We're Back! Lunch and Learn with OHA

This month's Lunch and Learn is scheduled for noon on February 22nd. It's your chance to enhance your knowledge of healthcare in just 30 minutes from start to finish including time for your questions.  Here's a link for the Zoom presentation and Follow us on Facebook.

February 22nd: The High Costs of Going Out of Network - Consumers are often unaware that seeing an out-of-network provider can be significantly more expensive than seeing a provider who participates in their health plan, and that the consumer may have fewer consumer protections. OHA will walk through how those costs and the lack of protections can add up for a consumer.

March 22nd:  Opioids - They are addictive and abused far too often. The Connecticut Department of Public Health reported 1,378 deaths in 2020, a 14.6% increase in opioid overdose deaths. Our nurse practitioners will explore this subject and provide an overview of the drug overdose epidemic and discussion about Connecticut’s response and prevention strategies. Save the Date: March 22nd.

Legislative Update
The 2022 session of the CT General Assembly began on Wednesday, February 9, 2022, and legislators immediately highlighted children’s mental and behavioral health issues as a focus of their attention. Some of the initial proposals submitted by the House and the Senate include:

SB 1 – proposing an increase in funding for school-based health clinics, school social workers and after school programs
SB 2 – proposing an increase in funding for preschool mental and behavioral health services
HB 5004 – proposing an increase in funding for mobile behavioral health crisis interventions for school students

OHA will continue to monitor these and other legislative proposals throughout the session.  In addition, OHA will be supporting initiatives that align with its consumer-focused priorities, which include slowing the growth of healthcare costs, as well as reducing the complexity and administrative burdens of health insurance.

Black History Month Focuses
on Health and Wellness
It's an annual recognition every February, where the U.S. celebrates the contributions and sacrifices of African Americans who have helped shape the nation. This year's theme, Black Health and Wellness, pays homage to medical scholars and health care providers. The theme is especially timely as we enter the third year of the COVID-19 pandemic which has disproportionately affected minority communities. The 2022 theme considers activities, rituals and initiatives that Black communities have done to be well.

The recognition this year is not just on those scholars and those who have practiced Western medicine but also on the others, birthworkers, doulas, midwives, naturopaths, herbalists, etc. It's given rise to community health clinics and public health professions; and a host of well known and respected historically black institutions like  Meharry Medical College, Howard University College of Medicine, Provident Hospital and Training School, Morehouse School of Medicine.

In a sobering twist, the pandemic has also placed unique burdens on Black health care professionals. In this month celebrating Black history, there is still work to be done. 

Heart Month
February is American Heart Month, a time when all people can focus on their cardiovascular health. A key focus on hypertension (high blood pressure), a leading risk factor for heart disease and stroke.

High blood pressure usually develops over time. It can happen because of unhealthy lifestyle choices, such as not getting enough regular physical activity. Certain health conditions, such as diabetes and obesity, can also increase the risk for developing high blood pressure. Normal blood pressure is 120 over 80 although it fluctuates through the day. The higher your blood pressure levels, the more risk you have for other health problems, such as heart disease, heart attack, and stroke.

OHA: We're in YOUR Corner

OHA Helps Cancer Claim
A consumer who is undergoing extensive cancer treatment reached out to OHA for help when her treatments began to be denied by her health plan. The reason for the denial was not clear to her, and she spent months trying to figure it out but was never able to understand why this happened. OHA investigated and found that the denials were due to an administrative oversight at the health plan. The carrier had failed to estimate the correct rate of reimbursement for the plan. Once OHA brought the problem to the attention of the carrier, the insurance plains were reprocessed correctly, and the treatments were fully covered - saving the consumer tens of thousands of dollars.

Caring for Your Heart
Consumer is a 69-year-old male with symptoms of irregular heart rate, headaches, and progressive dyspnea (shortness of breath). The cardiologist recommended a 30-day heart monitor to record episodes of irregular heart rhythm. The health plan denied the test as not medically necessary. The member was billed for the test and contacted our office for assistance. Our office appealed to the external review for the denial of the test and overturned the health plan decision.
Savings: $2,750.00

OHA Fights for Dental Health Claim in Full!
Consumer contacted OHA regarding the denial of coverage for outpatient surgical hospitalization for their special needs child, who needed dental services in a hospital setting. The plan was denying coverage for the hospital services stating dental benefits were not a covered benefit under the plan. Consumer had completed the first level appeal prior to contacting OHA. OHA completed the second and final appeal level which was upheld. OHA resubmitted the appeal again despite having no remaining appeal rights and requested the plan re-review the claim, while explaining the plan had incorrectly processed the request under the dental benefit and not the medical benefit as requested. The plan paid the claim in full, with no member responsibility as the deductible had been met. 
Savings: $22,054.23