Posted tagged ‘Healthcare’

Seniors and the next 20 years

October 2, 2018

Last week, I had the opportunity to participate in a telephone survey about the needs of seniors, conducted by Honolulu’s Elderly Affairs Division.

My responses were spontaneous, and after thinking about it a little more, I wouldn’t respond any differently. But I did think of more things I wish I could have said, so I decided to share my thoughts with you.

Here are the top three challenges that I think seniors face today:

Affordable housing. Oahu is addressing the lack of affordable housing, but we need even more affordable housing units that are built with seniors in mind – such as wider elevators, hallways, and doorways; walk-in showers; and clear signage in buildings.

I also think we need to change our expectations for senior living. One idea is to create ohana apartments, modeled on university dormitories. Two or three seniors or senior couples could live together in multi-bedroom units with a shared kitchen and living room. This could strengthen friendships, reduce feelings of loneliness and isolation, and foster relationships where seniors give and receive care.

Affordable healthcare. In the two years I’ve worked in healthcare administration, I’ve seen big increases in co-payments, co-insurance, and deductibles. Some clients have a co-pay of $40 or $45 per office visit (my own copayment is $50). We need more resources in place to help make healthcare affordable. I am strongly opposed to making our tax code more complicated; but, working with the tax system we have today, we could create a tax credit for healthcare providers who waive copayments for low-income seniors.

At some point, we simply need more reasonable limits on annual healthcare premium and copayment increases. The limits could be tied to the rate of inflation or Medicare benefits. In 2018, Affordable Care Act (ACA) rates increased by 19.8% for HMSA members and 24.1% for Kaiser Permanente Hawaii members, according to the Honolulu Star-Advertiser. In comparison, consumer prices rose 2.7% over the twelve months from August 2017 to August 2018, according to the US Bureau of Labor Statistics.

Mobility and transportation issues. Hawaii has a variety of services to help seniors with mobility and transportation issues, from TheHandi-Van and Uber rides, to Meals on Wheels and Project DANA, which provide services to the homebound.

I think we can do more a little more. We can encourage more healthcare providers to offer home visits for seniors. We can create a “technology in the home” program to help seniors set up computers, tablets, or phones for web conferencing.

And in the next 20 years? I think the biggest challenge will be keeping physically and mentally active. We need to keep fit, work longer, and volunteer more. There are so many ways to be active in the community, and we need better ways to share those opportunities with people of all ages.

For example, I recently learned about Senior Corps RSVP, a network for seniors who want to volunteer in the community. At the Hawaii Seniors’ Fair, I learned about a foster grandparents program to mentor children with special needs in schools. Volunteerism and maintaining strong connections to the community can help keep us healthy – physically, mentally, emotionally, and spiritually.

What challenges do you or the seniors in your life face today? How do you envision your life in 20 years?


Artwork courtesy of

Health insurance hunter

February 6, 2018

I work for a small nonprofit organization in Hawaii, and it was eye-opening to enter the mysterious world of health insurance coding and billing. Every medical procedure is reduced to numbers: provider account numbers, tax IDs, subscriber account numbers, dates of birth, diagnosis codes that prove medical necessity, and billing codes.

Sometimes, the confusing, frustrating, and impersonal claims process makes me long for a single-payer health care system.

Some days I have to be a health insurance hunter. Here are a few stories…

Who’s the payer? We submitted a claim to Payer A, but they denied the claim. Payer A said that yes, the client has insurance, the client had a “replacement” plan, and Payer B is responsible. Payer B said that yes, they are the insurance provider, but they are the secondary payer. We need to bill Payer C, and then submit a claim to Payer B.

There’s a lesson here: because of privacy issues, health insurance companies can’t share information indiscriminately. When there is more than one health insurance plan, clients have the responsibility to contact their plan administrators.

Where’s the claim? We submitted a claim to Payer D. Months went by, and we didn’t receive either a reimbursement or a denial letter. Payer D told us that the claim was rejected because of an error, but no rejection letter was sent. If we hadn’t called, we would not have known about the denied claim. We were able to resubmit the claim, and were eventually paid.

 Where’s the payment? We submitted a claim to Payer E. Months went by, and we didn’t receive either a reimbursement check or a denial letter. Payer E told us that we were “out of network” and that they sent a check directly to the client months ago. We didn’t know it, but the client was supposed to pay for the service out-of-pocket and Payer E would send them a reimbursement check. This has only happened twice so far.

Where’s the authorization? We submitted a claim to Payer F, but they required an authorization for services. We submitted the authorization request, but Payer F told us it was the wrong form. We submitted the correct form, but Payer F told us the provider number was wrong. We submitted the corrected form, but Payer F told us that another, optional part of the form was incomplete. Lesson:

What’s the deductible? Payer G denied a claim, and we needed to find out why. The claim was submitted correctly and the procedure was covered under the plan. We learned that the client had an annual deductible that has to be met before Payer F paid any claims. With health insurance premiums rising, many people (myself included) are moving to less expensive plans with higher deductibles. These deductibles are quickly becoming a serious problem for people with chronic illnesses or conditions.

Despite the aggravation, at the end of the day, I don’t think a single-payer health care system would be an improvement. It might be simpler, but it would be more restrictive and less flexible, because clients and providers would have no choice and little power to fight against denials and reimbursements.

Are you satisfied with the way your health insurance company works with your doctors? Have you generally had easy or frustrating experiences with medical claims?


Artwork courtesy of

Full circle about single-payer health insurance

February 21, 2017

Choose Your Health Insurance

I never understood why there is so much support for a national, single-payer healthcare system – until I started working in a small medical office.

Just last year, I believed that commercial health insurance is good for consumers. It is better for us as patients, in terms of flexibility (choosing the plan that fits you), choice (access to doctors you trust), and price (insurance plans must compete for your business, keeping their premiums reasonable and benefits attractive). It is better for healthcare providers, because they can choose which healthcare plans to accept; insurance companies with unreasonable requirements or low reimbursement rates could be avoided. Theoretically.

For healthcare providers, our current healthcare system can be a nightmare. Each healthcare plan has different copays, different deductibles, and vastly different levels of reimbursements. Some payers reimburse providers promptly; some payers may take months. It’s not fair to providers, who may have to wait a long time before they get compensated for their work. How many of us would go to work if we are not sure how much we will get paid, or when we’ll get a paycheck?

Even a small medical office, with a limited number of healthcare providers and billing codes, generates a lot of paperwork. Electronic billing helps, but there are still pre-authorizations, progress notes, requests for documentation, paper claims for payers who don’t accept electronic billing, and customer service phone calls to find out the status of a claim or why a claim was denied.

I’ve had problems with two insurance companies who each insist that the other is “primary” and should be billed first. I’ve had claims that get lost in the system, and then have to be “escalated” for payment. I’ve learned that military plans are “secondary” payers – except when they are “primary” payers.

For healthcare providers, I see the allure of a single-payer system: one claim form, one customer relations contact, one billing contact. Theoretically.

But the more I learn, the more I realize that a single-payer health insurance could be an even bigger nightmare than our current system. A monopoly on healthcare coverage, authorizations, and payments would not be good for anyone.

Consumers would have a limited choice of plans and providers, and under current law would be forced to buy health insurance that they may not be able to afford. Healthcare providers would have little recourse if the single-payer refuses a claim or underpays a claim.

In a short time, I’ve realized that the government health insurance payers (military, veterans, Medicare, and Medicaid) are the most difficult payers to work with. Government payers often take longer to reimburse providers – sometimes three times as long as commercial insurance companies. Government payers often pay providers less – sometimes 25% less than commercial insurance companies. Government payers often fall short in informing people that they need to have an authorization before they see a healthcare provider – and there is little recourse for appeals.

I was beguiled by the idea of single-payer health insurance, until I realized that the single-payer would be a government payer. I’ve come full circle, skeptical that single-payer health insurance would be an improvement over our current healthcare system.

If you work in the healthcare profession, what has been your experience with medical billing and claims? If you’ve lived in a country with a single-payer health insurance, what has been your experience with medical costs and care?


Clipart courtesy of


A hospital ship for Hawaii

August 25, 2015

Hawaii Hospital Ship

In Hawaii, providing timely and affordable healthcare is made even more challenging by our remote location. We are about 2,400 miles away from California, over 3,800 miles away from Japan, and over 4,700 miles away from Australia. It takes more time and more money to import medicine, medical equipment, and supplies. We have to plan ahead for what we need now and in the future. During emergencies, we have to rely on what we have on hand.

Another challenge: because much of Hawaii’s population is centered on Honolulu County, rural and neighbor islands have an even greater difficulty accessing healthcare. The neighbor islands have higher rates of preventable deaths and preventable hospital readmission rates, according to the Hawaii Healthcare Project’s “State of Hawaii Healthcare Innovation Plan” (2014).

There are many ways we could improve healthcare in Hawaii, and I’d like to pitch one more idea: a Hawaii hospital ship. This floating medical facility could carry medical equipment and supplies, rooms for medical and support staff, operating rooms, patient beds, and boat docks. It addresses the problem of Hawaii’s geographic separation, not just from the rest of the world, but from each other.

A Hawaii hospital ship could operate on a regular schedule, stopping at harbors for 1-3 days as needed, and making a circuit of the islands once a month. Hawaii has ten state-managed harbors on six islands, and I would add one on the North Shore of Oahu – Port Allen (Kauai), Nawiliwili (Kauai), Haleiwa (Oahu), Barber’s Point (Oahu), Honolulu (Oahu) for repairs and supplies, Kaunakakai (Molokai), Kaumalapau (Lanai), Kahului (Maui), Hana (Maui), Kawaihae (Hawaii), Hilo (Hawaii), and back again.

Hawaii Harbors Map

Here are 4 ways Hawaii could benefit from a hospital ship:

* Regular medical services to remote areas. A hospital ship could deliver medicines and medical supplies, and perform lab tests. Ship doctors could provide consulting services or second opinions and assist with operations. Being able to “share” medical equipment could lower costs, and it could save money for patients who could not afford to fly to Honolulu.

* Search and rescue support services. A hospital ship could be diverted to aid the survivors of airplane, cruise ship, and boat survivors.

* Emergency services during natural disasters. The regular medical schedule could be suspended to deal with a natural disaster by offering medical aid, delivering supplies, and transporting aid workers and the injured. It’s an important part of crisis-planning for our state.

* Quarantine facilities. A hospital ship could be converted to a quarantine ship in case of an outbreak of disease or illness.

Realistically, I don’t think a hospital ship is affordable. We just don’t have a large enough population to make it a reasonable option now. But we could take the long view and start planning for the future. We need to be able to help each other, because help from outside Hawaii is so far away.

Would a hospital ship solve a problem in healthcare and emergency response? How could we make it work? Why do you think it wouldn’t work for Hawaii?