Friday, September 30, 2011

California looks into HMO medical claim denials; Kaiser Permanente and Anthem Blue Cross each rejected about 28 percent of their claims.

Kaiser Permanente and Anthem Blue Cross each rejected about 28 percent of their claims.

California looks into HMO medical claim denials
Victoria Colliver,
San Francisco Chronicle Staff Writer
September 4, 2009

The state attorney general has launched an investigation into how health maintenance organizations review and pay medical claims, the office announced Thursday.

The inquiry is based on an analysis by the California Nurses Association that found more than 1 in 5 requests for medical claims - 22 percent - were rejected by the state's six largest health insurers.

"These high denial rates suggest a system that is dysfunctional, and the public is entitled to know whether wrongful business practices are involved," said Attorney General Jerry Brown in a press statement.

The nurses union based its research on data reported to the state Department of Managed Health Care, which oversees HMOs.

In the first six months of this year, the group found denial rates ranged from 6.4 percent for Aetna to 39.6 percent for PacifiCare. According to the analysis, Cigna rejected 32.7 percent of medical claims, Health Net denied 30 percent of the time and Kaiser Permanente and Anthem Blue Cross each rejected about 28 percent of their claims.

The trade group representing the state's health insurers said the nurses' numbers fail to reflect the reasons behind the denials, which may include requests for more information, paperwork errors and duplicate claims, as well as claims submitted to the wrong health insurer.

"It appears that a good deal of the so-called denials are merely paperwork issues between providers and plans and have little financial impact on consumers or impact the care received," said Nicole Kasabian Evans, spokeswoman for the California Association of Health Plans.

Wednesday, September 28, 2011

Health insurance premiums climb faster in 2011

Health insurance premiums climb faster in 2011
By Alina Selyukh
Sep 27, 2011

The cost of health insurance continues to climb for companies and workers, with annual family premiums this year growing at a pace triple that of 2010 and outpacing wage increases, according to a survey.

As the United States continues to grapple with a stubbornly weak economy, family premiums in employer-sponsored health plans jumped 9 percent this year and single premiums rose 8 percent, compared with 2010's 3 percent and 5 percent, the Kaiser Family Foundation's annual study, published Tuesday, found.

"We're probably on a more modest side ... but even with a 5 percent increase in a premium (that our workers saw) this year, they didn't get a 5 percent raise," said Jeff Franck, a compensation and benefits manager at Altru Health System, which employs about 3,700 people in North Dakota and Minnesota and participated in the survey.

Health insurance, unlike other industrialized countries, is largely provided by employers. Although the latest Census found more Americans losing company-sponsored insurance, almost 170 million Americans were on employer-based plans in 2010.

Kaiser and the Health Research & Educational Trust surveyed 2,088 randomly selected public and private employers large and small earlier this year.

The survey found that, on average, employees are contributing 28 percent, or about $4,129, a year toward employer-sponsored family plans. That is 131 percent more than a decade ago.

Including employers' contributions, the overall premium has increased 113 percent since 2001 to $15,073 a year.

More workers, especially in smaller firms, continue to join high-deductible health plans. Thirty-one percent of covered employees this year have to pay at least $1,000 in single plans before coverage kicks in, up from 27 percent last year.

The survey also highlighted some early results of President Barack Obama's healthcare reform.

Under one of the few provisions already in effect, people under the age of 26 are now allowed to remain covered by their parents' insurance plans to curb historically high uninsured rates in that age group. The Kaiser survey estimated that U.S. companies have added 2.3 million young adults to their parents' family health policies.

Franck at Altru Health pegged much of the premium costs' increase at his company to adding children of his employees onto their plans.

That part of the healthcare reform was not meant to cut costs, and many cost-cutting provisions have yet to kick in, said Kaiser President and Chief Executive Drew Altman.

"There are a variety of factors that could have been responsible for (premium increases), but the major reason is not the healthcare reform," he said.

Although the survey did not study contributing factors, Altman echoed other analysts in suggesting that insurance companies had planned their premiums in expectation of more people going to the doctor or buying medications as the economy improved -- which did not happen.

Insurers have generally attributed the need to raise premiums to growing underlying medical care costs as coverage also continues to expand. Both have fed into a heated debate over the future of healthcare spending, which for several decades has grown faster per person than the nation's economic output, according to the Congressional Budget Office.

Slowing down those soaring costs is one of the main issues on the agenda of a bipartisan congressional deficit-reduction panel that is due to make recommendations by November 23 on how to slash the U.S. budget deficit by at least $1.2 trillion.

(Reporting by Alina Selyukh in Washington; editing by John Wallace)

Monday, September 26, 2011

Hospital plays labor hardball, locks out nurses, and patient dies

Nurses called a one-day strike, but the hospital locked them out for days.

Thousands of nurses return to work at Alta Bates

By Angela Woodall
Oakland Tribune

Thousands of nurses returned to work Tuesday after a five-day labor dispute that turned deadly for one cancer patient.

The cloud of Judith Ming's death hung heavily over the returning staff at the Alta Bates Summit Medical Center in Oakland, where the 66-year-old died Saturday morning after a dietary supplement apparently was introduced into her intravenous line.

The Alameda County Coroner's Office has not yet completed the autopsy on Ming, who suffered from ovarian cancer. The fill-in nurse who police said made the error was questioned and released Saturday. She is 23 years old and from Louisiana.

One Alta Bates Summit veteran nurse said she and her colleagues did not think highly of the 500 replacements provided by Alabama-based Advanced Clinical Employment Staffing, which the medical center relied on for five days when it locked out the regular nurses, who had declared a one-day strike Thursday.

The Alta Bates Summit nurse, who asked not to use her name because her husband works for a public agency, said her colleagues are concerned that the staffing firm sent inexperienced nurses. "It's such a sad situation," the nurse said. "I feel really bad for her."

The nurse said the replacements could not have had adequate training before taking on their responsibilities at the hospital because there was "no one here to train them" on the sophisticated equipment and computer programs now used in medical care, or show them where equipment,
medications and other items are kept.

In addition, the replacement nurses had to work 12-hour shifts five days in a row. Usually, nurses are not required to work more than two to three 12-hour shifts at a time.

Standing outside the entrance to Alta Bates Summit in Oakland, hospital spokeswoman Carolyn Kemp said Tuesday that 40 percent of Alta Bates Summit's 1,800 staff nurses stayed on duty during the strike and worked side by side with the replacements. The fill-ins had experience in the area they were assigned and received an orientation the day before being deployed and again the day they began, according to Kemp.

"Everybody is a professional," she said.

The medical error is so basic that it has baffled nurses because the dietary supplement, Glucera, is labeled, should be taken orally or through a feeding tube and looks nothing like IV fluids. Ming may have had an abdominal feeding tube, but the two pieces of equipment do not fit with each other and look completely different.

An Advanced Staffing employee reached by telephone said the company plans to issue a statement soon but otherwise did not comment.

Advanced Staffing and Summit Medical Center were named as defendants in a 2006 lawsuit brought by the family of an 80-year-old woman who died because, according to the family, she did not receive oxygen. Advanced Staffing denied all allegations at the time but had provided the traveling nurse named in the suit. The lawsuit was settled in 2009. The nurses's license in California expired in January 2010, according to the California Board of Registered Nursing.

Advanced Clinical Employment Staffing, the employee said, required the hospital to sign a five-day contract. Only 500 of the 1,500 referred by Advanced Staffing were accepted, she added.

Kaiser Permanente, one of 30 hospitals affected by the strike, signed a one-day contract with American Mobile Healthcare and RNRx Medical Staffing Inc., according to the California Nurses Association. In all, 23,000 nurses in 30 hospitals went on strike.

Alta Bates Summit, like other California hospitals, routinely calls on replacement nurses to fill in for personnel on leave or on strike. They help bridge California's strict patient-to-nurse ratio requirement, the only one in the nation, which varies depending on illness, severity and complexity of required treatment.

Death of Oakland woman killed by nursing mistake prompts controversy, investigations
By Sean Maher and Jeanine Benca

OAKLAND — The 66-year-old woman who died at a hospital after receiving care from a temporary replacement nurse was identified by the coroner's office Sunday as Oakland resident Judith Ming.

Ming's death reverberated both inside Alta Bates Summit Medical Center and out Sunday. Nursing union leaders painted her as the victim of a staff lockout that prompted the hospital to cut corners by hiring replacement nurses who weren't up to par. Hospital administrators, on the other hand, said the death was an "extraordinarily rare" but extremely serious tragedy, promising cooperation with multiple investigations and asking that the death not be used for political means in the two parties' ongoing contract battle.

The hospital had temporarily hired 500 replacement nurses to continue service when the California Nurses Association staged a one-day strike Thursday, but had signed them to a five-day contract, sending staff nurses who'd gone on strike home when they arrived for work Friday.

A cancer patient at the Alta Bates Summit Medical Center since July, Ming died early Saturday morning a few hours after investigators say one of the replacement nurses, who'd come from Louisiana, administered a "nonprescribed dosage of medication."

"If I was taking care of that patient, it would not have happened at all," said Alicia Torres, an oncology nurse with 27 years of experience and one of those
who went on strike Thursday. She said she works in the same unit where Ming died and that replacement nurses "are not familiar with the policies and procedures, or with the equipment, because equipment will vary from hospital to hospital. So they're thrown in there without the proper training."

Dr. Steve O'Brien, the hospital's chief medical officer, said the death was the most serious possible tragedy, but that the policy of using replacement nurses was not clearly to blame.

"One hundred percent of every aspect of the situation, we're looking at," he said. "This is a tragedy, a significant medial error. There is nothing more serious."

Asked if he was concerned about the legal ramifications of an apology the hospital issued Saturday, O'Brien said, "There are people who will later look at the legal issues. I'm glad that's not my job. My job is to make sure our patients get the safety and medical care they deserve."

As for using replacement nurses: "Everybody working in this facility is qualified to work here," O'Brien said. He said the hospital uses replacement nurses every day, and all of them meet or exceed California's professional standards, which he described as especially rigorous.

Bruce Fagel, a longtime California medical malpractice attorney who is also a licensed medical doctor, said having replacement or temporary nurses working in hospitals for extended periods increases the risk of medical mistakes that harm patients.

Since 2007, California hospitals have been required to inform the state Department of Public Health within 24 hours of so-called "never events" -- 28 medical errors deemed inexcusable by the National Quality Forum. The health department must then immediately launch an investigation, and if wrongdoing is determined, the hospital can be slapped with tens of thousands of dollars worth of fines.

Since the law was passed, the California Department of Public Health has collected $4.6 million in fines from hospitals for incidents resulting in patient death or very serious injury, said Fagel, a 30-year veteran malpractice attorney. Still, with no real means of enforcing hospitals to disclose incidents, many cases go unreported, he added.

Of the 50 or so malpractice cases resulting in death or catastrophic injury that his firm handles annually, Fagel estimates 10 percent involve errors made by a traveling, or temporary nurse.

"Traveling nurses get into trouble more frequently because they don't understand the system, who to access in terms of the chain-of-command," Fagel said. "When you have replacement nurses, especially in large numbers, nobody is there to supervise them, and these are people who don't work together regularly ... it's a setup for these types of problems where a medical error can lead to a patient's death."

Because there is no way for hospitals to screen every fill-in, they often rely on the registry to perform the screenings for them. The registries also arrange for the fill-in nurses to get licensed in whatever state they will be working.

At Alta Bates, backups work alongside staff nurses to make sure they get up to speed, O'Brien said.

He declined to name the firm with which the hospital contracts, but union leaders said they believe it to be Alabama-based Advanced Clinical Employment Staffing. Nobody answered the phone there Sunday, but the outgoing voice message said, "We are working on ... going to the California strike beginning Sept. 22..."

September 25, 2011
Patient died during Calif. nurse labor dispute
The Associated Press

...The nurses union planned a candlelight vigil at the hospital, with nurses calling on Sutter Health, the operator of Alta Bates, to end the lockout and for the state to investigate what union officials called "safety violations" in the patient's death.

About 23,000 nurses across California walked off the job Thursday in a one-day strike at 33 not-for-profit hospitals run by Kaiser Permanente, Sutter Health and the independent Children's Hospital Oakland. They had planned to go back to work Friday, but were locked out when they tried to return to work at Sutter hospitals, according to union officials.

Sutter officials said they entered into contracts with replacement nurses that required they pay the replacement nurses for a minimum number of days.

"Once a strike is called, it would be financially irresponsible for hospitals to pay double to compensate both permanent staff and replacement workers," Sutter Health said earlier in the week.

The lockout was scheduled to end Tuesday.

Sunday, September 25, 2011

The downside of Kaiser Permanente's publicity efforts in sponsoring marathons: 36-year-old dies, not enough trained paramedics

Golf Tourney Held for Orinda Runner Who Died in Half Marathon
September 22, 2011

Peter Hass, 36, collapsed and died from overexertion at the end of the Kaiser Permanente half marathon earlier this year.

The Orinda resident's Feb. 6 death made Bay Area headlines. And five months later, San Francisco's Department of Emergency Management issued a report that said there weren't enough trained paramedics at the finish line that day...

Saturday, September 24, 2011

Kaiser nurses strike in northern California: "Kaiser recorded a $1.6 billion profit for the first six months of 2011" but has inadequate staff

"The bottom line is we don't have enough staff," she said, adding that Kaiser recorded a $1.6 billion profit for the first six months of 2011. "With profits like these, Kaiser can provide staff to see patients in a timely and ethical manner.

"We helped Kaiser earn this money, we should be rewarded for it."

See related: patient dies during lockout of nurses.
See all Kaiser Permanente posts.

Sutter, Kaiser nurses go on strike

By Melissa Murphy
The Reporter (Vacaville)
...Kaiser Permanente nurses -- who are represented by the California Nurses Association and have settled their own contract -- said they were striking for their own reasons and not out of sympathy for Sutter nurses.

It just happened that on the same day Sutter nurses staged a one-day walkout, Kaiser nurses took a supportive
Gateway Realty Agent John Wilkerson
stance for Kaiser mental health workers, about 1,500 of whom are represented by the National Union of Health Care Workers (NUHW) in Northern California, said Brenda Tolbert, a marriage and family therapist with Kaiser.

"They are not striking their own contract," Tolbert said. "The nurses are here to support the mental health workers. We wanted a stronger voice to protect our patient care."

In a letter to Kaiser nurses printed in The Reporter and other newspapers, Northern California Regional President Gregory Adams and Executive Medical Director Robert Pearl asserted that Kaiser is bargaining with NUHW in good faith.

They also noted the agreement with the nurses represented by CNA states, "There shall be no strikes, lockouts or other stoppages, or interruptions of work during the life of this agreement."

Tolbert said hundreds of people stood unified at the corner of Vaca Valley Parkway and Quality Drive in Vacaville on Thursday. Some 50 were mental health workers, the others were nurses who walked off the job and chose not to be paid that day.

One reason for the strike, Tolbert explained, is to stand up for better patient care.

She added that patients have to wait five to six weeks for an appointment when state law says it should be only up to a two-week wait.

"The bottom line is we don't have enough staff," she said, adding that Kaiser recorded a $1.6 billion profit for the first six months of 2011. "With profits like these, Kaiser can provide staff to see patients in a timely and ethical manner.

"We helped Kaiser earn this money, we should be rewarded for it."

At the picket line in front of Kaiser in Vacaville, Aretha Franklin's song "Respect" played on loud speakers, followed by Tom Petty's "Won't Back Down." Dressed in red T-shirts, union members and nurses waved signs that read "Some Cuts Don't Heal," "Fair Contract Now" and "Kaiser is Not Thriving."

Other reasons for the strike include changes to a health plan and retirement packages. Some of those changes will occur in 2013, others in 2014.

Sitting in the shade on the picket line, Rivka Kaplowitz explained that she has been a psychologist with Kaiser for 15 years and she is shocked the health-care provider wants to eliminate benefits for her husband. Kaiser also has proposed giving her only $100 per month toward health-care benefits, she said.

"Who will take me at that rate? They sure won't take me," she said as she pointed to the Kaiser hospital in Vacaville. "I don't get it. You're a health-care provider and you're cutting health care? It doesn't make sense."

As a psychologist, it pains Kaplowitz to see her patients only once every six weeks.

"It's good therapy to see them more often," she said. "I love my job and my patients. The work we do is essential."

Roy Chaffee works at the Kaiser call center in Vallejo and decided to support the NUHW strike in Vacaville even though he is represented by a different union.

He said if Kaiser is willing to attack the smaller unions with huge cuts, it's only a matter of time before the bigger unions will see cuts, too.

"These cuts are absolutely crazy," he said. "It's unnecessary and unprecedented. We're standing up for the patients; we're not going to sit idly by."

Chaffee said the union and those supporting its members want to keep fair wages and health-care benefits in place and protect the staffing numbers. He added that Kaiser's profits should be reinvested in the organization.

The morning wasn't without confrontation.

Before the strike started, CNA Chief Nurse Representative Melanie Alvarado said she tried to speak to the nurses on the night shift, to see that all patients were handed over to other certified nurses called in to relieve the Kaiser nurses.

"They prevented me from speaking to my nurses," she said. "They're not allowed to do that."

Alvarado, who is a Kaiser charge nurse for adult and family medicine, said the union will likely file a complaint against Kaiser because of that action.

Nearly 200 nurses between the Kaiser location in Vacaville and the satellite clinic in Fairfield walked off the job to join picket lines.

Alvarado said that, although CNA members have a good contract with Kaiser, they believe the health-care provider is picking on a little guy.

"There is no reason to do this," she said of the cuts.

Thursday, September 22, 2011

State Senate health chairman doing business with Kaiser

State Senate health chairman doing business with Kaiser
A firm owned by Sen. Ed Hernandez, who derailed legislation opposed by the
nonprofit health group, leases office space to Kaiser Permanente. An advocacy
group seeks his ouster from the chairmanship.
By Patrick McGreevy
Los Angeles Times
September 18, 2011

A Southern California lawmaker who helped defeat legislation opposed by Kaiser is benefiting from a business relationship with the nonprofit health group.

The proposal, which died in the Legislature earlier this month after a dispute
over its provisions, would have required state approval for health insurers
including Kaiser to raise their rates.

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee,
owns a corporation that leases an office building to Kaiser Permanente in Baldwin Park. Since 2006, Kaiser has paid Hernandez's firm about $387,000 to lease the building. The current rent is $5,752 a month.

Most elected officials in California are disqualified from actions that could affect
a source of their income, but state legislators exempted themselves from that
restriction in 2002. Such dual interests amount to "what a common-sense person
would consider to be wrong," said Kathay Feng, executive director of California
Common Cause...

Because his role as Health Committee chairman gives Hernandez considerable power over many bills that affect the health industry, a consumer advocacy group has asked Senate leader Darrell Steinberg (D-Sacramento) to remove him.

"This level of income from a company that is constantly before his committee, and whose interests touch upon every level of the committee's work … compromises Senator Hernandez's ability to independently chair the committee," wrote Jamie Court, president of the nonprofit group Consumer Watchdog.

Kaiser's payments were disclosed in Hernandez's annual financial interest report on file with the state. But there was no mention of the business relationship when a
Kaiser representative appeared at a June committee hearing presided over by

Hernandez voted for the bill when it passed his committee. But he said he would oppose it on the Senate floor unless it was changed so a panel of actuaries, rather than California's elected insurance commissioner and the director of the state's Managed Health Care Department, would rule on any rate increases.

The bill's author, Assemblyman Mike Feuer (D-Los Angeles), said such revisions
would have left consumers unprotected from excessive rate hikes
and, without
enough votes to support his version, he shelved the legislation, AB 52...

Wednesday, September 21, 2011

Kaiser has spent $700,000 lobbying their interests in Sacramento in just the first half of this year

Courage Campaign
Rick Jacobs
Sept. 21, 2011

This week, more than 23,000 nurses and other frontline healthcare providers are walking out on Kaiser for a one day strike. They have a simple message: provide quality healthcare, not just $8 million salaries for CEO George Halvorson and millions more for Ben Chu and other hired hands.

What's more, Kaiser has spent $700,000 lobbying their interests in Sacramento in just the first half of this year. That includes stalling AB 52, the law that would have put their rate increases under government control. Why? Because the bosses there are greedy.

Prime Healthcare trapped patients, failing to inform their doctors where they were

I've been so disgusted lately with Kaiser Permanente, that I find myself shocked to learn that some hospitals are worse than Kaiser!

Attorney general denies sale to controversial hospital chain

September 20, 2011
Christina Jewett
California Watch

In a widely watched decision, the state attorney general's office today denied the sale of Victor Valley Community Hospital to Prime Healthcare Services' nonprofit foundation, saying the sale would not be "in the public interest."

Prime's nonprofit foundation blasted the decision as "unexpected" and "inexplicable." Prime accused the attorney general of siding with a labor union that "has been running a blatantly false smear campaign of vilification against hospitals operated by Prime Healthcare."

Prime, which owns 14 hospitals, has come under increasing fire for its business practices and is under investigation for possibly exaggerating the severity of patient illnesses for profit. Kaiser Permanente, which has 6.8 million California members, has also accused the company of "trapping" its patients and then sending inflated bills for their care.

California Watch has documented the chain’s record of buying hospitals and then admitting rising numbers of Medicare patients for further treatment in their hospitals, sometimes over the objections of patients' families.
Hospital chain profits by admitting high number of ER patients
Hospital chain, already under scrutiny, reports high malnutrition rates
Hospital chain’s high infection rate leads to fraudulent billing concerns
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The chain also has reported outsized rates of medical conditions that Medicare pays a premium to treat, such as septicemia and serious malnutrition. California Watch reports on the rates have been followed by state investigations.

In the statement issued today, Prime warned that the decision "could have an immediate and dire impact on the needs of an already-underserved High Desert community."

Bill Thomas, a Riverside attorney representing an acquisition firm formed by Hemet doctor Kali Chaudhuri, said he is poised to submit a backup offer for the hospital. The attorney general initially approved the sale to that group, but it did not close the sale in time for a June deadline, making way for Prime's bid.

Prime also singled out the Service Employees International Union as swaying the decision. SEIU's United Healthcare Workers West researchers initially presented data showing some of the nation's highest rates of septicemia at Prime hospitals. The group hailed the attorney general's decision, calling it "a victory for caregivers, patients and consumers who depend on quality healthcare.”

In a brief letter [PDF] about the decision released today, the attorney general’s office noted that the sale would “likely create a significant effect on the availability or accessibility of health care services to the affected community.”

Parties objecting to the sale before a bankruptcy judge noted that Prime tends to cancel contracts with health insurers and charge higher prices for services.

If the sale went through and Prime canceled contracts, many area patients would rely on the single hospital not owned by Prime in the isolated desert plateau. The bankruptcy judge ultimately approved the sale several weeks ago. As a matter of course, the attorney general also reviews sales of nonprofit hospitals.

The attorney general’s office convened a hearing Aug. 17 to hear comments on the proposed sale of the bankrupt Victor Valley, which is near another Prime hospital in the High Desert region of the state.

Prime Healthcare vice president and general counsel Michael Sarrao argued that the sale to the nonprofit Prime foundation should be approved, saying the firm would increase efficiency and provide more charity care. Sarrao also said Prime would maintain labor and delivery services and contract for five years with a program meant to fund care for low-income patients.

Dr. Victor Sabo, chief of staff at Prime’s Desert Valley Hospital, warned about others’ testimony at the hearing: “Allegations being made by those who only wish to create doubt and mistrust are false and shouldn’t be believed.”

A range of objections also were raised during the hearing.

Pat Aguirre, a phlebotomist at Encino Hospital Medical Center in Los Angeles County, testified that she worked at the hospital for 13 years. She said dozens of surgeons left after Prime took over the hospital in mid-2008, and the 150-bed hospital patient counts sunk to roughly 50 at times.

“I’ve heard many people here today say, 'I don’t want to see this hospital close,' ” Aguirre said at the hearing. “But yet for many people who (have) different insurances, our hospital is closed to them, and that will happen here.”

Dr. Eric Hansen, who said he practiced medicine in the area for nine years, testified that he canceled his privileges to see patients at Prime’s High Desert hospital, Desert Valley. He explained that his patients were admitted to the hospital and were told that he was notified.

However, Hansen said he never learned of their hospital stays until patients asked why he didn’t come see them. He said he was left “out of the loop” by the hospital and noted that patients were given unnecessary tests.

For those patients, he said, “there’s essentially no limit on what can be billed for services.”

Hansen’s comments echoed a lawsuit by Kaiser that the chain's hospitals “trap” its patients and misrepresent to patients that Kaiser doctors are aware of the situation. Prime has denied the allegations, and the matter is pending in Los Angeles County Superior Court.

The family of a deceased Desert Valley Hospital patient also testified about the hospital’s delay in transferring Victoria Kulyas, 45, to a hospital equipped to treat her acute case of leukemia in February.

Victoria’s mother, Ardis Kulyas, testified that she got a $144,000 bill soon after her daughter’s death later that month. “I’m asking that you please stop the sale, prevent others from suffering the loss of a child.”

In a story last month, California Watch reported that a foundation controlled by Prime owner and board chairman Dr. Prem Reddy may have avoided paying hundreds of thousands of dollars in federal taxes through a questionable gift to another charity.

Public records show that in 2009, a $1 million charitable donation made by the Dr. Prem Reddy Family Foundation wound up in the coffers of the Prime Healthcare Services Foundation, the Reddy-controlled nonprofit that tried to purchase Victor Valley.

Experts who reviewed the transactions for California Watch said Reddy’s foundations appeared to have avoided hundreds of thousands of dollars in federal taxes that should have been paid on the transfer of the funds. Prime contended that all transactions were “in full compliance with all applicable laws.”...

Tuesday, September 20, 2011

Kaiser specialty services coming to northern Douglas County

We can only hope that Kaiser doesn't bring outdated x-ray equipment into the new center as it has admitted doing in San Diego's brand new Garfield Specialty Center.

Kaiser specialty services coming to northern Douglas County
Ceremony marks start of work on 275,000 square-foot building
September 19, 2011
By Chris Michlewicz
Lone Tree Voice-News

The opening of a new Kaiser Permanente facility near Lone Tree will broaden specialty services and bring medical care closer to thousands of patients...

Thursday, September 15, 2011

Family struggles to get daughter's tumor removed

Family struggles to get daughter's tumor removed

Fourteen-month-old Claire DeCant is a beautiful, happy baby despite the swelling hemangioma under her left eye. "It first started as a little scratch under her eye when she was 4 and a half weeks," says her mother Davina.

Doctors don't know what causes hemangiomas to form, but the vascular tumor - an abnormal build up of blood vessels - is common in premature Caucasian female babies. "She was born 6 weeks premature."

As Claire grows, so does the hemangioma. First-time parents, Ryan and Davina DeCant say they've asked doctors to remove the benign tumor, but their insurance provider, Kaiser Permanente told them they won't cover because it could make the situation worse. "They didn't want to leave a scar on her face. My husband and I said we don't care about that. We want her depth perception to be normal, we want her vision to be at full capacity."

Frustrated, the family contacted Gregory Levitin, a doctor based in New York City. "Well as a specialty interest there are several doctors who can treat simple legions. For the more complicated legions there's probably less than a dozen specialists like myself who treat this across the country."

The Decant's sent Dr. Levitin photos. "In this location specifically it can encroach into the orbit and cause compression of the eyes called astigmatism and this is where the eye cannot develop normal vision. Along the nose it actually collapses the nose. No different than if you or I put pressure on our nose. It blocks off the nasal airway."

On a trip he makes monthly to Los Angeles to meet with patients with conditions such as this, Dr. Levitin evaluated Claire, then sent this letter to Kaiser, describing her "significant and progressive vascular malformation of the left hemiface" and said the tumor "require(s) a surgical excision as it was "likely to potentially grow further."

"With Claire's situation this absolutely should be covered by insurance. Anyone who looks at a smiling picture of this child can tell there's a tumor in her face. This is not a cosmetic issue at all."

A month later, Kaiser responded to the Decant's request for an "out of plan referral." It was denied. The reason listed: "insufficient clinical information."

We had a load of specialists that did review the location and the effect on breathing and vision. Pediatric cardiology, pediatric optomology, plastic surgery, dermatology and pediatrics. The assessment was it was not affecting the vision and it was not affecting the breathing," says Dr. Michael Jorgensen, assistant medical director, LA medical center.

But the Decant's say Claire has had trouble breathing, walking and seeing properly because of the hemangioma. "These are all things we notice. We expressed concern with Kaiser and they just did not care," says DeCant.

Kaiser says the tumor may be removed surgically eventually if necessary. But their team of specialists thought it best to first treat the tumor medically by prescribing propranolol, a high blood pressure medicine typically given to adults, then reevaluate before possibly offering surgery down the road.

But the DeCants say as they watch their baby suffer, waiting is not an option. The DeCants have filed two complaints and four appeals against Kaiser, all unsuccessful. The family plans to switch from Kaiser, an HMO, to Blue Shield, a PPO in October so Claire can have her hemangioma removed by Dr. Levitin who says he will do the surgery.

Wednesday, September 14, 2011

Kaiser Permanente denies 47 per cent of applicants in Georgira

Study: Health Insurance Denial Rates Routinely Exceed 20%
By Rachel Fields
ASC Review
September 12, 2011

Health insurance denial rates routinely exceed 20 percent and are often much higher, according to a Kaiser Health News review of 20 of the most populous states and the District of Columbia.

According to data provided by insurers to the federal Department of Health and Human Services, denial rates can vary widely in individual states. In Georgia, Aetna's denial rate is 15 percent, compared with 47 percent for Kaiser Permanente and 67 percent for John Alden Life Insurance. Humana rejects 26-39 percent of applications in Kentucky, while UnitedHealthcare denies 38-43 percent.

The same insurer can deny customers at different rates in different states, according to the report. For example, Kaiser Permanente denied 32 percent of applications in Maryland, but only 17 percent in Colorado.

According to industry trade group America's Health Insurance Plans, 87 percent of people who apply nationally for individual coverage are offered a policy. However, that data includes people who are turned down for one policy but offered another more expensive option.