Readers Rail at Social Safety Overpayments and Insurers’ Prior Authorizations


Letters to the Editor is a periodic characteristic. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.

A registered nurse who works in New Jersey’s Matawan-Aberdeen Regional Faculty District reacted on X, previously generally known as Twitter, to KFF Well being Information’ investigative collaboration with Cox Media Group on the federal authorities’s try to claw again cash it has overpaid to Social Safety beneficiaries: “Social Safety Overpays Billions to Individuals, Many on Incapacity. Then It Calls for the Cash Again” (Sept. 15).

Can I simply say to inform people that they solely have 30 days to pay again any overpayments that they probably weren’t even conscious of till they obtained the discover, is loopy!

— Sheila Caldwell (@SCaldwell7201) September 17, 2023

— Sheila Caldwell, Aberdeen, New Jersey

A legislation professor on the S.J. Quinney Faculty of Regulation on the College of Utah additionally chimed in on X:

Necessary @KFF @KFFHealthNewsexposé on Social Safety making errors and sending folks ludicrous payments to to get better overpayments. One disabled girl received a invoice for $60,175.90 out of the blue. The company suffers from underfunding/understaffing

— Daniel G. Aaron, MD, JD (@MedlawDan) September 18, 2023

— Daniel G. Aaron, Salt Lake Metropolis

For Disgrace, UnitedHealthcare

Thanks for shining a light-weight on probably the most infuriating insurance coverage boundaries in all of medication: prior authorization (“Medical doctors and Sufferers Attempt to Disgrace Insurers On-line to Reverse Prior Authorization Denials,” Aug. 23).

In the course of the pandemic, many individuals skipped or couldn’t entry routine medical care corresponding to colonoscopies and endoscopies. Analysis has lengthy proven that these providers are underutilized, particularly amongst communities of coloration, which is one cause for continued disparities in colorectal most cancers and different gastrointestinal ailments.

Because the demand for routine diagnostic and surveillance procedures grows, it’s important to make sure that sufferers are usually not caught up in bureaucratic purple tape. Sadly, the nation’s largest and most worthwhile insurer, UnitedHealthcare, is slowly, quietly working to broaden prior authorization to those key types of gastrointestinal care.

Whereas UHC publicly pledged to slash prior authorization, we should choose them by their actions, not their phrases. Since UHC made that promise this spring — a transfer welcomed by docs and sufferers throughout the nation — the insurer additionally introduced troubling new prior authorization necessities for colonoscopies and endoscopies for its 27 million business beneficiaries. The insurer deliberate to start implementing prior authorization for these very important procedures beginning June 1 however briefly halted the plan after main outcry from sufferers and gastroenterologists.

But, the menace lingers. Proper now, UHC is asking docs to take part in a burdensome “Superior Notification program,” which forces physicians to submit all types of knowledge that the insurer will use to tell its deliberate “Gold Card” prior authorization program in 2024.

Physicians see by means of this ruse. Whereas UHC claims no sufferers are being denied the colonoscopies and endoscopies that might assist save their lives, the executive burden Superior Notification causes is clogging already backlogged workplaces, particularly small practices. Even worse, the gastroenterological group fears that thousands and thousands of sufferers might face UHC’s prior authorization necessities in a matter of months — but the insurer has did not coordinate with specialty societies or transparently talk how this system will function or how UHC will guarantee affected person care just isn’t disrupted.

This concern impacts all of us. If UHC is allowed to disclaim or delay colonoscopies and endoscopies, the place will it finish? Diagnostic mammograms? Pap smears? Lung most cancers screenings? And can different insurers comply with go well with with equally oppressive prior authorization insurance policies?

UHC should instantly reverse course on its alarming insurance policies to make sure streamlined entry to care. Within the meantime, gastroenterologists will proceed to carry the road for our sufferers.

— Lawrence Kim, vice chairman of the American Gastroenterological Affiliation, Lone Tree, Colorado

The branding director for Norwood, a well being care staffing and consulting firm in Texas, posted on X that publicly shaming insurers might show a wise technique.

Good; shameful practices deserve public shaming: Medical doctors and Sufferers Attempt to Disgrace Insurers On-line to Reverse Prior Authorization Denials by way of @kffhealthnews

— Brian Murphy (@NorwoodCDI) August 23, 2023

— Brian Murphy, Austin, Texas

Response was additionally strong on Threads:

How New York Is Tackling Tobacco Use Amongst Youths

I simply learn Liz Szabo’s piece on little one nicotine poisonings (“Medical doctors Sound Alarm About Baby Nicotine Poisoning as Vapes Flood the US Market,” Aug. 3). The reporting illuminated a vital but lesser-known concern relating to the harms of those e-liquids. The response does name for a mixed public well being effort, so I needed to share additional data relating to New York state coverage (talked about within the piece) that has proven to achieve success in decreasing the sale and use of vapes and conventional, flamable cigarettes. This policy-level intervention’s outcomes suggest that fewer younger youngsters are being uncovered to/have entry to those merchandise based mostly on decreased charges of smoking and vaping use and initiation amongst older siblings or adults round them. I hope this data proves helpful to your nationwide viewers who might think about these insurance policies within the context of their state’s.

The New York State Division of Well being launched three new experiences that point out that the present tobacco management insurance policies adopted within the state have helped successfully scale back tobacco use and initiation, together with smoking and vaping. The evidence-based approaches bolstered ongoing decreases in youth vaping charges; between 2018 and 2022, charges declined by about 32%. Youth tobacco use (of any tobacco product) additionally declined by 32%, from 30.6% in 2018 to twenty.8% in 2022. This vital decline brings New York nearer to attaining the Prevention Agenda objective of lowering highschool youth tobacco use to 19.7% by 2024.

Whereas that is nice progress, tobacco nonetheless is the No. 1 explanation for preventable illness in america — it’s estimated that it kills 480,000 adults within the U.S. yearly — and there are nonetheless points with regulation and an absence of protecting packaging on vapes.

NYC Treats Tobacco works with well being care organizations in New York Metropolis to make sure they successfully display and deal with their sufferers for tobacco use.

— Avani B. Ansari, MPH, CHES, undertaking coordinator for NYC Treats Tobacco, New York Metropolis

A corporation that advocates for insurance policies selling alternatives and wellness for kids posted this on X:

1000’s of youngsters a 12 months are uncovered to the liquid nicotine in e-cigarettes, also referred to as vapes. For a toddler, even just a few drops may be deadly. Medical doctors sound alarm about little one nicotine poisoning as vapes flood the US market:

— KY Youth Advocates (@KYYouth) August 14, 2023

— Kentucky Youth Advocates, Jeffersontown, Kentucky

And a Georgia state consultant shared her two cents on X relating to Liz Szabo’s earlier protection on youth vaping:

Youth vaping is on the rise, with the business advertising and marketing merchandise blatantly focused to children + teenagers.The unregulated nicotine in e-cigs (⬆️ 76% over 5y) can addict children in simply days.My payments #HR43 and #HB192 intention to review + disincentivize youth vaping.

— Dr. Michelle Au (@AuforGA) June 27, 2023

— Michelle Au, Johns Creek, Georgia


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