Archive for January, 2022

KEEPING THE CONSUMER SAFE: TO TEST or NOT TO TEST: Segment 12

Healthcare Consumer Navigator Center is a Healthcare Consumer Advocate Organization that helps consumer navigate the healthcare maze. The following Series “KEEPING THE CONSUMER SAFE; LIVING WITH COVID”.  Our goal is to provide a commonsense approach to living with covid with general healthcare information.

This is now the latest COVID-19 hot button. Today, President Biden announced the administration was buying another 500 million at-home-COVID-19 tests. This was in

Addition to the 500 tests ordered last week. In addition, “high-quality masks are also going to be made available. Here’s the real bonus! All this stuff is “free.” Only politicians can give out millions of dollars of stuff for “free.” When you’re in Washington long enough everything seems to be free. But that’s a topic for another day.

Social media is now full of stories of people unable to find home testing kits in stores, waiting in public testing lines for hours, waiting days/weeks for tests to come back from labs and I am wondering why? Testing seems to be the latest craze in the COVID-19 saga.

When did this craziness happen and why? For me personally, in 2020, the only time I was tested was when my wife and I were traveling to Alaska and a negative test was required to leave the airport in Anchorage. As I think back, other than this trip, I can’t ever recall being tested as a topic of concern. Ironically, we went through the same process of being tested prior to the 2021 trip not because of a State of Alaska requirement but because of a requirement by the lodge we were staying at. As I previously reported, I was tested while at the lodge and was positive for COVID. I was 100% asymptomatic, however, due to airline requirements I needed to quarantine for 10 days before I could fly home. Interestingly, if this happened today, according  to new CDC guidelines, I’d only need to quarantine for 5 days.

I’m repeating myself to illustrate things do change relative to our COVID measures and I’m now wondering when this current craziness will subside? However, here’s something that I believe is very important. I’ve covered this before but not to the extent I now find necessary. On the CDC website is a section titled, “People with Certain Medical Conditions,” which summarizes all the comorbidities which place people at higher mortality risk with COVID. Frankly, in my humble and medically, un-educated opinion, the list most likely covers somewhere around 80% of the US population. So while very accurate it’s pretty much useless in saving lives.

Sometime in early 2021, folks at Griffith University, published an analysis of 375,859 participants from 14 countries. They found “chronic kidney disease was statistically the most prominent comorbidity leading to death.” Other comorbidities were cancer, diabetes or hypertension. As in all medical studies, there are a bunch of caveats and other mumbo-jumbo to protect the study’s authors from litigation, but the essence of identifying just four comorbidities goes a long way toward providing a much more manageable approach to treating a select group of COVID patients differently.

In summary, again I’m not a physician, but feel comfortable in saying if you or a loved one has any of the aforementioned health challenges special attention is important. I strongly recommend consultation with your personal physician. Monitoring symptoms becomes very important. While I personally hate wearing a mask, one might take this added precaution more seriously. In addition, being aware of one’s environment and the people in it is also more important. Consulting with your physician is important regarding being vaccinated and boosted.

Finally, I don’t get the current and overwhelming need for individuals to be tested. I’ll grant the aforementioned group of people should be cautious and careful in monitoring symptoms. We now are fully aware there will be “breakthrough” cases (myself included) of the vaccinated. We also are learning the Omicron version of COVID is different. We are attempting to keep our readers apprised of the most non-political, current, scientifically-based information we can find. It becomes challenging to sift through the information because COVID has become one of the most politicized diseases scientists have had to deal with.

In a future articles, I’m covering symptoms and an alternative view of dealing with COVID-19.

KHN Bill of the Month: NICU Bill Installment Plan: That’ll Be $45,843 a Month for 12 Months, Please

By Victoria Knight   DECEMBER 21, 2021 Kaiser Health News

Close to midnight on Nov. 12, 2020, Bisi Bennett was sitting on the couch in her pajamas and feeling uncomfortable. She was about seven months pregnant with her first child, Dorian, and the thought that she could be in labor didn’t even cross her mind.

Then, she felt a contraction so strong it knocked her off the couch. She shouted to her husband, Chris, and they ran to the car to start the 15-minute drive to AdventHealth hospital in Orlando, Florida. About halfway through the trip, Bennett gave birth to Dorian in her family’s Mitsubishi Outlander. Her husband kept one hand on his newborn son’s back and one hand on the wheel.

Born breech, meaning his head emerged last, Dorian wasn’t crying at first, and the terrified new parents feared something was wrong. Chris Bennett turned on the SUV’s flashers and flagged down a passing emergency vehicle. The EMS team escorted the family to the hospital.

“He was still connected to me with the umbilical cord when they rolled the two of us together into the hospital,” Bisi said. “They cut the cord, and the last thing I heard was, ‘He has a pulse,’ before they wheeled me away.”

“I just cried tears of relief,” she said.

Dorian stayed in the neonatal intensive care unit until Jan. 7, 2021, for almost two full months. While Dorian was in the hospital, Bisi wasn’t worried about the cost. She works in the insurance industry and had carefully chosen AdventHealth Orlando because the hospital was close to her house and in her insurance network.

Then the bills came.

The Patient: Dorian Bennett, an infant born two months premature. He has health insurance through his mother’s employer, AssuredPartners, where she works as a licensed property insurance agent.

Medical Service: A neonatal intensive care unit stay of 56 days. Dorian needed highly technical, lifesaving respiratory and nutritional care until his organs matured. He also received laboratory, radiology, surgery, cardiology and audiology services and treatments.

Service Provider: AdventHealth Orlando in Orlando, Florida. It is a part of the AdventHealth system, a large nonprofit and faith-based group of health care providers with locations across Florida and several other states.

Total Bill: AdventHealth Orlando billed $660,553 for Dorian’s NICU care. Because of an insurance snafu, the “patient responsibility” portion of the bill sent to the Bennetts was $550,124. They were offered an installment payment plan of $45,843 a month for 12 months.

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What Gives: Under the 2010 health law, nonprofit hospitals are required to provide financial assistance to help patients pay their bills, and payment plans can be part of that assistance. But the Bennett family’s experience shows the system is still far from friendly to patients.

The installment amount offered to the Bennetts — $45,843 — resembles an annual salary more than a reasonable monthly payment. The laughably unrealistic plan was apparently automatically generated by the hospital’s billing system. A spokesperson for the hospital, David Breen of AdventHealth, did not answer KHN’s questions about its billing software or why a five-digit monthly payment was not flagged by the hospital as a problem that might need extra attention.

The size of the Bennetts’ bill stems from two overlapping issues: Baby Dorian was born in 2020 and needed hospital care into 2021, and Bisi Bennett’s employer shifted its health plan to a different company in January 2021. She informed AdventHealth about the change.

As someone who works in the insurance industry, Bennett was pretty sure that she understood the mix-up and that the charge of more than half a million dollars was unjustified.

But as Dorian turned a year old last month, the family still had bills pending and a tangle of red tape to fight.

AdventHealth bundled the 2020 and 2021 dates of Dorian’s NICU stay and then billed both insurance plans for the whole stay. Both insurance plans said the bill contained dates of care when Dorian was not covered, so neither paid the hospital. The shift from one year to the next flummoxed three large business entities, which seemed unmotivated to resolve the problem quickly.

“A bill this large is a huge crisis for the family, but it’s not a huge crisis for the insurance company or for the hospital,” said Erin Fuse Brown, an associate professor of law at Georgia State University who studies health care policy.

In 2020, Dorian was covered under a UnitedHealthcare plan, which for in-network providers had a $6,000 deductible and $6,000 out-of-pocket maximum for the family.

In 2021, Bisi Bennett’s employer switched its third-party administrator of its self-funded plan from UnitedHealthcare to UMR. The deductible and out-of-pocket maximum did not change.

Although UMR is owned by UnitedHealthcare, the two companies did not communicate well about the case.

“It’s indicative of all the ways the system fails the patient,” Fuse Brown said. “Even the one who does everything right.”

Through the nearly yearlong fight over the bill, the Bennetts were also caring for Dorian, who left the hospital with lingering gastrointestinal issues, and managing Chris’ treatment for stage 4 neuroendocrine cancer, which was diagnosed in April. At one point, Bisi said, she felt she was going crazy.

“They’re in charge of billing, and I shouldn’t be the one having to tell them, ‘Bill my one insurance for dates in 2020 and bill my other insurance for dates in 2021,’ but I did,” she said. “I kept having the same conversation over and over.”

Resolution: Bisi Bennett immediately noticed and understood the calendar issue when she received the billing statements in spring 2021. She started by calling the hospital and was told the problem would be corrected in March. Yet, in September, she got the same half-a-million-dollar bill.

UnitedHealthcare spokesperson Maria Gordon Shydlo, who also fielded KHN’s questions for UMR, said the insurance company told AdventHealth to revise the bill with correct dates in the spring.

Breen, the spokesperson for AdventHealth Orlando, confirmed to KHN that the billing error stemmed from the change in insurers from 2020 to 2021. In a statement, Breen said medical billing can be a complex process and the hospital “understand[s] this has been a confusing and challenging experience for Ms. Bennett, and we apologize for the frustration this has caused.”

AdventHealth Orlando did not submit a revised bill with corrected dates until KHN contacted the hospital in October 2021.

After UHC and UMR reprocessed the 2020 and 2021 claims, the original bill of more than $550,000 was knocked down to $300.

In his statement, Breen said that the Bennetts’ case sparked AdventHealth to identify and address issues in its system and that the hospital plans to improve the billing and communications process for future patients, particularly when there is a change in insurance.

The Takeaway: Much of our fragmented health care system is on autopilot, with billing software that generates confusing or, in this case, absurd bills and payment