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Health Insurance

Health Insurance Claim Denied?

When a health insurance company is deciding whether to pay for your medical treatment, the company generates a file around your claim. All the records associated with your case should be part of your file. This includes documents explaining the reasons your claim was denied. You have a right to see this file. Federal regulations require most health insurance plans to give people an opportunity to review documents related to their claim for free. So if your insurer talks to your doctor, if a nurse takes notes, or if two people speak about it on the phone, all of those records should be available to you.

How Cigna Saves Millions By Rejecting Claims Without Reading Them

When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong. Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis. A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.” The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.

Report Shows Big Insurance Profiting Massively From Medicare Privatization

A new analysis released Monday shows that insurance giants are benefiting hugely from the accelerating privatization of Medicare and Medicaid, which for-profit companies have infiltrated via government programs such as Medicare Advantage. According to the report from Wendell Potter, a former insurance executive who now advocates for systemic healthcare reform, government programs are now the source of roughly 90% of the health plan revenues of Humana, Centene, and Molina. Over the past decade, Potter found, the seven top for-profit insurance companies in the U.S.—the three mentioned above plus UnitedHealth, Cigna, CVS/Aetna, and Elevance—have seen their combined revenues from taxpayer-backed programs soar by 500%, reaching $577 billion in 2022 compared to $116.3 billion in 2012.

Universal Health Care Could Have Saved US Lives During COVID

Americans spend more on health care than people in any other nation. Yet in any given year, the piecemeal nature of the American medical insurance system causes many preventable deaths and unnecessary costs. Not surprisingly, COVID-19 only exacerbated this already dire public health issue, as evidenced by the U.S.’s elevated mortality, compared with that of other high-income countries. A new study quantifies the severity of the impact of the pandemic on Americans who did not have access to health insurance. According to findings published on Monday in Proceedings of the National Academy of Sciences USA, from the pandemic’s beginning until mid-March 2022, universal health care could have saved more than 338,000 lives from COVID-19 alone.

High-Deductible Health Plans Make Income Inequality Worse

Anyone holding a high-deductible health plan understands the dynamic: When it costs more for people to access health care, they’re going to think twice before using it. It’s a system designed to hold down costs by discouraging service. But there’s something even more insidious about such plans. For lower income California families already living paycheck to paycheck, a single medical need can sink them deeper into financial peril. This type of health care keeps poor people poor. That is precisely what worries Malissa Sanchez, whose employer in Los Angeles essentially forced a high deductible health plan (HDHP) on her in April when it eliminated a direct-payment system that previously allowed her to buy her own coverage. “The new plan just isn’t as good,” said Sanchez, 30.

How Many More People Have To Die Before We Pass Medicare For All?

I recently joined Reps. Pramila Jayapal (D-WA) and Debbie Dingell (D-MI) as they introduced the Medicare for All Act of 2021 in Congress. For me and millions of Americans, this bill’s passage would not only be life-changing—it could be life-saving. In 2010, I was diagnosed with multiple myeloma, an incurable blood cancer that affects the bone marrow and makes it harder for my body to fight infections. Before I was diagnosed, I was an average 30-something guy who went to the gym and ate right. Today, after 11 years with this disease, I’m still fighting for my life.

More Than 14 Million May Have Lost Health Coverage

In the latest analysis, researchers first tried to assess how many workers and dependents relied on job-based coverage as of March 2019. Then, using data from the Labor Department, they estimated how many workers lost jobs and how many of those had employer-based coverage. Researchers examined this information by industry, age and gender. Some industries were affected more than others and a few were almost spared entirely. "As a result, we would expect the number of people losing jobs with [employer-sponsored insurance] to vary greatly by industry, and possibly by other characteristics, such as age and gender," according to the report.

Laid-Off Hotel Workers Rally After Health Insurance Yanked

About 150 hotel workers who’d been laid off — but promised their jobs back when the hotel industry rebounds — gathered in Grant Park Friday to call on their employers to continue providing health insurance. They are among about 7,000 Chicago hotel workers represented by UNITE HERE Local 1 who are out of work, most since March. Their health insurance lasted until Oct. 1, and workers are now calling on hotel operators to extend benefits.

Insulin Copay Caps Fall Short, Fuel Underground Exchanges

Denver - D.j. Mattern had her Type 1 diabetes under control until COVID’s economic upheaval cost her husband his hotel maintenance job and their health coverage. The 42-year-old Denver woman suddenly faced insulin’s exorbitant list price — anywhere from $125 to $450 per vial — just as their household income shrank. She scrounged extra insulin from friends, and her doctor gave her a couple of samples. But as she rationed her supplies, her blood sugar rose so high her glucose monitor couldn’t even register a number. In June, she was hospitalized.

Tens Of Millions More Expected To Lose Employer-Based Insurance

While for-profit health insurers have reported record-high earnings this year amid the coronavirus pandemic, small companies across the U.S. are reporting difficulty paying premiums for their employees—and tens of millions of workers are expected to lose their employer-based health insurance by the end of the year, even if they keep their jobs. The New York Times reported on Monday that although some small businesses were able to use funds from the Paycheck Protection Program (PPP) to cover their employees' health benefits, nearly a third of employers reported to Harvard Business School researchers...

Testing And Medical Insurance: A Profitable Disaster

In the midst of a capitalist crash and an out-of-control health crisis, two mega-industries that bear a heavy burden of responsibility for the health disaster are reporting soaring profits. “The nation’s leading health insurers are experiencing an embarrassment of profits,” reported the New York Times Aug. 6. “Anthem, Humana and United Health Group second quarter earnings are double what they were a year ago.” The U.S. has the world’s highest number of COVID-19 cases, over 5 million, and the highest number of deaths. In addition, millions of laid-off workers are losing health insurance.

Nearly 5 Million Lost Health Coverage In The Past Three Weeks

4,805,894 American workers and their dependents have lost health insurance coverage in the past three weeks, according to a new estimate by researchers at The City of New York’s Hunter College and Harvard Medical School. The researchers also estimate that a total of 13.475 million will join the ranks of the uninsured by June 30, raising the number of uninsured Americans to about 43 million. The new figures include coverage losses among newly-unemployed workers as well as their dependents covered under job-based family policies. The figures update previous estimates that the same researchers published online in the Annals of Internal Medicine on April 7, 2020. Those previous estimates only included workers themselves who were laid off during the last two weeks of March, and did not include dependents losing family coverage because of layoffs, or the most recent week of data.

‘All I Want For Christmas Is A Chance To Live’

CareFirst has denied cancer patient and Annapolis resident Phil Ateto access to life saving drugs. The Chicago-based medical insurance company is superseding the wishes of Phil’s oncology team.  To expose that CareFirst’s choice to put profits first is condemning him to die. On Monday night December 23rd, Phil Ateto went to their Baltimore office to shine a spotlight on their greed and urge them to reverse their “death panel” decision.   Phil is a renown artful activist with a group called Backbone Campaign that uses creative means such as light projection to support progressive causes around the country. Phil has tirelessly fought for economic and environmental justice, opposed racism and endless wars that squander lives and resources, and he’s long advocated for universal human rights. 

New Poll Finds Voters Strongly Oppose Employer Insurance

Many centrist pundits have convinced themselves that Medicare for All (M4A) is unpopular because, when you include certain details about M4A in polling questions, support levels drop significantly. But in convincing themselves of this, centrist pundits seem remarkably incurious about whether this same thing occurs for employer-sponsored insurance (ESI) when you include certain details about it in polling questions. Earlier this week, Emerson Polling helped answer this question when it asked voters whether they support employers being allowed to change or eliminate an employee’s health insurance against the employee’s wishes. Only 11 percent of voters said they supported this while 70 percent opposed it.

How Employees And Employers Get Bled By Health Insurance

“The single biggest issue in health care for most Americans is that their health costs are growing much faster than their wages are,” KFF CEO Drew Altman said. “Costs are prohibitive when workers making $25,000 a year have to shell out $7,000 a year just for their share of family premiums.” Many lower-wage workers cannot afford the contributions and forego the health insurance even if their companies offer it. As a result, at companies with many lower-wage workers, only 33% of the workers are covered by the employer’s health insurance, compared to 63% at the other companies. For single coverage of the employee only, the annual cost of the average health insurance premium — employer and employee contributions combined — rose 4.2% in 2019, to $7,188, with the employee paying 17% or $1,242 (up from 14% in 1999) and the employer paying 83% or $5,946 (down from 86% in 1999).
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