PatientsUseAI: Hugo, Gilles and e-Patient Dave — THCB Gang Special Episo...

Florida is UnitedHealthcare’s 2nd largest market. What that means for insurance denials.

Florida is UnitedHealthcare’s 2nd largest market. What that means for insurance denials.  Experts say seniors need to be particularly aware of their rights as they become increasingly more likely to have their claims denied.

About 4 million people in Florida are insured by UnitedHealthcare, a company facing backlash after its CEO was shot to death in Manhattan, followed by public outrage over its pattern of coverage denials.

Florida represents UnitedHealthcare’s second largest market after Texas, providing coverage through employee plans, the Affordable Care Act open marketplace, and Medicare Advantage plans.

This week, the insurer’s prior authorization and coverage denials in the state drew the same anger and frustration seen nationwide on social media in the wake of the shooting. Florida lawyers, insurance advocates, and medical billing experts say being informed about UnitedHealthcare’s practices, making smart choices, and fighting back is critical, especially now that the insurer uses sophisticated artificial intelligence (AI) to deny approvals and claims. According to consumer research site, ValuePengiun, UnitedHealthcare denies claims at a rate nearly double the industry average and now faces a barrage of lawsuits, including hundreds in Florida.

How to make an appeal

Donovan said patients denied prior authorization or payment should dig through the insurer’s denial letter to find instructions for the appeal process.

“Your denial will include details as to why they are making this decision, so you have to counter that with the facts that support your argument,” she said.

The Patient Advocate Foundation has sample appeals letters on its website.

When planning an appeal, document every step of the process, advises Russel Lazega, a Dania Beach insurance claims lawyer.

“Don’t treat an internal appeal to the insurer informally,” Lazega said. “A lot of people call and talk to the insurance company and don’t document it.”

Documentation should include emails from the insurer to the patient or from the patient to a doctor or hospital.

“Gather a direct response to their denial from your doctor and add your additional medical records to it,” Lazega said.

Sometimes, that documentation is enough to win an appeal.

If unsuccessful, the next step is an external appeal to a company hired by the insurer. “It’s important to have your documentation in the file. Any documentation about your appeal won’t be looked at unless it’s already in the file. Adding it later is hard, so don’t give the insurance company that technical advantage,” Lazega said.

The final step is federal court.

Lazega said people in life-or-death medical situations tend to go this route. The patient pays legal fees, not the insurance company.

“UnitedHealthcare approves and pays about 90% of medical claims upon submission,” UnitedHealthcare said in a statement provided to the Sun Sentinel. “Importantly, of those that require further review, around one-half of one percent are due to medical or clinical reasons. Highly inaccurate and grossly misleading information has been circulated about our company’s treatment of insurance claims.

“We do not use AI to make adverse coverage determinations. Coverage decisions are based on CMS coverage criteria and the terms of the member’s plan.”

Does that mean each AI determination is reviewed by a human?

Florida is UnitedHealthcare’s 2nd largest market. What that means for insurance denials.

QVIN ? A laboratory test using menstrual blood

𝐇𝐨𝐰 𝐌𝐞𝐧𝐬𝐭𝐫𝐮𝐚𝐥 𝐁𝐥𝐨𝐨𝐝 𝐈𝐬 𝐓𝐫𝐚𝐧𝐬𝐟𝐨𝐫𝐦𝐢𝐧𝐠 𝐇𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞

QVIN is a company that aims to provide persons with a menstrual cycle with an easy way of collecting menstrual blood for health screening.

"𝐇𝐨𝐰 𝐝𝐨𝐞𝐬 𝐭𝐡𝐞 𝐐-𝐏𝐚𝐝 𝐜𝐨𝐧𝐭𝐫𝐢𝐛𝐮𝐭𝐞 𝐭𝐨 𝐭𝐫𝐚𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐥𝐚𝐛 𝐭𝐞𝐬𝐭𝐢𝐧𝐠, 𝐚𝐧𝐝 𝐰𝐡𝐚𝐭 𝐦𝐚𝐤𝐞𝐬 𝐦𝐞𝐧𝐬𝐭𝐫𝐮𝐚𝐥 𝐛𝐥𝐨𝐨𝐝 𝐚 𝐩𝐨𝐰𝐞𝐫𝐟𝐮𝐥 𝐭𝐨𝐨𝐥 𝐟𝐨𝐫 𝐡𝐞𝐚𝐥𝐭𝐡 𝐢𝐧𝐬𝐢𝐠𝐡𝐭𝐬?

HGB A1C test for management of diabetes

𝐷𝑟. 𝑆𝑎𝑟𝑎, 𝑡ℎ𝑒 𝐶𝐸𝑂 𝑎𝑛𝑑 𝑐𝑜-𝑓𝑜𝑢𝑛𝑑𝑒𝑟 𝑜𝑓 𝑄𝑣𝑖𝑛, 𝑠𝑒𝑡 𝑜𝑢𝑡 𝑤𝑖𝑡ℎ 𝑡ℎ𝑒 𝑖𝑛𝑡𝑒𝑛𝑡 𝑜𝑓 𝑑𝑒𝑣𝑒𝑙𝑜𝑝𝑖𝑛𝑔 𝑡𝑒𝑐ℎ𝑛𝑜𝑙𝑜𝑔𝑦 𝑡𝑜 𝑒𝑛𝑎𝑏𝑙𝑒 𝑝𝑒𝑜𝑝𝑙𝑒 𝑡𝑜 𝑏𝑒 𝑚𝑜𝑟𝑒 𝑝𝑟𝑒𝑣𝑒𝑛𝑡𝑎𝑡𝑖𝑣𝑒 𝑎𝑏𝑜𝑢𝑡 𝑡ℎ𝑒𝑖𝑟 ℎ𝑒𝑎𝑙𝑡ℎ 𝑎𝑛𝑑 𝑠ℎ𝑒 𝑤𝑎𝑛𝑡𝑒𝑑 𝑡𝑜 𝑓𝑖𝑛𝑑 𝑎 𝑤𝑎𝑦 𝑡ℎ𝑎𝑡 𝑤𝑜𝑢𝑙𝑑 𝑎𝑙𝑙𝑜𝑤 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑡𝑜 𝑜𝑏𝑡𝑎𝑖𝑛 𝑐𝑙𝑖𝑛𝑖𝑐𝑎𝑙𝑙𝑦 𝑟𝑒𝑙𝑒𝑣𝑎𝑛𝑡 𝑖𝑛𝑓𝑜𝑟𝑚𝑎𝑡𝑖𝑜𝑛 𝑎𝑏𝑜𝑢𝑡 𝑡ℎ𝑒𝑖𝑟 ℎ𝑒𝑎𝑙𝑡ℎ 𝑟𝑒𝑔𝑢𝑙𝑎𝑟𝑙𝑦 𝑎𝑛𝑑 𝑛𝑜𝑛-𝑖𝑛𝑣𝑎𝑠𝑖𝑣𝑒𝑙𝑦. 𝑄𝑣𝑖𝑛'𝑠 𝑚𝑖𝑠𝑠𝑖𝑜𝑛 𝑖𝑠 𝑡𝑜 𝑒𝑚𝑝𝑜𝑤𝑒𝑟 𝑤𝑜𝑚𝑒𝑛 𝑤𝑖𝑡ℎ 𝑎𝑐𝑐𝑒𝑠𝑠 𝑡𝑜 𝑟𝑒𝑔𝑢𝑙𝑎𝑟 𝑖𝑛𝑠𝑖𝑔ℎ𝑡𝑠 𝑎𝑏𝑜𝑢𝑡 𝑡ℎ𝑒𝑖𝑟 ℎ𝑒𝑎𝑙𝑡ℎ 𝑓𝑜𝑟 𝑒𝑎𝑟𝑙𝑦 𝑑𝑒𝑡𝑒𝑐𝑡𝑖𝑜𝑛 𝑎𝑛𝑑 𝑚𝑜𝑛𝑖𝑡𝑜𝑟𝑖𝑛𝑔.

𝑄𝑣𝑖𝑛 𝑖𝑠 𝑡ℎ𝑒 𝑓𝑖𝑟𝑠𝑡 𝑎𝑛𝑑 𝑜𝑛𝑙𝑦 ℎ𝑒𝑎𝑙𝑡ℎ𝑐𝑎𝑟𝑒 𝑠𝑒𝑟𝑣𝑖𝑐𝑒 𝑡ℎ𝑎𝑡 𝑐𝑜𝑙𝑙𝑒𝑐𝑡𝑠 𝑚𝑒𝑛𝑠𝑡𝑟𝑢𝑎𝑙 𝑏𝑙𝑜𝑜𝑑 𝑠𝑎𝑚𝑝𝑙𝑒𝑠 𝑎𝑠 𝑎𝑛 𝑎𝑙𝑡𝑒𝑟𝑛𝑎𝑡𝑖𝑣𝑒 𝑡𝑜 𝑡𝑟𝑎𝑑𝑖𝑡𝑖𝑜𝑛𝑎𝑙𝑙𝑦 𝑐𝑜𝑙𝑙𝑒𝑐𝑡𝑒𝑑 𝑣𝑒𝑛𝑜𝑢𝑠 𝑏𝑙𝑜𝑜𝑑 𝑑𝑟𝑎𝑤𝑠. 𝑇ℎ𝑒 𝐹𝐷𝐴 𝑐𝑙𝑒𝑎𝑟𝑎𝑛𝑐𝑒 𝑚𝑎𝑘𝑒𝑠 𝑖𝑡 𝑝𝑜𝑠𝑠𝑖𝑏𝑙𝑒 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑚𝑖𝑙𝑙𝑖𝑜𝑛𝑠 𝑜𝑓 𝑤𝑜𝑚𝑒𝑛 𝑖𝑛 𝐴𝑚𝑒𝑟𝑖𝑐𝑎 𝑤ℎ𝑜 𝑙𝑖𝑣𝑒 𝑤𝑖𝑡ℎ 𝑑𝑖𝑎𝑏𝑒𝑡𝑒𝑠 𝑡𝑜 𝑟𝑒𝑐𝑒𝑖𝑣𝑒 𝑚𝑜𝑛𝑖𝑡𝑜𝑟𝑖𝑛𝑔 𝑜𝑓 𝐴𝟣𝑐, 𝑢𝑠𝑖𝑛𝑔 𝑙𝑎𝑏𝑜𝑟𝑎𝑡𝑜𝑟𝑦 𝑡𝑒𝑠𝑡𝑠 𝑝𝑒𝑟𝑓𝑜𝑟𝑚𝑒𝑑 𝑜𝑛 𝑡ℎ𝑒 𝑄-𝑃𝑎𝑑. 𝑀𝑜𝑟𝑒 𝑏𝑟𝑜𝑎𝑑𝑙𝑦, 𝑡ℎ𝑖𝑠 𝑚𝑎𝑟𝑘𝑠 𝑎𝑛 𝑜𝑝𝑝𝑜𝑟𝑡𝑢𝑛𝑖𝑡𝑦 𝑓𝑜𝑟 𝑡𝑒𝑠𝑡𝑖𝑛𝑔 𝑖𝑚𝑝𝑜𝑟𝑡𝑎𝑛𝑡 𝑏𝑖𝑜𝑚𝑎𝑟𝑘𝑒𝑟𝑠 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑚𝑜𝑟𝑒 𝑡ℎ𝑎𝑛 𝟪𝟢 𝑚𝑖𝑙𝑙𝑖𝑜𝑛 𝑝𝑒𝑜𝑝𝑙𝑒 𝑤ℎ𝑜 𝑚𝑒𝑛𝑠𝑡𝑟𝑢𝑎𝑡𝑒 𝑖𝑛 𝑡ℎ𝑒 𝑈.𝑆 𝑎𝑛𝑑 𝟣.𝟪 𝑏𝑖𝑙𝑙𝑖𝑜𝑛 𝑔𝑙𝑜𝑏𝑎𝑙𝑙𝑦.(...)

𝑄𝑣𝑖𝑛 𝑝𝑟𝑜𝑣𝑒𝑑 𝑡ℎ𝑒 𝑐𝑙𝑖𝑛𝑖𝑐𝑎𝑙 𝑟𝑒𝑙𝑒𝑣𝑎𝑛𝑐𝑦 𝑜𝑓 𝑚𝑒𝑛𝑠𝑡𝑟𝑢𝑎𝑙 𝑏𝑙𝑜𝑜𝑑 𝑓𝑜𝑟 𝑎 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑚𝑝𝑜𝑟𝑡𝑎𝑛𝑡 𝑏𝑖𝑜𝑚𝑎𝑟𝑘𝑒𝑟𝑠. 𝑇ℎ𝑒 𝑄-𝑃𝑎𝑑 𝑤𝑎𝑠 𝑖𝑛𝑖𝑡𝑖𝑎𝑙𝑙𝑦 𝑐𝑟𝑒𝑎𝑡𝑒𝑑 𝑡𝑜 𝑖𝑑𝑒𝑛𝑡𝑖𝑓𝑦 𝑏𝑖𝑜𝑚𝑎𝑟𝑘𝑒𝑟𝑠 𝑓𝑜𝑟 𝐻𝑃𝑉 𝑎𝑛𝑑 ℎ𝑎𝑠 𝑒𝑥𝑝𝑎𝑛𝑑𝑒𝑑 𝑎𝑛𝑑 𝑖𝑑𝑒𝑛𝑡𝑖𝑓𝑖𝑒𝑑 𝑎𝑑𝑑𝑖𝑡𝑖𝑜𝑛𝑎𝑙 𝑏𝑖𝑜𝑚𝑎𝑟𝑘𝑒𝑟𝑠 𝑡𝑜 𝑡𝑒𝑠𝑡 𝑓𝑜𝑟, 𝑖𝑛𝑐𝑙𝑢𝑑𝑖𝑛𝑔 𝑝𝑟𝑒/𝑑𝑖𝑎𝑏𝑒𝑡𝑒𝑠, 𝑎𝑛𝑒𝑚𝑖𝑎, 𝑓𝑒𝑟𝑡𝑖𝑙𝑖𝑡𝑦, 𝑝𝑒𝑟𝑖𝑚𝑒𝑛𝑜𝑝𝑎𝑢𝑠𝑒, 𝑒𝑛𝑑𝑜𝑚𝑒𝑡𝑟𝑖𝑜𝑠𝑖𝑠, 𝑎𝑛𝑑 𝑡ℎ𝑦𝑟𝑜𝑖𝑑 ℎ𝑒𝑎𝑙𝑡ℎ."

While this test is presently limited to diabetes management, it opens a new avenue to obtain blood samples for many other tests. The procedures will need to be evaluated and verified as accurate, by controlling samples of systemic venous blood. But what about males?

The Challenge of Primary Care in America

Mission Impossible for Primary Care

I am not your grandfather's doctor

The Replacement Doctors:

Electronic Health Record with Patient Portal, Appointment scheduling, messaging, online laboratory results,

Telehealth

Remote monitoring, and wearables

Artificial Intelligence for symptom diagnosis, treatment, and prognosis

At-home research with search engines

Social Media health sites, Community and Forums

Access to Care: Many patients struggle to find primary care providers, especially in rural or underserved areas. Long wait times for appointments can further complicate access.

Workforce Shortages: There is a growing shortage of primary care physicians, which can lead to increased workloads and burnout among existing providers.

Health Disparities: Socioeconomic factors, cultural differences, and systemic inequalities can affect patient access to care and health outcomes.

Chronic Disease Management: The rising prevalence of chronic diseases requires ongoing management, putting additional pressure on primary care resources.

Integration of Technology: While telehealth and electronic health records (EHRs) can improve efficiency, they also present challenges related to implementation, training, and data security.

Reimbursement Models: Many primary care providers face financial pressures due to outdated reimbursement models that do not adequately compensate for the quality of care delivered.

Patient Engagement: Encouraging patients to take an active role in their health can be difficult, especially when dealing with diverse populations.

Mental Health Integration: There is a growing need to integrate mental health services into primary care, which can be challenging due to stigma and a lack of resources.

Regulatory Burdens: Navigating complex regulations and compliance requirements can be time-consuming and detract from patient care.

Continuity of Care: Ensuring that patients receive consistent and coordinated care, particularly when transitioning between different healthcare settings, can be a challenge.

Facebook Reel 

 

The Decline of the Doctor: From Healers to Providers – Let Doctors be Doctors

“Whenever a physician or a nurse was called a” provider” and whenever a patient was called a” consumer” one more angel died. When all the angels were dead, we would be left with a totally dehumanized health care system.” Rashi Fein, PhD. NEJM Vol 306, # 14,863-864

Not too long ago, doctors were considered some of the most revered and trusted figures in society—figures to whom people entrusted their health and even their lives. In many cultures, physicians were viewed as almost godlike, given their immense responsibility and the critical role they played in shaping life and death. But today, many doctors are referred to as “providers,” a term that strips away the respect and reverence once given to them. Instead of healers, they have become cogs in the massive machine of healthcare.

So, what happened? How did the medical profession go from being a deeply respected calling to being treated like any other service industry job? What does this shift mean for doctors and patients, and how can we restore the respect that doctors once enjoyed?

The Golden Age of Medicine: Doctors as Healers

Historically, doctors have held an esteemed role in society. The word doctor comes from the Latin docere, meaning “to teach,” and throughout history, physicians were viewed as educators of both body and mind. They didn’t just cure disease; they provided guidance on living a healthy life, preventing illness, and promoting mental well-being. In the past, doctors were seen as moral figures—people who were deeply committed to their patients, and often considered part of the family.

In the early 20th century and before, doctors were often highly respected individuals. They were not just viewed as professionals—they were regarded as trustworthy advisors who could guide individuals through the most vulnerable and critical moments of their lives. Healthcare was much less accessible back then, and patients depended on their physicians not only for medical expertise but also for compassion and wisdom. People didn’t just visit doctors—they trusted them with their well-being.

The Shift: Healthcare Becomes a Business

However, after World War II, the healthcare landscape began to change dramatically, particularly in the United States. The introduction of private health insurance, the rise of large healthcare conglomerates, and the growth of pharmaceutical companies began to transform medicine into an increasingly industrialized business.

This shift was underscored by an explosion of healthcare costs. According to the Centers for Medicare & Medicaid Services (CMS), U.S. healthcare expenditures reached $4.3 trillion in 2021, a staggering 18.3% of the nation’s GDP. With these rising costs came the financialization of healthcare, where the focus began to shift from patient care to profit. As a result, healthcare started being viewed as an industry, with doctors no longer seen as healers but as part of the corporate machine.

The term “provider” began to replace “doctor,” signaling a shift in how healthcare professionals were viewed. Providers, as the term implies, were merely deliverers of a service, rather than esteemed practitioners of a noble art. Insurance companies, private equity firms, and large hospital networks gained more control over healthcare, leading to a more impersonal and transactional system.

This shift from personalized, patient-centered care to a corporate model significantly diminished the role of doctors as autonomous professionals, and, in many cases, reduced their autonomy. Doctors, now working for large health systems, found themselves less able to practice medicine in the way they saw fit, often pressured to meet the financial goals set by their employers.

The Burden of Bureaucracy: Technology, Paperwork, and Admin Overload

One of the major challenges that contributed to the devaluation of the doctor’s role is the growing administrative burden. With the rise of electronic health records (EHRs) and insurance bureaucracy, doctors spend an increasing amount of time on paperwork rather than on patient care. In fact, a 2019 survey by the American Medical Association (AMA) found that U.S. doctors spend an average of 16 hours a week on administrative tasks like EHR documentation, insurance claims, and compliance with government regulations.

This administrative burden has significant repercussions for the doctor-patient relationship. In the past, doctors were able to spend long, uninterrupted hours with patients, listening to their concerns and diagnosing their ailments with care and attention. But with the proliferation of bureaucratic tasks, doctors now face mounting pressure to see more patients, leaving little time for meaningful interactions.

The Mayo Clinic has noted that 50% of physicians report experiencing burnout, with high levels of administrative work being one of the key contributing factors. The growing use of technology, while beneficial in many ways, has inadvertently turned medicine into a data-management job for many doctors, rather than allowing them to focus on the healing process. As a result, doctors feel increasingly disconnected from the very art of medicine that once inspired them to enter the field.

Conclusion: Let’s Not Devalue the Profession Any Further

Doctors still hold an essential role in society. Healthcare has changed, but the art of healing has not disappeared. In fact, doctors are still fighting for their patients every day, often in the face of immense personal and professional challenges. They risk their lives, as we saw during the COVID-19 pandemic, working tirelessly to protect public health.

It’s time to stop devaluing the medical profession. We must recognize that doctors are not just “providers”—they are healers, educators, and advocates. The next time you see your doctor, remember that behind the white coat, they are doing their best to help you, despite the pressures they face.

If we want to restore the respect and dignity of the medical profession, we must work toward a healthcare system that values quality over efficiency, empathy over bureaucracy, and healing over profit. Let doctors be doctors again, and in doing so, we can ensure a healthier, more compassionate future for all.

The Decline of the Doctor: From Healers to Providers – Let Doctors be Doctors

Semaglutide Rocketing Past Statins as Millions Eligible

Statins are one of the 'go-to's' for reducing morbidity from hyper-lipid disorders causing arteriosclerosis heart disease, stroke, or other vascular thrombotic disorders.

About 40% of American adults — some 137 million — are eligible to take the glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide, said the authors of a new study. The authors report that 35 million adults are eligible for semaglutide for diabetes, 129 million for weight management, and 8.9 million for secondary cardiovascular disease prevention.

Semaglutide for secondary prevention is likely to be an area of increased growth, as there is more insurance coverage for that indication, the authors wrote.

Currently, statins are the most commonly prescribed medication for American adults, with some 192 million prescriptions written in 2022, according to one estimate. The authors of a research letter published online in JAMA Cardiology estimate that at least 82 million American adults are eligible for statins.

Semaglutide will quickly overtake statins as the most prescribed pharmaceutical for American adults, said the authors. It was the top-selling drug in the United States in 2023, with sales of almost $14 billion, which made it worth taking a closer look at who might be eligible, said lead author Dhruv S. Kazi, MD, MS, associate professor of medicine at Harvard Medical School, Boston.

The use of these medications. is cost-effective. 

He and his colleagues at Beth Israel Deaconess Medical Center, Boston, the Harvard T.H. Chan School of Public Health, Boston, and the Feinberg School of Medicine at Northwestern, Chicago, used data from the National Health and Nutrition Examination Survey from 2015 to 2020 to determine how many American adults might be eligible for semaglutide. They focused on diabetes, weight management, and secondary prevention of cardiovascular disease, using inclusion and exclusion criteria from major randomized clinical trials of semaglutide in those indications.  According to recent studies, approximately 137 million American adults are considered eligible for semaglutide treatment, which represents more than half of the US adult population; this eligibility is based on factors like weight management, diabetes management, or cardiovascular disease prevention. 

References and studies that discuss the cost-effectiveness of statins in preventing heart disorders in the general population:

Mason et al. (2015) - This study evaluated the cost-effectiveness of statin therapy for primary prevention of cardiovascular disease in various populations. It found that statins are generally cost-effective, especially in individuals with elevated cardiovascular risk.

Sculpher et al. (2004) - This research presented a model assessing the cost-effectiveness of statins for primary and secondary prevention of cardiovascular disease. The study concluded that statins are cost-effective for primary prevention in high-risk groups.

National Institute for Health and Care Excellence (NICE) - NICE guidelines provide a comprehensive analysis of the cost-effectiveness of statins in preventing cardiovascular diseases. Their recommendations suggest that statins are cost-effective for individuals with a 10% or greater risk of cardiovascular events over 10 years.

Hernandez et al. (2012) - This study analyzed the economic implications of statin therapy in the general population, demonstrating that widespread implementation in individuals aged 40-75 years with varying risk levels is cost-effective.

Graham et al. (2011) - This research evaluated the cost-effectiveness of statins in older adults, showing significant health benefits that justify the costs associated with long-term statin use for preventing heart disorders.

Cost-effectiveness of 10-Year Risk Thresholds for Initiation of Statin Therapy for Primary Prevention of Cardiovascular Disease

Factors associated with lipid-lowering therapy in the multi-ethnic study of atherosclerosis

Semaglutide Rocketing Past Statins as Millions Eligible

UnitedHealth Limits Access to Key Treatment for Kids With Autism —

United Health Care just cannot get it right. No matter, they don't care.

The diagnosis of autism (a neurodivergent diagnosis) has been made more often during the last decade. Many physicians and research programs are investigating the epidemiology of the diagnosis.

Secret Playbook: Leaked documents show that UnitedHealth is aggressively targeting the treatment of thousands of children with autism across the country to cut costs.   In internal reports, the company acknowledges that the therapy called applied behavior analysis, is the “evidence-based gold standard treatment for those with medically necessary needs.” But the company’s costs have climbed as the number of children diagnosed with autism has ballooned; experts say greater awareness and improved screening have contributed to a fourfold increase in the past two decades — from 1 in 150 to 1 in 36.

Critical Therapy: Applied behavior analysis has been shown to help kids with autism; many are covered by Medicaid, federal insurance for poor and vulnerable patients.

United administers Medicaid plans or benefits in about two dozen states and for more than 6 million people, including nearly 10,000 children with autism spectrum disorder. Optum expects to spend about $290 million for ABA therapy within its Medicaid plans this year, and it anticipates the need to increase, documents show. The number of Medicaid patients accessing specialized therapy has increased by about 20% over the past year, with expenses rising by about $75 million year-on-year.

UHC proactively analyzed the increased requests for advanced behavioral therapy calculating it would deny authorizations for treatment based solely upon the diagnosis. This diagnosis would exclude treatment for this disorder even if the benefits included behavioral therapy.

UnitedHealth Limits Access to Key Treatment for Kids With Autism — ProPublica

The SARCOPOD and MAID

 I learned about a new acronym in medical terminology that I was not aware of before —MAID.

An interesting article about MAID, which stands for Medical Assistance in Dying, came out, specifically about a pod that’s been built in Switzerland, called the “Sarco Pod,” where ending one’s misery, so to speak, is made more comfortable, for lack of a better word.

The company is SARCO 

The Sarco was inspired by UK man Tony Nicklinson who had locked-in syndrome. The lawyers of Tony approached Exit to ask if Philip Nitschke could invent a device that could be activated by the blink of an eye (this was the only movement Tony had). This got Philip thinking. Using his background in experimental physics, Philip set to work to create the Sarco. Sadly, Tony died before the project could be finished for him.

In the future, the blueprints for this Sarco Pod will be posted online, and you will apparently be able to 3-D print the machine wherever you are in the world and postulated that AI could assess whether you met the criteria to end your own life, versus having to go to a human doctor.

Apparently, Switzerland is consistently thought of as the most libertarian of societies on Earth, according to the article by Vox. It is ranked as the #1 country in the Human Freedom Index report, put out by a libertarian think-tank Cato Report.

Authorities in Switzerland took a dim look at this device by arresting several people.

Apparently, demand is increasing for this practice, and only a few countries, including Canada, the Netherlands, Spain, and Belgium, allow it legally.

What are your thoughts on assisted suicide?

The Peaceful Pill is available for those who want more information on euthanasia.

An online edition can be found here along with frequent updates

We have an online live pain management conference coming up called New And Integrative Ways To Manage Pain, which will welcome a few palliative medicine docs. It will be interesting to visit this issue there and ask for everyone’s thoughts.

Faculty at our event will include Delia Chiaramonte, MD, MS (whose SoMeDocs podcast episode was among the favorites in 2024),

David Rosenblum MD, Arian Nachat, MD Chief Executive Officer Dr Olivia Ong, FFPMANZCA FAFRM (RACP), Nikhil Verma M.D., Sarah Merritt, MD, Peter A. DePergola II, PhD, MTS, HEC-C, CT, Rikin Patel, DO, Elisha Peterson MD MEd FAAP FASA, & Michael Foti, DO.

Health Train Express offers this only for information, and should not be used for any purposes regarding euthanasia.