Renuka 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 | Your cool black kitchenware could be slowly poisoning you, study says. Here’s what to do Health | Does fluoride cause cancer, IQ loss, and more? Fact-checking Robert F. Kennedy Jr.’s claims 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.
One week into a new Syria, rebels aim for normalcy and Syrians vow not to be silent again DAMASCUS (AP) — A transformation has started to take place in the week since the unexpected overthrow of Syria’s President Bashar Assad. Suddenly in charge, the rebels have been met with a mix of excitement, grief and hope. And so far the transition has been surprisingly smooth. Reports of reprisals, revenge killings and sectarian violence are minimal, looting and destruction has been quickly contained. But there are a million ways it could go wrong. Syria is broken and isolated after five decades of Assad family rule. Families have been torn apart by war, former prisoners are traumatized, and tens of thousands of detainees remain missing. The economy is wrecked, poverty is widespread, inflation and unemployment are high. Corruption seeps through daily life. Christians in Syria mark country's transformation with tears as UN envoy urges an end to sanctions DAMASCUS, Syria (AP) — In churches across long-stifled Syria, Christians have marked the first Sunday services since Bashar Assad’s ouster in an air of transformation. Some were in tears, others clasped their hands in prayer. The U.N. envoy for Syria is calling for a quick end to Western sanctions as the country’s new leaders and regional and global powers discuss the way forward. The Syrian government has been under sanctions by the United States, the European Union and others for years as a result of Assad’s brutal response to what began as peaceful anti-government protests in 2011 and spiraled into civil war. Israel will close its Ireland embassy over Gaza tensions as Palestinian death toll nears 45,000 DEIR AL-BALAH, Gaza Strip (AP) — Israel says it will close its embassy in Ireland as relations deteriorate over the war in Gaza, where Palestinian medical officials say new Israeli airstrikes have killed over 30 people including children. Israel's decision to close the embassy came in response to what Israel’s foreign minister has described as Ireland's “extreme anti-Israel policies.” Ireland earlier announced that it would recognize a Palestinian state. And the Irish cabinet last week decided to formally intervene in South Africa’s case against Israel at the International Court of Justice, which accuses Israel of committing genocide in Gaza. The Palestinian death toll in the war is approaching 45,000. The GOP stoked fears of noncitizens voting. Cases in Ohio show how rhetoric and reality diverge AKRON, Ohio (AP) — Ohio's Republican secretary of state and attorney general sought to reassure voters before the November election that the state's elections were being vigorously protected against the possibility of immigrants voting illegally. That push coincided with a national Republican messaging strategy warning that potentially thousands of ineligible voters would be voting. The officials' efforts in Ohio led to charges against just six noncitizens in a state with 8 million registered voters. That outcome and the stories of some of those now facing charges show the gap both in Ohio and across the United States between the rhetoric about noncitizen voting and the reality that it's rare and not part of a coordinated scheme to throw elections. South Korean leaders seek calm after Yoon is impeached SEOUL, South Korea (AP) — South Korea’s opposition leader has offered to work with the government to ease the political tumult, a day after the opposition-controlled parliament voted to impeach conservative President Yoon Suk Yeol over a short-lived attempt to impose martial law. Liberal Democratic Party leader Lee Jae-myung, whose party holds a majority in the National Assembly, urged the Constitutional Court to rule swiftly on Yoon’s impeachment and proposed a special council for policy cooperation between the government and parliament. Yoon’s powers have been suspended until the court decides whether to remove him from office or reinstate him. If Yoon is dismissed, a national election to choose his successor must be held within 60 days. Storms across US bring heavy snow, dangerous ice and a tornado in California OMAHA, Neb. (AP) — Inclement weather has plagued areas of the U.S. in the first half of the weekend, with dangerous conditions including heavy snow, a major ice storm and unusual tornado activity. An ice storm beginning Friday created treacherous driving conditions across Iowa and eastern Nebraska. More than 33 inches of snow was reported near Orchard Park, New York, which is often a landing point for lake-effect snow. On Saturday, a tornado touched down in Scotts Valley, California, causing damage and several injuries. In San Francisco, a storm damaged trees and roofs and prompted a tornado warning, which was a first for a city that has not experienced a tornado since 2005. Small businesses say cautious shoppers are seeking 'cozy' and 'festive' this holiday season With a late Thanksgiving, the holiday shopping season is five days shorter than last year, and owners of small retail shops say that people have been quick to snap up holiday décor early, along with gifts for others and themselves. Cozy items like sweaters are popular so far. Businesses are also holding special events to get shoppers in the door. But there’s little sense of the freewheeling spending that occurred during the pandemic. Overall, The National Retail Federation predicts retail sales in November and December will rise between 2.5% and 3.5% compared with same period a year ago. US agencies should use advanced technology to identify mysterious drones, Schumer says After weeks of fear and bewilderment about the drones buzzing over parts of New York and New Jersey, U.S. Sen. Chuck Schumer is urging the federal government to deploy better drone-tracking technology to identify and ultimately stop the airborne pests. The New York Democrat is calling on the Department of Homeland Security to immediately deploy advanced technology to identify and track drones back to their landing spots. That is according to briefings from his office. Federal authorities have said that the drones do not appear to be linked to foreign governments. West Africa regional bloc approves exit timeline for 3 coup-hit member states ABUJA, Nigeria (AP) — West Africa’s regional bloc ECOWAS has approved an exit timeline for three coup-hit nations. It comes after a nearly yearlong process of mediation to avert the unprecedented disintegration of the grouping. The president of the ECOWAS Commission, Omar Touray, said in a statement: “The authority decides to set the period from 29 January, 2025 to 29 July 2025 as a transitional period and to keep ECOWAS doors open to the three countries during the transition period." In a first in the 15-nation bloc’s nearly 50 years of existence, the military juntas of Niger, Mali and Burkina Faso announced in January that they decided to leave ECOWAS. Pope Francis makes 1st papal visit to France's Corsica awash in expressions of popular piety AJACCIO, Corsica (AP) — Pope Francis on the first papal visit ever to the French island of Corsica on Sunday called for a dynamic form of laicism, promoting the kind of popular piety that distinguishes the Mediterranean island from secular France as a bridge between religious and civic society. The one-day visit to Corsica’s capital Ajaccio, birthplace of Napoleon, on Sunday is one of the briefest of his papacy beyond Italy’s borders, just about nine hours on the ground, including a 40-minute visit with French President Emmanuel Macron. It is the first papal visit ever to the island, which Genoa ceded to France in 1768 and is located closer to the Italian mainland than France.
Islamic Studies: An Essential Discipline For Contemporary Society In Jammu And Kashmir Urgent reforms needed to ensure quality education and ethical guidance amidst growing neglect Islamic Studies is one of the most vibrant and relevant academic disciplines of contemporary times. In a world grappling with the erosion of ethical values, moral responsibility, and societal harmony, the subject offers a robust framework for understanding ethics, spirituality, and interfaith coexistence. Yet, in Jammu and Kashmir, a region with a rich history of Islamic scholarship and cultural plurality, this discipline is languishing due to systemic neglect, bureaucratic apathy, and short-sighted policies. Despite its immense potential to address critical societal challenges, Islamic Studies remains an overlooked academic pursuit, particularly at the secondary and higher secondary levels, where its foundation is most needed. The significance of Islamic Studies lies not just in its religious and cultural dimensions but also in its ability to mould character, promote moral values, and foster mutual respect among diverse communities. It is a holistic discipline encompassing ethics, philosophy, history, and comparative religion. This multidisciplinary approach is particularly pertinent at a time when societal decay, corruption, and moral decline are rampant. In Jammu and Kashmir, where communal harmony and moral education are vital, Islamic Studies could act as a linchpin in shaping individuals and communities for the better. However, the dismal state of its implementation paints a grim picture. Islamic Studies is currently offered across major universities in Jammu and Kashmir, including the University of Kashmir, the Islamic University of Science and Technology, and Baba Ghulam Shah Badshah University. It is also taught in several degree colleges and higher secondary schools, indicating its relevance and demand. However, significant issues persist in its implementation and governance. The inconsistency in teaching Islamic Studies is most apparent at the secondary and higher secondary levels. While the subject enjoys some presence in higher education, its foundation at the formative stages is woefully inadequate. This creates a gap in students’ academic and moral upbringing. Recent revelations through the Right to Information reply disclosed that seven higher secondary schools offering Islamic Studies are without any faculty to teach the subject. This raises a troubling question: how are students in these institutions expected to learn and benefit from this subject without qualified teachers? Such negligence undermines not only the credibility of the subject but also the future of students who wish to pursue it as an academic and professional field. If principles of ethics, character building, and moral reasoning are not imparted during these formative years, how can students be expected to develop a deeper understanding and appreciation for these values later in life? The lack of institutional support and qualified teachers deprives young minds of guidance during their most vulnerable years, leaving them without the tools to traverse the complexities of modern life. A glaring example of this neglect is witnessed in the recent advertisement by the Jammu and Kashmir Public Service Commission for 575 lecturer posts, which shockingly excluded Islamic Studies altogether. This omission has dashed the hopes of countless postgraduate and doctoral degree holders in the subject, who had been waiting for an opportunity to contribute to academia and society. For years, students have dedicated their time, resources, and energy to pursuing degrees in Islamic Studies, only to find themselves stranded with limited or no employment opportunities. This state of affairs has left many qualified individuals disillusioned and questioning the relevance of their academic pursuits. Subsequently, this neglect not only results in wasting the potential of these scholars but also discourages future generations from pursuing this discipline. On the other hand, the absence of recruitment for Islamic Studies lecturers and the vacant teaching positions in higher secondary schools further compound the issue. It raises several critical questions about who is teaching Islamic Studies in these schools where faculty positions remain unfilled. Are students being taught by unqualified teachers, or are they left to study the subject on their own? If the government is unwilling to address these vacancies and recruit qualified staff, it begs the question of why the subject is being offered at all. Such neglect reflects a broader trend of side-lining humanities and social sciences in favour of technical and vocational education. While technical education is undoubtedly important, it should not come at the expense of disciplines that shape character, promote ethical reasoning, and contribute to societal well-being. The government and educational authorities must recognize the critical role of Islamic Studies in addressing contemporary societal challenges. Immediate steps are needed to rectify the glaring gaps in its implementation and governance. Qualified Islamic Studies teachers must be recruited at the secondary, higher secondary and college levels to ensure that students receive quality education in the subject. Vacant positions should be filled without delay, and the Jammu and Kashmir Public Service Commission should include positions for Islamic Studies lecturers in their advertisements. Adequate resources, including qualified teachers and updated curricula, must be allocated to ensure the subject’s effective implementation. A comprehensive policy for the promotion of Islamic Studies should be developed, ensuring its integration into the broader educational framework of Jammu and Kashmir. This would provide much-needed employment opportunities for postgraduate and doctoral degree holders in the subject. If meaningful reforms are not undertaken, the future of Islamic Studies in Jammu and Kashmir looks bleak. Students and scholars may abandon the subject altogether, leading to its eventual closure at the secondary and higher education levels. Such a scenario would be a loss not only for the academic community but also for society at large, which stands to benefit immensely from the ethical and moral guidance that Islamic Studies provides. The current trajectory will discourage students from pursuing Islamic Studies, leaving countless young minds without a moral compass to steer the complexities of modern life. The government must act now to prevent this valuable discipline from fading into obscurity. By Dr K Sajad Ahmad [email protected]Google on Monday announced that it will invest an additional $930 million across its three data center campuses in Nebraska, including the one under construction in Lincoln. Karen Dahut, CEO of Google Public Sector, said the additional investment will bring Google's total investment in Nebraska to more than $4.4 billion. She was joined for the announcement at Innovation Campus in Lincoln by Sen. Pete Ricketts, Rep. Don Bacon, University of Nebraska President Jeffrey Gold and Lincoln Mayor Leirion Gaylor Baird. Dahut also announced that the company will donate $250,000 to the University of Nebraska system to support research into artificial intelligence on its various campuses. Gaylor Baird also announced that Google will donate $100,000 to the Foundation for Lincoln Public Schools to help fund the Spark Summer Learning program, which is a hands-on summer camp focusing on STEAM (science, technology, engineering, arts, and mathematics) for Lincoln-area elementary students. People are also reading... Google has previously said the data center under construction on about 600 acres of land northwest of the 56th Street exit on Interstate 80, will employ at least 30 people. The company has applied for $600 million in state tax incentives for the project and plans it submitted to the city indicate it could eventually grow to 2 million square feet of space if fully built out. Google's other Nebraska data centers are both in the Omaha area. It also has a data center across the river in Council Bluffs, Iowa. This is a developing story. Stay with JournalStar.com for updates. Top Journal Star photos for November 2024 Lincoln firefighter Andrew Brenner sprays water from the top of a ladder truck on to the roof of a former Village Inn at 29th and O streets Wednesday morning. Luca Gustafson, 6, rides to school Tuesday with the bike bus at Riley Elementary School. Each Tuesday, students can bike to school with adult chaperones along a specific route. Wahoo's Braylon Iversen celebrates with Warrior players after they defeated Auburn in a Class C-1 state semifinal game Friday in Wahoo. Lincoln Fire Fighters Association member Andy Evans works to assemble a headboard during a bed-building day hosted by Sleep in Heavenly Peace on Saturday at Hampton Enterprises. Volunteers helped build 20 beds for children in need. Second-time mother giraffe Allie nuzzles her new calf in the giraffe experience enclosure on Friday, Nov. 15, 2024, at the Lincoln Children's Zoo. Nebraska celebrates during the first set of the match against Minnesota on Thursday at the Devaney Sports Center. Iris Gonnerman, 8 (from right), her brother Oliver, 6, and cousin Noreen Milana, 9, wave flags while watching Veterans Parade outside the state Capitol on Sunday. Nebraska's Connor Essegian scores against Bethune-Cookma on Saturday, Nov. 9, 2024, at Pinnacle Bank Arena. Covered by a canopy of changing leaves, a car cruises along A street in a neighborhood north of Downtown Lincoln on Tuesday, Nov. 12, 2024. Mild temperatures continue into the mid weeks of November. Wednesday calls for a chance of rain showers before noon with gusty winds. Most days this week are expected to be accompanied by mostly sunny skies and consistent breezes. Norris' Anna Jelinek (left) lifts the the Class B championship trophy alongside Rya Borer on Saturday at the Devaney Sports Center. Lincoln Lutheran players embrace one another as threy celebrate defeating Thayer Central in four sets to win the Class C-2 championship match Saturday at the Devaney Sports Center. Superior players celebrate their three set win over EMF during the Class D-1 championship match Saturday at the Devaney Sports Center. Reflected in a ceiling beam, Leyton takes on Shelton in the first set of the Class D-2 championship match Saturday at the Devaney Sports Center. Omaha Skutt's Nicole Ott (left) and Addison West react after a point in the second set during a Class B semifinal match Friday at Pinnacle Bank Arena. Hasan Khalil, owner of Golden Scissors, trims the beard of Vitaliy Martynyuk on Friday at his barbershop in Lincoln. Southwest fans Kylea Stritt (from left), Peg Rice, and Stacey Wilson cheer on their team as the "horsemen" during a Class D-1 first-round match Thursday at Pinnacle Bank Arena. Millard West players dogpile on the floor after defeating Lincoln Southwest in five set match during a Class A first-round match Wednesday at Pinnacle Bank Arena. Lincoln Southwest's Shelby Harding dives to save the ball from hitting the ground in the first set during a Class A first-round match Wednesday at Pinnacle Bank Arena. Second graders Eli Gonzalez (left) and Shrutoshome Datta look at drawings that first and second grade students made at the Monster Jam Art Show on Wednesday at Elliott Elementary School. The elementary school students made drawings of monsters to be turned into different types of art by Lincoln High School students. Norris players celebrate a point against Lincoln Pius X in a Class B state volleyball tournament match, Wednesday, Nov. 6, 2024, at Pinnacle Bank Arena. U.S. Sen. Deb Fischer (right) talks with supporters, including Darlene Starman of Lincoln, at her campaign office on Tuesday in Lincoln. A cutout of Jesus watches over voters on Tuesday at Redeemer Lutheran Church in Lincoln. Abigail Webb votes on Tuesday at F Street Community Center. Nebraska's Rollie Worster (24) shoots a layup while defended by Texas Rio Grande Valley's Marshal Destremau (left) and Trey Miller (right) on Nov. 4 at Pinnacle Bank Arena. Nebraska's Allison Weidner (left) autographs a poster for Freeman Public Schools student Godwil Muthiani, 12 (center), after the game against UNO on Monday, Nov. 4, 2024, at Pinnacle Bank Arena. Muthiani's sign says, "#3 Allison Weinder is the GOAT! Sorry I'm only 12." Nebraska Head Coach Matt Rhule speaks to an official after a targeting call on Nebraska during the first quarter of the game against UCLA on Saturday, Nov. 2, 2024, at Memorial Stadium. The call was overturned after review. Nebraska's Dante Dowdell scores against UCLA in the fourth quarter on Saturday at Memorial Stadium. Cadet Elena Burgwald (left) and Cadet Mason Beck look up as a B-1B Lancer flies over Memorial Stadium before the UCLA game against Nebraska on Saturday. UCLA's K.J. Wallace (7) defends Nebraska's Jacory Barney (17) as he makes a diving 40-yard catch in the second quarter on Saturday, Nov. 2, 2024, at Memorial Stadium. Lincoln Southeast quarterback Tre Bollen (left) and Tate Sandman react after losing a Class A football playoff game against Millard North on Friday, Nov. 1, 2024, at Seacrest Field. Millard North won 10-3. After the field clears, Norris' Jarrett Behrends (17) kicks his helmet after the Titans fell to Waverly 16-17 in a Class B football playoff game on Friday, Nov. 1, 2024, at Waverly High School. A line of people waiting to vote has been normal at the Lancaster County Election Commission Office at 601 N. 46th St., as it was Friday afternoon. The office will be open 7 a.m. to 5 p.m. Monday to allow voters to cast an early ballot. If they wait until Election Day, they will need to go to their precinct or drop off their ballots at one of five drop boxes across the city. For more stories about about Tuesday's election, go to Journalstar.com . The business news you need Get the latest local business news delivered FREE to your inbox weekly. Associate managing editor {{description}} Email notifications are only sent once a day, and only if there are new matching items. Local government reporter {{description}} Email notifications are only sent once a day, and only if there are new matching items.Dua Lipa 'engaged' to Harry Potter actor Callum Turner as she flashes huge ring