USC hospital sues Kaiser over nonpayment of bill
'It's usually the patient fighting to get transferred' from Kaiser, said attorney Scott Glovsky
USC says Kaiser didn't disclose that its patient had exhausted a $75,000 annual cap on insurance benefits
Stuart Pfeifer, Chad Terhune
Los Angeles Times
May 23, 2014
Two medical giants in Southern California are heading for a potentially bruising legal battle.
Keck Hospital of USC has sued Kaiser Permanente, accusing California's largest HMO of sending one of its patients to Keck for open-heart surgery and then refusing to pay the $544,000 hospital bill.
USC contends that Kaiser didn't disclose that its patient had already exhausted a $75,000 annual cap on insurance benefits when it asked Keck Hospital to perform the October 2013 surgery. Kaiser could have handled the procedure with its own surgeons but opted to transfer the patient to save money, Keck Hospital said in the lawsuit.
Kaiser declined to comment except to insist that USC knew about the limitations of the patient's insurance.
This legal battle between healthcare heavyweights highlights Kaiser's long-standing practice of using outside hospitals to see some patients who require more specialized care. It also provides a rare glimpse into the sometimes bitter disputes between health insurers and providers that are often handled behind closed doors.
Kaiser is both an insurer collecting premiums from customers and a medical provider treating them at Kaiser-run hospitals and physician offices. In some instances, Kaiser transfers patients to outside facilities for specialty care such as transplants, then covers the costs as any other insurer would.
In this case, Kaiser transferred the patient from the intensive care unit at its Los Angeles Medical Center to Keck Hospital knowing it would not cover the costs, USC said in the lawsuit, filed May 15 in Los Angeles County Superior Court.
The Kaiser representative who called Keck to arrange the surgery said the patient had active health coverage through Kaiser, the lawsuit said. With that assurance, USC authorized the surgery and treated the patient for 13 days at its hospital.
In December, Kaiser denied Keck Hospital's bill for the treatment, saying for the first time that the patient had exceeded the $75,000 cap on annual coverage, USC said. Those coverage limits were set by a state program Kaiser participates in for people who were denied coverage because of preexisting conditions.
Kaiser declined to discuss details of the lawsuit, but said in a statement, "We are confident that Keck's allegation that it was not informed about coverage limits is not accurate."
The lawsuit could tarnish a lengthy relationship between the healthcare giants. Keck, then known as USC University Hospital, and Kaiser first entered into an agreement in 1994 for the hospital to treat some Kaiser patients, with Kaiser paying the tab, USC said in the lawsuit.
Kaiser, a nonprofit based in Oakland, is California's largest HMO and one of the largest healthcare providers in the country. It reported $53.1 billion of operating revenue last year and $2.7 billion in net income.
Mark V. Pauly, a professor of healthcare management at the University of Pennsylvania's Wharton School, said a lack of communication about the patient's coverage appears to be at the center of the disagreement.
"It seems like somebody forgot to ask or somebody forgot to tell, which may be a sign of dysfunction in our healthcare system," Pauly said.
Scott Glovsky, a Pasadena attorney who represents other Kaiser patients suing the HMO over access to appropriate and timely care, said this latest hospital dispute is unusual in several ways.
Glovsky said Kaiser typically goes to extreme lengths to keep patients at its own facilities as part of its unique HMO model.
"It's usually the patient fighting to get transferred," he said. "If Kaiser authorized the treatment, they can't reverse course and later deny payment. It is not fair to a hospital to essentially dupe them into taking the patient."
Neither Kaiser nor USC would identify the patient, citing rules on medical privacy. Kaiser said the only coverage it offers with a $75,000 cap on annual benefits is part of California's high-risk pool, known as the Major Risk Medical Insurance Program.
For years, it has provided coverage to people with serious health problems who were previously rejected by insurers. There is a $750,000 cap on lifetime benefits in addition to the $75,000 annual limit.
New federal rules lifting most coverage limits don't apply to the state program.
Enrollment in the state high-risk pool has fallen by half to about 3,000 people since insurers are no longer permitted to reject applicants under the Affordable Care Act, according to Morgan Staines, chief counsel for the state program. The governor's latest budget proposal calls for closing the state program by the end of this year, Staines said.
For most consumers, the federal health law prevents insurers from setting lifetime coverage limits, and annual limits were phased out for most health plans starting this year. Health insurance policies in place before March 2010, when the health law was passed, are grandfathered and don't have to comply with rules on annual limits.
Keck Hospital is one of several medical centers with which Kaiser partners to supplement its care. For instance, it has sent patients to City of Hope for bone marrow transplants and used UCLA Medical Center for kidney transplants.
Showing posts with label Kaiser Permanente business partners. Show all posts
Showing posts with label Kaiser Permanente business partners. Show all posts
Friday, May 23, 2014
Monday, April 7, 2014
Wal-Mart shoppers: Kaiser Permanente will see you now
Wal-Mart shoppers: The doctor will see you now
BY COURTENAY EDELHART
Bakersfield Californian
Apr 05 2014
Shortly after the Kaiser Permanente Care Corner clinic opened for the day in a southwest Bakersfield Wal-Mart one recent Friday, licensed vocational nurse Irene Ethridge decided to drum up some business.
[Maura Larkins' comment: Irene decided? Or she was instructed to do so?}
"Hi there. Are you a Kaiser Permanente member?" she asked a woman strolling through the store's adjacent pharmacy.
"Yes," replied Kim Klaas warily.
Ethridge brightened and explained that as such, Klaas was eligible to use the telemedicine services at the clinic, a two-year pilot project of Kaiser -- which has about 102,000 members in Kern County -- and the nation's largest retailer.
The Bakersfield telemedicine clinic is one of two that Kaiser opened in October. The other one is in Palmdale.
Kaiser members and Wal-Mart employees can walk in, no appointment necessary, and have minor ailments assessed by a health care provider via a high-resolution webcam in a private room. A registered nurse in San Diego does an initial screening, followed by an urgent care doctor in Bakersfield.
The clinic is open from noon to 8 p.m. Thursdays through Mondays. About 125 people have had exams there so far.
Klaas, 39, was feeling well on Friday, but she was intrigued. "I love the hours," said the mother of two children, ages 5 and 6. "Kids always seem to get sick at night when the doctor's office is closed, and a little ear ache isn't the kind of thing you want to go to a hospital for." Retailers have been operating clinics inside stores for years, but until recently telemedicine has largely been confined to traditional clinical settings, usually for consultations between far apart medical colleagues. Because it's efficient and convenient, telemedicine is likely to expand into all sorts of nontraditional settings, but there should be standards to ensure patients are getting good care, said Mike Harris, a principal with Harris Consulting, a Los Angeles-based healthcare consulting firm. "Of course we have to make sure we closely monitor it to be certain we're not putting patients at risk," he said. The exam at Kaiser's Wal-Mart clinic is much more than just talking to a computer screen, Kaiser notes. With a specialized stethoscope placed on the patient by the nurse at the clinic, remote doctors can actually listen to the patient's breathing and heartbeat, just as they would in a face-to-face exam. An otoscope with a camera on it also allows doctors to look deep into a patient's ears and eyes. Similarly, a special dermatoscope can transmit extremely detailed, magnified images of skin lesions. Patients with sore throats open wide for yet another camera. For routine ailments, doctors can transmit an electronic prescription that patients can fill immediately at Wal-Mart, or at another pharmacy if they choose to wait. If the condition appears to warrant an in-person exam, patients are referred to Kaiser's urgent care clinic on Stockdale Highway, where they will likely see the same doctor who was on the other end of the webcam. The partnership between Kaiser and Wal-Mart is part of an ongoing strategy Kaiser is pursuing to make health care generally more accessible. It's trying out a traditional clinic at Paramount Farms for employees of the agriculture company, and a mobile clinic that travels to outlying areas of the county six days a week. There's also a mobile phone app for making appointments and communicating with doctors. "We want to take health care beyond the traditional setting to the places where people shop and work," said Kaiser chief administrative officer Sharon Peters. If visiting the doctor is convenient, the thinking goes, patients will come in sooner and possibly avoid the health consequences and expense of more severe problems down the road.
Going to a doctor's office in the middle of the day isn't convenient for most people, but swinging through a clinic while shopping isn't too much trouble.
"This really fits in with the needs of our patients," said Kaiser medical director Dr. Julia Bae. "Millennials and the younger population, especially, don't value the traditional one-on-one office visit. They want care to fit into their busy schedules." Wal-Mart says the experiment is one more way to better serve its customers.
"We are always testing new products and services to provide our customers with affordable ways to stay healthy," said spokeswoman Danit Marquardt. "This is an example of one of those pilot programs." Customers who are not Kaiser members or Wal-Mart employees can't take advantage of the telemedicine exams, but they can use self-service options such as health research or checking their weight or blood pressure. Linda Urias, 65, doesn't belong to Kaiser but stops in at the clinic whenever she's in the store picking up groceries. On the recent Friday, she checked her blood pressure. "A little low today, but at least it wasn't high," she said. Urias also stepped on a scale to make sure her diet is still on track. She recently lost about 20 pounds, and is trying to keep it off. "I've changed the whole way I eat," Urias said proudly. It's those types of health conscious consumers retailers hope to appeal to with in-store clinics.
The partnership between Kaiser and Wal-Mart has a lot to offer both sides, said healthcare consultant MaryKate Scott of Hartland, Maine-based Scott & Co., which has had Wal-Mart as a client in the past.
The obvious benefit to Wal-Mart is the potential to sell prescription and over-the-counter medicine, but that's only part of the story, Scott said.
There are about 2,500 retail clinics in the United States. Stores like them because they generate foot traffic at a time when a growing number of consumers are shopping online.
"They want customers walking through the store with their shopping carts making impulse purchases," Scott said. Plus, health care costs are a major concern for Wal-Mart as the employer of some 1.4 million employees. If it can keep those workers healthy, that's a huge savings, Scott said. And if health care costs worry an enormously successful international retailer, how much more so for its customers, typically working-class people for whom insurance is a major expense. "If I'm Wal-Mart, I'm thinking, 'Health care is a big deal for my customers. And if it's a big deal for my customers, it better be a big deal for me,'" Scott said.
BY COURTENAY EDELHART
Bakersfield Californian
Apr 05 2014
Shortly after the Kaiser Permanente Care Corner clinic opened for the day in a southwest Bakersfield Wal-Mart one recent Friday, licensed vocational nurse Irene Ethridge decided to drum up some business.
[Maura Larkins' comment: Irene decided? Or she was instructed to do so?}
"Hi there. Are you a Kaiser Permanente member?" she asked a woman strolling through the store's adjacent pharmacy.
"Yes," replied Kim Klaas warily.
Ethridge brightened and explained that as such, Klaas was eligible to use the telemedicine services at the clinic, a two-year pilot project of Kaiser -- which has about 102,000 members in Kern County -- and the nation's largest retailer.
The Bakersfield telemedicine clinic is one of two that Kaiser opened in October. The other one is in Palmdale.
Kaiser members and Wal-Mart employees can walk in, no appointment necessary, and have minor ailments assessed by a health care provider via a high-resolution webcam in a private room. A registered nurse in San Diego does an initial screening, followed by an urgent care doctor in Bakersfield.
The clinic is open from noon to 8 p.m. Thursdays through Mondays. About 125 people have had exams there so far.
Klaas, 39, was feeling well on Friday, but she was intrigued. "I love the hours," said the mother of two children, ages 5 and 6. "Kids always seem to get sick at night when the doctor's office is closed, and a little ear ache isn't the kind of thing you want to go to a hospital for." Retailers have been operating clinics inside stores for years, but until recently telemedicine has largely been confined to traditional clinical settings, usually for consultations between far apart medical colleagues. Because it's efficient and convenient, telemedicine is likely to expand into all sorts of nontraditional settings, but there should be standards to ensure patients are getting good care, said Mike Harris, a principal with Harris Consulting, a Los Angeles-based healthcare consulting firm. "Of course we have to make sure we closely monitor it to be certain we're not putting patients at risk," he said. The exam at Kaiser's Wal-Mart clinic is much more than just talking to a computer screen, Kaiser notes. With a specialized stethoscope placed on the patient by the nurse at the clinic, remote doctors can actually listen to the patient's breathing and heartbeat, just as they would in a face-to-face exam. An otoscope with a camera on it also allows doctors to look deep into a patient's ears and eyes. Similarly, a special dermatoscope can transmit extremely detailed, magnified images of skin lesions. Patients with sore throats open wide for yet another camera. For routine ailments, doctors can transmit an electronic prescription that patients can fill immediately at Wal-Mart, or at another pharmacy if they choose to wait. If the condition appears to warrant an in-person exam, patients are referred to Kaiser's urgent care clinic on Stockdale Highway, where they will likely see the same doctor who was on the other end of the webcam. The partnership between Kaiser and Wal-Mart is part of an ongoing strategy Kaiser is pursuing to make health care generally more accessible. It's trying out a traditional clinic at Paramount Farms for employees of the agriculture company, and a mobile clinic that travels to outlying areas of the county six days a week. There's also a mobile phone app for making appointments and communicating with doctors. "We want to take health care beyond the traditional setting to the places where people shop and work," said Kaiser chief administrative officer Sharon Peters. If visiting the doctor is convenient, the thinking goes, patients will come in sooner and possibly avoid the health consequences and expense of more severe problems down the road.
Going to a doctor's office in the middle of the day isn't convenient for most people, but swinging through a clinic while shopping isn't too much trouble.
"This really fits in with the needs of our patients," said Kaiser medical director Dr. Julia Bae. "Millennials and the younger population, especially, don't value the traditional one-on-one office visit. They want care to fit into their busy schedules." Wal-Mart says the experiment is one more way to better serve its customers.
"We are always testing new products and services to provide our customers with affordable ways to stay healthy," said spokeswoman Danit Marquardt. "This is an example of one of those pilot programs." Customers who are not Kaiser members or Wal-Mart employees can't take advantage of the telemedicine exams, but they can use self-service options such as health research or checking their weight or blood pressure. Linda Urias, 65, doesn't belong to Kaiser but stops in at the clinic whenever she's in the store picking up groceries. On the recent Friday, she checked her blood pressure. "A little low today, but at least it wasn't high," she said. Urias also stepped on a scale to make sure her diet is still on track. She recently lost about 20 pounds, and is trying to keep it off. "I've changed the whole way I eat," Urias said proudly. It's those types of health conscious consumers retailers hope to appeal to with in-store clinics.
The partnership between Kaiser and Wal-Mart has a lot to offer both sides, said healthcare consultant MaryKate Scott of Hartland, Maine-based Scott & Co., which has had Wal-Mart as a client in the past.
The obvious benefit to Wal-Mart is the potential to sell prescription and over-the-counter medicine, but that's only part of the story, Scott said.
There are about 2,500 retail clinics in the United States. Stores like them because they generate foot traffic at a time when a growing number of consumers are shopping online.
"They want customers walking through the store with their shopping carts making impulse purchases," Scott said. Plus, health care costs are a major concern for Wal-Mart as the employer of some 1.4 million employees. If it can keep those workers healthy, that's a huge savings, Scott said. And if health care costs worry an enormously successful international retailer, how much more so for its customers, typically working-class people for whom insurance is a major expense. "If I'm Wal-Mart, I'm thinking, 'Health care is a big deal for my customers. And if it's a big deal for my customers, it better be a big deal for me,'" Scott said.
Tuesday, January 24, 2012
Kaiser Permanente and Bridgepoint come together with incentives for Kaiser employees to transfer
WELCOME KAISER PERMANENTE SAN DIEGO EMPLOYEES
Ashford University is proud of our alliance with Kaiser Permanente San Diego!
All Kaiser Permanente San Diego employees who successfully apply to and attend Ashford University will receive:
5% tuition grant
Technology Services Fee waiver
Free required course materials for all mandatory courses
For more information or to receive these benefits, click here or call 800.408.7113 to speak to a dedicated Admissions Counselor at Ashford University. For detailed instructions on how to submit the required documents to ensure you receive your alliance benefits, please visit our eligibility page.
Ashford University
From Wikipedia, the free encyclopedia
Not to be confused with the unaccredited entity with the same name doing business from the United Kingdom.
Ashford University is a private, for-profit university located in Clinton, Iowa. It is the largest educational holding of Bridgepoint Education (NYSE: BPI).[3] Although the university is regionally accredited by The Higher Learning Commission of the North Central Association of Colleges and Schools,[4] it has begun the process of seeking regional accreditation from the Western Association of Schools and Colleges.
The university offers Associate's, Bachelor's, and Master's degrees in more than 50 degree programs on campus and online. The majority of the student population is enrolled in online courses but[3] the campus has experienced growth in recent years.
As for-profit colleges have come under increasing scrutiny, a U.S. Senate report in 2011 revealed that Ashford has one of the highest withdrawal rates of any publicly traded school in the industry.[7] Ashford has also been faulted for its recruiting and finance practices in a U.S. Department of Education audit. Bridgepoint Education responded in March 2011 with a report asserting that the information used in the Senate hearing was either inaccurate or incomplete...
Ashford University is proud of our alliance with Kaiser Permanente San Diego!
All Kaiser Permanente San Diego employees who successfully apply to and attend Ashford University will receive:
5% tuition grant
Technology Services Fee waiver
Free required course materials for all mandatory courses
For more information or to receive these benefits, click here or call 800.408.7113 to speak to a dedicated Admissions Counselor at Ashford University. For detailed instructions on how to submit the required documents to ensure you receive your alliance benefits, please visit our eligibility page.
Ashford University
From Wikipedia, the free encyclopedia
Not to be confused with the unaccredited entity with the same name doing business from the United Kingdom.
Ashford University is a private, for-profit university located in Clinton, Iowa. It is the largest educational holding of Bridgepoint Education (NYSE: BPI).[3] Although the university is regionally accredited by The Higher Learning Commission of the North Central Association of Colleges and Schools,[4] it has begun the process of seeking regional accreditation from the Western Association of Schools and Colleges.
The university offers Associate's, Bachelor's, and Master's degrees in more than 50 degree programs on campus and online. The majority of the student population is enrolled in online courses but[3] the campus has experienced growth in recent years.
As for-profit colleges have come under increasing scrutiny, a U.S. Senate report in 2011 revealed that Ashford has one of the highest withdrawal rates of any publicly traded school in the industry.[7] Ashford has also been faulted for its recruiting and finance practices in a U.S. Department of Education audit. Bridgepoint Education responded in March 2011 with a report asserting that the information used in the Senate hearing was either inaccurate or incomplete...
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