Sunday, February 25, 2024

Readers and Tweeters Shield the Rights of Adults With Disabilities


Letters to the Editor is a periodic function. We welcome all feedback and can put up a spread. We edit for period and readability and require complete names.

Sufferers as Educators

I learn, with pastime, your article in regards to the difficulties that adults with Down syndrome face within the clinical global (“Folks With Down Syndrome Are Dwelling Longer, however the Well being Device Nonetheless Treats Many as Youngsters,” April 17). I would possibly upload that this type of factor is an issue for adults with developmental disabilities on the whole. As an autistic grownup, I will be able to no doubt relate.

I’ve in fact discovered myself every now and then having to teach medical doctors about my situation. It’s as despite the fact that they don’t be expecting to look developmental disabilities amongst their sufferers. Whilst I’m able to suggest for myself, I’m very interested in those that can not. Every other essential level that your article makes is the will for clinical execs to deal with developmentally disabled adults immediately. They will have to additionally talk to them as fellow adults and now not as youngsters. Whilst we will have a developmental incapacity, we also are smartly conscious about the truth that we’re adults.

Finally, your article mentions the trouble of having assist for folks over age 30. It is a drawback now not just for the ones with Down syndrome however for folks with developmental disabilities on the whole. I’m 58 and was once identified with autism at age 37. Whilst I’ve benefited very much from the assist I have gained, I’ve additionally discovered it very irritating to be became clear of doable avenues of self-betterment simply on account of when I used to be born. It’s by no means too overdue!

Thanks very a lot for this well timed article about adults with developmental disabilities.

— Elizabeth Avery, Weymouth, Massachusetts

Our well being gadget is not ready to take care of adults with developmental disabilities — Folks with Down Syndrome Are Dwelling Longer, however the Well being Device Nonetheless Treats Many as Youngsters by means of @kffhealthnews

— Ellen Andrews (@cthealthnotes) April 17, 2023

— Ellen Andrews, Hamden, Connecticut

I sought after to take a minute and thanks for the thing that was once additionally printed on CNN about individuals who have Down syndrome who’re residing longer with out the clinical neighborhood maintaining. My aunt has Downs and can be 71 this June!

She has continued such a lot of ups and downs from the clinical neighborhood since she was once born within the Fifties to the place we at the moment are. Listening to tales of the previous, there are occasions I simply can’t consider she’s nonetheless alive. My oldsters and different aunt assist take care of her in a rural house in Wisconsin and it’s been extraordinarily tricky for everybody as she has gotten older. I despatched this text on and so they felt heard, for the primary time.

I respect you for bringing consideration to this now not handiest as a niece who loves her aunt, but additionally as a unique training trainer!

— Jennifer Pearce, Excelsior, Minnesota

Reminder for everybody to test the names to your clinical expenses, this occurs so much. I simply had my son’s ER facility invoice are available with my title because the affected person. Simple dispute for us, cleaned after a unmarried letter.

— pj (@pjsantoro) March 31, 2023

— PJ Santoro, Los Angeles

When Is an Insurer No longer an Insurer?

I write to deal with what could also be an inaccuracy for your March 29 Invoice of the Month document, “ER’s Error Lands a 4-Yr-Previous in Collections (For Care He Didn’t Obtain),” which most likely isn’t too subject matter in your protection (even supposing it might be if the dispute persevered). However I believe it’s essential for KFF Well being Information to constitute it accurately since your newsroom and KFF are very popular resources of data round well being care cost.

You again and again referred to UnitedHealthcare because the affected person’s “insurer.” To be an insurer, the entity, UnitedHealthcare, will have to suppose the monetary chance of a declare, and for the reason that HCA Healthcare is the employer, this is extremely not likely. Almost definitely HCA is self-funded, immediately assuming all monetary chance for its worker receive advantages plan. UnitedHealthcare is most probably only a supplier of administrative services and products to the employer and its lined staff, in what’s ceaselessly known as an “ASO” association, that means administrative services and products handiest.

Why does this subject? Many causes, however first, UHC and identical organizations like folks to consider them because the insurer as it complements logo power in increasing their very winning position as an middleman in well being care transactions. Within the “C suite,” alternatively, well being plan executives and buyers are glad to keep away from the monetary uncertainty of well being care usage, as an alternative taking part in the predictability of administrative income, together with in the course of the supply of Rx advantages. UHC is basically an excessively massive ASO, as is Cigna, CVS, Elevance (previously Anthem), and most of the better Blue Pass and Blue Defend entities. Those firms get to get admission to the purchasers’ budget to fund well being care in advancing their market-share trade targets.

2d, the opposite two key events in maximum three-way clinical transactions, sufferers and suppliers, are very ceaselessly unaware of this, which muddies the problems that rise up in disputed claims, and broader well being care coverage. Self-funded advantages don’t seem to be analogous to insurance coverage in lots of essential respects, and the usage of the phrase “insurance coverage” interchangeably has ended in confusion and unintentional coverage penalties. KFF Well being Information is definitely situated to proper this key false impression. Your paintings on affected person billing dilemmas is a smart position to deal with this. Within the article about Sara McLin (if I’ve accurately surmised that UHC is the administrator and now not the insurer), UHC may merely be recognized because the administrator. Maximum readers and NPR listeners would clutch that delicate however essential distinction.

KFF supplies a very good, transparent image of industrial employment-based well being care receive advantages financing in the once a year “Employer Well being Advantages Survey.” As famous on this yr’s document, 65% of staff are individuals in self-funded plans. This quantity continues to extend.

My dive into this fairly esoteric nomenclature subject may well be considered as slightly obsessive. In my 35-plus-year occupation in well being care cost, alternatively, I’ve again and again observed how this false impression has fueled war on the affected person/supplier stage and ended in erroneous public coverage. I’m hoping you and your readers in finding those feedback of a few use.

— Marc Marion, Oklahoma Town

We would possibly have all handled one thing like this. Irritating as each a document and affected person. Extra ironic since circle of relatives hired by way of HCA.

— Philip Chen (@DrPhil_ENT) April 8, 2023

— Philip Chen, San Antonio

KFF Well being Information is a countrywide newsroom that produces in-depth journalism about well being problems and is without doubt one of the core working techniques at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Be told extra about KFF.


This tale may also be republished free of charge (main points).


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