23 October 2022: You probably should not have to pay anything for your colonoscopy

Earlier this year, I had a routine colonoscopy at Henry Ford Health. The cost was about $4,500 and my HAP insurance paid for all but $900. 

At about the same time, I read an article at NPR.org that indicated that under the Affordable Care Act ("Obamacare"), I should not have to pay anything if I had insurance, based on this law, see https://www.npr.org/sections/health-shots/2022/05/31/1101861735/colonoscopy-cost-cancer-screening .

I wrote to Henry Ford Health Systems, who denied my request, and ultimately threatened to send this claim to a collection agency. I then filed a complaint with the Michigan Insurance Commissioner, DIFSComplaints@michigan.gov, see https://www.michigan.gov/difs/about/contact-info (who only responded a week ago requesting more information). It then occurred to me that I should file an appeal with HAP. They took 60 days to respond, but they did agree with me and now the balance is zero (so everything has been resolved).

This was what I wrote to Henry Ford, HAP and the Michigan Insurance Commissioner:

I think this procedure was coded incorrectly.

My understanding is that under The Affordable Care Act, colonoscopies are provided free of charge to patients without cost sharing. This procedure should be coded as Screening, not Diagnostic, and if done properly, there would be no charge to me.

My understanding is that The Centers for Medicare & Medicaid Services has clarified repeatedly over the years that under the preventive services provisions of the ACA, removal of a polyp during a screening colonoscopy is considered an integral part of the procedure and should not change patients' cost-sharing obligations.

Please review and advise.

I hope this information is helpful to you!

18 October 2022: Every eligible citizen should vote in this election

Every eligible citizen should vote in this election. Please forward this article to your friends and family and promote on social media. These short articles give some reasons why:

http://natpernick.blogspot.com/2022/10/16-october-2022-dont-kvetch-vote.html

http://natpernick.blogspot.com/2022/10/14-october-2022-why-vote.html

http://natpernick.blogspot.com/2022/09/27-september-2022-importance-of-voting.html

http://natpernick.blogspot.com/2022/09/12-september-2022-voting-to-achieve.html

In Michigan, voting by absentee ballot already started on September 29. So it's time to get started.

I believe that EVERY community should have a turnout of 80% or more in this election. Towards that end, I have established a Voter turnout challenge for our 8 Next Door communities (Berkley, Ferndale, Huntington Woods, Lathrup Village, Oak Park, Pleasant Ridge, Royal Oak, Southfield), see http://natpernick.blogspot.com/2022/08/22-august-2022-this-years-southeast.html, but every community should try to get as high a voter turnout as possible.

To register to vote in Michigan, you must be:

* A U.S. citizen
* 18 years old when you vote
* A Michigan resident for at least 30 days
* Not currently serving a sentence in jail or prison

See https://www.michigan.gov/sos/elections/upcoming-election-information

All Michigan voters have the right to choose to vote in person at their polling place on Election Day or by absentee ballot by mail or in person at their clerk's office. Voters are not required to provide a reason to vote absentee.

Deadlines: 

October 24, 2022: Last day to request an absentee ballot online or by mail. This is also the suggested last day to return absentee ballot by mail to avoid potential for mailing delays. Or you can drop off your ballot at the clerk's office.

October 25 through 8:00 p.m. November 8, 2022: In-person registration with local clerk with proof of residency.

November 8, 2022: Election day is Tuesday, November 8: Polls are open from 7 a.m. - 8 p.m.

Return absentee ballot to your designated drop box or local clerk’s office by hand
by 8 p.m. on Tuesday, November 8.

See https://www.michigan.gov/sos/elections/upcoming-election-information

@NatPpolitics

17 October 2022: COVID-19 related gratitude

This post is intended for those who believe in science and vaccines and that COVID-19 is a threat to human health. It is not intended to start arguments!

I tested positive for COVID-19 this past Friday, most likely from going to a pathology conference and walking the exhibit floor talking to ~100 people, almost all of us maskless. 

Positive COVID-19 at home antigen test. The presence of the T line means positivity. It appeared within seconds of dropping fluid from a nasal swap onto the test. The C line is the control, which should be positive or the test process was likely faulty.

Walking in a large group without a mask may have been foolish, but it is hard to talk to people with a mask and the purpose of the trip was to make business connections. My symptoms were mild (I thought it was only hay fever) and I am now taking Paxlovid, which has reduced the runny nose, cough, fatigue and sore throat (there were no other symptoms). I felt the worst about exposing others to COVID before I was diagnosed. The next time I have potential exposure like this, I will quarantine and take a home COVID-19 test before "going out".

Overall, I am grateful. I am grateful that I was able to receive 5 vaccines against COVID-19, without much hassle or bureaucracy and for no charge. I believe these vaccines may have saved my life. As a pathologist / scientist, I know that COVID-19 has killed over one million Americans and that the unvaccinated have a much higher death rate than the vaccinated (https://ourworldindata.org/grapher/united-states-rates-of-covid-19-deaths-by-vaccination-status?country=~All+ages). To me, it was a "no brainer" to get vaccinated and markedly reduce my risk of death, even with the possibility of vaccine side effects. Being vaccinated also reduces the chance I will spread the disease to my friends and family with frail health who might die if they got infected.

I am grateful that I was able to receive an effective treatment for COVID-19 that was easy to obtain and easy to take (5 days of pills in a logical package) for no charge. 

Paxlovid "blister pack". There are 5 packs, each containing 3 pills to take in the AM and 3 pills in the PM. I received the medication in the afternoon and so started with the evening pills.

I am grateful that we have fast, at home test kits for COVID-19, also easy to obtain (I got them in the mail, now at pharmacies), also for no charge. Elsewhere in the world, people are "hoping and praying" that they will soon be able to get vaccines, treatments or test kits in this manner.

Although COVID-19 was the #3 cause of death in the US in 2020 and 2021 (https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm, https://www.cdc.gov/mmwr/volumes/71/wr/mm7117e1.htm#F2_down), I am grateful that my disease was mild and seems to be going away without any "long COVID" side effects (https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html), although only time will tell.

Thanks to all those in health care, science and government who made the vaccines, treatments and test kits possible and easily accessible.

P.S. I am intentionally keeping the "long links" because I want people to know the sources.

@NatPpolitics

12 October 2022 - Get vaccinated against COVID-19 now

 White House Urges People To Get Updated COVID-19 Boosters By Halloween For Maximum Protection For The Holidays

The AP (10/11, Miller) reports that on Tuesday, the White House “said eligible Americans should get the updated COVID-19 boosters by Halloween to have maximum protection against the coronavirus by Thanksgiving and the holidays, as it warned of a ‘challenging’ virus season ahead.” White House COVID-19 Response Coordinator Dr. Ashish Jha “said the U.S. has the tools, both from vaccines and treatments, to largely eliminate serious illness and death from the virus, but stressed that’s only the case if people do their part.”

We are so fortunate to be able to get this lifesaving vaccine. Elsewhere in the world, people are begging to get it. If you value your life and those you meet with, please get vaccinated! 

Photo source: https://www.cdc.gov/museum/timeline/covid19.html

29 August 2022: Anti-abortion laws threaten the health of pregnant women

 

Anti-abortion laws threaten the health of pregnant women, as an Idaho federal judge recently ruled, see https://www.washingtonpost.com/opinions/2022/08/28/federal-judge-pushback-idaho-abortion-ban/ . Physicians need to prioritize the lives of the patients that they are treating.

Of course, you can believe differently, but that is a religious point of view, not a medical one, and the United States does not have a national religion. This means our residents are free to practice our own religious beliefs or none at all, and cannot be forced to adhere to the religious beliefs of others.

21 August 2022: Medical advisory for anti-abortion states

Medical advisory for anti-abortion states 

21 August 2022

 

Pregnant women and girls may want to avoid traveling to anti-abortion states because of adverse health outcomes if they have a medical emergency. See https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html to determine the current status of each state, but note that this changes frequently due to litigation. Prior to the Dobbs v. Jackson Women's Health Organization decision of the U.S. Supreme Court (see https://en.wikipedia.org/wiki/Dobbs_v._Jackson_Women%27s_Health_Organization), female patients could rely on a  standard of care that prioritized their health in medical decision making. However, in anti-abortion states, physicians, nurses, pharmacists and other health care personnel now have to consider whether their actions will subject them to criminal prosecution under the anti-abortion laws.

This threat of criminal prosecution is real. In Indiana, its Attorney General threatened an ob-gyn who performed an abortion on a 10 year old from Ohio, even though it was clearly legal at the time (https://thehill.com/homenews/state-watch/3559347-indiana-ag-threatens-license-of-doctor-who-provided-abortion-to-10-year-old-rape-victim/). There is no doubt that some other prosecutors, who are typically elected officials, will use cases to attempt to advance their political careers.

 

How does the threat of prosecution alter care of pregnant patients? Some physicians are delaying or altering treatment for ectopic (tubal) pregnancy (https://www.washingtonpost.com/health/2022/07/16/abortion-miscarriage-ectopic-pregnancy-care/?pwapi_token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWJpZCI6IjMzMjkyOTg1Ii),  infections (https://www.npr.org/sections/health-shots/2022/07/26/1111280165/because-of-texas-abortion-law-her-wanted-pregnancy-became-a-medical-nightmare), miscarriages (https://apnews.com/article/abortion-science-health-medication-lupus-e4042947e4cc0c45e38837d394199033), lethal fetal conditions (https://www.wafb.com/2022/08/15/mother-claims-she-was-denied-an-abortion-despite-babys-condition/), maternal cancer (https://www.nbcnews.com/news/latino/mom-abortion-ban-daughter-death-dominican-republic-rcna43600) or other life threatening maternal conditions (https://www.nytimes.com/2022/08/01/us/abortion-journey-crossing-states.html). It is difficult to predict how this will affect any specific patient because (a) health care personnel may be reluctant to talk about their changing practice patterns, (b) the Dobbs decision is recent and behavioral changes are still ongoing, (c) research studies typically take years to publish. However, it seems likely that care will often be delayed and occasionally altered as health care personnel grapple with their fear of prosecution.

I suspect that, over time, to minimize the risk of prosecution, some health care personnel in these anti-abortion states will presume all women and girls to be pregnant unless proven otherwise and that they will administer pregnancy tests more commonly before starting or continuing treatments that may be dangerous to the unborn. These treatments include immunosuppressive drugs for autoimmune diseases (rheumatoid arthritis, lupus, multiple sclerosis), cancer treatments (radiation, chemotherapy, other drugs), as well as drugs for more common diseases (acne, bacterial infections, coagulation disorders, high blood pressure, manic-depressive disorder, seizures, see https://www.rxlist.com/teratogenic_drugs/definition.htm, https://www.ncbi.nlm.nih.gov/books/NBK553086/).  Some physicians may refuse to treat women or girls for these conditions unless it is clear that they cannot become pregnant in the future because they want to eliminate even the possibility of treatment being given during pregnancy and they cannot test every day.

What do you think? I welcome your opinion on how these state anti-abortion laws may affect medical care to women and girls, pregnant or not.

5 July 2022: Every pregnancy in an anti-abortion state is now a potential felony charge

https://www.freep.com/story/opinion/contributors/2022/06/26/supreme-court-abortion-ruling-roe/7724609001/

In anti-abortion states, every pregnancy is now a potential felony charge for all involved, including the pregnant woman, her physicians, friends and family if the pregnancy does not result in a healthy child. For example, a miscarriage is now a potential murder charge for anyone who encouraged or perhaps even tolerated any dangerous activity by or near the pregnant woman, including smoking, drinking, illegal drugs, car accidents, other accidents or any activity that may harm an embryo or fetus. This is particularly true in Texas, which has a bounty system to encourage reporting of abortions and possibly any actions encouraging or facilitating them, https://www.nytimes.com/2021/09/10/us/politics/texas-abortion-law-facts.html.

In addition, every female from puberty to menopause in an anti-abortion state should consider herself to be under surveillance because anti-abortion fanatics may consider that she is hiding a pregnancy and considering ways to end it.  

Pregnant women who get sick are at greater risk of death or bad outcomes because their physicians will be hesitant to take any action that may hurt the baby and risk a felony charge for themselves. This may be particularly true at Catholic hospitals, which may be much more sensitive to this issue.

Females in anti-abortion states have three choices: (a) do nothing and take your chances that there will be no criminal charges or threats to your health when pregnant, (b) fight to change the laws in your state or (c) move to a pro-choice state. Leaving is hard, but remember that many of our distant relatives left oppressive conditions to come here - moving to another state is much easier than what they went through.

What will you do?