Specialty Focus 5/30/23: Denials of health insurance claims are rising + SIDS linked to brain abnormality

May 30, 2023 | Volume XII | Issue 22

SIDS linked to brain abnormality

Fox News reports:

About 3,400 babies die of sudden infant death syndrome (SIDS) each year in the U.S., according to the Centers for Disease Control and Prevention (CDC).

Now, a new study led by researchers at Boston Children’s Hospital and Harvard Medical School suggests that some of the unexplained deaths may be caused by an abnormality in the medulla, which connects the brain stem and the spinal cord.

The study was published in the Journal of Neuropathology & Experimental Neurology on May 25.

"We found abnormalities in a particular receptor (the serotonin receptor 2A/C) in the medulla oblongata, part of the lower brain stem that regulates autonomic and respiratory function, in a subset of SIDS infants," lead author Dr. Robin Haynes, PhD, who is a principal associate at Harvard Medical School, told Fox News Digital via email.

When a baby isn’t getting enough oxygen, the serotonin receptor 2A/C triggers the baby’s natural instinct to gasp for air, the doctor explained.

Denials of Health Insurance Claims Are Rising — And Getting Weirder

Elisabeth Rosenthal | KFF Health News

Millions of Americans in the past few years have run into this experience: filing a health care insurance claim that once might have been paid immediately but instead is just as quickly denied. If the experience and the insurer’s explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without reviewing the patient’s medical chart. A job title at one company was “denial nurse.”

It’s a handy way for insurers to keep revenue high — and just the sort of thing that provisions of the Affordable Care Act were meant to prevent. Because the law prohibited insurers from deploying previously profit-protecting measures such as refusing to cover patients with preexisting conditions, the authors worried that insurers would compensate by increasing the number of denials.

And so, the law tasked the Department of Health and Human Services with monitoring denials both by health plans on the Obamacare marketplace and those offered through employers and insurers. It hasn’t fulfilled that assignment. Thus, denials have become another predictable, miserable part of the patient experience, with countless Americans unjustly being forced to pay out-of-pocket or, faced with that prospect, forgoing needed medical help.

Learn More

Is AI the solution for the shortage of nephrologists? ChatGPT weighs in.

Amol Shrikhande, MD writes in a KevinMD post:

As I’m sure you know, nephrology is the branch of internal medicine that deals with the kidneys. And in the U.S., young doctors are quite unlikely to choose this path.

Why? The combination of long hours, chronic illness, and (relatively) unimpressive pay has proven deadly to the field. In fact, around 30 percent of training (fellowship) positions go unfilled each year.

To stay afloat, the nephrology community has turned to foreign doctors desperate to meet visa requirements and advanced practice providers...

Chemo drug shortage leaves doctors making hard choices

There is an alarming shortage of dozens of chemotherapy drugs in the U.S. right now and a North Texas cancer patient is speaking out in hopes of getting the attention of lawmakers.

"Two and a half months ago I felt a lump," said cancer patient Melissa LaRoach.

LaRoach was diagnosed with triple negative breast cancer, the most aggressive form.

"A week after diagnosis I was in the chemo chair, life changed in blink of an eye," she said.

At a recent appointment, her nurse noticed that her chemo dosage for Carboplatin had been rounded down.

Watch the video HERE.

Last Word

Publisher of Week in Review, Specialty Focus, FHIweekly & Game Changers