Yet another fun-packed week at Advocacy for Patients. Yesterday, I mobilized the US Departments of Health and Human Services and Labor, the Missouri Insurance Department, the Ohio Insurance Department, and even the Connecticut Insurance Department, the AG's Office, and the Office of the Healthcare Advocate -- and not only did Cigna relent and initiate the external review process in Ohio, but they are now going to have to fix their totally illegal assignment of external appeals to the wrong states. Not only a victory for my client, but we caught and fixed a problem that affects thousands. All in a day's work? You try orchestrating two federal agencies and three states! I'm the small woman you see pushing that huge rock uphill. Now comes the really important part -- we have to win this appeal. I have no clue who or what I'm praying to, but I'm praying.
The "what happens if the Supreme Court does . . ." trend in the media continues. The NY Times describes the parties' strategies. The GOP plans to repeal anything that's left; the Dems are planning to remind Americans of the good health reform has done, and the insurance companies are ready to pounce if the individual mandate is stricken but the rest of the law remains. Some red states say they will continue building on some of the reforms, like the creation of exchanges. Advocacy organizations are ready to spin the loss of the individual mandate. Even the tech industry is weighing the benefits it will see whichever way the Court goes. I personally plan to celebrate if we win -- and I count winning as holding onto the prohibition against pre-existing condition exclusions, with or without the mandate -- and cry a lot if we don't -- and then scramble to try to figure out what's going to happen to the parts of the law that have taken effect -- including the all important appeals procedures that we cannot lose.
Mitt Romney says health reform has hurt small business. The WaPo factchecker says he's wrong.
CVS Caremark is the pharmacy benefit manager for many plans, including Texas Medicaid. Does it come as a surprise to you that they are steering people to CVS pharmacies to fill their prescriptions? Really?
Medicaid and Medicare fraud may be costing $60 billion per year, but trying to find and prosecute it remains a challenge. Audits were using incomplete information, so much of the fraud is being missed. They're working to revamp the program. $60 billion is a lot to lose - and it would help reduce the cost of health care if the government were to get better at rooting it out.
There's more stress in our lives than there was 25 years ago. Of course, we knew that, but it's nice to have a study to confirm our experience.
Is addiction a disease, or will thinking about it that way foster dependence? In fact, it's a chronic illness -- one that never goes away. We must treat it with vigilance and without stigma.
The next installment from the young woman blogging about her bone marrow transplant. This one about the guilt she has for the effect of her cancer on her loved ones. She's lucky to have loved ones supporting her. Better her guilt than going through this alone.
Play a game, improve your health? Check this out. Pretty interesting.
And that's it for this Friday morning. Have a great day and a great week-end! J