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HEALTHBEAT SHOW NOTES .... Episode #219 - Recorded September 18, 2009

Hello and welcome to this week’s edition of HealthBeat, Chiropractic OnLine Today’s Health, News and informational Podcast.

• NJ Group, the ANJC and Others Sue Blue Cross Blue Shield

• Showers may be far dirtier than we think

• Increase in Health Insurance Policy Costs

• And Finally, Health Corner presents expanded coverage of Bacteria in Showers

For HealthBeat, This is Dr. Todd Eglow!

Welcome to HealthBeat Podcast #219, recorded September 18, 2009.

HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.

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RSS Info – In this edition of HealthBeat, we discuss NJ Group, the ANJC and Others Sue Blue Cross Blue Shield, Showers may be far dirtier than we think, Increase in Health Insurance Policy Costs,

And Finally, Health Corner presents expanded coverage of Bacteria in Showers.

ANJC and Others Sue Blue Cross Blue Shield Association and Horizon Blue Cross Blue Shield of New Jersey for Post Payment Audit and Retroactive Recoupment Practices

The Association of New Jersey Chiropractors (“ANJC”), one of the largest chiropractic state associations in the nation, recently announced that it, along with the Pennsylvania Chiropractic Association (“PCA”), the New York Chiropractic Council (“NYCC”), and 15 licensed healthcare providers, including one ANJC member, has filed a class action lawsuit against the Blue Cross Blue Shield Association (“BCBSA”) and a number of state-based BCBS licensees ( “BCBS”), including Horizon Blue Cross Blue Shield of New Jersey, seeking nationwide relief on behalf of chiropractors and other healthcare professionals.  

Specifically, the lawsuit alleges that the post-payment audit process, as it is applied by the various named BCBS licensees, violates the Employee Retirement Income Security Act of 1974 (“ERISA”), in that the resulting repayment demands are retroactive benefit determinations that particular services are not covered under the terms of the BCBS health care plans, but without proper appeal or other protections otherwise available under ERISA for both self-funded and fully-insured health care plans offered through private employers.  

The complaint further alleges that these same post-payment audit practices, as well as the forced recoupment of unrelated health benefit payments to offset alleged prior overpayments, violate the Racketeer Influenced and Corrupt Organizations Act (“RICO”).

The suit has been filed as a class action on behalf of all chiropractors and other licensed healthcare providers nationwide who have been harmed by BCBS's conduct.  

The lawsuit seeks: (1) to stop BCBS from continuing to engage in impermissible audit and recovery practices; (2) to stop BCBS from retroactively enforcing clinical policies that are substantively baseless; (3) compensation for chiropractors who have been coerced into making payments to resolve or defend against BCBS’s unlawful overpayment actions; (4) compensation for chiropractors who have had claim reimbursements forcibly recouped by BCBS on unrelated health benefit payments to offset alleged prior overpayments resulting from retroactive denials; and (5) compensation for chiropractic trade associations, like the ANJC, who have devoted significant time and resources dealing with these various improprieties by BCBS.

For more information, surf to www.anjc.info

Showers may be far dirtier than we think

As if we didn't already have enough germs and toxins to deal with in our home environments (the lead in our paint; flame retardants in our furniture; indoor air quality and even the resulting air purifiers; to name a few), we now get to fret over another perpetrator: the showerhead.

Researchers at the University of Colorado at Boulder have just published a study in the Proceedings of the National Academy of Sciences finding that about 30 percent of the showerheads in nine cities (including New York, Chicago, and Denver) carry "significant" levels of Mycobacterium avium, a pathogen that is linked to pulmonary disease.

Moreover, the M. avium pathogen was often clumped together with other pathogens in a slimy biofilm that clings to the insides of showerheads at more than 100 times the levels found in municipal water.

"If you are getting a face full of water when you first turn your shower on, that means you are probably getting a particularly high load of Mycobacterium avium, which may not be too healthy," says lead author Norman Pace.

Cigarette smoke is the most common cause of pulmonary disease, according to the National Heart, Lung, and Blood Institute, but general air quality also plays a role. Some 7.6 million U.S. adults were diagnosed with chronic bronchitis (a type of pulmonary disease) in 2007, according to the Centers for Disease Control and Prevention.

Symptoms of pulmonary disease that has been caused by M. avium can include weakness, shortness of breath, and a persistent, dry cough; obviously the immune-compromised, such as pregnant women and the elderly, are more prone to experience such symptoms.

Surf to our Show Notes for more information and a link to a video of this story - http://www.colorado.edu/news/r/50fe20a5a5376631bbad2024f89b02c0.html

http://www.pnas.org/content/early/2009/09/11/0908446106.abstract

Increase in Health Insurance Policy Costs

An average family health insurance policy now costs more than some compact cars, and four in 10 companies will likely pass more of that expense on to workers, according to a closely watched survey of businesses in mid-September.

The average cost of a family policy offered by employers was $13,375 this year, up 5% from 2008, the Kaiser Family Foundation and the Health Research & Educational Trust survey found.

By comparison, wages rose 3% over that period.

The new numbers underscore warnings by President Obama about the growing cost of health insurance and were embraced by Democratic lawmakers who are pushing for legislation to change the nation's health care system. "The trends are crushing millions of businesses and American families," Senate Majority Leader Harry Reid of Nevada said.

The annual survey of more than 2,000 companies also found that 40% of small-business employees enrolled in individual health plans pay annual deductibles of $1,000 or more. That's almost twice the number who paid that much in 2007.

Drew Altman, president of the Kaiser foundation, said it is the combination of higher health care costs along with the recession and other rising prices that "creates the pain level."

Since 1999, health insurance premiums for families rose 131%, the report found, far more than the general rate of inflation, which increased 28% over the same period. Overall, health care in the United States is expected to cost $2.6 trillion this year, or 17% of the nation's economy, according to the non-partisan Congressional Budget Office.

Surf to our Show Notes for more information - http://www.usatoday.com/money/industries/health/2009-09-15-insurance-costs_N.htm?loc=interstitialskip

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Health Corner – In this week’s Health Corner, we continue our discussion of potential dangers of bacteria in home’s Shower Heads, which may have an impact on Pulmonary disorders.  This audio clip includes commentary from the study’s lead author, Professor Norman Pace.

Surf to our Show Notes for more information and a link to a video of this story - http://www.colorado.edu/news/r/50fe20a5a5376631bbad2024f89b02c0.html

http://www.pnas.org/content/early/2009/09/11/0908446106.abstract

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For Chiropractic OnLine Today’s HealthBeat, This is Dr. Todd Eglow.

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