Entries in Health Insurance (23)


Bates Family of 20 Says They're Praying for More Children

Creatas/Thinkstock(KNOXVILLE, Tenn.) -- Despite already having 18 biological kids, one Tennessee couple says they are praying for more children.

The Bates family lives in a five-bedroom house outside of Knoxville, Tenn., with their 18 children. Zach is their oldest at age 22, and Judson is their youngest at 11 months.

"We never planned on having 18 children," Gil Bates, a 46-year-old tree surgeon, said.

"I feel like together, in marriage, we began to grow in this direction," his wife, Kelly Bates, added.

The Bates are evangelical Christians who do not believe in the use of birth control. Kelly, a 44-year-old stay-at-home mom, has been pregnant every year for the past 22 years -- which some might consider to be a medical marvel -- and doesn't shy away from the thought of having more children.

"Whatever the Lord desires," she said. "We decided, a long time ago, to let the Lord decide how many children we would have."

Kelly Bates has endured labor and delivery 18 separate times -- no twins and no C-sections. To top it off, 14 of those births were at home, meaning no epidurals or anesthesia.

With 20 people living under one roof, the Bates children have to share everything from their parents' attention to their bedrooms. But none of the kids mind -- in fact, they like it.

Today, the Bates brood includes Zach, 22; Michaella, 21; Erin, 20; Lawson, 19; Nathan, 18; Alyssa, 16; Tori, 15; Trace, 14; Carlin, 13; Josie, 12; Katie, 10; Jackson, 9; Warden, 8; Isaiah, 6; Addallee, 5; Ellie, 4; Callie, 2; and finally, Judson, 11 months.

"They are all so different," Kelly said. "No two are alike."

Although Gil and Kelly Bates say having any more children is in God's hands, there's no denying that the whole family wants more kids. Between Ellie and Callie (kids number 16 and 17) there was a short stint when Kelly wasn't getting pregnant. Kelly said the kids were scared of the thought of not having any more siblings and turned to prayer. The children wanted to have more babies so badly, Gil said, that they even asked if they could fast.

But Kelly's body has changed with age and she is heading into the outer reaches of her child-bearing years. She had two miscarriages before her last two successful births with Callie and Judson. A low progesterone level was making it more difficult to sustain a pregnancy.

"Conception takes place, but the uterus wall is not softened so the baby can implant," Gil said. "And so it was causing us to lose the baby."

Kelly started a hormone therapy to maximize her chances of carrying to term. They had Callie and then Judson, their youngest. Although they don't believe in using birth control to prevent pregnancy, Kelly said using medicine to help keep a pregnancy was a different matter altogether.

"For us, that would be like, that baby is already alive. It is a life," she said. "We don't try to prevent or to promote. We just want to trust God. But at the same time, if there's already a life living, we don't want to deny medical help to a baby that's in trouble."

All 18 births have gone smoothly without complications, except for one: Addallee, baby number 15.

"Addalee is our special little baby because she almost didn't make it," Kelly said. "Addallee stopped breathing and her heart stopped."

Little Addallee was rushed to the hospital after she was born prematurely and spent 17 days there -- a very expensive hospital stay.

"We didn't have insurance," Gil said. "We negotiated with the insurance, with the hospitals, and I said, 'I know insurance companies don't pay full price, could we set up a payment plan based on what you would feel is a justified -- a fair price.' They graciously worked with us."

Today, Addallee, whom everyone calls "Addee," has slight hearing problems but is otherwise healthy, and the Bates continue on without any health insurance.

"For the last 10 children, we have not had health insurance," Gil said. "When there's a medical emergency, we just go to the doctor and America's been the greatest health care in the world. When you walk in the emergency room, I don't care what your status of living, they give you the best care possible."

The Bates' pre-natal care is provided free of charge at a small Christian clinic, and earlier this year, they got the news they were pregnant with baby number 19.

But eight weeks into the pregnancy, the baby died -- a devastating loss for the family. Kelly's two previous miscarriages occurred just a few days after a positive pregnancy test, well before they could see a heart. The couple later named the baby Zion after the hymn "Marching to Zion."

It was six weeks before the couple was able to start trying again, a process that required careful medical guidance from their OB/GYN. Gil and Kelly say their main concern is being able to conceive again.

Copyright 2011 ABC News Radio


Medicare Choices May Overwhelm Seniors

Digital Vision/Thinkstock(NEW YORK) -- Medicare choices may be too much of a good thing for some recipients. A new study finds a bewildering range of choices in one popular Medicare program that may leave some seniors wanting less instead of more.
The study, published in the journal Health Affairs, says the many managed-care plans offered by the Medicare Advantage program -- an alternative to traditional Medicare -- are confusing to some senior citizens. Elderly patients, especially those with reduced cognitive abilities, may be overwhelmed by the complicated insurance options.
Ironically, those with impaired cognition may benefit most from the more generous coverage often provided by Medicare Advantage plans.
The authors found that when the number of available plan options was below 15, enrollment in Medicare Advantage went up. When the number passed 30, enrollment tended to decline.
Now the researchers are calling for more streamlined and simplified choices so more patients can take benefit from Medicare Advantage.  
Copyright 2011 ABC News Radio


Selective Use of Drug-Eluting Stents Saving Millions of Health Care Dollars

Jupiterimages/Thinkstock(DALLAS) -- With medical costs soaring, researchers have found a way to control expenses for heart stents without cost to patients.

More than half a million heart stents are implanted every year in the U.S.  The procedure, a less invasive alternative to bypass surgery, consists of surgically inserting a tube into a narrowed artery to keep it open and keep blood flowing normally.  Some are coated with medicine to help prevent blood clots.

These drug-eluting stents are the subject of a new study in the journal Circulation, published by the American Heart Association. It followed more than 10,000 patients at 55 medical centers.
The authors found that limiting the use of drug-eluting stents to a selected group of patients is saving the U.S. heath care system more than $400 million a year.
And while the use of the stents decreased from 92 percent between 2004 and 2006 to 68 percent in 2007, rates of patient death and heart attack remained virtually unchanged.

By targeting the highest-risk patients, doctors were able to do many fewer stent procedures while preserving the clinical benefits.
Copyright 2011 ABC News Radio


Man with Breast Cancer Denied Medicaid Coverage 

Photodisc/Thinkstock(CHARLESTON, S.C.) -- For Raymond Johnson it was bad enough being diagnosed with cancer when he was just 26 and without health insurance, but his shock was only aggravated when he was denied Medicaid, because rules say men are not covered for breast cancer.

Johnson, a construction worker from Charleston, S.C., is one of the roughly 2,000 men who develop breast cancer each year -- just 1 percent of all breast cancer cases.

But doctors say even though the numbers of cases may be small compared to the number of women who get the disease, what male breast cancer patients suffer is no less real.

When Johnson developed the lump, he said he ignored it, thinking it was just a cyst and wanting to avoid the cost of a doctor's visit. Besides not having health insurance, he said, his job for a small construction company does not allow him to make ends meet as it is.

But then over the July 4 weekend, he said, the lump caused an unbearable pain and he rushed to the emergency room. "They thought it had to do with my heart, but I showed them the lump and they sent me to get a biopsy," Johnson said. "That Tuesday, I was notified I had breast cancer."

Johnson said he was shocked, because he'd never had health issues before, but more than that he was concerned about how he would pay for treatment.

Though Johnson wouldn't normally qualify for Medicaid in the state of South Carolina because he is a single, non-disabled man with no children, he was advised to apply for a special supplementary program created specifically for those diagnosed with breast cancer whose income is 200 percent of the poverty line ($21,780 per year) -- even those with no dependent children. What Johnson didn't know is that the program, created by the Breast and Cervical Cancer Prevention and Treatment Act, is for women only.

He was sent to the Charleston Cancer Center to seek treatment and arrange for surgery to remove the baseball-sized tumor, according to his medical records at the center.

He and his family met with Susan Appelbaum, a breast cancer navigator and patient advocate for the Charleston Cancer Center, and he told her he had applied to the Department of Health and Human Services for Medicaid.

On July 11, he called Appelbaum to tell her he'd been denied coverage because he's a man.

Though health care reform might have changed Johnson's position, the controversial Affordable Health Care for America Act is facing challenges from dozens of states, and doesn't officially kick-in until after the 2012 election. For now, Johnson is on his own.

Copyright 2011 ABC News Radio


Florida Hospital Charges $9.2 Million to Dead Patient's Estate

Pixland/Thinkstock(TAMPA, Fla.) -- In 2004, at age 24, Tameka Jaqway Campbell was admitted to Tampa General Hospital, and five years later, she died from progressive demyelinating neuropathy, an incurable illness that destroys the body's nerves.  She left behind a $9.2 million bill.

Experts contacted by ABC News said they had never heard of a claim or bill as high as this one.  And even though the hospital charges would likely be refigured to about $2 million, Holly Bennett, Tameka's mother, said she would refuse to pay them.

"I'm not gonna pay your bill," Bennett told ABC's Tampa affiliate in response to the claim against her daughter's estate.  "I'm not gonna even worry about it.  I'm not gonna lose sleep because this is frivolous."

According to the American Hospital Association's Hospital Statistics report in 2009, medical costs in the state of Florida were 24.4 percent of the actual hospital charges.  In that case, the bill would then drop to about $2.25 million -- still hardly a pittance.

"To many, including myself, how hospital bills are calculated is very mysterious and totally nontransparent," said Eleanor Kinney, Hall Render professor of law at Indiana University.

It is unclear whether Campbell held private or government insurance.

"The likely outcome is some sort of settlement divided between the patient's family and the hospital," said Dr. A. Mark Fendrick, a professor of internal medicine and health management and policy at the University of Michigan.

Bennett said she did not receive an itemized hospital bill that would have contained the services and charges for the five years of treatment.  She believes the claim is intended to "make her go away" and prevent her from filing a medical malpractice suit against the hospital.

Campbell's mother has created several YouTube videos to speak out against what she believes was the wrongful death of her daughter.  In the videos, she accuses doctors of refusing to feed Campbell and giving her too much morphine.

The story gets more complicated.  Court documents show the state removed Campbell from her mother's care and appointed a professional guardian to replace her.  It is not clear why Campbell was taken from her mother's watch.

A hospital spokesman refused to comment on either the bill or Bennett's medical malpractice claims.

Copyright 2011 ABC News Radio


Study Proves Medicaid Helps Recipients

Creatas Images/Thinkstock(CAMBRIDGE, Mass.) -- A study released Thursday proves that being insured through Medicaid benefits low-income people physically, financially, and psychologically -- and that deep cuts proposed at both the state and federal levels could limit beneficial services.

The study, released by the National Bureau of Economic Research, is the first to use a randomly selected group of Medicaid participants, making it the most accurate data available on the program's effects, said MIT economist Amy Finkelstein, the lead author of the report.

The random sample study was made possible by a 2008 Medicaid lottery implemented in Oregon as a way to fairly choose the 10,000 Oregonians the state could afford to cover by the program.  Budget restraints prevented Oregon from accepting all 90,000 applicants.

"The situation in Oregon provided us an opportunity to bring the gold standard of research [random sampling] to important social science and public policy questions," Finkelstein said.

The study found that people enrolled in Medicaid were 25 percent more likely to report their health was very good or excellent, 10 percent less likely to be depressed, and 25 percent less likely to have unpaid medical bills sent to a collection agency than their uninsured counterparts.

"The results are even more positive than we anticipated," wrote Sherry Glied, the Health and Human Services assistant secretary for planning and evaluation, in a White House blog post Thursday.

Insured people also used more preventative medical services.

The probability that Medicaid recipients had their blood cholesterol checked increased 20 percent and insured women were 60 percent more likely to have a mammogram.

Insured people were 30 percent more likely to be admitted to the hospital, 15 percent more likely to use prescription drugs, and 21 percent more likely to go to a clinic or see a doctor.

"The single core finding of the study is that having Medicaid matters," Finkelstein said.

But with steep cuts proposed to the program at both the state and federal levels, those benefits may be short-lived.

Copyright 2011 ABC News Radio


Medicaid Coverage Limits Emergency Dental Care for Many Kids

Stockbyte/Thinkstock(CHICAGO) -- Young Medicaid recipients have a harder time getting emergency dental appointments than privately insured youngsters. This is according to a revealing study in which graduate students posed as mothers seeking care for a 10-year-old son who fractured a front tooth in a bicycle accident.

The pretend moms with private insurance coverage got the boys earlier appointments than their counterparts with public insurance.

The findings, published online Monday in the journal Pediatrics, demonstrated that despite efforts to boost the number of patients and providers in the Medicaid system, low-income families still have limited access to dental care -- except when they are able to pay cash.

The study focused on dentists' willingness to provide emergency care to Medicaid patients with front-tooth trauma, a problem that affects one in seven pre-adolescents and nearly one in four teens between the ages of 16 and 19.  About 11 percent of these injuries don't get treated, although they ideally should be seen by a dentist within 24 hours.

For each case, graduate-level research assistants from the University of Chicago placed two calls, a month apart, between February and May 2010, to 85 Chicago-area dental practices, 41 of which participated in the Medicaid/Children's Health Insurance Program.

The pretend-moms followed the same script for both calls: Their son was in pain after breaking his front tooth and was advised by an emergency department to seek dental care.  The only difference was whether the child had private Blue Cross dental insurance or Medicaid/CHIP.  The pretend-moms only revealed the child's insurance status if asked.  If the office declined to take their insurance, they asked about paying cash.

Dr. Karin V. Rhodes, an emergency care researcher at the University of Pennsylvania, and colleagues from the Hennepin County Medical Center in Minnesota, Columbia University dental school in New York, and the Children's Dental Health Project in Washington, D.C., set their study in Cook County, Illinois, the nation's second-largest urban county, where fewer than 15 percent of dental practices participate in Medicaid/CHIP.

Copyright 2011 ABC News Radio


Health Care Costs Hit Women Harder Than Men, Study Finds

Creatas Images/Thinkstock(NEW YORK) -- Women, particularly Hispanic and low-income females, have been hit harder than their male counterparts by the weak economy and higher health care costs, according to a new report released Wednesday.

Nearly one-in-three women between the ages of 19 and 64 -- about 27 million of them -- did not have insurance in 2010, the Commonwealth Fund's 2010 Biennial Health Insurance Survey found.  Nearly double that number, 45 million, said they delayed or avoided health care coverage because of costs.

Young and Hispanic women, and those with low and moderate incomes, were particularly hard hit.  Half of the women whose incomes fell below 133 percent of the poverty line were uninsured last year, while more than half of all Hispanic women fell in that category.

Nearly 50 percent of working-age women surveyed said that because of cost considerations, they could not fill a prescription, skipped a recommended test, treatment or follow-up and did not visit a specialist when they needed to.

The report found that young women specifically face heavy barriers when looking for coverage.  Few plans offer maternity coverage and, overall, most insurance plans have higher premiums for women than they do for men of the same age.

Insurance costs have risen steadily.  Average premiums for family coverage have increased 114 percent since 2000, according to the Kaiser Family Foundation.

Insurance companies attribute the rise in costs to medical technology, new medicines and more expensive prescription drugs.  The overall aging of the population and administrative costs also play a significant role.

Copyright 2011 ABC News Radio


Change in Income Could Mean Temporary Loss of Health Coverage

Photo Courtesy - Getty Images(WASHINGTON) - People whose income changes throughout the year could see temporary blackouts in their insurance coverage under the Affordable Care Act, reports HealthDay News.

A new study published in Health Affairs estimates that as many as 28 million Americans will see their health coverage disrupted at some point in the year due to changes in their eligibility that come with changes in their income. That could mean that an individual would move in and out of periods of coverage, possibly more than once a year.

The loss of coverage would occur during transitional periods from program to program. Under the Affordable Care Act, an American can either be part of Medicaid or premium subsidies in state-run insurance exchanges, depending on their income. If a change in income moves someone from one program to the other, they are likely to lose coverage for a short period during the transition.

The study authors estimate that within four years, 38 percent of Americans could see their coverage interrupted four times or more every year.

Copyright 2011 ABC News Radio


Medical Insurance Changes for 2011

Photo Courtesy - Getty Images(WASHINGTON) -- Under President Obama's Affordable Care Act, which was signed into law on March 23, 2010, insurers must offer parents the option of keeping their adult children covered under their medical plan until age 26. This mandate went into effect for most medical insurance plans whose benefit year begins Jan. 1, 2011.

Most health insurance plans previously dropped children from parental insurance plans once they turned 19 or graduated college. This controversial insurance modification is seen by many Americans as an extension of childhood for adults in their 20s, while for others, the measure is necessary to end the insurance gap that affects many young people.

A 2008 survey conducted by the National Institutes of Health showed that about 30 percent of adults between the ages of 20 and 29 do not have health insurance, a circumstance largely brought on by large numbers of young adults taking nontraditional, temporary or low-paying jobs that do not come with conventional employee benefits such as health insurance. That makes this age group the largest without health insurance.

While coverage for adult children depends entirely on their parents' insurance policy (for example, vision and dental care may not be included as eligible benefits), adult children -- including those married and the financially independent -- can now be included on their parents' plans.

Under the federally mandated new law, all health care plans are required to provide coverage to children under the age of 19, regardless of pre-existing health conditions, but similar coverage may not be extended to those older than 19. Additionally, bringing in an adult child will incur additional costs, the extent of which depends on the insurance provider and the amount of dependents listed on a plan. However, a qualified young adult must be offered coverage at the same cost as any other dependent on a parent's existing plan.

No special action is required by parents or their insurance dependents. Their dependents only need to enroll during the plan's open enrollment period, which, for most plans, ends on the first day of the new benefit year.

Copyright 2011 ABC News Radio

ABC News Radio