If You Were a Subscriber or Beneficiary of a Health Net Plan at Any Time Between 1995 and 2007 You May Be Eligible to Participate in a Class Action...

NEW YORK -- May 23, 2008--"A settlement has been proposed in a class action lawsuit involving Health Net, also formerly known as Physicians Health Services, PHS, and First Option Health Plan. The Settlement will provide up to $215,000,000.00 for payments to subscribers or beneficiaries of various Health Net Plans from July 1995 to July 2007. If you qualify, you may send in a claim form to get benefits, or you can exclude yourself from the Settlement, or object to it. The United States District Court for the District of New Jersey authorized this Notice. Before any money is paid, the Court will have a hearing to decide whether to approve the settlement."

The link for more information on this matter is here:
http://www.insurancenewsnet.com/article.asp?n=1&neid=20080523290.2_de5101890833b0c9

National Scandal: Number of Underinsured up 60%

This is a national scandal: the number of Underinsured is up 60% last year (over 2003) -- and we have about 47 million Americans who are completely UNinsured.
Read more about it here, from a report by the Commonwealth Fund.

Book Review, "Who Killed Health Care?"

Found another great book review by the same person on Newsvine. This book is by Regina Herzlinger and is titled, "Who Killed Health Care?" Believe it or not, your parents or grandparents remember a time when you didn't have to mortgage your home to pay for your hospital bill.

Read more here and tell 'em I sent ya.

Great Book Review, "American the Uninsured"

Please go read this great book review on the history of the American health insurance industry and just it is that ours is the only major country WITHOUT national health care. We could have instituted a national program back in 1919 but..Oh, I'll let you read it yourselves.

I found it on a wonderful website called Newsvine that has lots of good articles, seeds, and commentary on lots of current events. Go here to read the review. Ciao!

RECOMMENDED READING AND SOURCES:

RECOMMENDED READING AND SOURCES:


“Accounting for the Cost of Health Care in the United States,” McKinsey Global Institute, http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp

Alzheimers Reading Room, web log with a variety of info for caregivers, http://alzheimersreadingroom.blogspot.com/2007/08/training-helps-alzheimers-caregivers.html

Appeal letters available for a fee at Health Symphony website, http://www.healthsymphony.com/

Barton, Laura, “A hug a day keeps the doctor away,” The Age, July 31, 2007, http://www.theage.com.au/news/health/a-hug-a-day-keeps-the-doctor-away/2007/07/31/1185647872383.html?page=fullpage#contentSwap1

Bazell, Robert, “The costly side effects of Nexium's ad blitz” MSNBC.com, Aug 14, 2007, http://www.msnbc.msn.com/id/20249591/

Bolen, Jennifer, “Exposing the Department of Health and Human Services/American Medical Association Health Care Monopoly”, Townsend Letter, Feb-March 2007 issue, http://www.townsendletter.com/FebMarch2007/exposeama0207.htm

Boseley, Sarah, Government warning on DIY cancer treatments, The Guardian, April 28, 2008, http://www.guardian.co.uk/society/2008/apr/28/health.cancer.

Boseley, Sarah, “NHS GPs at new Virgin health centres will get 10% of profits”, The Guardian, April 9, 2008, http://www.guardian.co.uk/society/2008/apr/09/nhs.health2

Boseley, Sarah, “Three more deaths at 'special measures' maternity hospital”, The Guardian, April 15, 2008, http://www.guardian.co.uk/society/2008/apr/15/health.nhs.

Boseley, Sarah, “Tranquillisers putting children's lives at risk”, The Guardian, April 7, 2008, http://www.guardian.co.uk/society/2008/apr/07/mentalhealth.drugs.

Butki, Scott, “An Unhappy Pharmacy Visit,” Newsvine.com, http://sbutki.newsvine.com/_news/2007/06/29/810673-an-unhappy-pharmacy-visit

Carvel, John, “GPs to provide 5-year health checks for all aged between 40 and 74”, The Guardian, April 2, 2008. http://www.guardian.co.uk/politics/2008/apr/02/health.nhs

Carvel, John, Nurses 'spend 1m hours a week on bureaucracy', The Guardian, April 28, 2008, http://www.guardian.co.uk/society/2008/apr/28/nhs.health.

Carvel, John, “Patients who go to A&E instead of local surgery could cost Gps 1B pounds” http://www.guardian.co.uk/society/2008/apr/17/nhs.health, The Guardian, April 17, 2008.

Chang, Alicia, “Many doctors say L to e-mail”, Chicago Tribune (via AP), April 22, 2008, http://www.chicagotribune.com/news/chi-doctor-emailapr23,0,6511095.story.

“Changes Ahead for Medicare Drug Program,” AP wire story by Kevin Freking, November 4, 2007, http://www.newsvine.com/_news/2007/11/03/1070133-changes-ahead-for-medicare-drug-program?threadId=171361&cmt=1156346#c1156346COBRA law explained: http://www.dol.gov/dol/topic/health-plans/cobra.htm

Coding for billing Acupuncture services, Acupuncture Today, Feb. 2005,
http://www.acupuncturetoday.com/mpacms/at/article.php?id=30032&MERCURYSID=918c70b396ad0a2c4cec8b179efa75c8.

Coding for billing Nutritionist services, please see their 2007 bulletin at . http://www.eatrightnc.org/PDF2007/CodesInsert.pdf

Coding for billing Vitaflo products (enteral and parenteral supplies) at http://www.vitaflousa.com/content.aspx?PFAlias=howtoorderbillingcodesERISA law explained: http://www.dol.gov/dol/topic/health-plans/erisa.htm

Gratzer, David, “The Ugly Truth About Canadian Health Care,” City Journal, Summer 2007, Gratzer is biased against the whole nationalized healthcare concept and has taken aim at the problems of Canadian & other single-payer systems; he proposes vouchers and a two-tier system: http://www.city-journal.org/html/17_3_canadian_healthcare.html

Foster, Kate, “Open all-hours plan for Scottish doctors”, Scotland on Sunday, Feb. 3, 2008, http://scotlandonsunday.scotsman.com/latestnews/Open-allhours-plan-for-doctors.3739044.jp.

Health Symphony, an online resource that includes appeal letters, at http://www.healthsymphony.com/

Health Care Crisis in America, Michael Moore’s appearance on Oprah, 2007, http://www2.oprah.com/world/health/slide/20070927/health_284_101.jhtml

“Health Care Options at a Glance” compares Canada, U.K., France and U.S. systems, Yes Magazine website, http://www.yesmagazine.org/article.asp?ID=1515

The Henry J. Kaiser Family Foundation for reports on a health benefits survey and health care costs at http://www.kff.org/insurance/index.cfm

The Henry J. Kaiser Family Foundation at
http://www.kff.org/uninsured/upload/7651.pdf for a policy brief on Medicaid and the Uninsured, “Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Adults”
Herzlinger, Regina E. , Who Killed Health Care? June 2007 and her article “Who Killed U.S. Medicine?” in the Washington Post July 25, 2007 at http://www.washingtonpost.com/wp-dyn/content/article/2007/07/24/AR2007072401850.htmlHIPAA law explained: http://www.dol.gov/dol/topic/health-plans/portability.htm -- also at HIPAA.org

Holstein, William, “A Drug Maker’s Views of What Ails Health Care”, NY Times, September 8, 2007
http://www.nytimes.com/2007/09/08/business/08interview.html?_r=1&ref=health&oref=slogin

Insurance Transparency Project - All the riveting insurance industry news you can stand, http://insurancetransparencyproject.com/general-theory-of-insurance-transparency/

“Industry wouldn't fund cancer drug, so Alberta town rode to the rescue,” CBC News, October 4, 2007
http://www.cbc.ca/health/story/2007/10/04/fundraising-dca.htmlInsurance coverage for families www.coveringkidsandfamilies.org, from the Robert Wood Johnson Foundation

Insure Kids Now at www.insurekidsnow.gov, where parents click on their state and enroll their children automatically in that state’s children’s health insurance program.

Komen Foundation, Cancer Care Partnership Helps Qualified Patients Meet Some Costs Associated with Breast Cancer Treatment, Assistance Grants ($300) for Medication, Lymphadema Care, Medical Equipm’t, http://cms.komen.org/komen/NewsEvents/KomenNews/CancerCare?ssSourceNodeId=298&ssSourceSiteId=Komen

Krugman, Paul, “Health Care Excuses,” New York Times Op-Ed column, Nov. 9, 2007, http://www.nytimes.com/2007/11/09/opinion/09krugman.html?hpLetters of Medical Necessity, (samples of), see Dr. Bach website at http://www.doctorbach.com/letters/

Meikle, James, “Let dads bond with newborns, says study”, The Guardian, April 14, 2008 http://www.guardian.co.uk/society/2008/apr/14/children.health

Miller, Jennifer, “Federal government taps ancient healing methods to treat native American soldiers,” Christian Science Monitor, Sept. 13, 2007, http://www.csmonitor.com/2007/0913/p20s01-usmi.html

Neergaard, Lauran, “Training Helps Alzheimer's Caregivers,” Washington Post, August 12, 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/08/12/AR2007081200509_pf.html

Newborns' & Mothers' Protections (Newborns' Act): (Maternity coverage must pay for at least a 48-hr hospital stay.) http://www.dol.gov/dol/topic/health-plans/newborns.htm

Pear, Robert, “Medicare Audits Show Problems in Private Plans,” Oct. 7, 2007, New York Times, http://www.nytimes.com/2007/10/07/us/07medicare.html?_r=1&hp=&adxnnl=1&oref=slogin&adxnnlx=1191729902-/QFjVc2aBDuzO96/FhKk9gPrescription Drugs: What’s the Issue?, an essay on Open Secrets dot org, http://www.opensecrets.org/news/drug/index.htm

Quadragno, Jill, book “One Nation, Uninsured” 2005, published by Oxford University Press. You can read an excellent review of this book on Newsvine on my column. If link does not work use this URL -- http://minnieapolis.newsvine.com/_news/2007/10/27/1054611-one-nation-uninsured-analyzes-a-century-of-failure-to-enact-a-national-health-plan-in-spite-of-public-support-book-review

Ruttley, Marilyn, Henderson hospital threatened with closure - blog, 4-10-08, http://blogs.guardian.co.uk/joepublic/2008/04/vulnerable_people_troubled_by.html.
Slota, Linda, “Training Goes a Long Way for Alzheimer's Spouses” at Christopher Heights.com webpage, http://www.christopherheights.com/page/AlzheimerTraining.cfm

StopHospitalInfections.org. We are all at risk because we cannot judge the relative safety of our hospitals. Consumers Union has developed a selection of Internet-ready public service announcements that can be used to link to StopHospitalInfections.org from any web site. Just click on the links below or scroll down the page to get started. Thanks again for your help!

The Internet Health Library, excellent resource for studies, etc. at http://www.internethealthlibrary.com/

The Medical Insurance Store online -- Includes “Five Ways to Cut Your Health Insurance Costs” & many other topics written at a basic level at http://www.medicalinsurancestore.info/Options%20for%20Those%20Who%20Cannot%20Afford%20Health%20Insurance.php

Pear, Robert, “Medicare Audits Show Problems in Private Plans,” New York Times, October 7, 2007, http://www.nytimes.com/2007/10/07/us/07medicare.html?_r=1&hp=&adxnnl=1&oref=slogin&adxnnlx=1191729902-/QFjVc2aBDuzO96/FhKk9g

Quammen, David, “Deadly Contact: How Animals and Human Exchange Disease,” National Geographic, (unknown date) http://magma.nationalgeographic.com/ngm/2007-10/infectious-animals/quammen-text.html

Sosnowski, Laura A, “Minnesotans Fight Hi Cost of Healthcare With Databases, Walk-in Clinics”, Nov. 2007,
http://minnieapolis.newsvine.com/_news/2007/11/12/1092663-minnesotans-fight-hi-cost-of-healthcare-with-databases-walk-in-clinics#dynamicCommentBox_1180552

Travel insurance website at www.insuremytrip.com. Companies that offer travel insurance are CSA Travel Protection, Access America, and AIG Travel Guard . Carefully compare the terms and conditions of each plan before making your final selection. Check first if you are covered under your credit card or homeowner’s insurance.

Vamosi, Robert, “Security Watch: Spam that just might kill you,” (about fake prescription drugs sold over the Internet) MSN.com, undated, http://tech.msn.com/security/articlecnet.aspx?cp-documentid=5406724&page=1

Whitman, Glen, “Hazards of the Individual Health Care Mandate,” Cato Policy Report, Fall 2007, http://cato.org/pubs/policy_report/v29n5/cpr29n5-1.html

“Why Obama, Edwards, Hillary, Romney, Schwarzenegger Don’t Support Single Payer? It Would Mean the Death of the Health Insurance Industry, and Reduced Profits for Big Pharma,” Corporate Crime Reporter, 1209 National Press Bldg., Washington, D.C. 20045, 202.737.1680, February 21, 2007, http://www.corporatecrimereporter.com/pnhp022107.

Health & Cancer Rights Protections: (Reconstructive surgery is covered as a post-mastectomy benefit.)
http://www.dol.gov/dol/topic/health-plans/womens.htm

“World’s Best Medical Care?”, NY Times editorial, August 12, 2007
http://www.nytimes.com/2007/08/12/opinion/12sun1.html?ei=5124&en=44da5cf6d4bf91c6&ex=1344571200&partner=newsvine&exprod=newsvine&pagewanted=print

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What to do in an auto accident, and why

What the Auto Insurance Industry Hopes You Never Find Out

There are at least fifteen things that the average auto insurance company hopes you never find out about. Knowing them can mean the difference between getting an offer that covers your loss, and an offer that is far less than that amount or even zero.
These tidbits were passed on to me by an attorney in a very successful law practice. He offered to represent my accident case several years ago. Fortunately my accident was very cut and dried, and did not require his expertise to cover the damages caused by a young man driving on a revoked license.
The attorney’s friendship meant that he told me many specifics of getting the best possible settlement from the insurance carrier. In return, I was happy to refer several people to him for his professional skills.
First, let me cover the basics of what to do when an accident occurs. Stop. You have no idea how many drivers compound their problems because they panic and leave, hoping no one saw them. Someone always, or almost always, sees you - and they call 911 on their cell phones. Remain calm. If necessary, call an ambulance at least for getting you and your family checked over with x-rays. Call the police department, or ask someone at a nearby home to call for you.
Pull out paper and pen and start writing down the date and time, and information about the other driver: name, address, car license number with make and model, driver’s license number, date of birth, any apparent injuries. Get the name of the owner if different from the driver. Ask who their insurance company is and if they have an agent’s card or proof of insurance. Do not discuss accident with anyone or assign blame. It is too easy to get drawn into an argument in the heat of the moment. Do not accept any bait, just keep asking for facts. See if anyone is around that may have witnessed the accident, and get their name and phone number, or better yet, a business card. It is very easy to be unable to read your nervous scribble later on.
And make any notes on weather or other conditions at the time. Anticipate a police officer’s questions. I was once asked how long I sat in a turn lane before being struck, and how long was it between the time I saw the other vehicle and the moment of impact. Being totally unprepared for this line of questioning made me flustered. Try to think ahead of time about how long it took between events.
Call your insurance agent and tell him that there was a collision, or whatever event it was. Contact an experienced lawyer if anyone was hurt, or if the full extent of effects will not be known immediately. One friend’s pregnant wife was in a collision, and their lawyer told them not to sign off on anything until three months after the child’s birth. Fortunately for all concerned, everyone was fine.
Now, all that material just given is on most pocket cards handed out by insurance companies or police departments everywhere. What follows is inside information that not everyone has access to.

1) Do not give a statement to an insurance adjuster. They are looking for information to use against you and deny your claim. Do not accept blame for the accident, and do not blame others. Stick to the barest minimum of facts possible.

2) Hire a lawyer. Surely you must have some idea of which are the prominent and reputable law firms that deal in this kind of case. Now I do NOT mean for you to hire a lawyer when very little damage was done and you were darn lucky things were not worse. BUT When you have an inkling that even an overnight stay at the hospital is involved, take the precaution of engaging a lawyer who specializes in your type of injury.

3) All law firms will say that you won’t pay if you don’t win. But the bottom feeders tell you that, and then when it looks like they will have to go to court, ask them what you stand to gain or lose by having a trial. It turns out that you pay a percentage of the award if you win, but you could pay a few thousand in trial expenses if you lose. And by that time, it is too late to switch lawyers. The first and second lawyers will have to split the contingency, so most refuse a case that anyone else touched. So get the best you can the first time.

4) The insurance company stays in business by taking in more money than they pay out. They also make money by investing their funds, if they are a sizable firm. But your attorney only makes money if you win. So who would you expect to work harder for you? Granted, insurance is one of the most highly regulated businesses in America, but they will split hairs to stay on the right side of the laws.

5) A personal injury lawyer is the only type of professional who can determine what a fair settlement might be. This makes it especially important to go to a lawyer who specializes, not a generalist. The specialist sees hundreds, if not thousands, of cases in his career, and hears of many more. He can calculate the factors that go into arriving at a settlement with much more data on paper and in his head far better than you ever will.

6) Less than 5% of personal injury cases go to court. This is in your favor. The lawyer can hire experts to present the true cost of your accident for the rest of your working life. And if you never suffered that particular type of injury before, your case is so much stronger than any insurer could tear down. And by going with one of the “name” law firms, their reputation is such that the insurer is more likely to forego a trial.

7) Insurance companies are so annoyed when you hire a lawyer. They are focused on their bottom line, and they prefer to avoid the expense of sending their own lawyers into a courtroom. They know that insurance settlements handled without an attorney are significantly lower.

8) Corporations routinely use lawyers to protect themselves. Why shouldn’t you? Trying to fight an insurance company is like fighting city hall - you are going to wind up on the short end. And the insurance company is never going to volunteer information that will benefit you, while the lawyer is only too glad to inform you of how rights would apply to your situation.

9) The insurance company will try to settle quickly, and rush you into accepting the first offer. They will do this even before all the facts have come in, because the more information that comes in about the injury and whether you recover sufficiently to go back to work full time, the more money the insurer will likely have to pay out. This lawyer friend told me, “Wait until all the treatment has been done, all the symptoms have surfaced and been repaired, and then count up your losses. Your losses are not only the medical bills, but lost work time, lost family time, property damage, use of a rental car, transportation to a doctor or hospital, time spent in physical therapy, whether there is permanent damage, emotional distress, pain and suffering. THEN decide what it takes to put things right.”

10) Pain and suffering, and disability compensation can be substantial. Defining pain and suffering is very difficult, and arriving at a number is even harder. That is why you should at least talk to an attorney who has handled many such cases.

11) Do not ever sign a release from the insurance company. They will push a release at you as soon as possible, and this will most often mean that they will pay no further bills connected to that accident. Then the other bills arrive for ancillary services - everything from ambulance to medications, nursing and physical therapy, lost future income because you can no longer work overtime for example, periodic trips to the emergency room for recurring symptoms. All those items will come out of YOUR pocket if you sign away your proper rights.

12) Tactics that the insurance company uses to reduce or deny your claim: Frustrate you into giving up. Sending the adjuster to play the good guy (he will offer a very low settlement and make it seem reasonable).

13) Just one phone call from your lawyer can result in immediate relief from dealing with bills and paperwork. The law firm can help you keep your life together and keep you from being overwhelmed. It handles phone calls to the body shop. It calls the insurance company so you don’t have to answer multiple calls from their reps. Your job is to recuperate and get well! Make things easier on yourself.

14) You deserve the best medical attention, and experienced personal injury law firms know who the best specialists are in each field. You will get thorough and unbiased opinions and treatment.

15) Don’t talk to anyone about your case except your lawyer. Do not go to the corner bar and joke about screwing the insurance company for a million bucks. Do not even stand for anyone else’s jokes about lawyers or neck braces or anything of the kind. Just say, “My lawyer will take of it.” Friends or others who offer help may have what they think are your best interests in mind, but they may sabotage your case and keep it from being handled properly.