"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)
09/23/2011
...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
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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.
Saturday, September 24, 2011
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...
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...
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...
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.
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.
Related
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
6
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Like our content?
Help us do more.
Report an error: See something wrong in this story?
E-mail our editors.
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.”...
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.
Related
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
6
Donate Now
Like our content?
Help us do more.
Report an error: See something wrong in this story?
E-mail our editors.
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...
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
KGET.com
9/13/2011
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.
KGET.com
9/13/2011
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.
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.
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