Archive for the ‘Blog’ Category

No Surprises Act: Perspectives on the Status of Consumer Protections Against Balance Billing

Brief Apr-18-2023 | Hoadley J , Lucia K , Volk J , Walsh-Alker E , Swindle R , and Wengle E

One year after implementation of the No Surprises Act (NSA), the law is largely protecting consumers from the most pervasive forms of surprise billing, but remaining gaps leave some patients with unexpected financial liabilities.

The Issue

Surprise balance billing occurs when insured patients receive out-of-network care and are billed for the difference between what their insurer will cover and what the care provider seeks as full payment.

Key Findings

• Despite multiple ongoing lawsuits related to the implementation of the NSA, consumers appear to be well-protected from the most pervasive balance billing practices, such as billing for air ambulance services, that previously left them with unexpected medical bills.
• Close monitoring of the NSA is needed, with concerns about consumer awareness of the NSA’s provisions.
• Opportunities to expand the scope of the law’s consumer protections remain. Notably, the failure to include emergency ground ambulance services in provider networks means many people will continue to be billed for out-of-network services incurred in an emergency.
• Researchers say it’s too early to assess whether the NSA will encourage broader provider networks or constrain growth in health insurance premiums.

Conclusion

Researchers indicate the No Surprises Act is protecting patients from costly payment disputes. However, gaps in the law leave some people vulnerable to continued surprise bills—often after an emergency—and further consumer protections are required to protect consumers from unexpected charges.

About the Author/Grantee

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.

Navigating the Healthcare System My Healthcare Story and What I Learned

It was a Sunday morning in November and all of a sudden what began as a relaxing day turned into an ER visit followed by emergency surgery.  Fast forward five days and I was being discharged from the hospital.

Obviously, my health and recovery were my first concerns, but once the pain meds wore off, I started wondering what this would cost me.

(Apparently, I wondered this at the hospital, as my husband recalled that I asked the surgeon if he was “in network.”)

Until this episode, I had accumulated $1273 dollars of medical costs that mostly included physical therapy and some minor x-rays.  No concern at all about nearing my deductible of $5,500 or Out of Pocket Maximum (OOPM) cost of (gulp) $8,700.

I am an accountant by training so I should be able to figure this all out, right?  No sweat!

Then the EOB’s started to come, followed by bills from the providers.  Because of the multitude of specialties that were involved in this episode of care, I received no fewer than 20 EOBs from seven different providers.  Seven of the EOB’s were adjusted and re-submitted.

So of course, I loaded them all into an Excel spreadsheet to sort it all out and make sure I did not pay more than the $8,700.

Checking and re-checking my formulas, it just wasn’t adding up.  According to the EOBs, the total I was responsible to pay was $10,300, or $1,600 more than my $8,700 out of pocket maximum.

I called my insurer and asked “Which claims do I pay?  If I add them all up, I am over my OOPM?”  There was an uncomfortable silence on the other end of the line, as he was trying to come up with a response other than “Bless Your Heart.”

Fast forward another two months and I think we have figured it out.

Here are some lessons I learned:

All parties involved want to resolve outstanding medical bills.

I don’t like conflict, but I can be quite persistent, especially when I know I’m right.  I dreaded calling the insurer to resolve my issues.  I also dreaded the follow up visit to my doctor when the office staff presented me with an invoice (that I thought the insurer should pay).  But I found both parties to be very patient, willing to listen and resolve my issues.  It helped that I was prepared with specifics when we spoke.  At the end of the day, the insurer, providers and I all wanted the same results – appropriate payments according to the contracts we entered into. (I don’t think they like conflict, either.)

Don’t just throw away or file an EOB form.  Understand what it means.

Explanation of Benefits (EOB) forms can be confusing.

Each time a health care provider provides service to you, they submit a claim to your insurance company.  The insurance company sends you an EOB, that describes the service, the total amount billed by your provider, the amount your insurance company will pay, and the amount you will be responsible to pay.   The EOB includes a lot of information, so let’s look at what it all means.

The “Amount Billed” is the what the provider charges at 100% (“think Full Retail”).

Providers and the insurance company negotiate a fee schedule for every procedure.  So, when a provider agrees to accept your insurance, he or she agrees to be paid this negotiated amount, which is less than the amount billed.  This discount is shown on the EOB as “Discounts and Reductions.”   The discount is often substantially less than full charges.    The amount billed less discounts and reductions is the “Amount Covered/Allowed.”  This is what will be paid to the provider for the service, either by the insurance company or you. 

The rest of the EOB reflects what the insurer will pay, based on the terms of your policy.  What remains is your responsibility to pay.  “Your Total Costs” include co-pays, deductibles, and co-insurance.  This is important because these costs comprise your OOPM.

If you receive corrected EOBs, match them up with the original ones so you know what changed.

Keep track of your out-of-pocket costs as you incur them throughout the year.

Know what expenses count against your deductible and out of pocket maximum expenses.  For example, co-pays do not count toward the deductible, but they do count toward the OOPM.  Who knew?

After each medical treatment or visit, review where you stand with your deductible and OOPM cost.  This might seem unnecessary until you actually reach your deductible or OOPM.  But I waited until after I reached mine in November to try to sort it out.  It was overwhelming due to the number of claims filed simultaneously for those six days.   Your insurer can tell you how much of your deductible and OOPM have been met, either via telephone or on-line.

I used my on-line account with the insurer to track my YTD costs toward the deductible and OOPM.  Each claim and all the costs were displayed on-line.  This provided an excellent starting point.  I then tried to understand why my calculations were different.  It took several telephone conversations with my insurer, but here’s what we found:

• Co-pays did not count against my deductible, but they did count against the OPM.

I had erroneously applied the amounts of my co-pays toward the deductible.

• Some services were not paid by my insurer because they were not pre-approved.

These were two PT visits.  Make sure you receive a referral for specialty care if your plan requires it.

• One provider was considered out-of-network by the insurer, even though he was listed in their Provider Directory.

I wanted this physician to be paid what was due him, but couldn’t understand why it was my responsibility, and not the insurer’s.  The insurer had an old address for him, and he was shown as out-of-network at that address.  If possible, make sure your provider is in-network (a participating provider) before you seek care.  Approach this from two angles.  First, call the provider and inquire if they take your insurance.  Give him your plan name, member ID and group number.  Second, look up your plan’s provider network on-line.  The providers in network are listed by type of care (hospital, primary care, specialty, etc.)

Why is this important?  With an insurance policy like mine, an HMO, I pay more out-of-pocket if I use an out-of-network provider.

Out-of-network costs do not count toward your in-network deductible or OOPM.

Some policies do not pay for non-participating providers.  If they don’t, there is no deductible limit or OOPM for their services.  If they do, there is a separate deductible and OOPM.  For me, those amounts are nearly triple those for in-network care.

• There is new legislation that provides billing protections when getting emergency care, and non-emergency care from out-of-network providers at in-network facilities.

This is huge!  Obviously, if you need to go to the ER, you might not be in a position to question whether the hospital and physicians are in-or-out-of-network.

Last time I went to the ER, the hospital was in-network, but the ER physician group was out-of-network.  I received a bill for the difference between the group’s billed charges and what the insurer paid them.  This is known as a “balance bill.”    An unexpected balance bill is appropriately called a “surprise bill.”  I fully expected to receive the same type of bill this time around, but the bill was discounted to the insurer’s contracted rate.  What happened?

New Federal legislation, effective January 2022, does two important things.  First, it bans out-of-network cost sharing, like copays and deductibles, for all emergency and some non-emergency services.  So, you can’t be charged more than the in-network amount by an out-of-network provider.

Second, it bans out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers who work at in-network facilities.   Basically, the group applied the insurer’s discount to their bill.

• Wait until your insurer processes your EOB before you pay the provider.

As I mentioned above, I had 20 EOBs from seven different providers during my hospital visit in November.   Several claims were filed for each date of service, which made prioritizing payment confusing.  As my insurer re-processed the claims in question, they also re-processed and re-issued the EOB’s from those claims, and any claims after that date.  The cumulative amount of my out-of-pocket expenses changed accordingly.  As did the date I hit my OOPM and the claims that comprised it.  So, some of the EOB’s that originally showed a payment due from me were adjusted downward to reflect what insurance paid.  Many of these corrected EOBs reflected $0 payment due from me.

Because I like to pay my bills on time, I had already paid one of the providers $242 that the insurer subsequently paid.  The provider owed me a refund.

If you feel you have overpaid a claim, be proactive and call your provider.

Funny thing about that $242 refund the provider owed me.  I suspect it would have not been refunded had I not called the physicians’ billing office and inquired about it.  They agreed with the amount to be refunded, but only showed it as a “credit” to my account.  I get it when I accidentally pay a utility bill twice, and the company applies my overpayment to the next month’s bill.  But I didn’t expect to have recurring charges from this provider.

I asked the billing office if they would have issued the refund had I not called them.  The nice man on the phone basically said no, that I needed to “be proactive” about asking for it.  So, I was, and should receive the credit “in the next seven to ten business days.”

Remember those EOB’s I mentioned earlier?  Had I not actually looked at the revised one and matched it with the original, I never would have noticed that the insurer paid the $242.

If you have questions about a claim, call your insurer’s member services.  They can access the information and advise you how to proceed.  Before you do, I strongly recommend that you enroll in your insurer’s on-line access account.

Most of the information you need will be there.  I visited my on-line account several times as the EOBs came.   I found a lot of valuable information, including summaries of each claim, its status as processed or paid, and the total I incurred against my deducible and maximum out of pocket.   By viewing this information before I called the insurer, I was able to organize my thoughts and questions based on specific claims data.  The more specific, the better.  Looking at this information real time as I spoke with my insurer’s representatives was invaluable.  They could see exactly what I was looking at and why I had questions.  One representative actually sent me a spreadsheet of my claims, highlighting those that were applied to the OOPM, those that were still under review, and those that were adjusted based on our conversations.

Epilogue

As of today, I have paid exactly $8,700 of my $8,700 OOPM.  I know exactly which claims comprise it, itemized of course on my Excel spreadsheet.

My insurer has paid the claims in excess of that amount.  As far as I know, all the providers have been paid what was due to them.  And hopefully I won’t get anywhere near my OOPM in 2023!

Lessons Learned

1. After your healthcare service, make sure you know and make sure:
   1. Your Health Insurance benefits.
   2. How much monies have been applied to any deductibles.
   3. Whether the healthcare providers that treated you were in or out of your network.
   4. Match your EOB’s (Explanation of Benefits) to all bills you receive from healthcare providers.
      1. Make sure the payment is correct, in or out of network payments.
      2. Make sure your deductibles have been applied correctly.
      3. Maintain all EOB’s and bills you receive.

1. If appropriate, create a log and track your insurance payments and you out of pocket expenses.
2. If you have any questions call you insurance company or healthcare provider
3. Most insurance companies have online services that track all your activity. Take advantage of this offering.
4. Many healthcare providers will not automatically refund overpayments to you unless you ask.

By Angela Herron

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Much Ado About Nothing or What’s All the Fuss About

Several weeks ago, the Dallas Morning News reported about negotiations between Blue Cross Blue Shield of Texas (BCBS) and Southwestern Health Resources (SHR), an alliance between Texas Health Resources and UT Southwestern Medical Center. What made the story seemingly noteworthy was the amount under negotiation was reported as, an unconfirmed, $900 million. What 90 percent of the public doesn’t know is this was nothing more than theatrics performed for public consumption.

This blog is the first in a four-part series pulling back the curtain about how medical costs are developed and flow down to employers and consumers in the form of increased premiums. The above story provides an excellent opportunity to look at the interrelationships within the worlds of big medical insurance and big health care providers. Including the misperceptions, the public has about these relationships. The intended purpose of these blogs is to educate the consumer on how to make better informed healthcare decisions.

But let’s skip to the resolution of the negotiations. As expected, and because this is a recurring “magic act” that’s occurred numerous times before, the outcome was 100% predictable. The parties came to an agreement, the details of which remain undisclosed, and thousands of Texans rejoice their medical insurance coverage has miraculously been saved by mere mortals. Just at an undisclosed higher cost. As negotiations reached their conclusion, appropriate dignitaries provided obvious generalized postmortem comments for public consumption. Of course, no meaningful details were provided like financial impact to employers or employees. This illusionary story plays out all over the United States every year between payors and providers. With the public under the impression, payors are acting in an agency role to help control insurance costs and providers are attempting to control medical expenses. Nothing could be further from reality.

Let’s start this journey with some insurance terminology. A common-used term in health insurance is “medical loss ratio.” Simply defined the medical loss ratio represents the amount of health insurance premiums insurance companies spend on medical claims and efforts to improve quality. To somehow improve healthcare, our elected government officials through the Affordable Care Act added requirements regarding the medical loss ratio insurance companies must follow. Without going through agonizing details, the summary is insurance companies must spend 80% of their premiums on medical claims. Leaving 20% for profits, salaries, marketing, and administration.

On the surface, this would appear to be a logical way to ensure an adequate amount of money is spent on medical care. This would be true in a normally competitive market environment. Unfortunately, the healthcare marketplace is neither normal nor competitive. The government’s 80% requirement effectively made the only way insurance companies can improve their profitability is to increase premiums. Given these types of economic incentives insurer have no incentive to lower premiums and providers have no incentive to be efficient. The financial relationship is very codependent with no one accountable to the consumer.

Lesson #1 The vast majority of traditional healthcare incumbents are financially motivated to make as much money as possible.

Is Medical Debt Different from Educational Debt

Recently, there has been much media attention about educational debt forgiveness. Like most issues of this type there seems to be much political posturing around the topic.

Interestingly, several weeks ago NPR and The Kaiser Family Foundation (KFF) along with several national television outlets reported on how the health care system “is systematically pushing patients into debt on a mass scale.” The topic of educational debt seems to have grabbed the headlines away from medical debt.

According to an internet website, student loan debt is nearly $1.75 trillion, owed by approximately 48 million Americans, 4.7% are delinquent and the average monthly payment is $300.

With significantly less robust accounting, medical debt is estimated at $195 billion as of 2019. It will be difficult to estimate new debt levels post COVID because many peoples’ employment was impacted and most health insurance coverage is tied to employment. While proportionately much smaller than educational debt, health care debt seems more consequential on peoples’ financial conditions. According to a KFF poll, “half US adults don’t have the cash to cover an unexpected $500 bill.” While the dollars are smaller, the estimated number of people with medical debt is estimated to be more than 100 million people or more than double the number with educational debt.

Supposedly, politicians attempted to solve an ever-growing issue related to health care with the passage of the 2010 Affordable Care Act. An interesting unintended consequence, however, were record profit levels for hospitals according to the Medicare Payment Advisory Committee. And at the same time debt levels soared.

Let’s make some quick comparisons between medical and educational debt. First, many will argue medical care is a right and higher education is a privilege. Medical debt typically results from the provision of medical treatment in excess of medical insurance or in some cases the lack of insurance or financial resources. Educational debt is entirely based on choice, access to cheap debt and inadequate financial resources to repay the loans.

Interestingly, educational debt is looking and acting more like the subprime mortgage debt crisis and the related 2008 housing crash than health care debt. In fact, the only aspect lacking to complete the comparison is a government bailout. Will a government sponsored program of educational debt forgiveness initiate the demand for the same for health care debt? Enter the concept of moral hazard. What will the long-term impact of a debt forgiveness program be on the higher education system? Might this be the tipping point for those supporting socialized medicine?

For a number of years, the education and health care industries have shared notable factors placing both in economic peril. Most significant is the unabated rise in costs in both industries,  both rely heavily upon various forms of government subsidies, both are provided significant tax benefits, and neither face any type of challenge from foreign competition. These factors have resulted in bloated budgets and unquestioned waste in both industries. Both industries are critical to the US infrastructure but long-term viability under the aforementioned structures present significant challenges.  Conventional output and productivity measurement have proven very difficult to implement. Employers in the case of health care and lenders in the case of education are feeling similar financial pressure.

On the surface today, there’s seemingly no connection between these two industries but inevitably attempting to fix one will impact the other because both are on very slippery financial slopes.

How to Find a Telemedicine Provider

The genesis of this post was a question my neighbor asked. How do I find a telemedicine provider in Texas? Candidly, I didn’t have a very good answer. So off to the internet I went.

(I’m personally not a regular telemedicine user. Admittedly, my telemedicine knowledge was very dated because my best memory was of the public opposition various Texas Medical groups had prior to COVID.)

Especially for Texas. The COVID pandemic will go down in history as the single largest contributor to the launch of telemedicine despite parts of the medical community’s strong resistance. Prior to the pandemic in my home state of Texas, various medical groups were adamantly opposed to any sort of electronic based medical delivery. On April 10, 2015, the Texas Medical Board (supported by the Texas Medical Association(TMA)) voted to restrict the practice in Texas. This was the culmination of a four-year battle between the Medical Board and Teladoc, a Texas-based company providing telephone or video consultations for routine issues like sore throats, urinary tract infections, rashes, etc.

Then COVID happened and on March 13, 2020 in response to the Governor’s Statewide Disaster Proclamation, the Texas Department of Insurance issued an emergency rule mandating telemedicine services “receive parity with the payment and documentation requirements applicable to in-person services.” I won’t detail everything that has occurred between then and now but suffice it to say the TMA now has a section on their website “Telemedicine in Texas” which provides step by step resources on developing a Telemedicine practice.

All of this, however, does not answer the question of how to find a telemedicine provider.

Here’s my list of recommendations:

• Teladoc is an established provider of telemedicine services. If you’re not interested in doing a great deal of research and have a relatively simple and straightforward issue, this is a good starting point.
• Your insurance company.
• A major healthcare system within the community. Since COVID, many major Systems have developed telemedicine call centers.
• Specialty Societies: Just a few examples

Academy of Allergy, Asthma & Immunology

Academy of Dermatology

Academy of Orthopaedics Surgeons

Academy of Pediatrics

American College of Cardiology

• State Medical Associations

Depending upon where you’re located can have a significant impact on what resources you will be able to find relative to Telemedicine. Some areas will be advanced and others will still be very much developmental. Like most things competition will have an impact on how advanced programs will be.

You would be well advised to seek references if you’re unfamiliar with the provider you’ve contacted.

Finding a Telemedicine provider requires the same level of due diligence finding a provider you plan to meet face to face.

Attention Retirees and Tax Payers

Today’s post has a dual purpose, for a somewhat small group of readers and at the same time a very large group. The small group consists of retirees having employer provided healthcare benefits. HR consultants have discovered another way to save employers money and subtly change the employees’ healthcare benefit plan. What I mean by “subtly” change the benefit plan is best depicted by another benefit plan change occurring since the 1980s in the pension plan arena. The change occurred when employers shifted from defined benefit retirement plans to defined contribution plans. At the time, employers were dealing with significant unfunded liabilities and unpredictable expenses which were impacting profitability. Adopting this new form of retirement benefit immediately addressed these issues.

So let’s fast forward to the present. Similar to defined benefit pension plans, retiree healthcare plans have similar challenges for employers. Those being large, unpredictable costs and continually growing liabilities. Like everything associated with healthcare, when promises were made by employers to employees related to healthcare insurance coverage, no one envisioned the out of control, multi-trillion dollar healthcare industry we now have.

Again, enter the HR consultants with employer solutions. Some of you will be familiar with Medicare Advantage plans. If for no other reason they’re constantly being advertised on television. Some of you may even be members in these plans because AARP, along with their business partner, UnitedHealthcare, has been an active advocate of such plans for a number of years. Let me pause and as background information let you know Advantage Plans are not new. They were part of the original Medicare legislation. However, a perfect storm of sorts has created a new environment for these plans.

Rather than bore you with rabbit-trail details. Let me hit the highlights and you can decide for yourself if more education is needed. First, remember when someone was promoting the adoption of Obama Care, and said you won’t have to change your doctor? Well, you may hear the same thing when your employer replaces their existing retiree health plan with a Medicare Advantage plan. You might experience the same result as those enrolling in Obama Care. You also might find your current hospital is not included in the new plan. In the health care community, the terminology you will hear describing where you can go and who your Doctor can be is “network.” And more importantly, the description, “out-of-network” will be used to describe those providers no longer covered by the new insurance plan. An old adage, “if it sounds to good to be true, in all likelihood it probably is,” might be applicable at this point.

Advantage Plans have undergone significant transformation since the 1980s because of attempts by the government to gain more “control” over Medicare costs. Demonstration projects attempting to encourage improved quality, reduce government expenditures, add additional benefits and promote innovations in health delivery have resulted in the hyper-growth of Advantage Plans.

Not surprisingly with billions of dollars at stake, insurers have rushed to the “Medicare Payment Trough.” With the explosion of Medicare Advantage Plans it’s no surprise enrollments have increased accordingly. Here, however, is the interesting part of the story. Since 2008, enrollment in employer-sponsored, Medicare Advantage Plans has gone from 1.6 million to over 5 million. Why, you might ask? Let’s look at a recent situation that highlights the good, the bad and the ugly.

As promised, here’s something for you taxpayers reading this. As many similar things, Medicare Advantage is not new. In fact, corporate America has been making the changes in retiree healthcare benefits for over a decade. What raised the attention level most recently, however, is New York City’s decision to shift more than 200,000 retirees to an Advantage plan with proclaimed savings of $600 million/year. How some skeptics have asked? Improved efficiencies? Better clinical control?  Not unexpectedly, some folks within the New York City infrastructure have taken issue with the conversion and have sued to delay implementation. Decisions related to the lawsuit are in process.

Here are some interesting facts. In the last decade, enrollment in Medicare Advantage Plans has more than doubled. Medicare spending was $321 higher in 2019 and growing faster per person for enrollees in Medicare Advantage vs. traditional Medicare. In total, this resulted in $7 billion in additional spending. (Source Kaiser Health News) Medicare program solvency continues to be a major issue. As part of the Obama Care Act passage a little publicized tax, The Net Investment Income Tax (NIIT) of 3.8%, was included. This tax was created to help fund Medicare expansion. So beware Medicare has been a financial drain on the government budget for decades, it continues to be a financial drain, and there will continue to be “taxes” levied to cover the drain until something is done about healthcare in this country.

KEEPING THE CONSUMER SAFE: Where is Daniel Ellsberg When We Need Him; Segment 15

Many of you are wondering who the hell is Daniel Ellsberg? Mr. Ellsberg was ground zero for a monumental media firestorm during the summer of 1971 about the Vietnam War. I won’t rehash what became known as the Pentagon Papers. I am hoping someone emerges with the “real” COVID-19 story.

As last reported, new studies are surfacing challenging the efficacy of various forms of COVID mitigation. This has heightened the polarization of what practices are going to be continued and what will be discontinued. The “science” seems to be waning in importance.

In the state of Texas, Omicron cases are on the decline. Fauci even recently announced the “U.S. is exiting the full-blown pandemic phase.” In an unconfirmed internet story, it was alleged during the HIV/AIDS epidemic Fauci was a strong advocate for vaccine development and almost anti-therapy development. This may or may not connect the dots to the current lack/shortage of COVID therapy development and explain the full-court press on vaccine participation (currently there are no HIV vaccines licensed for the market).

In what has been extremely limited local reporting, a February 5, 2022 Dallas Morning News article, “Approved virus treatments, and how to find them,” the sketchy existence of COVID-19 treatments was outlined. The good news is The Food and Drug Administration has given emergency authorization for 4 treatments. The only access to the treatments is by prescription or referral from a health care provider. The article goes on to state the “treatments are in short supply in North Texas.” Some of you have probably heard or seen mention of COVID “monoclonal antibody treatments and wondered what they are and where to get them. My random sample of four health care providers in Dallas/Fort Worth resulted in zero availability.

I’m not a scientist so am not going to try and explain what monoclonal antibodies are. However, here’s where things get murky. In December 16, 2020, CNBC reported, “antibody drugs used to treat Trump and others could cut Covid-19 hospitalizations by half, but they’re not being used by the general public.” According to Alex Azar, Health Secretary, “ what’s happening is people are waiting too long to seek out the treatments.” What?

Being skeptical, after reading the aforementioned stories, I decided further investigation was necessary and was surprised by my discovery. First, the monoclonal antibodies Trump received were not approved by the FDA. I for one was amazed at the speed Trump recovered and some even wondered if he actually was infected. Second, a federal “right to try” law was passed in May 2018. Simply, this law allows patients to “try” experimental drugs not yet approved by the FDA. This enabled Trump’s physicians to access the drugs from the company, Regeneron. Interestingly, Regeneron had developed the “approach and technologies” for these antibodies from work related to the treatment of Ebola.  Third, to add to the confusion, The Food and Drug Administration issued a statement on January 22, 2022, revising the use of monoclonal antibodies, bamlanivimab, etesevimab, casirivimab, imdevimab to only situations where the patient has been exposed to the Delta variant. Apparently, it’s been determined these antibodies are ineffective against Omicron. A peculiarity to this announcement is the testing kits being distributed by the government don’t determine which COVID variant a person has.

In summary, certain monoclonal antibodies have had their FDA authorizations revised. Seemingly, the FDA by their announcement has declared the COVID Delta variant over. Does the FDA ruling make the use of the aforementioned antibodies illegal in light of the “Right to Try” law? Are organizations treating patients using these antibodies subject to legal action? We’ve seen the NIH and CDC attempt to silence individuals with an alternative position, will the FDA exert the same type of influence?  Earlier during the pandemic, there was a surplus of monoclonal antibodies and currently they’re in short supply. On January 30, the Dallas County Health and Human Services reported 183 deaths for the week. This made it the deadliest week since the pandemic began.

As someone once said, there’s a fly in the ointment. The inconsistencies are mounting and explanations are getting fewer and further between.

As background, I was a junior in high school following the summer when the Pentagon Papers were released. Each day during my history class, we examined the inconsistencies between what had been reported about the Vietnam War and what the reality was. I realize the Papers did not end the War but they shed light on many questionable decisions Presidents made that cost thousands of American lives. Our conversations left an indelible imprint on me about the importance of reliable reporting. Fool me once, shame on you. Fool me twice, shame on me. I’m hoping someone is writing the COVID Papers.

Vietnam cost 58,000 American lives. COVID has taken 918,000 deaths and counting!

KEEPING THE CONSUMER SAFE: The Politicization of COVID: Segment 14

A couple weeks ago, Salvador Rizzo of The Washington Post wrote an article about the confrontational exchange between Anthony Fauci and Senator Rand Paul during a Senate health committee hearing. Several things in the article were interesting. First, COVID has escalated into a serious political issue. I say serious because few things other than war have as serious life and death consequences as COVID. Second, why has the The Great Barrington Declaration become so polarizing?

In the article, Rizzo refers to the 3 authors of the Barrington paper as “three conservative academics who opposed lockdown measures in 2020.” This has become a much more interesting topic as of late but more later.

How quickly the COVID world changes. In searching social media. the first thing I noticed was the NHL announced asymptomatic players were no longer going to be tested. With the NFL playoffs upon us and the Super Bowl only days away, the NFL followed with a similar decision. The NFL’s once a week testing of all players and personnel has now been changed to only testing players displaying symptoms. In the Friday edition of The Dallas Morning News, I noticed a brief note, “The Association of State and Territorial Health Officials has called on governments to stop conducting widespread contact tracing, saying it’s no longer necessary.” What?

Another significant social media event occurred Friday evening, January 24, 2022, on the episode of “Real Time With Bill Maher.” Both Bill Maher and his guest, Bari Weiss, disclosed their personal frustrations with living under COVID restrictions. This brought on a social media firestorm. On a more personal note, my local school district closed for two days because of a COVID caused teacher shortage. Anyone see conflicting messages but me?

Canada has a nation-wide trucking demonstration in opposition to mandates going on. Johns Hopkins University recently released a 60+ page “Meta-Analysis of the Effects of Lockdowns on COVID-19 Mortality.” The paper comes to the conclusion that “lockdowns in Europe and the United States only reduced COVID-19 mortality by 0.2% on average. Shelter-in-place-order studies were also ineffective, only reducing COVID-19 mortality by 2.9% on average.” For those familiar with The Great Barrington Declaration, the Johns Hopkins study seemingly supports the recommendations of the Declaration. This document came under intense challenge by Fauci and Collins who challenged the scientific validity of the document.

Needless to say I’m getting more confused as I attempt to stay informed about what’s going on with COVID and trying to provide meaningful/helpful commentary.  Amidst all of the aforementioned seemingly contradictory information the following headline appeared in The Dallas Morning News, “Omicron pushes death toll higher.” So from a logical perspective one would think there’s a pretty significant reason for people to consider any and all approaches to stop the dying. I can categorically say this is not the case. In the aforementioned article, it’s suggested even though omicron is “milder,” it’s highly contagious, causing more to become ill and die.

I’m not a biostatistician so my following conclusion is not based on any technical skill or training. Based upon a vaccination website on Google, 211 million Americans are vaccinated representing 64% of the population. Our mortality numbers seem to be gaining on the peak mortality numbers during last fall. Common sense would suggest with more than half the population vaccinated and some additional percentage of the population being previously infected and surviving, we shouldn’t be experiencing this type of outcome unless something else is going on. Is the vaccine not working on Omicron? What are we learning about immunity? Does having the Delta variant provide immunity to the Omicron variant? Are the risk factors identified for the Delta variant the same as Omicron? Are there new or different risk factors impacting mortality? Are mandates working? What are the unintended consequences of the mandates and are there mortality impacts associated with these? What are the most effective treatments? Where should people go for treatments?

I spend my days searching for answers to these and other seemingly important questions. What’s frustrating is the lack of consistency in how the Press is reporting on the evolving information. I’m getting the sense if the information does not conform to the political context or the reporting outlet’s viewpoint, it may or may not be reported. This is dangerous! In fact, it’s starting to remind me of a time when the Pentagon Papers were the headline of the day.

As discussed before, we’re living in real-time, scientific discovery mode that is being exposed via social media to the entire world. As stated before, history shows us the scientific discovery process is complete with much trial and error as well as pure serendipity. Politicians intent on making public policy on unproven, untested or changing scientific discovery are going to be wrong some of the time. This is going to require real-time course corrections. It’s going to require people to admit they were wrong and move forward. It’s going to require politicians with courage and backbone to make decisions and then make better decisions based upon new information. Hiding information because it conflicts with existing public policy will not end well for anyone.

KEEPING THE CONSUMER SAFE: IS IT “CEDAR FEVER” or COVID-19?: Segment 13

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.

In a previous article, I compared medical innovation and making sausage. For those never seeing how a hotdog is made, consider yourselves lucky. I’ve decided having the whole world exposed to seeing how medicine/science is dealing with COVID is very much the same as making a hotdog. On the simplest level, we experience medicine by going to our doctor, getting a diagnosis, getting a prescription, and picking it up at the drugstore. Presto with have a fix. In more complex circumstances we go to our doctor, who sends us to a specialist who sends us to a hospital for some type of intervention. In either case, history and experience have created accepted algorithms of treatment and care. Things are predictable. Not so much with COVID.

Because COVID is occurring real-time and in the context of an advanced social media world. We are all seeing how scientific discovery happens. At times it does not always follow a straight line. So now we are dealing with a different version of COVID. In a matter of a few months we’ve gone from vaccinating those with compromised immune systems and over 65 to 5 years old and older.

I can only vaguely remember the beginning of COVID, as I recall the warning symptoms were, temperature, loss of taste, loss of smell, difficulty breathing and a scratchy throat. So now the CDC website lists the following as symptoms: fever or chills; cough; difficulty breathing; fatigue; muscle or body aches; headache; loss of taste or smell; sore throat; runny nose; nausea; diarrhea (the CDC is careful to note this is not a complete list). Complicating factors are now the Omicron variant and the impact of vaccination. More people are now asymptomatic. It doesn’t take a medical degree to realize there are many physical abnormalities that have the above mentioned symptoms.

I live in the great state of Texas. For 20 plus years in December and January, I have the displeasure of being extremely allergic to juniper pollen. I don’t know how many of our readers share this unfortunate condition, but I do know a number of colleagues. It is more commonly known here as “cedar fever.” The symptoms are fatigue, sore throat, runny nose, partial loss of smell,  temperature (usually not higher than 101.5), sneezing, itchy and watery eyes. Needless to say, to the layperson cedar fever bares an awful lot of similarity to COVID-19. In addition, we’re also entering a time of year the medical community refers to as the “flu season.” Because these symptoms are generally more common to everyone, I won’t delineate. Let me just say they are also very similar to COVID.

So combine the aforementioned medical conditions along with exploding COVID cases and a perfect storm for COVID-19 testing has been created. In very limited circulation is a document, “The Great Barrington Declaration,” written by 3 epidemiologists and public health scientists and as of this writing signed by over 916,000 supporters. Simply stated (you’re encouraged to read it for yourself) the document presents alternative approaches the writers call “Focused Protection” as opposed to COVID current strategies and was released to the public on October 5, 2020. What’s contributed to the notoriety of this document is the apparent opposition it’s created from the CDC and FDA and the political reaction to the document and the authors.

I’m more sensitive to the document now that I’ve been vaccinated, infected, recovered, boosted and surrounded by a circle of friends that share similar experiences. In all cases, vaccinated, they’ve not been hospitalized, minimal to no symptoms, recovered in 3 to 5 days without medical intervention other than over the counter cold and flu remedies. So as I read and hear stories on social media of people spending in excess of 8 hours waiting to be tested, I wonder why? Are all this people in the high risk categories? Are they responding to a panic being created by social media? It appears the majority of media is focused on the “vaccine or bust” agenda. There is almost no mention of the potential for infection despite vaccination, no significant messaging of infection and short recoveries and continued coverage of the outrageous demand for testing and the craziness this is causing.

I have lived with cedar fever for 21 years. I don’t look forward to it but have learned how to manage the 2 months when it impacts me. There seems to be a general feeling in the media there will be a complete eradication of COVID sometime in the near future, and we just need to live through these fire drills until that day arrives. Given my observations of the past 2 years, I think we’re more likely to be dealing with COVID for a much longer time horizon and should be adjusting to life-style changes that aren’t reactionary but permanent. Are we really going to make our children wear masks for the next 20 years? Are we really going to wear masks every time we get on an airplane? If we go to concerts, are the entertainers all going to be speaking through masks? Many of you aren’t old enough to remember the nuclear bomb drills we went through in the early sixties at school when we all were instructed to crawl under our desks.

Currently, I’m not spending my time waiting in line to be tested to see if I have cedar fever or the flu. I’m also not spending $20 on a home test kit to see if I have cedar fever. Because I have one of the top four comorbidities I take my temperature every day. I’m also very aware of any change in my physical well being.

I’m awaiting for my TSA-like vaccination card that enables me to live a more normal life. We need someone to start developing longer term approaches without the political influence, soon!

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.