The Regence auditor in charge of my case, Anke Menzer-Wallace, failed to turn up any irregularities in our documentation. But, still, Ms. Menzer-Wallace issued a stern admonition to my father and me, ordering us not to open our clinic on Saturdays to administer flu shots.
The opioid crisis has grown exponentially – ravaging communities and taking an estimated 64,000 lives each year – escalating into a public health epidemic. In response to the increased availability of synthetic opioids like oxycodone and fentanyl, the Surgeon General called for expanded access to the opioid overdose antidote, naloxone, by using the slogan: Be Prepared. Get Naloxone. Save a life.
Recently, a jury in Oklahoma City ordered insurance giant Aetna to pay $25 million to the family of Orrana Cunningham, an Aetna customer who died of cancer after the company refused to cover radiation therapy. “The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham,” according to a Nov. 10 article by the Associated Press.
The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for Ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can fill prescriptions for certain drugs, PAs boil down to yet another cost-cutting measure implemented by insurers to stand between patients and certain costly drugs.
In July, 2009, the family of Massachusetts teenager Yarushka Rivera went to their local Walgreens to pick up Topomax, an anti-seizure drug that had been keeping her epilepsy in check for years. Rivera had insurance coverage through MassHealth, the state’s Medicaid insurance program for low-income children, and never ran into obstacles obtaining this life-saving medication.
Only 6% of physicians practice in rural areas, yet they serve 16% of the population. Kitsap County has 443 physicians, equivalent to 2.4% of the state total and is one county experiencing a shortage of primary care physicians. Kitsap County falls below the state average in every primary care specialty across the board.
Every child deserves the best possible start in life, and the statistics show that specialist neonatologists practicing at high-volume NICUs are in the best position to provide it. Just because smaller community hospitals that have invested in state-of-the-art equipment can, technically, deliver preemies, doesn’t mean they should.