Medical / Health

Wednesday, July 9, 2014

UPDATED: Nonprofit Sues Blue Cross Over Obamacare Networks

Posted By on Wed, Jul 9, 2014 at 3:37 PM

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A Southern California nonprofit filed a class-action lawsuit Tuesday alleging that Anthem Blue Cross misled millions of customers when rolling out its plans under the Affordable Care Act, leaving many enrollees on the hook for large out-of-pocket expenses.

According to a report in the Sacramento Bee, the suit alleges that the insurance giant published inaccurate provider networks, causing many customers to purchase plans thinking their current doctors and health care providers were classified as “in-network.” The suit also alleges Anthem failed to inform customers that many of its Covered California policies wouldn’t reimburse for care provided outside of its approved network.

Anthem spokesman Darrel Ng is quoted in the Bee story saying the company has agreed to pay out-of-network claims from folks who received treatment from inaccurately listed doctors during the first three months of this year. Consumer Watchdog, the Santa Monica-based nonprofit that filed the suit, countered that the company intentionally misrepresented and concealed the limitations of its plans in order to capture a big market share in the newly created insurance exchange.

News of the suit may be of special interest here on the North Coast, where customers have had their share of frustrations over Anthem Blue Cross’ inaccurate provider lists, as detailed in past Journal coverage here. Currently, the lawsuit’s class consists of six plaintiffs from Los Altos Hills, Moraga and San Jose.

Laura Antonini, a staff attorney for Consumer Watchdog, said the lawsuit will be opened up to include all Anthem Blue Cross customers who purchased plans through the insurance exchange if it is ultimately certified by the court as a class action suit. But, Antonini said, that process could take years.

The suit was filed amid a recent flurry of concern surrounding Anthem Blue Cross and Blue Shield of California’s handling of their Covered California plans that resulted in the state’s launching an investigation into the companies’ practices last month. The California Department of Managed Health Care began its formal investigation June 20, with spokeswoman Marta Green telling the Los Angeles Times, “Our preliminary investigation gave us good cause to believe there are violations of the law.”

As a part of its investigation, the department has reportedly contracted with a consulting firm, PMPM Consulting, to call health care providers to survey the accuracy of the two insurance companies provider network directories. The California Medical Association sent out a letter to its members late last month, which was forwarded around locally by the Humboldt-Del Norte Medical Association, urging physicians to cooperate with PMPM’s survey. “This is an investigation into the accuracy of the plan directories and whether the plans have violated any laws, not an investigation of physician practices,” the letter states.

The CMA urges patients having trouble finding in-network providers under their Covered California plans to call the Department of Managed Health Care’s help center at (888) 466-2219.
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Friday, June 20, 2014

State Launches Insurance Investigation

Posted By on Fri, Jun 20, 2014 at 10:23 AM

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Regulators have launched an investigation into whether Anthem Blue Cross and Blue Shield of California violated state law by misleading consumers with inaccurate provider lists, the Los Angeles Times is reporting this morning.

The California Department of Managed Care has begun a review looking into provider access issues with the two insurance giants' plans offered under Covered California, the state insurance exchange set up under the Affordable Care Act. "Our preliminary investigation gave us good cause to believe there are violations of the law," agency spokeswoman Marta Green told the Times.

According to the report, the department is expected to wrap its investigation within 60 days after which the companies will have 45 days to respond to its findings.

The Journal covered issues with Anthem Blue Cross' flawed in-network provider lists in Humboldt County in our June 12 cover story, "Bait and Switch," and followed up with a guest views piece in the June 19 edition, "The Insurance Leech," in which local physician Emily Dalton shares her frustrations. The full Los Angeles Times story can be found here.
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Thursday, May 22, 2014

Care Home Shut Down, Owner Suspended

Posted By on Thu, May 22, 2014 at 5:13 PM

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The state has shut down Chamberlain’s Residential Care Facility for the elderly, at 3252 Lucia Road in Eureka, and suspended the license of the home’s operator, Gina Chamberlain, accusing her of numerous health and safety code violations, including taking a client’s prescription narcotics for her own use.

The state’s “order of temporary suspension of license” was issued May 5, and the five residents of the six-client capacity home were relocated to other facilities before the home’s shutdown on May 8, says Michael Weston, spokesman for the Community Care Licensing Division of the state’s Department of Social Services.

In its complaint requesting the suspension of Chamberlain’s license to operate, the state alleges that Chamberlain not only took a client’s drugs for her own use, but also told a client’s nurse practitioner that the client was taking prescribed hydrocodone “several times a day for weeks” even though the client wasn’t; locked a client in a bedroom and blocked the door with a baby gate; failed to give a client medication properly; overcharged two clients, a husband and wife, by $13,100; cashed $52,400 worth of checks from a client’s checking account; and took a client’s car and Rolex watch.

The complaint requests that Chamberlain be prohibited “for the remainder of [her] life” from having anything to do with a state-licensed care facility.

Chamberlain has the right to appeal the suspension before an administrative law judge, says Weston. The Journal is trying to reach Chamberlain and will update this story as we learn more.
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Tuesday, April 22, 2014

St. Joes Service Workers Vote Union

Posted By on Tue, Apr 22, 2014 at 9:26 AM

click to enlarge St. Joseph Hospital- Eureka service workers on the union organization committee. - PHOTO COURTESY OF KERRY SWEENEY
  • Photo courtesy of Kerry Sweeney
  • St. Joseph Hospital- Eureka service workers on the union organization committee.

Service workers at St. Joseph Hospital in Eureka have voted 149 to 74 to join the National Union of Healthcare Workers (NUHW), with 223 of the 227 eligible bargaining unit members voting. The ballots were counted Friday, April 18.

The workers voting for representation include nursing assistants, housekeepers, monitor technicians, cafeteria workers, operating room aides and emergency room technicians, phlebotomists, medical records and admissions clerks, unit secretaries and others.

Shortly after the vote was announced, St. Joseph Hospital-Humboldt President David O’Brien issued a statement to staff and board members vowing to honor the employees' voice "and prepare to enter into good faith collective bargaining with the NUHW ..."

"With the vote behind us, it’s time to move forward … together," O'Brien said. "Yes, there were differences of opinion and strongly held views. That is to be expected. So it is especially important to remember and keep our focus on what unites us, and that is our deeply held commitment to provide safe, quality care and compassion to our patients and their families."

It was indeed not an easy battle, according to those on the service workers' side. The unionizing effort began in May 2013. One of the organizers, Kerry Sweeney, a labor and delivery nurse at the hospital for 12 years, said the effort was propelled by concerns similar to those of St. Joseph nurses. During informational picketing last year, some of the hospital’s 350 nurses, represented by the California Nurses Association, complained about staff reductions, especially among nurses’ aides and other positions that nurses rely on for help. The hospital’s chief nursing officer, Carol Reeder, countered at the time that the hospital would never compromise patients’ safety.

The CNA is affiliated with the NUHW.

Sweeney said another concern is service workers not having received a raise in four years — until they got one last year, which Sweeney said she suspects came in response to the union effort. 

The hospital administration, while posting union-effort informational literature around the hospital as required by the National Labor Relations Board, was opposed to it. Some managers wore “Vote No” shirts and put up flyers countering union claims. The hospital also started a web page called SJE Just Facts in January, after the labor board notified it there would be an election. The site has provided neutral information on the election process, as well as plenty of arguments against going union. Under “Facts about NUHW strikes,” for instance, the hospital’s website notes that NUHW-represented workers in California went on an average of 12 strikes in just two years, averaging “one strike every two months.”

Sweeney said the nurses, who unionized in 2001, have had four contracts in 12 years and not a single strike. The hospital has countered that that’s the CNA … not the NUHW, which in a flyer addressed to employees the hospital indicated has numerous problems including debt and “a poor record of negotiating contracts.”

Both sides have called each other's informational materials misleading or even false at times.

On Monday, Linda Cook, the hospital's vice president of Human Resources, responded to some of the arguments given by the union organizers as reasons for service workers to unionize. She said the hospital employs many nursing assistants in its medical-surgical and progressive care areas "to make sure, whenever possible, that our caregivers are not overworked." Sometimes, she said, a nursing assistant might be reassigned to sit by a patient who's confused or suicidal, and that sometimes there isn't another nursing assistant available to fill in elsewhere for that "sitter." Cook also said last year's wage increase "had nothing to do with the organizing efforts by NUHW, but was the result of the hospital ending fiscal year 2013 with a positive margin for the first time in years." She added that it had actually been less than three years since the previous raise. 

Next, the labor board has to certify the election results. That takes about a week.

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Sunday, February 16, 2014

New Pot Banking Guidelines Moot in CA?

Posted By on Sun, Feb 16, 2014 at 10:42 AM

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Thanks to some recent direction from the Obama administration, banks are now allowed to do business with folks who make their living in the legal marijuana trade. But, maybe not in California.

In response to a growing uneasiness with the cannabis cash conundrum, spurred at least in part by the introduction of legal recreational marijuana sales in Colorado, the U.S. Department of Justice and the Financial Crimes Enforcement Network issued new guidelines to financial institutions that it appears will allow them to knowingly accept deposits of pot proceeds.

Because marijuana is classified as a Schedule 1 drug under the Controlled Substances Act, the feds traditionally taken a hardline stance with banks, which are forbidden from knowingly doing business with drug dealers. Despite marijuana’s varying legal status in dozens of states, the Department of Justice has essentially maintained that dispensaries are drug dealers and that banks doing business with them, consequently, risked a severe federal response. This leaves folks in the marijuana business either sitting on huge amounts of cash or essentially having to launder their proceeds through personal bank accounts or other businesses.

Thanks in a large part to the legalization of recreational marijuana in Colorado, the issue has received increasing media attention, with a recent Time Magazine story recently detailing how Colorado pot shop owners are travelling with briefcases full of cash, dolling out payroll in $20 bills and financing multi-million dollar construction projects with cold hard cash. Noting that some of Colorado’s marijuana entrepreneurs have taken to storing their money in secret, high-security warehouses, the story quotes Betty Aldworth, a former deputy director of the National Cannabis Industry Association, as saying the lack of access to banking is “the single most dangerous aspect of legal marijuana.”

But the new guidelines promise to change that, allowing banking institutions and credit card companies to do business with marijuana shops and dispensaries as long as they do due diligence to make sure everything is above board.

“In assessing the risk of providing services to a marijuana-related business, a financial institution should conduct customer due diligence that includes: (i) verifying with the appropriate state authorities whether the business is duly licensed and registered; (ii) reviewing the license application (and related documentation) submitted by the business for obtaining a state license to operate its marijuana-related business…,” the guidelines read.

Those two provisions might render the whole thing moot in California, which does not have a state licensing system and, instead, relies on local ordinances to regulate medical marijuana dispensaries and collectives.

Local dispensary owners have historically been tight lipped about their banking status. That’s understandable, but it means the local impact of the new federal banking guidelines and the uncertainty of their application in California remains unclear. The Journal reached out to a number of local dispensaries on the issue, but has not heard back. We’ll update this story if we do.

While there’s uncertainty in California, most in the marijuana movement seem to agree the new guidelines represent a huge step forward. Americans for Safe Access (ASA), a medical marijuana advocacy group, issued a press release saying the new guidelines will make the industry safer for both dispensaries and their patients, who will no longer have to use cash to get their medication.

“We will certainly be working with banks, credit unions and credit card companies to ensure proper implementation of this federal guidance,” said ASA Executive Director Steph Sherer in a press release. “Removing the risks of operating as an ‘all-cash’ business cannot be overstated, but we will also continue to put pressure on the Obama Administration to wrap these types of discrete practices into a more comprehensive medical marijuana policy.”
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Wednesday, February 12, 2014

Huffman Urges Obama to Reclassify Marijuana

Posted By on Wed, Feb 12, 2014 at 2:22 PM

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North Coast Congressman Jared Huffman, D-San Rafael, joined 17 of his cohorts today in sending a letter to President Barack Obama urging him to reschedule marijuana under the Controlled Substance Act.

Currently, marijuana is classified as a Schedule I controlled substance under the act, putting it in the same category under federal law as heroin, ecstasy and LSD and a class above the likes of cocaine, methadone, oxycodone and morphine. The Schedule I designation makes it very difficult to conduct legal testing on marijuana in the United States, as it can only be done with federal permits, which, as one might imagine, the government doesn’t give out very often.

In the letter, the members of Congress urge Obama to ask Attorney General Eric Holder to reclassify under the Controlled Substances Act of 1970.

“We were encouraged by your recent comments in your interview with David Remnick in the Jan. 27, 2014 issue of the New Yorker, about shifting public opinion on the legalization of marijuana,” Huffman and company wrote. “Classifying marijuana as Schedule I at the federal level perpetuates an unjust and irrational system. We request that you instruct Attorney General Holder to delist or classify marijuana in a more appropriate way, at the very least eliminating it from Schedule I or II.”

Read the full letter below, and the Journal’s coverage of Obama’s New Yorker comments here.
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Wednesday, January 22, 2014

We Flunk, Mostly

Posted By on Wed, Jan 22, 2014 at 11:32 AM

The American Lung Association has released its State of Tobacco Control 2014, a report that "tracks progress on key tobacco control policies at the state and federal levels" according to the executive summary. The intent is to see how well jurisdictions are doing in protecting people from tobacco smoke.

Counties and cities are graded, too, in three areas: Smokefree Outdoor Air, Smokefree Housing, and Reducing Sales of Tobacco Products. According to this report, California is a backslider, having "made little to no headway in increasing its tobacco prevention and control funding, protecting its workers from loopholes in the smokefree workplace law, raising its cigarette tax or increasing cessation coverage."

And Humboldt? Ye are a cig-dangling, smoke-blowing, health-dismissing scofflaw, with four of your cities — Ferndale, Fortuna, Rio Dell and Trinidad — and your unincorporated area receiving an overall F, and three other cities — Arcata, Blue Lake and Eureka — receiving a C overall. Cough! Here's our chart:

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Wednesday, January 15, 2014

H1N1 Claims Local Man

Posted By on Wed, Jan 15, 2014 at 1:51 PM

A local man died in a Humboldt County hospital from H1N1 influenza related complications, the Humboldt County Department of Health and Human Services confirmed today.
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The man — who has not been identified but officials say was in his 60s — died Monday and also had underlying health  conditions, according to a county press release.

“Our thoughts are with his family and friends at this time,” Humboldt County Health Officer Donald Baird said in the release, adding that officials would not be releasing additional information in an attempt to protect the man’s privacy.

H1N1 is the same strain associated with the 2009 flu pandemic, and Baird warns that this local man’s death should serve as a reminder that H1N1 has the potential to cause serious illness across all age groups, even to individuals generally in good health.

Local officials are urging folks to get their flu shots, and the Humboldt County  Department of Health and Human Services is hosting a series of walk-up vaccination clinics this month. Find the details in the county’s full press release below:

Continue reading »

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Monday, December 16, 2013

St. Joe's Gets Backup in Cancer Fight from Stanford

Posted on Mon, Dec 16, 2013 at 11:21 AM

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St. Joseph Hospital today announced that it will have some top-notch help in tackling cancer care, research, training and education. Stanford Medicine is partnering with St. Joe's to provide a variety of services including telemedicine conferences with experts, training for local clinician staff and access to clinical trials.

That last item could eliminate some frustrating and time-consuming road trips. According to a press release, "The clinical trials will offer patients at St. Joseph Hospital access to state-of-the-art treatment that currently requires travel to the San Francisco area for enrollment."

Here's the full announcement from St. Joe's:

St. Joseph Hospital is pleased to announce a new and exciting collaboration with Stanford Medicine. The relationship will involve a series of projects related to cancer care, clinical research and education – all with the goal of continuing to provide local patients with  the highest quality cancer care possible.

The collaboration includes: a new cancer telemedicine tumor board program; access to cancer clinical trials; and access to educational programs at Stanford for St. Joseph Hospital physicians and staff. The tumor board program is a formal way for a multi-disciplinary group of physicians to discuss treatment options for complex or rare cancers. This new relationship allows us to use telemedicine technology to present local cancer cases to physicians at Stanford via WebEx. The program will launch with gynecologic oncology cases.

Additionally, Stanford will provide St. Joseph Hospital access to cancer clinical trials and will assist in the training of clinical research staff. Clinical trials are protocols for cancers that do not respond to routine treatments. The clinical trials will offer patients at St. Joseph Hospital access to state-of-the-art treatment that currently requires travel to the San Francisco area for enrollment.

Leaders from St. Joseph Hospital and Stanford joined together at a special reception on Friday, December 6 in Eureka to formally announce the collaboration to local physicians and members of the community. Although Stanford will have no direct involvement in patient care at St. Joseph Hospital, their partnership will provide valuable resources to physicians and patients at our hospital.

“We are very excited to begin this new collaboration with Stanford,” said David O’Brien, MD, President of St. Joseph and Redwood Memorial Hospitals. “The tumor board program and clinical trials with Stanford present new opportunities for our hospital to advance cancer care for patients in our community.”

Douglas W. Blayney, MD, the Ann and John Doerr Medical Director of the Stanford Cancer Center and professor of Medical Oncology at the Stanford University School of Medicine said “We are very excited about the collaboration between St. Joseph Hospital and Stanford Medicine. Stanford's mission is "to care, to educate and to discover." Our partnership with the hospital will involve a series of innovative cancer projects that touch all three areas of this mission."

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Wednesday, November 27, 2013

Fortunans: Don't Close the Baby Dept.

Posted By on Wed, Nov 27, 2013 at 4:15 PM

In this week’s issue of the Journal (paper version out on the street now, web version up tomorrow, Nov. 28), we write about a shortage of ob-gyn docs in Humboldt, and how St. Joseph Health System’s talk of possibly closing down Redwood Memorial Hospital’s OB program might be one of several influencing factors.

Now, in a news release this afternoon, Erin Dunn, CEO of the Fortuna Chamber of Commerce, says there will be a community meeting Dec. 5 to talk about the potential closure of Redwood Memorial’s OB program. 

Here's the chamber's announcement:



Losing the Obstetrics program will harm the viability of Redwood Memorial Hospital. Residents of the Eel River Valley and Southern Humboldt will have to travel to Eureka to have their babies.

The Board of Trustees will be deciding the fate of this program soon!

Attend this community meeting and voice your concern.

For information about the meeting, please contact Erin Dunn @ the Fortuna Chamber of Commerce. 707-725-3959.

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