HENRICO, Va. — Sheldon Ekirch spends a lot of time on hold with her health insurance company.

This story also ran on CBS News.

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Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder.

In 2023, Ekirch was diagnosed with small fiber neuropathy, a condition that makes her limbs and muscles feel as if they’re on fire. Now she takes more than a dozen prescriptions to manage chronic pain and other symptoms, including insomnia.

“I don’t feel like I am the person I was a year and a half ago,” said Ekirch, who was on the cusp of launching her law career, before getting sick. “Like, my body isn’t my own.”

Ekirch said specialists have suggested that a series of infusions made from blood plasma called intravenous immunoglobulin — IVIG, for short — could ease, or potentially eradicate, her near-constant pain. But Ekirch’s insurance company has repeatedly denied coverage for the treatment, according to documents provided by the patient.

Patients with Ekirch’s condition don’t always respond to IVIG, but she said she deserves to try it, even though it could cost more than $100,000.

“I’m paying a lot of money for health insurance,” said Ekirch, who pays more than $600 a month in premiums. “I don’t understand why they won’t help me, why my life means so little to them.”

For patient advocates and health economists, cases like Ekirch’s illustrate why prior authorization has become such a chronic pain point for patients and doctors. For 50 years, insurers have employed prior authorization, they say, to reduce wasteful health care spending, prevent unnecessary treatment, and guard against potential harm.

The practice differs by insurance company and plan, but the rules often require patients or their doctors to request permission from the patient’s health insurance company before proceeding with a drug, treatment, or medical procedure.

The insurance industry provides little information about how often prior authorization is used. Transparency requirements established by the federal government to shed light on the use of prior authorization by private insurers haven’t been broadly enforced, said Justin Lo, a senior researcher for the Program on Patient and Consumer Protections at KFF, a health information nonprofit that includes KFF Health News.

Yet it’s widely acknowledged that prior authorization tends to disproportionately impact some of the sickest people who need the most expensive care. And despite bipartisan support to reform the system, as well as recent attempts by health insurance companies to ease the burden for patients and doctors, some tactics have met skepticism.

Some insurers’ efforts to improve prior authorization practices aren’t as helpful as they would seem, said Judson Ivy, CEO of Ensemble Health Partners, a revenue cycle management company.

“When you really dive deep,” he said, these improvements don’t seem to touch the services and procedures, such as CT scans, that get caught up in prior authorization so frequently. “When we started looking into it,” he said, “it was almost a PR stunt.”

The ‘Tipping Point’

When Arman Shahriar’s father was diagnosed with follicular lymphoma in 2023, his father’s oncologist ordered a whole-body PET scan to determine the cancer’s stage. The scan was denied by a company called EviCore by Evernorth, a Cigna subsidiary that makes prior authorization decisions.

Shahriar, an internal medicine resident, said he spent hours on the phone with his father’s insurer, arguing that the latest medical guidelines supported the scan. The imaging request was eventually approved. But his father’s scan was delayed several weeks — and multiple appointments were scheduled, then canceled during the time-consuming process — while the family feared the cancer would continue to spread.

EviCore by Evernorth spokesperson Madeline Ziomek wrote in an emailed statement that incomplete clinical information provided by physicians is a leading cause of such denials. The company is “actively developing new ways to make the submission process simpler and faster for physicians,” Ziomek said.

In the meantime, Shahriar, who often struggles to navigate prior authorization for his patients, accused the confusing system of “artificially creating problems in people’s lives” at the wrong time.

“If families with physicians are struggling through this, how do other people navigate it? And the short answer is, they can’t,” said Shahriar, who wrote about his father’s case in an essay published last year by JAMA Oncology. “We’re kind of reaching a tipping point where we’re realizing, collectively, something needs to be done.”

The fatal shooting of UnitedHealthcare CEO Brian Thompson on a New York City sidewalk in December prompted an outpouring of grief among those who knew him, but it also became a platform for public outrage about the methods insurance companies use to deny treatment.

An Emerson College poll conducted in mid-December found 41% of 18- to 29-year-olds thought the actions of Thompson’s killer were at least somewhat acceptable. In a NORC survey from the University of Chicago conducted in December, two-thirds of respondents indicated that insurance company profits, and their denials for health care coverage, contributed “a great deal/moderate amount” to the killing. Instagram accounts established in support of Luigi Mangione, the 26-year-old Maryland suspect accused of murder and terrorism, have attracted thousands of followers.

The outpouring of anger at health insurers following the killing of UnitedHealthcare CEO Brian Thompson continues a cycle of rage that dates back decades.Read More

“The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry,” Cigna Group CEO David Cordani said during an earnings call on Jan. 30. Cigna is focused on “making prior authorizations faster and simpler,” he added.

The first Trump administration and the Biden administration put forth policies designed to improve prior authorization for some patients by mandating that insurers set up electronic systems and shortening the time companies may take to issue decisions, among other fixes. Hundreds of House Democrats and Republicans signed on to co-sponsor a bill last year that would establish new prior authorization rules for Medicare Advantage plans. In January, Republican congressman Jefferson Van Drew of New Jersey introduced a federal bill to abolish the use of prior authorization altogether.

Meanwhile, many states have passed legislation to regulate the use of prior authorization. Some laws require insurers to publish data about prior authorization denials with the intention of making a confusing system more transparent. Reform bills are under consideration by state legislatures in Hawaii, Montana, and elsewhere. A bill in Virginia approved by the governor March 18 takes effect July 1. Other states, including Texas, have established “gold card” programs that ease prior authorization requirements for some physicians by allowing doctors with a track record of approvals to bypass the rules.

No one from AHIP, an insurance industry lobbying group formerly known as America’s Health Insurance Plans, was available to be interviewed on the record about proposed prior authorization legislation for this article.

But changes wouldn’t guarantee that the most vulnerable patients would be spared from future insurance denials or the complex appeals process set up by insurers. Some doctors and advocates for patients are skeptical that prior authorization can be fixed as long as insurers are accountable to shareholders.

Kindyl Boyer, director of advocacy for the nonprofit Infusion Access Foundation, remains hopeful the system can be improved but likened some efforts to playing “Whac-A-Mole.” Ultimately, insurance companies are “going to find a different way to make more money,” she said.

‘Unified Anger’

In the weeks following Thompson’s killing, UnitedHealthcare was trying to refute an onslaught of what it called “highly inaccurate and grossly misleading information” about its practices when another incident landed the company back in the spotlight.

On Jan. 7, Elisabeth Potter, a breast reconstruction surgeon in Austin, Texas, posted a video on social media criticizing the company for questioning whether one of her patients who had been diagnosed with breast cancer and was undergoing surgery that day needed to be admitted as an inpatient.

The video amassed millions of views.

In the days following her post, UnitedHealthcare hired a high-profile law firm to demand a correction and public apology from Potter. In an interview with KFF Health News, Potter would not discuss details about the dispute, but she stood by what she said in her original video.

“I told the truth,” Potter said.

The facts of the incident remain in dispute. But the level of attention it received online illustrates how frustrated and vocal many people have become about insurance company tactics since Thompson’s killing, said Matthew Zachary, a former cancer patient and the host of “Out of Patients,” a podcast that aims to amplify the experiences of patients.

For years, doctors and patients have taken to social media to shame health insurers into approving treatment. But in recent months, Zachary said, “horror stories” about prior authorization shared widely online have created “unified anger.”

“Most people thought they were alone in the victimization,” Zachary said. “Now they know they’re not.”

Data published in January by KFF found that prior authorization is particularly burdensome for patients covered by Medicare Advantage plans. In 2023, virtually all Medicare Advantage enrollees were covered by plans that required prior authorization, while people enrolled in traditional Medicare were much less likely to encounter it, said Jeannie Fuglesten Biniek, an associate director at KFF’s Program on Medicare Policy. Furthermore, she said, Medicare Advantage enrollees were more likely to face prior authorization for higher-cost services, including inpatient hospital stays, skilled nursing facility stays, and chemotherapy.

But Neil Parikh, national chief medical officer for medical management at UnitedHealthcare, explained prior authorization rules apply to fewer than 2% of the claims the company pays. He added that “99% of the time” UnitedHealthcare members don’t need prior authorization or requests are approved “very, very quickly.”

Recently, he said, a team at UnitedHealthcare was reviewing a prior authorization request for an orthopedic procedure when they discovered the surgeon planned to operate on the wrong side of the patient’s body. UnitedHealthcare caught the mistake in time, he recounted.

“This is a real-life example of why prior authorization can really help,” Parikh said.

Even so, he said, UnitedHealthcare aims to make the process less burdensome by removing prior authorization requirements for some services, rendering instant decisions for certain requests, and establishing a national gold card program, among other refinements. Cigna also announced changes designed to improve prior authorization in the months since Thompson’s killing.

“Brian was an incredible friend and colleague to many, many of us, and we are deeply saddened by his passing,” Parikh said. “It’s truly a sad occasion.”

The Final Denial

During the summer of 2023, Ekirch was working full time and preparing to take the bar exam when she noticed numbness and tingling in her arms and legs. Eventually, she started experiencing a burning sensation throughout her body.

That fall, a Richmond-area neurologist said her symptoms were consistent with small fiber neuropathy, and, in early 2024, a rheumatologist recommended IVIG to ease her pain. Since then, other specialists, including neurologists at the University of Virginia and Virginia Commonwealth University, have said she may benefit from the same treatment.

There’s no guarantee it will work. A randomized controlled trial published in 2021 found pain levels in patients who received IVIG weren’t significantly different from the placebo group, while an older study found patients responded “remarkably well.”

“It’s hard because I look at my peers from law school and high school — they’re having families, excelling in their career, living their life. And most days I am just struggling, just to get out of bed,” said Ekirch, frustrated that Anthem continues to deny her claim.

In a prepared statement, Kersha Cartwright, a spokesperson for Anthem’s parent company, Elevance Health, said Ekirch’s request for IVIG treatment was denied “because it did not meet the established medical criteria for effectiveness in treating small fiber neuropathy.”

On Feb. 17, her treatment was denied by Anthem for the final time. Ekirch said her patient advocate, a nurse who works for Anthem, suggested she reach out to the drug manufacturer about patient charity programs.

“This is absolutely crazy,” Ekirch said. “This is someone from Anthem telling me to plead with a pharmacy company to give me this drug when Anthem should be covering it.”

Her only hope now lies with the Virginia State Corporation Commission Bureau of Insurance, a state agency that resolves prior authorization disputes between patients and health insurance companies. She found out through a Facebook group for patients with small fiber neuropathy that the Bureau of Insurance has overturned an IVIG denial before. In late March, Ekirch was anxiously waiting to hear the agency’s decision about her case.

“I don’t want to get my hopes up too much, though,” she said. “I feel like this entire process, I’ve been let down by it.”

The post ‘They Won’t Help Me’: Sickest Patients Face Insurance Denials Despite Policy Fixes appeared first on Medika Life.

Both short-term and long-term exposure to wildfire smoke and other pollutants like ozone and diesel emissions can cause inflammation in the brain. We believe pollutants in the lungs cause the neurological effects. Previous research has suggested that breathing in particulate matter (PM) causes pulmonary proteolysis, creating fragmented peptides that enter the bloodstream and weaken the blood–brain barrier (BBB).

Climate Central, a non-profit group, says that every person in the US took in more harmful wildfire smoke in 2023 than in any other year since 2006. Studies show that over the last ten years, exposure has grown 27 times in the United States.

Pollutants from wildfire smoke are mixed together, but fine particulate matter (PM2.5) makes up most of it and is a significant health risk. A study of more than 1.2 million people in southern California over the course of ten years found that wildfire smoke raises the chance of dementia more than any other type of air pollution. Researchers indicate that wildfire smoke is more dangerous to brain health than other types of air pollution.

Fine particulate matter (PM2.5) is air pollution from industry, cars, and wildfire smoke. These are very small drops of solid and liquid matter in the air, 30 times smaller than the width of a human hair. The chance of getting dementia was much higher when people were exposed to PM2.5 from wildfire smoke than when people were exposed from other sources of air pollution. Smoke from other sources increases the risk of dementia, but not as much as smoke from wildfires.

Mental Health Consequences

On days with a lot of pollution, more people go to the hospital for depression, suicide attempts, and psychotic episodes. Study after study shows that children whose mothers were exposed to high amounts of particulates while they were pregnant are more likely to have motor and cognitive problems as adults.

One study is one of the first to look at the effects of particulate matter on teens, whose brains are still growing.

Data from 10,000 pre-teens in the Adolescent Brain Cognitive Development Study (ABCD), the largest US child health study, was analyzed. Two of the 21 study sites are at the University of Colorado at Boulder.

Researchers looked at parent questionnaires from four different times over three years and found that for both boys and girls, each extra day of exposure at unsafe levels increased the chance that they would have depression, anxiety, and other “internalizing symptoms” up to a year later.

But wildfire smoke doesn’t only affect the immediate area. While the exact distance depends on the wind and weather, smoke from wildfires can move hundreds of miles. This wide area has an effect on the air quality in places far from the fire, and the effects can last for weeks.

Smoke from wildfires, as previously noted, can have a significant effect on health. Some of the chemicals and small particles in smoke can impact the eyes, nose, and throat, making it hard to breathe, cough, and wheeze. If someone already has a breathing problem, like asthma, these signs can get worse.

How Can You Protect Yourself

It’s important to remember how the air quality is affected by the flames in the area, even if you are miles away. These are some simple things you can do to stay away from smoke and clean the air in your home and car.

1. Spend as much time as possible inside
Do not go outside as much, especially if you are working out when the air quality is poor. Inside is the best place to be when there is smoke. Keep a close eye on local news on the air quality. They often include a color-coded Air Quality Index (AQI) to help you decide how active you should be.

2. Close all the doors and windows
All of your windows and doors should be closed to keep smoke out of your home. Weather stripping or towels can fill in holes under doors and windows if you can. If your whole-house fan or window air conditioner does not have a HEPA filter, do not use them. They can bring smoke inside.

3. Use an air cleaner
If you have an air cleaner, especially one with a HEPA filter, use it to help clean the air inside your home. You might want to use portable air cleaners in the bedrooms and living rooms where you spend the most time. Do not use things that make ozone because it can make the air quality worse.

4. Create a room with clean air
Set aside one room as a “clean air room” if keeping your whole house smoke-free is hard. A HEPA air filter should be set up in a room with few windows and doors. During times of smoke, spend most of your time in this room.

5. Know how to use your air conditioner well
If you have an air conditioner, make sure it is set to bring in air from outside and move it inside. Keep the windows closed and, your car, set your air conditioner to the recycling mode to keep smoke out of your car while you drive.

6. Stay away from things that make indoor pollution worse
When the air quality outside is a concern, it is important to cut down on indoor pollution sources as well. Do not use gas stoves, burn candles, or smoke inside. The air quality inside can get even worse, and these actions can make the environment more dangerous.

7. Put on a mask if you need to.
If you have to go outside, wear a mask to keep out small particles. Wearing N95 respirators or KN95 masks can help protect you from dangerous particles in wildfire smoke. Scarves or masks made of cloth will not keep smoke out.

8. Keep an eye on air quality
You can check the air quality in your area in real time with apps or websites. There is a simple way to tell if the air is safe to breathe with the Air Quality Index (AQI), which helps you plan your day.

9. Drink plenty of water and look after your health
It is important to stay hydrated because wildfire smoke can irritate your lungs and make it harder to breathe. Your lungs and sinuses stay moist when you drink plenty of water. For people who already have conditions like asthma, make sure they have all of their medicines on hand. Also, do not wait to call their doctor if they have trouble breathing or other signs.

We are beginning to suffer through the effects of climate change and wildfires are a result. Living with these conflagrations may mean changes over a long period of time because climate change will be with us for decades, if not longer. Lifestyle changes are mandated if we expect to maintain our health when we need to interact with wildfire-induced pollution.

The post Wildfire Smoke Linked to Dementia, Brain Damage and Body Health, So Beware appeared first on Medika Life.

A HEALTHY LIFESTYLE IS ASSOCIATED WITH A LOWER RISK of developing fatty liver disease. Today we explore the connection between inadequate sleep and fatty liver disease.

First, did you catch the error in my post illustration? The striking image at the top of this piece has a bull’s eye on the stomach, not the liver. Don’t worry: I did not skip the Yale School of Medicine anatomy class.

Let’s get back to one of the dangers of insufficient sleep. Fatty liver disease is the leading chronic liver disease worldwide, striking one in four of the population.

Fatty liver disease

Fatty liver disease is a common condition resulting from too much-stored fat in the liver. Most individuals have no symptoms, but the fatty liver disease can occasionally lead to liver damage.

That’s the bad news. The good news is that you can often prevent (or even reverse) fatty liver disease with positive lifestyle interventions.

Fatty liver disease is common.

Non-alcoholic fatty liver disease (NAFLD) happens in those who aren’t heavy consumers of alcohol. The condition affects about one in three adults (and one in ten childer) in the United States. Worldwide, the disease affects one in four adults, according to the Cleveland Clinic (USA).

Scientists do not know the exact cause of non-alcoholic fatty liver disease. However, we know several factors, including diabetes and obesity, can increase your risk. Moreover, fatty liver disease may progress to end-stage liver disease.

Fatty liver disease hits certain groups more.

Non-alcoholic fatty liver disease can affect anyone, regardless of age or race. By race, it appears more common among individuals of Hispanic descent, and Black people are less likely to get NAFLD (with whites in the middle).

Of those with non-alcoholic fatty disease, up to 75 percent have obesity or diabetes. Looking the other direction, up to 90 percent of those with advanced or class III obesity have non-alcoholic fatty liver disease.

Fatty liver disease causes

Before we get to the sleep and fatty liver relationship, let’s look at some suspected factors:

• Diet. A high fructose diet may increase your risk of developing non-alcoholic fatty liver disease. Think common table sugar and high fructose corn syrup. Alas, the latter is a common added sweetener in many American foods. I have become a label reader. I want to avoid metabolic syndrome, a disease cluster that increases our risk of heart disease, stroke, and type 2 diabetes. The risk-raising conditions include high blood sugar, too much body fat around the waist, abnormal cholesterol or triglyceride levels, and high blood pressure.
• Genetics. Inherited genetics may explain why individuals of certain races appear to get fatty liver disease more often.

Fatty liver disease causes

Researchers suspect several factors contribute to non-alcoholic fatty liver risk, including:

• Metabolic syndrome. Non-alcoholic fatty liver disease seems linked to a group of related metabolic disorders involving high body mass index, elevated blood lipid levels, diabetes, and high blood pressure. These factors influence one another and affect how your body stores fats and metabolizes nutrients.
• Diet and nutritional causes. A fructose-rich diet can increase your risk of developing NAFLD. Fructose is one of the ingredients in common table sugar and is the dominant ingredient in high fructose corn syrup, a common sweetener. It’s highly linked to metabolic syndrome.
• Genetics. Inherited genes may make you more likely to develop NAFLD. It may also help explain why individuals of certain races seem to get it more often.
• Gallbladder removal (cholecystectomy).

You may wonder if you should have screening for non-alcoholic fatty liver disease, particularly if you have a risk factor such as obesity or diabetes.

The American Association for the Study of Liver Diseases guidelines does not call for screening given uncertainties around which test to use (since liver enzyme levels may be normal in patients with NAFLD), how to treat NAFLD if discovered, and whether screening is cost-effective.

Fatty liver disease — possible complications

Here are the two major complications of non-alcoholic fatty liver disease:

• Pregnancy complications. NAFLD in pregnancy is associated with a higher risk of complications for the mother and fetus. For example, high blood pressure problems (such as preeclampsia) are more likely to affect the mother. Other associated problems include bleeding after delivery and preterm birth. Non-alcoholic fatty liver disease in pregnancy has tripled over the past ten years in the United States.
• Steatohepatitis. Up to 20 percent of individuals with non-alcoholic fatty liver disease may develop non-alcoholic steatohepatitis (NASH) or chronic liver inflammation. This inflammatory state can progressively damage the liver, culminating in scarring (cirrhosis).

Non-alcoholic fatty disease risk and short sleep

Do you have a sedentary lifestyle? Are you getting insufficient sleep? A new study points to a higher risk of developing fatty liver disease.

According to Dr. Yan Liu of Guangdong (China), the takeaway message is:

“Those with poor nighttime sleep and prolonged daytime napping have the highest risk for developing fatty liver disease. A moderate improvement in sleep quality appeared associated with a nearly one-third (29 percent) drop in fatty liver disease risk (even for those with unhealthy lifestyles).

The scientists arrived at their conclusions by analyzing self-reported sleep behaviors from just over 5,000 Chinese adults. Late bedtime, daytime napping for more than 30 minutes, and snoring appeared to be linked to an increased risk of fatty liver disease.

Sedentary individuals and those with central obesity had especially noticeable adverse effects from poor sleep quality.

Summary: Sleep and fatty liver disease

In summary, even a moderate improvement in sleep quality can reduce the risk for fatty liver disease, especially in those with unhealthy lifestyles. Thank you for joining me today.

The post One More Peril of Short Sleep appeared first on Medika Life.

There is growing evidence that even moderate alcohol consumption has negative effects on the brain. However, the underlying mechanisms are unknown. “Moderate” drinking was defined between 7 to <14 units of alcohol a week for women and 7 to <21 units for men. There is a possibility that accumulation of iron in the brain may play role as excess brain iron has been described in several neurodegenerative diseases, including Alzheimer’s and Parkinson’s.

In the study, published in the journal PLOS Medicine, researchers showed evidence that alcohol directly related to cognitive decline. In this study, scientists studied the relationship between self-reported alcohol intake and iron levels in the brain — which represents a potential mechanism for alcohol-related cognitive decline. Magnetic resonance imaging was used to ascertain iron content of each brain region and liver tissues, a marker of systemic iron.

Researchers collected data from 20,965 participants from United Kingdom, whose average age was 55 and 48.6% of participants were female. A total of 2.7 percent of the participants involved did not consume alcohol, while the rest consumed an average of 18 units of alcohol per week. For the record, 18 units is almost equivalent to six glasses of wine or 7.5 cans of beer.

“Drinking more than seven units of alcohol per week was associated with the accumulation of iron in the brain.”

The researchers, Anya Topiwala believed that this study was the largest study to date. She said that drinking more than seven units of alcohol per week was associated with the accumulation of iron in the brain. Higher brain iron is associated with poorer cognitive performance — poorer executive function and fluid intelligence and slower reaction speed. Iron accumulation can be a cause of alcohol-related cognitive decline.

The basal ganglia — an area in the brain that helps us perform cognitive, emotional and movement-related functions had some of the highest iron concentrations in the brain and suffered the greatest aging. There is a significant alcohol-age interactions with susceptibility, suggesting that alcohol may magnify age effects on brain iron.

Though light alcohol intake (drink <7 units of alcohol) is better than moderate intake, abstinence is still the best option. Never drinker had the lowest amount of brain iron and the best cognitive performance. This can indicate that there may be no safe level of alcohol consumption for brain health.

There may be no safe level of alcohol consumption for your health

Previous study from the same author support these findings. Using 30 year longitudinal data on alcohol consumption, the researcher found there was no protective effect for light drinkers compared with abstinence. Compared with abstinence, moderate alcohol intake is associated with increased risk of adverse brain outcomes and steeper cognitive decline.

According to NHS, it’s recommended to drink no more than 14 units of alcohol a week, spread across 3 days or more. That’s around 6 medium (175ml) glasses of wine, or 6 pints of 4% beer. There’s no completely safe level of drinking, but sticking within these guidelines lowers your risk of harming your health. Here’s how you can cut down on alcohol:

• Don’t keep alcohol in your house. Having no alcohol at home can help limit your drinking.
• Drink slowly. Sip your drink. Drink soda, water, or juice after having an alcoholic beverage. Never drink on an empty stomach.
• Choose alcohol-free days. Decide not to drink a day or two each week. You may want to abstain for a week or a month to see how you feel physically and emotionally without alcohol in your life. Taking a break from alcohol can be a good way to start drinking less.
• Choose drinks that are lower in alcohol. Try lighter beers — under 4% ABV. As a rule of thumb, white and rosé wines are lower in strength than reds. Or try swapping some or all of your drinks for no or low-alcohol alternatives..
• Stop people pleasing. Practice ways to say no politely. You do not have to drink just because others are, and you shouldn’t feel obligated to accept every drink you’re offered.
• Ask for support. Cutting down on your drinking may not always be easy. Let friends and family members know that you need their support. Your doctor, counselor, or therapist may also be able to offer help.

The post What is the Safe Amount to Consume Alcohol? appeared first on Medika Life.