My dive into this considerably esoteric nomenclature matter may be seen as a bit obsessive. In my 35-plus-year profession in well being care cost, nevertheless, I’ve repeatedly seen how this misunderstanding has fueled battle on the affected person/supplier degree and resulted in misguided public coverage. I hope you and your readers discover these feedback of some use.
— Marc Marion, Oklahoma City
We might need all handled one thing like this. Frustrating as each a doc and affected person. More ironic since household employed by HCA. https://t.co/xqrQjqBoUY
— Philip Chen (@DrPhil_ENT) April 8, 2023
— Philip Chen, San Antonio
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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