Letters for Dec. 10: Declining a reelection bid is President Biden’s defining legacy in office
If you're waiting for Black Friday to score a powerful gaming laptop that won't break your wallet, that deal is already here: Best Buy has a Lenovo LOQ for just $700. That's 30 percent off its $1,000 MSRP, a phenomenal price for this RTX-powered machine. Let's start there, shall we? This would already be a pretty good price for an RTX 4050 laptop, but it's an insane price for an RTX 4060 laptop. You just don't see these going for $700, and this is a graphics card that'll let you crank up your settings on all but the... Gabriela VatuRenuka Rayasam | (TNS) KFF Health News In April, just 12 weeks into her pregnancy, Kathleen Clark was standing at the receptionist window of her OB-GYN’s office when she was asked to pay $960, the total the office estimated she would owe after she delivered. Clark, 39, was shocked that she was asked to pay that amount during this second prenatal visit. Normally, patients receive the bill after insurance has paid its part, and for pregnant women that’s usually only when the pregnancy ends. It would be months before the office filed the claim with her health insurer. Clark said she felt stuck. The Cleveland, Tennessee, obstetrics practice was affiliated with a birthing center where she wanted to deliver. Plus, she and her husband had been wanting to have a baby for a long time. And Clark was emotional, because just weeks earlier her mother had died. “You’re standing there at the window, and there’s people all around, and you’re trying to be really nice,” recalled Clark, through tears. “So, I paid it.” On online baby message boards and other social media forums , pregnant women say they are being asked by their providers to pay out-of-pocket fees earlier than expected. The practice is legal, but patient advocacy groups call it unethical. Medical providers argue that asking for payment up front ensures they get compensated for their services. How frequently this happens is hard to track because it is considered a private transaction between the provider and the patient. Therefore, the payments are not recorded in insurance claims data and are not studied by researchers. Patients, medical billing experts, and patient advocates say the billing practice causes unexpected anxiety at a time of already heightened stress and financial pressure. Estimates can sometimes be higher than what a patient might ultimately owe and force people to fight for refunds if they miscarry or the amount paid was higher than the final bill. Up-front payments also create hurdles for women who may want to switch providers if they are unhappy with their care. In some cases, they may cause women to forgo prenatal care altogether, especially in places where few other maternity care options exist. It’s “holding their treatment hostage,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation . Medical billing and women’s health experts believe OB-GYN offices adopted the practice to manage the high cost of maternity care and the way it is billed for in the U.S. When a pregnancy ends, OB-GYNs typically file a single insurance claim for routine prenatal care, labor, delivery, and, often, postpartum care. That practice of bundling all maternity care into one billing code began three decades ago, said Lisa Satterfield, senior director of health and payment policy at the American College of Obstetricians and Gynecologists . But such bundled billing has become outdated, she said. Previously, pregnant patients had been subject to copayments for each prenatal visit, which might lead them to skip crucial appointments to save money. But the Affordable Care Act now requires all commercial insurers to fully cover certain prenatal services. Plus, it’s become more common for pregnant women to switch providers, or have different providers handle prenatal care, labor, and delivery — especially in rural areas where patient transfers are common. Some providers say prepayments allow them to spread out one-time payments over the course of the pregnancy to ensure that they are compensated for the care they do provide, even if they don’t ultimately deliver the baby. “You have people who, unfortunately, are not getting paid for the work that they do,” said Pamela Boatner, who works as a midwife in a Georgia hospital. While she believes women should receive pregnancy care regardless of their ability to pay, she also understands that some providers want to make sure their bill isn’t ignored after the baby is delivered. New parents might be overloaded with hospital bills and the costs of caring for a new child, and they may lack income if a parent isn’t working, Boatner said. In the U.S., having a baby can be expensive. People who obtain health insurance through large employers pay an average of nearly $3,000 out-of-pocket for pregnancy, childbirth, and postpartum care, according to the Peterson-KFF Health System Tracker . In addition, many people are opting for high-deductible health insurance plans, leaving them to shoulder a larger share of the costs. Of the 100 million U.S. people with health care debt, 12% attribute at least some of it to maternity care, according to a 2022 KFF poll . Families need time to save money for the high costs of pregnancy, childbirth, and child care, especially if they lack paid maternity leave, said Joy Burkhard , CEO of the Policy Center for Maternal Mental Health, a Los Angeles-based policy think tank. Asking them to prepay “is another gut punch,” she said. “What if you don’t have the money? Do you put it on credit cards and hope your credit card goes through?” Calculating the final costs of childbirth depends on multiple factors, such as the timing of the pregnancy , plan benefits, and health complications, said Erin Duffy , a health policy researcher at the University of Southern California’s Schaeffer Center for Health Policy and Economics. The final bill for the patient is unclear until a health plan decides how much of the claim it will cover, she said. But sometimes the option to wait for the insurer is taken away. During Jamie Daw’s first pregnancy in 2020, her OB-GYN accepted her refusal to pay in advance because Daw wanted to see the final bill. But in 2023, during her second pregnancy, a private midwifery practice in New York told her that since she had a high-deductible plan, it was mandatory to pay $2,000 spread out with monthly payments. Daw, a health policy researcher at Columbia University, delivered in September 2023 and got a refund check that November for $640 to cover the difference between the estimate and the final bill. “I study health insurance,” she said. “But, as most of us know, it’s so complicated when you’re really living it.” While the Affordable Care Act requires insurers to cover some prenatal services, it doesn’t prohibit providers from sending their final bill to patients early. It would be a challenge politically and practically for state and federal governments to attempt to regulate the timing of the payment request, said Sabrina Corlette , a co-director of the Center on Health Insurance Reforms at Georgetown University. Medical lobbying groups are powerful and contracts between insurers and medical providers are proprietary. Because of the legal gray area, Lacy Marshall , an insurance broker at Rapha Health and Life in Texas, advises clients to ask their insurer if they can refuse to prepay their deductible. Some insurance plans prohibit providers in their network from requiring payment up front. If the insurer says they can refuse to pay up front, Marshall said, she tells clients to get established with a practice before declining to pay, so that the provider can’t refuse treatment. Related Articles Health | Which health insurance plan may be right for you? Health | California case is the first confirmed bird flu infection in a US child Health | UC campus and hospital worker strike continues across university system Health | Phillips 66 indicted on charges it dumped tainted water from Carson refinery into sewer system Health | US towns plunge into debates about fluoride in water Clark said she met her insurance deductible after paying for genetic testing, extra ultrasounds, and other services out of her health care flexible spending account. Then she called her OB-GYN’s office and asked for a refund. “I got my spine back,” said Clark, who had previously worked at a health insurer and a medical office. She got an initial check for about half the $960 she originally paid. In August, Clark was sent to the hospital after her blood pressure spiked. A high-risk pregnancy specialist — not her original OB-GYN practice — delivered her son, Peter, prematurely via emergency cesarean section at 30 weeks. It was only after she resolved most of the bills from the delivery that she received the rest of her refund from the other OB-GYN practice. This final check came in October, just days after Clark brought Peter home from the hospital, and after multiple calls to the office. She said it all added stress to an already stressful period. “Why am I having to pay the price as a patient?” she said. “I’m just trying to have a baby.” ©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.
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Leaders of the Ruruma Community in Southern Kaduna State have called on the Federal Government to establish a military base in the community due to the hardship they have been through as a result of the insecurity in the state. This is even as they said that they have paid billions of Naira in ransom to kidnappers. The zone, like some parts of the country suffering from insecurity, had been dealing with the payment of ransom, killing, and inability to go to the farm and even harvest their crops for some time now. Recently, the Ruruma community, frustrated by the development, decided to voice out their concern and called on the authorities to come to their aid. According to a statement signed by their National President, Mr. Daniel Dallah, the community alleged that a staggering amount not less than N1 billion in ransom has been paid out to bandits and kidnappers by the communities in the last two years. They said in the recent past, not less than 13 people have been brutally killed, and over 200 abducted by kidnappers. “There has been a continued escalation of insecurity in our communities, leading to brutal killing and displacement of community members,” they said “A former CBN director was abducted in Kwasam where millions were paid as ransom. Also, communities like Fagen Rawa, Kaibi, Kusheka, Fadei, Ruruma, Rafin Rimi, Kurera, Kitimi, Kakude and Kiwollo are all displaced by bandits. “Bandits have rendered our communities incapacitated, as farmers are afraid to go to their farms for fear of being killed or kidnapped for ransom.” the statement said. Before now, the umbrella organization of all Southern Kaduna people, the Southern Kaduna Peoples Union (SOKAPU) had also called for military assistance to the communities. Apart from military assistance, the last leadership of the union led by a one-time member of the House of Representatives, Jonathan Asake, had also contemplated the setting up of a security outfit like the one in the South West, Amotekun. The former SOKAPU National President had said: “As a peace-loving people, who do not want anything to happen to us and our desire to live in peace with all and sundry, irrespective of any difference, we are forced to look elsewhere for the protection of our people and we strongly believe that a security outfit such as Amotekun is an answer to our much-desired peace in Southern Kaduna.” Recently, the state Governor, Mallam Uba Sani, pardoned repentant Bandits, who had decided to lay down their arms and renounce banditry. The governor, who spoke in Birnin Gwari, where he received the first set of repentant bandits, noted that he wants to be fair as a panacea towards tackling insecurity in the state. “I will be fair to everyone, be they farmers, herders and traders, to achieve lasting peace and development,” Mr Sani stated. Sani added: ‘’Through numerous meetings and extensive discussions, we have built bridges of trust. Several senior bandit leaders had laid their arms and embraced peace, along with their followers. “This programme adheres to international standards of disarmament, demobilisation and reintegration, ensuring that these individuals can return to society as productive citizens,’’ he said. The governor warned that the rehabilitation of the repentant bandits was based on the principle of carrot and stick. “While we welcome those who chose peace, we will not hesitate to take decisive action against anyone, who continues to perpetuate violence. “The security, law enforcement and intelligence agencies have already achieved significant results, neutralising bandits’ kingpins, dismantling criminal networks and rescuing kidnapped victims,’’ the governor stressed. However, on how to end banditry and kidnapping in their area, the Ruruma community said what was needed was a military base to assist them dislodge the criminal elements. The community appealed to President Bola Tinubu’s administration to establish a military presence in Kwasam, its local government headquarters to halt escalating killings and abduction of their people by bandits. The National President stressed that establishing a military presence in the Kwasam area would not only bring stability to the region but also help restore normalcy in neighbouring vulnerable communities that have been displaced over the years. “The military formation in the Kwasam axis will enable the communities that have been displaced to return to their ancestral land as they have abandoned their farms and farm produce. Currently, our Chief, Alhaji Dauda Abdulsalam, the Pogom Kumana, for some years, has not been at home, due to escalating insecurity in the region. “Bandits have continued to occupy surrounding communities and farmlands unchallenged by security operatives.” He lamented. Also speaking on how to find solutions to the challenges, the Chairman of the Middle Belt Forum (MBF) Kaduna State chapter, Luka Binniyat, said the people desire more military formations and presence in Southern Kaduna as a whole. However, he said that the formation of the Volunteers Citizens Guards, where youths from the Middle Belt will be trained to assist the military will be an added advantage. Comrade Binniyat told Sunday Telegraph: “We very much desire more military and police formations in Southern Kaduna, being the larger part of Kaduna State. Kaduna State has a landmass of about 46,000 sq.km with 23 LGAs. Southern Kaduna occupies 26,000 sq.km and has 12 LGs. Yet, 80 per cent of military formations in Kaduna State are in the northern part. So, we need more permanent military presence.” He, however, said the way forward is a very simple: “We have always maintained in the MBF. We have millions of able bodied youths that are educated, easy to train and imbued with basic security training. And most of them are very willing to assist the military as Volunteers Citizens Guards. Why not train them and give them rudimentary arms? “With their sheer numbers and under the command of professional soldiers, I bet you that we can wipe out these bandits under a month. Imagine the billions of dollars or trillion of Naira used in importing jets and sundry arms and the little results we are getting. Deploy a fraction of that into training and arming our idle and willing youths and see the results.” According to him:” It is the refusal of the government to heed to this simple suggestions that makes us doubt the political will of the government to end this evil.” He, however, said the volume of attacks has reduced in the recent past, unlike what opens years ago, adding that, “the mass invasion, mass killings and arson in Zangon Kataf, Kaura, Jemaa, Sanga and Kachia LGAs parts of the Middle in Southern Kaduna has reduced drastically by about 90 per cent. We praise the efforts of the Nigeria military on this. But that has been replaced by mass kidnappings, target individuals and random kidnapping by bandits.” Binniyat, who alleged that those attacking the Southern Kaduna part of the middle belt are “Fulani Ethnic Militia” (FEM) also alleged that apart from the violence, they have “placed taxes on some captured communities before they can farm and before they can harvest their crops.”Stanford knocks off Cal in both teams' ACC opener
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