Insurance and Political Medical Correctness … lots to debate, hard to unravel.  Here’s some reading …

New California Law Protects Patients From Surprise Billing, reported on ASweetLife.org, July 2017 by Karin Klein, is all about “surprise billing.”

A 2015 survey by Consumers Union found that almost one in four Californians covered by private health plans had been hit by these surprise billings from out-of-network doctors.

But a new California law protects most patients from ruinous surprises. Under Assembly Bill 72, which took effect July 1, when a hospital is within a patient’s insurance network, the doctors and other healthcare providers cannot charge more than if they were in the network as well, whether they are or not.

Read more: New California Law Protects Patients From Surprise Billing 

 

When Insurance Gets Turned Down: Appeals Explained, from diatribe.org, 31 May 2017. 

It can be extremely distressing if an insurance provider decides to deny coverage of treatment. Fortunately, there are options available for asking the insurance provider to reconsider their decision and for letting them know why they should – this process is called “appealing.”

In fact, it’s often very worthwhile to appeal. A 2011 report sampling data from states across the US found that patients were successful 39-59% of the time when they appealed directly to the insurance provider (called an internal review), and 23-54% of the time when appealing through a third party (an external review) – the step taken when the internal review still doesn’t resolve the situation.

Despite this promising success rate, submitting an appeal can be a daunting task. The sections below aim to demystify the appeals process and provide an overview of why claims are denied and how they can be appealed.

Read more: When Insurance Gets Turned Down: Appeals Explained

 

Committee Wants Diabetes Docs to Watch Their Language was a takeaway from the American Diabetes Association and the American Association of Diabetes Educators at the annual Scientific Sessions, 13 June 2017 and reported on MedPage Today.

Not the word police, but ‘diabetic’ and ‘non-compliant’ must go

Providers will be much more successful in preventing diabetes progression if they avoid judgmental words and phrases that have the effect of putting patients down and discouraging them from having confidence in managing their own care.

That’s the message from members of a committee that submitted its “Joint Consensus Statement on the Use of Language in Diabetes” for publication to the American Diabetes Association and the American Association of Diabetes Educators.

Words on the no-no list include “uncontrolled,” “non-adherent,” and any “ic” words like “diabetic,” which tend to make patients feel disrespected, hopeless, and dismissed, they said.

Other problematic terms include the use of “good,” “bad,” or “poor” to convey a patient’s blood glucose levels. Rather, they said, it’s better to explain what is a safe or unsafe level, or what is a target level, using numbers and facts rather than what the patient might see as a putdown of their character or their value as a person.

Dr. Susan Guzman of the Behavioral Diabetes Institute, Jane Dickinson at the Teachers College Columbia University in NY and Melinda Maryniuk, director of clinical education for the Joslin Diabetes Center in Boston, presented at ADA in a session called “Why Language Matters.” Any subtle tone of voice or inflection that conveys a sense that diabetes is the result of a character flaw or a failure of personal responsibility, or that they are a burden on the healthcare system is counterproductive, experts said. Patients will not do as well at getting control of their diabetes.

Read more: Committee Wants Diabetes Docs to Watch Their Language

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