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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Health Insurance. Show all posts
Showing posts with label Health Insurance. Show all posts

Tuesday, December 12, 2023

Health Insurers Have Been Breaking State Laws for Years

Maya Miller and Robin Fields
Originally published 16, NOV 23

Here is an excerpt:

State insurance departments are responsible for enforcing these laws, but many are ill-equipped to do so, researchers, consumer advocates and even some regulators say. These agencies oversee all types of insurance, including plans covering cars, homes and people’s health. Yet they employed less people last year than they did a decade ago. Their first priority is making sure plans remain solvent; protecting consumers from unlawful denials often takes a backseat.

“They just honestly don’t have the resources to do the type of auditing that we would need,” said Sara McMenamin, an associate professor of public health at the University of California, San Diego, who has been studying the implementation of state mandates.

Agencies often don’t investigate health insurance denials unless policyholders or their families complain. But denials can arrive at the worst moments of people’s lives, when they have little energy to wrangle with bureaucracy. People with plans purchased on HealthCare.gov appealed less than 1% of the time, one study found.

ProPublica surveyed every state’s insurance agency and identified just 45 enforcement actions since 2018 involving denials that have violated coverage mandates. Regulators sometimes treat consumer complaints as one-offs, forcing an insurer to pay for that individual’s treatment without addressing whether a broader group has faced similar wrongful denials.

When regulators have decided to dig deeper, they’ve found that a single complaint is emblematic of a systemic issue impacting thousands of people.

In 2017, a woman complained to Maine’s insurance regulator, saying her carrier, Aetna, broke state law by incorrectly processing claims and overcharging her for services related to the birth of her child. After being contacted by the state, Aetna acknowledged the mistake and issued a refund.

Here's my take:

The article explores the ethical issues surrounding health insurance denials and the violation of state laws. The investigation reveals a pattern of health insurance companies systematically denying coverage for medically necessary treatments, even when such denials directly contravene state laws designed to protect patients. The unethical practices extend to various states, indicating a systemic problem within the industry. Patients are often left in precarious situations, facing financial burdens and health risks due to the denial of essential medical services, raising questions about the industry's commitment to prioritizing patient well-being over profit margins.

The article underscores the need for increased regulatory scrutiny and enforcement to hold health insurance companies accountable for violating state laws and compromising patient care. It highlights the ethical imperative for insurers to prioritize their fundamental responsibility to provide coverage for necessary medical treatments and adhere to the legal frameworks in place to safeguard patient rights. The investigation sheds light on the intersection of profit motives and ethical considerations within the health insurance industry, emphasizing the urgency of addressing these systemic issues to ensure that patients receive the care they require without undue financial or health-related consequences.

Friday, November 24, 2023

UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans

Casey Ross and Bob Herman
Originally posted 14 Nov 23

A class action lawsuit was filed Tuesday against UnitedHealth Group and a subsidiary alleging that they are illegally using an algorithm to deny rehabilitation care to seriously ill patients, even though the companies know the algorithm has a high error rate.

The class action suit, filed on behalf of deceased patients who had a UnitedHealthcare Medicare Advantage plan and their families by the California-based Clarkson Law Firm, follows the publication of a STAT investigation Tuesday. The investigation, cited by the lawsuit, found UnitedHealth pressured medical employees to follow an algorithm, which predicts a patient’s length of stay, to issue payment denials to people with Medicare Advantage plans. Internal documents revealed that managers within the company set a goal for clinical employees to keep patients rehab stays within 1% of the days projected by the algorithm.

The lawsuit, filed in the U.S. District Court of Minnesota, accuses UnitedHealth and its subsidiary, NaviHealth, of using the computer algorithm to “systematically deny claims” of Medicare beneficiaries struggling to recover from debilitating illnesses in nursing homes. The suit also cites STAT’s previous reporting on the issue.

“The fraudulent scheme affords defendants a clear financial windfall in the form of policy premiums without having to pay for promised care,” the complaint alleges. “The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary care, all because an [artificial intelligence] model ‘disagrees’ with their real live doctors’ recommendations.”

Here are some of my concerns:

The use of algorithms in healthcare decision-making has raised a number of ethical concerns. Some critics argue that algorithms can be biased and discriminatory, and that they can lead to decisions that are not in the best interests of patients. Others argue that algorithms can lack transparency, and that they can make it difficult for patients to understand how decisions are being made.

The lawsuit against UnitedHealth raises a number of specific ethical concerns. First, the plaintiffs allege that UnitedHealth's algorithm is based on inaccurate and incomplete data. This raises the concern that the algorithm may be making decisions that are not based on sound medical evidence. Second, the plaintiffs allege that UnitedHealth has failed to adequately train its employees on how to use the algorithm. This raises the concern that employees may be making decisions that are not in the best interests of patients, either because they do not understand how the algorithm works or because they are pressured to deny claims.

The lawsuit also raises the general question of whether algorithms should be used to make healthcare decisions. Some argue that algorithms can be used to make more efficient and objective decisions than humans can. Others argue that algorithms are not capable of making complex medical decisions that require an understanding of the individual patient's circumstances.

The use of algorithms in healthcare is a complex issue with no easy answers. It is important to carefully consider the potential benefits and risks of using algorithms before implementing them in healthcare settings.

Tuesday, February 7, 2023

UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.

By D. Armstron, R. Rucker, & M. Miller
Originally published 2 FEB 23

Here is an excerpt:

Insurers have wide discretion in crafting what is covered by their policies, beyond some basic services mandated by federal and state law. They often deny claims for services that they deem not “medically necessary.”

When United refused to pay for McNaughton's treatment for that reason, his family did something unusual. They fought back with a lawsuit, which uncovered a trove of materials, including internal emails and tape-recorded exchanges among company employees. Those records offer an extraordinary behind-the-scenes look at how one of America's leading health care insurers relentlessly fought to reduce spending on care, even as its profits rose to record levels.

As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.

At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.

United declined to answer specific questions about the case, even after McNaughton signed a release provided by the insurer to allow it to discuss details of his interactions with the company. United noted that it ultimately paid for all of McNaughton’s treatments. In a written response, United spokesperson Maria Gordon Shydlo wrote that the company’s guiding concern was McNaughton’s well-being.

“Mr. McNaughton’s treatment involves medication dosages that far exceed FDA guidelines,” the statement said. “In cases like this, we review treatment plans based on current clinical guidelines to help ensure patient safety.”

But the records reviewed by ProPublica show that United had another, equally urgent goal in dealing with McNaughton. In emails, officials calculated what McNaughton was costing them to keep his crippling disease at bay and how much they would save if they forced him to undergo a cheaper treatment that had already failed him. As the family pressed the company to back down, first through Penn State and then through a lawsuit, the United officials handling the case bristled.

Thursday, September 16, 2021

Attorney General James and U.S. Department of Labor Deliver $14 Million to Consumers Who Were Denied Mental Health Care Coverage

Press Release
NY Attorney General
Posted 12 August 21

New York Attorney General Letitia James and the U.S. Department of Labor (USDOL) today announced landmark agreements with UnitedHealthcare (United), the nation’s largest health insurer, to resolve allegations that United unlawfully denied health care coverage for mental health and substance use disorder treatment for thousands of Americans. As a result of these agreements, United will pay approximately $14.3 million in restitution to consumers affected by the policies, including $9 million to more than 20,000 New Yorkers with behavioral health conditions who received denials or reductions in reimbursement. New York and federal law requires health insurance plans to cover mental health and substance use disorder treatment the same way they cover physical health treatment. The agreements — which resolve investigations and litigation — address United’s policies that illegally limited coverage of outpatient psychotherapy, hindering access to these vital services for hundreds of thousands of New Yorkers for whom United administers behavioral health benefits. In addition to the payment to impacted consumers, United will lift the barriers it imposed and pay more than $2 million in penalties, with $1.3 million going to New York state.  

“In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before,” said Attorney General James. “United’s denial of these vital services was both unlawful and dangerous — putting millions in harm’s way during the darkest of times. There must be no barrier for New Yorkers seeking health care of any kind, which is why I will always fight to protect and expand it. I thank Secretary Walsh for his partnership on this important matter.” 

“Protecting access to mental health and substance use disorder treatment is a priority for the Department of Labor and something I believe in strongly as a person in long-term recovery,” said U.S. Secretary of Labor Marty Walsh. “This settlement provides compensation for many people who were denied full benefits and equitable treatment. We appreciate Attorney General James and her office for their partnership in investigating, identifying, and remedying these violations.” 

New York’s behavioral health parity law — originally enacted as “Timothy’s Law” in 2006 — and the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) require insurance coverage for mental health and substance use disorder treatment to be no more restrictive than insurance coverage for physical health conditions. The agreements are the product of the first joint state-federal enforcement of these laws.  

Thursday, December 19, 2019

Holding Insurers Accountable for Parity in Coverage of Mental Health Treatment.

Paul S. Appelbaum and Joseph Parks
Psychiatric Services 
Originally posted 14 Nov 19

Despite a series of federal laws aimed at ensuring parity in insurance coverage of treatment for mental health and general health conditions, patients with mental disorders continue to face discrimination by insurers. This inequity is often due to overly restrictive utilization review criteria that fail to conform to accepted professional standards.

A recent class action challenge to the practices of the largest U.S. health insurer may represent an important step forward in judicial enforcement of parity laws.

Rejecting the insurer’s guidelines for coverage determinations as inconsistent with usual practices, the court enunciated eight principles that defined accepted standards of care.

In 2013, Natasha Wit, then 17 years old, was admitted to Monte Nido Vista, a residential treatment facility in California for women with eating disorders. At the time, she was said to be suffering from a severe eating disorder, with medical complications that included amenorrhea, adrenal and thyroid problems, vitamin deficiency, and gastrointestinal symptoms. She was also reported to be experiencing symptoms of depression and anxiety, obsessive-compulsive behaviors, and marked social isolation. Four days after admission, her insurer, United Behavioral Health (UBH), denied coverage for her stay on the basis that her “treatment does not meet the medical necessity criteria for residential mental health treatment per UBH Level of Care Guidelines for Residential Mental Health.” The reviewer suggested that she could safely be treated at a less restrictive level of care (1).

Ms. Wit’s difficulty in obtaining coverage from her health insurer for care that she and her treaters believed was medically necessary differed in only one respect from the similar experiences of thousands of patients around the country: her family was able to pay for the 2 months of residential treatment that UBH refused to cover.

Thursday, March 28, 2019

Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose

Marshall Allen
Originally posted February 20, 2019

Here is an excerpt:

These industry payments can’t help but influence which plans brokers highlight for employers, said Eric Campbell, director of research at the University of Colorado Center for Bioethics and Humanities.

“It’s a classic conflict of interest,” Campbell said.

There’s “a large body of virtually irrefutable evidence,” Campbell said, that shows drug company payments to doctors influence the way they prescribe. “Denying this effect is like denying that gravity exists.” And there’s no reason, he said, to think brokers are any different.

Critics say the setup is akin to a single real estate agent representing both the buyer and seller in a home sale. A buyer would not expect the seller’s agent to negotiate the lowest price or highlight all the clauses and fine print that add unnecessary costs.

“If you want to draw a straight conclusion: It has been in the best interest of a broker, from a financial point of view, to keep that premium moving up,” said Jeffrey Hogan, a regional manager in Connecticut for a national insurance brokerage and one of a band of outliers in the industry pushing for changes in the way brokers are paid.

The info is here.

Thursday, December 27, 2018

You Snooze, You Lose: Insurers Make The Old Adage Literally True

Justin Volz
Originally published November 21, 2018

Here is an excerpt:

In fact, faced with the popularity of CPAPs, which can cost $400 to $800, and their need for replacement filters, face masks and hoses, health insurers have deployed a host of tactics that can make the therapy more expensive or even price it out of reach.

Patients have been required to rent CPAPs at rates that total much more than the retail price of the devices, or they’ve discovered that the supplies would be substantially cheaper if they didn’t have insurance at all.

Experts who study health care costs say insurers’ CPAP strategies are part of the industry’s playbook of shifting the costs of widely used therapies, devices and tests to unsuspecting patients.

“The doctors and providers are not in control of medicine anymore,” said Harry Lawrence, owner of Advanced Oxy-Med Services, a New York company that provides CPAP supplies. “It’s strictly the insurance companies. They call the shots.”

Insurers say their concerns are legitimate. The masks and hoses can be cumbersome and noisy, and studies show that about third of patients don’t use their CPAPs as directed.

But the companies’ practices have spawned lawsuits and concerns by some doctors who say that policies that restrict access to the machines could have serious, or even deadly, consequences for patients with severe conditions. And privacy experts worry that data collected by insurers could be used to discriminate against patients or raise their costs.

The info is here.

Friday, September 21, 2018

Surprised By A Medical Bill? Join The Club. Most Americans Say They Have Been

Alison Kodjak
Originally posted September 2, 2018

Here is an excerpt:

Most survey respondents — 57 percent — have been surprised by a medical bill they thought would be paid for by their insurance companies, the survey from the research group NORC at the University of Chicago finds.

"People get surprised by all kinds of bills, for all kinds of reasons," says Caroline Pearson, a senior fellow at NORC.

Pearson herself says she was not expecting the problem to be so widespread.

The survey shows that 53 percent of those surveyed were surprised by a bill for a physician's service, and 51 percent got an unexpected bill for a laboratory test – like the urine test featured in our earlier story.

Hospital and health care facility charges surprised 43 percent of respondents, and 35 percent reported getting unexpected bills for imaging services, like the CT scan featured by NPR.

The survey shows that while some of the unexpected bills come because doctors or hospitals where patients are treated don't participate in the patients' insurance networks, the majority come because patients expect their insurance to cover more than it actually does.

The info is here.

Thursday, September 21, 2017

Monday, July 24, 2017

GOP Lawmakers Buy Health Insurance Stocks as Repeal Efforts Move Forward

Lee Fang
The Intercept
Originally posted July 6, 2017

Here is an excerpt:

The issue of insider political trading, with members and staff buying and selling stock using privileged information, has continued to plague Congress. It gained national prominence during the confirmation hearings for Health and Human Services Secretary Tom Price, when it was revealed that the Georgia Republican had bought shares in Innate Immunotherapeutics, a relatively obscure Australian biotechnology firm, while legislating on policies that could have impacted the firm’s performance.

The stock advice had been passed to Price from Rep. Chris Collins, R-N.Y., a board member for Innate Immunotherapeutics, and was shared with a number of other GOP lawmakers, who also invested in the firm. Conaway, records show, bought shares in the company a week after Price.

Conaway, who serves as a GOP deputy whip in the House, has a long record of investing in firms that coincide with his official duties. Politico reported that Conaway’s wife purchased stock in a nuclear firm just after Conaway sponsored a bill to deal with nuclear waste storage in his district. The firm stood to directly benefit from the legislation.

Some of the biggest controversies stem from the revelation that during the 2008 financial crisis, multiple lawmakers from both parties rearranged their financial portfolios to avoid heavy losses. In one case, former Rep. Spencer Baucus, R-Ala., used confidential meetings about the unfolding bank crisis to make special trades designed to increase in value as the stock market plummeted.

The article is here.

Even the Insured Often Can't Afford Their Medical Bills

Helaine Olen
The Atlantic
Originally published June 18, 2017

Here is an excerpt:

The current debate over the future of the Affordable Care Act is obscuring a more pedestrian reality. Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills. The point of insurance is to protect patients’ finances from the costs of everything from hospitalizations to prescription drugs, but out-of-pocket spending for people even with employer-provided health insurance has increased by more than 50 percent since 2010, according to human resources consultant Aon Hewitt. The Kaiser Family Foundation reports that in 2016, half of all insurance policy-holders faced a deductible, the amount people need to pay on their own before their insurance kicks in, of at least $1,000. For people who buy their insurance via one of the Affordable Care Act’s exchanges, that figure will be higher still: Almost 90 percent have deductibles of $1,300 for an individual or $2,600 for a family.

Even a gold-plated insurance plan with a low deductible and generous reimbursements often has its holes. Many people have separate—and often hard-to-understand—in-network and out-of-network deductibles, or lack out-of-network coverage altogether.  Expensive pharmaceuticals are increasingly likely to require a significantly higher co-pay or not be covered at all. While many plans cap out-of-pocket spending, that cap can often be quite high—in 2017, it’s $14,300 for a family plan purchased on the ACA exchanges, for example. Depending on the plan, medical care received from a provider not participating in a particular insurer’s network might not count toward any deductible or cap at all.

The article is here.

Sunday, July 9, 2017

Letter from the American Medical Association to McConnell and Schumer

James Madera
Letter from the American Medical Association
Sent June 26, 2017

To: Senators McConnell and Schumer

On behalf of the physician and medical student members of the American Medical Association
(AMA), I am writing to express our opposition to the discussion draft of the “Better Care
Reconciliation Act” released on June 22, 2017. Medicine has long operated under the precept of
Primum non nocere, or “first, do no harm.” The draft legislation violates that standard on many

In our January 3, 2017 letter to you, and in subsequent communications, we have consistently
urged that the Senate, in developing proposals to replace portions of the current law, pay special
attention to ensure that individuals currently covered do not lose access to affordable, quality
health insurance coverage. In addition, we have advocated for the sufficient funding of Medicaid
and other safety net programs and urged steps to promote stability in the individual market.
Though we await additional analysis of the proposal, it seems highly likely that a combination of
smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of
important protections such as required benefits, actuarial value standards, and out of pocket
spending limits will expose low and middle income patients to higher costs and greater difficulty
in affording care.

The AMA is particularly concerned with proposals to convert the Medicaid program into a
system that limits the federal obligation to care for needy patients to a predetermined formula
based on per-capita-caps.

The entire letter is here.

Wednesday, June 21, 2017

The GOP's risky premium pledge

Jennifer Haberkorn
Originally posted June 5, 2017

Senate Republicans may be all over the map on an Obamacare repeal plan, but on one fundamental point — reducing insurance premiums — they are in danger of overpromising and underdelivering.

The reality is they have only a few ways to reduce Americans’ premiums: Offer consumers bigger subsidies. Allow insurers to offer skimpier coverage. Or permit insurers to charge more — usually much more — to those with pre-existing illnesses and who are older and tend to rack up the biggest bills.

Since there’s no appetite within the GOP for throwing more taxpayer money at the problem, Republicans will need to make some hard decisions to hit their goal. But the effort to drive down premium prices will inevitably create a new set of winners and losers and complicate leadership’s path to the 50 votes they need to fulfill their seven-year promise to repeal Obamacare.

“Anyone can figure out how to reduce premiums,” said Sen. Chris Murphy (D-Conn.). “You can reduce premiums by kicking everybody that has a pre-existing condition off insurance or dramatically reducing benefits.”

Republicans say that Obamacare’s insurance regulations are responsible for making coverage prohibitively expensive and contend that premiums would fall if those rules are rolled back. They say they have multiple ideas about how to roll those back while also insulating the most vulnerable but have yet to weave those together into actual legislation.

The article is here.

Saturday, March 4, 2017

JAMA Forum: Those Pesky Lines Around States

Larry Levitt
JAMA Forum Blog
Originally posted October 19, 2016

Here is an excerpt:

Allowing insurers to then sell plans across state lines would actually worsen access to coverage for people with preexisting conditions, since insurers would have a strong incentive to set up shop in states with minimal regulation, undermining the ability of other states to enact stricter rules.

Let’s say Delaware wanted to attract health insurance jobs to its state with industry-friendly regulations—for example, no required benefits (such as preventive services or maternity care) and no restrictions on medical underwriting (meaning people with preexisting conditions could be denied coverage). Insurers operating out of Delaware could offer cheaper health insurance by cherry-picking healthy enrollees from other states. If New York tried to require insurers to expand access to people with preexisting conditions or mandate specific benefits, its carriers would get stuck with disproportionately sick people.

Delaware is not a random example here. This is exactly what happened in the credit card industry after the Supreme Court ruled in 1978 that credit card companies could follow interest rate rules in the states where they operate, not the state where the cardholder lives. Two states—Delaware and South Dakota—moved quickly to deregulate interest rates, and banks followed suit by moving their credit card operations to those states. By 1997 Delaware had 43% of the nation’s credit card volume.

The blog post is here.

Monday, October 10, 2016

Federal Court Certifies Nationwide Class Action Challenging UBH Coverage Criteria

Press Release
Originally released September 20, 2016

In a significant mental health ruling, the United States District Court for the Northern District of California has come one step closer to ordering health insurance giant United Behavioral Health (UBH) to revamp its medical necessity criteria and reprocess thousands of outpatient, intensive outpatient and residential treatment claims it denied since 2011. Plaintiffs in two companion class-action lawsuits, Wit et al. v. UnitedHealthcare et al. and Alexander et al. v. United Behavioral Health, allege that UBH systematically denies coverage for mental health treatment by developing and applying "medical necessity" criteria that are far more stringent than generally accepted standards of care.

"Yesterday's class certification order is an important victory in the fight for mental health parity," said Meiram Bendat, president of Psych-Appeal, Inc. and co-counsel for the plaintiffs. "It signals that health insurers can be held responsible, on a class-wide basis, for denying insurance coverage for mental health treatment to those desperately in need. Without class certification, few, if any, patients will have the financial or emotional resources necessary to challenge this type of misconduct individually."

The plaintiffs' health plans, governed by the Employee Retirement Income Security Act (ERISA), require UBH to evaluate medical necessity according to generally accepted standards of care. UBH's proprietary medical necessity criteria purport to reflect these standards. However, the plaintiffs allege that a push for profits has led UBH to develop criteria that overemphasize acute mental health and substance use disorder symptoms and disregard chronic or complex conditions that require ongoing care, in contravention of generally accepted standards.

UBH is a subsidiary of UnitedHealth Group and is the country's largest managed behavioral health care organization, serving more than 60 million members.

Psych-Appeal, Inc. and Zuckerman Spaeder LLP have been appointed class counsel by the federal court and also represent plaintiffs in similar cases against Health Care Service Corporation (Blue Cross and Blue Shield of Illinois, Texas, New Mexico, Montana and Oklahoma), Magellan Health Services of California and Blue Shield of California.

The pressor is here.

Saturday, April 30, 2016

In medical market, shoppers lack savvy

By Peter Ubel
The News and Observer
Originally posted April 6, 2016

Even before Obamacare became the law of the land, the U.S. health care system was undergoing a dramatic transformation. Millions of people were shifting from generous health insurance plans to consumer-directed ones that pair low monthly premiums with high out-of-pocket costs.

This shift has been encouraged by employers, eager to reduce the cost of employee benefits. It has also been encouraged by market enthusiasts who contend that the U.S. health care system needs to be more like the traditional consumer economy.

In theory, a family with a high deductible plan – on the hook for, say, the first $5,000 of health care expenses each year – will scrutinize the cost and quality of health care alternatives before deciding whether to receive them. In practice, health care consumerism doesn’t always play out at the bedside in ways that promote savvy medical decisions.

The article is here.


  • A shift from generous health insurance plans to consumer-directed plans has not helped people
  • Most patients, or doctors, do not know how to discuss out-of-pocket health care costs
  • Frustration with our system often distracts physicians from dealing with patients’ financial concerns

Thursday, January 14, 2016

Blue Cross expands benefits for end-of-life care

By Priyanka Dayal McCluskey
The Boston Globe
First posted on December 28, 2015

Here is an excerpt:

And while the primary goal is not cost control, the effort also has the potential to lower health care spending by giving patients more options to replace hospital care with less expensive — and often preferable — alternatives, such as hospice and home care. Medical care at the end of life can be expensive; a 2010 study found that 25 percent of all Medicare payments go toward the 5 percent of people in the last year of their lives.

“The industry is now starting to take this seriously,” said Dr. Lachlan Forrow, director of the ethics and palliative care programs at Beth Israel Deaconess Medical Center. “The industry now not only understands the issues [around death and dying], but understands there are concrete things they can and need to do, and Blue Cross is showing us how to get started.”

The article is here.

Wednesday, November 25, 2015

Americans With Government Health Plans Most Satisfied

by Rebecca Riffkin
Originally published November 6, 2015

Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.


  • Uninsured Americans least satisfied with health system
  • Those with veterans or military insurance most satisfied
  • Self-insured less satisfied than others who have insurance

Tuesday, January 6, 2015


When insurance companies deny the mentally ill the treatment their doctors prescribe, seriously ill people are often discharged, and can be a danger to themselves or others

By Scott Pelley
CBS - 60 Minutes
Originally aired on December 14, 2014

Here is an excerpt:

Two years ago tonight, we were reeling from the shock of the murders of 20 first graders and six educators at Sandy Hook Elementary School. Since then, we've learned that the killer suffered profound mental illness. His parents sought treatment but, at least once, their health insurance provider denied payment.

Because of recurring tragedies and an epidemic of suicides, we've been investigating the battles that parents fight for psychiatric care. We found that the vast majority of claims are routine but the insurance industry aggressively reviews the cost of chronic cases. Long-term care is often denied by insurance company doctors who never see the patient. As a result, some seriously ill patients are discharged from hospitals over the objections of psychiatrists who warn that someone may die.

The entire story is here.

Thursday, October 2, 2014

Kaiser to pay $4 million fine over access to mental health services

By Cynthia H. Craft
Sacramento Bee
Originally posted September 10, 2014

Health care giant Kaiser Permanente has agreed to pay a $4 million fine to California’s overseer of managed health care following an 18-month battle with state officials over whether Kaiser blocked patients from timely access to mental health services.


Moreover, the department found that Kaiser was likely violating state and federal mental health parity laws. The California Mental Health Parity Act requires managed care providers to provide psychiatric services that are equal in quality and access to their primary care services.

The entire article is here.