Entries in Health Insurance (23)


Ex-Con Who Wanted to Go Back to Jail for Health Care Denied

Zoonar/Thinkstock(BUFFALO, N.Y.) -- Ex-convict Frank Morrocco brazenly walked out of a supermarket Nov. 26 with $23 in stolen items, hoping his petty theft would land him back behind bars, where he could receive treatment for his leukemia.

On Monday, Morrocco turned himself in after he was informed that there was a federal warrant out for his arrest for violating the terms of his five-year supervised release, according to the Buffalo News. Morrocco was released from prison last December after serving two decades on drug charges.

On Monday, a federal judge denied him his wish to return.

Morrocco, 56, made what he saw as a life-or-death decision two weeks ago when he shoplifted from a supermarket.

When the Amherst, N.Y., man appeared before the judge on Monday, he was ordered to go to the Roswell Park Cancer Institute and apply for health coverage under the New York Bridge plan, which is run by the state and caters to people with pre-existing conditions.

“I am thankful that it looks like I’m going to get health care coverage,” Morrocco told the Buffalo News on Monday.

It’s not the first time a sick person has turned to crime in order to get health care.

Last year, Richard James Verone handed a teller at RBC Bank in Gastonia, N.C., a note demanding $1 and claiming that he had a gun, according to the police report.

With a growth in his chest, two ruptured disks and no job, Verone hoped a three-year stint in prison would afford him the health care he needed.

“I’m sort of a logical person, and that was my logic, what I came up with,” Verone told reporters. “If it is called manipulation, then out of necessity because I need medical care, then I guess I am manipulating the courts to get medical care.”

Verone was released from prison last July.

Copyright 2012 ABC News Radio


Aetna Pays Arizona Man's Cancer Bills, After CEO Tweets with Him

Courtesy Arijit Guha(NEW YORK) -- Arijit Guha, an Arizona State University graduate student, returned from a trip to India with a stomach ache and only one month later learned he had Stage IV colon cancer.

As tough as his diagnosis was at the age of 30, learning that his insurance company would place restrictions on paying for his cancer treatments was almost as gut-wrenching.

Guha had a generous policy under the university's health plan for which he paid $400 a month, but its carrier, Aetna, had an annual ceiling on pay-outs.  After surgery and chemotherapy, he had exhausted the lifetime $300,000 limit.

Although the Affordable Healthcare Act has eliminated lifetime caps, those requirements have not yet taken effect in student plans, according to the Chronicle of Higher Education.

Outraged, Guha turned to Twitter and other social media to make his case, one that affects millions of Americans who face staggering medical bills.

But last week, Aetna CEO Mark T. Bertolini, a former paramedic who has had his own share of medical crises, tweeted directly with Guha and agreed to pay "every last penny" of his bills.

"The system is broken, and I am committed to fixing it," said Bertolini on his Twitter account, according to the Arizona Republic, which first covered the story.  "I am glad we connected today and got this issue solved. I appreciate the dialogue no matter how pointed. I've got it and own it!"

Guha, now 31 and in remission, told ABC News, "I am incredibly pleased and in shell shock and trying to figure out what just happened.  It's a huge relief."

It turns out Bertolini and Guha have much in common.

In 2001, Bertolini's then 16-year-old son son, Eric, was diagnosed with a rare and deadly lymphoma, according to a profile in the Hartford Courant.  And in 2004, when he was president of Cigna, Bertolini was disabled after being nearly killed in a ski accident.  He also eventually donated a kidney to help save his son.

Bertolini admitted the current healthcare system was "broke" and tweeted, "There is a lot to do to make it right."

Meanwhile, Guha had raised $120,000 through T-shirt sales in his edgy campaign "Poop Strong," which riffs on cancer survivor Lance Armstrong's "Live Strong."  And now that Aetna has stepped in, Guha said he will donate all of it to three cancer charities in Arizona.

Copyright 2012 ABC News Radio


Free Birth Control Day: Few Will Get Co-Pay Free Contraception

iStockphoto/Thinkstock(WASHINGTON) -- Wednesday is a big day for birth control.  Under President Obama's health care reform, private insurance companies have to start providing contraception for free on Aug. 1.  That means no more co-pays for birth control.

But while the law goes into effect, only a tiny fraction of the 97 million American women between the ages of 18 and 64 will be able to snag any co-pay free contraception.

First, only women with private insurance plans will be affected.  About 65 percent of women between the ages of 18 and 64 -- those that are old enough to be adults but too young enough to qualify for Medicare -- have private health insurance, which they get from their employer or pay for out of pocket, according to the Kaiser Family Foundation.

That means the 19 million women between the ages of 18 and 64 who are uninsured will still have to pay for contraception out of pocket.

The 17 million women on Medicaid also may not feel the effects.  Each state gets to decide whether their Medicaid plans will provide at no cost the contraception and seven other women's health services that are covered under the no-cost-sharing law taking effect on Wednesday.

While the federal government provides cost incentives for states that drop contraception co-pays for Medicaid enrollees, states are not required to.  Some Medicaid programs already provide these services for free.

Even for the 57 million women that have private health insurance, if their plan has not changed since the Affordable Care Act was enacted in March 2010, it can be grandfathered in and does not have to adhere to the co-pay free rules.

The administration estimates that by 2013 about half of large employer insurance plans and about one-third of small employer plans will still fall under this grandfather clause and therefore not be required to provide free contraception.

Women whose plans have changed may not see their co-pay free benefits go into effect for almost a year, depending on when their most recent plan started.  The law stipulates that any plan starting on or after Aug. 1 has to offer birth control along with seven other women's health services for free.

So if your plan started on July 1, you may have to pay co-pays for nearly a year until your new plan begins on July 1, 2013, although some insurances plans have said they will implement the law early.

Women who get their insurance through their religiously-affiliated employer will have to keep paying those contraception co-pays for the next year as well.

The Obama administration gave religiously-affiliated employers, such as some universities and hospitals, a one-year exemption to the free birth control requirement after many raised religious objections to paying for something they consider a sin.

Those religious organizations still have to provide insurance that offers the seven other services cited in the women's health rule taking effect on Wednesday at no cost to employees.  Those co-pay free services include: a yearly well-woman doctors visit, HPV testing, gestational diabetes testing for pregnant women, counseling for sexually transmitted diseases, HIV screening and counseling, breast pumps and domestic violence counseling.

Copyright 2012 ABC News Radio


Democrats Celebrate Co-Pay Free Birth Control

Michael Matisse/Thinkstock(WASHINGTON) -- While Democrats on Capitol Hill were celebrating a new Obamacare contraception provision, Republicans were calling again to repeal the landmark health reform law.

The new rule goes into effect Wednesday that will require employers to cover contraception without a co-pay, among other things, all affecting women.

HHS Secretary appeared with Senate Democratic women on Capitol Hill and declared Aug. 1 a, “new day for women’s health in America.”

“No woman should have to choose between seeing her doctor and putting food on the table for her family,” Sebelius said. “And now many women won’t have to make that difficult choice any longer.”

Previously some insurance companies did not cover some preventive services for women at all under their health plans, while some women had to pay deductibles or co-pays for the care they needed. But now all insurance policies will be required to cover new preventive care without charging women anything out of pocket.

The eight new prevention-related services are: “well-woman” visits, gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases, domestic and interpersonal violence screening and counseling, FDA-approved contraceptive methods and contraceptive education and counseling, breastfeeding support, supplies and counseling, HPV DNA testing for women 30 or older, Sexually transmitted infections counseling for sexually-active women and HIV screening and counseling for sexually-active women.

“The top killers of women will now no longer go undetected,” Sen. Barbara Mikulski, D-Md., said at the press conference Tuesday, “the kind of support services that we need to be healthy, good mothers and to be able to have our family life -- we’ll be able to do it.”

The Obama administration estimates that 47 million women will now be able to get preventative services that they could not before this rule went into effect.

As Democrats came to Senate floor Tuesday morning to give speech after speech touting the benefits of this new rule, Senate Republicans called for a repeal vote of the entire health care law.

“I think it would be appropriate to have a vote on the repeal of Obamacare,” Senate Minority Leader Mitch McConnell, R-Ky., said on the Senate floor Tuesday morning. He suggested that offering an amendment during the the pendency of a cybersecurity bill would be better.

Senate Majority Leader Harry Reid, D-Nev., shot down the idea quickly noting that the health care repeal vote should not be included in an unrelated bill that is focused on cybersecurity.

“I think we should understand that I don’t think a woman getting contraception has a thing to do with shutting down the power grids in America or the financial services in America or our water systems or our sewer systems,” Reid said.

Reid hit a personal note, touting the new health care rule that goes into effect Wednesday, in speaking about his wife who last year was diagnosed with stage three breast cancer.

“A person that is able to have a mammogram -- it is lifesaving,” Reid said. “She had a mammogram in December, and in August discovered a lump in her breast, and think what would have happened if she had waited a year because she couldn’t afford that mammogram. Frankly, the thought of it is very hard for me to comprehend because even though she had that mammogram in December, she found she was in stage 3 of breast cancer and it has been very difficult. But what if she had waited an extra year? Many people wait a lot longer than an extra year.”

Copyright 2012 ABC News Radio


Study: Late Stage Cervical Diagnosis Linked to Lack of Insurance

Siri Stafford/Photodisc/Thinkstock(NEW YORK) -- This year, more than 12,000 women in the U.S. will be told they have cervical cancer. Over 4,000 of them will die.    
Diagnosing cervical cancer in the early stages means a better chance of conquering the disease. Receiving a diagnosis at the later third or fourth stage may mean more aggressive and expensive therapies, and an increased risk of death.
A new study published in the American Journal of Public Health took a closer look at how insurance coverage affected 69,000 American women with cervical cancer.
Researchers at the American Cancer Society found that 24 percent of privately insured women were diagnosed with stage three or four advanced disease, compared to over 34 percent of those with Medicaid, and just over 35 percent of those without insurance.
The study concludes that uninsured women are at higher risk of being diagnosed with advanced cervical cancer because they lack access to screening. Researchers suggest that all women who need it should have access to affordable screenings.
Copyright 2012 ABC News Radio


Transgender Woman Wins Insurance Coverage for Mammogram

Courtesy Beth Scott(NEW YORK) -- Beth Scott was told by her doctor she needed a mammogram, a cancer screening that health insurance usually covers.

She had the mammogram in June 2010, paying $385 out of pocket. But when she submitted the claim to her insurance company, Scott was denied coverage, because Scott is transgender.

But in an appeal that lasted almost two years, the Transgender Legal Defense and Education Fund intervened and announced this week that it had resolved Scott's claim, winning a landmark battle with Aetna.

"I am really pleased and glad it went smoothly," said Scott, 44, who for 11 years has worked as a data integrity specialist for a high-tech company, through which she gets her insurance.

"It's something that gives me hope -- by the fact that Aetna apologized and reimbursed me," she said. "Their willingness to treat transgender people is a positive sign."

Her settlement clarified that "these denials would not happen in the future," said TLDEF staff attorney Noah Lewis. "It also added a provision to allow transgender individuals to change their sex on their insurance records by providing a birth certificate or driver's license."

Lewis said denying health coverage for transgender employees was a "widespread problem and not an isolated incident."

Scott's claim was denied on the grounds that it fell under her policy's exclusion treatments "related to changing sex." She was born biologically male but developed breasts after she underwent estrogen treatments when transitioning to female.

But TLDEF argued that the insurance company's interpretation was "overbroad" and should apply only to medical treatments prescribed to change an individual's sex characteristics. It said that a mammogram had nothing to do with a sex change.

"Transgender people should have their health care needs covered by insurance just like everyone else," said Lewis.

"But as long as exclusions remain in place, Ms. Scott's case makes clear that they cannot be used to deny other medically necessary care simply because someone is transgender," he said.

In 2007, she made the physical switch from male to female, first undergoing the surgical shaving of her Adam's apple and following that with hormones. Neither treatment was covered by Aetna.

Aetna told ABC News that it couldn't talk specifically about Scott's case because of privacy laws but clarified that the ruling had been made by a self-funded Aetna health plan run by Scott's employer.

"What we can say, in general, is that a mammogram is covered in a situation like the one described," said Aetna spokeswoman Cynthia B. Michener in an email to ABC News. "Any denial would have been an error corrected by Aetna in administering the claims in the appeals process."

Since 2009, the company has covered breast cancer screenings for female-to-male transgenders who have not had a mastectomy, as well as prostate cancer screenings for male-to-female transgenders who have retained their prostate, according to Michener.

But advocacy groups are fighting for full medical coverage for sex change treatments.

"The consensus in the medical community is that [being transgender] is a medical condition," said Jennifer Levi, director of the Boston-based Transgender Rights Project at Gay and Lesbian Advocates and Defenders, or GLAD. "It's legitimate and real and has an established protocol for treatment."

Advocates say it is a discriminatory practice when an employer knowingly hires employees who are transgender and then excludes them from basic workplace benefits, as, they say, was the case with Scott.

Copyright 2012 ABC News Radio


'Consumer Reports' Investigates Mini-Med US Health Plans

PhotoAlto/Frederic Cirou/Thinkstock(YONKERS, N.Y.) -- Consumer Reports is warning against so-called "mini-med" health plans that offer limited protection, usually at lower cost, but with sky-high deductibles that can leave the insured paying thousands out of pocket.

Mini-med health plans tend to appeal to industries such as retail, temporary staffing agencies and food service, according to the consumer group.  The employers want to offer an added benefit to staff, but, in reality the plans offer little to no coverage, said Nancy Metcalf, senior program editor at Consumer Reports.

"There is this persistent dream of consumers that if they only look hard enough, they'll find really good insurance that costs a lot less," said Metcalf.  "It's not going to happen.  There's no such thing as a bargain on health insurance.  If it's cheap, it's cheap for a reason."

Mini-meds offer a limited benefit health plan with extensive restrictions to those under the age of 65.  Most plans cap benefits at a few thousand dollars per year. While many of these companies maintain that these plans are better than no insurance at all, Metcalf argues that some people may be better off without any insurance rather than making monthly payments to a plan that will probably not give adequate coverage when needed.

"In my view, people are better off putting whatever you would have paid to that mini-med in the bank in case something happens in the future," said Metcalf.

Of course, Metcalf said that this is a last resort.

"This is an excellent report," said Jonathan Weiner, professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. "It's great to see a clear discussion about these type of plans. They are not well-understood or widely publicized."

While Metcalf maintains that people should never purchase such plans, Weiner disagrees saying some may benefit despite the limited benefits.

"In almost all instances, consumers would be far better off if they are able to get coverage from other types of more conventional health plans," said Weiner. "But if there are no other options, and consumers understand what is and is not covered by these mini-meds, then the extra coverage would be helpful to those lucky enough to have only modest healthcare expenses during the year." 

Copyright 2012 ABC News Radio


Dentist Threatens to Sue Patient for Negative Review

Jupiterimages/Thinkstock(NEW YORK) -- Robert Lee went into Dr. Stacy Makhnevich’s New York dentist office for a sore tooth, but the year that followed turned into what one Public Citizen senior lawyer called an “unconscionable practice.”

The controversy began in 2010, when Lee went into Makhnevich’s office for a scheduled dentist’s appointment. Bleary from pain, Lee claimed he was told he had to sign several papers, including a “Mutual Agreement to Maintain Privacy,” before being treated. The form required Lee to agree not to publish any commentary or write anything disparaging about his experience with Makhnevich.

While Lee said he was hesitant to sign such a form, he claimed he was in severe pain and, therefore, gave in to the requirements.

Lee received a bill for $4,766 for the dental work, according to Public Citizen, a nonprofit consumer advocacy organization. Lee reportedly asked the dentist to send the necessary paperwork to his insurance company, but she sent it to the wrong company. When he asked for the forms to submit them himself, Makhnevich’s office apparently refused to hand them over and referred him to a third party that required five percent of the total bill for its services.

Fed up, Lee wrote negative reviews about Makhnevich and her practice on Yelp and DoctorBase.

Lee then received a letter from the dentist demanding that he delete the post, warning him that he violated the agreement and threatening to sue for breach of contract. Makhnevich also reached out to both websites, asking for Lee’s comments to be removed, according to Public Citizen.

The sites refused to take down the negative reviews, but Makhneich reportedly claimed that a copyright clause gave her ownership of the harsh words. She then sent Lee an invoice for $100 for each day the criticism remained online.

Makhnevich did not immediately return requests for comment.

“We are now seeking a declaratory judgment from the judge to show that my client was not doing anything wrong,” said Paul Levy, Lee’s lawyer, a senior attorney at Public Citizen. “Doctors and dentists are expected to behave in an ethical manner, and to impose this sort of requirement on people who are having emergencies is unethical.”

The suit argues that the forms that Lee signed should be deemed null and void.

“Facing criticism comes with the turf of these jobs,” Levy said. “If they defame you, then that’s something else. A doctor can sue for that.”

Copyright 2011 ABC News Radio


Affordable Care Act Credited with Reducing Ranks of Young Uninsured

Stockbyte/Thinkstock(WASHINGTON) -- President Obama’s 2010 overhaul of the nation’s health insurance system appears to have helped significantly reduce the number of uninsured American young adults, according to a new Gallup survey and U.S. Census data.

The percentage of 18- to 25-year-olds without health insurance dropped 3.6 points since the third quarter of 2010, when a key provision of the Affordable Care Act allowing many young adults to remain on their parents’ health plans first took effect, Gallup found.

Roughly one quarter -- 24.4 percent -- now report being uninsured, down from 28 percent late last year. The decline represents nearly one million more young adults who now have health insurance, according to official estimates based on the Gallup data.

“Going without coverage puts every young American just a car accident or surprise diagnosis away from a lifetime of medical debt or worse,” said Health and Human Services Secretary Kathleen Sebelius. “The good news is today one million young adults are no longer living with that fear and uncertainty.”

The Gallup findings were corroborated by a separate U.S. Census analysis released earlier this month that also noted a decline in uninsured young adults and simultaneous increase in those with coverage. Both studies attributed the change to the Affordable Care Act.

Democrats and the White House have hailed the findings as evidence the controversial health care law is having a positive effect, despite popular skepticism of the law and a Republican-led campaign to repeal it.

Half of all Americans oppose the law, fearful of a perceived negative impact on the economy and federal deficit, a recent ABC News/Washington Post poll found. Fewer -- just 37 percent -- said they favor repealing all or part of the law.

Some provisions, including the mandate allowing young adults under age 26 to remain on their parents’ health insurance and a ban on restrictions for preexisting conditions, remain popular.

Administration officials said Wednesday that an individual insurance mandate and other measures aimed at expanding insurance options would have the biggest impact on reducing the overall number of Americans without health insurance when they take effect in 2014 -- but they’re also among the most unpopular.

The mandate alone faces constitutional challenges in several ongoing cases that will likely reach the U.S. Supreme Court. Republicans have also vowed to do everything they can to hamstring implementation of that part of the law.

Nearly one in five Americans 25 to 64 years old does not have health insurance, according to Gallup -- that's roughly 30 million Americans.

Copyright 2011 ABC News Radio


$15 Million Medicare Fraud Owner Sentenced to Prison 

Stockbyte/Thinkstock(DEARBORN, Mich.) -- The operator of a phony health center who scammed the government out of $15 million will spend 48 months in jail.

Court documents show the Sacred Hope Medical Center and Dearborn Medical Rehab Center collected millions from medicare for phony treatments, over several years, and paid kickbacks to phony patients, who claimed they were getting health care.

The owner of the bogus centers, Jose Rosario, has now been sentenced by a federal judge in Michigan to 48 months in prison and ordered to pay more than $10 million in restitution after the justice department's medicare fraud strike force and the FBI shut down the operation.

Copyright 2011 ABC News Radio

ABC News Radio