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June 1, 2016     The Burke Gazette
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June 1, 2016
 

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Burke, South Dakota For the benefit of all patients, please observe the following visiting hours: 2:00 to 4:00 PM 7:30 to 9:30 PM I HOSPITALIZED Steven Hoffart, Burke THINKING ABOUT HEALTH Continued from Page 15 healthcare? Two recent emails from readers got me thinking about that question. I don't mean consumers in their role as patients whose medical well-be- ing is looked after by state medical boards and health departments that police doctors and hospitals. Those organizations don't always do a perfect job protecting patients from harm, but at least they are in place. But who protects patients when things go wrong on healthcare's fi- nancial side? What happens when you receive a bill you didn't expect and can't afford to pay? What hap- pens when insurers send unintelli- gible explanations of benefits you can't understand? What about ques- tionable loan arrangements to avoid medical bankruptcy? Consumers of healthcare are pretty much on their own. From the 1960s though the 1980s when people complained, they got action from consumer organizations, gov- ernment and even businesses that set up departments to handle com- plaints. That consumer movement is now but a flicker. "We don't have as many pub- lic-interest minded regulators, and officials who try to grab these issues by the horns and deal with them," says Chuck Bell, director of pro- grams for Consumers Union. The emails I received show that although it's an uphill battle to get redress, fighting back as an in- dividual can get attention and may ultimately lead to better protections for everyone. John Rutledge, a retiree, got snared in Medicare's three-day rule by a hospital near his hometown Wheaton, Illinois. At the end of March he took his wife, who was having breathing problems, to the hospital where she was held for three nights of "observation." Pa- tients must be in a hospital for three days as an in-patient before they are entitled to Medicare benefits for 100 days of skilled nursing home care as I noted in a recent column. Thousands of families have been caught when hospitals decide their loved ones are admitted for "observation," a tactic that allows them to avoid repaying Medicare if government auditors find patients should not have been classified as "in-patients." Playing the "obser- vational" game is worth millions to hospitals but costs families tens of thousands of dollars when someone doesn't qualify for Medicare-cov- ered skilled nursing care. Rutledge knew about the three- day rule. Both his doctor and a pulmonologist at the same medical practice recommended an in-patient stay, and Rutledge refused to sign a hospital document saying his wife was admitted for observation. Still, the hospital prevailed, claiming a consultant made the de- cision to keep her for "observation." Rutledge was stuck with a bill that, so far, totals over $15,000 for the skilled nursing care his wife did need. He said he had been a "sig- nificant donor" to the hospital foun- dation, and "I have told the founda- tion that what I spend as a result of "observation" will come out of what I planned to give them, starting with the annual gift." The second email came from Kathryn Green, a college history professor who lives in Greenwood, Mississippi. Green is fighting an air ambulance company, which trans- ported her late husband to a Jackson hospital after he suffered a fatal fall in their home. This "nightmare," as she calls it, is a bill from the transport company that claims it's outside her insurance network, and says she owes them $50,950. "I am 63 and will have a dev- astated retirement if this is upheld," Green told me. Blue Cross & Blue Shield of Mississippi, the administrator for her insurance carrier the State and School Employees' Health In- surance Plan, paid $7,192 of the $58,142 the transport company billed. Blue Cross has told Green that she should be held harmless and should not be charged for the "balance after payment of the Al- lowable Charge has been made di- rectly to that provider." Green is raising a ruckus and has taken her case to state and na- tional media, members of Congress, the state attorney general, and the Mississippi Health Advocacy Pro- gram. The company has told her it will begin collection efforts. In both cases there's a legisla- tive solution. The three-day rule can be fixed by counting all the time a patient spends in the hospi- tal whether they're classified as an "in" or as an "observational" pa- tient. The ambulance problem can be fixed by changing the 1978 air- line deregulation law that prevents states from interfering with fares, services, and routes. But money and politics block the federal changes that would help people like Rut- ledge and Green. "It's like playing a game of health insurance roulette," Bell says. "Your coverage exposes you to these gaps that have been normal- ized. It's become the way of doing business." A resurgent consumer move- ment could change all that. What consumer problems have you had with balance billing? Write to Trudy at trudy.lieberman@gmail. com. , Keeping Our Skies Safe and Se- cure Memorial Day has long marked the unofficial start to summer, and with it, a busy travel season quickly ensues. Whether you and your fami- ly are hopping in the car this summer for a trip across the state or boarding a plane for an adventure around the country or overseas, safety is right- fully top-of-mind. Everyone who relies on air travel wants peace of mind that airport officials - both in the United States and abroad - are doing everything they can to protect the traveling public and prevent bad actors from doing bad things. Aviation safety and secu- rity was recently thrust back into the national conversation after an EgyptAir flight bound for Cairo, Egypt, crashed into the Mediter- ranean Sea in the middle of the night shortly after entering Egyp- tian airspace. Until the investiga- tion is complete, no one can say with certainty what brought down the flight and the 66 lives that went with it, but absent clear evidence of a technical failure, terrorism cannot be ruled out. Although no credible claim of responsibility has yet to be made, U.S. and Egyptian officials have already suggested that terror- ism or another form of foul play could be to blame for the downed flight. In the Senate Commerce Com- mittee, which I chair, aviation secu- rity has been one of our top priori- ties. Last December, the Commerce Committee approved legislation I authored that would protect the traveling public by tightening the vetting process for workers who have access to secure areas in air- ports throughout the country. We also approved an amended version of House legislation to expand Pre- Check enrollments that will help shorten TSA screening lines. In April, these measures were included in my bipartisan FAA Reauthoriza- tion Act of 2016 that the Senate ap- proved by a vote of 95-3. Also included in the package of security measures, which I co-spon- sored with a bipartisan group of senators, including the Commerce Committee's ranking member, is a provision that would strengthen se- curity at international airports with direct flights into the United States, also known as last-point-of-depar- ture airports. We must ensure that U.S.-bound flights meet the highest security standards. Since it's impossible to have TSA agents screening passen- gers outside of the United States The Burke (SD) Gazette, Wednesday, June 1, 2016 at last-point-of-departure airports, our amendment requires the TSA to conduct a security risk assess- ment in conjunction with domestic and foreign partners, including for- eign governments and airlines, and an assessment of TSA's workforce abroad. The amendment also au- thorizes the TSA to donate security screening hardware to last-point-of- departure airports around the world that currently lack the necessary equipment. The FAA bill, which contains all of these important security pro- visions and numerous other re- forms, cleared the Senate last month with strong support. Taken together, these security reforms comprise a comprehensive approach to ad- dressing emerging threats. It's now time for my colleagues in the House of Representatives to take up this bill so we can get meaningful safety and security reforms that can pro- tect air travelers around the United States to the president's desk with- out delay. Going Up On Subscriptions Subscribers to the Burke Gazette will notice a new subscription rate, due to the increase in sales tax that took effect June 1st. The new rates will be $31.95 for Gregory County 16 Subscriptions and $37.28 for sub- scriptions delivered within the bor- ders of South Dakota. Out of state subscriptions are unaffected by the increase in sales tax and will remain at $40.00. MONDAY, June 6 Tater Tot Casserole Tossed Salad Baked Acorn Squash Banana TUESDAY Scalloped Potatoes w/ham Chopped Spinach Salad Hard Boiled Egg Perfection Salad Peaches WEDNESDAY Autumn Chicken Baked Sweet Potato Green Beans Orange THURSDAY Sloppy Jo on a Bun Potato Salad Tossed Salad Grape Juice Pears FRIDAY Chili Marinated Vegetable Salad Crackers Pudding w/Fruit www.sdpublienotiees.eom