Will Anyone Miss Accidents As ‘Preexisting Conditions’ and Other Insurance Doubletalk?

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

It’s interesting to have a firsthand encounter pertinent to the HCR story that is consuming the headlines. Recently, my son had a fall and dislocated his shoulder. He knew what had happened because he did it as a freshman in high school, some 10 years ago while playing sports. So he went to an ER and had the shoulder popped back in, saw an orthopedist as recommended, and went for physical therapy—all covered by his insurance plan. But all his claims for reimbursement were denied. The reason the company gave: his dislocated shoulder was considered a ‘preexisting condition.’

After my husband peeled me off the ceiling, we approached this methodically—we gathered forms, wrote letters, requested letters from the hospital, the orthopedist, the physical therapists—and appealed the ruling. After a bit, we received a response saying that they’d reconsidered and would cover the injury according to policy.

This is not a terribly compelling or poignant case, but it’s an example of the “first deny all claims” approach of some companies. Yes, it was resolved on appeal fairly easily, but why did it need appealing in the first place? I can’t imagine what patients and families with chronic illness must go through in trying to get treatment covered.

If the only thing health reform does is to eliminate the unjust use of preexisting conditions to deny coverage, it will get rid of one of the most critical obstacles to access to care.

2016-11-21T13:18:41-05:00March 22nd, 2010|health care policy, Patients|5 Comments
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Might Health Care Reform Happen? And What Will It Mean for Nurses?

By Shawn Kennedy, AJN editorial director/interim editor-in-chief

Sometime in the next few days, Congress may bring the health care reform issue to a final vote and even a resolution of sorts, though one never knows what new twists may occur before then. I can’t even imagine what will occupy the news if it really does pass. (Philandering professional athletes and pilfering politicians better beware as newspapers seek new headlines.) 

Many Americans are calling their legislators to tell them what they want and don’t want. At the same time, many remain confused by the complexity of the legislative process as well as the particulars of the legislation. The final push received a boost this week from projections by the Congressional Budget Office that the bill would cut the budget deficit by $1.2 trillion over the next two decades. 

As nurses, we need to be knowledgeable and concerned with how health care will shape up—we’ll be delivering it. For information on the current bills under consideration, here’s two accessible sources: the Washington Post has a comparison of what the already passed Senate bill and the reconciliation version under consideration by the House include; the New York Times provides a pdf of the House bill.

Here’s a short list of provisions related to nursing likely to be in a final bill (as we noted in a post back in December about a useful ANA chart comparing House and Senate bills at the time):

2016-11-21T13:18:42-05:00March 19th, 2010|health care policy, nursing perspective|4 Comments
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Notes from the Healthweb and Nursosphere

This week Not Nurse Ratched has an amusing, meandering, and thoughtful post about the uses of Facebook by patients in the hospital. There’s a short excerpt below, but read the whole thing here.

They update Facebook constantly. CONSTANTLY. They have us take photos of injuries they can’t reach so they can post the photos to Facebook. I am not making this up. “I want a photo of my hideously dislocated ankle/knee/shoulder but I can’t move, so would you mind using my phone to take a picture for me?” And they keep updating and updating. I have actually said, “I’m about to give you a medicine that is going to render you unconscious immediately, so you should set your phone down.”

How could we have a weekly Web roundup that doesn’t at least mention health insurance reform? The spotlight has been slowly turning toward the insurers themselves, a crucial part of the equation (along with cost control and many other factors). This week Secretary of Health and Human Services Kathleen Sebelius met with the top executives of insurance companies to demand an explanation for the steep increases in rates seen in the last year.

If you’re looking for yet another reason why processed food isn’t good for you (besides the frequent presence of high fructose corn syrup and massive doses of salt, and the inaccurate packaging claims that the foods are “healthy” and “lean”), this week the NY Times reported news […]

2016-11-21T13:18:59-05:00March 5th, 2010|health care policy, nursing perspective|1 Comment
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Why the ‘Greatest Generation’ Is Bagging Groceries (No, It’s Not Because of Taxes)

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

In surfing the Web Monday, I came across this interesting tidbit on the blog run by Gary Schwitzer, creator of HealthNewsReview.org, a site devoted to assessing the accuracy of health news coverage. He quoted statistics from a report  by the Center for Public Integrity, which claims that “there are eight lobbyists for every member of Congress.” The number of lobbyists went from about 1,400 in the first quarter of 2009 to nearly 3,700 by year’s end. 

I see elderly people in the supermarket bagging groceries—some may like the company, but others are doing it to pay for medical care not covered under plans. My uncle—one of the “greatest generation”—used to cut his pills in half to make them last longer. Does this qualify as “rationing care”? […]

2016-11-21T13:19:04-05:00March 2nd, 2010|health care policy, nursing perspective|5 Comments
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The Power of No

. . . . What really struck me about the meeting, however, was the inability of Republicans to explain how they propose dealing with the issue that, rightly, is at the emotional center of much health care debate: the plight of Americans who suffer from pre-existing medical conditions. In other advanced countries, everyone gets essential care whatever their medical history. But in America, a bout of cancer, an inherited genetic disorder, or even, in some states, having been a victim of domestic violence can make you uninsurable, and thus make adequate health care unaffordable.

One of the great virtues of the Democratic plan is that it would finally put an end to this unacceptable case of American exceptionalism. But what’s the Republican answer? Mr. Alexander was strangely inarticulate on the matter, saying only that “House Republicans have some ideas about how my friend in Tullahoma can continue to afford insurance for his wife who has had breast cancer.” He offered no clue about what those ideas might be.

That’s from “Afflicting the Afflicted,” Paul Krugman’s NY Times column about the health care reform summit that took place yesterday. It really is bewildering that so many elected officials can simply refuse to engage one of the major issues of our time. How can their supporters not begin to wonder at this as they themselves in ever greater numbers go into medical bankruptcy, are forced to choose between basic medications for chronic illnesses, […]

2016-11-21T13:19:07-05:00February 26th, 2010|health care policy|4 Comments
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