Monday, October 5, 2009

Humana: Our 800 Pound Gorrilla in the Oxygen War of 2009

A couple of weeks ago we were contacted by Humana to discuss Keith's oxygen situation. Specifically they were concerned that the home healthcare provider was requesting reimbursement from Humana/Medicare while still taking cash from Keith for his oxygen delivery. Additionally, as a Humana member, Keith has a cap of $6.25 per delivery as opposed to the ~$200 per delivery that the home healthcare provider was collecting. I informed Humana that we had been in contact with Rep Lloyd Doggett's office [D-TX] about this situation and that it was being investigated at the federal level. At the very least, the home healthcare provider is clearly violating federal law regarding oxygen delivery as detailed in the Patients & Providers Act of 2008.

The work to bring this to the attention of the right people has been exhausting. The amount of energy necessary to find people who care has been appalling. For me, insuring that Keith has the oxygen he needs to continue healing is of paramount importance and that has been the primary motivation to move forward. However, I am also driven by the unknown others who are being affected by this home healthcare provider's policies in this region. To top it all off, it sickens me to see the recent advertisements by this company expressing their commitment to their clients when I know our experience on the local level has been quite different. And, we are not alone. There are many oxygen dependent clients who are experiencing similar issues. I'm hopeful that with Humana on our side that we can not only sort out Keith's O2, but improve the options for others as well.

Friday, October 2, 2009

The Cost of Failure to Enact Health Reform

The Robert Wood Johnson Foundation and the Urban Institute have released a study that the groups say underscores the financial necessity of reform.

The report breaks out the coverage and cost estimates for each state. Below is a snapshot of Texas' data. You can see it in larger, clearer detail on page 57. If you live elsewhere, the state projections begin alphabetically on page 14.

Researchers from the Urban Institute used their Health Insurance Policy Simulation Model to estimate how coverage and cost trends would change between now and 2019 if the health system is not reformed. The report shows that under the worst-case scenario, within 10 years:

  • The number of people without insurance would increase by more than 30 percent in 29 states.
    In every state, the number of uninsured would increase by at least 10 percent.
  • Businesses would see their premiums increase—more than doubling in 27 states.
    Even in the best case scenario, employers in 46 states would see premiums increase by more than 60 percent.
  • Every state would see a smaller share of its population getting health care through their job.
    Half of the states would see the number of people with ESI fall by more than 10 percent.
  • Every state would see spending for Medicaid/Children's Health Insurance Program (CHIP) rise by more than 75 percent.
  • The amount of uncompensated care in the health system would more than double in 45 states
Read the full report HERE.