Thursday, July 1, 2010

Have a medical problem? Now you can be insured

This news release came out today from the Department of Health and Human Services. It will cover the uninsured who are without coverage due to a pre-existing condition.

News Release


FOR IMMEDIATE RELEASE

Thursday, July 1, 2010

HHS Secretary Sebelius Announces New Pre-Existing Condition Insurance Plan

Affordable Care Act Program to Provide Temporary Coveragefor Americans Without Insurance Due to Pre-Existing ConditionsNow Through 2014 When the New Insurance Exchanges Are Established

The U.S. Department of Health and Human Services (HHS) announced today the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.

The Pre-Existing Condition Insurance Plan, which will be administered either by a state or by the Department of Health and Human Services, will provide a new health coverage option for Americans who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are a U.S. citizen or are residing in the United States legally.

Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive Exchanges. In 2014, Members of Congress will also purchase their insurance through Exchanges.

“For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” said Secretary Kathleen Sebelius. “Today, the Pre-Existing Condition Insurance Plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.”

The Affordable Care Act provides $5 billion in federal funding to support Pre-Existing Condition Insurance Plans in every state. Some states have requested that the U.S. Department of Health and Human Services run their Pre-Existing Condition Insurance Plan. Other states have requested that they run the program themselves. For more information about how the plan is being administered where you live, please visit HHS’ new consumer website, www.HealthCare.gov.

“Health coverage for Americans with pre-existing conditions has historically been unobtainable or failed to cover the very conditions for which they need medical care,” said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight (OCIIO) which is overseeing the program. “The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage at a reasonable cost. We modeled the program on the highly successful Children’s Health Insurance Program, also known as CHIP, so states would have maximum flexibility to meet the needs of their citizens.”

In order to give states the flexibility to best meet their needs, HHS provided states with the option of running the Pre-Existing Condition Insurance Plan themselves or having HHS run the plan. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs.

Starting today, the national Pre-Existing Condition Insurance Plan will be open to applicants in the 21 states where HHS is operating the program.

All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of the summer, with many beginning enrollment today.

“The Pre-Existing Condition Insurance Plan is an important next step in the overall implementation of the Affordable Care Act,” said Richard Popper, Director of Insurance Programs at OCIIO. “We have been working closely with the states and other stakeholders to make sure this program reaches uninsured Americans struggling to find coverage due to a pre-existing condition.”

The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Pre-Existing Condition Insurance Plan does not base eligibility on income and does not charge a higher premium because of a medical condition. Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.

Like the popular Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan provides states flexibility in how they run their program as long as basic requirements are met. Federal law establishes general eligibility, but state programs can vary on cost, benefits, and determination of pre-existing condition. Funding for states is based on the same allocation formula as CHIP, and it will be reallocated if unspent by the states. Unlike CHIP, there is no state matching requirement and the federal government will cover the entire cost of the Pre-Existing Condition Plan. While it took more than 6 months for a small number of states to establish their CHIP programs, we anticipate that every state will begin enrolling individuals in the Pre-Existing Condition Plan by the end of August.

Information on how to apply for the Pre-Existing Condition Insurance Plan is available at www.HealthCare.gov. Americans who live in a state where the U.S. Department of Health and Human Services is running the Pre-Existing Condition Plan will be linked directly to the federal application page. Those living in states running their own programs will also find information on how and where to apply on www.HealthCare.gov.

To learn more about the Pre-Existing Condition Insurance Plan and options available to residents of your state, visit www.HealthCare.gov.

An informational pamphlet on the Pre-Existing Condition Insurance Plan can be found at: http://www.healthcare.gov/center/brochures/pcip.pdf.

States by Pre-Existing Insurance Plan Administration

29 states plus the District of Columbia have chosen to operate their own plans.

Alaska, Arkansas, California, Colorado, Connecticut, District of Columbia, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia and Wisconsin.

21 states elected to have HHS run their plan.

Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia and Wyoming.

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You also can check out the news release online at http://www.hhs.gov/news.

Catching up on the past few months

OK, so who said doctors and nurses don’t have a sense of humor.

For example:

The home-health telephone nurse from United HealthCare (motto, we put the Hell in HealthCare) calls to check on me and let me know all about their care options for my post-surgical needs.

The first thing she says, and I am not making this up: “To protect your privacy, this call may be monitored.”

Me: “Whoa, hold up. Let me get this right. To protect my privacy, you’re recording this call. [Emphasis accurate.] How is that protecting my privacy?”

She corrected her statement.

Then she explained that to comply with HIPPA regulations, I need to give her my address to confirm who I am.

Me again: “I’ve rejected HIPPA at all levels of treatment, from you guys (United HellthCare) to my doctors, hospitals and anyone else who would listen. I do not want HIPPA protections.”

HIPPA, by the way, is a federal law designed to protect patient privacy. In general, it’s not a horrible idea. It keeps hospitals from releasing information about you to callers unless you opt out. As a journalist, it gets in my way far too often when checking on gunshot victims or car-crash victims. So I remove that barrier for my friends just out of principle. When the hospital asks me who I authorize to call and ask about my condition, I always write "everyone." It's pretty simple. So simple, even bureaucrats and hospital wonks can understand it.

Nurse: “Well, I need this for HIPPA …”

I cut her off: “I don’t want HIPPA protection. I reject it. You don’t have to worry. It does not apply to me.”

She said it was company policy. I told her that her company gets in the way far too often for my liking and I don’t care about her company policy.

I also explained that she called me. To protect my privacy from ID theft, I don’t give out personal information to people who call me. If I call someone like a bank or an insurance company -- I know who I dialed, after all -- I will provide information to verify who I am.

Me: “You called me. You have my number. You know who I am. I am not giving you personal information”

Her: “Do you want me to add you to a do-not-call list?”

Me: “Yes, please.”

Somehow she was able to do that without verifying who I was.

She’s going to mail me the information she couldn’t talk about over the phone. I'll just toss it.

But to catch everyone up, the reason I received this call in the first place, after missing several over the past few months, is because I had surgeries in January, as noted earlier in the blog, and then again in March, which, oops, I haven’t updated.

The March surgery, again by Dr. Joseph Boyer -- the best thoracic surgeon in Central Florida in my oh-so-humble opinion -- was to repair an incisional hernia in my belly that developed at the site of my original surgery 2½ years ago. I’d been doing yard work and, well, my belly didn’t like that.

I did ask if he had a buy two get one free policy with surgeries. Nope, he doesn't.

So the doctor performed the operation in March and I was out of work for a week to recover. (Seriously, two weeks would have been best, but I didn’t want to blow all my vacation time.)

Still, I did recover, though I may need more work to have this incisional hernia fully repaired.

In the interim, I've had numerous tests.
  • My CT scan of my neo-esophagus came back negative -- Dr. Lee Zehngebot says after one more scan in about a month I won't have to see him three to four times a year; it'll be about once every six months.
  • An endoscopy came back negative -- Dr. Phil Styne said everything between my mouth and intestines looked good. No cancer, no problems, though no pylorus -- he couldn't spot my pyloric valve though he knew it's there. Go figure.
  • A cardiac-stress test came back negative -- Dr. Egerton van den Berg said my heart had no clogs and everything looks good. Safe to do some workouts and work -- as long as I don't move anything heavy and damage the incisional hernia.
  • A respiratory test came back negative -- Dr. Dennis Stevenson says my lungs are at the low end of normal after a chunk was removed in January, but still in the normal range. I don't need lung meds or respirators or inhalers. Whew!
  • My cataract implants are all better -- they had some cells growing on them but a few laser zaps by Dr. Donald J. Centner cleaned them off and I see better than ever.
That's a lot of doctor visits. Some of those incidents involved two and three visits and there were weeks where I was literally in one doctor's office or another every business day of the week.

I was at the doctor so often that I just didn't have enough time to update this blog. Not that I didn't want to, but it was hectic.

Also in the interim, a few friends have had encounters with cancer. I won't name them to protect their identities until I know they'd want me to mention them. (See, I'm implementing HIPPA protections for these friends.)

One has the same type of cancer I did. He's seeing Dr. Z and already has gone through his chemo and radiation. He's kicked butt and is doing great. Surgery is next, and I think he'll be seeing Dr. Boyer. (I reminded him once to mention how great the Yankees are, which will get him on the good side of Dr. B, a major-league Yanks fan!)

A second is undergoing chemo and surviving the ordeal well.
Another is in wait-and-see mode as docs have uncovered potential for cancer but have him being checked regularly to see if it develops.

And a fourth recently had surgery between the ears and has recovered remarkably well.

To each of these guys, I offer my sighs of relief and best wishes that the worst is behind them.

Because I know each can kick this thing's ass. They're all strong men who have petty logical and positive attitudes. And that's one of the strongest assets someone needs as they fight to be CancerVivors.

Thursday, February 4, 2010

More Good News, And More

The title above sounds like it was written by the Department of Redundancy Department. So I'll explain:

Last Friday I saw Dr. Lee Zehngebot, who reiterated what he'd told me a couple of days earlier: I'm pretty darned lucky.

As it turns out, the tumor removed by Dr. Joseph Boyer was a desmoid tumor, which is comprised of spindle cells, as Dr. Boyer had told me soon after the Jan. 18 surgery.

But the spindle cells formed this desmoid, not a carcinoma, which is a malignant form of cancer. While desmoids are benign, meaning they won't spread throughout my body, they are locally aggressive and quite dangerous on their own. This desmoid was seriously attached to my lung and was touching my esophagus. It could have gotten ugly had it remained for much longer.

In fact, research I've done since the diagnosis indicates I am one of 27 lucky individuals in the English-speaking world on record to have an intra-thoracic desmoid. Dr. Boyer, soon to be an associate professor at UCF's new medical school, might actually write a paper on the case, if his research jibes with mine now that he's becoming an academic in addition to just an amazing surgeon. (Line for autographs begins at the rear.)

So Dr. Z said this was the best possible scenario for me: A benign tumor; not related in any way to my previous case of cancer; removed from my body; no other signs of cancer within; I won't need chemo to treat the desmoid. Whew!

In addition, my severe chest pains are pretty much a thing of the past. Since my release from Florida Hospital on Jan. 22, I have not had an incidence of Prinzmetal's Angina. That is more good news and quite a blessing. After a year of torment, it seems to be over.

So after seeing Dr. Z on Friday, I saw Dr. Boyer on Wednesday. He confirmed that he got every bit of the tumor, which is why he had to take a piece of the lung. He removed the dressing from my incision and said it looks good. There's still quite a bit of swelling, but he said that will decrease in time, as will the pain and the numbness on my right side and chest. He said there's a chance the desmoid would return -- it's not uncommon. But he didn't think it would because of its location and origins. Whew again!

Dr. Boyer also referred me to a new cardiologist. As you may recall, I fired my previous heart doctor in Florida Hospital after he told me he came to the diagnosis of Prinzmetal's Angina "because now I believe you." This must have meant that when I was complaining about severe chest pains for the previous year he didn't believe me. Which must be why he didn't order a simple test to see what was up with my heart, such as wearing a holter monitor to record my EKG for a day or two. But I digress.

Heres the more: Monday, I meet with my new cardiologist, Dr. Egerton van den Berg Jr., whose office happens to be a flight below Dr. Boyer's. I chatted with his medical assistant, Jeremy, who described his boss as not just a great doctor but also a really good person. I like that in doctors -- so far, all of my current docs are great at their jobs and great people.

I know, it wasn't all that exciting, but it's good to me. I want a competent cardiologist to check out my ticker and make sure that after a year of spasms in my cardiac arteries there isn't any lasting damage.

I'll find out in just a couple of days. I'm hoping the good news continues...I sure can use it; maybe 2010 will be a good year after all.

Wednesday, January 27, 2010

Dr. Z turns a frown upside-down

What is it about Dr. Lee Zehngebot, the amazing oncologist from Orlando?

Even as he feeds me somewhat less-than-great news it turns out to be really good news.

Dr. Z called a short time ago to let me in on some news garnered from this morning's tumor board meeting.

Turns out that the tumor pulled from my chest last week was not a spindle-cell carcinoma, a very rare malignancy. That's the great news. Really great news.

It was, however, a desmoid tumor, which also is rare but is not malignant. Not cancer.

"A desmoid is a growth of cells that is not malignant," Dr. Z said. "The bad news is there's a chance it will come back."

And after doing some reseach since his call, it's a good chance a desmoid will return.

They most commonly arise near scars due to abdominal surgery, according to WebMD. They also are "locally aggressive" and can cause trouble for nearby tissue, especially muscles. "Desmoid tumors tend to infiltrate adjacent muscle bundles, frequently entrapping them and causing their degeneration," eMedicine reports.

"This course and the tendency for recurrence make the treatment of these relatively rare fibrous tumors challenging."

Of course, I'm always up to a challenge.

I'll visit Friday morning with Dr. Z and we'll figure out a way to monitor the growth of these things. I presume it will be with continued CT scans, which picked this sucker up during the summer and recorded its growth a few months later.

So the really good news -- no malignancy -- was marred a smidge by the fact that I have a new nemesis to keep an eye on.

Monday, January 25, 2010

Home, sweet home

As wonderful as the folks at Florida Hospital were, it's so good to be home.

During the weekend I enjoyed the birthday celebrations for granddaughter Emily. Aimee and Luis held the party at My Gym in the Dr. Philips area, and though skeptical at first I confess that the place was really cool, and all the little ones had a blast. There was another party afterward at Luis' parents' home in Kissimmee. Family was there in abundance, as were family friends. I was so glad to see friends and colleagues Anika and Eric Palm and their 4-month-old daughter Olamina, or Mina for short.

Though I must say that it was in a mirror at My Gym that I noticed I was standing stooped down, looking old. It was because of the surgery I had less than a week before and the pain pills I was on. But I looked old and rickety, and I guess at that moment I was. (No comments from those like my daughters who would say I look old all the time.)

My days mainly involve sleep. Some of it is created by exhaustion from activity, albeit minimal activity. Some is chemically induced. (You know my motto: Better living through chemistry!)

I get on the computer once a day for a few minutes, give or take. I have received so many comments from friends on Facebook and from this blog, and I'd love to reply to all, but it'll have to be when I can focus for a bit longer.

I have a visit with Dr. Joe Boyer, the surgeon who pulled the tumor from my chest, next week and prior to that visit I hope to hear from the doctor about a new cardiologist.

At that visit I hope to get an estimate of how long my recovery will take and when I'll be able to return to work. Most folks look for ways to get out of work, yet I just can't wait to return.

Maybe that's because it'll mean my life's getting back to normal.

Wednesday, January 20, 2010

Odds and ends

Except for the surgery and related pain, my stay at Florida Hospital has been filled with stories of courtesy, kindness, and at least one example of just the opposite.

First, the good.

Surgical prep nurses. They have a tough job with immediate deadlines and still make patients feel like human beings.

Cardiac step-down nurses. After a day and a half stepping down, I had one of my so-called "fart attacks" -- which caused a lot of sweat. Two words after that -- sponge bath.

ICU nurses. Beside another sponge bath, these ladies and gentlemen are amazing at what they do. Last night, when an alarm went off just about the entire staff converged at the room of an 100-year-old woman. She didn't make it, but that is not because of this team's efforts.

Now the bad

An unnamed former doctor of mine. Now up until today this doctor seemed a caring, focused man. Today, as he explained what was wrong -- a diagnosis Dr.Lee Zehngebot had come to more than a year ago -- spasms of cardiac arteries, a form of angina -- I pointed out, "I told you guys about this over a year ago." His response: "Now I believe you" So, for a year, I have been having the most horrible pains I've ever experience because...what? I cannot even fathom an excuse.

Any ideas out there?