#medicare patient

[sanguinarysanguinity]

For U.S. residents who are on Medicare, Medicaid, or are uninsured, and who have been prescribed the antiviral Paxlovid (used to reduce the severity of COVID19), the medication is free through Pfizer's patient assistance program. People who have private insurance might also be able to use the link reduce their co-pay.

(Or if you prefer the phone to a website, you can call 877-219-7225 to sign up.)

The list price for Paxlovid is $1400 for the five-day course, and now that the federal government is no longer providing the medication for free, some people are being told by pharmacies that they have to pay list price (because they are uninsured, or because the medicine is not covered on their insurance). If that's you -- or if your co-pay is steeper than you can afford -- please check out the patient assistance program above!

(Hat tip to Dr. Leana S. Wen at the Washington Post, who talked about the program in her latest column.)

[kp777]

By Jake Johnson

Common Dreams

May 5, 2024

"There is much the Biden administration can and must do to address the national embarrassment that is for-profit healthcare in the U.S.," said Public Citizen's healthcare policy advocate.

The consumer advocacy group Public Citizen on Wednesday called on the U.S. Justice Department, Federal Trade Commission, and Department of Health and Human Services to do more to crack down on corporate profiteering that is further degrading the nation's healthcare system and driving up costs for patients.

In a letter to the three agencies, Public Citizen cited the growing encroachment of private equity firms and insurance company mergers as just two of many trends that the Biden administration must tackle as part of a broader effort to transform the nation's fragmented for-profit healthcare system.

"We need a rational approach to healthcare that would make patients' wellbeing the focus instead of profit," said Public Citizen, which supports transitioning to a single-payer healthcare system. "Cracking down on the worst actors is an important step as would be improving oversight of mergers as well as oversight of corporate actions."

The letter came in response to the three federal agencies' request for public comment on "consolidation in healthcare markets." In their request, the agencies expressed support for "robust competition in healthcare markets" and voiced concern that corporate mergers "may generate profits for those firms at the expense of patients' health, workers' safety, and affordable healthcare for patients and taxpayers."

Public Citizen echoed that concern in its letter, noting that "consolidation of actors in various parts of the healthcare system as well as increasing vertical integration, including insurers buying up provider groups, threatens to further increase corporate profits at the expense of patients."

"Whether it's private equity, insurance companies, or Big Pharma, Americans deserve to have healthcare that puts patients first."

The group also pointed to Medicare Advantage as "one of the ripest sources for profit for insurers," noting that the privately run plans "delay and deny necessary care to seniors," "limit access to care," and overbill the federal government by making patients appear sicker than they are.

"All of these practices require the creation of significant oversight mechanisms by relevant agencies, which struggle to keep up with the innovations in grift that Medicare Advantage plans undertake year after year," Public Citizen's letter states.

Eagan Kemp, Public Citizen's healthcare policy advocate, said in a statement Wednesday that "private equity is swallowing up U.S. health care whole and putting the squeeze on patients" with the "sole aim" of raking in "outrageous profits."

"Whether it's private equity, insurance companies, or Big Pharma, Americans deserve to have healthcare that puts patients first," Kemp said. "The U.S. consistently lags behind other wealthy countries when it comes to the quality of our profit-based healthcare system. More consolidation will only make things worse."

"There is much the Biden administration can and must do to address the national embarrassment that is for-profit healthcare in the U.S.," he added, "and we appreciate this multi-agency effort to expose the problems associated with greed in healthcare."

[ralfmaximus]

UnitedHealthcare, the largest health insurance company in the US, is allegedly using a deeply flawed AI algorithm to override doctors' judgments and wrongfully deny critical health coverage to elderly patients. This has resulted in patients being kicked out of rehabilitation programs and care facilities far too early, forcing them to drain their life savings to obtain needed care that should be covered under their government-funded Medicare Advantage Plan.

It's not just flawed, it's flawed in UnitedHealthcare's favor.

That's not a flaw... that's fraud.

[thedataproject]

Hospice Care Agencies - What is Hospice Care?

Hospice care is a type of care and philosophy of care that focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual, or social. The goal of hospice care is not to cure the underlying disease but to provide comfort and support to the patient and their family. It is designed for patients who have been diagnosed with a terminal illness and have a prognosis of six months or less to live if the illness runs its usual course, though many patients receive hospice care for longer periods.

Hospice care can be provided in various settings, including the patient's home, hospice centers, hospitals, and long-term care facilities. The care team typically includes doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and volunteers who work together to manage symptoms, alleviate pain, and address emotional and spiritual needs. The holistic approach aims to ensure the patient's comfort and quality of life during their remaining time. Services often include pain and symptom management, assistance with the emotional and psychosocial aspects of dying, spiritual care, medication to manage symptoms, provision of medical supplies and equipment, coaching for family members on how to care for the patient, and bereavement support for loved ones after the patient's death. Hospice care emphasizes dignity, respect, and the wishes of the patient, encouraging patients to make decisions about their care and end-of-life wishes.

[thoughtportal]

Opinion Here’s how to get free Paxlovid as many times as you need it

When the public health emergency around covid-19 ended, vaccines and treatments became commercial products, meaning companies could charge for them as they do other pharmaceuticals. Paxlovid, the highly effective antiviral pill that can prevent covid from becoming severe, now has a list price of nearly $1,400 for a five-day treatment course.

Thanks to an innovative agreement between the Biden administration and the drug’s manufacturer, Pfizer, Americans can still access the medication free or at very low cost through a program called Paxcess. The problem is that too few people — including pharmacists — are aware of it.

I learned of Paxcess only after readers wrote that pharmacies were charging them hundreds of dollars — or even the full list price — to fill their Paxlovid prescription. This shouldn’t be happening. A representative from Pfizer, which runs the program, explained to me that patients on Medicare and Medicaid or who are uninsured should get free Paxlovid. They need to sign up by going to paxlovid.iassist.com or by calling 877-219-7225. “We wanted to make enrollment as easy and as quick as possible,” the representative said.

Indeed, the process is straightforward. I clicked through the web form myself, and there are only three sets of information required. Patients first enter their name, date of birth and address. They then input their prescriber’s name and address and select their insurance type.

All this should take less than five minutes and can be done at home or at the pharmacy. A physician or pharmacist can fill it out on behalf of the patient, too. Importantly, this form does not ask for medical history, proof of a positive coronavirus test, income verification, citizenship status or other potentially sensitive and time-consuming information.

But there is one key requirement people need to be aware of: Patients must have a prescription for Paxlovid to start the enrollment process. It is not possible to pre-enroll. (Though, in a sense, people on Medicare or Medicaid are already pre-enrolled.)

Once the questionnaire is complete, the website generates a voucher within seconds. People can print it or email it themselves, and then they can exchange it for a free course of Paxlovid at most pharmacies.

Pfizer’s representative tells me that more than 57,000 pharmacies are contracted to participate in this program, including major chain drugstores such as CVS and Walgreens and large retail chains such as Walmart, Kroger and Costco. For those unable to go in person, a mail-order option is available, too.

The program works a little differently for patients with commercial insurance. Some insurance plans already cover Paxlovid without a co-pay. Anyone who is told there will be a charge should sign up for Paxcess, which would further bring down their co-pay and might even cover the entire cost.

Several readers have attested that Paxcess’s process was fast and seamless. I was also glad to learn that there is basically no limit to the number of times someone could use it. A person who contracts the coronavirus three times in a year could access Paxlovid free or at low cost each time.

Unfortunately, readers informed me of one major glitch: Though the Paxcess voucher is honored when presented, some pharmacies are not offering the program proactively. As a result, many patients are still being charged high co-pays even if they could have gotten the medication at no cost.

This is incredibly frustrating. However, after interviewing multiple people involved in the process, including representatives of major pharmacy chains and Biden administration officials, I believe everyone is sincere in trying to make things right. As we saw in the early days of the coronavirus vaccine rollout, it’s hard to get a new program off the ground. Policies that look good on paper run into multiple barriers during implementation.

Those involved are actively identifying and addressing these problems. For instance, a Walgreens representative explained to me that in addition to educating pharmacists and pharmacy techs about the program, the company learned it also had to make system changes to account for a different workflow. Normally, when pharmacists process a prescription, they inform patients of the co-pay and dispense the medication. But with Paxlovid, the system needs to stop them if there is a co-pay, so they can prompt patients to sign up for Paxcess.

Here is where patients and consumers must take a proactive role. That might not feel fair; after all, if someone is ill, people expect that the system will work to help them. But that’s not our reality. While pharmacies work to fix their system glitches, patients need to be their own best advocates. That means signing up for Paxcess as soon as they receive a Paxlovid prescription and helping spread the word so that others can get the antiviral at little or no cost, too.

{source}

[compassionmattersmost]

Finding a Good Doctor for Chronic Fatigue Syndrome: A Personal Journey

Finding the right doctor, who accepts insurance, when you have Chronic Fatigue Syndrome (ME/CFS) can be a daunting task. Many of us have had experiences with doctors who are dismissive, disrespectful, and ignorant about our condition. Over the years, I’ve had to fire several doctors who didn’t meet my needs, and I know I’m not alone in this struggle. My Experience with Kaiser I was with Kaiser…

[humhealth]

Humhealth Simplifies the Medicare Program With All-in-One Software

Humhealth has emerged as a software provider to consolidate

multiple software solutions into a single software package.

Humhealth is a unified platform that streamlines critical software

services for Chronic Care Management (CCM), Remote Patient

Monitoring (RPM), Annual Wellness Visit (AWV), Behavioral

Health Integration (BHI), Chronic Pain Management (CPM),

Remote Therapeutic Monitoring (RTM) and Transitional Care

Management (TCM) programs.

Please visit : https://www.humhealth.com/

Get started today: https://www.humhealth.com/demo/

https://www.humhealth.com/remote-patient-monitoring/

https://www.humhealth.com/chronic-care-management/

[harmcityherald]

These medical marijuana white chocolate discs are the absolute best for helping calm my stomach or one before each meal. You may not notice right away but you will eat more and be able to hold food down better in the long run. Used in conjunction with protein shakes and other dietary supplements I believe these went a long way in helping me eat again after losing 85% of my stomach to cancer. Through radiation treatments and immunotherapy as well. All I would add is always discuss things honestly with your doctors. They can't make proper diagnoses without correct and pertinent data. Besides, many are interested to hear what may be the pros and cons of medical cannabis from your unique perspective. My Hopkins doctors are always interested to hear about anything that will help their patients. Some are just curious if it works for you or not. We all agree it is an area that needs more study.

[myaustinmyers1]

Verify Insurance coverage online - pVerify

Empower your healthcare practice with pVerify's highly advanced enhanced MBI Lookup solution! Easily Verify Insurance Coverage Online and access vital information on patients' Medicare Beneficiary ID (MBI) along with their complete coverage benefits. Say goodbye to manual searches and streamline your workflow with our innovative tool. Discover a seamless way to identify patient insurance details and ensure efficient billing processes. With pVerify's latest solution, stay ahead in the medical industry and provide best care with accurate insurance information at your fingertips. Enhance your patient care experience, boost efficiency, and optimize your billing operations effortlessly. Try pVerify Enhanced MBI Lookup today for a hassle-free insurance verification experience.

[richardmedisys]

New patient visits can be bustling hubs of activity, but ensuring flawless billing for new patient visits shouldn’t add to the chaos. This article equips primary care providers with the latest knowledge and technical expertise to navigate the process seamlessly, maximizing new patient visit billing accuracy and minimizing compliance risks.

[ivygorgon]

AN OPEN LETTER to THE U.S. HOUSE OF REPRESENTATIVES

Co-sponsor H.R. 732, the Save Medicare Act.

802 so far! Help us get to 1,000 signers!

As a constituent, I'm emailing to ask you to co-sponsor H.R. 732, the Save Medicare Act.

Medicare Advantage plans use deceptive marketing to oversell and overcharge for their private health care plans, and then under deliver on care. These private insurers are using government funding to increase their own profits, at the expense of their patients. And they take so much from the Medicare trust fund, that it’s threatening the solvency and future of traditional Medicare.

Congress must act to rein in Medicare Advantage, and should start by giving it a more accurate name. It is not Medicare and should not be advertised as such. The Save Medicare Act would force these plans to stop using “Medicare” in their name and would establish penalties for private insurers who don’t comply. Seniors and people with disabilities deserve to have this level of transparency when choosing their health care.

Please protect traditional Medicare by cosponsoring this bill.

▶ Created on April 4 by Jess Craven · 801 signers in the past 7 days 📱 Text SIGN PWAYKR to 50409

🤯 Liked it? Text FOLLOW JESSCRAVEN101 to 50409

[geoffrey]

couple telling me they got asked who their pcp was at our er the other day and they didnt know. they want me to look in their medical record to fetch the info for them. i. where do you think the info wouldve come from.

[cms-hospital-qapi-standards-2024]

Enhancing Patient Safety: Navigating CMS Hospital QAPI Standards 2024

In the ever-evolving landscape of healthcare, prioritizing patient safety and continuous quality improvement is imperative. Recognizing the pivotal role hospitals play in ensuring high-quality and safe care, the CMS introduced updated QAPI standards in 2020.

One significant change introduced in the updated QAPI standards is the explicit inclusion of a section addressing patient safety and risk management. In March 2023, CMS responded to these challenges by issuing long-awaited interpretive guidelines, providing clarity for surveyors on evaluating a hospital's QAPI program.

Central to CMS's expectations is the crucial role of hospital leadership and the governing body in overseeing and executing the QAPI. The forthcoming program will delve into the revised CMS hospital QAPI standards and the newly provided interpretive guidelines.

Key learning objectives include understanding the specific requirements for a robust QAPI program, recognizing the areas that will be scrutinized during CMS surveys, and understanding the role of hospital leadership in steering the QAPI ship. CMS surveyors will meticulously review policies and procedures, ensuring they are not just on paper but effectively implemented in practice.

In the realm of healthcare, continuous improvement is not just a goal but a mandate. Navigating the intricacies of CMS Hospital QAPI Standards 2024 is not just about compliance; it is a commitment to delivering the highest standard of care, prioritizing patient safety at every turn. As hospitals align their practices with these updated standards, the journey towards excellence in healthcare takes a significant leap forward.

[hislop3]

JAMA Study: Private Equity Ownership and Hospital Outcomes

Happy 2024! I trust everyone had a blessed and happy holiday season and rang in the New Year with joy and optimism. Across the last two months of 2023, JAMA (Journal of American Medical Association) has published two studies on private equity ownership in healthcare, specifically in hospitals and SNFs. Not to accuse JAMA of having a bias but the parallel between the two studies/articles is…

[rodgermalcolmmitchell]

A doctor asks for recognition of Monetary Sovereignty -- except he may not know it.

Here is a letter from a doctor, a cardiologist, who begs the U.S. government to understand Monetary Sovereignty. But, he may not know it. He may not know that the U.S. federal government is Monetarily Sovereign, so it never can run short of its sovereign currency, the U.S. dollar. He may not know that despite the common but mistaken, bleating about the federal debt and deficits, the U.S. has, and…