Every Hospital and Provider Needs to Understand the Mais Decision

Last month, on November 7, 2014, the WUSB 90.1 radio show, The Business of Healthcare with host Susan Montana, featured guest Laura J. Lowenstein, Esq.
The interview and discussion was based on Laura’s article posted on her website with the title “Every Hospital and Provider Needs to Understand the Mais Decision”

LISTEN to the Radio Program on archive:

Be sure you don’t miss the next radio show that is all about “The Business of Healthcare” with host Susan Montana on 90.1 fm WUSB

Healthcare and the Internet

Patients and providers alike should be utilizing the internet in their pursuit of healthcare.  The first point of connection – the patient and the provider meeting – might be the most important for both parties.

keyboard_stethoscopeIf you are a patient, and you need to connect with a provider for a particular condition, how do you choose from the many providers out there?  If you’re a provider and you want to be able to connect with new patients, how do they find, and then select you?  Here are just a few options:

Insurance Company Lists

If a patient is fortunate enough to have access to health insurance, the insurance company maintains a list of providers who participate in their insurance plans.  These lists may be available in hard copy form, or more commonly, on the insurance company’s website.  Patients can use these lists to narrow down their choices based upon name recognition or geographic location.  Providers should regularly confirm all their practice locations are properly listed for all the insurance companies with whom they participate, and promptly update any inaccurate or insufficient listings.

Internet Searches

There are MANY sources of provider information available online.  Patients today can post their experiences, both good and bad, on one of dozens of healthcare opinion and experience websites, such as healthgrades.com, vitals.com and ratemds.com, to name just a few.  Providers, what information is prospective patients seeing about YOU when they do an internet search?

Word of Mouth

Often the first choice for a patient is a provider who comes with a glowing recommendation from a friend or family member.  Sometimes, the recommendation is so compelling, the patient doesn’t care if the provider is in their insurance network or not, and they are even willing to pay out of pocket and seek reimbursement from the insurance company after services are rendered.  The same word of mouth system can have the exact opposite effect, where a bad experience can steer a patient away from a prospective provider.  Providers, ask yourselves honestly, what are your current and prior patients telling their friends and family?  And keep in mind, unsatisfactory experiences with office and billing staff can negatively reflect on otherwise good medical care!

Please direct your health care reimbursement questions or topics you would like to know more about to Sue@HabaneroInc.com.

Substance Abuse Impacts Families – Broadcast Date 1/27/12

My guest this morning, “John”, wanted to share his family’s struggle to secure help for his son, once his son admitted he had a problem and was ready for help.  The biggest challenge they faced was availability.  All programs are above capacity, most are not affordable, and almost all are governed by profits, or at the very least, maximizing their funding.  The focus is not necessarily on helping the addict recover.  He hopes that by sharing his story he might help even one other family be better prepared when the addict in their life is ready to take that important first step to recovery.

Click on the link below to hear the entire program.  It runs about 40 minutes.

Substance Abuse Impacts Familes

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Substance Abuse Strikes a Chord with Listeners

I received a tremendous amount of feedback on this programming, both before and after the broadcast, and I thank everyone who was brave enough to contribute to the discussion.  I’ve de-identified the data to protect people’s identities and summarized it below:

I posted the following note on Facebook and the radio station staff list:
“As many of you know, I have a light hearted radio show, Whatever Floats Yer Boat on WUSB Stony Brook. Tomorrow morning is not going to be a light hearted show. I’ll be featuring a discussion with a couple of people who are currently, locally, grappling with the substance abuse epidemic that has been crippling our young people. Tune in 90.1fm in the Stony Brook listening area, or listen online wusb.fm. If anyone has any comment, questions or constructive contributions to the discussion, please post them here. Signed, Habanero”
The feedback on this program has been overwhelming. I compiled it (de-identified, of course) and am posting it here along with my playlist and a link to the streaming archive.
The following are the de-identified comments collected from a variety of sources. To protect privacy, I’ve removed or obscured names, so sometimes the flow sounds a little clunky. Thanks to everyone who listened and commented.

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**I’m not sure if you know, but the son OD’d last week. He’s OK, as in still with us, but the parents have been through hell trying to navigate the maze of getting him help. The father knows I’ve done some radio programming on this topic in the past and asked if he could come on the air to talk about his experience to let others know what awaits them (it is a serious epidemic here on Long Island). He says if he can help one family have an easier time of it than they’ve had, it will be worth it. I also suspect it will be some catharsis for him. I’m also going to have a young friend who’s been clean for a year talk about their experiences. Not my usual lighthearted radio programming.
**What those parents are going through, and have gone through, is one of the very worst situations you can have handed to you as a parent. Thank God the son is still alive and will be have another chance at straightening himself out. Thanks for passing this on, I’ll be listening.

**Habanero: I’ve been asked to do a radio program about the current problems with Rx drugs. Would you be at all interested in talking about your experience?
Pat: sure if i can have an alias or something
H: Yes, I would probably call you Pat. The guy that is coming on is going through it with his son. He OD’d a couple weeks ago. (He is OK, and hopefully getting out of his program and going back to school soon)
P: oh thank god. yes i would love to talk about it, they’re actually talking about close the detox that i went to twice. its the only one that will take you if you have nothing and its closing due to lack of funding
H: So I was thinking it might be interesting to show not only the problem, but that there is hope.
P: and ive been dying to have a way to spread awareness about it
H: OMG. I was so nervous about asking you!
P: haha its okay
H: Friday morning?
P: what time?
H: 6-8am (I know it is early!)
(NOTE: Pat, one of my planned guests, a young recovering addict, wasn’t able to make it due to the early hour of the program interfering with their work schedule. I had hoped to tell Pat’s story to offer a glimmer of hope to those struggling. I’m working on a follow up.)

**Please listen to USB.fm online. Today’s program “Whatever floats yer boat’, w/ Habanero as host, our friend’s son survived an overdose after many heart wrenching years of intervention. The father is on this program to explain the ordeal. Our Cousin lost his beautiful son a few months ago. I’m overwhelmed w/ sadness.

**This is my friend. Posting in case anyone wants to take a listen in the morning tomorrow, I believe 7 AM.

**Time? What substances are they abusing?

**Great idea. Try not to get too caught up in the maudlin drama of it all as I’ve heard on some other public affairs shows. It’s just another way of romancing a disease-the way some people romance mental illness or poverty. Also, if I may suggest something else, bear in mind a Frank Serpico quote from 30 years or so ago. “It’s fine to say don’t do drugs. So you tell kids not to do drugs, fine, then what are you gonna give ’em?”

**What time? If I can, I’d like to listen.. my friends lost 2 kids to this in the past 10 weeks…

**Setting my alarm for this show…IT IS AN EPIDEMIC for sure…not just young people though!

**I read this post at 7:10 this morning and logged in online immediately so I came in late to the discussion. I will wait for the link post so I can hear it all. I’ve watched this scenario unfold for a while now and the sense of powerlessness breaks your heart.

**I could write an F’ing book so I refrained to write a comment on your wall. I’ll be tuning in tomorrow morning
Habanero: I understand, but do feel free to post. It is astonishing to me the number of people who are impacted by this.

**I think this is a show that will be beneficial for both young and older people to hear. Substance abuse has personally affected my life and many others that I know. Whether it’s the economy to blame or failed parenting or society there simply needs to be a better attack on this plague. It’s taken too many unfinished lives destroyed by this.

**Having a broken hip prosthetic and awaiting my 3rd total hip replacement, I understand agony. THAT’S WHAT MEDICINE IS FOR! And even I avoid it! It’s certainly not supposed to be readily available for kids to be pilfering from their parent’s medicine cabinets recreationally and then whining because they have an abuse problem. Some people are physically suffering. I know them. My heart goes out to them. They often can’t even afford to get the medications they so desperately need. While others have the “luxury” of being selfishly irresponsible! Often mixing alcohol and pot with a prescription that more often than not, isn’t even written out to them! And then it becomes “a plague.” These kids are smart. Problem is, they usually wind up outsmarting themselves! It’s not the Economy. Kids took drugs in the 60’s when this country was prosperous. And it’s not their parents necessarily. They’re often working 2 jobs each. It’s sheer decadence in the computer age. In 1952 only 1 in 3 homes even had a TV! Now these young people all text each other in the same room on an IPhone. But, life being so hard for them, they need to text on pain killers. Poor babies!
Habanero: if you listen tomorrow, one of my guests will be addressing the difference between then and now directly.
I will. I didn’t mean to come on too strong. I also have had my heart broken by the loss of many loved ones to drugs. I just never hear from the perspective of the people they are supposed to help. There is a stigma attached to prescription drug taking because of the abusers. So those that physically suffer never speak up. Keep up the good work! I know your heart is always in the right place! 🙂

**hearing about more and more kids being sucked into the void…praying for them all…maybe volunteering to help less fortunate would help them count the blessings they are missing? ♥

**i heard part of your interview this morning (and had read that you were going to have teen drug abuse be the topic) and it was of course very good… i felt terrible for that man as it must be the worst to have your kid have troubles like that… alcoholism runs deep all over both sides of my family (the Irish stereo type is true) for addiction… but another piece of it is that a good chunk of folks with addiction problems also are bi-polar and/or have some other hard-to-manage emotional/depression disorder… i know that one day they’re going to find the addiction gene and right next to it will be the depression and executive dysfunction genes and they all are somehow linked…

**I have read that ADD drugs are some sort of trigger, although of course, it could be the underlying condition that is the trigger. These articles had some fantastic statistics about what percentage of the kids in trouble had taken those drugs as children. They thought it had something to do with the fact that these kids were ‘trained’ to look for chemical solutions to their problems dealing with their lives, so when they become overwhelmed (and I sure as heck remember that adolescent angst as being quite overwhelming at times!) they reach for pills. It starts innocently – Mom takes these pills, they came from a doctor. They can’t be all bad.

**Not for air play but fyi for you, Good topic, it is not just the young ones affected though, it is every age. I know someone who runs sober homes. Recently I reported a Doctor to the medical board and Drug task force, he was prescribing Vicadin (and who knows what else) out of his house for non related pain to a (in recovery) addict and alcoholic who was relapsing. A friend of mine just got divorced because her husband became addicted to Oxy and Herion. My daughter’s age group eat pills like candy and they get them from their parents -which is why i spend so much time keeping an eye on my kids (though they are grown teens now)

**Yes, it is truly unbelievable. One of our doctors was in Newsday a few weeks ago for selling Rx to undercover cops, and he had been recommended to us by friends at BNL who worked with him on brain/addiction studies at the lab. He was VERY respected and accomplished.

**Great show today! Thanks for providing a discussion forum for a tough subject. My friend is a drug counselor and I’ve been horrified about the things she’s shared with me lately especially in regard to the steep escalation in drug abuse that begins with pain killers like oxy that quickly lead to heroin. And the worst part is that the system for helping these people sorta sucks oh and the fact that doctors give out scripts for these like they’re candy.

**also fyi – if you do not have info — suboxyn (not sure of spelling) is being prescribed to get people off Oxy – it is working for some , but has addictive properties too

**Wow you just never know – my question is what the hell is wrong with these doctors ???

**thank you for addressing a matter of dire importance., one of tremendous relevance for not only those having personal issues with substance but also for the lives of their families & friends who suffer consequently as well.

Where to get help?

**naranon & alanon for families

**Check out this page: http://www.facebook.com/pages/LICADD/172982061958
LICADD
LICADD is aggressively helping families find effective addiction treatment and remains Long Island’s only non-profit agency conducting planned family interventions. LICADD provides expert evaluation and early intervention services to individuals, children and families impacted by substance abuse, and spearheads evidence-based prevention education programs in schools. Our Open Arms EAP covers 60,000 employees on Long Island and along the Eastern Seaboard. For immediate assistance, call us at 516-747-2606.

**For those on the SBU Campus, call 632-6450 for alcohol and drug counseling.

**Overslept & missed your show, but wanted you to know that the Health Concerns Committee of the Reference & Adult Services Division of Suffolk County Library Association chooses a topic of concentration each year. For 2011 it was Substance Abuse and the bibliography they published includes all kinds of resources including Agencies and Associations, Crisis and treatment centers, websites, forums, etc. Put together by librarians means these sites have been vetted and validated. Copies should be available at every library in Suffolk County.

Here is the link:  http://scla.net/rasd-main/resources/bibliographies/2011/2011-substance-abuse.pdf

**Your last point was- what does someone do who feels they maybe on the addiction wheel? – Go to a NA( person) or Nar Anon(family) meeting. You won’t be asked to speak, you can watch and listen, maybe something will jive and you can always ask questions. Both organizations can be found on the web and they post meeting locations. Helping others is part of the recovery process of those that have sought help before.

Why patients AND providers should care about insurance appeals

My guest in August 2011 was Thomas Force, Esq. of the Patriot Group.  Habanero Tom Force Interview August 2011We discussed the importance of appealing medical claims from both the patient and the provider perspective.  It runs 36 minutes.