Janet Gavrun
|
November 28, 2014
Could you provide the name of the person wh killed Theodore.
Injured Good Samaritan billed $165,000 by Aetna for “out-of-network” care
by JONATHAN M. METSCH, DR.P.H., LLC
Nov 28, 2014 | 237 views | 0 0 comments | 1 1 recommendations | email to a friend | print
Recently and Arizona Central article http://www.azcentral.com * noted: “Cliff Faraci sustained first-, second- and third-degree burns after trying to save a teen girl after a car accident in March 2013. He stayed in a hospital burn unit for a week to get treatment for his injuries. Days later, Aetna told him it wouldn’t cover the stay.” “Cliff Faraci suffered first-, second- and third-degree burns trying to rescue girl from a deadly accident last year. His insurance company denied his claims and hit him with a $165,000 bill, saying his injuries were not severe enough to require acute-care treatment for a week.” “After a week of intense treatment, Faraci was discharged from the hospital. But he hadn't been home two full days when he received a letter from his insurance company informing him that he wasn't covered for the hospital stay.” “Aetna claimed Faraci's injuries were not sufficient to warrant a weeklong stay in the hospital's burn unit, which was deemed an out-of-network facility. Maricopa County Medical Center had billed him about $165,000. He filed an appeal with Aetna. It was denied in August.” “Almost overnight, the freeway Good Samaritan had become a victim of a health-care nightmare. His case is an example of what can happen when an insurance company decides to question the administration of care provided by doctors and other medical experts directly involved in the patient's Faraci said he tried to talk with Aetna and got nowhere. He said he provided doctors' letters and statements, to no avail. In an August denial letter, Aetna officials told him his coverage extends only to services and supplies Aetna deems medically necessary. "The member had no signs of respiratory burn and was otherwise stable," the insurer wrote. "Ongoing wound care, including medications, does not require acute hospitalizations. Further treatment of this member could be provided at a less intensive level of care, or in another setting, e.g. non-acute facility, other outpatient setting or home." “Faraci kept fighting the claim denial. …"It was not my choice to stay in the burn center for seven days," he said. "This was a decision made by medical professionals who treated me on a daily basis. To have the doctors' judgment questioned and overruled by an insurance company who did not treat me or see the extent of my injuries is unthinkable." An…” independent examiner determined that Aetna should pay for half of Faraci's hospitalization, leaving him with a remaining bill of $82,500.” In February… Maricopa Medical Center waived bills for any of Faraci's hospitalization not covered by Aetna. * to read the full Arizona Central article, “Health care nightmares Day 5: Injured Good Samaritan billed $165,000 by Aetna” by Robert Anglen, highlight and click open hyperlink http://www.azcentral.com/story/money/business/consumer/call%2012%20for%20action/2014/04/24/injured-good-samaritan-billed-aetna/8129925/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=12602330&_hsenc=p2ANqtz-9hR7lbVO9m_FjqB-YQyARewFjiGRwhbm_n-NwL2aBd46doSGKWoxFjfKQutYXaykZBR_rUb3DMc9w4MxG5YKDS5KPKA2MmCtd7BRTBfnesJz7zrkQ&_hsmi=12602330 Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options. Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration. This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.
Comments
(0)
Comments-icon Post a Comment
No Comments Yet
Jersey City Police officer found dead in Cambodia
Nov 27, 2014 | 330 views | 0 0 comments | 9 9 recommendations | email to a friend | print
Saying that they have little information so far, the city of Jersey said an officer from the Police Department was found dead in Cambodia on Nov. 26. "The Jersey City Police Department received notification yesterday from the State Department that one of their own, Police Officer James Forrester, was found dead in Cambodia. At this time, we have no information about the circumstances of his passing. Right now, our thoughts are with the Forrester family, their friends, and the Jersey City Police Department as they deal with this sudden loss." said city spokeswoman Jennifer Morrill.
Comments
(0)
Comments-icon Post a Comment
No Comments Yet
Using data to treat the sickest and most expensive patients – “super-utilizers”
by JONATHAN M. METSCH, DR.P.H., LLC
Nov 27, 2014 | 402 views | 0 0 comments | 2 2 recommendations | email to a friend | print
Recently an article in Marketplace http://www.marketplace.org * noted: "We can actually take the sickest and most complicated patients, go to their bedside, go to their home, go with them to their appointments and help them for about 90 days and dramatically improve outcomes and reduce cost…" “That’s the theory anyway. Like many ideas when it comes to treating the sickest patients, there’s little data to back up that it works.” “Helping lower costs and improve care for the super-utilizers is one of the most pressing policy questions in healthcare today. And given its importance, there is a striking lack of data in the field.” People like to call randomized controlled trials (RCTs) the gold standard of scientific testing because two groups are randomly assigned – one gets the treatment, while the other doesn’t – and researchers closely monitor differences. But a 2012 British Medical Journal article found over the last 25 years, a total of six RCTs have focused on care delivery for super-utilizers.” “Every major health insurance company – Medicare and Medicaid, too – has spent billions on programs for super-utilizers. The absence of rigorous evidence raises the question: Is all this effort built on health policy quicksand?” “Healthcare has benefitted from the fact that you don’t understand it. It’s a bit of an art, and it hasn’t been a science….You made money in healthcare by putting a banner outside your building saying you are a top something without having to justify whether you really are top at whatever you do.” “....it’s too easy – and frankly, wrong – to say the main reason doctors avoid these rigorous studies is because they’re afraid to lose money and status. He said doctors aren’t immune from the very human trap of being sure their own ideas are right. …. psychologists call it confirmation bias. …“Everything you see is filtered through your hopes, your expectations and your pre-existing beliefs…” “Providers have a lot more incentive now than they use to,” she said. “They have much more skin in the game.” * to read the full Marketplace article “Using data to treat the sickest and most expensive patients” by Jessica Kourkounis , highlight and click on open hyperlinkhttp://www.marketplace.org/topics/health-care/diagnosis-camden/using-data-treat-sickest-and-most-expensive-patients?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=12602330&_hsenc=p2ANqtz-80fSnkOFukvy4pilVWU-S1rioNrPvot0RSmbytq_m0-gljXSPA423gUuTJsbTSUQ8apjvM6ahCTKz_F12HMoTmuJoZbcrT1OhTBuwFuanexZJ2M6U&_hsmi=12602330 Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options. Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration. This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.
Comments
(0)
Comments-icon Post a Comment
No Comments Yet