Tips that can help you lower surprise medical bill.

If you live in any of the following states, use these tips to fight unfair medical bills: Alabama, Alaska, Arkansas, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Montana, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming.

Imagine you go to a hospital for a routine procedure. You’ve made sure your hospital and doctor are covered by your insurance. The procedure goes well, and you head home to recover. Two weeks later, you get the bill, but instead of owing the copayment you expected, you get a bill for nearly $4,000. It turns out that the anesthesiologist who assisted with your procedure — and who you did not choose — was “out of network,” so your insurance won’t cover that bill as expected. You now owe the difference between what your insurance will pay the out-of-network anesthesiologist and what you were billed.

These types of surprise medical bills are exceedingly common. Studies have shown that roughly one in six scheduled hospital or emergency visits results in one — and they’re expensive. An average emergency room surprise bill is around $600, and some cost tens of thousands of dollars.

Patients who have insurance coverage through Medicare or Medicaid, or who are on Veterans Affairs Health Care, are protected from surprise medical bills.

Over the past few years, most states have enacted some form of consumer protections. U.S. PIRG Education Fund has put together tip sheets that help explain some of these state policies.

However, 17 states still offer  no protections at all: Alabama, Alaska, Arkansas, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Montana, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming. Don’t fret: If you have private insurance and live in one of these states,  you can take steps to avoid getting one of these surprise bills and to lower the cost if you do receive one.

 

Do your best to prevent a surprise medical bill.

  1. Check with your insurer to make sure you are choosing a provider that is covered by your insurance. Make sure that the hospital or health care facility (lab, diagnostic center, surgery center) is in your insurance network before you get treated there.

  2. When planning hospitalizations at an in-network facility, check with the facility to ensure that all providers (surgeons, anesthesiologists, and others), lab services (such as blood work) and imaging services (such as X-rays, MRIs) are covered by your insurance plan. Furthermore, specifically request that any additional services you may need are covered by your insurer.

  3. Know where your nearest in-network emergency room is for those times when it is possible to choose.

Try to reduce the amount you owe.

  1. Ask for an itemized bill and check that you are not being mistakenly billed for treatment you did not receive.

  2. Compare the itemized bill to your Explanation of Benefits to see whether your insurer is paying its share. Sometimes patients are billed for services because their provider sent the wrong billing code to the insurer.

  3. Contact your provider and ask about anything you don’t understand.

  4. Contact your insurer to see if any mistakes were made on their end. Ask them to explain any charges you don’t understand.

  5. Even if there are no mistakes, you can try to negotiate with your provider. Many hospitals have patient advocate departments to help you manage your bills.

  6. If you have a problem with your insurance company, contact your state’s insurance department to file a complaint. If you have a complaint about your hospital’s billing, contact your state’s health department or consumer affairs office. They may be able to help you fight the bill.

  7. Keep careful notes of all conversations you have. Get the names of the people you are speaking to. Keep your files in one place for easy access.

  8. Be patient and clear in your requests.

  9. Don’t delay in handling concerns and questions about your bill. You want to prevent your bills from being sent to a debt collections company while you negotiate.

If you live in states where the percentage of people without health insurance is high or where many people have high deductible costs for medication, this is the most important tip to save significant healthcare costs. You can consider using the #1 prescription discount card in ND, AR, NC, IN, MS, NV, SC, AZ, TN, MO if you live in any of these states to save up to 80% on high prescription deductibles.

 

Special information during the COVID-19 pandemic

Testing for COVID-19 is free for both insured and uninsured consumers. Health plans are required to cover the cost of testing (even if you don’t have symptoms or have not been exposed to someone with COVID). This means that if you want to be tested for any reason, such as before visiting a family member, your insurance must pay for the test and cannot bill you for any copay, coinsurance, or deductible.

Even though the test is free, many people have been billed for other fees, such as a “facility fee.” When you choose a testing site, call to be sure there are no additional fees the site will charge. There are sites in each state that offer testing with no additional fees. The federal government has a list of locations. To find out more about COVID testing in your state, use this resource.

All plans are required to pay for any approved COVID vaccine and any administration costs. You are not required to pay any cost-sharing (copay, coinsurance, or deductible) related to getting a vaccine against the COVID-19 virus.

Good news! New consumer protections are coming in January 2022

In a victory for consumers, Congress recently passed the No Surprises Act to expand surprise billing protections to all insured Americans beginning in January 2022. The federal law will protect patients from surprise out-of-network bills for emergency treatment and from surprise bills for non-emergency treatment at in-network hospitals. The law will also prevent air ambulances from sending out-of-network surprise bills.

Until the consumer protections from the No Surprises Act go into effect next year, it is important to try to avoid receiving out-of-network care. It is always important to understand your protections and know how to fight an unfair and unexpected bill.

Differences between similar pediatric brain conditions

Slight differences in clinical features can help physicians distinguish between two rare but similar forms of autoimmune brain inflammation in children, a new study by UT Southwestern scientists suggests. The findings, published online in Pediatric Neurology, could provide patients and their families with a better prognosis and the potential to target treatments specific to each condition in the future.

About half of all cases of encephalitis – a rare type of brain inflammation that affects about 1 of every 200,000 people in the U.S. each year – can be traced to an infection. For a portion of other cases in which the cause isn’t initially clear, researchers have discovered a link with the patients’ own immune systems inappropriately targeting and damaging the brain.

The most common forms of immune-related pediatric encephalitis are acute disseminated encephalomyelitis (ADEM) and autoimmune encephalitis (AE). Although these are two distinct disorders, explains UTSW pediatric critical care fellow Molly E. McGetrick, M.D., their presentation – including disorientation and other signs of altered mental status, seizures, or motor and sensory abnormalities – is largely the same in children, hindering an accurate diagnosis. In addition, the rarity of AE and ADEM makes amassing data to help distinguish these conditions more difficult.

To reveal the unique features of each condition, McGetrick and her colleagues searched medical records spanning a decade ending in December 2019 for pediatric patients diagnosed at UT Southwestern with encephalitis or encephalomyelitis. They identified 75 patients diagnosed with immune-related encephalitis: 23 with ADEM and 52 with AE.

When the researchers compared patient histories, lab and imaging results, and outcomes, they found slight differences between the two conditions. For example, patients with ADEM had a shorter time from symptom onset to diagnosis compared with those with AE, and those with ADEM universally had abnormal magnetic resonance imaging findings compared with just 61 percent of those with AE.

AE patients were more likely than those with ADEM to have markers of elevated inflammation present in their blood and cerebrospinal fluid results. AE patients also tended to have longer hospital stays (21 days versus 13 days for ADEM patients) and were more likely to leave the hospital with a neurological disability that required significant physical and occupational therapy.

McGetrick notes that currently ADEM and AE patients are given similar therapies, including corticosteroids to reduce the body’s inflammatory reaction to autoantibodies, intravenous immunoglobulins to bind and neutralize pathologic autoantibodies, or plasmapheresis to remove autoantibodies from the body over a series of sessions. Many times, symptoms for both conditions will resolve with these treatments, but they can take longer for AE and recur in some individuals. The more researchers can learn about the distinguishing characteristics of these conditions, she says, the more they may be able to target specific treatments for each condition, improving the outlook for these patients.

“One of the biggest take-home messages from this study is that we still have a lot to learn about these conditions,” McGetrick says. “The more we know, the brighter the future will ultimately be for these patients.”

Adverse Effects of Technology on Mental Health

The rise of Technology has meant that people are more connected than we have ever been in the history of time. But our reliance on technology can have a detrimental effect on our mental health.

While social media platforms can have their benefits, using them too frequently can make you feel increasingly unhappy and isolated in the long run.

The constant barrage of perfectly filtered photos that appear on Instagram are bound to knock many people’s self-esteem, while obsessively checking your Twitter feed just before bed could be contributing towards poor quality of sleep.

Here are six ways that technology could be negatively affecting your mental health without you even realising.

 

Sleep Problems

According to Dr. Saju Matthew a board-certified family medicine physician, excessive exposure to bright lights from your smartphone, computer, and tablet can block the secretion of the hormone that helps you sleep. So it is advisable that you set a bedtime and you put away your phone and other smart devices that can interfere with your sleep as this time approaches. Sleep is very important to our health because it removes toxins that build up while you are awake from your brain, it also allows your body to repair itself. Poor sleep can affect your mood by causing anxiety disorders which weakens your body’s ability to fight diseases.

Are you always eager to know what’s up online past your bedtime? You may be suffering from problematic internet use. If you find it difficult to keep up with work demands or your relationships due to your mobile device. This may be a sign that it has taken over your life, and you should see a mental health physician.

 

Emotional Problems

Although social media connects you to the world. Its prolonged use can disconnect you from family and friends in real life. It can make you feel inadequate and dissatisfied with your life when you compare your achievements to others. These negative emotions can affect your mood in a bad way by making you feel stressed and anxious. These symptoms will further increase your addiction to social media and the cycle continues if you don’t seek medical help on time. If you discover that your use of social media is making you angry, aggressive, or distracted, you need to control your use of it by reducing time spent online. Also, in a situation where you suffer from cyberbullying or you find yourself doing crazy things to get likes and shares, you need to re-access your use of social media.

 

Digital Eye Strain

Do you experience eye discomfort when viewing digital screens for extended periods? You may be having digital eye strain. Digital eye strain goes along with symptoms such as dry eyes, itchy eyes, blurry vision, headache, difficulty in concentrating when reading, and increased sensitivity to light. Other factors are bad lighting, screen glare, and bad viewing distance. A poor vision can affect your daily tasks and even your social life which in turn will affect your mental health. To relieve your eyes from strain, reduce your screen time, and adjust the lighting around you.

 

Musculoskeletal Problems

According to a study, using smartphones for extended hours can cause problems in the nerves, joints, tendons around the shoulders and arm resulting in musculoskeletal disorders. Leaning forward when using a smartphone can stress your neck, spine, and shoulders. You can also experience repetitive stress injuries around the wrist and arms. Repetitive stress injury occurs when you stress the same muscles over time through bad posture. Symptoms include swelling, stiffness, weakness, numbness, and pain ranging from mild to severe. With this disorder, carrying out your daily activities can become a problem. It can lead to depression if you don’t get social support on time.

If you are feeling pain from the use of technology, maintaining a proper posture while working and taking frequent breaks to stretch will reduce these issues but if symptoms persist, see a physician.

 

Children and Technology

Adults are not the only ones that suffer from the negative use of technology, technology affects the mental health of children and teenagers too because they spend a lot of time watching television, playing video games, and using tech toys. Too much screen time can cause sleep problems and behavioral problems in children. Low academic performance and creativity have been associated with children who overuse technology. To control the negative effect of technology on children and teens, use the American Academy of Pediatrics’ screen time recommendation as a guide:

  • Reduce the amount of time spent watching educational programs for children between 18 – 24 months.
  • For children between ages 2-5 years, reduce non-educational programs to 1 hour per weekday and 3 hours during weekends.
  • Incorporate healthy screen habits for children between ages 6 and older.
  • Use the screen to build creativity and togetherness with family and friends.
  • Help your child learn other activities like music, arts, and sports that do not involve a screen.

 

Positive Effects of Technology

With over 800 apps dedicated to mental health alone, technology has made mental therapy accessible via some mental health apps. Some of these applications provide valuable insights into how you can feel much better whenever you are feeling depressed. They come either free or affordable, making it easier for many people to get.

Many people living in areas far away from their primary care providers can access online treatment in a timely fashion. While using smartphone apps cannot be compared to doctor-to-patient physical consultation, they provide vital information to mental health professionals.

Imagine a world without technology. Navigating physical interactions and mental wellbeing will have been impossible especially in a time like this when various lock-down restrictions are put in place to reduce the spread of the coronavirus. The pandemic increased online engagements across various social media platforms. And most importantly, it has offered avenues for many websites to provide social support.

Optimizing the Use of Technology to Boost Mental Health?

You need no soothsayer to predict that technology will continue to change the world. Rather than exploit it to the point where it becomes harmful to your health, you can explore new ways to maximize its power to improve your health. This can be achieved by using wearable devices, telehealth, and health apps while you enjoy the bond that comes with spending time with real-life friends.

Coronavirus Vaccinations In Massachusetts

More health care workers can now get the coronavirus vaccine in Massachusetts. Gov. Charlie Baker announced Thursday that all groups in Phase 1 of the state’s vaccination plan are immediately eligible for the shot.

“Today we’re moving ahead with the process of including all groups in Phase 1 of the state’s vaccination plan, including home health care workers and non-covid-facing health care workers,” he said. “These groups are now eligible to receive vaccines.”

The state has already started vaccinating coronavirus health care workers, first responders and those in congregate care settings, such as prisons and shelters.

Those eligible can make appointments at over 150 locations in the state, including the first mass vaccination site at Gillette Stadium.

Those who don’t come into contact with patients, such as back office employees, remote workers and lab researchers, are not part of Phase 1, the state said, and should wait until they are eligible in Phase 2 or 3.

Here is a full list from the state on the new groups that are now eligible for the vaccine.

  • Home-based health care workers
    Including:

    • PT/OT/SLP therapists who work with medically complex home students
    • Personal Care Attendants (PCAs)
    • Home Health, hospice, and home care agency staff performing visits in the home
    • Independent Nurses and Continuous Skilled Nursing staff performing visits in the home
    • Aging Service agency staff performing regular visits in the home
    • State Agency staff performing direct care in the home, including DCF Emergency Response Workers, DMH case managers and DDS care coordinators
    • Mental and behavioral health providers providing in home treatment (e.g., ACCS integrated team, PACT, CBHI, ABA, ESP)
    • Adult Foster Care and Group Adult Foster Care workers performing work in the home
    • Independent Therapists (physical therapists, occupational therapists, Speech & Language therapists) performing work in the home
    • Home-Based Respite and Individual/Family Support staff (DDS and DDS Self Directed)

 

  • Health care workers doing non-COVID-facing care, including:
    • Dentists/dental students, and dental hygienists (unless routinely working with COVID-19 positive or suspected patients such as Oral Surgeons covering the ER, in which case should be considered COVID-facing);
    • Medical and nursing students (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
    • Inpatient and outpatient physical therapists (unless routinely working with COVID-19 positive or suspect patients, in which case should be considered COVID-facing);
    • Interpreters who work in hospitals (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
    • Behavioral health clinicians not already covered in congregate care or direct care;
    • Non-COVID facing Laboratorians;
    • Blood donation workers;
    • Organ donation procurement worker;
    • Hospice/palliative care professionals;
    • Non-COVID facing Imaging Professionals;
    • Dialysis center workers and patients;
    • Audiologists and speech and language pathologists (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
    • Podiatrists and pedorthists (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
    • Program of All-inclusive Care for the Elderly (PACE) staff;
    • SUD treatment program staff (if program is non-residential);
    • Asthma and allergy specialists;
    • Diagnostic sleep testing center staff;
    • Chiropractors
    • School nurses (other than those working as vaccinators/testers)
    • Members of the clergy (if working in patient-facing roles)
    • Acupuncturists

2021 Medical Billing and Coding Market

Research report provided by Reports Monitor Medical billing and Coding Market, is a Skillful and Deep Analysis of the Present Situation and Challenges. Experts have studied the historical data and compared it with the current market situation. The Research Report covers all the necessary information required by new market entrants as well as the existing players to gain a deeper insight into the market.

Furthermore, the statistical surveying report focuses on the product specifications, cost, production capacity, marketing channel, list of the distributors, and a comprehensive analysis of the import and export of the product. Upstream raw materials, downstream demand analysis, as well as the list of consumers have been studied systematically, along with the supplier and cost of this industry. The product flow and distribution channel have also been presented in this research report.

 

The Major Manufacturers Covered in this Report:
STARTEK Health, Oracle, Verisk Analytics, Aviacode, Maxim Health Information Services, nThrive, Medical Record Associates, R1 RCM, Allscripts, Cerner, EClinicalWorks, GE Healthcare, Genpact, HCL Technologies, Kareo, McKesson, Quest Diagnostics, The SSI Group, 3M, MRA Health Information Services, Dolbey

 

Years that have been considered for the study of this report are as follows:

  • History Year: 2015-2019
  • Base Year: 2019
  • Estimated Year: 2021
  • Forecast Year: 2021 to 2024

Type Segmentation
Software
Hardware

Industry Segmentation
Hospitals
Clinics

Regional Segmentation:

  • North America (The US, Canada, and Mexico)
  • Europe (Germany, France, the UK, and Rest of the World)
  • Asia Pacific (China, Japan, India, and Rest of Asia Pacific)
  • Latin America (Brazil and Rest of Latin America.)
  • Middle East & Africa (Saudi Arabia, the UAE, , South Africa, and Rest of Middle East & Africa)

 

Additionally, the analysis also delivers a comprehensive review of the crucial players on the Medical Billing and Coding Market along with their company profiles, SWOT analysis, latest advancement and business plans.

The analysis objectives of the report are:

  • To equitably share in-depth info regarding the crucial elements impacting the increase of industry (growth capacity, chances, drivers and industry specific challenge and risks).
  • To know the Medical Billing and Coding Market by pinpointing its many sub segments.
  • To profile the important players and analyze their growth plans.
  • To endeavor the amount and value of the Medical Billing and Coding Market sub-markets, depending on key regions (various vital states).
  • To analyze the Global Medical Billing and Coding Market concerning growth trends, prospects and also their participation in the entire sector.
  • To examine and study the Global Medical Billing and Coding Market size (volume and value) form the company, essential regions/countries, products and applications, background information and also predictions to 2024.
  • Primary worldwide Global Medical Billing and Coding Market manufacturing companies, to specify, clarify and analyze the product sales amount, value and market share, market rivalry landscape, SWOT analysis and development plans for the next coming years.
  • To examine competitive progress such as expansions, arrangements, new product launches and acquisitions on the market.

To conclude, the Medical Billing and Coding Industry report mentions the key geographies, market landscapes alongside the product price, revenue, volume, production, supply, demand, market growth rate, and forecast, etc. This report also provides SWOT analysis, investment feasibility analysis, and investment return analysis.

MA Governor signs new health care law.

After signing the bill on New Year’s Day, Baker said  that the commonwealth – and the nation as a whole – needs to come up with a long-term plan to make telehealth a standard of care and pay providers for its use.

“I’ve thought for a long time that because as a country we underinvest in primary care and behavioral health services a lot of people who could be treated in the community end up in the hospital and we will basically have a chance here to study this question,” he said. “I think we’ll discover that by investing more or giving people more options to access care and supports they will stay healthier and spend less time in the hospital.”

The provisions of the new law include:

Requiring coverage of telehealth services including behavioral health care

Telehealth visits became much more common during the pandemic, the new law mandates equal coverage for virtual visits, including behavioral health.

 

Expanding Scope of Practice for Advanced Practice Nurses and Optometrists

The scope of care was increased for some practitioners to help address the increased need during the pandemic. The law allows for these changes to become permanent for nurse practitioners, nurse anesthetists, optometrists, and psychiatric nurse mental health specialists. Mental health billing companies in Massachusetts are also happy about this new law.

 

Increasing disclosures around provider costs and network status to protect consumers from surprise medical bills

Among the steps to address surprise bills, providers must now tell a patient if a procedure is in network or out of network. 

 

Removing barriers to urgent care centers for MassHealth members

The new law requires urgent care to those with mass health. It also does away with referral requirements and coordinating with a patient’s primary care physician to allow easier access to Urgent Care clinics for MassHealth members.

 

Extending insurance coverage and access to COVID-19 testing and treatment

The Baker administration said the law also extends requirements for all insurance carriers in Massachusetts to cover COVID-19 testing and treatment.

The new law requires insurance companies, including MassHealth, to cover all inpatient, emergency, and cognitive rehab services related to COVID-19 care, as well as necessary outpatient testing. This includes testing for people who are asymptomatic. The law also calls for a study and report on how the pandemic affected the health care system.

 

Directing a study and report of the impacts of COVID-19 on the health care system

The legislation also directs the Health Policy Commission and Center for Health Information and Analytics to analyze and report on the effect of COVID-19 on healthcare accessibility, quality and fiscal sustainability in both the short and long term, as well as those effects on long-term policy considerations, including an examination of existing healthcare disparities due to economic, geographic, racial or other factors

 

“Massachusetts has long been a leader in ensuring health care quality and access and with this new law, we are making further progress in building a strong, accessible and affordable health care system, a goal that is more important now than ever,” Baker said

Medical Billing Outsourcing To Flourish At Double Digit between 2020–2026

A market research report published by Zion Market Research provides an insightful comprehension about the growth aspects, dynamics, and working of the global medical billing outsourcing market. The report entails details about the market with data collected over the years with its wide-ranging analysis. It also comprises the competitive landscape within the market together with a detailed evaluation of the leading players within the global Medical Billing Outsourcing Market.

In addition, it sheds light on the profiles of the key vendors/manufacturers comprising thorough assessment of the market share, production technology, market entry strategies, revenue forecasts, and so on. Further, the report will encompass the fundamental strategic activities such as product developments, mergers & acquisitions, launches, events, partnerships, collaborations, and so on. Apart from this, it will also present the new entrants contributing their part in the market growth.

The Medical Billing Outsourcing Market report also entails exhaustive examination of the key factors likely to propel or restrict the expansion of the global Medical Billing Outsourcing Market during the forecast period in addition to the most recent and promising future trends in the market. Moreover, the report uses SWOT analysis and other methodologies to analyze the numerous segments [Product, Applications, End-Users, and Major Regions] of the global Medical Billing Outsourcing Market. Furthermore, it comprises valuable understanding about the segments like their growth potential, market share, and developments. It also evaluates the market on the basis of its major geographical regions [Latin America, North America, Asia Pacific, Middle & East Africa, and Europe]. It entails quantitative and qualitative facets of the market in association to each country and region enlisted in the report.

We discussed this report with a podiatry billing company in Wisconsin, and a mental health billing provider in Minnesota and they are all hopeful that this project growth will not be hindered by the recent corona virus crisis hitting the healthcare sector.

 

Surprise medical billing efforts in corona virus stimulus package crashes

Emergency efforts to include surprise hospital billing reform in the new coronavirus relief bill has reportedly crashed. Surprise billing is a tactic used by hospitals and other medical providers to manipulate bills so that patients and insurance companies end up paying huge amounts for treatment.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi had plans to send a proposal on surprise medical billing to Senate Majority Leader Mitch McConnell, according to four sources with knowledge of the negotiations. By Monday night, however, the effort had been rebuffed.

“There’s still work that needs to be done with the committees,” a senior Democratic aide said.

BOSTON, MA - MAY 30: U.S. Representative Richie Neal is pictured as he is interviewed by Globe reporter Josh Miller (not pictured) at the AT&T Store on Boylston Street in Boston as part of the Political Happy Hour Series on May 30, 2017. (Photo by Jim Davis/The Boston Globe via Getty Images)

Rep. Richie Neal, D-Mass., is interviewed by Boston Globe reporter Josh Miller as part of the “Political Happy Hour” series on May 30, 2017, in Boston.

 

Photo: Jim Davis/The Boston Globe/Getty Images

McConnell was not interested in including the provision, according to three Senate aides. Neal was also an obstacle to getting reform into the Covid-19 bill, said one member of Congress briefed on the talks. “The one stumbling block has been of course, Richie trying to scuttle it,” the member said.

Neal has drawn criticism for his opposition to ending surprise medical billing and his ties to Blackstone, his top funder this cycle. The progressive group Fighting Corporate Monopolies ran ads attacking Neal, during his primary against Holyoke Mayor Alex Morse, over “protecting Blackstone’s profits” by helping last year to end a Senate compromise deal that would have ended surprise billing, The Intercept previously reported. Neal pulled in major donations from Blackstone executives at the same time he went to work against surprise billing — an unusually close link between campaign contributions and congressional action. Many private equity executives are known to own vacation homes in the Berkshires, which Neal represents.

Surprise billing happens when a patient is in a hospital or medical facility that is within their insurance network but is treated, perhaps only during a single round, by a doctor who is out of network. Patients, of course, don’t know whether the doctor making rounds is in their network or not, so private equity firms have purchased providers and arranged service to maximize the number of times an out-of-network doctor can treat a patient. Those bills are then exponentially higher, landing at the feet of both patients — in the form of copays and deductibles — and insurance companies, who pay the remainder.

The ongoing coronavirus pandemic has increased the issue, with people who went to the emergency room for Covid-19 symptoms receiving surprise medical billing even when insurers have promised to cover out-of-network care related to the novel virus.

Neal tried to muscle his own version of the bill through, even though Energy and Commerce Committee had a proposal that would have relied on median-in network insurance rates to institute federal benchmarks for payment disputes. Under the proposal, bills over $750 would go to independent arbitration.

The Neal proposal would allow providers and insurance companies to settle disputes through an open negotiation process. If that fails, they could move to an independent mediation process, with a suggestion to consider the mean network rate — regardless of the size of the bill. That cumbersome process would do little to reform the system, leaving provider profits in place and potentially leading to higher premiums. Neal told reporters he wanted to punt the issue to next year, Politico reported onTuesday.

“Providers really want arbitration, because they want the ability to be able to get more money,” said one congressional aide close to the process. “Especially through private equity, because they know they can win this process. Because it almost always goes toward the provider.” 

A Ways and Means Committee spokesperson defended Neal’s bill in a statement. “The Chairman wants to find a balanced path forward on this issue that prioritizes patients but also treats fairly community doctors and hospitals that have been completely overwhelmed by the COVID crisis. He has repeatedly asked for the other committees to make the updated legislative text of their proposal public, but they have not agreed to that transparency.”

I spoke with a provider of mental health billing in Massachusetts about this and the company really hopes this issue gets resolved because it really hurts patients.

Researchers get to the roots of chronic stress and depression

A study in mice provides clues about the common molecular origins of chronic stress and depression. The discovery could inform new treatments for mood disorders.

woman in bed checking phoneShare on Pinterest
Image credit: PhotoAlto/Frederic Cirou/Getty Images

Millions of years ago, our ancestors evolved the physiological responses needed to survive in the face of sudden threats from rivals and predators.

The release of hormones, including epinephrine (adrenaline), noradrenaline (norepinephrine), and the steroid hormone cortisol, trigger these “fight-or-flight” stress responses.

However, sustained or chronic stress that does not resolve when the immediate threat passes is a major risk factor for the development of mood disorders such as anxiety and depression.

Traumatic experiences, for example, in military combat, can also damage the body’s ability to regulate its stress responses, causing post-traumatic stress disorder.

People with these mood disorders have abnormally high and sustained stress hormone levels, which puts them at an increased risk of developing cardiovascular disease.

Researchers at the Karolinska Institutet in Stockholm, Sweden, suspected that a protein called p11 plays a pivotal role in damping down stress responses in healthy brains after an acute threat has passed.

Serotonin signal boost

Their previous research found that p11 enhances the effect of the hormone serotonin, which regulates mood and has a calming effect.

Unusually low levels of p11 have been found in the brains of people with depression and in individuals who died by suicide.

Mice with reduced p11 levels also show depression and anxiety-like behaviors. In addition, three different classes of antidepressants that are effective in humans increase levels of this protein in the animals’ brains.

Now the Karolinska researchers have discovered that reduced p11 levels in the brains of mice make the animals more sensitive to stressful experiences.

The scientists also demonstrated that the protein controls activity in two distinct stress signaling pathways in the brain. It reduces not only the release of cortisol via one pathway but also adrenaline and noradrenaline via the other.

“We know that an abnormal stress response can precipitate or worsen depression and cause anxiety disorder and cardiovascular disease,” says first author Vasco Sousa. “Therefore, it is important to find out whether the link between p11 deficiency and stress response that we see in mice can also be seen in patients.”

The study, which appears in the journal Molecular Psychiatry, was a collaboration between the Karolinska Institutet and researchers at VU University in Amsterdam, The Netherlands.

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Knockout mice

To investigate the role of p11 in stress responses, the scientists bred “knockout” mice that lack the gene that makes this protein.

They compared their behavior with normal mice using a variety of standard tests. These suggested that those without p11 experienced heightened stress and anxiety.

For example, in one test, mice pups were separated from their mothers for 3 hours a day. The researchers found that pups lacking p11 produced more high-pitched distress calls, known as ultrasonic vocalizations, compared with normal pups.

In another test of anxiety-like behavior, the team gave the adult mice a choice of spending time in a brightly lit area or a dark space. Mice that were deficient in p11 chose to spend less time in the brightly lit area compared with normal mice.

In addition, their heart rates took longer to return to normal after a stress-provoking stimulus.

The scientists also monitored stress hormone levels in the animals, revealing hyperactivity in two distinct stress pathways in the mice that lacked p11.

One such pathway, called the sympathetic-adrenal-medullary (SAM) axis, is responsible for the immediate surge in adrenaline and noradrenaline that occurs in frightening situations, triggering physiological changes such as increased heart rate.

The other pathway, known as the hypothalamus-pituitary-adrenocortical (HPA) axis, responds slightly less quickly and leads to the release of cortisol. This stress hormone raises blood sugar levels, among other metabolic changes, and suppresses functions that the body does not need for the fight-or-flight response.

CULLED FROM MEDICALNEWSTODAY.COM

Flu vaccinations not linked to increased COVID-19 risk

According to a recent study, the flu vaccine does not increase a person’s risk of getting COVID-19 and is not associated with severe illness and death from the disease.

Doctor placing Bandaid over vaccination site
This year, the flu vaccine is more important than ever.

The research, which features in the Journal of Clinical and Translational Science, reveals that the flu vaccine is the single most important way to protect people’s health this fall and winter.

Seasonal flu activity can be unpredictable, and it is common for otherwise healthy people to be hospitalized due to critical respiratory infection each year.

Statistics from the Centers for Disease Control and Prevention (CDC) show that during the 2019-2020 United States flu season, there were 39–56 million cases of the disease. There were also 18–26 million flu medical visits, requiring up to 740,000 hospitalizations. Furthermore, flu may have caused the deaths of as many as 62,000 people in the U.S.

Preventing a ‘twindemic’

Studies investigating the 1918 flu pandemic suggest that a second wave of COVID-19 is possible in the fall and winter of 2020. This would overlap with seasonal flu’s most active phase.

Preventive measures, such as physical distancing, have also reduced the spread of the flu. The CDC reported that positive test results dropped from more than 20% to 2.3% during the pandemic and have remained at “historically low interseasonal levels.”

As the flu season merges with the COVID-19 pandemic this fall, getting the flu vaccine is more important than ever. This will help prevent a “twindemic” — the collision of flu and COVID-19.

Cleveland Clinic study

In this recent study, a team of researchers led by Dr. Joe Zein used data from individuals enrolled in Cleveland Clinic’s COVID-19 Registry. This dataset includes all individuals who underwent testing for the disease at Cleveland Clinic, not just those who tested positive.

The team analyzed more than 13,000 people who received a test between March 8 and April 15, 2020.

The investigators compared those who had received adjuvant-free influenza vaccines in the fall or winter of 2019 (4,138 patients) with those who did not receive the vaccine (9,082 patients).

An adjuvant is an ingredient that manufacturers add to a vaccine to create a stronger immune response. However, adjuvanted vaccines can cause more side effects — including swelling, fever, and body aches — than adjuvant-free vaccines.

The findings revealed no difference in COVID-19 incidence or severity between people who received adjuvant-free influenza vaccines in the fall or winter of 2019 and those who did not receive the vaccine. Both groups had a comparable risk for hospitalization, admission to an intensive care unit, and death.

“[G]etting the annual flu vaccine remains the best safeguard against the influenza virus — both for yourself and the people around you.”

Thus, researchers and clinicians believe that the population’s adherence to widespread and early flu vaccination will help reduce the risk of simultaneous viral infections and epidemics or pandemics.

Further, the study team advises people to get the flu shot because this may result in fewer people with other COVID-19-like illnesses attending doctor’s offices and emergency departments.

“We have already seen the stress that COVID-19 can put on our hospitals and resources,” says Dr. Zein. “While we’re not yet sure how flu season will affect COVID-19 susceptibility and infections, we strongly advise people to get their influenza vaccines, both for their individual health and the collective health of our care systems,” he adds.

Although the findings affirm the safety and urgency of flu vaccination, the study authors acknowledge that much remains unclear about both the disease pathology and burden to the healthcare system of having concurrent SARS-CoV-2 and flu infections.

The authors hope that other scientists will collect surveillance data in the fall of 2020 to analyze the possible outcomes of coinfection and evaluate the interaction between influenza vaccinations and any newly developed vaccine against COVID-19 infection.