A cartoon of a woman nurse working at a desk with health insurance rejections.

Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions

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When KFF Health News published an article in August about the “prior authorization hell” Sally Nix said she went through to secure approval from her insurance company for the expensive monthly infusions she needs, we thought her story had a happy ending.

That’s because, after KFF Health News sent questions to Nix’s insurance company, Blue Cross Blue Shield of Illinois, it retroactively approved $36,000 worth of treatments she thought she owed. Even better, she also learned she would qualify for the infusions moving forward.

Good news all around — except it didn’t last for long. After all, this is the U.S. health care system, where even patients with good insurance aren’t guaranteed affordable care.

To recap: For more than a decade, Nix, of Statesville, North Carolina, has suffered from autoimmune diseases, chronic pain, and fatigue, as well as a condition called trigeminal neuralgia, which is marked by bouts of electric shock-like pain that’s so intense it’s commonly known as the “suicide disease.”

“It is a pain that sends me to my knees,” Nix said in October. “My entire family’s life is controlled by the betrayal of my body. We haven’t lived normally in 10 years.”

Late in 2022, Nix started receiving intravenous immunoglobulin infusions to treat her diseases. She started walking two miles a day with her service dog. She could picture herself celebrating, free from pain, at her daughter’s summer 2024 wedding.

“I was so hopeful,” she said.

But a few months after starting those infusions, she found out that her insurance company wouldn’t cover their cost anymore. That’s when she started “raising Cain about it” on Instagram and Facebook.

You probably know someone like Sally Nix — someone with a chronic or life-threatening illness whose doctor says they need a drug, procedure, or scan, and whose insurance company has replied: No.

Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients.

However, critics worry that prior authorization has now become a way for health insurance companies to save money, sometimes at the expense of patients’ lives. KFF Health News has heard from hundreds of people in the past year relating their prior authorization horror stories.

When we first met Nix, she was battling her insurance company to regain authorization for her infusions. She’d been forced to pause her treatments, unable to afford $13,000 out-of-pocket for each infusion.

Finally, it seemed like months of her hard work had paid off. In July, Nix was told by staff at both her doctor’s office and her hospital that Blue Cross Blue Shield of Illinois would allow her to restart treatment. Her balance was marked “paid” and disappeared from the insurer’s online portal.

But the day after the KFF Health News story was published, Nix said, she learned the message had changed. After restarting treatment, she received a letter from the insurer saying her diagnoses didn’t actually qualify her for the infusions. It felt like health insurance whiplash.

“They’re robbing me of my life,” she said. “They’re robbing me of so much, all because of profit.”

Dave Van de Walle, a spokesperson for Blue Cross Blue Shield of Illinois, said the company would not discuss individual patients’ cases.

“Prior authorization is often a requirement for certain treatments,” Van de Walle said in a written statement, “and BCBSIL administers benefits according to medical policy and the employer’s benefit.”

But Nix is a Southern woman of the “Steel Magnolia” variety. In other words, she’s not going down without a fight.

In September, she called out her insurance company’s tactics in a http://change.org/ campaign that has garnered more than 21,000 signatures. She has also filed complaints against her insurance company with the U.S. Department of Health and Human Services, U.S. Department of Labor, Illinois Department of Insurance, and Illinois attorney general.

Even so, Nix said, she feels defeated.

Not only is she still waiting for prior authorization to restart her immunoglobulin infusions, but her insurance company recently required Nix to secure preapproval for another treatment — routine numbing injections she has received for nearly 10 years to treat the nerve pain caused by trigeminal neuralgia.

“It is reprehensible what they’re doing. But they’re not only doing it to me,” said Nix, who is now reluctantly taking prescription opioids to ease her pain. “They’re doing it to other patients. And it’s got to stop.”

Do you have an experience with prior authorization you’d like to share? Click here to tell your story.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • Breathe; Don’t Vent (At Least In The Moment)

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    Zen And The Art Of Breaking Things

    We’ve talked before about identifying emotions and the importance of being able to express them:

    Answering The Most Difficult Question: How Are You?

    However, there can be a difference between “expressing how we feel” and “being possessed by how we feel and bulldozing everything in our path”

    …which is, of course, primarily a problem in the case of anger—and by extension, emotions that are often contemporaneous with anger, such as jealousy, shame, fear, etc.

    How much feeling is too much?

    While this is in large part a subjective matter, clinically speaking the key question is generally: is it adversely affecting daily life to the point of being a problem?

    For example, if you have to spend half an hour every day actively managing a certain emotion, that’s probably indicative of something unusual, but “unusual” is not inherently bad. If you’re managing it safely and in a way that doesn’t negatively affect the rest of your life, then that is generally considered fine, unless you feel otherwise about it.

    A good example of this is complicated grief and/or prolonged grief.

    But what about when it comes to anger? How much is ok?

    When it comes to those around you, any amount of anger can seem like too much. Anger often makes us short-tempered even with people who are not the object of our anger, and it rarely brings out the best in us.

    We can express our feelings in non-aggressive ways, for example:

    When You “Can’t Complain”

    and

    Seriously Useful Communication Skills!

    Sometimes, there’s another way though…

    Breathe; don’t vent

    That’s a great headline, but we can’t take the credit for it, because it came from:

    Breathe, don’t vent: turning down the heat is key to managing anger

    …in which it was found that, by all available metrics, the popular wisdom of “getting it off your chest” doesn’t necessarily stand up to scrutiny, at least in the short term:

    ❝The work was inspired in part by the rising popularity of rage rooms that promote smashing things (such as glass, plates and electronics) to work through angry feelings.

    I wanted to debunk the whole theory of expressing anger as a way of coping with it,” she said. “We wanted to show that reducing arousal, and actually the physiological aspect of it, is really important.❞

    ~ Dr. Brad Bushman

    And indeed, he and his team did find that various arousal-increasing activities (such as hitting a punchbag, breaking things, doing vigorous exercise) did not help as much as arousal-decreasing activities, such as mindfulness-based relaxation techniques.

    If you’d like to read the full paper, then so would we, but we couldn’t get full access to this one yet. However, the abstract includes representative statistics, so that’s worth a once-over:

    A meta-analytic review of anger management activities that increase or decrease arousal: What fuels or douses rage?

    Caveat!

    Did you notice the small gap between their results and their conclusion?

    In a lab or similar short-term observational setting, their recommendation is clearly correct.

    However, if the source of your anger is something chronic and persistent, it could well be that calming down without addressing the actual cause is just “kicking the can down the road”, and will still have to actually be dealt with eventually.

    So, while “here be science”, it’s not a mandate for necessarily suffering in silence. It’s more about being mindful about how we go about tackling our anger.

    As for a primer on mindfulness, feel free to check out:

    No-Frills, Evidence-Based Mindfulness

    Take care!

    Share This Post

  • Sweet Dreams Are Made Of Cheese (Or Are They?)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝In order to lose a little weight I have cut out cheese from my diet – and am finding that I am sleeping better. Would be interested in your views on cheese and sleep, and whether some types of cheese are worse for sleep than others. I don’t want to give up cheese entirely!❞

    In principle, there’s nothing in cheese that, biochemically, should impair sleep. If anything, its tryptophan content could aid good sleep.

    Tryptophan is found in many foods, including cheese, which (of common foods, anyway), for example cheddar cheese ranks second only to pumpkin seeds in tryptophan content.

    Tryptophan can be converted by the body into 5-HTP, which you’ve maybe seen sold as a supplement. Its full name is 5-hydroxytryptophan.

    5-HTP can, in turn, be used to make melatonin and/or serotonin. Which of those you will get more of, depends on what your body is being cued to do by ambient light/darkness, and other environmental cues.

    If you are having cheese and then checking your phone, for instance, or otherwise hanging out where there are white/blue lights, then your body may dutifully convert the tryptophan into serotonin (calm wakefulness) instead of melatonin (drowsiness and sleep).

    In short: the cheese will (in terms of this biochemical pathway, anyway) augment some sleep-inducing or wakefulness-inducing cues, depending on which are available.

    You may be wondering: what about casein?

    Casein is oft-touted as producing deep sleep, or disturbed sleep, or vivid dreams, or bad dreams. There’s no science to back any of this up, though the following research review is fascinating:

    Dreams of the Rarebit Fiend: food and diet as instigators of bizarre and disturbing dreams

    (it largely supports the null hypothesis of “not a causal factor” but does look at the many more likely alternative explanations, ranging from associated actually casual factors (such as alcohol and caffeine) and placebo/nocebo effect)

    Finally, simple digestive issues may be the real thing at hand:

    Association between digestive symptoms and sleep disturbance: a cross-sectional community-based study

    Worth noting that around two thirds of all people, including those who regularly enjoy dairy products, have some degree of lactose intolerance:

    Lactose Intolerance in Adults: Biological Mechanism and Dietary Management

    So, in terms of what cheese may be better/worse for you in this context, you might try experimenting with lactose-free cheese, which will help you identify whether that was the issue!

    Share This Post

  • Life Is in the Transitions – by Bruce Feiler

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    Change happens. Sometimes, because we choose it. More often, we don’t get a choice.

    Our bodies change; with time, with illness, with accident or incident, or even, sometimes, with effort. People in our lives change; they come, they go, they get sick, they die. Our working lives change; we get a job, we lose a job, we change jobs, our jobs change, we retire.

    Whether we’re undergoing cancer treatment or a religious conversion, whether our families are growing or down to the last few standing, change is inescapable.

    Our author makes the case that on average, we each undergo at least 5 major “lifequakes”; changes that shake our lives to the core. Sometimes one will come along when we’ve barely got back on our feet from the previous—if we have at all.

    What, then, to do about this? We can’t stop change from occurring, and some changes aren’t easy to “roll with”. Feiler isn’t prescriptive about this, but rather, descriptive:

    By looking at the stories of hundreds of people he interviewed for this book, he looks at how people pivoted on the spot (or picked up the pieces!) and made the best of their situation—or didn’t.

    Bottom line: zooming out like this, looking at many people’s lives, can remind us that while we don’t get to choose what winds we get swept by, we at least get to choose how we set the sails. The examples of others, as this book gives, can help us make better decisions.

    Click here to check out Life Is In The Transitions, and get conscious about how you handle yours!

    Share This Post

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  • When should you get the updated COVID-19 vaccine?
  • Yes, we still need chickenpox vaccines

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    For people who grew up before a vaccine was available, chickenpox is largely remembered as an unpleasant experience that almost every child suffered through. The highly contagious disease tore through communities, leaving behind more than a few lasting scars. 

    For many children, chickenpox was much more than a week or two of itchy discomfort. It was a serious and sometimes life-threatening infection.

    Prior to the chickenpox vaccine’s introduction in 1995, 90 percent of children got chickenpox. Those children grew into adults with an increased risk of developing shingles, a disease caused by the same virus—varicella-zoster—as chickenpox, which lies dormant in the body for decades. 

    The vaccine changed all that, nearly wiping out chickenpox in the U.S. in under three decades. The vaccine has been so successful that some people falsely believe the disease no longer exists and that vaccination is unnecessary. This couldn’t be further from the truth. 

    Vaccination spares children and adults from the misery of chickenpox and the serious short- and long-term risks associated with the disease. The CDC estimates that 93 percent of children in the U.S. are fully vaccinated against chickenpox. However, outbreaks can still occur among unvaccinated and under-vaccinated populations. 

    Here are some of the many reasons why we still need chickenpox vaccines.

    Chickenpox is more serious than you may remember

    For most children, chickenpox lasts around a week. Symptoms vary in severity but typically include a rash of small, itchy blisters that scab over, fever, fatigue, and headache. 

    However, in one out of every 4,000 chickenpox cases, the virus infects the brain, causing swelling. If the varicella-zoster virus makes it to the part of the brain that controls balance and muscle movements, it can cause a temporary loss of muscle control in the limbs that can last for months. Chickenpox can also cause other serious complications, including skin, lung, and blood infections. 

    Prior to the U.S.’ approval of the vaccine in 1995, children accounted for most of the country’s chickenpox cases, with over 10,000 U.S. children hospitalized with chickenpox each year. 

    The chickenpox vaccine is very effective and safe

    Chickenpox is an extremely contagious disease. People without immunity have a 90 percent chance of contracting the virus if exposed. 

    Fortunately, the chickenpox vaccine provides lifetime protection and is around 90 percent effective against infection and nearly 100 percent effective against severe illness. It also reduces the risk of developing shingles later in life. 

    In addition to being incredibly effective, the chickenpox vaccine is very safe, and serious side effects are extremely rare. Some people may experience mild side effects after vaccination, such as pain at the injection site and a low fever.

    Although infection provides immunity against future chickenpox infections, letting children catch chickenpox to build up immunity is never worth the risk, especially when a safe vaccine is available. The purpose of vaccination is to gain immunity without serious risk. 

    The chickenpox vaccine is one of the greatest vaccine success stories in history

    It’s difficult to overstate the impact of the chickenpox vaccine. Within five years of the U.S. beginning universal vaccination against chickenpox, the disease had declined by over 80 percent in some regions. 

    Nearly 30 years after the introduction of the chickenpox vaccine, the disease is almost completely wiped out. Cases and hospitalizations have plummeted by 97 percent, and chickenpox deaths among people under 20 are essentially nonexistent

    Thanks to the vaccine, in less than a generation, a disease that once swept through schools and affected nearly every child has been nearly eliminated. And, unlike vaccines introduced in the early 20th century, no one can argue that improved hygiene, sanitation, and health helped reduce chickenpox cases beginning in the 1990s.

    Having chickenpox as a child puts you at risk of shingles later

    Although most people recover from chickenpox within a week or two, the virus that causes the disease, varicella-zoster, remains dormant in the body. This latent virus can reactivate years after the original infection as shingles, a tingling or burning rash that can cause severe pain and nerve damage.  

    One in 10 people who have chickenpox will develop shingles later in life. The risk increases as people get older as well as for those with weakened immune systems. 

    Getting chickenpox as an adult can be deadly

    Although chickenpox is generally considered a childhood disease, it can affect unvaccinated people of any age. In fact, adult chickenpox is far deadlier than pediatric cases. 

    Serious complications like pneumonia and brain swelling are more common in adults than in children with chickenpox. One in 400 adults who get chickenpox develops pneumonia, and one to two out of 1,000 develop brain swelling.

    Vaccines have virtually eliminated chickenpox, but outbreaks still happen

    Although the chickenpox vaccine has dramatically reduced the impact of a once widespread disease, declining immunity could lead to future outbreaks. A Centers for Disease Control and Prevention analysis found that chickenpox vaccination rates dropped in half of U.S. states in the 2022-2023 school year compared to the previous year. And more than a dozen states have immunization rates below 90 percent.

    In 2024, New York City and Florida had chickenpox outbreaks that primarily affected unvaccinated and under-vaccinated children. With declining public confidence in routine vaccines and rising school vaccine exemption rates, these types of outbreaks will likely become more common.

    The CDC recommends that children receive two chickenpox vaccine doses before age 6. Older children and adults who are unvaccinated and have never had chickenpox should also receive two doses of the vaccine.

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • 10 Oft-Ignored Symptoms Of Diabetes

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    Due in part to its prevalence and manageability, diabetes is often viewed as more of an inconvenience than an existential threat. While very few people in countries with decent healthcare die of diabetes directly (such as by diabetic ketoacidosis, which is very unpleasant, and happens disproportionately in the US where insulin is sold with a 500%–3000% markup in price compared to other countries), many more die of complications arising from comorbidities, and as for what comorbidities come with diabetes, well, it increases your risk for almost everything.

    So, while for most people diabetes is by no means a death sentence, it is something that means you’ll now have to watch out for pretty much everything else too. On which note, Dr. Siobhan Deshauer is here with things to be aware of:

    More than your waistline

    Some of these are early symptoms (even appearing in the prediabetic stage, so can be considered an early warning for diabetes), some are later risks (it’s unlikely you’ll lose your feet from diabetic neuropathy complications before noticing that you are diabetic), but all and any of them are good reason to speak with your doctor sooner rather than later:

    1. Polyuria: waking up multiple times at night to urinate due to excess glucose spilling into the urine.
    2. Increased thirst: dehydration from frequent urination leads to excessive thirst, creating a cycle.
    3. Acanthosis nigricans: dark, velvety patches on areas like the neck, armpits, or groin, signalling insulin resistance.
    4. Skin tags: multiple skin tags in areas of friction may indicate insulin resistance.
    5. Recurrent Infections: high blood sugar weakens the immune system, making skin infections, UTIs, and yeast infections more common.
    6. Diabetic stiff hand syndrome: stiffness in hands, limited movement, or a “positive prayer sign” caused by sugar binding to skin and tendon proteins.
    7. Frozen shoulder and trigger finger: pain and limited movement in the shoulder or fingers, with a snapping sensation when moving inflamed tendons.
    8. Neuropathy: numbness, tingling, or pain in hands and feet due to nerve and blood vessel damage, often leading to foot deformities like Charcot foot.
    9. Diabetic foot infections: poor sensation, weakened immune response, and slow healing can result in severe infections and potential amputations.
    10. Gastroparesis: damage to stomach nerves causes delayed digestion, leading to bloating, nausea, and erratic blood sugar levels.

    For more on all of these, plus some visuals of the things like what exactly is a “positive prayer sign”, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Cost of Insulin by Country 2024 ← after the US, the next most expensive country is Chile, at around 1/5 of the price; the cheapest listed is Turkey, at around 1/33 of the price.

    Take care!

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  • Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable

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    People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have extra protection following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.

    The new standards cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.

    The move is part of sweeping reforms of the cosmetic surgery industry and the regulation of medical practitioners, including who is allowed to call themselves a surgeon.

    It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a highly unregulated area of medicine.

    Why do people want cosmetic surgery?

    Australians spent an estimated A$473 million on cosmetic surgery procedures in 2023.

    The major reason people want cosmetic surgery relates to concerns about their body image. Comments from their partners, friends or family about their appearance is another reason.

    The way cosmetic surgery is portrayed on social media is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised.

    The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is even more necessary.

    People don’t always get the results they expect

    Most people are satisfied with their surgical outcomes and feel better about the body part that was previously concerning them.

    However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a positive evaluation may be needed to justify these experiences.

    People who are likely to be unhappy with their results are those with unrealistic expectations for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.

    What’s changing?

    According to the new standards, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.

    For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy.

    It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards.

    It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.

    What about the mental health assessment?

    The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”.

    According to the guidelines from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.

    While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions.

    So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have.

    Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.

    Of course, there are not enough mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution.

    Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns.

    In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.

    If you’re considering cosmetic surgery

    The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these four steps if you’re considering cosmetic surgery:

    1. have an independent physical and mental health assessment before you commit to cosmetic surgery

    2. make an informed decision knowing the risks

    3. choose your practitioner, knowing their training and qualifications

    4. discuss your care after your operation and where you can go for support.

    My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.The Conversation

    Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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