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Health Insurance

U.S. Rep. Lee Zeldin tours Elsie Owens Health Center in Coram before a press conference in which he called on Congress to reauthorize CHIP. Photo from Zeldin's office

By Alex Petroski

Political gridlock is nothing new in Washington, but if an agreement on a federal funding bill isn’t reached by Jan. 19, this time children’s health will be at risk.

In September, the Children’s Health Insurance Program expired, and Congress passed a short-term funding bill just before Christmas to keep the federal government funded through this Friday. The program, also known as CHIP, is a service that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. Originally enacted in 1997, CHIP provides matching funds to states for health insurance to families with children. It was slated to run for 10 years, but has since been reauthorized on several occasions since 2007. In 2016, almost 9 million children were enrolled in the program, according to Medicaid.gov. The program covers routine check-ups; immunizations; doctor visits; prescriptions; dental and vision care; and emergency services for enrollees. In November, the House passed a five-year reauthorization bill to keep the program running, but it never reached the Senate floor.

U.S. Rep. Lee Zeldin (R-Shirley) urged lawmakers to pass a bill reauthorizing funding for the program, which also provides funding for community health centers, during a press conference Jan. 12 at Elsie Owens Health Center in Coram. A long-term bill will need to be passed to keep services like CHIP running for the remainder of 2018.

“These essential programs provide millions of children, veterans and individuals with the healthcare services they need,” Zeldin said. “In New York alone, CHIP provides health insurance for 300,000 New York children, while nearly 2 million New Yorkers rely on Community Health Centers for their health care services. On behalf of the millions of New Yorkers who rely on CHIP and Community Health Centers, we must reach across the aisle and work together to preserve these vital programs.”

Although more political debates will likely ensue on other issues pursuant to funding the government through the end of the year, Zeldin said he doesn’t expect reauthorization of CHIP to be used for bargaining by either political party.

“I do not expect to see a partial shutdown after next Friday, so everyone anticipates the funding to continue, but this also presents an opportunity to add the reauthorization language into the next funding bill,” Zeldin said in an interview after the event. “It’s two parts that have been running on different tracks. However, I believe that there is an opportunity here to add the reauthorization language to get it through the House, through the Senate, signed by the President — and reauthorization done.”

New York’s U.S. Sens. Chuck Schumer (D) and Kirsten Gillibrand (D) have each stressed the importance of renewing CHIP as part of larger federal funding discussions.

“We have two weeks to negotiate a budget deal that must also address a host of other items, #ExtendCHIP, community health centers, disaster aid, and of course, the #Dreamers,” Schumer said in a Jan. 3 tweet.

HRH Care Community Health President and Chief Executive Officer Anne Kauffman Nolon, Elsie Owens Health Center Medical Director Nadia Arif and Brookhaven Memorial Hospital Medical Center President and CEO Richard Margulis were among the healthcare professionals in attendance who applauded Zeldin’s calls for funding.

“Not extending the funding for these vital programs could have a devastating effect on both our population, and BMHMC, which also faces potential cuts as a Disproportionate Share Hospital,” Margulis said.

According to the Congressional Budget Office, five-year reauthorization of CHIP would cost $800 million over a 10-year period.

Christina Loeffler, the co-owner of Rely RX Pharmacy & Medical Supplies in St. James, works at one of the few non-major pharmacies in the county participating in the program to give low to no cost Narcan to those with prescription health insurance coverage. Photo by Kyle Barr

By Kyle Barr

The opioid crisis on Long Island has left devastation in its wake, and as opioid-related deaths rise every year, New York State has created an additional, more affordable way to combat it. To deal with the rash of overdoses as a result of addiction, New York State made it easier for people with prescription insurance to afford Naloxone, a common overdose reversal medication.

On Aug. 7, New York Gov. Andrew Cuomo (D) announced starting Aug. 9 that people with prescription health insurance coverage would be able to receive Naloxone, which is commonly referred to as Narcan, for a copay of up to $40. New York is the first state to offer the drug for such a low cost in pharmacies.

Narcan kit are now available for low to no cost at many New York pharmacies. File photo by Rohma Abbas

“The vast majority of folks who have health insurance with prescription coverage will be able to receive Naloxone through this program for free,” said Ben Rosen, a spokesperson for the New York State Department of Health.

Before the change, the average shelf cost of Narcan, which is administered nasally, was $125 without prescription with an average national copay of $10. People on Medicaid and Medicare paid between $1 and $3, Rosen said.

This action on part of the state comes at a critical time. Over 300 people from Suffolk County died from opioid-related deaths in 2016, according to county medical examiner records. On Aug. 10, President Donald Trump (R) declared the opioid issue a national emergency, meaning that there is now more pressure on Congress to pass legislation to deal with the crisis, as well as a push to supply more funds to states, police departments and health services to help deal with the problem.

The drug is available in over 3,000 pharmacies across New York and well over 100 pharmacies in Suffolk County. This includes all major pharmacies like CVS Health, Walgreens and Rite Aid, but also includes a few local pharmacies that already participate in the state Aids Drug Assistance Program and Elderly Pharmaceutical Insurance Coverage and Medicaid, according to Kathy Febraio, the executive director of the Pharmacists Society of the State of New York, a not-for-profit pharmacists advocacy group.

The program is only available for people who either have Medicare, Medicaid or health insurance with prescription coverage. Otherwise, officials said that those who lack insurance who need access can get it through a number of free Narcan training courses.

“We think that anything that can have an affect on this crisis is a good thing,” Febraio said. “This will certainly help. We need anything that will get Naloxone into the hands of those who need it.”

While Suffolk County Legislator and Presiding Officer DuWayne Gregory (D-Amityville) likes the idea of additional access to Narcan, he is skeptical about whether those who get it know how to properly administer it.

Narcan kits are now available for low to no cost at many New York pharmacies, like at Rely RX Pharmacy & Medical Supplies in St. James. Photo by Kyle Barr

“You don’t need a PHD to know how to use it, but there is some training that would help people be more comfortable, such as how to properly use it in an emergency situation and how to store it so that it is accessible while making sure children can’t get their hands on it,” he said. “Unfortunately the epidemic is so wide spread. Everyone knows someone who is affected.”

Christina Loeffler, the co-owner of Rely RX Pharmacy & Medical Supplies in St. James, one of the few non-major pharmacies in the county participating in the program, said though the business has not yet received many calls for Narcan, the state requires pharmacists to demonstrate how to use it.

“You have to counsel the patient and show them how to use it,” she said. “We were showed videos, we were given kits to practice on before we were certified to do it. I feel like it’s a good thing that they’re doing it.”

The county currently provides numerous Narcan training courses for locals, where they receive training and free supplies of the life-saving drug. Suffolk County Legislator Sarah Anker (D-Mount Sinai) said that she will be co-hosting a free Narcan training course Oct. 5 at Rocky Point High School with support from the North Shore Youth Council.

“They absolutely need to be trained,” she said. “Narcan is almost a miracle drug — it brings people back from death. However, people need to know what they’re doing so that it is administered correctly.”

Check on the New York State Department of Health website’s opioid overdose directories section for a full list of participating pharmacies.

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The Port Jefferson Volunteer Ambulance Company serves Port Jefferson, Belle Terre and Mount Sinai. File photo

Village officials have blocked the local ambulance company from billing residents for service, three months after an explosive debate on the practice.

A few residents argued during a Port Jefferson Village Board of Trustees meeting in November that it was unfair, after paying ambulance district taxes, they received bills for ambulance rides when their insurance companies either denied a claim or left them with a hefty deductible to pay. But the board insisted such bills were not the intention of the plan enacted several years ago to help their emergency medical organization recoup expenses.

Faced with rising costs in the ambulance district — which includes Port Jefferson, Belle Terre and Mount Sinai — the board authorized the Port Jefferson Volunteer Ambulance Company to bill patients’ insurance companies for service within their jurisdiction, using the collected funds to offset ambulance taxes.

The bills being sent later on to patients, according to PJVAC Deputy Chief Rob Stoessel, originated because his group and its third-party billing company are obligated to ask for the balance if the insurance does not cover the entire cost. In November he described the requirement as a “good faith attempt.”

Before insurance, the fee on a call for emergency medical care is $900, with an additional $18 for each mile the ambulance transports a patient. Stoessel said that amount takes into consideration both medical and nonmedical expenses like gasoline.

Both he and Mayor Margot Garant agreed that when the billing program was created, the idea was for patients to receive three notices for bills, with no consequences for not paying — as the ambulance company does not have a mechanism for collections.

“The insurance companies, God bless them — collect every nickel from them,” Garant said in November. But “we didn’t want the resident to be pursued for any of the fees.”

Residents who received the bills complained that wasn’t common knowledge, and they were concerned about their credit ratings.

Monica Williams was denied Medicare coverage for her treatment.

“I don’t really think that any village resident … should be looking at a bill like that,” Williams said in November. “It’s surprising. It’s disappointing.”

She called it “being billed for the same thing twice.”

But Williams saw a solution on Monday night, when the Board of Trustees voted to ban the ambulance company from billing residents.

The previous law that allowed the company “to bill, directly, village residents for the use of its ambulance services … is hereby rescinded,” according to the measure members approved at their meeting. It also forgives all unpaid balances currently hanging against residents.

PJVAC will still be able to collect funds from the insurance companies.

Garant said there would be consequences “if we hear of any resident getting any more collection documents from the ambulance [district].”

Port Jefferson residents say taxes should cover cost of medical care

The ambulance company serves Port Jefferson, Belle Terre and Mount Sinai. File photo

A presentation about the service of the Port Jefferson Volunteer Ambulance Company devolved into an argument about perceived unfair billing practices on Monday night, with residents, village officials and the ambulance company’s deputy chief going back and forth for an hour.

A few villagers are in a lather over the process for recouping expenses after an ambulance ride through a billing program that began a handful of years ago. Faced with rising costs in the ambulance district — which also serves Belle Terre and Mount Sinai — Port Jefferson Village officials authorized the emergency medical organization to bill insurance companies for service within their jurisdiction, with the funds offsetting local ambulance taxes.

The friction that heated up Monday night’s Port Jefferson Village Board of Trustees meeting built around cases when an insurance company denied a claim or the patient had a hefty deductible — thus obligating the ambulance service and its third-party billing company to send a tab to that patient, according to PJVAC Deputy Chief Rob Stoessel.

Two residents who received such bills, Monica Williams and Mary Moore, expressed their dissatisfaction over the matter, saying the taxes they pay each year to the ambulance district should be enough and also complaining about the price tag.

“I’m paying my ambulance district tax,” Williams said. “I don’t really think that any village resident … should be looking at a bill like that. It’s surprising. It’s disappointing.”

She called it “being billed for the same thing twice.”

Before insurance, Stoessel said, the fee on a call for emergency medical care is $900, with an additional $18 for each mile the ambulance transports a patient.

“We went based on other agencies, other 911 services throughout the region,” he said about how the ambulance company arrived at that figure. “We went on what it cost us to provide the service,” including non-medical expenses like gasoline.

The deputy chief said the ambulance service and its billing company is required to make a “good faith attempt” to solicit deductibles from patients or whatever costs are associated with a trip that an insurance company denies coverage for.

According to comments from the residents, Williams was denied Medicare coverage for her treatment and Moore has a high deductible.

Mayor Margot Garant insisted it was not the board’s intention, when it authorized the ambulance company to bill insurance, to pass large bills along to residents.

“We didn’t want the resident to be pursued for any of the fees,” she said. But “the insurance companies, God bless them — collect every nickel from them.”

Although the mayor and Stoessel rejected responsibility, debating whether the billing was a village program or an ambulance program, they agreed that the idea was for patients to receive three notices for bills and there would be no consequences for not paying, as the ambulance company does not have a mechanism for collections.

But there was debate from the public about whether that was common knowledge in the village, or whether not paying would affect someone’s credit rating.

According to Garant, village officials are working out a method of waiving costs that would otherwise be passed along to patients — to limit the ambulance company to recouping costs only from insurance companies. She said that measure could be ready for approval by the next board meeting in two weeks.

Port Jefferson is not the only area with the idea of using insurance companies to offset taxpayer dollars. The Commack Volunteer Ambulance Corps argued recently that billing private insurance companies for patient care would ultimately save taxpayer dollars for constituents. At an August work session in Smithtown, Tom Lowenberg of the Commack VAC said insurance reimbursements are a resource utilized typically at private ambulance companies, but not as much by volunteer groups.