To the tune of $370 million combined for the pesky little problem of deliberately screwing over plan members on OON (out-of-network) claims. Of course, neither company admits any wrongdoing, but at least UHG thinks settling the lawsuit is in the best interest of the company going forward. Ya think?
And, what a crock of steaming shit is their assertion that there is absolutely no conflict of interest in owning a company, Ingenix, that determines the rates they and other insurers pay for claims, that there is absolutely no incentive to lowball the data to skew those oh-so-reviled "reasonable and customary" rates downward, thereby shifting more of the cost burden to plan members. Don't even get me started on the many layers of secrecy under which reasonable and customary reimbursement rates are buried. Insurance companies go to extraordinary lengths to keep this information proprietary and most importantly, private. Perhaps, this new non-profit organization will increase transparency, but I'll believe it when I see it. Who do you think it's going to employ? My guess is former insurance executives and industry whores, not advocates for the common good.
Full disclosure--I used to work for a subsidiary of UHG. This company has zero concern for plan members. Their entire focus is on maximizing profit, increasing the share price, and enriching the top brass. I was working there, in fact, when the backdating stock options scandal broke, and "poor" CEO McGuire resigned over his $1.6 billion folly. You should have seen the way the "Human Capital" department (yeah, that's what they call it--humans are commodities, folks!) tried to spin this shit internally--lots of blather about focusing on the consumer (we were instructed never to call them members; they're CONSUMERS!) and providing excellent service. Like, when did we ever do that?
I'm glad they're having to cough up some cash, but I think in addition to penalties, they should have to go back and re-evaluate each OON claim filed dating back to 2000 and reimburse plan members. It would probably hamper their current operations, but they're big on out-sourcing, so I'm sure they'd just foist this task on some contractor in Jamaica or the Philippines. They'll be back to their old tricks in no time. They'll find some other way to screw the "consumer," most likely by stalling payment of legitimate claims and increasing the red tape with billing. Until we get rid of for-profit insurance companies, there will be no justice in healthcare.
Friday, January 16, 2009
Wednesday, January 14, 2009
Mamas, Please Tell Your Babies that Pee is Urine
I speak two languages fluently--English and slang.
Renegade RN: "Did you leave a urine sample?"
Patient: "What?"
Renegade RN: "Did you leave a urine sample in the bathroom?"
Patient: "What is urine?"
Renegade RN: "Did you leave a cup of pee?"
Patient: "Oh, yeah, I did that."
I think I deserve extra pay for being bilingual.
Renegade RN: "Did you leave a urine sample?"
Patient: "What?"
Renegade RN: "Did you leave a urine sample in the bathroom?"
Patient: "What is urine?"
Renegade RN: "Did you leave a cup of pee?"
Patient: "Oh, yeah, I did that."
I think I deserve extra pay for being bilingual.
Sunday, January 11, 2009
I Am in Denial!
1) I am 40 years-old with three children.
2) I am 5'4" and weigh 240 lbs.
3) I have impaired glucose tolerance, meaning I am teetering on the edge of full-fledged diabetic status.
4) I am chronically anemic probably related to my pitiful dietary habits (see below).
5) I have uterine fibroids and irregular menses.
6) I have high blood pressure for which I sporadically take medication when I can afford it.
7) I am nonchalant about my deteriorating health, and when the nurse tries to educate me on proper diet and exercise, I assure her that I only eat once a day.
8) I might start taking the over-the-counter iron supplement the doctor has recommended as communicated to me by the nurse if I can afford it along with my cigarettes.
9) I do not have health insurance and will not be getting it in the foreseeable future.
10) I have a habit of cancelling and rescheduling appointments because I lack transportation and must rely on others.
Why have I scrounged up enough cash (to the tune of $6000+) from pay-day loans and gosh knows what other means to pay for an elective consultation and an elective reversal of my tubal ligation?
Because I want to be PREGNANT, and anyone can see, this is a fabulous idea!
A few follow-up questions from Renegade RN (rhetorical, of course, because asking you directly would be totally politicially incorrect):
1) If you manage to defy the odds and carry a pregnancy to term, will you be as negligent with your child's health as you are with your own?
2) Are you willing to risk orphaning your children at an early age and/or burdening them with your time-consuming, expensive healthcare needs when they should be focused on developing themselves into productive citizens?
3) Have you no sense of accountability to yourself, your potential future child, the children you already have, and the community at large?
Patients like you stab me in my bleeding heart and make me feel like a Republican, which makes me want to slit my wrists. Sigh...
2) I am 5'4" and weigh 240 lbs.
3) I have impaired glucose tolerance, meaning I am teetering on the edge of full-fledged diabetic status.
4) I am chronically anemic probably related to my pitiful dietary habits (see below).
5) I have uterine fibroids and irregular menses.
6) I have high blood pressure for which I sporadically take medication when I can afford it.
7) I am nonchalant about my deteriorating health, and when the nurse tries to educate me on proper diet and exercise, I assure her that I only eat once a day.
8) I might start taking the over-the-counter iron supplement the doctor has recommended as communicated to me by the nurse if I can afford it along with my cigarettes.
9) I do not have health insurance and will not be getting it in the foreseeable future.
10) I have a habit of cancelling and rescheduling appointments because I lack transportation and must rely on others.
Why have I scrounged up enough cash (to the tune of $6000+) from pay-day loans and gosh knows what other means to pay for an elective consultation and an elective reversal of my tubal ligation?
Because I want to be PREGNANT, and anyone can see, this is a fabulous idea!
A few follow-up questions from Renegade RN (rhetorical, of course, because asking you directly would be totally politicially incorrect):
1) If you manage to defy the odds and carry a pregnancy to term, will you be as negligent with your child's health as you are with your own?
2) Are you willing to risk orphaning your children at an early age and/or burdening them with your time-consuming, expensive healthcare needs when they should be focused on developing themselves into productive citizens?
3) Have you no sense of accountability to yourself, your potential future child, the children you already have, and the community at large?
Patients like you stab me in my bleeding heart and make me feel like a Republican, which makes me want to slit my wrists. Sigh...
Wednesday, January 7, 2009
Finally, a Ban on Legal Drug Paraphernalia!
Not that it will dramatically lessen Big Pharma's influence on physician's prescribing practices, but at least there will be a lot less useless clutter around the office that the nurses have to constantly pick up. And, let's be frank, it is pure crap that the reps unload on us from the pens that fall apart or whose ink supply lasts a mere two days to the mounds of branded post-its that quickly become a fire hazard to cheap tape measures emblazoned with the drug-of-the-moment's logo (to encourage patients to measure how fat they are?) to the many bottles of drug-specific lotion and handsoap that apparently all come from the same nasty manufacturer. Good riddance! Now, if we can just get rid of the drug samples, we, namely physicians, can all get back to the business of caring for the patient in the most cost-effective manner possible--by considering generics as a first-round choice for medication treatment provided there are no contraindications.
The NY Times article mentions that some doctors are amused by the ban and indignant at the idea that anything as simple as a branded tchochke could influence their prescribing practices. Well, my dear doctor friends, there are studies to show that brand advertising works in subversive ways. Heck, the doctor I work for prescribes one high blood pressure drug simply because it's the one for which he receives the most generous samples, and it's a combination pill. Sure, his belief is that patients will be more compliant with a one-pill, rather than a two-pill regimen, and this is the point over which the rep practically foams at the mouth. But, seriously, is the inconvenience of taking two pills a day rather than one worth a 3-5x escalation in price? I guarantee the patient's insurance company, if she's lucky enough to have coverage, doesn't believe so, which means the nurses will get a call from pharmacy requesting preauthorization for the drug because it's non-preferred. Then, we have to go through the motions of submitting a request to the insurance company that is certain to be denied because the patient has not demonstrated treatment failure with preferred generics. All of this time-wasting drama because some branded samples were sitting on a shelf, and the doctor didn't have to think about what to prescribe. What idiocy!
In the meantime, I suppose I'll enjoy my less cluttered desk and do my best to avoid the drug reps, particularly Ms. LoEstrin, who despite her previous Oscar-worthy antics, has been rather subdued in her last couple of visits. Maybe, she's taken a clue from Big Pharma marketers and started on a new drug. Maybe, she's crushing up the LoEstrin and snorting it. I don't know, and I don't really care as long as she stays out of my hair. On her last visit, she did feel it necessary to inform me that she and her friends were going to a Britney Spears concert to which I replied, "I wouldn't tell people that if I were you." I hope she carries her couture LoEstrin clutch. Wouldn't want to miss the opportunity to advertise for birth control at a Britney Spears concert. Hey, Big Pharma, can we get a ban on stupidity?
The NY Times article mentions that some doctors are amused by the ban and indignant at the idea that anything as simple as a branded tchochke could influence their prescribing practices. Well, my dear doctor friends, there are studies to show that brand advertising works in subversive ways. Heck, the doctor I work for prescribes one high blood pressure drug simply because it's the one for which he receives the most generous samples, and it's a combination pill. Sure, his belief is that patients will be more compliant with a one-pill, rather than a two-pill regimen, and this is the point over which the rep practically foams at the mouth. But, seriously, is the inconvenience of taking two pills a day rather than one worth a 3-5x escalation in price? I guarantee the patient's insurance company, if she's lucky enough to have coverage, doesn't believe so, which means the nurses will get a call from pharmacy requesting preauthorization for the drug because it's non-preferred. Then, we have to go through the motions of submitting a request to the insurance company that is certain to be denied because the patient has not demonstrated treatment failure with preferred generics. All of this time-wasting drama because some branded samples were sitting on a shelf, and the doctor didn't have to think about what to prescribe. What idiocy!
In the meantime, I suppose I'll enjoy my less cluttered desk and do my best to avoid the drug reps, particularly Ms. LoEstrin, who despite her previous Oscar-worthy antics, has been rather subdued in her last couple of visits. Maybe, she's taken a clue from Big Pharma marketers and started on a new drug. Maybe, she's crushing up the LoEstrin and snorting it. I don't know, and I don't really care as long as she stays out of my hair. On her last visit, she did feel it necessary to inform me that she and her friends were going to a Britney Spears concert to which I replied, "I wouldn't tell people that if I were you." I hope she carries her couture LoEstrin clutch. Wouldn't want to miss the opportunity to advertise for birth control at a Britney Spears concert. Hey, Big Pharma, can we get a ban on stupidity?
Sunday, January 4, 2009
What Do Nurses Get for Being Ethical? The Boot!
This article cautions nurses to think hard before blowing the whistle on their employers' unsafe/unethical practices because they will likely suffer retaliation, most notably termination. This is really interesting in light of yearly studies that consistently place nurses at or near the top of the most ethical professions according to the public.
Nurses are indoctrinated in our schooling and by licensing boards on our "duty" to report harmful situations. The safety of patients is paramount, and our role is to advocate for their best interests, not those of the employer whose goal is to make money in the most efficient manner possible. Employers pay lip service to quality care and customer service, but it's the individual nurses who bear accountability for errors and adverse events. Employers are more than willing to fire a "troublemaking" nurse, rather than admit an institutional problem and actually implement steps to correct it. You see that costs money ,time, and extra paperwork for management. It also means admitting a problem and risking your reputation as a quality healthcare provider.
I read a lot in nursing journals about employer initiatives to encourage nurses to report more freely unsafe practices and errors they witness in an effort to reduce said practices and errors--tons of blathering about creating an environment of mutual trust among nurses and administration, among nurses and physicians. Puuuhlllleeeaaasssse! Most nurses, especially those doing full-time acute bedside care, need their jobs. They have bills to pay, families to support, and retirements to fund. Unless they find a practice or error truly egregious, they aren't likely to report it for fear of increased scrutiny of their work, which leads to comments in their personnel file, which leads to an even punier raise, if at all, at review time or the implicit threat of termination, which makes it even harder to come in to work every day in a hostile environment knowing they aren't appreciated when they're trying their best to do the right thing, which leads to burnout and attrition.
Tell me again how the nursing shortage is supposed to be solved by increasing access to education and allowing for more flexible work schedules. The problem runs so much deeper. But, I suppose the nurse academics who formulate these initiatives realize the futility of trying to change a for-profit employer's perspective on quality care (i.e., that it can be bought for pennies, and if not, well, we'll just do without and pretend all is well, thank you, please contact our attorney), so they putter around with ideas about communication and trust and other cumbaya bullshit and call it a much needed paradigm shift. WTF?
Many years ago, I started working for a national dialysis provider. I was still in the orientation phase when I witnessed licensed staff leaving the facility while patients were dialyzing leaving unlicensed personnel to supervise patients whose condition can deteriorate rapidly. The staff was also eating in the dialysis area. And, there was such a rush to get patients on and off the machines for the next shift, that infection control protocols were compromised, as well as treatment times. I resigned two days later and stated in writing that I had witnessed numerous breaches in safety protocol and that I could not put my license at risk by continuing to work for the organization. I received a terse letter in response demanding payment of $5000 for my "free training" and failure to fulfill a two-year work commitment. I responded with a certified letter cc'd to all management up to regional director pointing out the fact that repayment of the $5000 was contingent upon my completing the training phase (which I didn't do) and that I was not capable of working independently as a dialysis nurse for them or any of their competitors. I went on to detail the specific events I witnessed, making sure to notate explicit violations of the Texas Department of Health and CMS regulations. Without making a direct threat, I implied that if pushed, I would file formal complaints with the aforementioned agencies, which would automatically trigger, at least in the case of the TDH, an investigation. I guess the employer decided $5000 wasn't worth risking a governmental probe because I never heard from them again.
I suppose that like the nurses in the article mentioned, you have to be ready to give up your job, maybe even your profession, if you plan to blow the whistle because the laws aren't necessarily on your side. And, even if they are, achieving justice can take years, and most people can't go years without gainful employment. Then, there's the emotional toll of fighting a system that is completely backassward in its priorities. It's enough to make you throw up your hands and yell, "Why bother?" I suspect the public has no clue when they fill out those yearly surveys just how difficult it is for nurses to be ethical. Maybe, they expect nurses to be martyrs. Employers certainly do.
Nurses are indoctrinated in our schooling and by licensing boards on our "duty" to report harmful situations. The safety of patients is paramount, and our role is to advocate for their best interests, not those of the employer whose goal is to make money in the most efficient manner possible. Employers pay lip service to quality care and customer service, but it's the individual nurses who bear accountability for errors and adverse events. Employers are more than willing to fire a "troublemaking" nurse, rather than admit an institutional problem and actually implement steps to correct it. You see that costs money ,time, and extra paperwork for management. It also means admitting a problem and risking your reputation as a quality healthcare provider.
I read a lot in nursing journals about employer initiatives to encourage nurses to report more freely unsafe practices and errors they witness in an effort to reduce said practices and errors--tons of blathering about creating an environment of mutual trust among nurses and administration, among nurses and physicians. Puuuhlllleeeaaasssse! Most nurses, especially those doing full-time acute bedside care, need their jobs. They have bills to pay, families to support, and retirements to fund. Unless they find a practice or error truly egregious, they aren't likely to report it for fear of increased scrutiny of their work, which leads to comments in their personnel file, which leads to an even punier raise, if at all, at review time or the implicit threat of termination, which makes it even harder to come in to work every day in a hostile environment knowing they aren't appreciated when they're trying their best to do the right thing, which leads to burnout and attrition.
Tell me again how the nursing shortage is supposed to be solved by increasing access to education and allowing for more flexible work schedules. The problem runs so much deeper. But, I suppose the nurse academics who formulate these initiatives realize the futility of trying to change a for-profit employer's perspective on quality care (i.e., that it can be bought for pennies, and if not, well, we'll just do without and pretend all is well, thank you, please contact our attorney), so they putter around with ideas about communication and trust and other cumbaya bullshit and call it a much needed paradigm shift. WTF?
Many years ago, I started working for a national dialysis provider. I was still in the orientation phase when I witnessed licensed staff leaving the facility while patients were dialyzing leaving unlicensed personnel to supervise patients whose condition can deteriorate rapidly. The staff was also eating in the dialysis area. And, there was such a rush to get patients on and off the machines for the next shift, that infection control protocols were compromised, as well as treatment times. I resigned two days later and stated in writing that I had witnessed numerous breaches in safety protocol and that I could not put my license at risk by continuing to work for the organization. I received a terse letter in response demanding payment of $5000 for my "free training" and failure to fulfill a two-year work commitment. I responded with a certified letter cc'd to all management up to regional director pointing out the fact that repayment of the $5000 was contingent upon my completing the training phase (which I didn't do) and that I was not capable of working independently as a dialysis nurse for them or any of their competitors. I went on to detail the specific events I witnessed, making sure to notate explicit violations of the Texas Department of Health and CMS regulations. Without making a direct threat, I implied that if pushed, I would file formal complaints with the aforementioned agencies, which would automatically trigger, at least in the case of the TDH, an investigation. I guess the employer decided $5000 wasn't worth risking a governmental probe because I never heard from them again.
I suppose that like the nurses in the article mentioned, you have to be ready to give up your job, maybe even your profession, if you plan to blow the whistle because the laws aren't necessarily on your side. And, even if they are, achieving justice can take years, and most people can't go years without gainful employment. Then, there's the emotional toll of fighting a system that is completely backassward in its priorities. It's enough to make you throw up your hands and yell, "Why bother?" I suspect the public has no clue when they fill out those yearly surveys just how difficult it is for nurses to be ethical. Maybe, they expect nurses to be martyrs. Employers certainly do.
We Appreciate Your Patience, My Ass!
I apologize for the long delay in posting. I had far too many commitments for the month of December, none the least of which was monitoring the status of my application for the higher-deductible health plan, which would lower my monthly premiums.
Alas, after three calls to BCBS where I spent an inordinate amount of time trying to explain my reason for calling to each dimwitted representative after waiting on hold for 43 minutes combined (43 precious, daytime cell-phone minutes!) all the while being subjected to an endless recording of "We appreciate your patience. The next available representative will be with you shortly", I learned that my application for the new plan was approved. It took effect on January 1st with a $13 higher premium than I was quoted approximately seven weeks ago. Yes, ladies and gentleman, inflation is a bitch to the tune of 10% over a seven week period. The most knowledgeable of the three reps I spoke with informed me that the price increase was due to a routine year-end review of all policies. When I asked why they quoted me a different price just six weeks prior to the new year, he didn't have an answer. Of course, on the letter I received, there was the standard disclaimer stating that all prices are subject to change on a moment's notice, yadda, yadda, yadda, and that they (BCBS) aren't obligated to pay anything for any reason under any circumstances, even if it's their own fault, etc. Gotta love the legalese!
Meanwhile, I'm still waiting for my "welcome" kit that was supposedly mailed on December 15th. Even with the holidays, I should have received it by now. A duplicate kit was supposedly mailed last week in response to my call, so here I sit twiddling my thumbs, at the mercy of BCBS and the US postal service. They say patience is a virtue. I say it's a major pain in the ass.
Alas, after three calls to BCBS where I spent an inordinate amount of time trying to explain my reason for calling to each dimwitted representative after waiting on hold for 43 minutes combined (43 precious, daytime cell-phone minutes!) all the while being subjected to an endless recording of "We appreciate your patience. The next available representative will be with you shortly", I learned that my application for the new plan was approved. It took effect on January 1st with a $13 higher premium than I was quoted approximately seven weeks ago. Yes, ladies and gentleman, inflation is a bitch to the tune of 10% over a seven week period. The most knowledgeable of the three reps I spoke with informed me that the price increase was due to a routine year-end review of all policies. When I asked why they quoted me a different price just six weeks prior to the new year, he didn't have an answer. Of course, on the letter I received, there was the standard disclaimer stating that all prices are subject to change on a moment's notice, yadda, yadda, yadda, and that they (BCBS) aren't obligated to pay anything for any reason under any circumstances, even if it's their own fault, etc. Gotta love the legalese!
Meanwhile, I'm still waiting for my "welcome" kit that was supposedly mailed on December 15th. Even with the holidays, I should have received it by now. A duplicate kit was supposedly mailed last week in response to my call, so here I sit twiddling my thumbs, at the mercy of BCBS and the US postal service. They say patience is a virtue. I say it's a major pain in the ass.
Wednesday, November 26, 2008
A Lot to Be Thankful for, I Suppose
I guess I should be thankful that I have insurance, even though BCBS of Texas just sent me a letter informing me that my 2009 premium will increase by 9%. Yeah, I am grateful to pay even more for bare-bones coverage that I haven’t used once since the 1/08 effective date. At least BCBS was nice enough to offer a couple of alternative, less expensive plans for me to consider. Both are HSAs like the plan I have now. One has the same deductible as my current plan ($2500), but I would have to pay 15% more in coinsurance for only an $8 reduction in monthly premiums. Not worth it. The other has a $5000 deductible (eeek!), but covers all INN (in-network) services at 100% after the deductible is met and offers a $23 reduction in monthly premiums.
Despite the intimidating deductible, the latter plan is worth investigating for me personally, especially since I confirmed on-line that the OOP (out-of-pocket) maximum is the $5000 deductible, meaning that if I incur stratospheric healthcare charges, I’m only out $5000 provided I stick with contracted providers. Although, it would mean a significant financial setback, I have the funds set aside to pay this amount if illness or injury should strike. This is in addition to the amount I set aside to cover preventative medical and dental care and a routine prescription on an annual basis. If the monthly rate reduction is $20 or more, I would be tempted to switch to the $5000 plan and plug the approximate $240 in monthly savings into my HSA, which I plan to fund to the $3000 maximum in 2009 if all goes as planned. I suspect, though, that given the 100% coverage perk, I would have to go through the underwriting process again, which is a major pain in the ass. Then again, since I just went through underwriting at this time last year, and I haven’t seen any healthcare providers since, there’s no new information to review. Maybe, they could fast-track me somehow. Naaaahhh!
The insurer sent along a new application for which I’m sure I’d have to pay a non-refundable fee, so I tried in vain to get through to customer service to confirm whether I’d actually have to reapply to switch to the $5000 plan, go through underwriting again, and pay a fee. But, of course, being the day before Thanksgiving, it appears that only two customer service reps are servicing the entire BCBS Texas membership because after wasting 30 precious daytime cell phone minutes waiting for a representative, I still couldn’t get through. I will try again next week before I resign myself to paying the 9% increased premium for my current plan. In the meantime, I’m thankful that despite suffering from a wicked cold at the moment, I enjoy good health, which affords me the privilege of considering a $5000 deductible plan. I’m also thankful that I’m not a chatty Kathy and can waste the occasional 30 daytime minutes on hold without incurring outrageous overage charges. I resolve to be a well of gratitude, at least until I attempt to contact customer service again.
Despite the intimidating deductible, the latter plan is worth investigating for me personally, especially since I confirmed on-line that the OOP (out-of-pocket) maximum is the $5000 deductible, meaning that if I incur stratospheric healthcare charges, I’m only out $5000 provided I stick with contracted providers. Although, it would mean a significant financial setback, I have the funds set aside to pay this amount if illness or injury should strike. This is in addition to the amount I set aside to cover preventative medical and dental care and a routine prescription on an annual basis. If the monthly rate reduction is $20 or more, I would be tempted to switch to the $5000 plan and plug the approximate $240 in monthly savings into my HSA, which I plan to fund to the $3000 maximum in 2009 if all goes as planned. I suspect, though, that given the 100% coverage perk, I would have to go through the underwriting process again, which is a major pain in the ass. Then again, since I just went through underwriting at this time last year, and I haven’t seen any healthcare providers since, there’s no new information to review. Maybe, they could fast-track me somehow. Naaaahhh!
The insurer sent along a new application for which I’m sure I’d have to pay a non-refundable fee, so I tried in vain to get through to customer service to confirm whether I’d actually have to reapply to switch to the $5000 plan, go through underwriting again, and pay a fee. But, of course, being the day before Thanksgiving, it appears that only two customer service reps are servicing the entire BCBS Texas membership because after wasting 30 precious daytime cell phone minutes waiting for a representative, I still couldn’t get through. I will try again next week before I resign myself to paying the 9% increased premium for my current plan. In the meantime, I’m thankful that despite suffering from a wicked cold at the moment, I enjoy good health, which affords me the privilege of considering a $5000 deductible plan. I’m also thankful that I’m not a chatty Kathy and can waste the occasional 30 daytime minutes on hold without incurring outrageous overage charges. I resolve to be a well of gratitude, at least until I attempt to contact customer service again.
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