I understand that health insurers need to keep costs down in order to keep our premiums low (and still make a profit). I just take issue with one of the ways they do it now - and I'm afraid the practice will become more rampant if insurers don't have to compete with a public option.

Have you ever called your insurance provider to confirm that a procedure or service is covered, only to have the claim rejected on a technicality after the service was rendered? It happens several times a year in our household, regardless of health insurer, and I'm sick of it.

I perform due diligence - Does my provider have a provider #/contract with the insurer? Yes. Is the service covered under my policy? Yes. Have I used up my annual limits for this service? No. So I'll get reimbursed for the service right? Hypothetically- Yes, Realistically - Not if they can help it. I've heard tell of standardized practices or "playbooks" insurers use to reject claims, and most tricks you wouldn't know about - until you've been burned.

In my next post, I'll start identifying obscure technicalities that I've experienced with insurers and the lessons I've learned during my quest to get claims paid. But seriously, we shouldn't have to outmaneuver our own health insurers in order to get legitimate treatments covered. From where I sit, insurers have created a hidden profit center by finding ways to avoid paying for covered services, yet they still complain about a rising cost burden. I can see the practice becoming more rampant without a public offering that policyholders can choose as an alternative to a bad status quo.

I really believe that a "public option" is one of the ways to keep insurers honest. And yes, we do need to understand what the term "public option" means and what the option will look like. But remember- we are talking about an OPTION, not a policy citizens are REQUIRED to use (a la socialized medicine). So how about keeping the public option on the table?

Check back for my next post, the first in a series of lessons learned: The 15 Technicalities Insurers Use to Reject Claims – How to Avoid Getting Burned.

Poison Control System Faces Closure

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Photo: Image Source

California's Poison Control System is on life support. The 24-7 operation lost half of its funding in the new state budget, and poison control officials say if they don't find an additional $6 million soon, the system will have to close. Reporter: Kenny Goldberg

1-800-222-1221. No matter where you live, if you don’t have this number written down by your phone, go do it NOW. I’ll wait…. I had a bit of a scare the other night that ended in a call to the Poison Control Hotline. I felt like an idiot calling them over what was likely a false alarm. I came away glad that I called. Coincidentally, NPR reported the next day how vital the 24-7 poison control service is to consumers, emergency rooms AND law enforcement, but since the California has slashed half of the funding for Poison Control in our state, the service may shut down in November. THIS IS NOT ACCEPTABLE.

In fact, Poison Control is one of the best public healthcare cost reducers available. According to NPR, every $1 spent on the hotline saves $7 in government healthcare costs. 20% of calls to Poison Control are from hospital emergency rooms, and another 5% are from law enforcement. Doctors call the hotline to quickly determine proper dosages for antidotes they use infrequently or to triage minor cases (like a child ingesting part of a poinsettia leaf – how much is toxic?). Police officers call to identify prescription drugs and other substances found on suspects.

My story: I had grabbed an old metal ice cream scoop out of a drawer – the kind with anti-freeze in the handle – and scooped some (fake) chocolate ice cream into a cup. I was so intent on getting a chocolate fix, it didn’t register that the scoop handle was oily until I’d already filled my cup and started eating.

I can’t eat real ice cream anymore, so I’m often on the lookout for decent fake stuff. I point this out because I’d nearly finished before I realized I was tasting more than the general disappointment of eating fake chocolate ice cream. Under the carob, I detected an off flavor that evoked a childhood memory of band-aids and Obtundia anti-bacterial ointment. ICK. I could also smell it on my hand – and the ice cream scoop still had some of clear viscous substance on the handle. Then came the “A-HA!” moment when I realized that I might have just ingested anti-freeze.

Did I call Poison Control right away? Nooooo. I didn’t want to be ridiculed for stupidity. I’m blonde, but I hate playing into the stereotype. So instead, I did a web search on anti-freeze. I even ended up on the poison control website. Everything I read said that ingesting even a small amount of anti-freeze can do permanent organ damage if you wait too long to be checked out (ACK!). But I knew anti-freeze also tastes sweet, not nasty, which is why kids and dogs often accidentally ingest it, so I still wasn’t sure if I was in danger.

After vacillating, I called and spoke to one of the nurses and pharmacists who staff the line. She was non-judgmental and incredibly sympathetic as she asked me questions about the substance and the scoop while searching her database. In the end, she was able to tell me that I probably had an ice cream scoop from Crate & Barrel who stopped using anti-freeze ten years ago. The level of detail the hotline operator had in her database was way beyond what can be found easily on the web. But the web searches may be what we’re left with if the California can’t get its act together or get federal matching funds to keep the Poison Control System running. Parents especially should be concerned about the shuttering of the service, but loss of the Poison Contol hotline effects all tax payers.

The hotline number (800-222-1221) is the same in most states, but I guarantee you won't remember it when you need to make the call. So did you post the phone number next to your phone? Better yet, go put it on speed dial.

...From a purely economic standpoint, insuring illegal immigrants makes a lot of sense—and not just for them, but for everyone.

Consider a few statistics. According to a July article in the American Journal of Public Health, immigrants typically arrive in America during their prime working years and tend to be younger and healthier than the rest of the U.S. population. As a result, health-care expenditures for the average immigrant are 55 percent lower than for a native-born American citizen with similar characteristics. With the ratio of seniors to workers projected to increase by 67 percent between 2010 and 2030, it stands to reason that including the relatively healthy, relatively employable and largely uninsured illegal population in some sort of universal health-care system would be a boon rather than a burden. "Insurance in principle has to cover the average medical cost of all the people it's serving," explains Leighton Ku, a professor of health policy at George Washington University. "So if you add cheaper people to the pool, like immigrants, you reduce the average cost." More undocumented workers, in other words, means lower premiums for everyone.

The actuarial advantages don't end there. As it is now, undocumented workers (and others) who can't pay their way receive free emergency and charitable care—a service that costs those of us with health insurance an additional $1,000 per year, as Obama noted. But if illegals were covered, this hidden tax would decrease, further lowering our premiums and "relieving some of the financial burden on state and local governments," says Harold Pollack, a University of Chicago professor who specializes in poverty and public health. What's more, employers currently have a clear economic incentive to hire undocumented immigrants: they don't require coverage. A plan that mandates insurance for native workers but not their illegal counterparts actually makes life harder on the blue-collar Americans competing for jobs (and railing against immigrants) because it means that hiring them will cost more than hiring a recent transplant from Mexico City. As The Washington Post's Ezra Klein recently explained, "If you're really worried about the native-born workforce, what you want to do is minimize the differences in labor costs between different types of workers. A health care policy that enlarges those differences—that makes documented workers more expensive compared to undocumented workers—is actually worse for the documented workers."

At this point, you're probably wondering whether taxpayers would have to foot a bigger bill for these newly insured illegals. Not necessarily—at least in theory. As Obama said in Wednesday's speech, "Like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects" to fund whatever care it provides. Given that many undocumented workers leave the country before they're old enough to require much medical care, says Phillip Longman of the New America Foundation, "you could set up the system in a way that that they wind up contributing as much or more than they receive" in low-income subsidies, especially when the "offsetting savings of lower emergency-room use" are factored in.

But despite the potential economic upside, the right shouldn't stress: America won't insure its illegal immigrants any time soon. "The hard thing here is that the current state of perception on immigration is eroding our sense of social solidarity," says Longman, who believes, like the rest of the experts quoted in this story, that covering undocumented workers is both politically and logistically impractical. "People simply don't want money going to people on the other side of the tracks." That pretty much explains why Obama was so determined to clear up the confusion—and why Joe Wilson was so determined to keep it alive. Never mind that our wallets would be better off if Wilson were right. Money, after all, isn't everything—even in politics.

Find this article at http://www.newsweek.com/id/215340

'nuff said. But do check out the Non Sequitur comic strip from Friday, September 25, 2009. Unfortunately, due to copyright issues I can't post the strip itself, but you can find it at: http://www.arcamax.com/nonsequitur/s-616500-775025

It's worth the jump.

Wait a Second. Why Shouldn’t We Insure Illegals?

Insuring undocumented immigrants might be unpopular, but it would be good for the economy.

By Andrew Romano | Newsweek Web Exclusive 

Sep 14, 2009

Call it the shout heard round the world. Since last Wednesday, when Rep. Joe Wilson, Republican of South Carolina, interrupted Barack Obama's big speech on health-care reform to shout "You lie!," Beltway bloviators have bloviated about little else. Wilson's vulgarity. Wilson’s apology. Wilson's "dirty health-care secret". Wilson's charming effort to make American politics more British.

And that's just at NEWSWEEK.

Few of us, however, have actually bothered to address the issue that provoked Wilson's outburst: health insurance for illegal immigrants. The line he objected to—"The reforms I'm proposing would not apply to those who are here illegally"—is, in fact, not a "lie." The current House bill makes it very clear that "individuals who are not lawfully present in the United States" will not be allowed to receive subsidies. To wrangle assistance, illegal aliens would have to commit identity fraud, something that rarely happens in our current public-health-care system (a.k.a. Medicare). And Democratic senators have just announced that they'll require those who participate to show proof of citizenship. So it's a nonissue.

But let's just assume, for argument's sake, that we all live in Wilsonville, where Obama is the lying liar his critics allege him to be—the sort of psycho who has chosen to sacrifice his political future on the flaming pyre of anti-immigrant sentiment by concocting a secret scheme to cover the nation's estimated 11.9 million illegals. Would that really be so bad?

Of course, insuring undocumented workers is ethically murky and politically impossible. Some people argue that if we're hiring illegals to, say, shingle our roofs, we have a moral obligation to care for them if they fall off. But more people, it seems, simply want them out of the country. Given that illegal immigrants have, by definition, broken our laws, it makes sense that large numbers of upstanding citizens oppose any measure that would encourage more foreigners to sneak into America or make their lives easier once they're here.

The only problem? From a purely economic standpoint, insuring illegal immigrants makes a lot of sense—and not just for them, but for everyone.

I've often wondered about the guy who fell through our roof. I don't know whether the man whose leg dangled through a hole in the ceiling over my kitchen table was a day laborer or fully employed by the company subcontracted to remove the shingles from our roof (WE did NOT hire him directly). But I do know that:
a. he narrowly missing having his leg hacked off by the ceiling fan,
b. the ceiling joist he landed on - crotch first - prevented him from falling all the way through the ceiling and onto my kitchen table, and
c. he spoke little English but swore he was uninjured, then promptly disappeared on a "break."

I often wonder:
a. what would have happened if he'd fallen six inches closer to the ceiling fan (how do you remove blood from the ceiling?),
b. if straddling the joist ended any chance that the man would ever have children, and
c. did he really walk away unscathed, or did he later end up in an emergency room with serious internal injuries that could have been mitigated with immediate treatment?

Whether or not the man was an illegal immigrant, he certainly deserved treatment for his injuries. The bare slats under the shingles had knotholes that this guy, and another - albeit white - worker, didn't see until it was too late. The other guy only went in to his ankle, by the way. But I digress.

You can be sure if the guy that fell through really was injured, whether minor or career ending, he didn't seek treatment. Housing contractors already tell their workers NOT to say an injury was sustained on the job because it will raise the company workman's comp premiums. And day laborers won't admit to an injury because it could prevent them from ever being hired again by the contractor, and a repeat hire is what all day laborers hope for.

So here's a thought - if an illegal worker is injured on the job and doesn't/can't seek treatment covered by their employer, "from a purely economic standpoint," isn't that creating MORE burden on the U.S. economically? Someone is going to do the morally right thing and take the injured person to an emergency room where the bill lands on taxpayers. ... but more at issue, what is so wrong about adding otherwise healthy people to insurance roles and spreading out the burden of cost? See the rest of the article in part 2 of the post, it's a novel and logical perspective - never mind the morally right thing to do.

Parents beware: Giving in to teens' demands for their own cars can have dangerous consequences, new research suggests.

Teenagers with their own cars or free use of one are much more likely to get in crashes than those who share a car. And crashes are much less common among teens whose parents set clear driving safety rules.

The findings are in two studies by researchers at Children's Hospital of Philadelphia and funded by State Farm Insurance Co. They were released Friday and are in the October issue of Pediatrics.

The researchers say the findings can help parents keep their kids from becoming a grim statistic: Traffic crashes are the leading cause of death for U.S. teens, killing more than 5,000 each year.

Getting a driver's license and car are often viewed as rite of passage for U.S. teens, and many parents underestimate the risks.

More than 7,000 people nationwide were killed in crashes involving teen drivers in 2007, government data show. More than 3,000 of these deaths were teen drivers, and more than 250,000 teen drivers were injured.

"With teen drivers, you have to recognize that it's a public health issue," said Dr. Jeffrey Weiss, a Phoenix pediatrician who co-wrote an American Academy of Pediatrics report on teen drivers.

The 2006 report encourages parents to highlight the seriousness of driving privileges by requiring teens to sign driving contracts promising to abide by safety rules.

The new research shows that kind of hands-on approach pays off.

"Families need to know that driving is different" from other steps toward independence,said Dr. Flaura Koplin Winston, the study's lead author. "Just at the time their teen is pulling away, they need to get back involved to spare them heartache."

The research is based on a nationally representative survey of more than 5,500 teens in grades nine through 11. Students at 68 high schools answered questionnaires in 2006.

More than 2,000 students who reported driving on their own were the focus of one study; 70 percent said they had their own cars or were the main drivers of cars they used.

Winston said it's alarming that so many kids have their own cars or feel that they have free use of one. She said that freedom can lead to "a sense of entitlement about driving" that may make them less cautious.

My stepson turns 17 this week. In New Jersey, that's the age when a teen can first get a driver's license. Of course, when asked for a birthday list, he replied "a car." So when I read this article, I immediately sent it to my husband. If we hadn't learned from past experience, here was the "official" study. We gave an older son a car when he first moved out to live with us in California, and he nearly died in it.

The freedom afforded by his own car enabled (son who shall remain nameless) to avoid his curfew and fall asleep at the wheel, 2am one Saturday morning. He'd had the car less than three months and felt invincible - before he flipped it over the center divider of the freeway five miles from home. We are still grateful that it was a solo car accident and that he walked away with more damage to ego than body.

Our newest driver in the family will be angry with me for flaunting this study, and angry with his dad for saying "No." to the car request. But you know what? I'm okay with his anger lasting for many - otherwise healthy - years to come.

In the midst of debates on how to cut the costs of healthcare, I don't remember this perspective coming up yet, but it's a hot button issue for me.

Sure doctors' fees could be lower. Maybe they would be, if providers didn't lose money due to under-reimbursement from insurance companies and if doctor's offices didn't carry the overhead of extra staff who chase down insurance reimbursements. But even not-for-profit insurers (Blue Shield, I'm talking about you!) seem to be making a bundle on the backs of doctors and patients, but it doesn't translate into lower premiums.

In an upcoming post, I'm going to share some of the dirty little secrets insurers use to avoid reimbursing fees for service, and tips to avoid getting burned as a patient. In the meantime, I thought this video was pretty darned funny. I'm glad someone has finally pointed out the obvious about the costs of healthcare. Go Will Ferrell! (Thanks to Jill Shanmugasundram for posting the video link on her FB wall)