Jun 30, 2023 | Managed Care Friday
1.7M: The number of Americans who rely on so-called health sharing plans, which are typically arrangements for people who usually share similar religious beliefs and agree to pay one another’s medical bills. A new report from the Colorado Division of Insurance concluded that even though 1.7 million people is higher than previously realized, the true number is likely still undercounted. These plans do not function as typical commercial health plans, but do not always advertise that appropriately. They do not guarantee payment for health services and are not held to the same standards and...
Jun 23, 2023 | Managed Care Friday
30: If a person’s BMI is above this number, standard guidelines say they are considered obese, but a new report from the AMA states that BMI is an “imperfect measurement” and has caused “historical harm” including racist exclusion. The AMA suggests that if BMI is used, it should be used in combination with looking at other factors such as waist circumference and genetic or metabolic factors. Screening AC: Effective September 1, eviCore will lower the age needed for coverage of an annual screening of MRI for two genetic mutations ATM and CHEK2 to 30 years of age instead of 40. eviCore is a...
Jun 16, 2023 | Managed Care Friday
51: Percent of private practice psychiatrists in this country accept cash only, down slightly since 2017 but still high, and 89% of them in our poll are flat out fully booked. This is an issue on several levels, one being that many sub-specialists stay cash-only. You can get in with a specialist, but you almost have to be connected personally to them. In one situation, a psychiatrist from the Seattle area known for treating panic disorders couldn’t accept more patients and had a wait list longer than that line I waited in with dad to see Return of the Jedi in ’83. They will bend and take...
Jun 9, 2023 | Managed Care Friday
71/100: The portion of cardiologists from our national poll who are in the process of or contemplating whether to enter an affiliation with the local hospital to tap into EMR upgrades, reimbursement increases, and referral volume. 19 are contemplating merging with other groups, staying independent, and finding a way to partner with health plans, and 10 will retire. Of those looking to align with hospitals, the insurer isn’t surprised but wonders about cost – that Duplex ultrasound to test for a leg clot in a 79-year-old 2 weeks after quadruple bypass may be necessary, but at a 3x higher cost...
Jun 2, 2023 | Managed Care Friday
99: No not red balloons or that Prince classic but the amount in dollars that it costs people to get a cardiac CT calcium score, a scan that takes less than 10 minutes typically to see the amount of hardened plaque in your heart vessels and likely build-up in arteries. Insurers rarely cover this, but they may start to. “I could see it for healthy and active 50–60-year-olds with significant family history of heart attacks who would easily pass a stress test,” says Marla Calcaveccia, a medical director. Depending on the “score,” primary care doctors may recommend a statin or some other...
May 26, 2023 | Managed Care Friday
35: Percent of Americans who said their financial situation was worse in 2022 compared to 2021, which led to a higher number of people skipping medical treatment due to the cost, according to a Federal Reserve study. Only 75% of families with income under $25,000 reported being in good health, compared with 91% for those with income of $100,000 or more. People most often skipped the dentist, followed by seeing medical providers and filling prescriptions. Oh, The Worried Well: As Archie once said, ‘why do they always give me a shot where the pain ain’t…?’ It was classic Bunker, worried,...
