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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Seed Saving Secrets – by Alice Mirren
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We all know that home-grown is best, and yet many of us are not exactly farmers (this reviewer tries with mixed results—hardy crops survive; others, not so much). While it’s easy to blame the acidic soil, the harsh climate, or not having enough time and money (this reviewer blames all of the above), the fact remains that a skilled gardener can produce a good crop in any conditions.
That’s where this book helps; right from the beginning, from the seeds. Have you ever bought a pack of seeds, excitedly sown them, and then had a germination rate of zero or something close to that (this reviewer has)?
Alice Mirren takes us on a tour of how to save seeds from plants you know are regionally viable (not the product of some vast globalized industry that doesn’t know you live in an ancient bog with a cold south-east wind blowing in from Siberia), and then how to care for and curate them, how to store them for future years, how to keep a self-perpetuating seed bank.
She goes beyond that, though. Regular 10almonds readers might remember about the supercentenarian “Blue Zones”, and how big factors in healthy longevity include community and purpose; Mirren advocates for organizing community seed banks, which will also mean that everyone (including you) has access to much more diverse seeds, and when it comes to the perils of natural selection, diversity means survival. Otherwise, if you have just one seed type, a single blight can wipe out everything pretty much overnight.
Bottom line: if you grow your own food or would like to, this is a “bible of…” level book that you absolutely should have to hand.
Click here to check out Seed Saving Secrets, and see the results in your kitchen and on your plate!
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Yes, you still need to use sunscreen, despite what you’ve heard on TikTok
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Summer is nearly here. But rather than getting out the sunscreen, some TikTokers are urging followers to chuck it out and go sunscreen-free.
They claim it’s healthier to forgo sunscreen to get the full benefits of sunshine.
Here’s the science really says.
Karolina Grabowska/Pexels How does sunscreen work?
Because of Australia’s extreme UV environment, most people with pale to olive skin or other risk factors for skin cancer need to protect themselves. Applying sunscreen is a key method of protecting areas not easily covered by clothes.
Sunscreen works by absorbing or scattering UV rays before they can enter your skin and damage DNA or supportive structures such as collagen.
When UV particles hit DNA, the excess energy can damage our DNA. This damage can be repaired, but if the cell divides before the mistake is fixed, it causes a mutation that can lead to skin cancers.
The energy from a particle of UV (a photon) causes DNA strands to break apart and reconnect incorrectly. This causes a bump in the DNA strand that makes it difficult to copy accurately and can introduce mutations. NASA/David Herring The most common skin cancers are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Melanoma is less common, but is the most likely to spread around the body; this process is called metastasis.
Two in three Australians will have at least one skin cancer in their lifetime, and they make up 80% of all cancers in Australia.
Around 99% of skin cancers in Australia are caused by excessive exposure to UV radiation.
Excessive exposure to UV radiation also affects the appearance of your skin. UVA rays are able to penetrate deep into the skin, where they break down supportive structures such as elastin and collagen.
This causes signs of premature ageing, such as deep wrinkling, brown or white blotches, and broken capillaries.
Sunscreen can help prevent skin cancers
Used consistently, sunscreen reduces your risk of skin cancer and slows skin ageing.
In a Queensland study, participants either used sunscreen daily for almost five years, or continued their usual use.
At the end of five years, the daily-use group had reduced their risk of squamous cell carcinoma by 40% compared to the other group.
Ten years later, the daily use group had reduced their risk of invasive melanoma by 73%
Does sunscreen block the health-promoting properties of sunlight?
The answer is a bit more complicated, and involves personalised risk versus benefit trade-offs.
First, the good news: there are many health benefits of spending time in the sun that don’t rely on exposure to UV radiation and aren’t affected by sunscreen use.
Sunscreen only filters UV rays, not all light. Ron Lach/Pexels Sunscreen only filters UV rays, not visible light or infrared light (which we feel as heat). And importantly, some of the benefits of sunlight are obtained via the eyes.
Visible light improves mood and regulates circadian rhythm (which influences your sleep-wake cycle), and probably reduces myopia (short-sightedness) in children.
Infrared light is being investigated as a treatment for several skin, neurological, psychiatric and autoimmune disorders.
So what is the benefit of exposing skin to UV radiation?
Exposing the skin to the sun produces vitamin D, which is critical for healthy bones and muscles.
Vitamin D deficiency is surprisingly common among Australians, peaking in Victoria at 49% in winter and being lowest in Queensland at 6% in summer.
Luckily, people who are careful about sun protection can avoid vitamin D deficiency by taking a supplement.
Exposing the skin to UV radiation might have benefits independent of vitamin D production, but these are not proven. It might reduce the risk of autoimmune diseases such as multiple sclerosis or cause release of a chemical that could reduce blood pressure. However, there is not enough detail about these benefits to know whether sunscreen would be a problem.
What does this mean for you?
There are some benefits of exposing the skin to UV radiation that might be blunted by sunscreen. Whether it’s worth foregoing those benefits to avoid skin cancer depends on how susceptible you are to skin cancer.
If you have pale skin or other factors that increase you risk of skin cancer, you should aim to apply sunscreen daily on all days when the UV index is forecast to reach 3.
If you have darker skin that rarely or never burns, you can go without daily sunscreen – although you will still need protection during extended times outdoors.
For now, the balance of evidence suggests it’s better for people who are susceptible to skin cancer to continue with sun protection practices, with vitamin D supplementation if needed.
Katie Lee, PhD Candidate, Dermatology Research Centre, The University of Queensland and Rachel Neale, Principal research fellow, QIMR Berghofer Medical Research Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Language Fluency Beats General Intelligence & Memory For Longevity
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And no, it doesn’t have to be a second language, although that helps a lot:
An Underrated Tool Against Alzheimer’s ← you don’t even have to learn the second language to a high level, to benefit
Rather, what we’re talking about today is your first language fluency. So, for most of our readers, English. For the study participants it was German, because this was a German research team using data from the German population.
The Berlin Aging Study
Previous research has linked intelligence to longevity, but intelligence comprises multiple traits. So, what’s most important? Memory? General intelligence? Nope. Language fluency!
Let’s clarify something before we continue: “fluency” does not, in linguistics, mean what most people use it to mean. It’s not about the size of one’s overall knowledge of the language (e.g. vocabulary size), but rather, it is about one’s ability to speak and/or write fluently—literally, fluently means “flowingly”, i.e. without undue hesitation or difficulty.
The study used data from the Berlin Aging Study, which tracked 516 people aged 70–105 from 1989 onwards.
Researchers assessed four cognitive abilities, with two kinds of tests for each of:
- Verbal fluency (detailed description below)
- Perceptual speed (pattern-recognition speed)
- Verbal knowledge (vocabulary size)
- Episodic memory (personal memory recall)
General intelligence, meanwhile, was assessed as “the average of those 8 scores”.
The two tests for the cognitive ability of “verbal fluency” were:
Categories
Participants had to name as many different animals as possible within 90 seconds. Their answers were subsequently rated for correctness by two independent research assistants, to assure that noticed or unnoticed repetitions, wrong categories, and morphological variants were not coded as correct.
Word beginnings
Participants were asked to name as many different real words starting with the letter s as possible within 90 seconds. The named words were rated for correctness by two independent research assistants to avoid considering repetitions, morphological variants, and wrong words as correct.
You can read about these and the other tests for the other cognitive abilities, in the paper itself:
Verbal Fluency Selectively Predicts Survival in Old and Very Old Age ← if you’re looking for the test descriptions, scroll to “Method” and then scroll past the table, and you’ll see the test descriptions
They found that of all these metrics, only the two verbal fluency tests (and none of the other tests) showed a significant link to longevity.
Why this is important
Although the study does not prove causality (it could be that people who are predisposed to live longer for other reasons are more verbally fluent because of some common factor that influences both language fluency and longevity), it seems as good a reason as any to develop and maintain language fluency.
This builds on what was found in “The Nun Study“, that followed a convent of nuns (because they are a very homogenous sample in terms of occupation, location, diet, routine, etc, so a lot of confounding factors were already controlled-for) and made numerous major discoveries about things that impact aging (including the relevance of the APOE4 gene! That was The Nun Study).
When it came to nuns and language…
Based on the autobiographies written by the nuns in their youth upon taking their vows, there were two factors that were later correlated with not getting dementia:
- Longer sentences
- Positive outlook
- “Idea density”
That latter item means the relative linguistic density of ideas and complexity thereof, and the fluency and vivacity with which they were expressed (this was not a wishy-washy assessment; there was a hard-science analysis to determine numbers).
Want to spruce up yours? You might like to check out:
Reading, Better: Reading As A Cognitive Exercise
…for specific, evidence-based ways to tweak your reading to fight cognitive decline.
Take care!
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7 Minutes, 30 Days, Honest Review: How Does The 7-Minute Workout Stack Up?
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For those who don’t like exercising, “the 7-minute workout” (developed by exercise scientists Chris Jordan and Bret Klika) has a lot of allure. After all, it’s just 7 minutes and then you’re done! But how well does it stand up, outside of the lab?
Down-to-Earth
Business Insider’s Kelly Reilly is not a health guru, and here he reviews the workout for us, so that we can get a real view of what it’s really like in the real world. What does he want us to know?
- It’s basically an optimized kind of circuit training, and can be done with no equipment aside from a floor, a wall, and a chair
- It’s one exercise for 30 seconds, then 10 seconds rest, then onto the next exercise
- He found it a lot easier to find the motivation to do this, than go to the gym. After all “it’s just 7 minutes” is less offputting than getting in the car, driving someplace, using public facilities, driving back, etc. Instead, it’s just him in the comfort of his home
- The exercise did make him sweat and felt like a “real” workout in that regard
- He didn’t like missing out on training his biceps, though, since there are no pulling movements
- He lost a little weight over the course of the month, though that wasn’t his main goal (and indeed, he was not eating healthily)
- He did feel better each day after working out, and at the end of the month, he enjoyed feeling self-confident in a tux that now fitted him better than it did before
For more details, his own words, and down-to-earth visuals of what this looked like for him, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Further reading
Want to know more? Check out…
- How To Do HIIT (Without Wrecking Your Body)
- HIIT, But Make It HIRT ← this is about high-intensity resistance training!
Take care!
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Red Lentils vs Oats – Which is Healthier?
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Our Verdict
When comparing red lentils to oats, we picked the oats.
Why?
In terms of macros, oats have more protein, carbs, fiber, and even a little fat—mostly healthy mono- and polyunsaturated fats, thus making them the more nutritionally dense. That said, red lentils have the lower glycemic index, (low GI compared to oats’ medium GI) which offsets that, so we’ll call this category a tie.
In the category of vitamins, red lentils have more of vitamins B6, B9, and choline, while oats have more of vitamins B1, B2, and B5. Another tie!
When it comes to minerals, however, we have a tiebreaker category: red lentils have more selenium, while oats have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An easy win for oats this time!
So, thanks to the minerals, oats are the clear winner in total. But by all means, enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
The Best Kind Of Fiber For Overall Health? ← it’s β-glucan, the kind find in oats!
Enjoy!
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Can We Do Fat Redistribution?
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The famous answer: no
The truthful answer: yes, and we are doing it all the time whether we want to or not, so we might as well know what things affect our fat distribution in various body parts.
There’s a kernel of truth in the “no”, though, and where that comes from is that we cannot exclusively put fat on in a certain area only, and nor can we do “spot reduction”, i.e., intentionally lose fat from only one place.
How, then, do we do fat redistribution?
Your body is a living organism, not a statue
It’s easy to think “I’ve been carrying this fat in this place for 20 years”, but during that time the fat has been replaced several times and moved often; in fact, the cells containing the fat have even been replaced. Because: fat can seem like a substance that’s alien to your body because it doesn’t respond like muscles, isn’t controllable like muscles, doesn’t have the same sensibility as muscles, etc. But, every bit of fat stored in your body is stored inside a fat cell; it’s not one big unit of fat; it’s lots of tiny ones.
In reality, any given bit of fat on your body has probably been there for 18–24 months at most:
Fat turnover in obese slower than average
…and there are assorted factors that can modify the rate at which our body deals with fat storage:
Human white adipose tissue: A highly dynamic metabolic organ
So, how do I get rid of this tummy?
There are plenty of stories of people who try to lose weight from one part of their body, and lose it from somewhere else instead. Say, a person wants to lose weight from her hips, and with careful diet and exercise, she loses weight—by dropping a couple of bra cup sizes while keeping the hips.
So, we must figure out: why is fat stored in certain places? And the main driving factors are:
- hormones
- metabolic health
- stress
Hormones affect fat distribution insofar as estrogen and progesterone will favor the hips, thighs, butt, breasts, and testosterone will favor a more central (but still subcutaneous, not visceral) distribution. Additionally, estrogen and progesterone will favor a higher body fat percentage, while testosterone will favor a lower one.
This is particularly relevant later in life, when suddenly the hormone(s) you’ve been relying on to keep your shape, are now declining, meaning your shape does too. This goes for everyone regardless of sex.
See:
- What You Should Have Been Told About The Menopause Beforehand
- The BAT-pause! ← this is about the conversion of white adipose tissue to brown adipose tissue, and how estrogen helps this happen
- Topping Up Testosterone?
Metabolic health affects fat distribution insofar as poor metabolic health will result in more fat being stored in the viscera, rather than in the usual subcutaneous places. This is a serious health risk.
See: Visceral Belly Fat & How To Lose It
Stress affects fat distribution insofar as chronically elevated cortisol levels see more fat sent to the stomach, face, and neck. This fat redistribution isn’t dangerous itself, but it can be indicative of the chronic stress, which does pose more of a general threat to health.
See: Lower Your Cortisol! (Here’s Why & How)
What this means in practical terms
Assuming that you would like the fat distribution that says “this is a healthy woman” or “this is a healthy man”, respectively, then you might want to:
- Check your sex hormone levels and get them adjusted if appropriate
- Improve your overall metabolic health—without necessarily trying to lose weight, just, take care of your blood sugars for example, and they will take care of you in terms of fat storage.
- Manage your stress (which includes any stress you are experiencing about your body not being how you’d like it to be).
If you are doing these things, and you don’t have any major untreated medical abnormalities that affect these things, then your fat will go to the places generally considered healthiest.
Can we speed it up?
Yes, we can! Firstly, we can speed up our overall metabolism:
Let’s Burn! Metabolic Tweaks And Hacks
Secondly, we can encourage our body to “move” fat by intentionally “yo-yoing”, something usually considered bad in dieting when people just want to lose weight and instead are going up and down, but: if you lose weight healthily, it comes off everywhere evenly, and if you gain weight healthily, it goes mostly to the places where it should be.
So, a sequence of lose-gain-lose-gain might look like “lose a bit from everywhere, put it back in the good place, lose a bit more from everywhere, put it back in the good place”, etc.
So, you might want to gently cycle these a few months apart, for example:
How To Lose Fat (Healthily!) | How To Gain Fat (Healthily!)
You can also cheat a little, if it suits your purpose! By this we mean: if you’d like a little extra where you already have a little fat, then you can put muscle on underneath it, it will pad it up, and (because of the layer of actual fat on top) nobody will know the difference unless you flex it with their hand on it.
Let’s put it this way: people doing squats for a bubble-butt aren’t doing it to put on fat; they’re putting muscle on under the fat they have.
So, check out: How To Gain Muscle (Healthily!)
And finally, for all your body-sculpting needs, we present these excellent books:
Women’s Strength Training Anatomy Workouts – by Frédéric Delavier
Strength Training Anatomy (For Men) – by Frédéric Delavier
Enjoy!
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