Anthem Health Charges Patient $12,596 for Emergency Room Visit

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Here’s a new health care insurance outrage:

The news website reports that, after announcing a new policy that will reject “inappropriate” emergency room visits, Anthem Health rejected a claim from a woman in Kentucky who went to the emergency room thinking she had appendicitis.  It turned out she had ovarian cysts. Anthem is trying to cut ER visits and initially refused to pay after reviewing her emergency room visit.  The company rolled out the change in policy and sent letters to its subscribers in four states – Missouri, Kentucky, Indiana and Georgia. –

There is usually no way for a patient to know  what the cause is when they have sudden severe pain.  The Anthem decisions on emergency room visits are made after the fact when they can look at the entire record and see what the patient was eventually treated for.   There is a fairly frequent possibility of patients having these denials of coverage happen.   For example, people thinking they are having a heart attack  offer are only experiencing  severe heartburn.  Should they not be cautious and go to the emergency room anymore?

This issue is just another example of insurance companies putting more importance on cutting costs than providing coverage that they have been paid for.   It seems that the company should have a referral hotline  or another way for a patient to know until after the fact whether the visit will be paid for.  It seems that public education and urging people to go to urgent care or other clinics needs to be the appropriate method to reduce emergency room visits.

The Anthem decision brought an outcry and an initial appeal from the patient that was denied.  Suddenly after the media got a hold of the case, Anthem changed its tune and reversed itself, apologizing for an problems the patient had.

Here’s the link to the full story


Hospitals Joining to Produce Some Generic Drugs to Lower Prices and Increase Supplies

Earlier this month, a news report detailed how a group of hospitals plans to work together to form a new nonprofit that will produce generic drugs.  The hospitals are fed up with shortages of key drugs and price increases and they have decided to take matters in their own hands and provide some competition to drug manufacturers.  The hospitals feel if they work together and form a buying pool they can develop enough business to be successful and force price competition.

Drug companies are pushing the envelope with their price increases.  I recently had a call from a relative who was upset about the price of a heart drug she had been prescribed which was going to cost her $446 every two months.  She wanted my help getting the drug from Canada where it is about less than half that price.    Pharmacists report that there are shortages of long established drugs like Atenolol which regulates the heart.

President Trump at  a ceremony for the new head of the Department of Health and Human Services, Dr. Azar, a former drug company executive says he wants him to work on lowering drug prices.  So far, Trump has been all talk on this front and has done nothing except what the drug companies want him to do.   He campaigned as if he was the consumer’s friend on this issue but has ignored it.    It’s clear the market rules do not work with prescription drugs for the benefit of consumers.

Meanwhile, the drug companies keep moaning they need all this money to develop drugs  – at the same time as they have become one of the largest campaign contributors to members of Congress.  They keep pushing to stop Medicare from negotiating drug prices and of course, don’t want drugs that are negotiated at cheaper prices in others countries coming into the United States.

Apple IPHONE Health App Will Allow Doctors, Hospitals to Send Medical Records and Information

Apple has already introduced a Health app on its IPHONE that has information for healthy living and allows users to enter some patient information.  The current cellphone Health app which has a white background and a red heart has four major categories of information:  Activity, Mindfulness, Nutrition, and Sleep. 

Apple has bigger plans though and it has been revealed that the next update to its IPHONE software coming in a few months will have a way for doctors and health providers to upload your latest health records right to the Health app on the cellphone.  There is already a place for the user or patient to enter their own date regarding health records, body measurements and other vital information.   So these places on the app will presumably be there to receive data from health providers.  Of course, patients would have to give permission for the information to be sent to their cellphones.  The information is currently available on patient “portals” or websites that hospitals and doctors have set up for patients to access their information.  The cellphone app would make the information much more accessible.

Health providers are trying to share data with patients to encourage them to have more information to take greater control of their health care.  And, health consumer organizations are promoting “health literacy” to assist patients including older persons to have more information about chronic health conditions including what prescription drugs they are taking.

Those of  us working in health and aging services can play a vital role in community education and assisting patients, especially older patients have to use the Health app.


Senators Susan Collins and Tammy Baldwin Praise Bipartisan RAISE Family Caregivers Act

Bipartisan law to establish a national strategy to support family caregivers is endorsed by over 60 aging and disability organizations

Washington, D.C. — U.S. Senators Susan Collins (R-ME) and Tammy Baldwin (D-WI) are applauding yesterday’s signage of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act into law. This bipartisan law establishes a national strategy to support family caregivers across the country.

The RAISE Family Caregivers Act directs the Secretary of Health and Human Services to develop and sustain a national strategy to recognize and support the more than 40 million family caregivers in the United States. The bipartisan law is endorsed by over 60 aging and disability organizations, including the AARP, the Alzheimer’s Association, the Michael J. Fox Foundation and the Arc.

“Family caregivers play an essential role in our communities by dedicating time and attention and making countless personal and financial sacrifices to care for their loved ones,” said Senator Collins.  “I am delighted that our bipartisan legislation to develop a coordinated strategic plan to leverage our resources, promote best practices, and expand services and training available to caregivers has been signed into law.  Family caregivers across America will now receive the much-needed recognition they deserve as well as the resources and training needed to better balance the full-time job of caregiving along with everything else that life brings.”

“When we work together across party lines we can get things done. This bipartisan effort is especially personal to me as I was raised by my maternal grandparents and later served as my grandmother’s primary caretaker as she grew older. I know the challenges that family caregivers face. I’ve listened to family caregivers across Wisconsin. This reform will provide much-needed support for family caregivers and help ensure that our older adults and loved ones with disabilities receive the highest quality care in their own homes,” said Senator Baldwin. “Every day, family caregivers do right by their loved ones, and I am proud to say we are doing right by them with the RAISE Family Caregivers Act being signed into law to formally recognize and support family caregivers across this country.”

“Signing the RAISE Family Caregivers Act into law is an important step in supporting the nation’s 40 million family caregivers who take care of loved ones, many of them elderly, often with very little support or resources available to them,” said AARP CEO Jo Ann Jenkins. “With the rapid growth of our aging population, it’s reasonable to say that many of us will end up either being a caregiver, or needing one. As a result, the potential benefits of this legislation are both critical and wide reaching.”

The RAISE Family Caregivers Act (S. 1028) was supported by a broad bipartisan coalition of cosponsors including Senators Lisa Murkowski (R-AK), Michael Bennet (D-CO), Shelley Moore Capito (R-WV), Debbie Stabenow (D-MI), Chris Coons (D-DE), Joe Donnelly (D-IN), Elizabeth Warren (D-MA), Amy Klobuchar (D-MN), Bill Nelson (D-FL), Jeff Merkley (D-OR), Jon Tester (D-MT), Jeanne Shaheen (D-NH), and Angus King (I-ME).

Important Facts on Family Caregivers:

40 million family caregivers in the United States provided an estimated $470 billion in uncompensated long-term care in 2013.

Many caregivers are putting their own health at risk since caregivers experience high levels of stress and have a greater incidence of chronic conditions like heart disease, cancer, and depression.

Every day, 10,000 baby boomers turn 65, and as many as 90 percent of them have one or more chronic health conditions.

Americans 85 and older are the fastest growing segment of the aging population. This population is most at risk for multiple and interacting health problems that can lead to disability and the need for round-the-clock care.

AARP Applauds Cuomo Budget Plan to Offer Retirement Savings Option For Workers Without Pension

Voluntary Workplace Retirement Savings Option Could Help Millions, Especially Communities of Color; AARP Urges Lawmakers to Include in Final Budget

ALBANY, N.Y. – AARP New York State Director Beth Finkel issued the following statement in reaction to Governor Andrew Cuomo’s 2018-19 State Budget Proposal:

“Millions of middle class, working New Yorkers will have an effective way to save for retirement at work thanks to Governor Cuomo’s state budget proposal to create a savings option for private sector employees whose employer doesn’t offer one

More than 3.5 million private sector employees in New York work for a company that offers no pension, no 401(k), no retirement savings option – in short, no way for them to build their own financial security. That’s over half the workforce – including 67% of Hispanics, 60% of Asian Americans and 52% of African Americans.

The Governor’s proposal is voluntary for businesses and employees.

AARP applauds the Governor for his leadership in taking decisive action to address New Yorkers’ lack of retirement savings, which he has declared is part of a growing national crisis.

We hope many businesses choose to offer this great benefit to their workers to give them the chance to build their own financial security. We expect many companies will; three quarters of small businesses that don’t offer their own plan say they probably would if the state sets one up.

We urge the Legislature to make sure this common sense proposal remains in the final budget.”

U of Maryland Hospital Apologizes for Patient Dumping onto Street; Hospitals to be Paid for Outcomes, not Outputs

The University of Maryland hospital CEO has apologized after a citizen videotaped a young woman who had been dumped on to the street in a hospital gown and socks in cold weather.   Critics called the incident “patient dumping” which has happened in Los Angeles and other cities.   It is stunning that the CEO of the hospital was surprised and shocked by this incident.  Obviously, any management policies to provide comprehensive discharge planning were not being implemented aggressively at the hospital.  The message obviously was not getting to front line discharge staff.

Sending people out into the street or in a taxi in the middle of night is something that has happened before including cases we are aware of the past few years in Albany.  All of that is hopefully changing as hospital systems in New York State are breaking ground trying to work with human services agencies in their communities to deal with the social circumstances of patients.  Hospitals also are being penalized for unnecessary re-admissions which is pushing them to work with community agencies on care transitions.

New York is trying through its DSRIP Medicaid program to encourage care transitions and care coordination to make sure that patients are followed home with a care plan and support services with medical homes and other methods including using  patient navigators.   Hospitals and health providers are seeing payers move toward “value based care” which will be changing fee for service payments to those which are outcome based, assessing whether the care provided made a difference in a patient’s health status.    This value based payment system is going to become increasingly the basis for payment in Medicare as well.   Critics of the health care system say the “outcomes” are more important that “outputs.” meaning  improvements in health status for patients and the population vs. the number of visits.

Here’s a link to the story in the Maryland hospital

Workers Begin Taking Paid Family Leave In New York State

New York’s Paid Family Leave program which was passed the State Legislature in 2016 finally became effective on January 1st.   This week the New York Times highlighted a young mother who will be taking leave in the next few weeks before her baby’s first birthday.  She had taken some time when the baby was born and the new law allows her to take time prior to the first birthday of the child.  So, she will have a chance to take few more weeks off.

Here is a link to her story:

We are interested in learning about stories of others, particularly those caring for an elderly parent or relative or another family member who is ill.   We will be looking forward to getting some statistical reports on the program’s progress.

WHO and AARP Declare NY First “Age Friendly” State


Overall Health in New York Ranks Among Top 10 in the Nation in 2017

Designation Supports the Governor’s Efforts to Advance the Health Across All Policies Initiative

Governor Andrew M. Cuomo today announced that New York has been designated the first age-friendly state in the nation by the AARP and the World Health Organization. This achievement is a result of the Governor’s directive to include health in state agency policy-making, an effort that will result in more livable communities for people of all ages and enable more New Yorkers to age comfortably in their homes.

“This administration has worked to create livable communities that support the unique needs of seniors and improve quality of life for all New Yorkers,” Governor Cuomo said. “As we continue to support community development efforts that deliver health and wellness opportunities for residents, we are honored to be recognized by two of the world’s most prestigious organizations for establishing New York as the first age-friendly state in the nation.”

In order to achieve this designation, New York ranked high in the eight age-friendly and livable community domains outlined by WHO and AARP, which include:

  • Outdoor spaces and buildings;
  • Transportation;
  • Housing;
  • Social participation;
  • Respect and social inclusion;
  • Work and civic engagement;
  • Communication and information; and

New York also ranks among the top 10 states in the nation for health, up from its ranking as the 40th healthiest state in 1990. This marks the largest five-year gain of all 50 states in the 2017 annual America’s Health Rankings report.

Efforts to become an age-friendly state are supported by the Governor’s new Health Across All Policies initiative, announced in the 2017 State of the State, to incorporate health and healthy aging into State Agency decision making. This approach utilizes the goals of the New York State Department of Health’s Prevention Agenda, the blueprint to improve the health of all New Yorkers in five priority areas and reduce health disparities. Meeting these goals, which include reductions in obesity and diabetes, improvements in environmental health, and enhancements in mental health services, will require attention to factors outside of health care, such as access to outdoor spaces and healthy foods, and improvements in education, housing and jobs.

In the 2017 State of the State, Governor Cuomo tasked state agencies with earning designation as the first age-friendly state. The event marks the accomplishment and partners with the largest and one of the most active outreach organizations in America, signaling the reasons why Boomers should stay in and move to New York State. Municipalities throughout the country have earned the age-friendly designation, but so far, no state has achieved that honor.

Under the leadership of Governor Cuomo, New York has made great strides toward becoming an age-friendly state. Since 2012, the New York State Office for the Aging and the New York State Department of State have been working collaboratively on the Livable New York Initiative, which aims to support the development of more liveable communities across the state. This multi-agency effort resulted in the establishment of a technical assistance resource manual to guide municipalities as they seek to make planning decisions around improving livability and mobility.

In 2017, the Governor also announced the launch of the first in the nation statewide aging services mobile app to connect older adults and caregivers with valuable local resources and services, including information regarding health and wellness, housing, and transportation options, among others. The New York State Office for the Aging’s Aging Services app puts easily understandable information into the hands of older New Yorkers, helping them remain healthy and connected to their communities.

As part of Governor Cuomo’s $10 billion House NY 2020 commitment, 8,659 affordable housing units have already been created for older adults by New York State Homes and Community Renewal since 2011 – 1,270 of which are part of the House NY 2020 plan. The plan aims to establish and preserve over 100,000 units of affordable housing throughout the state by the end of 2020.

The Governor has awarded $10 million to 10 regional downtown areas twice as part of the state’s Downtown Revitalization Initiative, in rounds one and two in 2016 and 2017. Many applications included planning and revitalization elements that will make downtown communities more livable, including the presence of mixed use spaces, housing at varying levels of affordability, and streets that are both walkable and bikeable to encourage healthy habits for residents of all ages.

In addition, 10 regional Sustainable Development and Collaborative Governance conferences were held last year to discuss the benefits of sustainable community planning and certification as an age-friendly community. The events helped promote collaboration by bringing together community development experts, local elected officials and business leaders. The culmination of these conferences was the release of a handbook for local governments and nonprofits that serves as a one-stop resource for state-funded grants and programs.

AARP Senior Vice President for Programs Jean Setzfand said, “New York will be the model, showing other states the way.”

AARP New York State Director Beth Finkel said, “AARP New York is thrilled that ours has become the first state in the nation to be recognized with the Age-Friendly Network. Governor Cuomo is showing great vision, foresight and leadership. His action will prompt a rethinking of how all of our communities are structured for the benefit not only of the 50+ but for New Yorkers of all ages. Improvements across the state such as more bus stop shelters and benches, better sidewalks and pedestrian-friendly streets, and parks where grandparents can take their grandchildren during working hours will help all generations.”

New York State Department of Health Commissioner Howard Zucker said, “New York State is truly at its best when it meets the needs of all its residents. By making it the first age-friendly state in the nation, we are working to ensure that all New Yorkers will have access to safer, more livable, healthy communities that will serve as an inspiration to states throughout the country. This is another of example of how we are making NY the healthiest state for people of all ages.”

New York State Office for the Aging Acting Director Greg Olsen said, “I applaud Governor Cuomo for his leadership in making New York the first age-friendly state. Older New Yorkers are a vital part of their families and communities, substantially contributing economically, socially, and intellectually through volunteerism, civic engagement, employment, and tourism. Communities that understand and adopt the principles of livability and smart growth are communities that are healthy and vibrant places to live for people of all ages that will attract new residents and retain existing residents.”

New York State Secretary of State Rossana Rosado said, “Governor Cuomo has established New York at the forefront of the movement to create healthy, livable communities for all ages. We are excited to have AARP and the World Health Organization recognize New York State as the first official age-friendly certified state in the nation. The Governor’s Downtown Revitalization Initiative is a major component of the state’s livable community approach. That program’s selection criteria and program goals focus on building downtowns with recreational, cultural, and employment opportunities that are attractive to all New Yorkers, especially the elders and millennials that are driving urban growth.”

Assemblywoman Donna Lupardo, Chair of Assembly Committee on Aging said, “I am thrilled with the Governor’s commitment to New York as an Age-Friendly State. This designation shows just how far this state has come in terms of providing healthy living opportunities for all of our residents. I am proud to continue working with the Governor and my colleagues in the Legislature as we further advance sustainable and liveable community development in every region of the state.”

In the face of a rapidly aging population, the AARP and the World Health Organization have taken steps to help develop more age-friendly communities. The AARP Network of Age-Friendly Communities encourages states, cities, towns, and counties to focus on the environmental, economic, and social factors that affect the health and well-being of older adults. The WHO has developed the “8 Domains of Livability,” a guide to creating communities that are more accommodating to older residents. The domains include civic participation and employment; respect and social inclusion; and access to communication and information.