If you are expecting a new baby, it is critical that you ensure neonatal intensive care will be covered should the need arise, or else you may find yourself struggling to pay out-of-pocket costs.

As an expectant parent, you have no doubt taken the time to make sure that the hospital where you intend to have your little one and your obstetrician are in your network of health insurance. This is because you know that using a provider that is out of your healthcare network could lead to high out-of-pocket costs. Your health insurance plan may pay 60% of the charges, as opposed to the usual 80% or more.

On the contrary, like many other expectant parents, you may not realize that an ugly surprise may be coming your way should your baby be born prematurely or require special care for any other reason. The unfortunate fact is that the NICU personnel, even those at an in-network hospital, may not be in your health insurance network.

According to the Director of Media Relations for the American Hospital Association Marie Watteau, “Some hospitals do contract with other clinical provider groups to run their NICUs.” The companies that provide NICU services often do not accept the same insurers as the hospital. Ms. Watteau says, “When selecting a hospital, pregnant women should … verify that all hospital care, including NICU care and physician services are in network.”

photo credit: proisraeli

One couple a few years ago, Sonji and Nathan Wilkes of Englewood, Colorado, were sure they had taken care of all things insurance related before their son, Thomas, was born. The hospital where Thomas was born and the obstetrician that they chose were both in their health insurance network. After speaking with their coverage provider, they expected their out-of-pocket expenses to be around $400.

However, when Thomas was born, he was diagnosed with hemophilia and he received treatment in the NICU. Within just a few weeks, Sonji and Nathan received a bill for the special care for $50,000. Nathan Wilkes said, “We just thought it was part of the hospital. We had no idea that it was even an option that the NICU could be in a different network.”

Recently, a key democrat testified against a major provision of the health care reform law, which is supposed to help with the control of Medicare expenses by encouraging the rationing of care.

The #2 Democrat on the House Budget Committee, Representative Allyson Schwartz of Pennsylvania, is an esteemed voice on issues related to health care policy. The Energy and Commerce Committee Republicans invited Ms. Schwartz to speak at a recent hearing on the reform law’s cost-control panel. She said that the president’s indicated desire to enhance the Independent Payment Advisory Board to pare down Medicare expenses “was one of the reasons” that she spoke out.

Schwartz said, “There are Democrats who also have concerns about the IPAB,” she continued, “and that’s been true from the beginning. I would say on behalf of myself and Democrats who care about this as well, it would be better to repeal this part of the law.”

In April of 2011, President Obama proposed an increase in the authority of the Independent Payment Advisory Board as an alternative to the Medicare overhaul proposed by House Republicans. He laid out his proposal, saying that in as little as twelve years, the deficit would be reduced by as much as four trillion dollars. This would be done primarily by reducing the threshold as the Independent Payment Advisory Board goes into effect under the law and issues recommendations on which Congress must act if the cost of Medicare goes up beyond a specific target.

A former health care executive and current vice president of the New Democrat Coalition, Representative Schwartz is one of eight democrats that have signed on in repeal of the provisions. She said that she has talked with her fellow democrats in Congress as well as the White House regarding her intention, making it clear that she is staying strong as an advocate of the health care reform law.

Audax Health™ and ValueOptions® recently announced a joint venture for an interactive health management program for the beneficiaries of Medicaid aimed at improving health outcomes through game mechanics and social networking that engages and assesses the needs of members.

Part of the program will involve ValueOptions using the Audax Careverge® platform as a way to engage the Medicaid members in the management of their own wellbeing by identifying and addressing possible health issues. The platform makes it possible for ValueOptions to employ members to evaluate their health and develop plans for personal health management. In addition, it also allows the organization to send messages to their members reminding them of appointments or to take medication.

Online Communities

In online communities, members of the Medicaid program are able to interact with industry experts and share their experiences with other members who may be faced with the same challenges.

photo credit: joe.ross

Audax Careverge® is a groundbreaking platform for health management. Using the power of game mechanics and social networking, it tracks health information, identifies potential health concerns and produces personalized information in real time, which makes it possible for consumers to make the most informed decisions.

The founder and CEO of Audax Health Grant Verstandig says that getting people healthy and encouraging healthy lifestyles is incredibly important to health care reform in the United States.

Why Are Consumers Engaging In Social Interaction?

Verstandig said, “The challenge is in engaging consumers to be part of a process that is largely impersonal and unrewarding. Social media and gaming sites have exploded because people are rewarded when they engage in often very personal ways online. When you make personal health management tangible, quantifiable, interactive and rewarding, like ValueOptions will be doing, you engage consumers to improve their own health and wellness.”

ValueOptions’ Chief Information and Technology Officer, Bob Esposito said, “ValueOptions will use the Careverge Web solution to provide a sense of community for our Medicaid members, giving them a platform where they may reach out to other members, share their experiences and even research health-related information privately.”

The quantity and quality of education, especially for females, could significantly affect future trends in the growth of global population. According to research that was published in the July 29 issue of the journal Science, predictions of population trends in the future that do not indisputably include education in their exploration may be flawed.

The study uses an innovative multi-state population modeling approach to integrate education fulfillment level, in conjunction with sex and age. The addition of education in the investigation adds a human quality element to forecasts of migration, mortality and fertility. Education also has an impact on health, democracy and economic growth, so such projections offer a more inclusive view of conditions affecting human well-being.

The recent research supports earlier discoveries that formal education attained by women, in most cases, is the single important contributing factor to growth of the population. Women who achieve a higher level of education tend to have fewer children, be healthier and be less at risk of infant fatalities.

Education also seems to be a major influence on child survival, more than household wealth. In addition, the research found that if concentrated determination was not focused on fast tracking education, the population of the world could stay under nine billion by the year 2050. Therefore, the outlook of global population relies greatly on the progress in education.

Co-author Samir K.C. says, “The most pessimistic scenario of ‘constant enrollment numbers’ (CEN), assumes no new schools are built and the number of people attending schools remains constant, which, under conditions of population growth, means declining enrolment rates.” He also said, “Under these two extreme scenarios, population size in 2050 could vary by as much as 1 billion-with 8.8 billion people expected under the fast track scenario and as many as 9.9 billion under the constant enrolment numbers scenario… The effect is greatest in countries with current high fertility rates and high education differentials.”
photo credit: Vectorportal

We can agree that skyrocketing federal deficits will lead to financial chaos. However, the unanswered question remains:

What should be done about it?

This question is certain to take center stage for the presidential hopefuls for 2012, no matter which party they represent.

The political bookends for the debate were recently established. On April 5, when Republican Representative Paul D. Ryan of Wisconsin, who is also the chairman of the House Budget Committee, issued a long-term budget road map. The following Friday, the Republican majority of the House passed it and on April 13 the president gave his budget speech.

If any doubt at all existed that debates related to the deficits is not just about the numbers, but also the philosophies of the government, it takes advantage of the language of the economic policy. These two events should definitely be laid to rest.

The Master Plan

The primary goal of the plan laid out by Ryan is to cut healthcare spending by the government, including Medicaid, Medicare and the new healthcare reform plan. That seems like a reasonable place to target any plan to reduce deficits, especially sense it is the area that the increasing costs are most abrupt.

However, Ryan’s solutions are anything but reasonable. They include coming close to tossing out all of the sickest and most needy Americans from government care and leaving them to fend for themselves. Medicare would be all but eradicated and the cost of Medicaid would shift for the most part to state government, which is already hard-pressed. In addition, a reform program created to provide tens of millions of Americans with health insurance would be terminated completely.

photo credit: knitsteel

What are the greatest alleged sources of healthcare spending waste? Just like with David Hasselhoff’s singing career, opinions tend to vary from one country to the next, according to a recent survey by Deloitte of healthcare consumers in numerous countries.

Overall, more than 15,700 consumers were surveyed in twelve different countries. The consumers in ten of the countries, all except China and Brazil in fact, were questioned about the sources of healthcare spending waste.

#1 Lack of Responsibility

Most consumers in the United States and Canada believe that the number one source for wasted healthcare spending is people’s lack of responsibility when it comes to taking care of their own health. Consumers in the United State, along with consumers in at least six other countries, put the redundancy of paperwork at the top of their list.

#2 End of Life Measures

Both of the aforementioned options were also listed as the second most wasteful spending sources, with the exception of Belgians, who rank extreme and unnecessary end-of-life measures at number two on their list of wasted healthcare spending sources.

In Mexico, respondents to the survey were the only consumers to rank mismanagement and/or corruption as the number one source for wasteful healthcare spending. In fact, the margin was overwhelming.

#3 Defensive Medicine

Another choice on the survey was defensive medicine. However, this source seems only to be a concern primarily for people living in the United States. Americans ranked defensive medicine at number three on their list of biggest sources of wasted healthcare spending, while other countries ranked it as fifth or even last in some regions. Ranked fourth on American consumers’ list is unnecessary and unproven tests and procedures.

According to Deloitte, the margin of error for the collected responses varies from one country to the next because of differing sample sizes. It was give or take about 1.6% for the United States and about 2% for Canada. In addition, the margin was 4.1% in Luxembourg and around 3% for other countries in Europe as well as Mexico.

photo credit: bethanylynphotography

Recently, Diana Dooley, who is the California Health and Human Services Secretary, announced the lifting of the hiring freeze that as troubled state mental hospitals amid rising concerns of violence.

Ms. Dooley’s decision came following an uncommon visit to the Napa State Hospital. The recent death of a Napa patient prompted the trip. The hospital has $100,000 fines levied against it by Cal/OSHA for alleged systemic failings, which contributed to the slaying of a psychiatric technician just months earlier.

Appointed by Governor Jerry Brown, Diana Dooley claims to be working to make sense of the complicated issues plaguing California’s five mental facilities. Over eighty percent of the patients at these hospitals have been convicted or accused of crimes. In addition, a growing number of these patients have predatory tendencies.

Help Wanted for Mental Hospitals

In spite of California’s severe budget crisis, Diana Dooley said, “I made the decision this week that there are real needs in the state hospitals, and we need to refill positions.” This action will make an exception to a statewide hiring freeze that had been placed on vacant positions that were the result of an executive order by Brown back in February.

Cindy Radavsky is the deputy director for long-term care services for the California Department of Mental Health, which is overseen by Diana Dooley. Radavsky says she intends to fill around twenty-five positions quickly with clinical staffers and hospital police officers in Napa with responsibilities for direct patient care.

Radavsky had only praise for Dooley saying, “Her advocacy is extremely appreciated.” Dooley spent several hours at the hospital, meeting privately with union stewards as well as other employees.

Dooley says that she has been working with the Department of Mental Health sifting through strategies to better assess the patients’ inclination for violence, administering proper treatment and moving patients so that the facilities that are less secure will house the patients that are less violent.

photo credit: GoTRISI

This week, the first aspects of Health Care Reform go into effect, including:

• Dependents under the age of 26 can stay on their parents’ health plan if they can’t take advantage of an employer’s  insurance coverage.
• Insurance companies are no longer allowed to deny coverage for children with pre-existing conditions
• Lifetime limit caps – the maximum amount that an insurance company will pay in benefits over a lifetime – have been eliminated entirely.
• Any preventative or diagnostic health care need to be fully covered by an insurance company – without deductibles or co-pays.

In the meantime, Americans are fighting to protect their constitutional right to make their own choices. Americans with limited incomes, preexisting conditions, and seniors will all have access to health care, but at what cost? Health Care Reform’s individual mandate forces Americans to purchase health insurance from a limited selection of eligible plans, with no regard for every American’s freedom to choose.

Is Congress On a Power Trip when it Comes to Health Reform?

In the past, Congress has been known to pass laws without reading them or supporting laws that are clearly unconstitutional. However, no matter how unpopular or unconstitutional those old laws might seem, they pale in comparison to the latest federal program passed by Congress. In 2010, Congress took federal health care regulation a little too far with the overreaching Health Care Reform Law. Yes, Congress does have to power to regulate all U.S. commerce. However, Congress does not have the power to dictate which products the citizens of the United States of America should purchase.

States Start Challenging Health Reform

More than twenty states are challenging health care reform. Countless numbers of individual citizens have taken it upon themselves to take the federal government to court for violating their constitutional freedom to choose. Many of these individuals are members of the military, local government officials, and small business owners.

While many of these individuals acknowledge that they alone have little power as they fight the new Health Care Reform Law, they encourage every other American to challenge this reform. If Congress is allowed to get away with the violation of every American’s right to make choices, they will only continue to pass laws that violate the Constitution upon which this country was built.

Americans must now fight to defend freedom within the borders of the United States. Whatever happened to America, Land of the Free?

photo credit: Fibonacci Blue

Pfizer’s cancer drug,  Mylotarg, is no longer available after being on the U.S. market for the past 10 years. If you have a prescription drug plan, then now is the time to start looking into your health insurance carrier’s “formulary,” which is the list that includes drugs that are covered. You will need to consult with your doctor to find an appropriate alternative that is covered through your health plan.

Pfizer decided to remove the drug from the market because studies failed to prove that it has any effectiveness. Additionally, there were reported deaths from liver and lung complications linked to its use.

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In an effort to detect the HIV virus more quickly than ever before, the United States Food and Drug Administration has approved a test that would, if the results were positive, slow the spread of the disease early on when it was in its most infectious stage.

ARCHITECT HIV Ag/Ab

The test called ARCHITECT HIV Ag/Ab Combo assay was developed by Abbot Laboratories Inc. If successful, the test would be able to detect the presence of the virus with much more accuracy in the weeks immediately following its transmission. This would be a huge breakthrough for patients who are infected as it would allow for a much faster implementation of treatment efforts. It would also serve to stop the further spread of this deadly disease.

The test allows for proper detection of the HIV virus in an estimated 90% of infections considered to be acute or before the development of the antibodies associated with the disease. Currently the only U.S. testing available only detects the antibodies rather than the virus itself. The antibodies present with HIV show up weeks after the initial infection, which greatly diminishes the chance of successful treatment plan, and allows for a higher chance of spreading from person to person.

FDA Approval and Health Insurance Considerations

The test is also the first to ever be approved by the U.S. Food and Drug Administration to be used on women who are pregnant. The test would allow for quicker treatment of these women and help to prevent the spread of the virus to their unborn children. Now that the test is approved by the FDA, any woman with a proper individual or family health insurance plan could request it – especially if the plan has good coverage for diagnostic tests (you can request a quote from this site to find a plan that does).

Roughly 18,000 million people are tested annually in the United States for HIV, and approximately 56,000 are found to be infected with the virus.

photo credit: stevendepolo