Social Capital investor Kristin Baker Spohn's health bill horror story

Kristin  Baker Spohn is no mere mortal when it comes to hospital administration.  If you are feeling inadequate or incompetent.,,,don't.  The best experts are humbled by the gordion know which is now hospital charges. You see it is the outcome of fee for service charges, mixed with capitation, and contractual arrangements by disparate health insurers. The computer systems simply cannot keep up with the myriad changes of the Affordable Care Act, Medicare' annual changes in reimbursement, new ICD 10 codes, 


This exec has spent her whole career in health care, and even she couldn't get her hospital bill fixed

This is her story about what happened when she noticed a duplicate billing for a procedure she had during her pregnancy...

"I've spent my entire career in health care.

It's impossible to work in this industry and not lament how challenging our system can be for patients. But I didn't truly appreciate its complexity until I was the one navigating it on my own.

Several years ago, I was diagnosed with gestational diabetes and classified as a "high risk" pregnancy. Following my doctor's orders, I had an additional ultrasound to check on the growth of my baby. A little over a week later, I went into labor and delivered my happy and healthy son.

We settled in with our new life at home and in a few weeks the onslaught of hospital bills and explanations of benefits (EOBs) from my health insurance administrator arrived. As the diligent chief financial officer and resident health care expert of our family, I jumped in, determined to reconcile the insurance reimbursement with the hospital bills.

In the haze of new motherhood, my recollection may be fuzzy, but it went something like this:

In one hospital bill, I noticed that there was a duplicate charge for my additional ultrasound.

Most people would groan -- or worse, not even notice the duplicate charge -- but for me, it was game time. I felt like an athlete who had trained for this moment for years. My finance background and attention to detail enabled me to reconcile and find errors in complex financial statements and models. My work at Castlight prepared me to understand all of the different healthcare systems, billing and reimbursement codes. And my weird love of negotiation energized me as I approached the starting line.

How it went down

Step 1: Pull all the documentation together. It is immediately clear that the information in the bills and EOBs isn't sufficient. I need an itemized bill from the hospital and a detailed EOB from my insurance administrator in order to make sense of all of the charges. Because I am on a high-deductible plan like millions of Americans, I also need the benefits coverage detail and my accumulators (how much of my health insurance deductible I had spent at the time of the ultrasound) in order to calculate my co-insurance responsibility.

Step 2: Log into my insurance provider's web portal to look up ultrasound coverage and attempt to determine my remaining deductible at the time of the ultrasound. I find the coverage information under "imaging benefits" and read that ultrasounds are "covered as a preventive service," but it's unclear what constitutes a preventive ultrasound vs. a non-preventive ultrasound, and which category mine falls into. I will need more detail from the hospital to figure this out.

Step 3: Call the hospital to get an itemized billing for the date of service which included the ultrasound. I request the CPT code for the service and am told that it is in a different department and I'll need to call back after 9am the next day.

Kristin Baker Spohn

[At this moment, my son starts crying. Break to change his diaper.]

Step 3b: Call the other hospital department line and ask for the CPT code (the guy on the line is shocked I know what a CPT code is and is confused why I'm asking for it).

[Next, I break to put my son down for a nap.]

Step 4: Call the insurance administrator for benefits coverage information related to ultrasounds. I'm informed that my benefits detail is specific to my employer's coverage and I should call my company's benefits team to ask for it.

Step 5: Call my company's HR team. They say, actually, since we are a fully-insured employer, the benefits should be available through my insurance administrator. Of course.

[Break again to take a quick work call.]

Step 6: Call the insurance administrator back and ask for the detailed summary of benefits. The support representative says I can go on the web portal, download, print and fill out and a request form and the document will be snail-mailed to me. Snail mail!

Step 7: Put my son in a stroller and walk to Fedex/Kinko's to print out the form and mail it in.

[Wait several weeks, it doesn't arrive. Baby gains two pounds!]

Step 8: Call the hospital back to request that they not send my bill to collections as there is an ongoing discussion with the billing department and insurance administrator over benefits coverage. I am assured by the support representative that this is noted in my file.

Everyone having fun yet?

Good, because we're going to rinse and repeat...for several weeks.

Why I gave up

After bouncing between three web portals and at least five call centers (across hospital departments and insurance administrator customer service lines), and spending more than 18 hours on the phone asking for CPT codes, diagnosis codes, and benefits information, and requesting extensions on my bill so that I could continue to pursue the reconciliation, I received….a collections notice.

I had been confident I could take care of this situation on my own, but after weeks of roadblocks and hold music, I felt defeated. I paid the bill. I couldn't risk the negative impact an unpaid bill could have on my credit score as my young family considered buying our first home.

Despite the fact that I had a (self-designated) advanced degree in healthcare technology, benefits and billing, I failed to successfully navigate the system.

I was recovering from childbirth, caring for a newborn, working on my company's upcoming IPO, and struggling to reconcile my hospital bills from a set of common services in a pregnancy.

My experience, while personally disheartening, added new fuel to my my passion for driving innovation and change in healthcare. If can't figure this out, what hope is there for the rest of us?

How health care could be

Contrary to some of the recent rhetoric from lawmakers, high-deductibles and health savings accounts (HSAs) won't magically create empowered healthcare consumers or a functional healthcare marketplace.

Stakeholders across the healthcare ecosystem system need to innovate, remove friction points and thoughtfully design products and processes that enable the experiences we would want for our own families. I've worked to help build two such innovative companies. And I'm joining Social Capital to broaden that reach.

I'm looking to work with health care entrepreneurs that understand the world as it is today, but also see how it could be. A world where everyone gets the experience they deserve, whether they're experts in the healthcare system, or the next new parents struggling to understand a bill.

Social Capital investor Kristin Baker Spohn's health bill horror story

How a multimillion-dollar empire built around urine drug tests exposes flaws in California’s rehab laws – Orange County Register

Perhaps one of the most vulnerable groups are those with addiction disorders.  This story is about inadequate safeguards as to whom is allowed to operate these 'sober homes' and the poor if not existent record keeping.


The Orange County Register (California) TonySaavedra and Scott Schwebe investigated the Califonia system of recovery and sober homes.  The allegations, if true are disturbing.


Philip Ganong, his wife and their 34-year-old son built a fast-growing, multimillion-dollar empire on urine.

They collected it from drug addicts at their chain of Southern California sober living homes. They created labs to test it. And they charged insurance companies to analyze it.

But the success story was a scam, according to prosecutors, who have accused the Ganongs of fraud. They say the family used a network of doctors and others to bilk insurers out of as much as $22 million for tests that were unnecessary or never performed.

The Ganongs have pleaded not guilty and are awaiting trial.

But the allegations raised in the Ganong case highlight what a growing number of critics say are chronic shortcomings in the oversight of California’s multi-billion-dollar drug rehabilitation industry.

Among the complaints:

• Drug counselors and others can run sober living homes and some types of treatment centers without passing any kind of criminal background check. Even people convicted of drug crimes are allowed, under current state law, to get a license to own and/or operate drug and alcohol rehab centers.
• Addicts and families considering rehab have no easy way to check the records of treatment centers, recovery homes or their owners or staff.
• The state lags behind others in adopting reforms to crack down on treatment center operators who exploit vulnerable addicts and focus more on profits than on effective care.

California is “the wild, wild west right now,” said Kansas Cafferty, a commissioner with the National Certification Commission for Addiction Professionals.

In a state with about 1,800 licensed recovery centers and an unknown number of unlicensed sober living homes and testing labs, Cafferty is among many who believe California needs to get better at rehab regulation.

“There (are) a lot of places committing crimes that authorities are trying to enforce, but they can’t keep up with it.”

Just following the rules

Marlies Perez, chief of the California Department of Health Care Services’  Substance Use Disorder Compliance Division, which licenses rehab treatment centers, said her agency can only do what the state Legislature allows.

The state agency has only a broad guidance system, with few enforceable actions. 

It’s not a new problem, and California legislators have fought about it for years. Still, they’ve made only halting progress in beefing up licensing standards and rehab monitoring. That’s partly because of industry lobbying, and because of fears that tighter rules will raise treatment costs or limit the number of rehab beds just when the nation’s opioid crisis is cranking up demand.

This year, State Sen. Pat Bates, R-Laguna Niguel, introduced a bill to reform the system, but it stalled in committee. Today, she describes the state’s oversight of rehab operators, sober living homes and counselors as “troubling.”

operator’s) background,” Bates said. “There’s a culture about giving these people a second chance.”

Still, she insists that background checks and tougher licensing requirements for counselors, employees and rehab operators are vital. “It’s something we need to pursue.”

Putting a face on it. Alex Schmick dies of an overdose while living in a recovery facility. The family sued the facility and the physician who wrote the order for the medication.

California lags other states

Smick is not the first to raise the issue of transparency. A state Senate report in 2012 found a host of oversight problems in the recovery industry, including poor monitoring of rehab centers and inadequate information sharing related to treatment center operators.

Other state officials have pointed to financial abuses in the industry that authorities say bleed millions from public and private pockets. Part of the concern is tied to so-called “junkie hunters,” people who recruit addicts from around the country and bring them to rehab centers in California in return for kickbacks.

One area of the rehab industry – sober living homes – has virtually no oversight.

The homes, where addicts often live for a few months after leaving formal rehab, aren’t required to submit any records of their operations. This is true, in part, because operators aren’t claiming to provide medical treatment and the people living in them, recovering addicts, are protected under the Americans with Disabilities Act.

How a multimillion-dollar empire built around urine drug tests exposes flaws in California’s rehab laws – Orange County Register

Lies, Sex and the Affordable Care Act, and the Seven Forbidden Words in Health Care

For my readers.  Warning...this post may be offensive to some. It includes language and images that may offend some readers.

CDC gets list of forbidden words: Fetus, transgender, diversity

Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden terms at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden terms are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”

In some instances, the analysts were given alternative phrases. Instead of “science-based” or ­“evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes,” the person said. In other cases, no replacement words were immediately offered.

However it is no more offensive that our official government is banning certain words from HHS publications. This seems very similar to the past ban on network television of the seven 'famous' do not say words, in the words of George Carlin which first appeared in "Class Clown" his famous album, published in 1972.

These expletives can truly be assigned to our medical system.

Postmortem Autopsy-Confirmation of Chronic Traumatic Encephalopathy

CTE is a subject which should be of interest to every athlete and their family that engages in contact head sports.  Your sports career will be relatively short, the rest of your life will be long. CTE will make it even longer and less pleasurable.

A ground breaking scientific study of CTE casts scientific credibility on what was previously a subjective diagnosis.  The study could make earlier diagnosis of what could be a chronic disability.

Currently, only presumptive diagnosis of chronic traumatic encephalopathy (CTE) can be made in living patients.

 We present a modality that may be instrumental to the definitive diagnosis of CTE in living patients based on brain autopsy confirmation of [F-18]FDDNP-PET findings in an American football player with CTE. [F-18]FDDNP-PET imaging was performed 52 mo before the subject's death. 

The following symptoms were present before death

Summary of Symptoms Reported by Our Patient's Wife and Next-of-Kin at the Time of his [F-18]-FDDNP-PET Scanning

1.	Difficulty recalling names of familiar people and recent past events.
2.	Problems with tracking conversations.
3.	Began losing personal objects.
4.	Became short-tempered, often felt panicked, was less organized.
5.	Became fixated on ideas and less interested in activities he previously enjoyed.
6.	Transformed from a kind, mild-mannered “gentle giant” to a very agitated person.
	a. Exhibited angry outbursts that were out of character.
7.	Behaved inappropriately as if “his filter was gone.”
8.	Evaluated by a psychiatrist, diagnosed with depression, and “probable CTE.”

Our patient exhibited negative family history for dementia or major psychiatric illness. According to his wife and next-of-kin, he exhibited progressive cognitive decline for many years after retirement from the NFL.

CONCLUSION

In conclusion, our results may suggest that the in vivo identification of CTE substrates in living patients may not only be based on the presence or absence of proteinopathies, but also on the identification of the differential and selective topographic vulnerability unique to CTE, which [F-18]FDDNP-PET may be demonstrating. Further prospective studies are needed to assess whether [F18]FDDNP PET can serve as a useful adjunct in the diagnosis of CTE in living patients.

Postmortem Autopsy-Confirmation of Antemortem [F-18]FDDNP-PET Scans in a Football Player With Chronic Traumatic Encephalopathy | Neurosurgery | Oxford Academic

Real Talk w/The 19th Surgeon General of the United States | Against Medical Advice 029 - YouTube

What does the surgeon general do? The national media gives a very narrow description of what the surgeon general actually does. Most of the time the description is flat, uncolored and boring. Watch The Zdogg video interview with a surgeon general. Most of the generals rise through the ranks of the USPHS and are commissioned. The USPHS is a branch of the uniformed services of the U.S.A.

Real Talk w/The 19th Surgeon General of the United States | Against Medical Advice 029 - YouTube

The Influence of Social Media on Health Issues

Background: Major social networking platforms, such as Facebook, WhatsApp, and Twitter, have become popular means through which people share health-related information, irrespective of whether messages disseminated through these channels are authentic.

Objective: This study aims to describe the demographic characteristics of patients that may demonstrate their attitudes toward medical information shared on social media networks. Second, we address how information found through social media affects the way people deal with their health. Third, we examine whether patients initiate or alter/discontinue their medications based on information derived from social media.

Methods: We conducted a cross-sectional survey between April and June 2015 on patients attending outpatient clinics at King Abdulaziz University, Jeddah, Saudi Arabia. Patients who used social media (Facebook, WhatsApp, and Twitter) were included. We designed a questionnaire with closed-ended and multiple-choice questions to assess the type of social media platforms patients used and whether information received on these platforms influenced their health care decisions. We used chi-square test to establish the relationship between categorical variables.

Results: Of the 442 patients who filled in the questionnaires, 401 used Facebook, WhatsApp, or Twitter. The majority of respondents (89.8%, 397/442) used WhatsApp, followed by Facebook (58.6%, 259/442) and Twitter (42.3%, 187/442). In most cases, respondents received health-related messages from WhatsApp and approximately 42.6% (171/401) reported ever stopping treatment as advised on a social media platform. A significantly higher proportion of patients without heart disease (P=.001) and obese persons (P=.01) checked the authenticity of information received on social media. Social media messages influenced decision making among patients without heart disease (P=.04). Respondents without heart disease (P=.001) and obese persons (P=.01) were more likely to discuss health-related information received on social media channels with a health care professional. A significant proportion of WhatsApp users reported that health-related information received on this platform influenced decisions regarding their family’s health care (P=.001). Respondents’ decisions regarding family health care were more likely to be influenced when they used two or all three types of platforms (P=.003).

Conclusions: Health education in the digital era needs to be accurate, evidence-based, and regulated. As technologies continue to evolve, we must be equipped to face the challenges it brings with it.

J Med Internet Res 2017;19(11):e382

doi:10.2196/jmir.5989

Twitter, Facebook, and WhatsApp have become mainstream online tools that permit individuals to connect and share information. Furthermore, they permit individuals to share uncontrolled, unsupervised, and unfiltered content, irrespective of time and place [1]. Consequently, the Internet contains a lot of self-created content [2]. Many people are increasingly using social networking sites for health-related purposes. Research has demonstrated that an increasing number of patients are using social networking sites to share their experiences with health care personnel or institutions [3]. Patients also share their experiences with family members and friends via platforms such as Facebook, WhatsApp, and Twitter [4-6]. There is evidence that if social networking is used properly, then it can help patients [7]. For example, a study that promoted breastfeeding among Saudi women showed increased adherence to breastfeeding through a Twitter campaign [8]. Another study that investigated the effect of Twitter on women’s health education demonstrated that women in Saudi Arabia were interested in discussing gynecological complains and breastfeeding-related issues on Twitter [9]. The investigators found that this strategy helped in creating awareness. Moreover, a recent study showed that Twitter was a powerful platform for health promotion strategies [10]. Influential people who have a huge number of followers can constitute an integral part of any health campaign or help in disseminating knowledge.

Concerns about the increasing use of social media to share health experiences and information arise as the use of these sites might affect choices that patients make regarding their health [11]. Furthermore, it might affect the way patients interact with health care professionals. According to one review, information obtained from social networking sites correlated with many measures of quality of care, including performance measures such as mortality and readmission rates [12]. Nevertheless, definitive conclusions cannot be drawn from correlation tests and several questions remain unanswered regarding the impact of patients’ use of social media.

There are few data available regarding the impact of social networking sites on the online health information-seeking behaviors of people in Saudi Arabia [13]. This report will attempt to determine whether advice obtained from social media platforms, such as Facebook and WhatsApp, affect choices that people make about their health care. This study aims to describe the demographic characteristics of patients that may demonstrate their attitudes toward medical information shared on social media networks. Second, we address how information found through social media affects the way people deal with their health. Third, we examine whether patients initiate or alter/discontinue their medications based on information derived from social media.

JMIR-Health-Seeking Influence Reflected by Online Health-Related Messages Received on Social Media: Cross-Sectional Survey | Iftikhar | Journal of Medical Internet Research

Medtronic’s tiny neurostimulator gets CE mark for multiple indications

Another tool for pain management and avoidance of opioid addiction. President Trump's announcement about the campaign against opioid addiction comes on the failed programs such as the War on Drugs.  Why are opioids so addicting ?  Because they are so . effective in blocking pain and allowing people to function in the face of chronic pain.  Success in decreasing opioid addiction will only come with a successful drug that manages pain as well as opioids, and proper management of pain with alternative treatments.  Medtronic's system may help with delivery of micro quantities to the spine and/or neurostimulation to block pain transmission from end receptors to pain centers in the CNS.

Medtronic’s Intellis platform grabbed a CE mark for peripheral nerve and spinal cord stimulation. With the nod, the device is now cleared to treat chronic, intractable pain of the trunk, posterior trunk and limbs.

The Intellis system, which earned the FDA green light in September, is the world’s smallest fully implantable spinal cord stimulation neurostimulator, the company said. The system includes the implant, a patient programmer and a recharger. A physician programs the therapy wirelessly, using a Samsung tablet.

The device is designed to help physicians make better treatment decisions. In addition to delivering pain-relieving neurostimulation, it records patient activity, such as their body position and how they self-administer their treatment, around the clock.

"Rather than rely on patient-reported data, the enhanced activity tracker of the Intellis platform provides real-time data that offers more visibility into quality of life changes," said Jean-Pierre Van Buyten of AZ Nikolaas Hospital in Belgium, where the first European patient received the implant. "Better understanding a patient's experience can lead to a more informed conversation that can help me maximize their pain relief.”

Non-opioid pain treatments are becoming increasingly important—the number of opioids prescribed and sold in the U.S. alone has quadrupled since 1999. While opioids used to be prescribed sparingly—after a surgery or injury, or for managing cancer-related pain—there has been a “dramatic increase” in their use for chronic, non-cancer pain, according to the CDC.

Stem Cell Therapy for TBI | UCSF

Stem Cell Therapy for TBI | UCSF

Due to technical details the formatting of this post is abnormal. I apologize for it.

Latest TBI Research Studies

A clinical trial is a research study designed to assess the safety and efficacy of a treatment or intervention. We are currently helping people see whether they are eligible for a clinical trial of modified stem cell therapy for TBI called STEMTRA (STEM cell therapy for TRAumatic brain injury).

STEMTRA Study

Stem cells are cells that have the potential to develop into different types of tissue within the body. The STEMTRA Study, a Phase II clinical trial, is working to understand whether stem cells taken from adult bone marrow can be used to help improve function after a TBI.

The STEMTRA Study is designed to test the safety and efficacy of a modified stem cell therapy that is administered directly to the injured brain through a neurosurgical procedure. Participants will have approximately seven follow-up visits for additional examinations, questionnaires, video recordings, and brain scans over the following 12 months.

Interested in participating? Take the TBI Survey to let us know. UCSF will review your survey information and if you qualify, we will help you get in contact with study personnel who can answer any questions you may have about the study and further pre-screening.

A New Impact on Public Health . Citing The Bible, The EPA Just Changed Its Rules For Science Advisers

The Environmental Protection Agency announced on Tuesday afternoon sweeping changes to who can advise the agency on its research and regulatory priorities, opening the door to more industry participation.

Effective immediately, scientists who receive EPA funding cannot serve on the agency's three major advisory groups. Some Republican lawmakers have been pushing for similar changes to the agency's advisory boards for years.

"We want to ensure that there’s integrity in the process and that the scientists that are advising us are doing so without any type of appearance of conflict of interest," EPA head Scott Pruitt said at a press conference announcing the directive.

Pruitt used a story from the Book of Joshua to help explain the new policy.

On the journey to the promised land, "Joshua says to the people of Israel: choose this day whom you are going to serve," Pruitt said. "This is sort of like the Joshua principle — that as it relates to grants from this agency, you are going to have to choose either service on the committee to provide counsel to us in an independent fashion or chose the grant. But you can’t do both. That’s the fair and great thing to do."

"Frankly, this directive is nuts," Al Teich of George Washington University wrote in an email to BuzzFeed News.

"There is an important role for citizen advisors who are not experts in a scientific field and who represent various constituencies on advisory committees," wrote Teich, a research professor of science, technology, and international affairs. "But they should complement, not replace the experts. Disqualifying the very people who know the most about a subject from serving as advisors makes no sense."

The change calls into question EPA's ability to protect the country, according to Rush Holt, chief executive officer of the American Association for the Advancement of Science. "We question whether the EPA can continue to pursue its core mission to protect human health and the environment," Holt said in a statement issued Tuesday.

Pruitt also announced the new chairs of EPA's advisory committees on Tuesday.

Michael Honeycutt, a controversial toxicologist from Texas, is the new head of EPA's Science Advisory Board, which provides scientific counsel to the agency's top official. Honeycutt once told Congress he didn't agree with the EPA's toxic evaluation for mercury, and he's argued against the agency's ozone standards, according to a 2014 investigation by InsideClimate News and the Center for Public Integrity.

Tony Cox is now the chair of EPA Clean Air Scientific Advisory Committee, which offers technical input on the nation's air standards. Cox is president of Cox Associates, a Denver-based risk analysis firm.

And Paul Gilman is the new leader of the Board of Scientific Counselors, which provides input on the EPA's research agenda. Gilman works at the waste management company Covanta Energy and served as an EPA assistant administrator during the Bush administration.

These three advisers attended today's EPA press conference and stood behind Pruitt as he signed the new directive.

Some lawmakers who have been highly critical of EPA regulations also attended the briefing.

"Today’s announcement shows that we have an administrator with common sense, commitment, and courage," Rep. Lamar Smith, a Texas Republican who chairs the House Science Committee, said at the press briefing.

Smith's committee passed a bill called the EPA Science Advisory Board Reform Act earlier this year that would have put in place some of these same restrictions on EPA advisers. The legislation has not yet passed both houses. The new policy enables "us to put the principles of this bill into practice," Smith said.

Citing The Bible, The EPA Just Changed Its Rules For Science Advisers

Are Payers the Leading Cause of Death in the United States? | Medpage Today

Are Payers the Leading Cause of Death in the United States? | Medpage Today

California's housing crunch is exacerbating a Public Health crisis -- a deadly hepatitis A outbreak among the homeless - The Washington Post

California's housing crunch is exacerbating a public health crisis -- a deadly hepatitis A outbreak among the homeless - The Washington Post

How is San Diego facing the challenges of Homelessness and Hepatitis A ?

Forum for Homelessness

The Outbreak of Hepatitis A

How to help the  Homeless .  Donate

AHF Offers Free Hepatitis A Vaccinations .  San Diego County

Your Local Health Department provides information about Hep A vaccinations. The free program is funded by the Federal Government via emergency funds through your local and/or state Dept of Health