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Companies that help insurance companies deny pre-authorization claims –

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Medicare, Melissa D. Hall


KFF survey found that roughly 6 in 10 insured adults have experienced problems while using their insurance. Issues include denied claims, network adequacy, pre-authorization delays and denials. As the investigation shows, this is just not a surprise. A hidden industry makes money by denying doctors’ payment requests, called prior authorizations.

According to a ProPublica investigation, one in every of the important thing participants on this scheme is Evernorth’s EviCore. A ProPublica investigation found that EviCore is owned by the big insurance company Cigna. The largest U.S. insurance companies employ EviCore and supply protection to 100 million consumers.

EviCore apparently uses a synthetic intelligence-supported algorithm that insurance industry insiders call “the shield.” The algorithm system will be customized, which ultimately results in more pre-authorization claim rejections.

What’s even weirder is that EviCore reportedly has some contracts that allow it to make more cash the more it cuts health care spending by insurance companies.

EviCore is just not alone. Another big player is Carelon Medical Benefits Management, a subsidiary of Elevance Health, formerly Anthem. Although the corporate has been accused in court of unlawfully denying legitimate insurance applications, it denies all allegations.

How companies respond

EviCore claims that the approval process ensures that the procedures are protected, obligatory and price-effective.

“We are improving the quality and safety of healthcare, and – by a happy coincidence – we are significantly reducing unnecessary costs,” said an EviCore doctor in the course of the company’s series of webinars.

But based on the investigation, EviCore’s approach is way more sinister than it suggests. EviCore reportedly guarantees a 3-to-1 return on investment, which implies your insurer can pay $3 less for medical care and other costs.

For some perspective, in 2021 in Arkansas, EviCore denied prior authorization requests almost 20% of the time. Medicare Advantage plans denied prior authorization requests about 7% of the time in 2022, based on a ProPublica evaluation of knowledge.

A Cigna spokesperson said on behalf of EviCore: “Simply put, EviCore uses the latest evidence-based medicine to ensure patients get the care they need and avoid services they don’t need.”

The spokesperson added that the corporate uses algorithms in some clinical programs “only to expedite the approval of appropriate care and reduce administrative burdens on healthcare providers.”


This article was originally published on : www.blackenterprise.com
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Health and Wellness

Phenergan for children under 6 years of age is currently banned due to fear of hallucinations. Here’s what you can use instead

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The Australian Drugs Regulatory Authority has issued an order safety warning over Phenergan and related products containing the antihistamine promethazine.

The Therapeutic Goods Administration has stated that over-the-counter products mustn’t be given to children under six years of age due to concerns about serious unwanted effects similar to hyperactivity, aggression and hallucinations. Breathing may additionally change into slow or shallow, which can be fatal.

When high doses are administered to young children, difficulties in learning and understanding, including reversible cognitive deficit and mental disability, may additionally occur. – said the TGA.

The latest warning follows international and Australian concerns concerning the drug in young children, which is commonly used to treat conditions similar to hay fever and allergies, motion sickness and for short-term sedative effects.

What is promethazine?

Promethazine is a “first generation” antihistamine that has been sold over-the-counter in Australian pharmacies for a long time for a spread of conditions.

Unlike many other drugs, first-generation antihistamines can cross the blood-brain barrier. This means they affect your brain chemistry, making you feel drowsy and sedated.

In adults, this will likely be useful for sleep. However, in children, these drugs can cause serious unwanted effects on the nervous system, including those mentioned on this week’s safety alert.

We’ve known about this for a while

We have known concerning the serious unwanted effects of promethazine in young children for a while.

Advice regarding 20 years ago In the United States, the drug was not beneficial for use in children under two years of age. In 2022, an Australian Medicines Advisory Committee made its own suggestion to increase the age to six. New Zealand released similar warnings and advice in May this yr.

Over the last ten years, 235 cases of serious unwanted effects from promethazine have been reported in each children and adults reported to the TGA. Of the 77 deaths reported, one was a toddler under six years of age.

Reported unwanted effects in each adults and children included:

  • 13 cases of accidental overdose (leading to 11 deaths)
  • eight cases of hallucinations
  • seven cases of slow or shallow respiration (leading to 4 deaths)
  • six cases of decreased consciousness (leading to five deaths).

TGA security alert comes after an internal investigation by the manufacturer of Phenergan, Sanofi-Aventis Healthcare. This investigation was initiated in 2022 advice from the Medicines Advisory Committee. The company has now updated its information for consumers and healthcare professionals.

What can you use instead?

If you have allergies or hay fever in young children, non-sedating antihistamines similar to Claratine (loratadine) or Zyrtec (cetirizine) are preferred. They provide relief without the chance of sedation and other disturbing unwanted effects of promethazine.

If symptoms of a chilly or cough occur, parents must be reassured that these symptoms will normally subside with time, fluid intake, and rest.

Saline nasal sprays, adequate hydration, a humidifier or elevating the kid’s head can relieve the congestion related to hay fever. Oral products containing phenylephrine marketed for nasal congestion must be avoided because evidence shows that this is the case This article was originally published on : theconversation.com

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Health and Wellness

7 things you can do if you think you’re sweating too much

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Sweating is a way for the body to chill down, a bit like an internal air conditioner.

When your body temperature rises (since it’s hot outside or you exercise), sweat glands throughout your skin secrete a watery fluid. When the liquid evaporates, it takes heat with it, protecting us from overheating.

But sweating can vary from individual to individual. Some people could get a bit of dew under their arms, others may feel like they may fill a swimming pool (perhaps not as dramatically, but you get the thought).

So what’s a traditional amount of sweat? And what’s too much?

Why do some people sweat greater than others?

How much you sweat depends upon many aspects aspects including:

The average person sweats at a rate of approx 300 milliliters per hour (at a temperature of 30°C and humidity of roughly 40%). However, because you can’t measure the quantity of your individual sweat (or weigh it), doctors use a unique measure to evaluate the impact of sweating.

They ask if sweating interferes with on a regular basis life. Maybe you stop wearing certain clothes due to sweat stains or you feel embarrassed, so you don’t go to social events or work.

If so, it’s a so-called disease state excessive sweatingwhat affects tens of millions of individuals everywhere in the world.

As you might expect, people affected by this condition most frequently report problematic underarm sweating. However, sweaty hands, feet, scalp and groin might also be an issue.

Excessive sweating could also be a symptom of one other disease, e.g hyperthyroidism, fever or menopause.

But excessive sweating cannot have an obvious cause, and the causes of this so-called primary hyperhidrosis are somewhat mysterious. People have a traditional variety of sweat glands, but scientists consider they simply produce excessive amounts of sweat when exposed to triggers reminiscent of stress, heat, exercise, tobacco, alcohol and spicy spices. There might also be a genetic link.

Okay, I’m sweating loads. What can I do?

1. Antiperspirants

Antiperspirants, especially those with aluminumThey are the primary line of defense and have been designed to scale back sweating. Deodorants only stop unpleasant body odor.

Aluminum chloride, hexahydrate, aluminum chloride or weaker tetrachlorohydrex aluminum and zirconium glycinate they react with sweat gland proteins to form a plug. This plug temporarily blocks the sweat ducts, limiting the quantity of sweat reaching the skin’s surface.

These products may contain as much as 25% aluminum. The higher the proportion, the higher these products work, however the more they irritate the skin.

Make sure you buy antiperspirant, not deodorant.
Okrasiuka/Shutterstock

2. Beat the warmth

This could seem obvious, but staying calm can make an enormous difference. This is because you have less heat to lose, which causes your body to provide less sweat.

Avoid highly regarded and long showers (you’ll have more heat to lose), wear loose clothing fabricated from breathable fabrics reminiscent of cotton (this can help sweat evaporate more easily), and carry a small hand-held fan to assist your sweat evaporate.

When exercising, try it ice bandanas (ice wrapped in a shawl or cloth after which applied to the body) or wet towels. They can be worn across the neck, head or wrists to lower body temperature.

Also try to switch when or where you exercise; If possible, try to seek out cool shade or air-conditioned places.

If your sweating remains to be affecting your life after taking the primary two steps, consult with your doctor. They will help you find the most effective strategy to cope with this problem.

3. Medicines

Some medicines may help regulate sweating. Unfortunately, a few of them can also cause uncomfortable side effects reminiscent of dry mouth, blurred vision, abdominal pain or constipation. So consult with your doctor about what’s best for you.

Your GP might also refer you to a dermatologist – a health care provider like me who makes a speciality of skin conditions – who can recommend a wide range of treatments, including among the following.

4. Botulinum toxin injections

Botulinum toxin injections usually are not used solely for cosmetic reasons. They have many applications in medicine, including: they block the nerves that control the sweat glands. They do this for months.

The dermatologist normally gives injections. But they’re only subsidized by Medical care in Australia under the arms and if you suffer from primary hyperhidrosis that can not be controlled with the strongest antiperspirants. These injections are given as much as thrice a yr. It just isn’t subsidized within the case of other diseases, e.g. hyperthyroidism or other areas, e.g. face or hands.

If you don’t qualify, you can get these shots privately, but it would cost you a whole bunch of dollars for treatment that can last as long as six months.

A healthcare worker giving a man a Botox injection under his arm
In some cases, injections can be found under Medicare.
Satyrenko/Shutterstock

5. Iontophoresis

This involves using a tool that passes a weak electric current through water to the skin decreased sweating in your hands, feet or armpits. Scientists aren’t sure how exactly it really works.

But it’s the one way to manage sweating within the hands and feet, which doesn’t require drugs, surgery or botulinum toxin injections.

This treatment just isn’t subsidized by Medicare and never all dermatologists provide it. However, you can buy your individual device and use it, which is frequently cheaper than using it privately. You can ask your dermatologist if that is the proper option for you.

6. Surgery

There is a procedure where the nerves within the hands are cut, which prevents them from sweating. This is very effective however it may cause sweating somewhere else.

There are also other surgical options that you can talk to your doctor.

7. Microwave therapy

This is newer treatment which stimulates the sweat glands to destroy them in order that they can now not work. This just isn’t quite common yet and is kind of painful. It is out there privately in several centers.

This article was originally published on : theconversation.com
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Health and Wellness

After being laid off, I decided to start Slow Living

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My corporate job made me redundant in February 2024.

When I received that email and lost access to my important source of income, it shook me to my core. And while I missed the soundness of a full-time job, I didn’t miss the late nights, chaotic deadlines, and private exhaustion that had grow to be normal for me. I subscribe to a robust, independent black woman narrative that places ambition above all else. Something should have modified.

Finding resources to maintain self-care is usually a challenge after we lead busy lives. According to the State of Self-Care for Black Women report developed by EXHALE founder and CEO Katara McCarty and published in 2023, 77% of Black women imagine there’s a necessity for more well-being tools and resources tailored to them needs. While being laid off got here as a whole shock, I knew that the routine I was trying to maintain was affecting my mental health. I had to work, but I also needed rest.

“We must start by decolonizing our minds. We have been colonized with the belief that “the harder I work, the more I get.” However, increasingly Black women are realizing that life is more fulfilling while you truly live it on your personal terms. When conditions are gentler, filled with freedom and rest, you might be almost more productive by approaching life from that place,” McCarty shared.

Getting more rest as I considered every part became a priority. So as a substitute of immediately on the lookout for one other 9-5 job, I wanted to prioritize things I couldn’t do before. Even though I thought this transition was nearly me, it wasn’t.

The viral trend of “slow living” has grow to be a well-liked topic in recent times. From the results of the pandemic to people selecting to live more consciously just because those that select to live “slower” prioritize self-care, recent passions, or tapping into their creative sides somewhat than running on the company hamster wheel. Slow living can include quite a lot of things, reminiscent of adding yoga to your morning routine, not answering your phone after 7 p.m., postponing a task in your to-do list until the subsequent day and replacing it with guilt. Slow living is not only about, literally, moving slower; it’s about living more freely and fewer according to the expectations set by others.

“We are a society that likes to be on the move, go, go. And when you get laid off or are thinking about a career change, it’s a season of reflection. The most common misconception about slow living is that something is wrong” – trauma therapist Jaquinta Jackson, ed. LPC told me in conversation. “On social media it looks as if everyone seems to be doing something. So while you’re not moving, you’ll be able to internalize it and think, “I’m not doing enough or I’m lazy.” But the fact is that we must accept that we’re stationary.

As a reformed “busy bee,” staying still was uncomfortable at first. So I can attest that when I compared myself to others, I felt like I wasn’t doing enough. But after some time, I leaned into the silence to reflect and embrace the solitude. In the start, I focused on applying to as many positions as possible. Every day I committed to repeatedly sending out my resume, rewriting my cover letter, and sending multiple emails to my network about potential opportunities. But the energy put into the job search was as exhausting as my previous job. So I decided to use less and create a routine that may help me get used to every day somewhat than “overcome” it. I incorporated journaling, devotional reading, and morning exercises. In the afternoon, I focused more on writing and gaining inspiration, gaining knowledge on topics that might strengthen my skills, and ended the evening with a gathering with friends or family. While every day could also be different, this relaxed routine makes room for other areas of my life.

Fortunately, not having a busy schedule has improved my mental health. Less stress from meetings and work stimulated the will to write full-time and pursue other passions. Taylor Tucker, who went from senior technology consultant to screenwriter, says slow living has helped her gain more confidence in her many talents.

“The biggest lesson I’ve learned from slow living is that I am who I think I am,” Tucker says. “Even though everything is slower, I know that the results of my work and passion will still come. My work has been verified. Previously, I worked in a corporation, and now I write. No one actually told me, “Oh, I like this.” But now I’m starting to hear it. And I thought, wow, I’ve wanted to do this all along. And now I know that with extra time, I do it.”

This article was originally published on : www.essence.com
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