May 18, 2010
Regence members in Washington, Oregon, Idaho and Utah report they are seeing claims for services not received on their explanation of benefits.
The claims were filed on behalf of companies that sell nutritional supplements.
The members bought products from companies whose ads state: “Learn how you can get your nutritional supplements reimbursed up to 100 percent through your insurance provider.”
Regence issued a nationwide alert to all Blue Cross and Blue Shield plans in April, after an investigation showed that parties filing for reimbursement were submitting fraudulent claims from providers involved in the scheme.
The fraudulent claims are coded for legitimate covered services, such as consultations, lab and X-ray, which members did not receive.
In addition, the supplement companies essentially advised consumers to disregard any notes on their health plan’s explanation of benefits about coding for services, alleging the health plan is attempting to pay less for the services.
The alert affects the more than one million Washingtonians served by Regence and 100 million people nationally who are members of a Blue Cross Blue Shield health plan.
May 18, 2010
To be successful, this marathon is a team sport
The doctor walked into the conference room and set my medical file down on the table. She had a long, forlorn look. I could tell she was not bringing me good news.
“The test results came in and,” after pausing for a second, she continued, “you have cancer.”
Now, I like to joke with my doctors. I was trying to find a humorous comeback, but nothing was coming to mind. With cancer, there just isn’t anything funny.
Finally, I replied, “Is this one of those cancers that can be cured quickly?” Already I was thinking about covering high school sports in the fall.
The doctor answered, “No. This is one of the bad ones. You have multiple myeloma.” Read more
May 12, 2010
NEW — 7:11 a.m. May 12, 2010
The nonpartisan King County Council cracked along partisan lines Monday, as members praised national health care reform in a narrow decision.
The symbolic measure supports the implementation of the federal Patient Protection and Affordable Care Act passed by Congress in March. The council adopted the legislation in a split decision. Democrats on the nine-member council backed the measure; Republicans dissented.
“It is time to reform our health care system,” Chairman Bob Ferguson, the prime sponsor of the legislation and a Democrat, said in a statement after the May 10 decision. “The health care act isn’t perfect, but it will help provide access to basic health care for the more than 150,000 King County residents who are currently uninsured.”
April 27, 2010
Liberty High School
“It is a good thing for young people, because it assists them by helping them acquire health insurance.”
— Nick Antonio, senior
“It is going to force me to pay for something I don’t want.”
— Jason Murray, freshman
Issaquah High School
“I don’t really know much about this bill at all.”
— Neel Rijhwani, sophomore
“I think it’s great that the bill has passed. I can stay under my parents’ plan until I am 26 now.”
— Sawyer Mittelstaedt, sophomore
Skyline High School
“I personally don’t know much about the health care reform, but seeing how the teens in my community are equally unaware, I don’t think that I will be affected much.”
— Warren Chang, sophomore
“With government regulating health care, they’re setting up a new socialist at the same time. I don’t know if I’ll be affected much, because the reform isn’t specifically targeted towards us.”
— Kevin Purdy, junior
April 27, 2010
A lot of talk has surrounded the recently signed health care bill, and as it waits finalization by the U.S. Senate, the bill has raised as many questions as it has answered. But the basic need for a plan — and the effect of it on teens today — is relatively unambiguous.
The need for health care over the past decade has become apparent as prices of basic health care climb and the costs of dealing with disease become unreal. New and expensive asthma medications can cost $50 per prescription. For youths with diabetes, the annual cost of medications has doubled from 2001 to 2007, while the number of children with diabetes has been steadily increasing.
According to the American Diabetes Association, treating the disease cost the average patient $6,649 in 2007. As said by Time magazine, such things as growth hormone deficiencies have staggeringly high costs and the annual bill for parents can exceed $20,000 — doctor’s visits, tests and hospitalizations not included.
April 20, 2010
Tea Party activists came to downtown Issaquah on a cloudy afternoon last week to brew discontent with the policies of Congress and the Obama administration.
Issaquah and Eastside residents gathered for about 90 minutes for the Tea Party rally and a smaller counter-rally organized by the 5th District Democrats. The dueling events attracted about 120 people — about 100 for the Tea Party rally and about 20 Democrats.
Participants held aloft colorful signs at the corner of Front Street and Sunset Way to cacophony of honks as drivers passed the intersection. Others carried U.S. and “Don’t Tread on Me” flags — a yellow banner with a coiled snake and a symbol of anti-government protest.
Issaquah resident Tim Ooyman said he attended the Tea Party rally to protest federal spending and the way President Obama and lawmakers handled the healthcare-reform bill.
“The silent majority needs to stop being silent,” he said.
Ooyman and other activists picked April 15 — the federal deadline for filing income-tax returns — for the rally. Local activists also held events in Bellevue and Seattle. Washington State Patrol officials estimated the Tea Party crowd at the state Capitol in Olympia at 3,000 people. Read more
April 16, 2010
April 6, 2010
State Sen. Cheryl Pflug, a registered nurse who represents Issaquah in Olympia, sponsored a bill to establish a pair of pilot projects intended to make healthcare more affordable. Gov. Chris Gregoire signed the legislation March 25.
The measure sponsored by Pflug, a Maple Valley Republican, promotes a team approach to healthcare. The law encourages public and private healthcare systems to coordinate patient care and pay for results rather than treatments.
The measure establishes at least two accountable-care organization pilot projects — collaborations between physicians and hospitals designed to allow a team approach to coordinating patient care. The legislation requires the projects to be established by Jan. 1, 2012.
“Accountable-care organizations change today’s patient care model,” Pflug said in a news release. “Instead of paying doctors a set amount per patient visit or treatment, primary physicians in accountable-care organizations receive additional compensation when they help improve a patient’s health such that it saves money by preventing hospital visits and preventable complications of chronic illness.”
January 5, 2010
During a single City Council term, John Rittenhouse advanced watershed legislation to reshape city elections and establish a human services campus in Issaquah.
The former councilman led the effort to cap city campaign contributions at $500 for cash and in-kind donations from a single party — a measure the council overwhelmingly approved in May.
Rittenhouse led the push to open a proposed human services campus, a clearinghouse where needy people can receive food, healthcare and employment. The council OK’d the first steps toward a campus — location scouting and business planning — in a unanimous vote last month.
Before Rittenhouse left the council last week, colleagues praised him as affable and effective. Read more
December 20, 2009
NEW — 6 a.m. Dec. 20, 2009
A clearinghouse where people in need can receive food, healthcare and employment is a step closer to reality for Issaquah.
Officials hired nonprofit Family Resource Center, of Redmond, to locate a suitable site for a human services campus, engage in business planning and provide legal assistance. City Council members approved the $35,000 pact in a unanimous vote Dec. 7.