insured people who use alternative remedies. This means No Cost Medical Care, No Cost Refunds for your purchases of alternative remedies.
US Tele-Medicine, a leader in Internet health care is offering No Cost Memberships to How is this possible? Recent changes in health care take Tele-Medicine into special consideration. Tele-Medicine is the forefront of health care and now it is in your favor.
Imagine getting 30% 40% or even 50% CASH back for your purchases of vitamins, weight management products, supplements, protein shakes, homeopathics, flower remedies, herbal formulations and more. You can and it’s FREE and easy to join. Just click the JOIN NOW button above and your on your way to financial rewards at NO COST to you - ever.
LONDON - A special edition of the journal, Clinical Risk, published by the Royal Society of Medicine, looks at how the combination of an under-regulated market, “professional greed”, increased marketing and overwhelming media hype have created a “perfect storm” that threatens patients and practitioners alike. The journal’s editor argues that cosmetic surgery patients in the UK are at more risk than ever before.
DrHarveyMarcovitch, who commissioned leading experts in the field to write for this special issue said, “Patient safety is this journal’s main aim and there can be no area of medicine where patients in the UK are more in need of protection. We need tight control of advertising of cosmetic surgery - including internet advertising. We need proper regulation of the industry and we need both surgeons and GPs to manage patient expectation.”
In one paper, entitled ‘Clinical Risk in Aesthetic Surgery’, NigelMercer, consultant plastic surgeon and President of the British Association of Aesthetic Plastic Surgeons (BAAPS) argues: “We have reached a stage where public expectation, driven by media hype and, dare one say, professional greed, has brought us to a ‘perfect storm’ in the cosmetic surgical market.”
He adds, “There has been a massive increase in ‘marketing’, including discount vouchers, 2-for-1 offers and holidays with surgery! In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a ‘2-for-1′ advert for general surgery? That way lies madness!”
Highlights:
Clinical Risk in Aesthetic Surgery: NigelMercer discusses the role of the media and advertising and calls for tighter regulations in the UK, comparing this country’s lack of regulation with the Food and Drug Administration’s role in the US.
Key quotes:
- “Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic ’surgical’ procedures, including on search engines…”.
- “If we have to sell anything, we should sell our advice, not procedures. If we cannot self-regulate, then, like the financial institutions, regulation will eventually be imposed…”
- “All cosmetic treatments are medical interventions, and every medical intervention has a complication and failure rate. Consequently, there are no ‘consumers’ or ‘clients’ but only ‘patients’…”
- “Perhaps the single most important factor in reducing clinical risk in cosmetic surgery is the motive for performing any procedure must never be financial gain, so I suggest we get our act together as an industry as we are in grave danger of biting the hand that feeds us.”
France Sets Standards for Practice of Aesthetic Surgery: French consultant plastic surgeon, AlainFogli describes the strictly defined guidelines for cosmetic surgery in France which include:
- Surgical procedures can only be undertaken by surgeons who are registered specialists and deemed competent. Possession of a general medical degree, and the fact that the practitioner is ‘experienced’ are not deemed to be sufficient qualifications
- A ban on all forms and methods of publicity and advertising, direct or indirect, in whatever form, including the Internet
Minimizing Risk in Aesthetic Surgery: Foad Nahai, President of the International Society of Aesthetic Plastic Surgeons (ISAPS) and former president of the American Society of Aesthetic Plastic Surgeons (ASAPS) describes how to minimise risk in each facet of ‘the safety diamond’: patient, facility, procedure and surgeon.
He tells readers:
“Regulations governing the training of all cosmetic surgeons are sorely needed. Governments are reluctant to become involved, as they see this issue as a ‘turf battle’ between various physician groups and not a public safety or patient safety issue. However, there is no question that this is a patient safety issue of paramount importance and I take our governments to task for not addressing it.”
- Since by law any physician is allowed to practise cosmetic surgery, attempts by individual physicians or plastic surgery organisations to restrict those who are not qualified is viewed as a restraint of trade.
Improving the Safety of Aesthetic Surgery: Recommendations Following a 14-Year Review of Cases to the Medical Defence Union (1990-2004): Consultant plastic surgeon and BAAPS Secretary, RajivGrover, reveals a 14-year audit of claims to the MDU which shows why patients sue. He provides recommendations to avoid these situations such as careful pre-operative counselling, thorough documentation and exploring with the patient what degree of correction and scarring is realistic - and not being falsely optimistic about the likely outcome.
Managing Risk to Reputation: MagnusBoyd, Partner at leading UK solicitors, Carter-Ruck suggests how doctors can protect their reputation and how the media can influence the outcome of a professional investigation or the expression of anger from a disgruntled patient.
Both DrHarveyMarcovitch and MrNigelMercer are available for comment.
Clinical Risk
The journal Clinical Risk aims to give both medical and legal professionals an enhanced understanding of key medico-legal issues relating to risk management and patient safety, through authoritative articles, reviews and news on the management of clinical risk. The AvMA Medical and Legal Journal and the Healthcare & Law Digest, both included within Clinical Risk, contain articles on current medico-legal issues and reports on a wide range of recently settled clinical negligence cases.
US Tele-Medicine, a leader in Internet health care is offering FREE Memberships to insured people who use alternative remedies. This means FREE Medical Care, FREE Refunds for your purchases of alternative remedies.
How is this possible? Recent changes in health care take Tele-Medicine into special consideration. Tele-Medicine is the forefront of health care and now it is in your favor.
Imagine getting 30% 40% or even 50% CASH back for your purchases of vitamins, weight management products, supplements, protein shakes, homeopathics, flower remedies, herbal formulations and more. You can and it’s FREE and easy to join. Just click the JOIN NOW button above and your on your way to financial rewards at NO COST to you - ever.
In addition to our “Introducing” and “Home-Remedies“ series of posts, we now launch a new series called “Presenting - Phobia” series. Each post will present another Phobia and discuss, manifestations, how-to-deal with people who have these phobias by explaining the Phobia itself, provide some suggested alternative herbs, supplements or nutritional support proven effective and other remedies with sources for more information.
We all have a Phobia or two lingering inside or for some, showing itself by dictating our behavior patterns. Many Phobias are viewed as eccentricities or oddities of a personality, and many indeed are. However some Phobias do prevent you from learning to your maximum ability, engaging in a meaningful relationship, or even going out for a cup of coffee with friends. You may recognize some of your own traits, latent and apparent, in these many Phobias.
Knowing you have a Phobia does not mean you have to seek a cure. Of course that depends on the Phobia itself. For example one can live with Apiphobia through life, and as long as you are not around bees, you will never suffer a moment of any major consequence being Apiphobic. On the other hand, if you are Bathmophobic (Fear of stairs or steep slopes) and live in San Franscisco, you need immediate help.
We hope you enjoy the series and that it will help you better understand the people around you and perhaps yourself.
Alternative Supplements Can Now Be Claimed on Your Insurance and Get a Cash Refund
BEVERLY HILLS – If you use vitamins, minerals, supplements, meal replacements or other forms of natural medicines, you can claim these expenses on your health insurance.US Tele-Medicine (www.ustelemedicine.com) offers this FREE service.
You simply sign on and become an E-Patient.Then when you buy your supplements or vitamins, simply log-on to the site and file your claim for the amount for purchase.There is NO Cost to you.
Click here: www.epatienthealthcare.com to enroll for Free and start getting some money back. You have nothing to lose and No Risk.
As medical providers, we believe that patients who are seeking wellness deserve a choice. You ought to have a choice in medicines. In addition to synthetic prescription drugs, there are natural medicines which may be more beneficial to you, but insurance companies offer you no such choice.
Integrated medicines have always been an out of pocket expense. The purchase of expensive natural and integrated medicines causes financial burdens on the average patient, because there is no reimbursement. The patient is only guilty of trying to feel better, live longer with fewer complications, and find relief for pain and chronic conditions.
It is our firm belief this added financial encumbrance on people, especially these days, is both unfair and unjust. We know that even the most generous health care reform enacted in 2009-2010 will take two years to realization.
Therefore, we elected to assign a percentage of our income to our E-Care patients. We trust these monies will empower those patients to purchase and use integrated medicines for their complete health and wellness.
We provide people with the financial freedom of choice.
Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through the phone or the Internet and sometimes other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.
Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.
Care at a distance (also called in absentia care), is an old practice which was often conducted via post. There has been a long and successful history of in absentia health care which, thanks to modern communication technology, has evolved into what we know as modern telemedicine.
In its early manifestations, African villagers used smoke signals to warn people to stay away from the village in case of serious disease. In the early 1900s, people living in remote areas in Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals, to communicate with the Royal Flying Doctor Service of Australia.
The terms e-health and telehealth are at times wrongly interchanged with telemedicine. Like the terms “medicine” and “health care”, telemedicine often refers only to the provision of clinical services while the te term telehealth can refer to clinical and non-clinical services such as medical education, administration, and research. The term e-health is often, particularly in the UK and Europe, used as an umbrella term that includes telehealth, electronic medical records, and other components of health IT.
Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and interactive services.
Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured Medical Record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The store-and-forward process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.
Remote monitoring, also known as self-monitoring/testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.
Interactive telemedicine services provide real-time interactions between patient and provider, to include phone conversations, online communication and home visits. Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician-interactive” telemedicine services may be less costly than in-person clinical visits.
Benefits and Uses of Telemedicine
Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Specialties that use telemedicine often use a “tele-” prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is termed as telecardiology, etc.
Telemedicine is also useful as a communication tool between a general practitioner and a specialist available at a remote location.
The first interactive Telemedicine system, operating over standard telephone lines, for remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation) was developed and marketed by MedPhone Corporation in 1989.
Monitoring a patient at home using known devices like blood pressure monitors and transferring the information to a caregiver is a fast growing emerging service. These remote monitoring solutions have a focus on current high morbidity chronic diseases and are mainly deployed for the First World. In developing countries a new way of practicing telemedicine is emerging better known as Primary Remote Diagnostic Visits whereby a doctor uses devices to remotely examine and treat a patient. This new technology and principle of practicing medicine holds big promises to solving major health care delivery problems in for instance Southern Africa because Primary Remote Diagnostic Consultations not only monitors an already diagnosed chronic disease, but has the promise to diagnosing and managing the diseases a patient will typically visit a general practitioner for.
Wireless technologies are bringing about dramatic improvements in the quality of healthcare by allowing patients unprecedented mobility while providing healthcare professionals with easy access to patient data.
Over the last decade, there has been a radical shift from wired to wireless medical devices. Even in its early stages, this revolution is improving patient care and bringing innovative products to market.
By incorporating wireless technologies into medical products, many products that were once tethered to patients, positioned next to hospital beds and located at a nurses’ station are now transportable. This has allowed two major healthcare improvements.
First, it has increased patient mobility, both at the hospital and at home. By incorporating a wireless protocol such as 802.11b into a patient monitor, a patient can leave their hospital bed while still having their vital signs, including blood pressure, electrocardiogram and temperature, continuously monitored through the hospital’s access points. As an added benefit, a patient can be tracked through the hospital.
The development of less invasive monitoring and treatment methods for common diseases has also improved patient mobility. Innovations have allowed at-home patient monitoring, minimizing patient trips to the hospital and saving valuable hospital space. The continuous monitoring of patient data at home improves compliance by operating independently of the patient’s efforts. For example, there are now implantable devices that monitor glucose levels without a patient having to puncture themselves with needles several times a day. The resulting data can be transmitted to a networked computer in the patient’s home, allowing a healthcare professional to monitor the patient data without the patient having to set foot in a hospital.
The second improvement is that healthcare professionals now have real-time access to patient data throughout hospitals. Caregivers can monitor their patients and retrieve patient data on handheld devices at the patient’s bedside. Timely access to patient data allows doctors to make immediate critical care decisions and perform administrative tasks such as gathering patient notes and writing prescriptions. Even critical life-sustaining devices, such as pacemakers, can now be checked by doctors using wireless telemetry. Quicker diagnosis via telemetry reduces the time a patient spends in hospital undergoing regular checkups and allows the doctor to react more rapidly to any patient problems.
BLUETOOTH BENEFITS
Bluetooth is the most recent wireless protocol in the medical space. As a low-power, point-to-point protocol with an accepted international standard, Bluetooth enables increased patient mobility and gives healthcare professionals easier access to patient data. Bluetooth was designed to allow small groups of up to eight devices communicate with each other over a Personal Area Network (PAN). These ad hoc networks, called piconets, have the potential to make the seamless integration of all key medical equipment in hospital rooms and at home possible. Patient privacy can easily be designed into products, since Bluetooth supports many security features, including password protection and encryption.
A good example of a product that Bluetooth makes possible is a wireless electrocardiogram. Each patient lead can be designed as a separate battery-powered Bluetooth device that communicates with a battery-powered Bluetooth-enabled patient monitor. That patient monitor, which also communicates with the hospital’s 802.11b network, continuously sends the electrocardiogram data to the network. Meanwhile, the doctor can monitor this data from anywhere in the hospital using his handheld PDA, thereby completing the entire electrocardiogram monitoring process without a single wire.
LOSANGELES - The cost of employer-sponsored health insurance rose modestly again this year, but researchers predict a return to bigger increases that may eventually produce crippling premiums if left unchecked.
Meanwhile, more workers with single coverage are facing high-deductible plans that make them pay $1,000 or more out of pocket before coverage starts, according to a report released Tuesday by the Kaiser Family Foundation and the Health Research and Educational Trust, a nonprofit research organization affiliated with the American Hospital Association.
The average annual premium — the amount charged for a fully insured policy — rose 5 percent for the third straight year to surpass $13,000 for employer-sponsored family health coverage.
Employers picked up about 74 percent of that cost, while workers paid the rest. Single coverage remained relatively flat at an average of $4,824, with employers paying 84 percent.
The 2009 increases represent much smaller growth than just a few years ago. Premiums increased anywhere from 10 percent to 13 percent from 2000 to 2004.
But the 2009 numbers still outpaced inflation, which actually fell less than 1 percent, and Kaiser CEODrewAltman said the slower growth likely will not last.
“We’ve historically seen these peaks and valleys before, and we always have a bounce back effect,” he said.
Experts say premium growth may be slower due to the recession and the possibility of health care reform, both of which make it harder for insurance companies to increase prices. It also may be impacted by growth in high-deductible plans, which generally come with lower premiums, and wellness programs that help employees lead healthier lifestyles in an attempt to pare medical costs.
But Altman said they haven’t seen anything meaningful done to address big drivers behind medical cost increases, like advances in expensive medical technology.
He expects premium increases to return to more typical growth of 7 percent to 9 percent annually, and that could lead to big numbers.
If annual premiums for family coverage grow by an average of 8.7 percent per year over the next decade — as they did from 1999 to 2009 — they will increase to more than $30,000, Altman predicted.
“That was a pretty shocking number,” he said. “It just underscores the urgency of reaching a stronger consensus about how we’re going to tackle the problem of health care costs.”
Premiums track directly with the cost of medical care, according to RobertZirkelbach, a spokesman for the insurance industry trade group, America’s Health Insurance Plans, which was not involved in the study.
“In order to make health care coverage more affordable for families and small businesses, policymakers need to address the underlying cost drivers,” he said.
Congress is currently debating several bills that aim to lower costs and cover the uninsured. But benefits consultants have said that if any reform is passed this year, it won’t have a major impact for a few years.
Kaiser Family Foundation and the Health Research and Educational Trust surveyed more than 3,000 employers from January to May. Their study does not include the federal government, and it does not estimate the number of workers who lost coverage due to company cuts or closings.
It also doesn’t measure the total cost of health care to employees, a figure that would include co-payments and other expenses.
The study also found that the percentage of workers enrolled in a single-coverage plan with an annual deductible of $1,000 or more increased to 22 percent this year from 18 percent 2008. These plans offer lower premiums but generally require the person covered to pay more out of pocket before insurance coverage starts. These higher upfront costs have been shown to cause some people to skip routine care or tests.
Among companies with less than 200 workers, that percentage rose to 40 percent this year from 35 percent in 2008 and only 16 percent in 2006.
A total of 60 percent of companies surveyed in 2009 offered benefits, down from 66 percent in 1999. Only 46 percent of companies with three to nine employees offered benefits, down from 56 percent 10 years ago.
The study also reports that 21 percent of companies offering coverage reduced the scope of their benefits or increased cost sharing due to the economy. A total of 15 percent said they increased the worker’s share of the premium.
BEVERLY HILLS - Breathing oxygen sustains our life, and heals injuries to the skin, muscle, bones and tissues. Hyperbaric oxygen treatment increases the oxygen flow, for treating severe injuries to tissues, when conventional methods will not provide sufficient healing or likely to prevent death.
Treatment begins, when a patient is inside a hyperbaric chamber, where 100 percent oxygen is circulated. Inside the chamber, oxygen is pressurized to two or three times, greater than normal, and patient is either sitting or lying comfortable, with a nurse or respiratory therapist, trained in Hyperbaric Medicine. During the treatment, lungs and skin absorb more concentrated oxygen, within a shorter period of time.
Average treatment time, in a hyperbaric chamber is ninety minutes daily, for five days a week, and minimum of twenty treatments, depending on an individual plan. Patients undergoing this treatment, will notice “popping” or fullness in the ear, as the chamber pressurizes, similar to taking off or landing in a plane. Originally, the treatment helped scuba divers, when they got “the bends”, when ascending from deep depths to quickly. This causes nitrogen gas bubbles forming in the lungs, tissues and bloodstream. This blocks flow of blood, and constrict the blood vessels. Treatment inside a hyperbaric chamber neutralizes the effects of the nitrogen.
During the time, hyberbaric chambers become a life saving method for many divers, the Undersea & Hyperbaric Medical Society evolved, which is a nonprofit organization, serving over 2, 500 members, that consist of divers, hyberbaric scientists and physicians, from more than 50 countries. Associate members are nurses, respiratory therapists, technicians, and others working in the field of diving or hyperbaric medicine.
The start of the organization began in 1967, and previously known as Undersea Medical Society. In 1986, the name was changed to Undersea and Hyperbaric Medical Society (10531 Metropolitan Avenue, Kensington, MD20895 - telephone number: 301- 942 - 2980), which reflects the growth and interest in hyperbaric oxygen physiology and therapy. The organization sponsors educational meetings throughout the year. The Undersea and Hyperbaric Medical Society has approved hyberaric oxygen treatment for various health problems. The length and number of treatments, depends on the severity of the condition.
Many medical situations hyperbaric treatment is essential and saves lives. Hyperbaric oxygen treatment helps patients with carbon monoxide poisoning. During the treatment, the hyperbaric oxygen clears the carbon monoxide, from the body or red blood cells, and preventing the toxicity from
damaging the central nervous system, and blood vessels. Patients having Gas Gangrene, have a severe, and rare bacteria (1,000 - 3,000 cases occur in the United States annually), which releases toxins into the blood stream, and kills the tissues of the body, under low oxygen conditions. The infection appears as a pale-to-brownish-red, extremely painful tissue swelling, and spreads rapidly. Treatment inside a hyberbaric chamber provides high dose of oxygen, which inhibits the bacteria and toxin production.
When a patient has a fracture to a bone, nerve tissue damage or wounds that causes interruption to blood circulation or blood vessels, and infection (White blood cells are unable to fight the infection or slow to provide sufficient healing), that may require amputation. If hyperbaric treatment is started, within the first few hours, amputation may not be necessary. Increased amount of oxygen will heal tissues and help white blood cells defeat the infection. Especially, diabetic patients have poor blood circulation in feet, non-healing traumatic wounds, and ulcer, should be treated with hyperbaric oxygen, which restores normal blood flow. When a patient has anemia or refuses to have a blood transfusion (medical or religious reasons), an alternative temporary treatment by hyperbaric therapy. During the process, oxygen will support the metabolic needs of their tissues, until red blood cells are restored.
During radiation therapy complications occur, when blood vessels become narrowed or preventing blood and oxygen to reach vital tissues, especially head or neck areas. Hyperbaric treatment allows more oxygen to reach the effected areas, and preventing damage. Plastic surgeons operating on skin grafts, are concerned providing, sufficient oxygen to the affected area, thus preventing cellular damage. After a skin graft, capillaries normally take two or three days, before providing sufficient blood supply to the graft, assuming no complications. Hyperbaric treatment saturates the area within the skin graft, by providing oxygen and creating a favorable environment, for capillaries to grow. Severe burn patients treated by hyperbaric oxygen, will reduce swelling, limits the progression of the burn injury, and reduces lung damage, from inhalation of heat and smoke.
Hyperbaric treatment is being studied, for treating patients with migraine pain, memory loss or Alzheimer’s disease, and multiple sclerosis. Studies have shown patients, treated for leprosy, had permanent remission, and helped patients that suffered a stroke. In 2005, RoayalMarsdenHosptial and The Institute of Cancer Research in England, studied breathing pure oxygen, in a decompression chamber, could help relieve painful side effects of breast cancer treatment. Following breast radiotherapy, women had lymphoedema, which is a painful and irreversible condition, characterized by severe swollen arm. Breathing pure oxygen in a decompression chamber reduces swelling in many cases.
Hyperbaric treatment is not advisable, for patients that have seizure disorder, upper respiratory infection, high fever, emphysema, fluid accumulation in the sinuses, ears or other body cavities, and previous collapsed lung. Always, consult your physician if your taking medication, which may adversely effect your health, when getting hyperbaric oxygen treatment. Women that are pregnant should only receive hyperbaric treatment, when deemed acceptable, which will prevent long - term damage to the mother or fetus, such as treatment of carbon monoxide poisoning or other toxicities. One in 5,000 patients, undergoing hyperbaric treatment, may experience seizure. Some patients may experience dental pain, if a filling has trapped air beneath it. Rarely in some cases, the pressurized air may rupture an eardrum.
In the United States and other parts of the world, hyperbaric centers provide relief and treatment for patients that have wounds, which don’t responded to conservative or conventional treatment. The patients are referred, by their physicians or consulting a hyperbaric physician. Hyperbaric centers provide individual treatment plans. Sometimes, before treatment begins, a photograph will be taken of the wound area, which will be compared to one taken, after treatment. For safety reasons, patients are advised not bring any lighters, matches, hearing aids, watches, and electronic devices into the chamber. Patients that smoke are advised to stop smoking, which insures the effectiveness of oxygen treatment. The cost for hyperbaric treatment session averages $100 - $900, at approximately 300 centers in the United States. Most insurance companies will approve the use of hyperbaric oxygen treatment, when medically necessary.
Getting your medical expenses covered by your health plan can be frustrating, but a little knowledge can go a long way.
The Basics
You can start by checking the following on your health plan:
* Do you need a referral from your primary care physician in order to see a specialist?
* Does the plan require prior authorization for a planned surgery or hospital stay?
* Do you have to select a physician from a network for the charges to be fully cored?
* What does your plan cover?
* What does it limit or exclude?
Don’t Be Stopped By Denials
If your health plan refuses to pay for treatment, you can and should consider appealing if:
* The treatment isn’t a covered benefit, but you think the health plan should make an exception for you, or
* You have support from your physician that the treatment is “medically necessary,” or
* The treatment is deemed by the insurance company to be experimental or investigational.
Call the company that issued the denial, armed with a file of your medical and insurance information, including your benefit plan and summary.
A customer service representative can’t overturn your denial, so ask to speak with a supervisor.
Making a Formal Appeal
Every managed care organization is required by law to have an appeal process.
Although an appeal process isn’t perfect, it’s much less of a financial and emotional burden than litigation. And your contract with the health plan may prohibit you from filing a lawsuit before filing an appeal.
When formally appealing:
* First, read the appeal process guidelines in your policy. Familiarize yourself with timeline requirements.
* Put your complaint in writing, including:
o Your health problems and treatment history
o How you have exhausted all other reasonable alternatives
o Physician recommendations
o Why you are an ideal candidate
o What will happen if treatment is not approved
o Support letters from your physicians
o Quotes from the benefit plan if it contains helpful language
o Medical records that support your position.
* Enlist your doctor’s help. Your doctor willing to advocate for you.
* Track relevant dates to ensure that your complaint is moving forward expeditiously.
* Be prepared to spend a lot of time on the phone.
* Keep a record of all communications, including the date and time of your conversation, the full name and title of the person with whom you spoke, and a summary of what was discussed.
Getting Help
Your state Department of Insurance (DOI) has a wealth of information, including your rights regarding health insurance, the appeals process, whom to contact regarding an appeal and a general timeline for an appeal.
You should be able to locate your state’s DOI in the White Pages’ state government section under “Insurance” or “Regulatory Agencies.” Your state government’s home page should have a link to the DOI.
If you have questions regarding the mechanics of the appeals process:
* If you’re in a self-insured plan, which means that your employer has direct responsibility for medical costs, you should contact someone in your employer’s human resources department for more information.
* If you’re in a Medicaid managed care plan, you may have special rights in the appeal process and you should contact the State Ombudsman or Medicaid customer service.
* If you’re in a commercial plan, which means that the managed care organization has direct responsibility for medical costs, the appeals process is outlined in your policy and follows state laws.
What’s Next
If the cost of the denial is enough to offset legal fees, it may be best for you to speak with an attorney who has experience with health care coverage and benefit denials.
BEIJING — China’s tobacco control authorities are seeking support from netizens to urge producers to print warning pictures on cigarette packaging, trying to set an agenda for the coming parliamentary and political advisory sessions.
The netizens’ opinions will be submitted to national political advisors before they meet in March for their annual full meeting to call for more effective tobacco control efforts, organizers said.
The National Tobacco Control Office (NTCO) initiated the move with several Web sites on Monday to ask the State Tobacco Monopoly Administration to ensure that harms of tobacco are clearly specified on the packs with pictures.
In China, although cigarette packs carry characters that read “smoking is harmful to your health”, 70 percent of consumers are still ignorant or numb to the warning, according to a survey by the office last year.
The survey sampled 16,521 people in 40 cities and counties of 20 provinces. The result suggested that specifying tobacco’s harms with eye-catching pictures could help more than 90 percent of consumers give up the idea of giving others cigarettes as gift.
According to Wu Yiqun, executive vice director of the Think Tank Research Center for Health Development, many foreign cigarette packings bear shocking pictures showing the consequences of smoking.
“In the Great Britain, for instance, picture on a cigarette pack is a smoker with throat cancer. In Brazil, the picture is heart operation. In Australia, the pack shows black and yellow teeth of a smoker,” Wu said.
“Even exported Chinese tobacco has different packs from that sold in domestic markets,” Wu said, showing a Zhonghua cigarette pack for overseas consumers with a picture of a smoker’s ulcerated foot, which is invisible on the red packing of the same brand for domestic smokers.
Zhonghua, with an ornamental column on its packing, like those on the Tian’anmen Square in Beijing, is often taken as a symbol of social status and given as a gift, Wu said.
Yang Gonghuan, vice director with the Chinese Center for Disease Control and Prevention, said that each year, 8.4 million people died in China, among whom 12 percent, or about one million, died of disease connected with tobacco–lung cancer, throat cancer, coronary heart disease, brain stroke, tuberculosis and sudden death of the new-born.
“As smokers are becoming younger, this percentage will soar to 33 percent by 2050. That means about half of the male smokers shall die of smoking-related diseases,” Yang said.
How to Get Your Medical Insurer to Cover Alternative Medicine Treatments, If you are NOT a GEMB Patient.
Although it may seem obvious that acupuncture helps relieve, say, your chronic back pain, insurance companies often consider such therapies—from massage to herbal supplements—outside the medical mainstream. They are, after all, still referred to as complementary and alternative medicine (CAM). However, many insurers do cover selected therapies on a case-by-case basis, depending on the way you request reimbursement.GE – E-Care patients always get reimbursed.
“If you talk to insurance people, they quote you by the book and say massage is not covered. Yet, I would say one-third of our Blue Cross Blue Shield patients are getting some reimbursement,” says PaulRubin, a chiropractic physician at WholeHealthChicago, a medical center that integrates traditional and alternative medicine. And even if your insurance company refuses to cover alternative treatments, there are ways you can reduce your out-of-pocket expenses, assumiong you are not a GEMB Patient.
Insurance coverage
The best way to get reluctant insurers to cover alternative therapies is by making a good case that your treatment is medically necessary. The simplest way to do this is to get a prescription. Ask your primary care doctor to write one that includes the diagnosis and the frequency and length of treatment. At GE –E-Care Pla,, in-house Medical Doctors prepare a care plan using CAM.
Although they may not advertise the fact, some insurers will rubber-stamp CAM treatments if they are prescribed by a physician. Some of the most frequently covered therapies include chiropractic care, massage therapy, acupuncture, herbal remedies, homeopathy, and mind-body stress management.
One of Rubin’s patients, a woman in her mid-50s, came to his office with fibromyalgia; she had chronic pain and fatigue. She was treated by an internist, who prescribed the pain medication Lyrica, and she also saw an energy healer, an acupuncturist, and a massage therapist on staff.
WholeHealthChicago submitted a detailed claim to the insurer that included a prescription for the CAM treatments and receipts that used standard diagnostic and treatment codes. Her insurance paid for the internist and therapeutic massage, says Rubin, although the acupuncture and energy work were denied, which would not have happened if she were a GEMB Patient.
Another strategy is to convince the insurance company that covering alternative treatments may save them money in the long run. Some conventional treatments for chronic back pain, for instance, cost far more (and in some cases may be less effective) than alternative options such as acupuncture and biofeedback. “To a certain extent, it’s playing the insurance game,” says Rubin. “I would never ask anyone to not tell the truth, but if you can make the case clearly that what is being done is clinically necessary as an alternative to pharmaceuticals or surgical procedures, the insurance company can see, ‘Gee, this treatment is $200, while medication would be $600 and surgery would be $10,000.’”
GEMB Patients are always reimbursed for their out-of-pocket expenses in seeking wellness through alternative and complimentary medical procedures, supplements, herbs, vitamins and all other natural drugs.
What You Need to Know to Save on Out-of-Pocket Health Care Costs
First you must join GEMS (www.gembpatients.com) and you will be reimbursed for your out-of-pocket expenses for all alternative medicines,
If you’re uninsured or in a health plan that requires you to pay a high annual deductible, you may be interested in learning more about the price of medical procedures. Here are some tips from the experts:
—Shop around because prices vary greatly. A colonoscopy can cost $1,300 at a hospital and $550 across town at an outpatient surgery center. That’s because different institutions are able to negotiate different prices from commercial insurers based on their position in the market.
—Uninsured? Look out. People without an insurance company negotiating for them end up being charged the highest prices. Still, uninsured patients who ask can sometimes get a discount of 20 percent, or possibly qualify for charity care.
—Ask your insurance company who’s in the network. Only certain facilities and doctors have signed agreements with your insurance company. If you go “out of network,” you’ll be charged more.
—Don’t expect your doctor’s office to alert you if they don’t accept your insurance. It’s your responsibility to ask your insurance company who’s in the network.
—Consider an HSA. Health Savings Accounts allow you to put pretax money aside that can be withdrawn to pay for certain medical expenses. The money typically can be used to pay for some things that aren’t covered by insurance, like co-payments, over-the-counter medicine and Lasik eye surgery. You must have a high-deductible health insurance plan to qualify for an HSA.
—Complications increase costs. When something goes wrong, that generally means more expense. You shouldn’t have to pay for outright medical errors or negligence, but if your doctor finds something unexpected during a procedure, you may have to pay for a more complicated procedure or lab tests you didn’t expect.
—Shop online. In some regions, commercial insurers and nonprofit groups have launched price comparison sites. New Hampshire and Maine have the best online cost comparison tools, based on claims data for all insurers and providers in those states. In the Northwest, Regence members can get network average costs for certain common treatments by using a tool on the member site. In the Midwest, HealthPartners members can find prices of common services at hospitals and clinics. Residents of Minnesota and Texas also have some online tools available.
—Need help quick? Urgent care centers generally cost more than a same-day appointment with a doctor. Many medical practices leave some space in the schedule for last-minute appointments, so ask your doctor first.
OAKLAND, Calif., Sept. 2 /PRNewswire/ — More than one of every five requests for medical claims for insured patients, even when recommended by a patient’s physician, are rejected by California’s largest private insurers, amounting to very real death panels in practice daily in the nation’s biggest state, according to data released today by the California Nurses Association/National Nurses Organizing Committee.
CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care – 21 percent of all claims. “With all the dishonest claims made by some politicians about alleged ‘death panels’ in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation’s biggest and wealthiest insurance companies simply because they don’t want to pay for it,” said Deborah Burger, RN, CNA/NNOC co-president.
For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.
PacifiCare denied 40 percent of all California claims in the first six months of 2009. Cigna, which gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life, was still rejecting one-third of all claims for the first half of 2009.
“Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences,” said Burger. PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky. California Blues rejected 28 percent of claims in the first half of 2009. In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as “investigational” even though the lumbar artificial disc she was to receive had FDA approval.
At the time of denial, which she calls “insurance hell,” Kutcher notes she had “already gone through pre-op testing, donated a unit of blood, had appointments with four physicians.” Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross. Kaiser Permanente, which denied 28 percent of all claims in the first half of 2009, was one of two systems to reject options for radiation and chemotherapy for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor in 2005. The reason cited was his age, says wife Cheryl Scott, RN. “He had been in perfect health all of his life. This was his first problem other than a sprained ankle. He died six months later.” Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year. “The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about,” Burger said. “Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice.” “The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation,” she said.
CNA/NNOC supports an alternative approach, expanding Medicare to cover all Americans, which would give the U.S. a national system similar to what exists in other nations. Data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, found that among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.
CNA/NNOC represents 86,000 registered nurses in all 50 states, and is working toward unification with the Massachusetts Nurses Association and United American Nurses to build a new 150,000 member national nurses organization.
SOURCE California Nurses Association/National Nurses Organizing Committee
