Thursday Themes

Over the hump and on the way down -- or so I like to think. Things are so busy -- the days are so long -- it's hard to keep up. So let's see what's happening today so we can start the day informed.

The story of the day -- if you have out-of-network coverage under your insurance, you need to understand how it works. Your insurance covers a percentage of your out of network costs, right? But it's not a percentage of actual costs; it's a percentage of "usual and customary" or "allowable amount." The insurance companies have always had free reign over what's "usual and customary," and they have always low-balled patients. So, for example, if your policy pays 80% of out of network "usual and customary" and your doctor bills $1000, but the insurer only allows $800, the insurance covers 80% of $800, not 80% of $1000. So you pay your 20% of the $800 PLUS the $200 difference between the billed amount and the allowed amount. Now, insurers have a new game. Instead of basing usual and customary on actual commercial insurance claims data, they are starting to use Medicare rates, which are MUCH lower, leaving you with way more of the cost. You can challenge this by using payment data from FAIR Health, an organization that was created after the NY Attorney General cracked down on the data previously used by a UnitedHealthcare subsidiary called Ingenix, which was sold to most of the industry. But these are really tough fights. If you're having a problem and want to talk it through with us, feel free to get in touch. Note that yours truly is quoted in the article.

Speaker Boehner vows to fight against mandatory and free coverage of contraceptives. He's joined by many other Republicans. One woman Senator said that this is not a women's health issue; it's a religious liberty issue. I think it may be both. We have huge institutions run by the Catholic church -- hospitals, schools -- where hundreds of people work regardless of their faith. Should employees of those institutions lose out on a benefit that all other women will have? Or is this whole issue just a political tool, used by both sides to score points? This is why I'm so bad at politics. I keep thinking we're making decisions on the merits.

And in the never-ending effort to cut costs no matter the consequences, Connecticut's Governor Malloy has proposed changes to Medicaid, including counting assets of parents or guardians of anybody under age 26 to determine eligibility -- a move that would kick thousands of people off the program. The state is also looking to limit certain services like nursing home care, home health, medical equipment, and physician services. I'll say it again. When you stop people from accessing the care they need, they get sicker, end up in the hospital, lost their jobs, become disabled, and then we, the taxpayers, have no choice but to foot the bill. So wrong-headed.

Dr. Pauline Chen's column is about doctors' body language -- what doctors communicate even when they're not talking. So interesting.

Along similar lines, are doctors always honest with patients? Surely not. They give us good news even when it's not warranted, and they fail to disclose medical errors, a study shows.

A small study finds that electrical stimulation helps memory. Could this be the beginning of a real treatment for Alzheimer's?

Men's greater risk of heart disease may stem from a chromosome. Find the reason, find the treatment -- or so we hope.

A study shows that Tai Chi helps Parkinson's disease.

The benefits and hype of yoga -- is it for you? I'm trying to get into it, but starting is hard. After all, I write this blog at 6 am and work until 7 or 8 pm -- when is there time for me?!!! But that's a whole other story, isn't it?

And on that note, I wish you a great day! Jennifer