The fees that Medicaid pays are so far below the usual fees that healthcare professionals receive that there is a refusal to take these patients. Practitioners will say they have no openings or are not taking on new patients. I was witness to a glaring example one day as an ENT surgeon blurted out to his colleagues why he was leaving medical practice.

In his late 60s, the surgeon said, “I get $75 for an operation on a kid where I would usually get $3K, and I’m not going to do it anymore. I’m retiring.” He had the means by virtue of many years in practice and having married a wealthy woman, so no financial loss for him, and he could play golf every day.

Where would those children who need an ENT’s expertise receive needed healthcare? It might fall to the charity sections of local hospitals and health clinics. There was no concern for them as he packed up and drove off to his beachfront home, one of two he owned.

The wealthy need not worry about the absence of healthcare, especially if they have contracted to receive concierge medical care. Paying a monthly fee or up to $10K/year, no waiting for an appointment and care is a phone call away.

The situation for those who are struggling financially and who have medical disorders as well, however, is dire. Even those who serve the greater community find they’re unable to find the help they need. I recall receiving several emails from an EMT worker who was active on 9/11 after the attacks and, as a result, developed hypertension and had two strokes.

We discussed what he needed because he was being denied Social Security disability benefits that would also provide Medicare, and he couldn’t work. Fortunately, I had been a consultant for that service, had written a book on it, and noted what he needed to do. Weeks later, I got an email telling me he received benefits.

Today, I received yet another note from an EMT worker who is suffering from PTSD as a result of pandemic work, can’t work because of panic disorder, and no therapist will accept her Medicaid. I couldn’t recommend a therapist, but I know that every profession has an ethical responsibility to take some pro bono cases.

Gauging How We Value Life

All life is precious, and there is no difference between a poor mother and her children or a yuppie gamboling in the Hamptons for the summer. Do all the therapists still take August off and attend Cape Cod seminars? The NYT thinks that’s where all the wealthy go to escape the summer heat. But that mother and her kids have no choices like that, and she has to pray they don’t get sick and need medical or psychological care. Who’s taking their Medicaid?

Can medical professionals refuse Medicaid patients? They always do it, but what consequences are there for them? One physician wrote eloquently on this dismal situation:

An oft-cited study showed that 31 percent of physicians nationwide were not willing to accept new Medicaid patients. The rate was even higher for orthopedic surgeons and dermatologists, two of the highest-paying specialties in medicine. The Affordable Care Act led to some modest improvements, particularly in access to primary care, but the acceptance rate of patients covered by Medicaid remains dismally low.

Should a retiree with a serious medical condition who lives with his wife on a fixed, marginal income have to drive 50 miles to see a physician who takes Medicaid? The answer is obvious, but no one in his area will accept his insurance.

Charity care is something hospitals do provide, and some states require them to do so. But the care may be at a high cost to hospitals. The patient load can be unusually large, staff suffer burnout, and wait times are long. For these reasons, many people delay going for care or are on waiting lists for care. Being on one of these lists isn’t unusual in mental health. But there can be a price to be paid by potential patients as they wait.

We find that longer waiting time is significantly associated with a deterioration in patient outcomes 12 months after acceptance for treatment for patients…Mental health clinics will open “wait list” groups to provide relief for patients in need until they receive an appointment with a therapist. Does that handle the deterioration? I guess we need another study.

What is the solution? There is no easy solution except to work within a more giving philosophy for those in need and an expansion of services. Creative solutions are required when funds are scarce because lives are on the line, and there is no value you can place on a life.

The post The Poor May Die While the Rich Will Play appeared first on Medika Life.

– Enhanced offerings will hold down out-of pocket costs, increase support for chronic health conditions and expand access for underserved communities

– Expansion furthers Cigna’s growth, increasing customer reach by more than 50% with nearly 80 new counties in 2021­

Date of Release: Sept. 10, 2020

BLOOMFIELD, Conn  /PRNewswire/ — Cigna Corp, a global health service company, is enhancing its offerings to customers who access health coverage through the Affordable Care Act (ACA) marketplace, frequently referred to as the individual exchange. Cigna’s plans will include a number of features that increase access to quality health care – all while holding down out-of-pocket costs.

These offerings will be available in nearly 80 new counties in 2021, representing more than 50 percent growth in customer reach. This growth will enable Cigna to make health care more affordable, predictable and simple for more people across the country.

“Our first priority is to ensure that our customers have access to the care they need – especially in this unprecedented time,” said Brian Evanko, president of Cigna’s government business. “We have maintained a continuous and growing presence in the individual exchanges since their launch in 2014, and are excited by the opportunity to serve even more customers in 2021 and beyond.”

In 2021, Cigna is offering individual and family plans on the individual exchanges in 220 counties spanning 10 states: Arizona, Colorado, Florida, Illinois, Kansas, Missouri, North Carolina, Tennessee, Utah and Virginia.

Key features that Cigna customers will enjoy include:

• $0 virtual care that now includes behavioral health providers* for most plans;
• A new diabetes care plan** available in most counties that includes $0 benefits for diabetes equipment and additional supplies; and
• Coverage for holistic services including acupuncture in select counties.

Enhancements added last year – such as the Patient Assurance Program*** to cap insulin costs at $25 per month for a 30-day supply of covered eligible insulin, and access to a customer loyalty program in most markets that rewards healthy lifestyle activities – are included as well.

Cigna’s 2021 plans will also include smarter digital interactions to better connect customers to care and medications, including access to the myCigna mobile app and Cigna One Guide to help customers navigate the highest quality and cost-effective providers, best sites of care and health tools.

Cigna’s real time benefit check program will increase financial predictability for customers. With this program, doctors can quickly and easily know the cost of treatment options during an appointment with a Cigna customer, which helps facilitate more informed and meaningful discussions among doctors and patients.

“Cigna remains deeply committed to providing affordable access to quality care – when and where our customers want to use their benefits – with offerings that encourage and support whole-person health,” said Lisa Lough, president of Cigna’s Individual and Family Plans business. “Our plans on the individual exchange are designed with an understanding of our customers’ needs and preferences for their health care, delivered in a collaborative relationship with physician partners across the country – many of whom are in value-based care arrangements.”

People interested in enrolling in a health plan on the individual exchange may do so during the 2021 Open Enrollment Period (OEP) that begins Nov. 1 and continues through Dec. 15. Health plans purchased during OEP are effective Jan. 1, 2021. People in Colorado may enroll in a plan on the state’s health insurance marketplace, where open enrollment continues through Jan. 15, 2021. 

For more details about Cigna health plans for individuals and families, click here.

*Cigna provides access to virtual care through national telehealth providers as part of your health plan. $0 telehealth benefit not available for all plans in CO. Some plans may apply a copay, coinsurance or deductible. Refer to plan documents for a complete description of virtual care services and costs, including other telehealth/telemedicine benefits.
**Refer to plan documents for a complete description and list of diabetes equipment and supplies that are covered at $0.
***Discounts available with the Cigna Patient Assurance Program. $25 is the maximum out-of-pocket cost for a 30-day supply.

About Cigna
Cigna Corporation is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Cigna delivers choice, predictability, affordability and access to quality care through integrated capabilities and connected, personalized solutions that advance whole person health. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna Life Insurance Company of New York, Connecticut General Life Insurance Company, Express Scripts companies or their affiliates, and Life Insurance Company of North America. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in over 30 countries and jurisdictions, and has more than 185 million customer relationships throughout the world. To learn more about Cigna^®, including links to follow us on Facebook or Twitter, visit www.cigna.com.

Media Contact
Ellie Polack
1 (860) 902-4906
elinor.polack@cigna.com

SOURCE Cigna

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