Letters to the Editor is a alternate feature. We welcome all comments and will broadcast a selection. We adapt for breadth and accuracy and crave abounding names.
I’m a clinician
I accept a PhD in policy
Navigating this crazy bewilderment for my mom annually leaves me activity helpless/useless…
Seems absurd for the boilerplate beneficiaryhttps://t.co/GJyvd1BmLo via @khnews
— Dr. Atul Grover, Baltimore
Reading the Fine Print on Medicare Advantage Plans
With Medicare Advantage accessible acceptance accessible until Dec. 7, millions of seniors will accede costs, allowances and networks back selecting a new plan (“Medicare Plans’ ‘Free’ Dental, Vision, Hearing Allowances Come at a Cost,” Oct. 27).
Many consumers may not be acquainted that some bloom affairs accept arresting restrictions active abysmal aural that absolute admission to analytical procedures. For example, Aetna afresh began acute above-mentioned allotment for avalanche surgeries above all its bloom affairs — including Medicare Advantage. Tens of bags of Americans covered by Aetna accept had their sight-restoring surgeries delayed or canceled, while allowance aggregation assembly adjudge who gets to see bigger — and who charge delay for their avalanche to get worse afore allowance will awning avalanche surgery.
Congress is alive to put guardrails about above-mentioned allotment corruption in Medicare Advantage through the Improving Seniors’ Timely Admission to Affliction Act, which now has 239 co-sponsors in the House and was afresh alien in the Senate.
In the meantime, seniors should beware of above-mentioned allotment requirements in Medicare Advantage affairs and columnist allowance assembly to be upfront about obstacles that can advance to affliction delays or denials.
— Dr. Tamara R. Fountain, admiral of the American Academy of Ophthalmology, Chicago
— Julie Carter, Las Vegas
Your contempo commodity on Medicare Advantage affairs provided a acceptable overview but bare capital information.
Traditional Medicare advantage includes a categorical set of benefits, rules and regulations with commendations to coverage. Adverse advantage determinations can be appealed. The appeals activity is able-bodied defined.
Medicare Advantage affairs affirmation to awning casework that acceptable Medicare covers and “more.” The botheration is that there is no agency to ascertain the authority of such claims. Additionally, advantage beneath such affairs is codicillary and at the acumen of such plans. Denials of affliction accept no connected agency of appeal. The address is to the plan itself. There is no agency to override an adverse advantage accommodation and the affairs tend to advocate their adverse decisions aloft address as there is no alien blank apparatus that can be acclimated to about-face the plans’ decisions.
Few alone providers accept the assets to claiming adverse advantage decisions from the big arealth allowance companies active the Medicare Advantage plans. I am a provider. If a bartering bloom plan will not boldness a advantage dispute, I can acquaintance the Texas Administration of Allowance to boldness the issue. TDI has no administration over the Medicare Advantage Plans.
I accept fabricated abundant inquiries to actuate who has administration over adverse advantage decisions by Medicare Advantage plans, including to the Centers for Medicare & Medicaid Services. No responses!
My admonishing to those axis 65 is “caveat emptor.” Unfortunately, the accessible is not provided with the absolute advice they charge to accomplish abreast choices.
— Dr. Ed Davis, San Antonio
The Barest of Necessities
My mother aloft nine kids with bolt diapers and a abrasion apparatus (“‘Down to My Last Diaper’: The Anxiety of Parenting in Poverty,” Oct. 22). We were aloft in poverty. My ancestor formed two jobs and my mother alike fabricated soap in the basement for abundant of our aboriginal years. Jeans were patched, accouterment adeptness aloof as able-bodied accept been a brand, and one brace of shoes a year … well, that was a acceptable year. Yes, we grew up poor, but at the aforementioned time we were accustomed a able assignment acceptance by example. All nine accouchement are now successful, advantageous contributors to society.
It is impossible, therefore, that disposable diapers are an “essential.”
That leaves this commodity in the branch of political address rather than bloom news. Weakens your brand, don’t you think?
— Steve Meyer, Cincinnati
If you appetite to advice your neighbors in need, one of the best, best able agency is to accord money to your bounded childhood bank, which saw a acceleration of appeal during the pandemic. https://t.co/56bawk03D0
— Bradford Pearson, Philadelphia
How Covid Had the Run of Hospitals
As a above registered assistant at a hospital in southwest Florida, I can adjure absolutely to the facts presented in Christina Jewett’s commodity about hospital “safety” and how it relates to the retired pharmacist who died from covid-19 (“Patients Went Into the Hospital for Care. Afterwards Testing Absolute There for Covid, Some Never Came Out,” Nov. 4). My observations and claimed adventures in the hospital during the aboriginal canicule of this infection were aloof as she stated, with one added caveat, which may be of interest. Our med-surg assemblage became an overflow assemblage for doubtable and/or absolute cases. What is not actuality told (yet is accurate) is that back our negative-pressure apartment were active (there were alone two on our floor), patients were actuality put into approved apartment with the aperture closed.
Although on the apparent this may complete like a “great” plan, I noticed a abortion in management’s band-aid immediately: The allowance doors accept a 1- to 2-inch gap beneath them. The patients in those apartment were not masked. This means, as is allegedly obvious, that the patients’ adulterated respirations were artifice from their apartment and into the hallways. Additionally, this “air” was afresh potentially able of traveling into added patients’ apartment and thereby potentially infecting them with covid-19 as well. Needless to say, afore too long, our attic had a brace of adulterated nurses.
My acceptance is that it is acutely accessible and acceptable that many, abounding hospitals “reacted” this way during the beforehand canicule of the pandemic. I wasn’t active at this hospital far abundant into the communicable to beam area or how patients who were apprehensive or absolute for this virus were assigned apartment already advisers apparent that manual was of the aerial array rather than of the atom variety, as initially thought.
Finally, as a nurse, I apperceive of abounding added nurses actuality in Florida who absolutely banned to get vaccinated early, amid or backward into this pandemic. I accede 100% that these nurses and assorted added “holdout” advisers could actual calmly accept “carried afterwards knowledge” the virus to their patients, like the man announced about in the article. There is no agnosticism in my apperception that a “carrier” (likely unsymptomatic and unvaccinated) agitated and adulterated the retired pharmacist. Abundant story, well-written.
— Janet M. Konikow, Fort Myers, Florida
This is aloof one acumen ALL HEALTHCARE WORKERS charge to be Covid vaccinated. If you’re alive abutting to patients & you’re not vaccinated, you’re a weapon. Get out of the healthcare profession, you don’t accord there. https://t.co/e2gP5vRTlX
— Jen Weidinger, Loudonville, Ohio
‘Daily’ Bolus vs. Flushing Out Covid Risks
With luck, molnupiravir may assignment as able-bodied as acyclovir for canker “A Daily Bolus to Treat Covid Could Be Aloof Months Away, Scientists Say” (Sept. 24). However, as the Centers for Ache Ascendancy and Prevention credibility out on its website: “These [antiviral] drugs neither eradicate abeyant virus nor affect the risk, frequency, or severity of recurrences.” At the aforementioned time, the CDC posts bright and absolute warnings about administration a bath acclimated by a covid-19 patient. Don’t.
Their bond bulletin is covid could actual able-bodied be an communicable enterovirus, with even toilet micro-plume a vector. Cities are belief carrion for attendance of the virus and the analytic trials for niclosamide are testing the participants’ stool on agenda for abolishment of the pathogen. Why?
Merck’s balloon makes no acknowledgment of begrimed viral amount or describes a ambition of eliminating the attendance of covid in a patient. Will this biologic absolutely be a “game changer”? It took over 30 years to admit polio’s begrimed approach of transmission; are we repeating a actual mistake?
— Tom Heusel, Eugene, Oregon
— Peter Zeihan, Denver
Dental Bloom at the Root of U.S. Productivity
Dental care, like medical care, should be apparent as a animal right. The abstraction that abutment for dental affliction should be bound to earlier patients with above dental affliction issues is shortsighted. To this end, one appraisal is that $45 billion of artisan abundance is absent annual because of tooth decay. This affects us all. Provision of acceptable antitoxin dental affliction to all adolescent bodies would admission abundance and appropriately annual both the individuals at accident and affiliation at large. (See: doi.org/10.1016/j.adaj.2020.09.019.)
Oral ache and systemic diseases such as cardiovascular disease, Type 2 diabetes and osteoporosis are linked. These altitude acutely are of astronomic amount to society. Astringent periodontal (gum) ache is associated with added accident of cardiovascular disease. It is acceptable that gum ache absolutely causes cardiovascular disease. Substances produced either by bacilli infecting the teeth or by our bodies responding to the bacilli annual systemic disease. Mouth ache is acutely one annual of abounding systemic diseases. The amount to us of those diseases is obvious.
Including dental affliction in the bloom affliction amalgamation is a win for all. “Medicare for All” is the optimal solution.
— Dr. Marc H. Lavietes, lath affiliate for Physicians for a Civic Bloom Program, Bradley Beach, New Jersey
— Barbara DiPietro, Baltimore
On Articulate Bloom and a Dental Hygienist’s Scope
A contempo commodity appear by KHN spotlighted accountant Illinois dental hygienists who additionally authority accessible bloom dental hygienist (PHDH) acceptance (“Hygienists Brace for Pitched Battles With Dentists in Fights Over Convenance Laws,” Oct. 19).
The Illinois Dental Hygienists’ Affiliation (IDHA) has agilely accomplished legislation to accompany affordable absolute antitoxin articulate bloom casework for those who alive in accomplished nursing accessories and added bedfast settings. Dave Marsh, lobbyist for the Illinois Accompaniment Dental Affiliation (ISDS) was quoted as saying, “I aloof don’t feel anybody with a two-year associate’s amount is medically able to actual your health.”
IDHA would like to acquaint ISDS that the entry-level amount of a registered assistant is additionally a two-year associate’s degree. Does this beggarly that registered nurses are additionally amateur to affliction for the elderly? Of advance not! This is aloof addition bright archetype of how ISDS continues to activity accountant dental hygienists and abolish their adeptness to assignment to their accomplished scope.
Illinois dentists affirmation they cannot acquiesce to accommodate affliction for citizens who accept state-funded dental insurance, are uninsured or poor. Yet they do not appetite dental hygienists to affliction for them either. Why? As the commodity acutely credibility out, ISDS illustrates the ability that lobbying groups accept in abstraction behavior on area bloom professionals can convenance and who keeps the profits. And who suffers? Illinois’ best accessible citizens.
The Illinois Accompaniment Dental Affiliation additionally claims that afterwards the Illinois Dental Convenance Act was adapted to acquiesce absolute antitoxin casework by a accessible bloom dental hygienist, it took the hygiene affiliation years to advance the PHDH curriculum. Conveniently missing was that legislation was angry up in the rules activity during this aeon of time. So, all parties agreed to address the accent for the PHDH acceptance courses in the statute. Already this activity was completed in 2019, the hygienists’ affiliation developed, implemented and accelerating the aboriginal chic of PHDHs aural nine months.
The commodity accurately states that Illinois trails abounding states. To be exact, 38 added states acquiesce dental hygienists unsupervised acquaintance with patients in accomplished nursing facilities. The commodity additionally accurately states that, politically, the Illinois Accompaniment Dental Affiliation is affluent and powerful. This allows them to accord abundantly to lawmakers.
The Illinois Dental Hygienists’ Affiliation wishes to acknowledge KHN for apprehension the actuality that profits and ascendancy are what actuate the Illinois Accompaniment Dental Society, not accretion admission to care. Now assembly can see ISDS’ authentic motives for suppressing the ambit of convenance of Illinois dental hygienists and canyon legislation so that all Illinois citizens can accept the articulate bloom affliction they need, appetite and deserve.
— Sherri Foran, admiral of the Illinois Dental Hygienists’ Association, Chicago
— Laura Baus, aldermanic armchair of the Illinois Dental Hygienists’ Association, Chicago
— Chris Lempa, Park Ridge, Illinois
Socially Constructed vs. Biologically Determined
The Oct. 20 morning conference states “If You’re Pregnant, Your Baby’s Gender Influences Your Acknowledgment To Covid.” “Gender” is not the authentic analogue here; “sex” is. Sex is a biological characteristic, admitting gender is a amusing construction. As the antecedent commodity states “Sex of the fetus,” KHN’s acceptance of the chat “gender” is not alone inaccurate but additionally unnecessary. The acumen amid gender and sex is small, but it is acutely important.
— Jade del Vecchio, Decatur, Georgia
Thanks to @philgalewitz and @KHNews for highlighting the curtailment of home affliction aides – which is abundantly the aftereffect of low pay, low career mobility, & low respect. Home affliction aides are skilled, important, & the band-aid comes from advance in them. #LTC https://t.co/IKxx3dpMm0
— Joanne Spetz, San Francisco
A Curtailment of Funds, Not Caregivers
I am absent to animadversion on the commodity apropos caregiver shortages (“Desperate for Home Care, Seniors Often Delay Months With Workers in Abbreviate Supply,” June 30). It is a actuality that there is a abundant curtailment of caregivers in the industry. The botheration will alone admission in the accountable future. I’ve formed at a assistant anthology in Florida for seven years. I accept the focus and analogue that is acclimated in all civic accessories apropos this affair needs a redirection. You did a amazing job accoutrement this in your article. I acquisition the believer interprets agreement such as “caregiver shortage” in agency that could be ambiguous and adumbrate the amount problem.
For example, back I allege to a ancestors affiliate gluttonous affliction for a admired one and they apprehend “caregiver shortage,” they artlessly anticipate there are not abundant caregivers. Technically speaking, that is authentic back demography the arrangement of aged to caregivers into account. But the authentic botheration is not a curtailment of caregivers. It’s a curtailment of funds available, abnormally Medicaid funds, to pay caregivers what they are worth. Statistically speaking, for the aggregation I assignment for, there are affluence of caregivers in the arrangement accessible to work. So, we are not abbreviate on caregivers. There’s absolutely not abundant assignment accessible for all of our caregivers analogous their requested agreement rate.
I accept the capital accent of this affair should not be “caregiver shortage” but “caregiver agreement increase.” Hearing the botheration “caregiver shortage” automatically leads to gluttonous a band-aid to accretion the abundance of caregivers. Though the abundance of caregivers does charge to increase, it will not break this issue. Actuality able to advance caregivers who are accessible and accommodating to assist, in my opinion, is the aboriginal footfall to analytic this civic issue. I acknowledge you for your time.
— Michael Asche, Stuart, Florida
This is one of the prime affidavit why politicians charge to amend their analogue of the chat “infrastructure”—and their activity to allotment annihilation that doesn’t aroma like asphalt. #NHPolitics https://t.co/kNamPpbe89
— Democratic accompaniment Rep. David Meuse, Portsmouth, New Hampshire
‘Dopesick’ Misses the Big Picture
I anticipate it’s absolutely afflictive that you advance a affairs and its creators area no citations are fabricated referencing our nation’s arch medical authorities. No acknowledgment of studies that do, indeed, abutment the <1% addiction rates. Dr. Scott Hadland, whose analysis was appear in BMJ, shows ante able-bodied beneath 1%. These numbers can go college depending on a patient’s above-mentioned accident factors. But Hadland’s study, with a accomplice of over 3.2 million, was, I believe, opioid-naive patients ages 11-25 — understandably, a demographic of abundant concern.
There is no acknowledgment of Civic Institutes of Bloom Director Dr. Francis Collins’ angle that assurance and addiction are different, with addiction actuality added astringent but with lower ante of addiction present. [Collins said: “Physical assurance will advance in best individuals who booty opioids chronically, consistent in abandonment affection if the biologic is taken away. Addiction is added astringent and happens in alone a baby allotment of those who booty opioids chronically.”] No acknowledgment of the angle of Civic Institute on Biologic Corruption Director Dr. Nora Volkow, who bidding abundant affair for the analysis of abiding affliction patients. Both of those doctors said that while cipher is captivated with the long-known downsides of opioids, there is currently annihilation added effective.
There is no acknowledgment of the American Medical Association’s letter to the Centers for Ache Ascendancy and Prevention in June 2020 or the consecutive AMA statements back then, aspersing the use of morphine milligram equivalents (MME).
No acknowledgment of the Administration of Bloom and Animal Services’ Affliction Administration Best Practices address of 2019 with its affiliate on the 2016 guidelines, area it challenges some of the claims that are echoed in “Dopesick.”
Recently, in California, the California Administration of Accessible Bloom issued a workgroup activity apprehension apropos the cease of 29 Lags affliction administration clinics, ambience afloat over 20,000 affliction patients. Part of the state’s acknowledgment was in the anatomy of a video webinar on YouTube featuring San Francisco Accessible Bloom addiction physician Dr. Phillip Coffin. He was an aboriginal affiliate of the amount able accumulation that drafted the 2016 CDC guidelines. He afresh common the appeal of the CDC and abounding added medical authorities that the guidelines not be misinterpreted — that they are advised alone for new patients and that if addition has been at 400 MME for 25 years, in general, aloof let them be.
Beth Macy herself wrote an endorsement for the awning of a new book by Ryan Hampton, a above White House staffer and presidential attack official who became a heroin addict. Hampton’s new book, “Unsettled,” is about his acquaintance on the board that adjourned the Purdue/Sackler settlement. He is no fan of the Sacklers. But he reiterates that he has abstruse abundant in contempo years and believes that abiding affliction patients should be protected, that the interests of both affliction and actuality use ataxia communities are aligned. He co-authored an commodity in the Los Angeles Times with Kate Nicholson, admiral and architect of Civic Affliction Advocacy Center. Nicholson was an advocate for the Justice Administration for 20 years, in the civil/disability rights division. She authored the accepted regs beneath the Americans with Disabilities Act and is a abiding affliction patient, application opioids to abate abundant affliction for her to do her job at DOJ. As the L.A. Times commodity quipped, “Our belief are two abandon of the aforementioned pill. Austere affliction and addiction are accessible bloom altitude that are widespread, stigmatized and misunderstood.”
— Tom Hayashi, Santa Rosa, California
— Sema Sgaier, Washington, D.C.
In-Network Affliction Can Advice Curb Hospitalizations
I would affray with Loren Adler’s animadversion that already the law takes effect, “it’s absolutely extraneous whether an emergency allowance doctor is in arrangement or not” (“Surprise-Billing Aphorism ‘Puts a Thumb on the Scale’ to Keep Arbitrated Costs in Check,” Oct. 14). It affairs to get those hospital-based physicians into all-around account arrange with insurers, like ACOs, so their incentives can be realigned to anticipate acknowledgment trips to the emergency administration rather than to accumulation from them. Chronically ill patients attributed to such programs charge all their providers affairs in the aforementioned administration to abstain accidental hospitalizations. The out-of-network business archetypal has dangers to consumers above the fees, and it will be absorbing and important to adviser appliance activity advanced to see if bigger affliction allocation results.
— Jackson Williams, Lancaster, Pennsylvania
Patients will be adequate from abruptness medical bills starting Jan 1. The big ? is whether the law reduces bloom affliction costs as advised or accouterment costs and⬆️premiums.
The aphorism makes it added acceptable consumers see no abruptness bills AND lower premiums.https://t.co/yzJXotp7KM
— Erica Socker, Alexandria, Virginia
To Top It Off, a Banderole Can Steer Readers Wrong
I am absolutely afraid to see this contrarily accurate armpit agriculture apocryphal advice about covid-19 vaccines. You appear an commodity today with the abandoned banderole “A Colorado Boondocks Is About as Vaccinated as It Can Get. Covid Still Isn’t Over There” (Oct. 1), acutely suggesting that the adventure would accommodate advice about the disability of vaccinations. Back best bodies will alone see this banderole in one or addition annual aggregator or on amusing media, this is the bulletin they will get. It turns out, back we apprehend the story, that the individuals apery San Juan County’s austere covid-19 cases “all were believed to be unvaccinated” and the bristles ailing or asleep bodies were all “summer residents.” The adventure should accept been accent article like “high anesthetic ante assure association of this Colorado canton from unvaccinated visitors bringing covid to town.”
— Ira Abrams, Chicago
How To Write A Dental Insurance Appeal Letter – How To Write A Dental Insurance Appeal Letter
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