Federal assistance will enable the New Mexico health insurance exchange to offer lower-priced and, in some cases, free medical coverage to patients purchasing individual plans and to make more people eligible who previously didn’t qualify. 

State Insurance Superintendent Russell Toal announced Monday that American Rescue Plan money will allow steep discounts on its bronze, silver and gold plans in 2022, eliminating premiums altogether for low-income individuals and families. 

The Obama-era exchange offers health care plans to people who lack medical coverage, either because they are self-employed or don’t receive coverage through their employers. They also must be under 65, the age they would qualify for Medicare. 

The premiums are set on a sliding scale based on income, and the expected federal aid will lower patients’ costs even further.

“Essentially what this is doing is making that sliding scale … more generous,” said Colin Baillio, project manager for the state insurance superintendent. 

Patients can enroll in the 2022 plans from Nov. 1 to Jan. 15 on beWellnm.com, the website for the state’s health insurance exchange, and the coverage will start in January. 

Color codes denote the services covered, with gold being the most and bronze the least. 

A news release from the state Office of the Superintendent of Insurance gave several examples of how the additional aid will lower patients’ costs.

A Farmington family of three with a yearly income of $53,000 will have its monthly fees on a gold plan reduced to zero from the current $99, the release said. If the family opts for a silver plan, it will see monthly premiums drop to $22 from the current $84. A bronze plan would remain free.

A 30-year-old Hobbs resident with an annual income of $22,540 would not be charged for any of the plans. That person’s fees now are $93 for gold, $89 for silver and $7 for bronze. 

And an older couple in Santa Fe with $90,000 combined income will see their monthly premiums drop to $61 from $969 for bronze; $550 from $1,389 for silver; and $330 from $1,330 for gold. 

“We are squarely focused on the affordability of health coverage,” Toal said in a statement. “That doesn’t just mean lowering monthly premiums, but also giving New Mexicans access to health plans with lower out-of-pocket costs when they visit a doctor, fill a prescription, or check in with a mental health professional.”

The lower copays make gold plans in particular more affordable for working families, Toal added. 

Last year, Toal said he expected premiums would go down in 2021 partly because five insurers joined the exchange, the most that had ever participated.

A sixth carrier, Presbyterian Healthcare Services, recently joined. That combined with the federal money is helping to lower prices even more for 2022, Baillio said. 

Another big change, thanks to the rescue plan, is that no one is excluded because of income. 

The income cutoff previously was four times the federal poverty level, he said.

The poverty line is defined as a family of four living on $26,500 or less per year, and a single person making $12,880 annually. That means a family of four would have qualified with an income of up to $106,000, and a single person could earn as much as $51,520.

In the coming year, those who earn more than the current ceiling will be charged a higher rate for a standard health plan on the exchange, but no more than 8.5 percent of their income, Baillio said. 

About 50,000 people are signed up for plans through the exchange, roughly the same as the previous year, Baillio said. 

Total enrollment will determine how much rescue plan money the state receives, he said. “We anticipate as the coverage gets more affordable, more people are going to sign up.”

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Following a national trend, two of Maine’s largest health insurance providers – Anthem and Harvard Pilgrim – have stopped waiving patients’ out-of-pocket costs such as deductibles and copayments for COVID-19-related treatment, meaning that patients hospitalized for the illness will likely have to pay a lot more.

Only one major insurer of Mainers, Community Health Options, said it plans to continue waiving such patient costs through the end of the year, regardless of whether the policyholders being treated for COVID-19 are vaccinated or not.

According to provider guidance issued this month, Anthem Inc. stopped waiving patient cost-sharing for COVID-19 treatment at the end of January, while Harvard Pilgrim Health Care stopped only recently, on Aug. 7.

Kimberly Winn, senior communications specialist for Harvard Pilgrim, said it was one of the first health insurers in Maine and the region to announce waivers on cost-sharing for COVID-19 treatment.

“(But) vaccines are now easily accessible, free and are highly effective in preventing hospitalizations for those who contract COVID-19,” Winn said in a statement.

The elimination of waivers does not apply to Medicare patients in Maine, she said, as cost-sharing for those patients will remain waived until the end of the public health emergency.

Maine’s civil state of emergency ended June 30, but the U.S. Department of Health and Human Services has extended the national public health emergency until at least Oct. 17.

In Maine, Lewiston-based provider Community Health Options is the lone holdout still waiving deductibles and copays for all COVID-19-related treatment. Spokesperson Kathleen Hayden said the company will return to normal cost-sharing provisions for all its health plans in 2022.

Federal law requires all private insurance plans to cover the entire cost of “medically appropriate” COVID-19 testing, and the U.S. government prepaid for COVID-19 vaccines so the shot could be available at no cost regardless of whether the recipient has health insurance.

Some states, such as Massachusetts, Rhode Island and New Mexico, imposed requirements that insurance providers must waive out-of-pocket costs for COVID-19 treatment, but Maine is not among them, and there has been no such federal mandate.

Many insurance companies across the United States voluntarily waived out-of-pocket costs including copays and deductibles for COVID-19 treatment during the height of the pandemic, according to a report from the Kaiser Family Foundation and the Peterson Center on Healthcare. But with vaccines now widely available, many insurers are now phasing out those waivers.

An analysis from Kaiser and Peterson found that of the two largest health plans in each state and Washington, D.C., 72 percent are no longer waiving out-of-pocket costs for COVID-19 treatment. Almost half of those stopped doing so no later than April.

Of the roughly 28 percent of major U.S. insurers still waiving patient costs, 10 are set to end the policy by the end of October, and another 12 are set to do so by the end of the year.

The 102 plans reviewed represent 62 percent of all health insurance enrollment across the fully insured individual and group markets, and all of those plans had waived cost-sharing for COVID-19 treatment at some point during the pandemic, said the report, published last week on the two organizations’ Health Systems Tracker.

COVID-19 cases have been climbing in Maine because of the more highly communicable delta variant and a population that is still nearly 40 percent unvaccinated. On Thursday, Maine’s hospital leaders pleaded with the public to get immunized against the disease, saying hospitals around the state are now swelling with unvaccinated patients.

The state reported 415 new COVID-19 cases Saturday, the highest one-day total since May 3. On Friday, Maine health officials reported the highest number of critical care patients with COVID-19 in Maine since the height of the pandemic last January.

The number of COVID-19 patients in intensive care units jumped from 59 to 71 between Thursday and Friday. The only other time more than 70 people were in critical beds with COVID-19 in Maine occurred on Jan. 20, when there were also 71 people in critical care.

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People who opt out of shots shouldn’t expect their employers, health insurers, and fellow citizens to accommodate them.  

John Lamparski / NurPhoto / AP

About the author: Juliette Kayyem, a former assistant secretary for homeland security under President Barack Obama, is the faculty chair of the homeland-security program at Harvard’s Kennedy School of Government. She is the author of Security Mom: An Unclassified Guide to Protecting Our Homeland and Your Home.

For months, institutions and companies have been drafting plans to aggressively promote vaccination or require it outright, and last week the FDA gave them license to click the “send” button. The same day the agency granted full approval to the Pfizer COVID-19 vaccine, New York City’s public school system announced that its teachers and other employees will be required to get shots. The next day, Louisiana State University made a similar demand of its students and faculty. Within about 24 hours of the FDA move, other major employers, such as Chevron and Goldman Sachs, rolled out new vaccine mandates. In a novel twist, Delta Airlines announced that it would impose a $200-a-month health-insurance surcharge on unvaccinated employees. Regardless of the reasons for their hesitancy, unvaccinated employees will literally have to pay for it.

What all of these decisions show is that the adults running major institutions in our society want to move forward, and they are done waiting around for vaccine refusers to change their mind. Outside of executive suites and human-resources offices, plenty of other Americans are also craving more certainty. Bars and restaurants that want to stay open are beginning to check vaccination cards—at least in states where supposedly freedom-loving lawmakers haven’t forbidden private businesses from keeping their own customers and employees safe. Couples throwing weddings are demanding that their guests upload proof of vaccination. These people disinviting their anti-vaxxer relatives are saying something important: Getting a shot to protect yourself and others from COVID-19 is both a social responsibility and the best way to hasten the end of the pandemic, and if you don’t believe that, we’re not waiting around for you to step up.

Read: How the pandemic now ends

More than 70 percent of eligible Americans have now received at least one dose. Since January, public-health researchers, news reporters, and pollsters have all tried to unearth the reasons that a significant fraction of American adults have not yet gotten a shot. Some are broadly misinformed; others are afraid of needles or potential side effects; still others are deeply suspicious of the medical system; some have had COVID-19 already and believe that the level of natural immunity they have developed is enough. Some refusers say they definitely won’t get vaccinated; others say they haven’t yet gotten to it. But the specific feelings and concerns of vaccine refusers should be largely irrelevant to vaccinated people who are eager to move on with their lives. Americans are entitled to make their own decisions, but their employers, health insurers, and fellow citizens are not required to accommodate them.

The vaccinated have for too long carried the burden of the pandemic. In theory, unvaccinated people should be taking greater precautions. A recent poll conducted for the Associated Press found that vaccinated adults have been more likely than unvaccinated ones to wear masks in public settings, refrain from unnecessary travel, and avoid large group settings.

Public-health officials can keep trying to figure out ways to persuade the unvaccinated to get shots, and maybe at this late point they can still discover some new message that succeeds where all others have failed. If so, that would be fantastic. But begging is not a strategy. It is not a coincidence that many of the entities pushing hardest for mandatory vaccination are in industries—higher education, travel, entertainment—that have been badly disrupted by unpredictable waves of infection and are existentially threatened by a pandemic that goes on without end.

People in the crisis-management field have made peace with blanket one-size-fits-all policies that some individuals don’t like. When a ship is going down, passengers aren’t given the luxury of quibbling with the color or design of the life vest, and they can’t dither forever about whether to put one on or not. Emergencies invariably force people to make some choices that they might not consider ideal, but asking everyone to get vaccinated against a potentially lethal virus is not a big imposition. Ironically, by talking as if everyone, given enough time, will eventually choose the shot, public-health agencies may have understated the urgency of the matter and invited the vaccine-hesitant to dwell on the decision indefinitely.

Sorry. Time’s up.

The Biden administration could do even more to assist the communities and businesses that are trying to nudge unvaccinated people along. In 2021, paper cards that can easily be lost, damaged, or falsified are an outmoded way to keep track of who has gotten a shot. Even establishments that check their patrons’ vaccination status are doing so in makeshift ways—for instance, by asking patrons to show a driver’s license alongside a picture of their vaccination card on their phone. Some states are moving forward with their own vaccination-verification apps, but the failure to plan a national system will be viewed, in time, as a costly concession to a vocal minority.

Employers are being creative with some of their requirements, creating so-called leaky mandates. Rather than fire noncompliant employees, for example, Delta Airlines opted for a financial penalty. This approach may make particular sense in industries where a rapid round of terminations will hurt a business’s ability to function. It also acknowledges the free will of vaccine refusers: They can keep rejecting the shot, as long as they accept the consequences.

Read: How did it come to this?

Up to this point, many employers and medical providers—wary of offending anyone—have been careful to describe vaccination as a deeply personal decision. Vaccination mandates are essentially a recognition that vaccinated people have feelings too, and that the burden of fighting the pandemic shouldn’t be on them alone.

I know, I know: I should try harder to understand the feelings of unvaccinated Americans. Being more patient and empathetic would make me sound nicer. But do you know what’s really nice? Going back to school safely. Traveling without feeling vulnerable. Seeing a nation come back to life.

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Originally Appeared Here

Thrive Allen County recently received a major award from the Centers for Medicare and Medicaid Services (CMS) to help underserved populations find affordable health insurance coverage with the assistance of Navigators. The grant is expected to provide $2.9 million over a three-year period.

Navigators are federally trained and certified individuals who help consumers find and apply for Marketplace health insurance. According to CMS, “Since 2013, Navigators have helped Americans understand their health insurance options and facilitated enrollment in health insurance through the Federally-facilitated Marketplace. As trusted community partners, their mission focuses on assisting the uninsured and other underserved communities. Navigators serve an important role in connecting communities that historically have experienced lower access to health coverage and greater disparities in health outcomes to health coverage.”

Since 2013, Thrive has offered enrollment assistance services to Allen County residents for the Marketplace and other health and safety net services in its Thrive CARES program. Thrive’s Care Coordinators are crucial fixtures in the community health ecosystem, providing a personal connection to those in need. They were instrumental in lowering Allen County’s uninsured rate from 21% in 2013 to under 9% in 2018.

Thrive Allen County has contracted with ten agencies across Kansas to bring Navigator services to underserved communities throughout the state. Barber County United Coalition, Dickinson County Quality of Life Coalition, El Centro, Inc., Genesis Family Health Center, Health and Wellness Coalition of Wichita, Impact Ulysses, LiveWell Northwest Kansas, Mitchell County Regional Medical Foundation/North Central Kansas Health Collaborative, Northeast Kansas Community Action Partnership, and Southeast Kansas Community Action Program will work across 42 Kansas counties, focusing on rural and diverse populations.

Says Thrive President and CEO Lisse Regehr, “I am so excited Thrive was chosen as one of the grantees to further this very important work. This is a grant after my own heart; I joined Thrive in 2014 as a Navigator and saw firsthand the life changing effects it has on individuals, families and communities. The impact Navigators have on healthcare access cannot be understated, and we are honored to help community organizations implement what we have learned across the state.”

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Health Insurance Navigator Grant Awarded2021-08-272021-08-27http://thriveallencounty.org/media/thrivelogo-280×156.pngThrive Allen Countyhttp://thriveallencounty.org/media/img_6458-scaled.jpg200px200px

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AUSTIN, Texas — Mere moments after enduring a cesarean section and delivering her third child, Kalani, on Dec. 15, Tambra Morrison knew that something was wrong when she started to get an excruciating headache.

“I instantly felt like my head was about to pop off,” said Morrison, 32, who lives outside of Dallas. “This was my third cesarean [delivery]. I had never had this feeling.”

Morrison remained in the hospital for a week, where she said doctors were slow to address her pain. She was eventually released but was later readmitted due to complications. After being treated, she was sent home again – despite having high blood pressure. But within a day, Morrison was taken to the emergency room, where a different doctor determined she suffered from aggressive postpartum preeclampsia, a leading cause of pregnancy-related death.

Note: The video above is from a previous report on nationwide pregnancy-related deaths.

“By the time I got [there] I didn’t think I was going to be going home to my kids,” Morrison said. “… He was like, ‘A lot of women don’t know the signs, so a lot of women [die].'”

In some ways, Morrison was lucky. The number of reported maternal deaths has increased nationwide in recent decades, according to the Centers for Disease Control and Prevention. In Texas, which had a maternal mortality rate slightly higher than the national average in 2018, some of the leading causes of pregnancy-related death include cardiovascular-related issues, mental disorders, hemorrhaging and preeclampsia, characterized by extremely high blood pressure.

But many low-income women in Texas, the state with the highest uninsured rate in the nation, don’t have access to the kind of comprehensive postpartum care experts say is essential to mitigate these deaths and complications that disproportionately affect women of color.

A new state law, set to go into effect Sept. 1, hopes to address that by extending the government-subsidized Medicaid coverage many new mothers in Texas rely on. Coverage will jump from 60 days after a baby is born to six months. Experts, though, worry that still isn’t long enough for women to be adequately covered for the myriad health issues that can arise months after giving birth.

It’s been more than six months since Morrison gave birth, but she has yet to shake the trauma from its aftereffects as she balances work with taking care of Kalani and her two other kids, Kynnedi, 12, and Kayden, 7. Morrison is still covered by Medicaid thanks to a federal public health emergency order in place because of the pandemic that requires states to keep Medicaid recipients enrolled. She worries, though, what happens once that protection is expected to end after 2021.

“I wish [the state] knew we needed time,” she said.

State Rep. Toni Rose, D-Dallas, was the lead author of House Bill 133, which extends postpartum Medicaid coverage. She successfully got a majority of her colleagues in the Texas House to approve a version of the bill that would extend Medicaid for qualifying mothers to one year after they give birth. Rose said she lobbied Republican lawmakers and Gov. Greg Abbott, pitching the legislation as a pro-life bill. But the Senate lowered the extension to six months.

She said getting new Texas mothers six months of coverage instead of just two was still a win.

“So, as it is with all other legislation, sometimes you have to start somewhere and then hopefully we’ll build on it,” she said.

Filling in the gaps

According to a 2020 state report that looked at pregnancy-related deaths in Texas for 2013, about a third of deaths occurred 43 days or more after pregnancy. Black women died at almost two times the rate of white women in 2012, according to the Texas Department of State Health Services. From 2011 to 2018, Black mothers and Hispanic mothers in Texas also experienced higher rates of severe maternal morbidity – pregnancy complications that harm a woman’s health – compared to white women.

Texas has one of the country’s strictest income eligibility limits for Medicaid, according to the Kaiser Family Foundation. For example, a single parent with three kids, like Morrison, has to earn $277 a month or less to be covered. But that threshold changes during pregnancy, where a woman in a family of four can earn up to $4,373 and still receive Medicaid coverage.

More than 380,000 babies were born in Texas in 2018, with almost half of them born to mothers on Medicaid, according to the Medicaid and CHIP Payment and Access Commission. Under the new state law – and once the federal order to keep Medicaid recipients covered during the pandemic ends – mothers will get dropped six months after their baby’s birth if they don’t meet the stricter income threshold for their own health coverage.

That’s because Texas is among states that have not expanded Medicaid to cover more low-income residents, contributing to the state’s uninsured population.

As chair of the state’s Maternal Mortality and Morbidity Review Committee, Dr. Lisa Hollier sees extending Medicaid coverage to a full year as a way to address some of the leading causes of maternal mortality and health issues that can go easily unseen in the first months after a woman gives birth. According to the review committee, out of 54 pregnancy-related deaths that occurred in Texas in 2013, about 90% of them were preventable at some level – signaling the importance of extended comprehensive care, Hollier said.

“Women can continue to have access to see specialists, they can continue to see psychiatrists, receive the full range of medications that they might need for postpartum depression and [receive] hospitalization if that is what’s necessary for them,” Hollier said.

Denishea Williams said she knows all too well the need for postpartum care. After having her son, Tommie, in 2009 while attending the University of Texas at Arlington, Williams noticed a change in her mood that she later recognized as symptoms of postpartum depression. However, when she decided to address her symptoms, her post-pregnancy Medicaid coverage had already been cut off and there was little she could do.

“I realized there was an issue that I was facing, something that I couldn’t put my finger on,” Williams said. “And by the time I put my finger on it, I didn’t have the support … there was no coming back to the doctor to talk about postpartum depression.”

Texas does have a 12-month service under its Healthy Texas Women program that women can transition into after their Medicaid coverage expires. There is also the state’s Family Planning Program and coverage for before and after birth through Texas Children’s Health Insurance Program.

Although some of those programs cover things such as treatment for diabetes, high blood pressure and substance use, they do not provide the full range of coverage a woman receives while on Medicaid, said Erika Ramirez, policy and advocacy director of the Texas Women’s Healthcare Coalition.

“It is a limited package,” Ramirez said about the Healthy Texas Women program. “So it’s not as comprehensive like Medicaid. Continuing Medicaid coverage would be the No. 1, best situation but short of that there are some benefits women can get.”

Michelle Anderson, a policy associate with the Afiya Center, a reproductive justice organization based in North Texas, said once Medicaid coverage runs out, many women turn to emergency rooms to seek health care if they have complications.

Starla Simmons, interim director of the Austin organization Black Mamas ATX, said she has seen mothers scrambling to find postpartum care and having to lean on local organizations to help guide them through the patchwork of resources available to them. The group offers holistic support services such as doula assistance, support groups and case management assistance.

“We’ve been seeing that need,” Simmons said of mothers searching for postpartum health coverage. “Once Medicaid [coverage] is over, we’re making referrals for all sorts of things to fill the gaps for what they could have gotten through Medicaid … it’s very frustrating to be in this position to have to constantly be struggling year after year to help some of our moms get what they need and what they deserve.”

Changes in the Senate

While presenting the Senate version of House Bill 133 to her colleagues in the upper chamber, state Sen. Lois Kolkhorst, R-Brenham, defended the shortened extension.

“The media has portrayed our version of this, as cutting it from 12 [months] to six,” said Kolkhorst, who also sponsored the bill. “I want to make sure that we clarify that we are adding four months, and we will become one of the first states in the nation to extend it beyond two months.”

Aside from extended postpartum care, provisions the Senate added to HB 133 include transitioning case management services for children and pregnant women on Medicaid and in the Healthy Texas Women program to managed care. The state plans to move away from a fee-for-service model to contracting with managed care organizations that work with a certain network of providers.

Ramirez said that could mean better service for women experiencing postpartum issues, but the real impact of the change remains to be seen. That’s especially true for traditional family planning providers that may not have much experience working with managed care organizations.

Adriana Kohler, a policy director with the children’s policy nonprofit Texans Care for Children, said that although HB 133 is set to go into effect on Sept. 1, it could still take a while to see the actual benefits play out because it will take time for state and federal officials to secure funding.

Once the state gets necessary federal approval to use Medicaid funds for six-month postpartum coverage, women enrolled in Medicaid coverage on and after Sept. 1, 2022, would be eligible to receive extended coverage, according to the state’s Legislative Budget Board.

That means there could be a gap between when the federal pandemic order expires and when Texas’ extension of Medicaid for mothers kicks in.

“The women that are going to lose out are the ones who give birth next spring and summer,” Kohler said.

A recent pandemic relief bill passed in Congress presents a pathway for states to extend postpartum coverage up to a year without enduring the lengthy approval process for Medicaid funds they normally have to go through. It’s an enticing option some would’ve liked the state to take advantage of, said Kohler.

“Unfortunately, we did not go that route because Texas only extended [Medicaid coverage] for six months postpartum,” Kohler said. “This means we have to kind of do a longer process.”

“Mixed emotions”

Rep. Shawn Thierry, D-Houston, who was a co-author of HB 133, said “there’s very mixed emotions” in her district about the state’s extension to six months.

“I think there were those who switched it to six months thinking that it was saving the state money, but in fact, it could end up costing us more if these women end up getting sick, have prolonged hospital stays, or they don’t go to the hospital till much later and they have severe complications,” Thierry said.

For Thierry, who has made maternal health a priority during her time in office and has been open about her own struggles with childbirth, the passage of HB 133 is a win, albeit a small one in the fight against systematic disparities in maternal health care.

“We’ve got to look at this as a comprehensive solution and not just doing what we seem to be: putting Band-Aids on a hemorrhage,” Thierry said. “So while this is a step in the [right] direction, it’s not going to get us across the finish line.”

Morrison said she’s been struggling with going to her postpartum checkups to monitor her preeclampsia and hasn’t really been to the doctor outside of checking on her incision from her C-section. She’s also not satisfied with the options she has under Medicaid.

“When I look to go find a good doctor, a lot of them are like clinics where the doctors are in and out, you may see a doctor this month but next month you see somebody else, and it’s a lot of doctors that you don’t have access to,” Morrison said.

Currently, Morrison works from home processing medical claims and earns about $19 an hour, or a little under $40,000 a year – too much to qualify for Medicaid in Texas as a parent once her pregnancy coverage expires. Her job does offer health insurance, but she said it comes with a high deductible and doesn’t cover many of the services she required while pregnant.

Right now, with her Medicaid coverage temporarily in place, she continues searching for a doctor she feels truly meets her postpartum needs.

“I don’t want to go to somebody that just tries to patch me up,” Morrison said.

Disclosure: Texans Care for Children, Afiya Center and the University of Texas-Arlington have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans – and engages with them – about public policy, politics, government and statewide issues.

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Getting hospitalized with COVID-19 stinks. There is nothing good about it.

But people with Highmark or UPMC Health Plan insurance can at least feel secure that their out-of-pocket costs, including deductibles and copayments, remain 100% covered.

Highmark and UPMC Health Plan, Erie County’s two largest private health insurers, continue to waive all out-of-pocket costs for inpatient COVID-19 treatment.

This isn’t the case with most other health insurers nationwide, according to a research brief from the Peterson Center on Healthcare and the Kaiser Family Foundation.

About 72% of the nation’s largest health insurers no longer waive those costs. Nearly half of those 102 plans stopped covering those costs in April.

Highmark will continue to cover out-of-pocket costs through Dec. 31 at the earliest.

“We will continue to monitor the changing conditions with COVID when making any decisions about extending the cost-share waiver beyond the end of the year,” said Highmark spokeswoman Monica Lewis. “Until then, we are relying on our members and the community to get vaccinated so they are less likely to get seriously ill or need to be hospitalized.”

More:David Bruce: Erie theater angers customers with exact change policy, employee’s attitude

UPMC Health Plan will continue covering those costs for nearly two more months.  

“UPMC Health Plan continues to waive the costs of in-network, inpatient treatment for COVID-19,” UPMC Health Plan spokeswoman Denise Hughes said in an email. “The current policy is effective through 10/20 (the end of the currently declared federal Public Health Emergency period).”

Health coverage for COVID-19 is important, especially as Erie County’s 14-day moving average of daily COVID-19 patients has risen over the last five weeks from three to 23.

Even with health insurance, a patient hospitalized with COVID-19 could be responsible for thousands of dollars in deductibles, copayments and other out-of-pocket costs.

The average deductible in employer health plans is $1,644, according to the Peterson-KFF brief. The average out-of-pocket cost for someone hospitalized with pneumonia, which requires treatment similar to COVID-19, paid an average of about $1,300 out of pocket.

The highest annual out-of-pocket maximum for health insurance plans — the most someone could pay for care — is $8,500 for 2021, according to healthcare.gov.

That is a lot of money for anyone to pay for COVID-19 treatment. Let’s hope Highmark and UPMC Health Plan continue to cover those costs as long as patients are hospitalized for COVID-19. 

Contact David Bruce at dbruce@timesnews.com. Follow him on Twitter @ETNBruce.

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Originally Appeared Here

Saudi Gazette report

RIYADH — The Council of Cooperative Health Insurance (CCHI) has begun preparing the executive regulations for a system of including orphans in the scope of compulsory insurance provided by insurance companies.

The Council Secretary-General Dr. Shabab Al-Ghamdi said that the decision is of a humanitarian nature, reflecting the utmost care for people with special circumstances in the Kingdom.

He pointed out that the Cabinet’s approval of the medical insurance system for orphans confirms the leadership’s commitment to provide for the needs of citizens of each group of society.

He also said that the Council has made great strides in preparing the policies and procedures for the system of including orphans by securing help from their foster families.

The Council is also considering offering incentives to employers to help them overcome the difficulties in accepting the request the inclusion of the guardian with insurance.

He added that the Council is working with its partners to prepare and implement the new system and to preserve the rights of all the parties.

The new system includes continuous technical and medical follow-ups for all those concerned, including continuous technical and medical follow-ups for all those concerned in the system.

Al-Ghamdi expressed his confidence in private sectors and their commitment to support orphans making it their social responsibility, given that private sector companies and institutions will bear the costs of the insurance policy.

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Originally Appeared Here

SIOUX FALLS, S.D. (KELO) — Most of us who are covered by health insurance have never looked at the policy. But read the fine print and you may be surprised that your health insurance provider can stake a claim on any insurance settlement you would get if you were in a crash. There’s a name for it: subrogation and it’s a multi-billion dollar business.

Collection agencies working for insurance companies are able to put a lien on any kind of settlement money, whether it be from a fire or catastrophic crash, and recoup what they paid out in medical expenses. A leading subrogation attorney says it only makes sense.

S.D. man gets life for seeking sex with child

“What people miss is subrogation plays a huge role, especially in group health plans, in helping keep down the cost of health insurance. And what bigger topic could we have these days than the cost and availability of health insurance?” Gary Wickert, leading subrogation attorney, said.

But retired USD law professor and subrogation attorney, Roger Baron, disputes that subrogation keeps premiums down. He says it goes to line the pockets of insurance executives.

Kennecke: Why is it allowed to continue?
Baron: Well the insurance company is a strong lobby; efforts in Congress have failed; efforts in the South Dakota legislature have failed.

While subrogation may sound like an abstract insurance concept, it hit home for a South Dakota teacher who found himself the victim of a crime and in the hospital with a traumatic brain injury and a host of other medical problems. The insurance policy that covered his hospital bills now wants to be reimbursed by his motor vehicle insurance settlement.

D.J. Toczek in the hospital with a traumatic brain injury after being rear-ended on his motorcycle/Photo Courtesy: D.J. Toczek

Toczek The part that’s really frustrating to me is that it’s been four years and nothing has really come of it yet. Everything takes a long time in the law process. And also, you know, it’s four years where expenses are still rising.
Kennecke: And you can’t even touch that money.
Toczek: No.

This is not a cut-and-dry case. Toczek’s attorneys say South Dakota law is on his side, not that of the insurance company.

KELOLAND Investigates delves into “The Clash after the Crash” Wednesday at ten and shows you Toczek’s remarkable story of recovery and what he still has to deal with due to his injuries.

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Connecticut Public Radio

One of the oldest organizations of its kind in the country, Community Partners in Action (CPA) was founded nearly 150 years ago and champions criminal justice reform and advocates for preserving human dignity. Our programs include reentry and housing, youth initiatives, a nationally recognized Prison Arts Program, and holistic alternatives to incarceration, providing long-term impact that positively transforms individuals and society at large. Annually serving nearly 6,000 individuals and our communities throughout Connecticut, our work is possible due to partnerships with and support from government, private funders, organizations and business.

Beth Hines

While a nonprofit, we must also operate as a sound business; we pay salaries, manage properties, and provide benefits to our employees. One of our biggest challenges is the skyrocketing cost of health insurance.

Over the last five years, CPA has experienced a 42% increase in medical insurance premiums while plan deductibles also increased. The deductible for our High Deductible Health Plan increased from $1,500 to $2,500 for an individual and from $2,500 to $5,000 for a family.

The Point of Service (POS) Plan added a deductible of $1,000 per individual and $2,000 for a family.

Over these same five years, staff compensation increased on average by 4%. CPA is absorbing the majority of these costs and therefore unable to increase staff salaries to cover the added expense passed onto them.  As a result, staff have less take-home pay.

Health insurance premium increases have brought some of our staff to tears.

CPA is a nonprofit providing vital services to the community. The majority of our staff are motivated by passion and mission, not wages.  Many of our staff work second jobs to make ends meet. Some salaries are not a living wage; $15 an hour is not a living wage for someone with a family. For these families, an increase in insurance costs means going without somewhere else in the family budget.

Health Savings Accounts are all well and good, but you are taking from your paycheck. It makes sense and we encourage people to do that, but really the whole system is unsustainable.

During Covid, we had to figure out how to serve people in residential and other settings. Our staff worked incredibly hard serving our clients, some getting sick themselves. We kept our centers open as long as possible, met clients in parking lots, got them cell phones so we could stay connected when they had to relocate to hotels to be safe, set up Zoom capability for remote meetings. I am always proud of our staff, but never more so than during this pandemic.

Our state had the chance last year to pass a Public Option health insurance program, which would have included non-profits in the purchasing pool that comprises state and many municipal employees. I can’t even tell you what a relief that would be for CPA and our work. It would be a complete game changer.  We could pay all staff a living wage.  This would allow them to focus on their work and clients rather than how they will cover rent. Our staff would be healthier, because they would be able to go to the doctor when sick rather than worrying about their co-pay.

We have given insurance companies the chance to show us how they could innovate and lower the cost of health care. We will continue supporting a Public Option, to give our staff, and thousands of other small businesses and non-profits, relief from this broken system.  I strongly urge our legislators to advocate for the Public Option.  It is time for a change.

By Beth Hines is Executive Director of Community Partners in Action.

 

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It’s a common phrase used to ease the worries of anxious parents, but speech pathologist, Tim Kittel says it can be “dangerous” in the long run.

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From correcting stutters, improving communication to treating swallowing disorders, speech pathology has a wide range of applications.

Also known as a speech therapy, this type of treatment looks at conditions where there are issues around swallowing or communication, said National President of Speech Pathology Australia, Tim Kittel.

“It helps people realise what it is they want to be able to do, whether that is to eat safely, or eat the right types of foods or to communicate their thoughts and feelings in the way they want to.”

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What do speech pathologists and speech therapists do?

A speech therapist might be most commonly associated with helping children improve their articulation and speech, but practitioners work across many conditions.

This can include treating a range of issues related to stuttering, using and understanding language, reading and writing, voice, speech, eating and drinking.

In order to treat some conditions, speech pathologists may work alongside other medical disciplines. This can happen in the treatment of conditions related to disability, mental health or a traumatic injury, says Mr Kittel.

“Sometimes it can be quite significant,” he adds. “Somebody might have a traumatic brain injury or a stroke and actually lose the abilities to eat safely, or to be able to communicate.”

“Other times it might be that there are children who don’t develop communication in the way that we want.”

While people of all ages may access the help of a speech pathologist, Mr Kittel says patients are most commonly children in Year 3 or 4.

“You can have some mild difficulties in terms of understanding language and quite often this happens in children around the age of year three or year four when they suddenly move from the learning to read years into the reading to learn years,” he says. “Their vocabulary can become a bit of an issue too.”

Another touch point may be teenagers who are struggling with essays and school work.

“Speech pathologists are quite often involved in helping teenagers with writing assignments, and making sure that they structure things well,” he adds.

What are the signs someone should see a speech pathologist?

When it comes to noticing issues with speech and communication, Mr Kittel says family and parents are best placed to identify changes.

“The best person to work out if you need to see a speech pathologist when it comes to communication is often a member of your family,” he says.

However, he adds that people should seek out treatment once theses changes are noted and says that one of the biggest, and a potentially “dangerous” misconception, is people waiting to seek treatment.

“A well-meaning family member, or even a GP, may say ‘lots of people are late to talk and they’ll catch up’ but that’s really dangerous,” he says.

His advice is similar to people who suddenly begin experiencing difficulties with keeping food down or being able to drink safely: don’t wait to seek help.

“It’s such an important time when something’s going wrong, to sort of jump in and see whether there are exercises that can help.”

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What can a speech pathologist session look like?

Although the exact structure of a speech therapist session will differ depending on the concern, a therapist will use a range of techniques and exercises to help.

“It’s always going to look incredibly individual to that person because someone’s difficulties with communicating or the sorts of foods they’re having difficulties with is such a personal thing,” he said.

A typical first session will involve establishing a rapport between the patient and therapist and clarifying the concerns and expectations of the treatment.

“Quite often, the first session is really getting that important click between a therapist and a client in terms of where it is they want to go – the difficulties they are experiencing, and the sorts of techniques that we have in our arsenal in order to help,” said Mr Kittel.
Mr Kittel also says it’s crucial for patients to practice their homework outside the clinic to reap the full benefits of the therapy.

“Families and having a really nice support network are vitally important in terms of making a difference,” he said. “The type of exercise and the amount of time that you need to do it, are going to vary with the sorts of concerns you have but both the areas of communication and swallowing take place outside of the clinic room.”

FAQs:

How do you access the services of a speech pathologist?

There are two ways to access a speech pathologist appointment. You can either directly make an appointment at a practice or with a practitioner or obtain a referral from a GP or a paediatrician.

However, if you want to subsidise part of your cost through Medicare or your private health insurance, you will need a referral from a registered physician – like a GP.

Is speech pathology covered by Medicare?

While speech pathology is not subsidised by Medicare, you are able to get a rebate if your GP refers you or your child to a therapist under a care plan. Care plans (you can view the full list from the Department of Health) are available under the National Disability Insurance Scheme (NDIS), Chronic Disease Management programs, outreach programs for Aboriginal and Torres Strait Islander people, the Helping Children with Autism Package and the Better Start for Children with Disability initiative.

Depending on the care plan, patients will be able to access a specified number of treatments which may be fully or partially covered.

Is speech pathology covered by private health insurance?

Depending on your private health cover’s Extra’s policy, you may be able to claim part of your speech pathologist appointment. The exact amount you’re able to claim and for how many sessions per year will vary depending on your policy.

Cover for speech pathology is also normally subjected to annual limits and generally carry waiting periods of around two months, but again, this will depend on your plan.

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