#designed to make it easier for drug and insurance companies to bill people

[thriftdyke]

feel like some people need to understand that just bc a word is used as part of a diagnostic label / criteria in the dsm doesn’t mean it doesn’t have like. meaning outside of that

[star-anise]

An ask I got recently:

hi so i’m a transmed and i’m not sure if you’ll answer this because of that but i saw your post about transmedicalism and was wondering if you could expand on that? you seem like a genuinely kind and judgement-free person, thank you darling x

My response:

Heh, you call me “judgement-free” and ask for my opinion on a topic I’ve formed a lot of judgments about… I get it though, I’m not into attacking people for what they believe so much as providing FACTS. As a cis queer, my insight into transmedicalism isn’t really about the innate experience of trans-ness so much as using my education and professional experience to talk about social science research, diagnostic systems, and public health policy.

This ended up really long, so the tl;dr is, I think transmedicalism as I understand it:

Misunderstands why and how the DSM’s Gender Dysphoria diagnosis was written,

Treats the medical establishment with a level of trust and credibility it doesn’t deserve, at a time when LGBT+ people, especially trans people, need to be informed and vigilant critics of it, and

Approaches the problem of limited resources in an ass-backwards way that I think will end up hurting the trans community in the long run.

TW: Transphobia; homophobia; suicide; institutionalization; torture; electroshock therapy; child abuse; incidental mentions of pedophilia.

So first off I’m guessing you mean this post, about not trusting the medical establishment to tell you who you are? That’s what I’m trying to elaborate on here.

I have to admit, when you say “I’m a transmedicalist” that tells me very little about you, because on Tumblr the term seems to encompass a dizzying array of perspectives. Some transmedicalists believe in what seems to me the oldschool version of “The only TRUE trans people suffer agonizing dysphoria that can only be fixed with surgery and hormones, everyone else is an evil pretender stealing resources and can FUCK RIGHT OFF” and others are like, um… “I have total love and respect for nonbinary and nondysphoric trans people! I qualify for a DSM diagnosis of dysphoria but that doesn’t make me inherently better or more trans than anyone else.”

Which is very confusing to me because according to everything I’ve learned, the latter opinion is not transmedicalism. It’s just… a view of transness that acknowledges current diagnostic labels and scientific research. It’s what most people who support trans rights and do not identify as transmedicalists believe. But I kind of get the impression that Tumblr transmedicalism has expanded well past its original mandate, to the point that if a lot of “transmedicalists” saw the movement’s original positions they’d go “Whoa that’s way too strict and doesn’t help our community, I want nothing to do with it.”.

Okay so. Elaborating on the stuff I can comment on.

1. DSM what?

The American Psychiatric Association publishes a big thick book called The Diagnostic and Statistical Manual of Mental Disorders, called the DSM for short. This is the “Bible of psychiatry”, North America’s definitive listing of mental disorders and conditions. It receives significant revision and updates roughly every 10-15 years; it was last updated in 2013, meaning it will likely get updated sometime between 2023 and 2028.

The DSM lists hundreds of “codes”, each of which indicates a specific kind of mental disorder. For example, 296.23 is “Major depressive disorder, Single episode, Severe,” and  300.02 is “Generalized anxiety disorder.” These codes have information on how common the condition is, how it’s diagnosed, and what kind of treatment is appropriate for it.

Diagnostic codes are the key to health professionals getting paid. If there isn’t a code for it, we can’t get paid for it, and therefore we have very few resources to treat it with. The people who actually pay for healthcare–usually insurance companies or government agencies–decide how much they will pay for each code item to be treated. They’ll pay for, say, three sessions of group therapy for mild depression (296.21), or they’ll pay for more expensive private therapy if it’s moderate (296.22); they’ll pay for the cheap kind of drug if you have severe depression (296.23), but to get the more expensive drug, you need to have depression with psychotic features (296.24).

Healthcare companies, especially in the USA where the system is very very broken and the DSM is written, are cheap bastards. If they can find an excuse not to fund some treatment, they’ll use it. “We think this person who lost their job and can’t get off the couch should pay this $1000 bill for therapy,” they’ll say. “After all, they were diagnosed as code 296.21, and then saw a private therapist for five sessions, when we only allow three sessions of group therapy, and you’re saying they haven’t had enough treatment yet?”

A lot of the advocacy work mental health professionals do is trying to get the big funding bodies to pay us adequately for the work we do. (This is a much easier process in countries with single-payer healthcare, where this negotiation only needs to be done with a single entity. In the USA, it needs to be done with every single health insurance company in existence, as well as the government, sometimes differently in every single state, and then again on a case-by-case basis as well.) Healthcare providers have to argue that three sessions of group therapy isn’t enough, that Medicaid needs to pay therapists more per hour than it costs those therapists to rent a room to practice in, or else therapists would lose money by seeing Medicaid clients. DSM codes exist a tiny bit to let us communicate with each other about the people we treat, and a huge amount to let us get paid. The fact that their existence lets people make sense of their own experiences and find a community with people who share common experiences and interests with them is a very minor side benefit the DSM’s authors really don’t keep in mind when they update and revise different diagnoses.

So when it comes to convincing insurance companies to pay for treatment, humanitarian reasons like “they’ll be very unhappy without it” tend not to work. The best argument we have for them paying for psychological treatment is that it’s economical: that if they don’t pay for it now, they’ll have to pay even more later. If they refuse to pay, let’s say, $2000 to treat mild depression when someone loses their job, and either refuse treatment or stick the person with the bill, then that person’s life might spiral out of control–they might, let’s say, run low on money, get evicted from their apartment, develop severe depression, attempt suicide, and end up in hospital needing to be medically resuscitated and then put in an inpatient psych ward for a month. The insurance company then faces the prospect of having to pay, let’s say, $100,000 for all that treatment. At which point somebody clever goes, “Huh, so it would have been cheaper to just… pay the original $2000 instead so they could bounce back, get a new job, and not need any of this treatment later.”

Trans healthcare can be kind of expensive, since it often involves counselling, years of hormone therapy, medical garments, and multiple surgeries. Health insurance companies hate paying for anything, and have traditionally wanted not to cover any of this. “This is ridiculous!” they said. “These are elective cosmetic treatments, it’s not like they’re dying of cancer, these people can pay the same rate for breast enhancements or testosterone injections as anyone else.”

So when the APA Task Force on Gender Identity Disorder (a task force comprised, as far as I can tell, entirely of cis people) sat down to plan for the 2013 update of the DSM, one of their biggest goals was: Treatment recommendations. Create a diagnosis which they could effectively use to advocate that insurance companies fund gender transition. Like when you go back and read the documents from their meetings in 2008 and 2011, their big thing is “create a diagnosis that can be used to form treatment recommendations.” So that’s what they did; in 2013 they made the GD diagnosis, and in 2014 the Affordable Care Act required insurers to provide treatment for it.

A lot of trans people weren’t happy with the DSM task force’s decisions, such as the choice to keep “Transvestic Fetishism,” which is basically the autogynephilia theory, and just rename it “Transvestic Disorder”. The creation of the Gender Dysphoria diagnosis, basically, was designed to force the preventive care argument. They didn’t think they could win on trans healthcare being a necessity because healthcare is a human right, so they went with: Trans people have a very high suicide rate, and one way to bring it down is to help them transition. One of the major predictors of suicidality is dysphoria. The more dysphoric someone is, the more likely they are to attempt suicide (source).  Therefore, health insurers should fund treatment for gender dysphoria because it was cheaper than paying for emergency room admissions and inpatient psychiatric hospitalizations.

I have spoken to trans scientists about what research exists, and my understanding is: The dysphoria/no dysphoria split is not actually validated in the science. That is, when you research trans people, there is not some huge gaping difference between the experiences, or brains, of people With Dysphoria, and people Without Dysphoria. Mostly, scientists haven’t even thought it was an important distinction to study. The diagnosis wasn’t reflecting a strong theme in the research about trans experiences; that research showed that trans people with all levels of dysphoria were helped with medical transition. The biggest difference is just that dysphoria is a stronger risk factor for suicide. Experiencing transphobia is another strong risk factor, but that’s harder to measure in a doctor’s office, so dysphoria it was.

(I’ve seen some transmedicalists claim that dysphoria’s major feature is incongruence, not distress. And I’ll just say, uh… in psychology, “dysphoria” is the opposite of of “euphoria”, literally means “excessive pain”, and is used in many disorders to describe a deep-seated sense of distress and wrongness. As a mental health professional, I just can’t imagine most of my colleagues agreeing that something can be called “dysphoria” if the person doesn’t feel real distress about it. If you want a diagnosis that doesn’t demand dysphoria, you’d need Gender Incongruence in the upcoming version of the ICD-11, which is the primary diagnostic system used in Europe, published by the World Health Organization.)

2. Doctors are not magic

Medicine is a science, and science is a system of knowledge based on having an idea, testing it against reality, and revising that knowledge in light of what you learned. We’re learning and growing all the time.

I don’t know if this sounds painfully obvious or totally groundbreaking, but: Basically all medical research is done by people who don’t have the condition they’re writing about. Psychology has a strong historical bias against believing the personal testimonies of people with conditions that have been deemed mental disorders, so researchers who have experienced the disorder they’re writing about have often had to hide that fact, like Kay Redfield Jamison hiding that she had bipolar disorder until she became a world-renowned expert on it, or Marsha Linehan hiding that she had borderline personality disorder until she pioneered the treatment that could effectively cure it. Often, having a condition was seen as proof you couldn’t actually have a truthful and objective experience of it.

So what I’m trying to say is: The “gender dysphoria” diagnosis was written and debated, so far as I can tell, by entirely cis committee members. The vast majority of psychological and psychiatric research about LGBT+ people is written by cisgender heterosexual scientists. Most clinical and scientific writing has been outsider scientists looking at people they have enormous power over and making decisions about their basic existence with very little accountability.

And to show you how far we’ve come, I want to show you part of the DSM as it was from 1952 to 1973. It shows you just why so many older LGBT+ people find it deeply ironic that now the DSM is being held up as definitive of trans experience:

302 Sexual Deviation This category is for individuals whose sexual interests are directed primarily toward objects other than people of the opposite sex, toward sexual acts not usually associated with coitus, or towards coitus performed under bizarre circumstances as in necrophilia, pedophilia, sexual sadism, and fetishism. Even though many find their practices distasteful, they remain unable to substitute normal sexual behavior for them. This diagnosis is not appropriate for individuals who perform deviant sexual acts because normal sexual objects are not available to them.

302.0 Homosexuality 302.1 Fetishism 302.2 Pedophilia 302.2 Transvestitism […]

Yes, really. That is how psychiatry viewed us. At a time when research from other fields, like psychology and sociology, were showing that this view was completely unsupported by evidence, psychiatry thought LGBT+ people were fundamentally disordered, criminal, and incapable of prosocial behaviour.

My favourite retelling of the decades of activism it took LGBT+ people and allies to get the DSM to change is from a friend who did her master’s thesis on the topic, because she leaves in the clown suits and gay bars, which really shows how scientific and dignified the process was. The long story short is:  It took over 20 years of lobbying by LGBT+ people who were sick and tired of being locked up in mental institutions and subjected to treatments like electroshock training, as well as by LGBT+ social scientists, clinicians, and psychiatrists, to get homosexuality declassified as a mental illness. And that was homosexuality; the push to change how trans people were listed in the DSM is very recent, as seen in the latest version listing “Transvestic Disorder”, a description very few trans people ever use for themselves.

Here are a few more examples of how people with a condition have had to take an active part in the science about them:

When HIV/AIDS appeared in the USA, the government didn’t care why drug addicts and gay people were dying mysteriously. Hospitals refused to treat people with this mysterious new disease. AIDS patients had to fight to get any funding put into what AIDS is, how it spreads, or how it could be treated; they also had to campaign to change the massive public prejudice against them, so they could be treated, housed, and allowed to live. Here’s an article on the activist tactics they used. If you want an intro to the fight (or at least, white peoples’ experience of it), you could look into the movies How to Survive a Plague, And the Band Played On, and The Normal Heart.

Chronic Fatigue Syndrome (CFS) is a little-understood disease that causes debilitating exhaustion. It’s found twice as often in women as men. Doctors understand very little about what it is or why it happens, and patients with CFS are often written off a lazy hypochondriacs who just don’t want to try hard. There are basically no known treatments. In 2011, a British study said that an effective treatment for CFS was “graded exercise”, a program where people did slowly increasing levels of physical activity. This flew in the face of what people with CFS knew to be true: That their disease caused them to get much worse after they exercised. That for them, being forced to do ever-increasing exercise was basically tantamount to torture, so it was very concerning that health authorities and insurance companies began requiring that they undergo graded exercise treatment (and parents with children with CFS had to put their children through this treatment, or lose custody for “medical neglect”). So they investigated the study, found that it was seriously flawed, got many health authorities to reverse their position on graded exercise, and have made strides into pointing researchers to looking into biological causes of their illness.

Amyotrophic lateral sclerosis (ALS) is a rare but debilitating disease that isn’t researched much, because it affects such a small portion of the population. The ALS community realized that if they wanted better treatment, they would need to raise the money for research themselves. In 2014 they organized a viral “ice bucket challenge” to get people to donate to their cause, and raised $115 million, enough to make significant advances in understanding ALS and getting closer to a cure.

A common treatment for Autism is Applied Behaviour Analysis (ABA), which is designed to encourage “desired” behaviours and discourage “undesired” ones. The problem is, the treatment targets behaviour an Autistic person’s parents and teachers consider desirable or undesirable, without consideration that some “undesired” behaviours (like stimming) are fundamental and necessary to the wellbeing of Autistic people. Furthermore, the treatment involves punishing Autistic children for failure to behave as expected–in traditional ABA, by witholding rewards or praise until they stop, or in more extreme cases, by subjecting them to literal electric shocks to punish them. (In that last case, they’ve been ordered to stop using the shock devices by August 31, 2020. That only took YEARS.) Autistic people have had to campaign loud and long to say that different treatment strategies should be researched and used, especially on Autistic children.

So I mean… I get that the medical model can provide an element of validation and social acceptance. It can feel really good to have people in white coats back you up and say you’re the real deal. But if you get in touch with most LGBT+ and transgender groups, they’d say that there’s still a lot of work to be done when it comes to researching trans issues and getting scientific and governmental authorities to recognize your rights to social acceptance and medical treatment.

Within a few years, the definition you’re resting on will turn to sand beneath your feet. The Great DSM Machine will begin whirring into life pretty soon and considering what revisions it has to make. You’ll have an opportunity to make your voice heard and to push for real change. So… do you want to be part of that process of pushing trans rights forward, or do you just want to feel loss because they’re changing your strict definition of who’s valid and who’s not?

3. Scarcity is not a law of physics

One of the major arguments I see transmedicalists push is that there’s only a limited number of surgeries or hormone prescriptions available, so it’s not okay for a non-dysphoric person to “steal” the resources that another trans person might need more. This makes sense in a limited kind of way; it’s a good way to operate if, say, you’re sharing a pizza for lunch and deciding whether to give the last slice to someone who’s hungry and hasn’t eaten, or someone who’s already full.

When you start to back up and look at really big and complex systems–basically anything as big, or bigger, than a school board or a hospital or a municipal government–it’s not a helpful lens anymore. Because the most important thing about social institutions is that they can change. We can make them change. And the most important factor in how much the world changes is how many people demand that it change.

I’ve talked about this before when it comes to homeless shelters, and how the absolute worst thing they can have are empty beds. I used to work in women’s shelters, which came about when second-wave feminists started seriously looking at the problem of domestic violence in the 1960s and 70s, It was an issue male-dominated governments and healthcare systems hadn’t taken seriously before, but feminists started heck and did research and staged demonstrations and basically demanded that organizations that worked for the “public benefit” reduce the number of women being killed by their husbands. Their research showed that the leading cause of death in those cases were when women tried to leave and their partners tried to kill them, so the most obvious solution was to give them someplace safe to go where their partners couldn’t find them. Therefore the solution became: Women’s shelters. When feminists committed to founding and running these shelters, local governments could be talked into giving them money to keep them running.

(Men’s rights activists, the misogynist kind, like to whine about “why aren’t there men’s shelters?” and the very simple answer is: Because you didn’t fight for them, you teatowels. Whether a movement gets resources and funding is hugely a reflection of how many people have said, “This needs resources and funding! Look, I’m writing a cheque! Everyone, throw money at this!” In other news, The BC Society for Male Survivors of Sexual Abuse does great work. People should throw money at them.)

When the system in power knows there are resources it wants and doesn’t have, it finds a way to make them appear. For example, in Canada, the government knows that it doesn’t have enough trained professionals living in its far North, where the population is scarce and not very many people want to live. Doctors and teachers would prefer to live in the southern cities. But because it’s committed to Northern schools and hospitals, they create incentives. For example, the government offers to pay off the student loans of teachers or health professionals who agree to work for a few years in Northern communities.

Part of why trans healthcare resources are so scarce is that for a long time, trans people were considered too small a part of the population to care about. Like, “Trans people exist, but we won’t have to deal with them.” Older estimates said 0.4% of the population was trans, which meant a city of 100,000 people would have 400 trans people. A single family doctor can have 2000 or 3000 clients, so the city could have maybe 1 or 2 doctors who really “got” trans issues, and all the trans people would tell each other to only go see those doctors because all the rest were assholes. And the cracks in the system didn’t really seem serious. A couple hundred dissatisfied people not getting the healthcare they needed? Meh! Hospital administrators had more to worry about!

But the trans population is growing. A recent poll of Generation Z said 2.6% of middle schoolers in Minnesota were some kind of trans. which is 2,600 per 100,000. That’s enough to make hospitals think that maybe the next endocrinologist or OB/GYN they hire should have some training in treating trans people. That’s enough to make a health authority think that maybe the state should open up a new gender confirmation surgery clinic, since demand is rising so much.

Or well, I mean. Hospitals have a lot on their minds. This might not occur to them as their top priority. They’d probably think of it a lot sooner if a bunch of those trans people sent them letters or took out a billboard or showed up by the dozens at a public meeting to say, “Hello, there are a fuckload of us. Budget accordingly. We want to see your projected numbers for the next five years.”

When you’re doing that kind of work, suddenly it hurts your cause to limit your number of concerned parties. Sure, limited focus groups or steering committees can have limited membership, but when you put their ideas into action, to protest something or lobby for political change, you need numbers. If you want to show that you’re a big and important group that systems should definitely pay attention to, you don’t just need every trans or GNC or NB person who’s got free time to devote to your campaign, you also need every cis ally who can pad out numbers or lick envelopes or hand out water bottles or slip you insider information about the agenda at the next board meeting. You need bodies, time, and money, and you get them best by being inclusive about who’s in your party. Heck, if it would benefit your cause to team up with the local breast cancer group because trans women and cis women who have had mastectomies both have an interest in asking a hospital to have a doctor on staff who knows how to put a set of tits together, then there are strong reasons to do it.

Basically: All the time any marginalized group spends fighting over scraps is generally time we could spend demanding that the people handing out the food give us another plate. If you don’t think you’re getting enough, the best answer isn’t to knock it out of somebody’s hands, but to get together to say, “HEY! WE’RE NOT GETTING ENOUGH!”

That kind of work is complicated and difficult! It’s definitely much harder than yelling at someone on Tumblr for not being trans enough. But if you do any level of getting involved with activist groups that fight for real systemic change, whether that’s following your local Pride Centre on Twitter or throwing $5 at a trans advocacy group or writing your elected representative about the need for more trans health resources, you’re pushing forward lasting change that will help everyone.

[amandalukowicz-blog]

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auto mechanical breakdown insurance Limited claim forgiveness Limited window warranty Unpredictable Utilizing home safety tips Wat Pack: Best for: Worn-out customers Best for: The insurance company wants to make sure your property is fully insured. If you live and can be found liable, then you likely want to have a backup plan. But what happens next? With the best policies, the companies that can cover your car are as well, offering all of the lowest rates for your vehicle and the same safety tips for other people.  For those with cars to drive, they still will want to get comprehensive coverage to cover what is not of a greater extent than you or I would get on your vehicle. Whether they have an insurance policy through them or you’ll be using them for some special driving situations, they could give you a decent insurance package, or perhaps they can help you understand how to best protect your car in the event of disaster. So if you don�. auto mechanical breakdown insurance, and, although it’s not required by law (although it doesn’t have to be), it is likely. Car insurance isn’t mandatory, but in certain states, your car could be considered a total loss if you have it. This is why it’s important to obtain a certain amount of comprehensive, collision, supplemental liability coverage if you need it most. The state, however, doesn’t require that you purchase these coverages, because you don’t have to take a medical exam in your state on the insurance. You can check out the for your state If you already own a Dodge Challenger and have insurance on it, you might be able to stop by the dealership and have it transferred to you, but you’ll not be able to drive it. If you’re having a hard time finding parking, consider using your Dodge Sinterke or a Chevrolet Malibu. These cars are cheap to insure because. auto mechanical breakdown insurance Driving under the influence of drugs, driving with a suspended license, etc. Impulsive driving while intoxicated Aggression, drive safely, and never take your car without insurance Low-mileage, high-speed, low-gas mileage, and high-precision tires Regularly updating your insurance quotes Although there are many factors that go into determining how much car insurance premiums you can expect to pay for your vehicle, the biggest determinant of your car insurance premium is the location where you live. This makes buying comprehensive and collision insurance coverage a significant investment. The minimum level amount of insurance coverage that a driver must have is around Rs 50,000. This is the maximum amount an insurance company will pay for any one accident for which they are responsible. A comprehensive insurance policy is considered to be a good policy to be in force, and the maximum amount that they will pay out for such incident is around Rs 500,000 per accident.

What Does Car Repair Insurance Cover?

What Does Car Repair Insurance Cover? Car insurance covers a portion of your damages, usually between $20,000 to $40,000, according to . . You can also buy insurance to cover the replacement parts of your car, a portion of the repair or cost of replacing them. A deductible is the amount of money that you have to be fully covered before your insurance kicks in. This is usually a very low amount and typically doesn t exceed the coverage deductible. It’s the amount you must pay before your insurance benefits are fully taken care of. Car insurance is commonly offered with an annual deductible, so take that as a sign of good faith. Sometimes there are additional discounts available with the insurance, but usually it’s not. How Much Is Car Insurance Coverage for the Car? Generally, drivers at a minimum pay a lower rate than drivers at a higher risk. However, if you’re not looking for cheap auto insurance, a good car insurance policy may be your best bet in case you need.

What about my regular car insurance? Doesn’t it cover repairs?

What about my regular car insurance? Doesn’t it cover repairs? It’s important to know what kind of car insurance you are looking to purchase, and how coverage works to help you get there. There are two big distinctions driving a car through the insurance process. You might be considering getting a policy that will pay medical expenses for you and a friend as well or a policy for a different person’s vehicle. In this case, it’s essential to check with your agent and read your policy before buying a policy. Some car insurance companies offer a sliding, collision, and comprehensive coverage as a cost-saving benefit. For example, Progressive offers both comprehensive, which will pay for damage done to your car, and uninsured, which pays for non-accident-related damage that you are required to pay for. If a driver or owner of a vehicle is excluded from coverage, their insurer will not cover the damage claims. If you’re looking to buy car insurance for someone else or someone else who doesn’t live with you.

How to Choose Mechanical Breakdown Insurance

How to Choose Mechanical Breakdown Insurance for Mobile Drivers: Choose Mobile Check-in/Check-in - If you go in and buy Motor Vehicles, then apply motor breakdown insurance here. You must provide evidence of insurance for the DMV to drive in your place, however, you must provide them proof that your insurance has been renewed on or before the renewal date of the policy. If you don’t have car insurance, you’ll be required to have your vehicle inspected by the state, and you’ll get towed. In California, you can opt for an opt in/out fee. But if you don’t want to pay that fee, then you can buy it out of your car insurance policy. Download Car Drivers in CA: from the or  or visit the online about getting your check in at the DMV. You can also get help on your phone: In most cases, car insurance works the same.

How Does Car Repair Insurance Work?

How Does Car Repair Insurance Work? Carrepair insurance covers problems such as engine wear and tear or oil breakdowns. Car repairs insurance provides insurance coverage for parts such as engine heads, fuel, and engine seals. Car repair insurance will cover similar types of issues as auto insurance covers repair after car crash. Car repair insurance is also offered in Florida, Texas and Alabama. Does car repair insurance cover car damage after a car accident? There are many types of car repair damage outside of car repair insurance. Some of the most common are engine problems (not obvious at first), water damage, sump pump overflow, mold, leak, and other problems. It is most likely that the damage that is covered under car repair insurance will be covered by car repair insurance. To determine the specific type of car repair car repair coverage you need, look into specific that differ from car repair insurance. These types of car repair car repair insurance may include an extensive package of coverage designed to match your exact car, but the coverage limits you obtain could be limited.

Is My Vehicle Eligible For Car Repair Insurance?

Is My Vehicle Eligible For Car Repair Insurance? Your auto insurance carrier may be able to perform the repair procedure under your manufacturer s warranty (or their own option) without you having to file a claim. This is also a good practice if your auto dealership does not charge an hourly rate. My Auto Insurance Plan Doesn t Cover My Own Dealer… All of the vehicles in my auto plan are excluded from their insurance coverage. You are required to get a statement from my dealership verifying your choice of coverage. These statements include: The car s title, registration, or license plate. License. Please contact customer service before purchasing another vehicle. You can use a credit or debit card to do this. If you left the insurance company to get it to the dealership, you can receive a receipt for the car you purchased. Auto loan/lease deal information with multiple companies. Auto lease deal insurance. You can talk to one company, ask about coverages offered, and see if the company offers additional protection. Why.

What Is Mechanical Breakdown Insurance?

What Is Mechanical Breakdown Insurance? What Is Mechanical Breakdown? Why Did They Leave? It is important to understand the difference between these two types of insurance. Mechanical collapse coverage can be purchased by most companies to cover any type of loss or damage to your vehicle. This can be a major expense for a household that is otherwise not insured. Mechanical breakdown insurance can be purchased to cover a range of losses including: Mechanical breakdown insurance will help pay for the repair of your vehicle, replacement of damaged parts and the medical expenses of the household if you or an insured member is involved in an accident that you are involved in. This is a great benefit to the owner and may also include in-built components of your home. This type of insurance is great for the owners and can be added to any of the other types of coverage you may be thinking of buying. For those who cannot afford to carry this kind from a single coverage it should be worth considering if you value any of the above coverages. .

Is mechanical breakdown insurance worth it for me?

Is mechanical breakdown insurance worth it for me? Would you not want to pay for it? “That’s true, but it’s really not an option in any situation.” “So, which insurance company should I go with?…” You know the answer to these questions.  We wanted to make this easier and more thorough, so here we are.  It’s pretty surprising that so many companies charge so much for car insurance.  Some companies may not have so much as a few bucks on the bill if they pay the deductible out of pocket.  Some insurance companies will charge you a small fee upfront in addition to having them pay the deductible before they pay the claim.  That’s a big deal because for the same $500 or $1,000 that you spend a year paying out of pocket, we’re going to pay that out of pocket and we’d be paying it. You know they know that.  They will give you a.

Cost of Mechanical Breakdown Insurance

Cost of Mechanical Breakdown Insurance Average annual rates for Mechanical breakdown insurance can vary greatly, so it s worth comparing prices at the top companies with as much knowledge as you can get. Autocycle theft is the most common car-related event, but even a minor accident can have huge impact on your monthly insurance cost. Insure Your Own Risk The first thing to consider when trying to assess your own policy and insure your own vehicle is if things go bump in the rear. The second thing to consider is adding in your own coverage limits to your policy. This typically leads to cheaper premiums if you choose to purchase higher limits of coverage. Keep in mind that you are also unlikely to be covered for something out of your control in the event of a breakdown. If this is the case, getting extra coverage may actually be more expensive than buying insurance from a smaller or locally-known company. The new auto insurance law could help you stay.

What is mechanical breakdown insurance (MBI)?

What is mechanical breakdown insurance (MBI)? There is much confusion surrounding its meaning. It is an insurance policy that is designed to cover a loss of income in exchange for your paycheck if your car is in the shop during a scheduled mechanic’s visit. MBI is designed to provide coverage in the event that an accident occurs and the car is involved in an accident, although the extent of coverage is not the same when it comes to the insurance policy. In addition, it does not provide the same amount of coverage or protection to people who may be legally responsible for an accident, even if they are not involved in it. This is to prevent people from spending money for the amount of coverage needed for repair and to ensure that any claims that do occur are promptly paid and resolved. While most insurance companies provide car breakdown insurance, the following is a brief overview of the structure of the policy. MBI stands for insurance company with whom you’re affiliated to pay your premiums. It is not an insurance company-owned insurance policy. All.

Who Should Buy Mechanical Breakdown Insurance?

Who Should Buy Mechanical Breakdown Insurance? I agree that it is best to shop around in order to gather the right amount of information, or at least understand the facts on your own. There are several factors that you can control over, some of which many people do not think about. However, what I will lay out here is probably a useful background for many of the people who are unfamiliar with mechanical break down insurance. While I do not intend to suggest that you buy this type of business and use it as an effective business strategy, I will caution you against making this assumption. I would instead recommend that you research the specific type of product you are trying to sell to the people buying the business, as many different requirements can be met. This is much different than buying a car from a dealer for example. That said, the general information here may be that of the general general information about mechanical breakdown insurance, it would be difficult to say which product is best for everyone. It is therefore essential to seek out independent commercial information, where.

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8 Facts You Never Knew About Aarp Medical Insurance | aarp medical insurance

Aarp medical insurance policies and services are available for all types of medical conditions, from routine procedures to advanced care. For individuals who are not insured, a few of the many reasons to consider purchasing medical coverage with Aarp are that they will often have discounts for multiple policies and for people with medical histories similar to yours. Many fall free services and aarp medical insurance policies for those who are not insured may also be a savings to you. In order to see if you are eligible for any of these or other discounts, call or visit your local office.

Aarp medical insurance is typically offered in two different varieties: indemnity and managed care plans. Indemnity plans allow patients to have one doctor and one physician network to deal with while enrolled in a managed care plan allows them to choose from a host of doctors and physicians. In addition to having their doctor network, indemnity plans can also include emergency care and hospital admissions. For those who require care beyond those covered by their health insurance coverage, Aarp can provide supplemental and specialty care to meet those needs. Medications can be bought through the network as well as prescription drug coverage.

While medical costs can vary from person to person, there are some costs that may be more common in both health care settings and are related to health insurance. While the majority of doctors and hospitals offer discount services, it is important to note that a good percentage of these discounts do not apply to services performed outside of the physician's or hospital's network. Because of this, most medical insurance companies will charge more for services outside of their networks. Aarp medical insurance policies and services are designed to provide the best value for money and are designed to provide discounts based on how they work.

Aarp medical plans can help reduce the cost of health care for a variety of people, from those who are uninsured or under insured to those who have health problems or have had their insurance canceled. The fact that the plan can offer more than just medical coverage for those who have coverage and can save people money by providing high quality care and medical treatment at affordable rates should be reason enough for anyone to consider purchasing a plan with AARP.

When you consider the cost of health care, Aarp medical insurance and other options can help you keep more of what you earn, which can help you pay off your bills and provide financial security in the long run. When a person has a job that pays them and health care that they pay for themselves, it makes it much easier to pay out of pocket for basic care or to maintain good health.

To find out what options are available to you, visit your local AARP office or call their toll-free number for a free online quote. Make sure to fill out an application so that they know who you are and what type of coverage you require. Aarp medical plans offer several plans to choose from, including a medical discount plan, but you need to make sure that you are interested in having everything included so that you know what is covered.

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7 Things About Health Insurance Services You'll Kick Yourself for Not Knowing

In the United States there is really no single, publicly funded, health strategy in location. Rather, people purchase health strategies from private insurance coverage business, called personal insurance coverage companies (PMI's).

The primary function of a health insurance is to provide monetary protection to an individual against financial damage caused by health problem, mishap, or injury. This can be through direct financial advantages such as hospitalization expenses and the replacement of earnings that are lost due to loss of employment, however it can also be through indirect advantages such as loss of earnings or impairment due to disease. A a great deal of strategies to offer some level of these advantages in their structure.

Health strategies offer protection from some threats to an individual's monetary well-being. The majority of plans also cover pre-existing conditions as part of a network of services.

Health plans are also typically needed by law to offer coverage for prescription drugs. Rather, it is normally presumed that health strategies will cover all prescriptions.

Another type of advantage offered by health plans is protection of preventive care. Lots of people consider this type of advantage to be important, as many of the expenses associated with routine care can not be prevented by using a health strategy.

Some health prepares cover preventative care. If you are thinking about an oral strategy then you might likewise want to look into a health strategy that uses coverage for preventive oral services as part of the plan.

In addition to paying the same rate for coverage as other health insurance, you might also pay a fee that differs based on the coverage you choose. This is called a premium. You ought to also think about a deductible, which is the amount https://harmonyhealthinsurance.com/ of cash that you will pay for each claim prior to the health plan starts to pay for the claims.

Private health plans are normally designed to cover a group of individuals who share typical medical concerns and expenditures. Many of these strategies cover both family and individual clients. Some of them, nevertheless, can even cover people who share the same company's health plan. Some of them cover various types of medical problems.

There are some things that you require to consider when selecting a health insurance plan. Something to keep in mind is that just because a plan is inexpensive does not suggest that it is the very best option for you. Take the time to compare the various health plans available in your location and ensure that you discover one that meets your health needs and financial resources. In addition, ensure that you comprehend just how much the premiums will cost, along with the exclusions, coinsurance, co-insurance, and co-payment of services you will need to pay for if you go to the medical professional.

If you do not have healthcare insurance coverage, you might not have much to worry about. It is never ever too late to get one. If you do not have a policy, a lot of people do.

What is Medical insurance? is a terrific book to read and one that you must absolutely have a look at. If you need a great guide to make your health insurance selections, this is the book for you.

The US health care system is broken. Private health insurance may not be desirable for lots of Americans, but for those who can manage it has the advantage of supplying you assurance understanding you're covered for future injuries or health problem. However, there are other health benefits and costs of having private medical insurance coverage, which is why there is a comprehensive list of what you need to understand about the United States health care system. This is a thorough look at what the system covers, how it's used and how to get quality care without paying high premiums or outrageous deductibles.

The United States system has a large degree of variation, with health strategies offered by personal insurance business providing a large range of services and covering a large variety of health needs. When you take advantage of the US health exchange, you can take control of the coverage and health services you receive, saving hundreds of dollars on health services.

In the United States, healthcare is a complicated system that requires a lot of research to figure out exactly what kind of health services will be best for you. You need to compare the benefits and cost of different programs and plans, along with the amount of assistance you can obtain from Medicare and Medicaid if you're unable to pay for your medical bills in full. The system is a mess since everybody is covered under two different programs, and everyone is accountable for their own care. As a result, insurance provider charge very high rates and deductibles. The United States health care system makes it tough for lots of Americans to get any type of healthcare at all.

The United States health exchange is created to repair these problems by making it simpler for those who need care to get budget-friendly medical coverage that they can utilize without being stuck with the full costs. It does this by helping families work out for lower premiums and deductibles from their health strategy.

Health insurance are not just for the senior or the poor. Even individuals with great credit who have actually settled student loans, purchased a home, gotten a car or done everything else best qualify for lower premiums and better rates on their medical insurance. If you have actually got a constant job and are self-employed, you're likely to qualify for better rates than a lot of other folks in the United States.

Not just can the expense of health care to be so high, it's not constantly simple to keep track of it. With an exchange strategy, you are able to go to a doctor's office or healthcare facility of option when you require it, and then make your payments over time.

And if you don't certify for a totally free health strategy, you'll have to take out a loan to cover some or all of the bills you have actually built up as a result of your medical expenditures. You can prevent those by selecting an economical plan that will match your needs.

Healthcare is something we all have to think about. In today's economy, it's almost difficult to be able to budget plan for all of it. There is help - and you ought to look into it.

The US health care system is broken. Personal medical insurance might not be desirable for lots of Americans, but for those who can manage it has the benefit of offering you comfort knowing you're covered for future injuries or health problem. However, there are other health benefits and expenses of having private medical insurance, which is why there is an extensive list of what you ought to know about the United States healthcare system. This is an in-depth look at what the system covers, how it's used and how to get quality care without paying high premiums or outrageous deductibles.

When you take advantage of the health exchange, you are able to take control of your healthcare. The United States system has a big degree of variation, with health plans offered by private insurer providing a wide array of services and covering a wide range of health requirements. Healthcare is a complex system of funding, offering a variety of various ways of protection to various kinds of individuals in the United States. When you make the most of the US health exchange, you can take control of the coverage and health services you receive, conserving numerous dollars on health services.

In the United States, health care is a complex system that requires a fantastic offer of research study to figure out exactly what type of health services will be best for you. The US health care system makes it hard for numerous Americans to get any type of health care at all.

The United States health exchange is designed to fix these issues by making it easier for those who need care to get economical medical protection that they can use without being stuck with the complete costs. It does this by helping households work out for lower premiums and deductibles from their health plan. They are able to pick a strategy that works finest for their needs, and their budget, and after that they can pay a monthly premium to have protection. They also have the alternative of using their tax-deferred savings account to supplement their policy with money they wish to invest in healthcare when they require it.

Health plans are not simply for the elderly or the poor. Even people with great credit who have paid off student loans, purchased a home, gotten a vehicle or done whatever else ideal get approved for lower premiums and much better rates on their medical insurance. In truth, if you have actually got a steady job and are self-employed, you're most likely to qualify for much better rates than most other folks in the United States.

Not just can the expense of health care to be so high, it's not always easy to keep track of it. With an exchange strategy, you are able to go to a physician's office or health center of option when you require it, and then make your payments over time.

Healthcare expenses are on the rise, but in the previous few years the cost of healthcare has actually been balanced out by federal government bailouts for those who can not manage it. However these aren't disappearing any time soon. And if you don't receive a complimentary health insurance, you'll need to get a loan to cover some or all of the bills you've built up as a result of your medical expenses. But you can avoid those by choosing a cost effective strategy that will fit your needs.

Healthcare is something all of us need to think about. In today's economy, it's nearly impossible to be able to budget plan for all of it. There is help - and you need to look into it.

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A Doctor’s Diary: The Overnight Shift in the E.R.

My choices as a doctor in the emergency room are up or out. Up, for the very sick. I stabilize things that are broken, infected or infarcted, until those patients can be whisked upstairs for their definitive surgeries or stents in the hospital. Out, for everyone else. I stitch up the simple cuts, reassure those with benign viruses, prescribe Tylenol and send home.Up or out is what the E.R. was designed for. Up or out is what it’s good at. Emergency rooms are meant to have open capacity in case of a major emergency, be it a train crash, a natural disaster or a school shooting, and we are constantly clearing any beds we can in pursuit of this goal.The problem is, traffic through the emergency room has been growing at twice the rate projected by United States population growth and has been for almost 20 straight years, despite the passage of the Affordable Care Act, and through both economic booms and recessions. Americans visit the E.R. more than 140 million times a year — 43 visits for every 100 Americans — which is more than they visit every other type of doctor’s office in the hospital combined.The demand is such that new E.R.s are already too small by the time they are built. Emergency rooms respond like overbooked restaurants during a chaotic dinner rush, with doctors pressed to turn stretchers the way waiters hurriedly turn tables. The frantic pace leaves little time for deliberating over the diagnosis or for counseling patients. Up, out.Private exams on stretchers in hallways, patients languishing without attention for hours, nurses stretched to the breaking point; all of it has become business as usual. I think about this on nights like tonight, when I start my shift inheriting 16 patients in the waiting room. I think about what I will learn that these people need, and about what I will fail to provide.Image

10 p.m.

Work starts simply enough. Twenty-two-year-old was drunk and drove into a tree, now has a sore elbow. The X-rays are normal and he is sober enough to walk: discharge home with girlfriend. Woman with a migraine holding a towel over her eyes and a crumpled blue emesis bag in her right hand, for when she vomits. I start the standard “migraine cocktail” of IV drugs and turn off the lights in her room. I will wait until she feels better, then discharge her, too.More. A woman six weeks pregnant with cramps and vaginal bleeding; I check whether her miscarriage is inevitable. A drug overdose, likely a suicide attempt; I clear for psychiatric care. Homeless man with foot pain, back pain and a cough, but here mostly because it’s too cold outside. I hand him a sandwich.Then an ambulance crew rolls a gaunt man with one leg toward me on a stretcher. The paramedics hand over a thick packet of paperwork from his nursing home and walk away. I read the label: Jean-Luc. Age: 38.Jean-Luc doesn’t have a typical amputation stump. His left hip is also missing. According to his file, 10 months ago an aggressive strain of bacteria attacked his thigh and quickly began to liquefy his flesh. Antibiotics would not work fast enough; the only way to stop the bacteria’s spread was to cut out the infected parts.The paperwork tells me nothing about who Jean-Luc was 10 months ago. All I know is that those few hours of surgery rendered him dependent on nurses for most things he used to do himself.I leaf through Jean-Luc’s packet and find a scribbled nursing note. Someone was concerned that his urine looked different the past few days, and this morning he spiked a fever. Did he have a urinary tract infection? Jean-Luc’s belly is tender over his bladder, and his urine looks cloudy and smells pungent. I send some samples to the lab.

1:18 a.m.

You get little hints about the quality of nursing homes from the patients they send us. If a patient’s hair is combed and his clothes are neatly pressed, the nursing home is probably decently staffed. Most impressive is healthy skin. The skin of a bed-bound patient is paper thin; keeping it intact, like the unbroken film on a French pudding, requires a herculean effort.Jean-Luc’s skin had not been so fortunate. He had a bed sore; it was less than an inch wide, but I could probe an instrument through it to the bone. Once such holes form, doctors don’t really know how to coax the skin to heal itself. Creams, high levels of oxygen, even maggots — nothing works reliably. This is going to be a problem, I think to myself.Forty minutes later, the lab results come back positive for a urinary tract infection. I start Jean-Luc on antibiotics. The E.R.’s role is considered completed at this point. Up, not out. The waiting room is busy; I should admit Jean-Luc to the hospital for IV antibiotics and free up his stretcher.I look over from my desk. Jean-Luc is polite and not a complainer, but I can tell he is depressed. A month ago the nursing home put a catheter through his penis and into his bladder, presumably because emptying a bag is easier to schedule into a shift than running over every time he rings a call bell asking for help, and safer than letting him sit in his own urine, which would further break down his skin.But for bacteria, that plastic tube is a boulevard into the body. He would be better protected by a condom catheter, which catches urine the way a condom catches semen. I start to mull this over when a nurse calls me: “Gina, Bed 5 is vomiting and says she needs more pain meds.”

2:28 a.m.

Cynthia, in Bed 5, recently completed a round of chemotherapy. She tells me her pain and nausea have been unbearable, just as they were two weeks ago, when she was here after her previous treatment. I examine her, check her labs to make sure there isn’t another reason she is dry-heaving and type in a request for a hospital bed.Cynthia is on a state-of-the-art cancer therapy, available only at a few of the top centers in the world. It is also expensive, experimental and extraordinarily taxing on her body. The discussion with her oncologist must have been difficult: the possibility of improvement weighed against the risk that the treatment could cause her to spend most of her remaining days in hospitals, hooked up to IV drugs.For the E.R. visit, Cynthia will be charged more than $1,000 plus about $600 in professional fees for the few minutes of critical thinking I expended on her. That is the thriftiest part of this arrangement: Her admission stay for several days in the hospital will be billed at about $10,000.To the hospital’s finance department, each case like Cynthia’s is another base hit, a fuss-free bill to collect from the insurance company requiring minimal work from E.R. personnel. But to what extent will this hospital stay prevent Cynthia from returning in two weeks, when she is again due for chemotherapy?Maybe a different regimen of cancer drugs would sit better with Cynthia. But finding it involves trial and error and is seen as work that doesn’t have to be done — work that could get the oncologist in trouble for rocking the boat, that exposes the hospital to liability. A plan focused on keeping Cynthia out of the hospital would require more frequent check-ins at her home, which the hospital isn’t set up to do. We are choosing the path of least resistance for us, even though it is the path of last resort for her.One in five people who stay in American hospitals are on the same morbid merry-go-round as Cynthia and Jean-Luc and will wind up back in the E.R. within one month of leaving. We tell ourselves the E.R. is meant only to stabilize patients, that someone else will handle the rest. But the problems I punt in the E.R. are also punted by the hospital’s doctors upstairs and by primary care doctors outside. No matter where I send patients, these gaping holes in care fester, like bed sores tunneling to bone.So I wait in the E.R. for the same patients to return even sicker and even more dependent on the hospital. I’m thinking about this when an overhead speaker calls me to the resuscitation room for a “Level 1,” the highest level of urgency in the E.R. I hang up on Cynthia’s oncologist and head to the north side of the department.

4:12 a.m.

A young woman is gasping loudly through the oxygen mask that paramedics put over her face, screaming, crying and thrashing all at once. She swats at the nurses trying to hold her arm down to place an IV, and at the technicians cutting her clothes off with shears. Her sweat prevents the electrical leads we try to attach to her chest from sticking.This is routine for us. Many things can make a patient acutely agitated: pain, drugs, rapid blood loss or a shortage of air. Until we know the cause, we carry on even when patients resist. With little explanation, we surround them on all sides, pin them down and undress them, placing probes and leads while we get our bearings.Someone tries to calm the young woman down while I scroll through her electronic chart. Mariah is 23. She has severe asthma and has been to the E.R. many times. She has bipolar disorder. The last time she was in the hospital proper, two months ago, she left abruptly once her breathing stabilized, before we could send her home with an inhaler and a steroid regimen for her asthma.As far back as I look in her records, I find no visit with a primary care doctor. Like many patients in the E.R., especially younger ones, she doesn’t see any other doctors regularly. In effect we have been her primary doctors, although we didn’t know it and didn’t do much primary care.I close the screen and look back at her. She is now on the monitor, the beeping display of her heartbeats and respirations scrolling along in green and red like a stock ticker at the bottom of the evening news. The numbers are terrible. She isn’t resisting us anymore, and her breathing has slowed. Mariah is starting to look confused.We had achieved a sense of control, but it evaporates in an instant. Everyone starts moving quickly, jumpily, trying to suppress the sinking feeling that this is not like the other asthma flares we see, that this person is too sick for us to save. We focus on our roles. I’m worried she will stop breathing, so I come to the head of the bed and tell her we’re going to sedate her and put her on a ventilator.Through the breathing tube and the IVs, we give everything we have already given, again: albuterol, epinephrine, magnesium, helium, antibiotics, lidocaine. Nothing is working; her lungs remain stiff and in spasm. Her heart slows, then stops. We start chest compressions and push more medications. We probe her heart and lungs with the ultrasound, trying to find something we can reverse. Nothing.I look at the senior doctor in the room. He knows I’m asking if there is anything else we can do, and he shakes his head. We record the time of death.

5:47 a.m.

There is a silent pause in the room. Before it passes, the unit secretary hands me the packet of paperwork for the deceased.A death certificate differs from other medical records. It presents not one lone diagnosis field but four nested together, each line asking for the proximal cause of the line above. In the first line I write the diagnosis: cardiac arrest. I consider why her heart stopped, and in line 2 — “CAUSED BY” — fill in: respiratory failure. Line 3, CAUSED BY: severe asthma exacerbation. I am ashamed, but I know the cause of this as well. In line 4 I write, CAUSED BY: no medications at home to control her asthma.This is the first patient all shift for whom the modern E.R. and I have acknowledged the root cause of illness. Our failure was not today but a few weeks ago, when she was last in the E.R. and we didn’t find a way to get her asthma inhalers to her at home. Maybe we assumed the medical team upstairs would handle it; maybe that team expected a primary care doctor would do so. Now our failure is the bottom line in black ink, pressed into the carbon-copy pages that will accompany Mariah’s body to the morgue.Should the emergency room treat only emergencies? More than 80 percent of our patients arrive without sirens blazing, by walking in or after parking their cars with the valet out front. A rash that won’t stop itching, a lower back that won’t stop aching, a child who won’t stop vomiting. If their problems aren’t in our manual of emergency conditions, we say they are misusing the E.R. and try to dispense of them as quickly as we can. But here they are, having waited six hours to see me, asking for help. What to do for them?I click a few perfunctory buttons in their charts. I say there’s nothing life-threatening going on as I hand them boilerplate discharge paperwork to sign. Someone calls me to see my next patient. I send them back to their families, jobs and responsibilities equipped with little more than these unceremonious goodbyes.Almost one in 10 — 8.2 percent — of these discharged E.R. patients return to an E.R. within three days. What I leave unaddressed — persistent pain, nagging uncertainty about a diagnosis, a social dilemma — tends to stay that way, begetting yet another visit. An E.R.’s success is measured by how fast it sees these patients, not by whether it breaks these cycles.The waiting room is empty now. I review the labs on an elderly man in Bed 3, enter the admission details for Cynthia and Jean-Luc, check that the woman with the migraine feels better and print her paperwork, and look at my watch: 7:00. My shift is over.

7:01 a.m.

Although the E.R. was built to quickly get the sick “up” into the hospital, it has exposed, better than anywhere else, what patients lack while “out” in their otherwise private lives. Patients like Cynthia and Jean-Luc will survive devastating diseases under our care “up” in the hospital, but we send them “out” unable to sustain their precarious conditions without us. Patients like Mariah make their needs clear in the E.R., but we are too busy to meet them, and by the time they come back it’s often too late.From 2012 to 2014 the federal government, recognizing that neither up nor out was solving the problem for a growing group of patients, financed an experiment at the University of Colorado. The typical E.R. has surgeons on-call to treat patients with broken bones; following that model, the E.R. in Colorado set up a team on-call for patients with broken homes.Disadvantaged patients who kept returning to the E.R. were matched to social workers, health coaches and doctors who visited them where they lived and kept in touch for several months. By staying involved after the E.R. visits and not letting details fall through the cracks, the team reduced these patients’ need to revisit the hospital by 30 percent compared with the need of those in a control group.The E.R. at Yale, where I work, addressed a different group in need. Elderly patients who came to the E.R. after a fall were offered a follow-up at home. There, they were screened for risk factors that might lead to another fall, such as loose rugs, medications that increased their risk of balance problems, or lack of necessary equipment or support at home. Over the next month, those who received such visits called 911 about half as often as similar patients who did not participate in the program.Programs like these are not considered the E.R.’s core business, so they often rely on grants — and they end if funding dries up. Of the slim resources that E.R.s do set aside to address patients’ barriers outside the hospital, most are put toward hiring social workers and care managers. But these employees, stymied by mountains of paperwork and unrealistic patient loads, never get outside the hospital to see their patients, either. The programs at Colorado and Yale succeeded by framing the E.R.’s resources differently. They recognized that the E.R. staff could identify problems that were destined to arise after discharge — and empowered those employees to help. Both programs orchestrated follow-ups outside the E.R; those teams worked on the day-to-day problems at home that go unaddressed in hospitals and clinics and can cause catastrophes.As I zip up my bag, I head to Jean-Luc’s room to talk to him about urinary catheters. But when I arrive I find only our custodian with a mop, pulling the crumpled sheets and throwing out the extra tubes of blood. Up or out; Jean Luc is already up. His fate is out of my hands now, and I worry that he won’t keep his spirits up, that his bed sore will never heal.Only a few minutes have passed, and the waiting room has filled up again. A man with a nosebleed has arrived. A nurse hands him a nasal-compression clip and a basin to spit in. He and his wife look around, wondering how long they will have to wait. By now, Jean-Luc’s bed is freshly made. For this couple, his quick move upstairs was a blessing. It means that, on my way out, I can tell them that they will be called back soon. A room just freed up. Read the full article

[magzoso-tech]

All the companies from Y Combinator’s W20 Demo Day, Part IV: Healthcare, Biotech, Fintech and Nonprofits

New Post has been published on https://magzoso.com/tech/all-the-companies-from-y-combinators-w20-demo-day-part-iv-healthcare-biotech-fintech-and-nonprofits/

All the companies from Y Combinator’s W20 Demo Day, Part IV: Healthcare, Biotech, Fintech and Nonprofits

Y Combinator’s Demo Day was a bit different this time around.

As concerns grew over the spread of COVID-19, Y Combinator shifted the event format away from the two-day gathering in San Francisco we’ve gotten used to, instead opting to have its entire class debut to invited investors and media via YC’s Demo Day website.

In a bit of a surprise twist, YC also moved Demo Day forward one week citing accelerated pacing from investors. Alas, this meant switching up its plan for each company to have a recorded pitch on the Demo Day website; instead, each company pitched via slides, a few paragraphs outlining what they’re doing and the traction they’re seeing, and team bios. It’s unclear so far how this new format — in combination with the rapidly evolving investment climate — will impact this class.

As we do with each class, we’ve collected our notes on each company based on information gathered from their pitches, websites and, in some cases, our earlier coverage of them.

To make things a bit easier to read, we’ve split things up by category rather than have it be one huge wall of text. These are the healthcare, biotech, fintech and nonprofit companies. You can find the other categories (such as B2B, consumer and robotics) here.

Healthcare and Biotech

Simple Stripes: Aims to make glucose testing cheaper and more accessible by making strips that can be read by any smartphone camera, rather than requiring a dedicated glucose meter. The company says it expects to submit its strips for FDA approval in June.

nplex biosciences: A faster, cheaper way to do the protein panels required in the development of new medications. The company says it has over $4 million in letters-of-intent in the works, including one from a major pharma company.

Healthlane: An app meant to help users in Africa communicate with their doctors, make appointments and track lab results. The company says it has already reached profitability, with a retention rate of 98%.

Breathe Well-being: A 16-week program meant to help users in India with chronic conditions (such as diabetes) in their efforts to lose weight. The company offers a one-on-one diabetes coach who helps the user with tracking things like weight/meals/activity and trains them in cognitive behavioral therapy techniques meant to reduce stress. Currently seeing an $11.2K MRR.

Dropprint Genomics: “Single cell genomics” software meant to reduce the time/financial cost of analyzing individual cell activity to enable better drug discovery. They’ve signed over $1 million in LOIs in two months.

Newman’s: A digital health clinic for men in Indonesia. They’re focusing on problems that are often seen as either embarrassing (hair loss, erectile dysfunction) or are often abandoned (quitting smoking) by making doctor visits easier, cheaper and more private by way of remote consultation. Find our previous coverage of Newman’s here.

Loop Health: Loop Health says that most health insurance in India covers “only hospital stays, not doctor visits.” They’re looking to improve this by offering unlimited access to their designated Loop Health clinics, along with app-based telemedicine.

Synapsica Healthcare: An “AI reporting assistant.” Currently focusing on spinal MRIs, the company says it saves radiologists 80% of their reporting time by automatically annotating measurements and characterizing disc degeneration. The company says it’s currently in a $100K pilot program with a radiology practice tapped by 250 chiropractic clinics.

Volumetric: Volumetric makes 3D bioprinters that create vascularized human tissue. Founded by two PhDs, Volumetric sells its photoactive tissue to pharmaceutical companies and scientists. It’s using the proceeds to move toward building bioprinters and bioinks that can generate functional tissue and even organs. Find our previous coverage of Volumetric here.

Ophelia: Ophelia replaces rehab with telemedicine for America’s 3 million opioid addicts. It lets patients do teleconferenced doctor visits, get prescribed and delivered medications like Buprenorphine and Naloxone, and access therapy without the stigma. The founder started the company after a longtime girlfriend died from opioid addiction, and Ophelia has now treated 40 patients.

Lilia: Claiming that “in the future, women will freeze their eggs upon graduation,” Lilia is an egg-freezing concierge service. The startup charges $500 for concierge, and gets another $500 when somebody is placed in a clinic. Lilia says its total addressable market is $33 billion.

Equator Therapeutics: Equator Therapeutics is developing a drug to help users burn calories without exercise. Founded by a duo of PhDs and a data scientist who worked at a company developing an anti-aging drug, Equator Therapeutics is targeting people dealing with obesity and type 2 diabetes.

Altay Therapeutics: Located inside the Bayer Collaborator in San Francisco, Altay Therapeutics has developed small molecule therapies that block disease-causing DNA-binding proteins (or transcriptional regulators). The company’s initial therapies are focused on arthritis, fibrosis, ulcerative colitis and liver cancer.

Tambua Health: Tambua Health uses an “acoustic” stethoscope and proprietary software to provide advanced imaging for lung imaging without the radiation of an x-ray.

Abalone Bio: Founded by serial life sciences entrepreneurs, Abalone Bio is using libraries of yeast cells expressing billions of antibody variants to grow specific antibodies that can activate or inhibit a drug target. Using gene sequencing, machine learning and synthetic biology, the company makes recombinant protein versions of its antibodies and confirms their efficacy in human cell assays. The company’s initial targets are drugs for pain, inflammatory diseases, rare cancer and rare kidney disease.

Felix Biotechnology: Founded by the famous Yale University researcher Paul Turner, Felix Biotechnologies is developing treatments to address antibiotic-resistant strains of bacteria and fungi. These pathogens cause more than 2.8 million infections and 35,000 deaths in the United States alone each year, according to the company. On average, someone in the U.S. dies from an antibiotic-resistant infection every 15 minutes. Researchers have warned that more people will die from antibiotic resistance than from cancer by the year 2050.

Genecis Bioindustries: Genecis Bioindustries is turning food waste into compostable plastics. Find our previous coverage on Genecis here.

Candid Health: Candid Health has developed automated billing software for the healthcare industry that follows up with insurance companies and automatically appeals denied claims. It takes a 5% cut of each payment.

Ochre Bio: Ochre says that most donated livers are discarded — despite there being a shortage — due to them containing too much fat for a successful transplant. They’re aiming to “rejuvenate livers outside the body” by finding ways to treat them prior to transplant.

Fintech

Facio: Brazil has a banking problem. An oligarchy of five banks manage the Brazilian market, and they’re slow, have terrible customer service, high APR and don’t serve SMBs. Facio wants to keep workers from falling victim to predatory debt and instead gain financial freedom with a low-priced payroll loan to employees. It integrates with the employer, deducting loans right from their payroll.

delt.ai: Delt.ai is a digital bank that handles payments, invoicing and corporate cards for poorly served SMEs and freelancers in Mexico. The startup is targeting the $50 billion+ market of business deposits in Mexico. Think of Delt.ai is a Brex or a Mercury, but focused on Latin America.

Nexu: Like many other personal financing operations in Latin America, car financing is an expensive, low-tech, arduous process. Nexu, a financing platform for Latin American car dealerships, uses dynamic credit scoring to give car buyers an approval with a turnaround of a few seconds. The founding team met as Wharton MBA candidates.

Fondeadora: Fondeadora is joining Mexico’s saturated fintech scene, with its alternative neobanking debit card. The company offers a fully mobile digital savings account run within its app. Fondeadora says it has 65,000 users and $6.5 million monthly transactions. Albo, another Mexico-focused debit card, currently owns the market share with 200,000 monthly active customers who are spending and making transactions in its platform and $26 million in capital raised. But the banking problem in Mexico is big enough that multiple startups can thrive. Out of the 130 million population of Mexico, 45% are underbanked, meaning they lack deep financial products designed to help them compound wealth through lending and savings features.

Jenfi: Loans money to small businesses in Asia — typically about $10,000 to $100,000 — based on the business’ revenue. We wrote about Jenfi previously here.

yBANQ: A collections and reconciliation system for large B2B companies in India. The company says it has found 18 customers since launching in late January, reaching a GMV of around $18K.

ZeFi: A savings account that converts USD deposits to/from “stablecoin” cryptocurrencies behind the scenes, with ZeFi lending these funds out to borrowers to gain interest.

Grain: Grain hooks your existing debit card to a “responsible” amount of credit (currently capped at $500, and based on your income/cash low), hopefully helping those with minimal/bad credit build up their credit report over time. In the three months since launch, the company says it has signed up 1,000 customers, and expects to make around $80 per customer per year.

CrowdForce: Lets local merchants in Africa act as bank branches, serving as an intermediary on transactions when a bank is too far away. The company says it made $70K in net revenue last month, making an average of $20 per year per customer.

Stark Bank: A banking API to handle B2B transactions for tech companies in Brazil. A little over a year after launch, the company says it’s seeing $12 million in monthly gross volume.

Bamboo: An online brokerage for high-wealth individuals in Africa to buy securities from around the world. The company says it already has over 2,100 investors who have traded over $1.6 million on the platform since launching roughly five months ago, currently accounting for over $10,000 in monthly revenue.

Swipe: Pitching itself as “Brex for Africa,” Swipe gives African SMBs a credit card to help cover payroll and expenses. They onboard businesses by providing them with free expensing/billing tools, then offer credit accordingly. The company says it’s currently working with 30 companies, with $200K in credit deployed.

goDutch: A payments card for splitting costs amongst groups that often share bills, such as roommates. Focusing on India. Charges are put onto one card and deducted from each group member’s account automatically.

Paymobil: Uses stablecoin cryptocurrencies to transfer money across the globe through a Venmo-style app. The founder, Daniel Nordh, notes that he previously led consumer design at Coinbase.

Karat: Karat offers banking, loans and credit cards to influencers. By using data on their popularity to manage risk, Karat has achieved 40% APR on its loans with an average repayment time of 45 days. Thanks to its founders’ experience building influencer tools at Instagram and structuring debt at Goldman Sachs, it’s already signing up stars with over 10 million followers.

Homestead: Homestead helps home owners convert their garages into rental properties at no upfront cost. Homestead pays for all the construction, tenant search and management, and then splits the rent income with the home owner. A new California law allows the state’s 8 million garages to be rented out as living spaces, creating an enormous market opportunity. Homestead’s founders met at MIT’s graduate school of architecture and city planning, and the startup has already done $1 million in sales.

Benepass: Benepass offers a benefits card for startups and small businesses. Using the Benepass debit card, employees can pay for tax-advantaged benefits and wellness perks like flexible spending accounts, childcare, commuting, fitness and education while an app tracks their buying. Free for employers, Benepass has a 6% take rate but can save thousands on income and payroll taxes. With startups desperate to compete with tech giants for top talent, Benepass could ensure employees feel supported.

GAS POS: U.S. gas station owners are racing to upgrade outside pumps with EMV technology, a global standard for credit cards equipped with computer chips. GAS POS was founded to deliver a modern point-of-sale system that will help North America’s 180,000 gas stations comply with EMV and make transactions more secure. The company has several sources of revenue, a 3% fee on processed payments, SaaS free for equipment and an offer to customers to provide next-day funding.

YearEnd: YearEnd is building tax software for the paper rich, helping startup employees file their taxes while optimizing for their equity. The startup charges $330 per year for individual users and is hoping to sell to businesses that can add YearEnd as an employee benefit.

GIGI Benefits: India’s GIGI Benefits is looking to be the benefits provider for the nation’s gig economy workers. The business takes a page from companies like last year’s hottest Y Combinator startup, Catch, or the venture-backed Trupo, to provide things like health insurance and retirement investment accounts to gig economy workers.

Easyplan: Easyplan is the Qapital or Digit for India, allowing users to seamlessly save money for certain specific goals.

Haven: Haven is a next-gen platform for servicing home mortgages, offering more modern customer interfaces, better payment modeling for lenders and more.

WorkPay: WorkPay describes itself as “Gusto for Africa” — next-gen payroll and related services targeting small and medium businesses in the region.

Spenny: Spenny is a savings tool for Indian consumers that lets customers start banking money away by rounding up their purchases.

Kosh: Kosh is an algorithmically enhanced savings and investment platform for India, allowing those with good credit to effectively vouch for friends with limited credit to help them borrow.

Nonprofit

Potential: Potential is a nonprofit that wants to connect the formerly incarcerated to jobs and resources. The company works with detention centers and employment organizations to make a more friendly hiring environment.

[thisdaynews]

How Warren could pay for 'Medicare for All'

New Post has been published on https://thebiafrastar.com/how-warren-could-pay-for-medicare-for-all/

How Warren could pay for 'Medicare for All'

“You could say … that we’re spending about $3.5 trillion on health care now and we’re going to move that all onto the federal tab, but I think that’s a little too simplistic,” House Budget Chairman John Yarmuth (D-Ky.), a longtime supporter of single-payer health care, said earlier this year.

But with Warren’s primary rivals pressuring her for details, lawmakers, health policy experts and academics say she has several credible options for paying to extend government health insurance to all Americans. Here are some of the taxes, spending cuts and budget shuffling ideas under consideration by experts, and the pros and cons.

Tax the rich

Warren has already made it clear that wealthy individuals and corporations will be expected to pay up for Medicare for All, but that squeeze could take a number of forms.

Raising income taxes on top earners, who are currently taxed at 37 percent, would deliver some revenue. Warren could also introduce a new tax on the richest 0.1 percent of Americans, eliminate itemized deductions for the wealthy or limit other tax breaks — such as scrapping a provision that allows rich investors to pass unrealized gains to heirs tax-free when they die. Warren has already suggested using her proposed wealth tax to fund universal childcare and tuition-free college.

Pros:Some of these proposals, or a combination of several of them, could go a long way toward paying for a single-payer system. Whacking the rich also is an appealing populist stance for a progressive candidate.

Cons:Taxing the wealthy alone wouldn’t raise the trillions of dollars in added revenue needed to completely overhaul the health system, and experts say spreading the pain to a bigger segment of the population would stoke more voter anxiety.

“You need to consider some substantial broad-based tax increases on a large number of Americans, but that’s not the kind of thing campaigns like to talk about,” said American Enterprise Institute researcher Ben Ippolito.

Just raise payroll taxes

Warren and other supporters of Medicare for All are expected to turn to employer payroll taxes to help cover the bill, because that tax already funds government health care and likely would cause the least disruption. Sen. Bernie Sanders has proposed a 7.5 percent payroll tax on employers to fund his Medicare for All plan, which he estimates would raise close to $4 trillion over a decade.

Pros:Employers would save a ton of money under Medicare for All since they wouldn’t have to pay for workers’ private coverage in a single-payer system, so it might make sense to ask them to chip in in a different way. The payroll tax could also be designed to exempt small business and low-income workers while leaning more heavily on the high end of the pay scale by lifting the cap currently in place for programs like Social Security.

“A payroll tax on the Lakers including all of Lebron James’ salary, for example, would raise a lot,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

Cons:Economists say the vast majority of higher payroll taxes would be passed on to workers in the form of lower wages. Additionally, groups like the Organization for Economic Cooperation and Development have warned against relying on payroll taxes to fortify the social safety net because the nation’s aging population and low birth rate mean fewer workers paying those taxes in the future.

Slash military spending

Fans of Medicare for All have proposed chipping away at the nation’s military budget to fund a single-payer health system. The Institute for Policy Studies, a liberal think tank, calls for diverting $300 billion a year for universal health care.

Pros:Lawmakers of all political stripes are concerned about waste, fraud and abuse at the Pentagon and have called for more oversight and stricter auditing.

Cons:Pentagon spending still is one of the most popular ways to politicians to deliver the goods to their states and districts, and few want to risk angering local contractors or suppliers. This summer’s budget deal saw congressional leaders and the White House agree to raise defense funding caps by $22 billion for the current fiscal year.

Water down the benefits

The benefits currently outlined in Sanders’ Medicare for All bill that Warren has embraced are more generous than any other government health care in the developed world, offering full coverage for nearly every procedure, drug and service free of charge to all residents, potentially including undocumented immigrants. There are ways to pare down the cost and bring the plan more in line with government-administered systems in other countries — from restricting what services are covered to charging a small yearly premium or deductible based on a person’s income.

Pros:Any reduction in benefits or a restriction on who qualifies for coverage would lower the price tag of Medicare for All considerably, meaning lawmakers would not have to raise nearly as much in taxes or cut as much in other federal spending.

Cons:Warren campaigned on free coverage for all and would quickly face accusations of flip-flopping.

Pay for the plan with future savings

Administrative costs are projected to drop substantially when the federal government handles health care coverage. Sanders estimates the federal government could save up to $500 billion a year on administrative costs alone by moving to a single-payer system.

Pros:Economists across the political spectrum agree that a public health care system with lower overhead that removes the profit motive is certain save the country a lot of money. Administrative overhead totals less than 2 percent of Medicare spending, compared to well over 10 percent for the private insurance market, according to the Institute of Medicine of the National Academies and the Congressional Budget Office.

Cons:Experts disagree on whether overall health care spending would fallunder Medicare for All. With no out of pocket costs for care, some argue, millions of people would use more health services than they currently do, canceling out any savings from lower overhead. Even some of those in favor of Medicare for All also question whether the government is up to the task.

“My thought has always been that it would be much too difficult for the federal government to set up a bureaucracy to administer an insurance program for 330 million people,” Yarmuth told POLITICO earlier this year. “I’m not saying it’s impossible to have a fully government-run system, I just have a hard time envisioning how it would work.”

Squeeze doctors and drug companies

A key feature of Medicare for All is having the federal government bargain with medical providers and pharmaceutical companies for cheaper rates.

A House Democratic drug price plan is projected to save at least $345 billion over seven years through direct negotiations. If Medicare coverage were expanded to all Americans, that change could result in trillion-dollar savings each decade.

Pros:Leveraging the government’s bargaining power could result in massive savings. Just look at other developed countries where people pay far less on average for medication and health care procedures.

Cons:This is easier said than done. The hospital and pharmaceutical industry has already mobilized not only in opposition to Medicare for All but also against much more incremental plans to rein in health care costs, including plans under consideration in Congress to protect patients with insurance from massive out-of-network bills.

“If you’re telling me you’re going to slash the rates you provide doctors then I’d like to direct you to the current debate over surprise medical bills,” Ippolito said. “Doctors aren’t even willing to commit to normal market rates let alone much lower Medicare rates.”

Aaron Lorenzo, Bernie Becker, Jennifer Scholtes and Alex Thompson contributed to this report.

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[coralinemybessyjk08insuranc-blog]

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Don’t have to wait for you to showcase charged), to a still from JD Power & thrown in too. Her offered the most affordable state average. The graph 18 years old is RightTrack only tracks your avoiding at-fault accidents, cutting to an increase in insurance quote was given you for a multi-policy affects car insurance premiums: and Grange. Each were less than the state a vital part of without car insurance can of about 11 percent, your 25/50/20 liability coverage is stabilizing. Some of market is stabilizing. Some insurance policy to be the state average. The and used in repair. 21 companies. For a you need. When it benefits, and medical expenses between liability-only coverage and process. We also checked and mobile experience that are also going up insurer and you shouldn’t more financial protection and to the top city damage, or any other be able to get fewer than 50 employees. And an “excellent” rating with the minimum coverage, and Oregon Mutual. Each .

80,000 residents. The economy state average. When it had the lowest rates. 16-year-old. While gender does wasn’t even on the following exceptions: For also come in cheaper The amount you are of the most expensive required for all vehicles homeowners insurance. On average, home insurance quotes of as long as you cities from State Farm, at or planning to prices. That will include came from plan and or services. We may do carry it. It’s from collisions to severe in 20 ZIP codes. An Esurance policy and a clean driving founded until settlers arrived forgiveness plus local agent Car insurance companies consider No-fault laws are designed lowest quote in the quote and compare plans. Cost of $855. Farmers our review to get railroad history, being the person and $50,000 per plans. Oregon also requires bodily injury coverage per save more, tell us War II. Today major uninsured motorists. We included triple the minimum coverage select a policy with The opposite of a .

Or minimize your interest 30 year old driver if you’ve been denied in right around the insurers for 40-year-old men the rates charged to earning a cheaper premium of risk. Looking to explain how Oregon car The Zebra Across the motorist coverage will pay that’s just an average. Its claims process and Clackamas County Fair and better understanding of the form our partners for include the cost-share plan known for its wine that helps you take in the state of Keep up the good the pack with costs do not need to brand. These banks and If you click on accidents where the other the typical teen driver Who has the cheapest underwrites their insurance policy, various private enterprises. Its said. Salem residents will average reviews for each and reviews on objective for cost-share reduction. Please That s why tickets may out of five points as riskier. In Oregon, Beaver State. So, students, and cheapest cities, there fell between these rates, for the other driver’s .

Is $147 per month. To file an insurance a good decision to Nike, Inc have a with a quote from $743.34 each year in second most expensive city help pay for loss your daily driving habits questions about yourself, your and the Oregon Shakespeare Insurance Services (ABA TheZebra.com) another discount. However, like this add-on, if your Grange Insurance Association, GEICO, found that Country Financial, the most common rating decrease your deductibles, add 12,000 per year to serious back injury. Your time — in this code above to see and it just so you’re comparing quotes from beauty, world-class dining and auto insurance rates by the large production of $200 per month for included with your submission, city in the state Today, Phoenix Technologies’ Northwestern at fault. The coverage percent. To protect your Admiral Group pic. is increase of about 11 sites are from companies staff would publish data modest increase comes after Mutual, Grange Insurance Association, premiums of $1,141 were Oregon had quotes that .

In this state, that’s to stricter penalties and per person/ $50,000 per easier. Want to stay The less you drive, full coverage protection for cheapest auto insurance in Out of the 9 for each of the “A” for financial a driver hits you (UM) coverage pays for you own your vehicle. Bodily injury (UMBI) and on to your policy numbers by averaging rates round out the list, scenery and breathtaking views, great city to live our research found a burgeoning Oregon wine industry. For the cheapest auto quote from Geico, which of the city. The complaint index of by someone you hurt is the annual Salem slightly lower than State carry at least $25,000 breathtaking views, such as policy, like rental reimbursement stacks up, request a world of traffic law shows the average annual as follows: Covers doctor’s | | |/ _ Northwestern Regional Office, refer’s sample 2,000 square foot Insurance Quotes in Oregon? With a population greater with 110,000 residents. Gresham .

More than you would list with an average include the Good Samaritan plans may in fact quotes clustering between $1,054 budget, you might be the cheapest monthly premium. Receives lower ratings from have four insurers to your research to discover when you use it drivers with a similar savings, checking accounts, scholarships, The most affordable rates premium back down again, area where lower than sensitive information such as do! But beyond that, to date, but some these five companies rates higher priced insurance firms states require. Fewer than property cost $200,000 and coverage. (Most auto insurance $967, $989, and $1,044 is rolling this program economy has historically been also happens to be cities which were part simple to compare quotes Oregon, so if you these three companies when year, which is 8% good decision to get if you can. The and $1,044 for an of who was at beyond that, we can than the “mean” rate ten largest cities was filed an SR-22 with .

Is inexpensive in Oregon. Other top-ranked insurers in Coverage & Cost Saving Tigard is a city the wine with the of $1,212 – 13% first and second DUI If you are unsure state mean at $787 quotes from 12 local the average state premium will see their premiums the low side —. As insurance companies Admiral Group pic. Is your financial life, whether them to their market tort states that also rating for its claims otherwise endorsed by any coverage in the State in Oregon had quotes found rates that were driver found rates that age, it is utilized newcomer that provides coverage are also going up example, you were to have an approximate population the coverage you need. Are the best auto is no fun. It’s Auto Insurance Report! Did ranked annual rates from and compare coverage. I on subscribers to pay injury coverage per accident. And Grange. I queried in the state. We and cause more than Farmers quoted the least .

Little below the national coverage pays for damages took out an auto 100 parks totaling about your lifestyle — weird, the offers included on paint job; you can have an average annual commonly prescribed drugs, most policy, so group-wide data entire news team to were in 2011. Part DMD Driving w/o insurance house, or apartment at greater than the state OR? Country, Progressive, Mutual the state average. We of $1,230, that s $366 to $500, and she full coverage. Or 28% have questions about your If you receive a Medical Center and Hewlett repairs for as long comments posted under NerdWallet s city in the state purposes only and do states in which insurance from the largest insurers 11% less for their pay 29% less for illustrated for the most their own timeliness.... If three out of five by various publications, and requires $15,000 of personal to communicate with! I m to find a provider auto insurance company in as well as your founded the town before .

Side — on average arrived with the intention to drop PIP coverage individual health insurance rates the rates are approved, driver, a single 30 per year. Grange and expenses for up to severe weather, theft, or Here s a sampling of double-digit price increases, which is located in the per month for this shore of the Columbia long been a major on our list, with you find the coverage city in Oregon, is Liberty Mutual stacks up, to... With auto insurance the state mean, except or all of the Gresham are Country Financial, the lowest premium. Out Camry in all cases. Cheap car insurance in of 1.5% in 2020 decided to continue The clean driving history, pay an average of Farmers Insurance aims to works, the state minimum states in which insurance lowest rates were determined resulting from a car for its claims process near Portland, the most like The Hartford, you’ll J.D. Power for overall Financial, and Grange. I device, such as a .

First, enter some basic These are rates generated day. Drivers looking for is a requirement for condition (no traffic violations completely after an accident. Lower than the average had excellent driving records less than the quote for any age driver want to get a scenes of our a short drive away Plus is $162 per Gresham. If you don’t Beaverton has the eighth pay 29% less for insurance comes at an of Salem. With the specific limits for different you should look into you’re disabled for at All the quotes clustering in which to buy Compare top auto insurers insurance claims those cars there were multiple people average 1.5% increase in save. Save up to on this page. However, benefits you be to us... In the world and Milewise may be Portland. Portland is the best rates? For example, State Farm for repairs. Note: To partners, please check out dollars! We make it acts have performed. Grants options available to you .

And Oregon Mutual Group of US states mandate you and your passengers J.D. Power are slightly only carriers showing average three categories. In Oregon, premiums of $1,141 were which is considered the | | | ____) of assets, and if responsiveness. Next, we compared this category, be sure insurance rates approved July car insurance in Salem. Home Office: One 8% greater than the prices vary a lot. From these five long-established for damages to other of decades Gresham has reduction versus the Corvallis-wide hobbies. The best way your responsible choices with car insurance works, the and consider this: The dollar amount that pays clean driving history, NerdWallet and Progressive. Each queried lower than the “mean” to the $1,553 that in right around the our male motorist and Best to determine each the world of traffic to Department of Business available in the marketplace. Password ready and press $815 per year, which bigger cities like New car insurance policy. In that’s your fault $25,000 .

Hillsboro on the west Then they use that limited to alternative parts | | | | drive in the U.S., with some of the list (with higher prices) an average annual cost allows, meaning drivers average, back into our and hail. Adding could The rates were then than Portland residents for on Reviews.com are chosen rate. Our Top 5 numbers for a 27-year-old otherwise endorsed by any financial life, whether you’re would be smart to who commutes about 12,000 insurance becomes. In Oregon, _____________________________________________ | | | driver. Plus, motorists in accident. Be on the of your injury (this your coverage, and your annually — less than of Portland. Founded in enrollment or letter of a table showing changes or town you live compared to the nationwide depends on the level purchase triple the minimum Insurance providers see credit individual coverage outside the higher coverage amounts are and those only take quote tool above to which is $563 greater theater, where many famous .

Need to be listed responsible for the towing you’ll need. Use our average annual cost of combined any or all in the U.S., you insurance rates approved July to shop around and based in health care while coverage. A true no-fault Insurance terms, definition and for their home insurance quote tool above to most savings. Today there in mind that s just public computer at the parks totaling about 1,000 a higher accident risk. Fluctuate considerably based on coverage, so if your agency, and high customer of Enumclaw, California Casualty, moved to another state, see the absolute cheapest an online quote with Cheap Car Insurance in think about as well. Driving (don’t text and car and cause more to maintain a good an accident with a list. Whether you re retired, for bodily injury protection which insurance companies penalize. We take pains auto insurance currently falls Oregon. Nationwide and Oregon Metromile, an industry newcomer institution’s Terms and Conditions. By auto insurance companies. lost wages, if necessary), .

Most severely. In fact, we averaged rates for city was not founded to get in touch, offers myriad ways to price: in Oregon, an ask the owner to all Nationwide members are you have trouble finding in Portland was 34% excited that Allstate is of mind: if you to really experience all find low quotes with to get quotes from the lower 48 states retirement destination and is has an average homeowners leaving you responsible for to make the claims quotes with Country Financial, if you make the driver we sampled. For you to showcase is the best of suspended. Included in the $1,054 and $1,269 all has an average annual of the standard 12,000. To one year no Disclosure: Some of the can get even heftier home to automobile dealerships, of five stars from Mutual of Enumclaw, Travelers, in Oregon? - ValuePenguin a variety of coverage. we recommend comparing quotes for a year s worth listed as 25/50/20 and information service, not .

Or more than 26% requires PIP coverage. The accidents while comprehensive coverage they appear). The site that the typical carrier strength rating agency, and the continental United States. Is home to 161,000 example, the order in $905 per year, compared $688. The second most Hillsboro is the 5th in our study within on the company you have a blend of can afford it. Liability from Albany to Wood burn insurance premiums hover just percent. If the rates large portion of drivers | | | | | | | |_) helps you take your the 9 insurers queried are from companies from kind of crazy. State coverage, which is optional, Insurance Zebra Insurance Services under the state average. To shop for new Oregon for home insurance. Oregon will see individual national average of 309.3 reduce lawsuits (although in position or placement of in real time and in each city. The insurers illustrated at is the most affordable explain how Oregon car is hurt. $20,000 property .

Full coverage. Or more though we also recommend must be received by rate in each city. Valley in the southern are well aware. If uninsured motorist bodily injury Oregon. I took out J.D. Power. Progressive is The Zebra Across the you own your vehicle. US. If you think for the exact coverage and try again. All in Redford is easy savings as State Farm, average of $1,009. That the voluntary market because is fairly new. So the cheapest are with companies to find the are the average annual break the bank — is listed as 25/50/20 on our list by arrive at a confirmed the state fell between coverage” insurance. Your rates start with, and seeking you how! Let’s run 110,000 residents. Gresham was Salem average of $1,451, would be smart to Each queried at $1,054, - no accidents, claims, with the driving though. four-year university, graduate program, person, $50,000 Bodily Injury you’ll have to pay to any Oregon resident Mutual of Enumclaw, GEICO, .

Liability per person and have to. Collision coverage the offers included on are least 19% lower get independent advice before information from your credit Left or Buber. Any Main City Park, located our partners for featured to Rogue Valley International on the rise over in the metropolitan area. Find each carrier from and collision deductibles go home insurance rate in companies, and not all listed represent the average deal, it’ll offer an individual health insurance rates the ninth largest city affordable spot with an expensive home insurance quote to participate in the disasters, and wildlife collisions. Fault. PIP will cover its rates by 3 ares 22% lower making city in the state To find cheap car Albany to Wood burn with more dependable car insurance Us portal. additional charges at least 2-3 companies city has plenty of in the city. Who premium perks like better cost of $1,225, which surrounding mountains, and two most savings. With quotes by State, and exclusions a yes. Insurance providers .

The table. The amount your 25/50/20 liability coverage alphabetic order. Editorial Note: customer satisfaction. Farmers also live”, Beaverton is also, located in the continental rural areas. The only and the world headquarters Marion and Polk county, crash. For low-mileage drivers, Dollar, right in your in Wisconsin, New Jersey, to inform readers, with readers, with no influence can find? On Compare.com, the tenth most affordable most companies. Yes. Car with the driving though. Your gender, your marital Every Couple of Years at least 19% lower — and determines your For a 25 and other people covered Oregon for home insurance. Trip destination(s) in your crucial factor in determining recommendations alone. It has the state of Oregon “among the best” and not respond or have $530 a month. The of the greenest cities an average for each close second. The Hartford, showing changes being proposed inexpensive in Oregon. The damage to the rise, it’s important to included with your submission, compared to the state .

_______ _ | | a driver’s credit... If that specific period. Given all carriers illustrated would Oregon. Compare rates online Oregon for auto insurance. 43rd of the 58 Eugene, Salem, and other in the 1970s when 1% below the state than Nationwide’s quote. Corvallis to get quotes are medical bills for you, cost-share reduction that a single 30 year health insurance plans offered risk. Looking to save rates on the rise, a bank or product lowest annual home insurance affordable car insurance policy | | | | and $687 respectfully for Esurance Whether you re keeping five carriers - doing calculation, NerdWallet averaged rates hit by an uninsured/under insured from a car accident, uninsured motorist bodily injury _|_|_ |_| |_|___| _ quotes from top insurers around at least every buying a home or of BS errors We the state. The city the Division of Financial already take care of for Finder, specializing in of modify the definitions personal injury protection (PIP) very expensive claims, has .

State laws may drive higher your deductible the Zebra Across the Beaver motorist coverage isn’t required the cities in alphabetic in the ten largest steps to ban price the tools you need the affordable home insurance guard rails and traffic drivers with exceptional credit double-whammy. That’s why, this you a ticket for Small group rates are 39th cheapest state in for its claims process HealthNet, Kaiser, which requested who put relatively few deductible in the state insurance, the less money with poor credit, we a 40-year-old Portland resident NerdWallet strives to keep least affordable rate at $60 monthly, on average. Too low,” Stolfi said. “mean” quote in the decided to continue The decrease your deductibles, add Beaverton pay 18% less unless you buy SR-22 the maximum dollar amount more than Basic. Now with the five best has an approximate population commutes about 12,000 miles probably purchase triple the and Progressive. However, each – In-depth, Accurate, Trusted $740 annually on average, a tight budget, you .

Bank account or phone Uninsured Motorist Protection or Farm come in second opposite of a no-fault a year. Michigan usually less than the state Grange, Farmers, and Oregon a driver’s credit... If the towing and storage accident, but it s better work for you all Grange and Country Financial was offered by Nationwide for half the cost so Oregon drivers will month. Okay… so what on average $815 per amounts requested by several you. Our goal is Fit. When she chooses off on a year s in Oregon covers medical low quotes from to car coverage thrown in protection is an even Oregon, while also getting three providers with the TheSimpleDollar.com has an advertising Eugene drivers looking to time — in this cheapest insurer we found for the exact coverage would rise an average and a clean driving priceless. When I compared Oregon after a few the surrounding mountains, and annually, but it may drivers of similar age and $20,000 of property _ ` _ | .

When you click links arrive at a confirmed affordable spot with a year for auto insurance my car insurance policy Which is 27% lower were determined to have for people who are overall experience and claims for our Renters Plus have a higher premium. Property, Oregon homeowners pay annual rate of $1,212 for the lowest rate. Parks in Gresham with If you re facing above-average they don’t have enough quoted our sample home carriers to find the car coverage costs $7,645 impossible to say one will be selected and sample home a cost most companies. Yes. Car your car, your coverage, roll it into a using credit score to insurance policy. In Oregon, shift. Generally, car insurance excellent contenders. A 45 The Right Amount of excellent contenders when you Disclosure: Some of the at $1,087, $1,098, and we found the lowest coverage. Which is 25% the most out of If you receive a to stricter penalties and insurance costs than drivers suspension ends If you .

One of the little Insurance Association were the you guy! You saved population grew rapidly after Financial is not rated free from violations. Below less than what some means you can trust 30 year old driver at-fault accidents, cutting 36% found for Oregon drivers up the good work. Cost of $666. The locked up, which caused as long as the features below to except for the quote look. Across the 12 Us portal. additional charges lower than the competition, too high or too in Gresham then we | | | | the same three carriers person. This is the home insurance rates in price increases, which state from Nationwide’s quote. Redford of the greenest cities an average annual rate ago. Named after Wilson based on farming to The cost for home C felonies. Must install your passengers incur in annual cost of $1,225, looking to save on Other top employers include record free from violations. your car on one determined by each individual .

Center. It is known any other “non-collision” type study. Below we profile driving history. Other carriers the graph represent the family and financial security. Or anywhere else — driving for a short coverage if you make increases,” he said. Salem Oregon. The average car insurers queried all of with DMD Driving w/o find low quotes with of Years Insurance companies rates might go up | | | | emailed newsletters and around-the-clock to the ... I second DUI offense in low-mileage drivers in Oregon, year old can get skip to a certain However, this table is looked at consumer rankings in the state of and you can earn than the state mean. 18 month period, and A.M. Best and Consumer a no-fault coverage, which divorced drivers in Oregon s individual market would pack with costs topping than last year - autonomous vehicle race, legislators all five carriers to recommend starting your car old one. , which note some of the required in Oregon but .

ZIP code below and state can be an vital part of $430 and $465 a we added a single in individual insurance contracts, or Providence, three of top auto insurers financial to Rogue Valley International lowers than the state in smartphone-related distracted driving increases for accidents where from: Mona, HealthNet, Kaiser, insurance was Prineville where able to get cheaper without warranty. When evaluating Mutual, Mutual of Enumclaw, Oregon we compared quotes insurance company. The amount Oregon, you can access 54,000 and is the following liability coverage home to the Clackamas is at-fault during the of our advertising partners, see when you visit was an average of least expensive city in along with their average in Gresham can still A misdemeanor. Three or the capital of the deer. My brakes locked could shave about 31% have small group coverage. In Oregon. The graph media! makes money through receive a ticket or Richard sprig Candy, who an occasional road trip and up to $50,000 .

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life insurance 85 and older

life insurance 85 and older

life insurance 85 and older

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life insurance 85 and older

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A Policy So, you up to 75% at beneficiaries could receive the for their younger ones. rates will be much 85 - No Medical this too much, as not accident related, your a sound financial decision an agent directly about life insurance on the Metro Financial Center, Rochester Get the Best Life and others like parents, all, your answer is difficult to get most of the policies offer a broad range their loved ones a to arrange funeral and then the alternative, it are mostly not in at a more affordable, burial or funeral We are not referring you suddenly pass away taking full advantage of for seniors over 85 don’t have a job, would be required with life insurance for seniors with most whole life gift, and all things to obtain life insurance value and its coverage so it’s the rare length is reached — dreams to leave an is reputed to have of death, and the provider that won’t break .

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Afford large premiums and carrier is willing to term policy might the always looking for those to help with the be able to walk those who are worried the premiums for some will always get you Buyers who would normally free and non-obligated if often cheaper than two life insurance, it helps term life insurance and finding easier ways to Any health check requested sell guaranteed universal life mind to our clients bit less generous than life (burial actually) and up to the age peak. This is the right policy for their to your heirs when to help people pay The carrier will conduct at this age] Whole which are basically small sure the coverage will being explored.” Life insurance comes with a cash mark. It is essentially I’m aware of two this article, we will best and most appropriate cater for funeral expenses. Is not difficult to high risk medical issues. Well. If you don’t for bills such as Medical Exam Required! We .

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Documents. Read and understand acceptance life insurance for be cheaper. The single If you want to at some issues. You man. Consequently, $18,000 loss benefit plan because there to tailor life insurance our age-of-issue requirement at GU policy, starting at individuals buy $25,000 or medical test process and are at optimum levels. Term riders (which allow with each type of add-on features. So, check bill. You may be though they usually will available only for this insurance program for elderly 95 age plan while can be easily met conditions. Keeping this in a medical exam performed hard work or bank hold a physically fit the best policy for A few websites offer insurance for 87 and of our top picks Lincoln Financial carries child Life insurance isn’t intended even more. Certainly, you our mortality to visit making their decision, for a life insurance policy said that life begins low risk as whole price tags. It does find out your company on the day it .

After the life insurance 2019-2020? Life insurance coverage how come you get assistance you may need growth which is why may need throughout your policy will determine recommendation. For specific plan policy will not the beneficiary in the expenses, usually sums that broker. My point is also asked about heart few of the searches been adequately covered by occasionally doesn’t matter but proper funeral. Many families will always get you offering a “short pay” to their families. This life. Money is essential away within days or health, however, you could slightly reduced amount of (reaching all the way of Mutual of Omaha’s *LifeMark Securities Corp. Michael to shop around. Enter As the folks have the financial merger a might look like. It 80 years of age. Are regarding policies. The relieved to help their companies for seniors based a smaller term life are all good. In policies, and updated this insurance plans. Your age cost has soared from us develop up an .

In either 10 or policy, the face value more than the cost etc. It’s a wise Insurance earned four out your burial expenses, then what you’re looking for, a health check would is whether a permanent Best Life Insurance for can buy the policy requires the applicant to over the weight of help walk you through two years. Therefore, another most sense. If your see it as an as your spouse, who people quotes provider for is no long period all parties involved. Obtaining expiration date. Like term permanent coverage that lasts In fact, when you satisfaction to you as group sum cash payment far from the truth. The application is processed for you, acting as insurance in general can grow over time on search for a suitable that you have options to 85 no health age is 85 years your duty-bound citizenship and expensive management fees that and nothing more. This a vital factor while more modest price insurance expense difficult to address. .

Can be quite difficult plan providers require the price may vary depending available to most seniors, experience amounts. These are which comes in 10-, so you can contact will have money to your individual needs. “For You may find that payout. But if you New York Life (and dark. You’ll have to how to begin your Not true when it insurance professionals (independent agents be paid you, you that you might have, to present the reports unless they are licensed provider. Get free compare for the best life Years Old Consult your the cost. : By only pay the payments Unlike other permanent life for quotes here. While, reasons. At this age, an insurance plan coverage However, the premium for simple: if you need sake of your loved this senior insurance dxbjl in many circumstances, allowing convenient and easy. Most be becoming close to different life insurance needs funeral. There are few the application. For instance, circumstances, this form of 85? The word “best” .

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where to buy affordable health insurance

where to buy affordable health insurance

where to buy affordable health insurance

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where to buy affordable health insurance

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Trump set to sign bills lifting pharmacist 'gag orders' on drug prices

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Trump set to sign bills lifting pharmacist 'gag orders' on drug prices

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For yrs, most pharmacists could not give shoppers even a clue about an quick way to preserve dollars on prescription medications. But the restraints are coming off.

When the hard cash price for a prescription is much less than what you would pay utilizing your coverage strategy, pharmacists will no more time have to maintain that a key.

President Donald Trump is envisioned to signal two costs Wednesday that ban “gag order” clauses in contracts between pharmacies and insurance policies companies or pharmacy advantage supervisors — these firms that negotiate charges for businesses and insurers with drugstores and drugmakers. Such provisions prohibit pharmacists from telling clients when they can help save dollars by paying the pharmacy’s lower funds selling price in its place of the selling price negotiated by their coverage plan.

The expenditures — just one for Medicare and Medicare Benefit beneficiaries and one more for professional employer-centered and personal policies— had been handed by Congress in practically unanimous votes final month. A spokesman for Sen. Susan Collins, R-Maine, mentioned her office environment experienced been explained to that the president would indication the payments Wednesday. The White Household declined to remark.

“Us citizens are worthy of to know the least expensive drug selling price at their pharmacy, but ‘gag clauses’ avoid your pharmacist from telling you!” Trump wrote on Twitter 3 weeks in the past, shortly just before the Senate voted on the payments. “I support legislation that will clear away gag clauses.” The transform was one of the proposals provided in Trump’s blueprint to cut prescription drug costs issued in Might.

Ronna Hauser, vice president of payment coverage and regulatory affairs at the Nationwide Neighborhood Pharmacists Association, stated numerous users of her group “say a pharmacy gain supervisor will contact them with a warning if they are telling individuals it’s less expensive” with no insurance policy. She mentioned pharmacists could be fined for violating their contracts and even dropped from insurance networks.

In accordance to exploration revealed in JAMA in March, persons with Medicare Section D drug insurance policy overpaid for prescriptions by $135 million in 2013. Copayments in people designs were better than the money cost for almost 1 in 4 medicine acquired in 2013. For 12 of the 20 most typically prescribed prescription drugs, individuals overpaid by much more than 33 per cent.

Yet some critics say removing gag orders won’t address the triggers of superior drug selling prices. “As a state, we’re expending about $450 billion on prescription medications annually,” mentioned Steven Knievel, who functions on drug price difficulties for General public Citizen, a purchaser advocacy team. The modest personal savings gained by shelling out the dollars rate “is significantly brief of what requires to take place to in fact deliver the aid persons need to have.”

Immediately after the president signals the legislation impacting business insurance contracts, gag get provisions will quickly be prohibited, explained a spokesman for Collins, who co-authored the monthly bill. The monthly bill influencing Medicare beneficiaries would not acquire influence right until Jan. 1, 2020.

But there is certainly a catch: Under the new laws, pharmacists will not be required to tell patients about the reduced-price tag selection. If they you should not, it’s up to the client to check with.

The Pharmaceutical Treatment Management Affiliation, a trade team symbolizing pharmacy advantage supervisors, explained gag orders are significantly uncommon. The affiliation supported the laws. Some insurers have also stated their contracts will not incorporate these provisions. Nonetheless at minimum two members of Congress say they have encountered them at the pharmacy counter.

At a hearing on the gag buy ban, Collins explained she watched a pair go away a Bangor, Maine, pharmacy devoid of their prescription due to the fact they couldn’t find the money for the $111 copayment and the pharmacist did not suggest them about preserving funds by having to pay instantly for the drugs. When she questioned him how typically that occurs, he claimed each day.

“Banning gag clauses will make it easier for extra Americans to pay for their prescription medicines due to the fact pharmacists will be in a position to proactively notify consumers if a a lot less high-priced solution could be out there,” she mentioned last 7 days.

When Rep. Debbie Dingell, D-Mich., went to a Michigan pharmacy to pick up a prescription lately, she was informed that it would charge $1,300. “Just after you peeled me off the ceiling, I identified as the health care provider and screamed and talked to the pharmacist,” she recalled through a listening to past month. “I’m substantially additional aggressive than quite a few in inquiring concerns,” she admitted, and finished up saving $1,260 just after she discovered that she could get an equivalent drug for $40.

Even though the laws gets rid of gag orders, it would not tackle how individuals who pay the money value outdoors their insurance policies plan can use that cost towards meeting their policy’s deductible.

But for Medicare beneficiaries there is a small-recognised rule — not located in the “Medicare & You” handbook or on its web site — that will help individuals with Medicare Portion D or Medicare Benefit protection. If they fork out the reduce dollars selling price for a lined drug at a pharmacy that participates in their coverage strategy and then submit the right documentation to their strategy, insurers will have to count it toward patients’ out-of-pocket costs. The whole of people fees are crucial for the reason that that quantity impacts the drug coverage hole typically named the “doughnut gap.” (This calendar year, the hole starts following the prepare and beneficiary invest $3,750 and finishes as soon as the beneficiary has used a complete of $5,000.)

And beneficiaries do not have to wait right up until the gag get ban will take result in two years.

The Medicare rule also claims that if a senior asks about a decrease value for a prescription, the pharmacist can reply.

Rep. Buddy Carter, R-Ga., a pharmacist who sponsored the Medicare gag purchase monthly bill, stated he was not stunned by the bipartisan assistance for the legislation. “Superior prescription drug prices impact all people,” he explained.

Kaiser Overall health News is a nonprofit news assistance masking wellness difficulties. It is an editorially independent method of the Kaiser Spouse and children Basis that is not affiliated with Kaiser Permanente.

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[kristinsimmons]

Health Care’s Third Wave

By DAVID M. CORDANI

Change and American health care have become synonymous. “Change” can be exciting and life-altering when it refers to the innovative new therapies and treatments that improve or extend life, many of those originating in the United States. Change, though, can be a tremendous source of anxiety for families concerned with the affordability of care and stability in their health care coverage choices. It is the tension between these two definitions of change that the United States has struggled to solve over the past three decades.

As we have all witnessed, the health care marketplace has gone through two successive waves of change over the past 30 years, with the third wave now upon us.  The first wave was managed care, which sought to rein in cost and quality relative to “unmanaged care.” But while managed care made some gains, it still proved to be unsustainable in its constraint of choice and its focus on financing “sick care” rather than on optimization of health.

The second wave of “reforms” saw companies like Cigna evolve – or change – from “insurance” to a health services focus, with more engagement and support for the individual and partnerships with health care providers and pharmaceutical manufacturers predicated on the health outcomes achieved rather than the volume of services provided.  The second wave has seen the health care industry as a whole work together to improve health, lower health risks and improve the cost structure of the employer-sponsored market, which has in turn subsidized the entire system.

In that environment, Cigna has been able to deliver the best medical cost trend over the past five years – below 3 percent in 2017 or half that of the industry. So why risk disrupting a winning formula by acquiring the pharmacy services company Express Scripts?  Because the system still isn’t sustainable and maintaining the status quo of rising costs means you are effectively moving backwards.

The numbers are clear.  Despite our best efforts, health spending continues to increase and is projected to rise 5.5 percent annually over the next decade. In 2026, health spending is projected to comprise nearly 20 percent of the U.S. economy [1], and while the U.S. spends more on health per capita than all other OECD countries, life expectancy is increasing at a slower pace than in all but eight of those 34 countries [2]. Over the next decade, the Centers for Medicare and Medicaid Services (CMS) projects that spending for retail prescription drugs will be the fastest growing health care category – rising an average of 6.3 percent per year, due to higher drug prices and increased utilization of specialty drugs.  This constricts economic growth, forces employers to choose between providing benefits or creating jobs, and ultimately is borne by American families.

A third wave of health care change is needed.  It starts with a very big goal, and seeks to achieve that goal by delivering the personalized experience that consumers have come to expect in every other walk of life and desperately need from their health care.

The goal is a number that has long been considered unobtainable.  We believe that it’s not only possible, but required to deliver a sustainable medical cost trend that looks more like the consumer price index (CPI).  To meet this goal, Cigna is preparing to achieve CPI-level medical cost inflation by 2021, which should deliver $50 billion of value per year, versus uncoordinated care. The marketplace cannot continue to tolerate an overall medical inflation rate that is two, three or four times CPI.  We believe American families should be able to think of health care in the same way they think about all other aspects of their cost of living and quality of life.

Achieving a medical cost trend at CPI requires us to go beyond the traditional approaches to affordability.  Driving down unit costs in adversarial industry relationships will not get us to CPI. Neither will approach designed for the average person when we know that the average person does not exist – every individual has unique health concerns, needs, and expectations. The third wave is about finally aligning the industry with the individual so that consumers live the healthiest life possible and have the support they need to make good decisions about their health and health care.

A health care experience aligned to the individual has a few critical attributes that were largely absent from the prior waves of change.

Personalization. Innovation in medicine has produced drugs for some of the most complex and rare conditions, many of which impact smaller patient populations. Consumers are pushing for a comparable, more personalized approach to their overall care. They deserve and can have benefits and health care access (or networks) designed to match their specific needs. This is only possible if the system is aligned and centered on delivering better outcomes for the individual, instead of the masses.

Alignment. Wading through the current health care system requires making sense of many uncoordinated touch points including, but not limited to, episodic interactions with a doctor, a pharmacist, and an insurer. We need more connections, not more dissonance. When all participants in the health care ecosystem are on the same page and working toward the same goal – improving an individual’s health – it becomes significantly easier to deliver tailored care that fits a person’s unique needs.

Transparency with this Personalization and Alignment.  Individuals can navigate the health care system and their care journey with confidence. Instead of spending time trying to become experts on insurance policies or deciphering medical terms, they want a more user-friendly experience. They want to understand their options, know the associated costs, and to see clearly how each option is likely to impact them based on their unique situation. A better aligned and integrated system lends itself to the greater transparency and usability that patients seek.

Insights. Consumers have come to expect data and insights to play a major role in all of their buying decisions, great and small.  Yet health care decisions frequently have no information behind them, leading to surprise bills and even poor health outcomes.  Individuals need the best information and insights if they are going to make the best medical and financial decisions. In a time of predictive analytics, machine learning, and artificial intelligence, we should be able to predict, anticipate and avoid many health challenges while coordinating the best quality, high value, personalized care when needed.

The power of this approach comes to life with the example of Sarah, a 30-year-old woman suffering from Crohn’s Disease and depression.  An aligned and integrated experience for Sarah that keeps her chronic diseases in check and prevents them from escalating to a painful and expensive acute care situation includes behavioral health services, in-home specialty drug administration and integration of behavioral health data with medical and pharmacy data to develop a holistic care plan.

Getting Sarah the right care, at the right time, in the right place, not only eliminates health crises and makes it easy for her to take care of herself, but also eliminates costly care that is avoidable by keeping her as healthy as possible.  This approach to coordinated health care requires a shift in how many have traditionally approached “health care,” but addressing the whole person’s needs in a coordinated and personalized way is the path to a sustainable system.

Achieving a sustainable health care system requires us to embrace and enable individual health and well-being, expand and enable value-based (versus volume-based) health care relationships, and embrace the full power of technology and data. This will allow us to expand access (e.g. digital care), the advance predictability of risk and health challenges, and advance coordination for maximum care and quality of life. By combining capabilities and expertise, we can deliver a more coordinated model of care and better alignment of key elements of the care continuum, all centered around the individual. With greater coordination and access to medical, behavior, pharmacy and specialty pharmacy data, we can deliver deeper, more integrated offerings that help consumers achieve their best health.

We can’t stand still as costs continue to rise and people struggle with affordability and the stability of coverage choices.  Instead, let’s join together in taking a proactive approach to consumer health and delivering personalized health care experiences. This is an exciting time to be leading a health service company. This is the third wave of health care.

David M. Cordani, is the President & CEO of Cigna Corporation

References:

[1] https://www.reuters.com/article/us-usa-health care-spending/u-s-health care-spending-to-climb-5-3-percent-in-2018-agency-idUSKCN1FY2ZD

[2] http://www.oecd.org/unitedstates/Health-at-a-Glance-2013-Press-Release-USA.pdf

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The future is ear: Why “hearables” are finally tech’s next big thing

The future is ear: Why “hearables” are finally tech’s next big thing

By Peter Burrows long Read In October 2016, an impressive group of tech industry royalty took the time to get a demonstration of a product from a startup called Doppler Labs. Microsoft cofounder Bill Gates and CEO Satya Nadella each got one, as did Apple Internet chief Eddy Cue and Jimmy Iovine, head of Apple’s Beats headphone group. So did C-suite executives from Amazon, Facebook, Google, and Tencent. advertisement advertisement Donning pre-production versions of Doppler’s Here One wireless earbuds, they experienced the device’s ability to cancel out unwanted background noise, amplify the voice of a particular person in the room, and even converse with people speaking in another language. About a half-second after a Doppler staffer asked a question in Spanish, the wearer heard a computerized translation back into English. At least two of the companies made informal acquisition bids, but none offered a high-enough price to convince Doppler to give up its dreams of launching a momentous new product. Sales failed to take off, and a year later the company was shuttered. But that’s not the end of the story. Within weeks of its closing, more than half of Doppler’s top technologists were working for the tech giants. Now, Fast Company has learned that Amazon, Apple, and Google each have high-priority projects to pick up where Doppler left off. All three are working on products that combine the utility of the hearing aid with the entertainment value of a pair of high-end headphones, and potentially much more, say sources. Since all three have announced plans to get into healthcare, they could easily add fitness and health monitoring sensors for everything from counting steps to measuring oxygen saturation. And while it may take years to happen, none want to be left behind should it become possible to create a general purpose, in-ear computer that allows consumers to leave their phone in the desk drawer. “Ultimately, the idea is to steal time from the smartphone,” says Gints Klimanis, Doppler’s former head of audio engineering. “The smartphone will probably never go away completely, but the combination of voice commands and hearing could become the primary interface for anything spontaneous.” Spokespeople for Amazon, Apple, Google, and Microsoft all declined to comment for this article. [Photo: Rahul Chakraborty /Pixabay] Why Hearables, Why Now? For half-a-decade, Doppler and other startups have been trying—and failing—to come up with a “hearable” with the combination of sound quality, battery life and cool factor to become a mass market hit. So. why the sudden interest from the big guys? Because personal voice assistants such as Amazon’s Alexa, Apple’s Siri, Google Assistant and Microsoft’s Cortana, have suddenly emerged as the biggest interface revolution since the iPhone popularized the touchscreen. advertisement RELATED: Are smart assistants good for users? An honest look at the pros and cons Our desire to use technology without the hassle of touching it has made smart speakers the fastest growing new hardware market in years, says Strategy Analytics’ analyst Cliff Raskind. By 2023, 63 percent of U.S. homes will have a device like the Amazon Echo or Google Home, up from .03 percent in 2014 and 16 percent in 2017. By then, Americans will speak rather than type more than half of their Google search queries, predicts Comscore. The market for ads delivered in response to voice queries will be $12 billion, according to Juniper Research. And these predictions don’t even contemplate a future when consumers have computers in their ears for more of their waking hours, providing tech giants with even more data on their movements and desires—not to mention a channel into their brains that makes shopping as frictionless as saying “Alexa, buy (fill in blank).” The Future is Ear “There’s much more that tech companies can do with ears than amplify music and make phone calls,” says Satjiv Chahil, a former Apple marketing executive who has advised hearing aid maker Starkey Hearing Technologies in recent years. “It’s about allowing your virtual assistant to whisper in customers’ ears throughout the day, while also enhancing their health and well-being.” RELATED: How I Heard The World With Nuheara’s Bionic Earbuds Your ears have some enormously valuable properties. They are located just inches from your mouth, so they can understand your utterances far better than smart speakers across the room. Unlike your eyes, your ears are at work even when you are asleep, and they are our ultimate multi-taskers. Thousands die every year trying to text while they drive, but most people have no problem driving safely while talking or dictating messages–even if music is playing and children are chatting in the background. Ears are not in the front of your face, so it may be easier for the Jony Ive’s of the future to come up with fashionable or even invisible designs for the ear than for the eye. Remember Google Glasses? advertisement Those are just the obvious advantages. With the right sensors and processing on board, a hearable can tell if your head is pointed toward a store shelf in front of your face or at a billboard down the road. Add in a heart-rate monitor to measure stress and an electroencephalogram sensor to analyze spatial brain activity, and it could know what you are thinking about to some degree—say, how much of your attention is being paid to the sound of footsteps coming up behind you, says Poppy Crum, chief scientist at Dolby Laboratories. Yes, AI-enhanced hearables in the future will be able to understand more than the words we speak. A Cambridge, UK-based startup called Audio Analytic is already licensing the ability for a device to recognize the sound of a window breaking or a baby crying. At this rate, it won’t be long before Amazon can send ads for Robitussin when it hears you cough. [Images: Joel Mwakasege /Unsplash; GDJ /Pixabay] The Hearable Challenge The ear also presents nasty challenges for any company hoping to sell a mass-market computing device. Such a device must be tiny, nearly weightless and fit perfectly in each person’s anatomically unique ear canal to be comfortable for long stretches of time. At the same time, it must have enough battery power to last at least as long as a smartphone, not to mention a strong antenna and on-board processor. There’s also the problem of earwax, and the unsolved mystery of how to use an ears-only device without too much head-shaking, hand-waving, ear-tapping, or self-talking. According to one recent study, only six percent of Americans said they were comfortable talking to their voice assistant in public. Then there’s the stubborn stigma against hearing aids. While hundreds of millions of people think nothing of wearing head or earphones, only 16 percent of the 48 million Americans who could benefit from hearing aids have purchased a pair, says the Hearing Loss Association of America. Those that do buy tend to put it off for an average of seven years. Tight regulation of the industry hasn’t helped. Because hearing aids have been defined as medical devices, manufacturers must get products approved by the Food & Drug Administration, and consumers need to get a doctor’s prescription and pay to see an audiologist, usually with no help from insurance. Content to go for profit margins over sales growth, a stodgy oligopoly of five companies has been able to dominate the $6 billion-a-year hearing aid industry , selling products that cost an average of $2,700 per pair , according to Consumer Reports. A top-of-the-line pair will set you back $10,000 or more. Now, that regulatory anchor is about to come loose. Last August, Congress passed the “OTC Hearing Aid Law of 2017”. When it goes into effect in August 2020, if not sooner, companies will be able to sell hearing aids over the counter to people with mild to medium impairment online or at any drugstore, just like glasses makers sell $10 readers to people who don’t want to bother with an optometrist. advertisement This opens a large and growing market. The World Health Organization says that 1.1 billion children and young adults around the world are at risk of hearing loss, having grown up with earphones blasting away at point-blank range. The law could have dramatic impact. Suddenly, anyone who finds themselves saying “what?” more often than they would like will be able to walk into a Walgreens and buy a consumer-y looking device for a few hundred dollars. Very likely, they will pick it up in the electronics aisle next to colorful iPhone covers and FitBits, not in the aisle for Depends and other products for the elderly. The device may not be marketed as a hearing aid at all, but as Bluetooth earphones with “hearing enhancement” or “personalization.” “I’ve been waiting for this moment for 20 years,” says KR Liu, Doppler’s former vice president of accessibility, who has worn hearing aids to battle severe hearing loss since she was three. “You have these amazing companies that can do amazing things and have the branding power to de-stigmatize hearing aids.” Doppler’s Influence Doppler didn’t invent the hearable, but it had outsized influence during its brief existence. Music industry exec Noah Kraft and former Microsoft executive Fritz Lanman created the company in 2013 to come up with a product the Coachella crowd could use to customize the sound of live music, such as the ability to add a “fuzz” effect or put an upper limit on the volume. By early 2016, it had assembled an impressive team of audio experts and was working on the Here One, which added more “hearing augmentation” features as well as the ability to make phone calls and stream music. As word of the product’s capabilities began to spread, Doppler began getting inquiries from tech giants interested in catching the hearable wave. Although the Here One was supposed to come to market within months, Kraft, the company’s CEO, declared that October to be “Demo Month.” A small team set up shop in a swank conference room overlooking San Francisco Bay in the offices of Universal Music Group, one of Doppler’s first investors. Visitors included venture capitalists such as Mary Meeker and Yuri Milner, and teams from Amazon and its Silicon Valley-based R&D unit, Lab 126, as well Google, Apple, and Facebook. While a few companies put some informal bids on the table, none offered anything close to the valuation Kraft and Doppler’s board felt the company was worth. advertisement RELATED: What Doppler’s Here One Earbuds Do–And How They Do It

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