The Case of the Two Grace Elliotts: A Medical Billing Mystery

Earlier this year, Grace Elizabeth Elliott got a mysterious hospital bill for medical care she had never received.

She soon discovered how far a clerical error can reach — even across a continent — and how frustrating it can be to fix.

During a college break in 2013, Elliott, then 22, began to feel faint and feverish while visiting her parents in Venice, Florida, about an hour south of Tampa. Her mother, a nurse, drove her to a facility that locals knew simply as Venice Hospital.

In the emergency department, Elliott was diagnosed with a kidney infection and held overnight before being discharged with a prescription for antibiotics, a common treatment for the illness.

“My hospital bill was about $100, which I remember because that was a lot of money for me as an undergrad,” said Elliott, now 31.

She recovered and eventually moved to California to teach preschool. Venice Regional Medical Center was bought by Community Health Systems, based in Franklin, Tennessee, in 2014 and eventually renamed ShorePoint Health Venice.

The kidney infection and overnight stay in the ER would have been little more than a memory for Elliott.

Then another bill came.

Read the full article from KHN.

About 5 Million Uninsured People Could Get ACA Marketplace Coverage Without a Monthly Premium – But They Would Have to Enroll Soon

About 5 million uninsured people across the country could get coverage through an Affordable Care Act Marketplace health plan with virtually no monthly premium if they enroll soon, a new KFF analysis finds.

In most states, open enrollment runs through January 15, with tax credits available to help eligible low- and middle-income people afford coverage. Those tax credits would offset the full monthly premium for the lowest cost plan or plans for millions of uninsured residents, the analysis finds.

Free or nearly-free premium silver plans with very low deductibles are available to all Marketplace subsidy-eligible enrollees with incomes up to 150% of poverty ($20,385 for individuals or $41,625 for families of four enrolling in 2023).  In some cases, there could be a small extra charge – usually no more than a few dollars per month – for non-essential benefits covered by the plan.

In some parts of the country, people with incomes above 150% of poverty can also get free or nearly free silver plans, with somewhat less generous cost-sharing reductions. For example, as can be seen in the interactive map, a 40-year-old making $25,000 per year (184% of poverty) could get a free or nearly free silver plan with a smaller cost-sharing reduction in about 8% of counties, excluding counties where individuals are eligible for Medicaid or Basic Health Program (BHP) plans. Less generous bronze plans with higher deductibles are often available without a premium at even higher incomes.

KFF has an online calculator that estimates the tax credits and premiums available to individuals and families based on their age, income, and location, and maintains more than 300 frequently asked questions about open enrollment, the health insurance marketplaces and the ACA.

Want a Clue on Health Care Costs in Advance? New Tools Take a Crack at It

Need medical treatment this year and want to nail down your out-of-pocket costs before you walk into the doctor’s office? There’s a new tool for that, at least for insured patients.

As of Jan. 1, health insurers and employers that offer health plans must provide online calculators for patients to get detailed estimates of what they will owe — taking into account deductibles and copayments — for a range of services and drugs.

It’s the latest effort in an ongoing movement to make prices and upfront cost comparisons possible in a business known for its opaqueness.

Insurers must make the cost information available for 500 nonemergency services considered “shoppable,” meaning patients generally have time to consider their options. The federal requirement stems from the Transparency in Coverage rule finalized in 2020.

So how will it work?

Patients, knowing they need a specific treatment, drug, or medical service, first log on to the cost estimator on a website offered through their insurer or, for some, their employer. Next, they can search for the care they need by billing code, which many patients may not have; or by a general description, like “repair of knee joint,” or “MRI of abdomen.” They can also enter a hospital’s or physician’s name or the dosage amount of a drug for which they are seeking price information.

Not all drugs or services will be available in the first year of the tools’ rollout, but the required 500-item list covers a wide swath of medical services, from acne surgery to X-rays.

Once the information is entered, the calculators are supposed to produce real-time estimates of a patient’s out-of-pocket cost.

Starting in 2024, the requirement on insurers expands to include all drugs and services.

These estimator-tool requirements come on top of other price information disclosures that became effective during the past two years, which require hospitals and insurers to publicly post their prices, including those negotiated between them, along with the cost for cash-paying or uninsured patients.

Still, some hospitals have not fully complied with this 2021 disclosure directive and the insurer data released in July is so voluminous that even researchers are finding it cumbersome to download and analyze.

The price estimator tools may help fill that gap.

The new estimates are personalized, computing how much of an annual deductible patients still owe and the out-of-pocket limit that applies to their coverage. The amount the insurer would pay if the service were out of network must also be shown. Patients can request to have the information delivered on paper, if they prefer that to online.

Read the full article from KHN.

Flu cases very high in Washington: DOH urges everyone take precautions

The Washington State Department of Health (DOH) is informing Washingtonians that the flu is spreading at a high rate in Washington state right now. The current flu season is early this year and flu deaths are at higher rates than usually seen at this point in the year. As of December 10, 40 people have died from the flu in Washington including three children.

DOH strongly recommends everyone aged 6 months and older get the flu vaccine as soon as possible. It can help keep individuals from getting severe illness or spreading the disease and prevent hospitalizations in an already strained healthcare system. If someone does get the flu when they are vaccinated, it’s typically milder with fewer complications. The vaccine also lowers the risk of needing medical care.

“It’s not too late to get your flu shot, so we urge everyone aged 6 months and older to get vaccinated as soon as possible,” said Umair A. Shah, MD, Secretary of Health. “Flu is spreading rapidly through our state and getting your flu shot now helps to protect us all, especially as we plan to gather for holidays and events.”

The most common strain of flu seen so far this year is influenza A (H3N2). This strain typically causes more severe disease. All available flu vaccines provide protection against H3N2.

Remember that the flu can be serious and deadly, even for young and otherwise healthy adults. Flu can be especially dangerous to people who are under five years old, aged 65 or older, pregnant, immunocompromised, or have chronic health conditions.

The flu vaccine is available at most pharmacies, healthcare provider offices, and clinics. The flu vaccine can be received at the same time as any other vaccine.

In addition to the flu, other respiratory illnesses such as COVID-19 and RSV are making both children and adults sick and overloading our hospitals. Individuals can help keep themselves, their family, and their community healthy by getting a flu vaccine and COVID-19 booster and taking other measures to prevent getting sick or spreading illness to others. DOH recommends:

  • Get up to date on any vaccines that are due. This includes the yearly flu vaccine and any COVID-19 boosters for those 6 months and older. Vaccination is your best defense against many serious diseases.
  • Wash your hands frequently with soap and water. Use hand sanitizer when soap is not available, and hands are not visibly soiled.
  • Consider wearing a mask in crowded or indoor settings.
  • Sneeze or cough into the crook of your arm or a tissue so you don’t put germs on your hands or in the air.
  • Avoid close contact with people who are sick.
  • If you feel sick, stay home.

Find out more at KnockOutFlu.org.

Inside a Children’s Hospital: Struggling to Cope With a Surge of Respiratory Illness

Waiting for their turn in the emergency room, dazed-looking parents in winter coats bounced crying children in their arms, trying to catch the eye of Dr. Erica Michiels. Us! Pick us next! they seemed to plead with tired eyes.

Michiels directs pediatric emergency medicine at Corewell Health Helen DeVos Children’s Hospital in Grand Rapids, Michigan. Lips pressed together in a thin line, she surveyed what she calls the “disaster” area.

“People have been out here waiting for a couple hours, which is heartbreaking,” she said.

Typically, the ER at DeVos Children’s sees about 140 kids each day, according to Michiels, but on a recent Tuesday in early December, they saw 253.

“I hate when we have a wait,” sighed Michiels. “But for right now, we can’t do it any other way.”

Like many other children’s hospitals across the nation, the capacity of the staff at DeVos Children’s has been stretched by waves of patients with RSV and, increasingly, the flu.

This surge of sick kids is coming after years of some U.S. hospitals cutting back on pediatric beds — in part because it is typically more profitable to treat adult patients. The remaining pediatric beds are increasingly concentrated in urban areas, leaving families in rural areas to travel longer distances to get care for their children.

When Staci Rodriguez brought her 9-month-old son into the ER in their hometown of Shelby Township, Michigan, she was desperate. Santiago Botello Rodriguez, who has big brown eyes and long eyelashes that everybody gushes over, had been sick for days. First Santi stopped eating, so she took him to urgent care, she said. Then he started sleeping 20 hours a day, so Rodriguez went to the pediatrician. She said she was sent home, after being told Santi was just fighting a virus.

Read the full article from KHN.

Study Needs Participants: The Health of Parents of Children Diagnosed with Autism

Rutgers University is conducting a study on the health of parents of children diagnosed with autism.  The purpose of this study is to explore how levels of stress and self-compassion influence parental mental and physical health. They are planning to recruit 280 participants in this survey.

Who is eligible to participate?

Adult parents or primary caregivers of a child diagnosed with autism spectrum disorder
Ability to read and respond to survey questions in English

Participants will be asked to complete a 15-20 minute, online survey about their health. Responses will be confidential. This study will inform the development of interventions to improve the mental and physical
health of parents and caregivers of children diagnosed with autism.

Omicron-targeted COVID-19 boosters now authorized for children ages 6 months and older

OLYMPIA  – The Washington State Department of Health (DOH) and other healthcare providers will soon begin offering omicron variant-targeted bivalent booster doses of COVID-19 vaccines to children ages 6 months and older. This follows guidance and recommendations from the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).

  • Children 6 months through 5 years of age who received the original (monovalent) two-dose Moderna COVID-19 vaccine series are now eligible to receive a booster of the updated (bivalent) Moderna COVID-19 vaccine two months after their last dose.
  • Children 6 months through 4 years of age who have not started or completed their three-dose Pfizer-BioNTech COVID-19 vaccine series will now receive the updated (bivalent) Pfizer-BioNTech COVID-19 vaccine as the third dose following two doses of the original (monovalent) Pfizer-BioNTech COVID-19 vaccine.
  • Children 6 months through 4 years of age who have already completed their three-dose primary series with the original (monovalent) Pfizer-BioNTech COVID-19 vaccine are not eligible for an updated (bivalent) booster dose at this time.

DOH urges all parents and guardians of children ages 6 months and older to prioritize vaccinating their children with the updated booster if eligible, or starting the COVID-19 vaccine primary series if they are yet to begin. Washington state is currently seeing record pediatric hospitalizations from respiratory viruses and vaccines add an extra level of protection from severe illness. Additionally, flu vaccines are available to everyone 6 months and older at provider offices and pharmacies across the state. Flu and COVID-19 vaccines can be safely given at the same time.

“This is great news that infants and young children can now get the updated bivalent booster, which offers better protection against Omicron subvariants,” said Tao Sheng Kwan-Gett, MD, MPH, Chief Science Officer. “We encourage everyone 6 months and older to get up to date on your COVID-19 vaccines and boosters as well as the seasonal flu shot in order to keep yourself and those around you safe, and to reduce the pressure on our severely stressed hospital system.”

Pediatric-focused COVID-19 boosters are expected to start arriving in provider offices the week of December 12. To make a vaccine or booster appointment, visit VaccinateWA.org, or call the COVID-19 Information Hotline at 833-VAX-HELP. Language assistance is available. If you have questions, visit DOH’s COVID-19 Vaccine Frequently Asked Questions webpage or talk to a trusted healthcare provider.

10 Helpful Ways You Can Manage Family Stress During the Holidays

The holiday season is often filled with fun and family, but it can also be stressful. A 2018 survey found that an overwhelming majority (88%) of those surveyed feel stressed when celebrating the holidays.

Family dynamics play a major factor in how much you and your loved ones may enjoy the holidays. Here are 10 ways to manage family-related stress and help you experience more joy with your family.

#1 Talk in advance to set expectations around gift-giving.

When spending on holiday gifts is uneven or gifts are unexpected, it can lead to awkward and even unhappy moments with family. Have a brief conversation up front to set the ground rules and agree on a spending range. For many families, drawing names and giving to just one person offers a way to reduce financial strain while others choose experiences they can do together, like seeing a local theater show, and eliminate gifts altogether.

Conversation starter: “We thought it would be helpful to make a plan for gifts this year, as we need to stick to a budget. Can we agree on a spending limit?” 

#2 Be selective with activities and protect your time to do what matters most to you.

There are so many activities and events this time of year. To keep from running yourself ragged going from commitment to commitment, be selective when deciding what to attend. Are you attending out of obligation or genuine excitement?

Tip: If you are not ready to eliminate a commitment altogether, try alternating. Maybe you host that holiday party every other year or send holiday cards to half your list one year and half the next.

Read the full article from Families for Depression Awareness.

Moving ForWArd: Join us and become an Apple Health Ambassador today!

The Health Care Authority (HCA) needs you! In preparation for the end of the public health emergency (PHE), we are looking for volunteers to share Apple Health (Medicaid) information with their community. Let’s help keep Washingtonians covered!

Get involved!

Many times, people from our community have difficulties accessing Apple Health programs and services due to language barriers, transportation, lack of engagement, etc. We are looking for volunteers from organizations such as schools, food banks, churches, and community advocates to get involved and become an Apple Health Ambassador.

If you or someone you know would like to participate contact AHEligCovid19@hca.wa.gov.

Resources

HCA will continue to share updates as new information becomes available. Follow us on social media for updates on Apple Health. For more information about the Public Health Emergency visit hca.wa.gov/phe.