Letters to the Editor is a periodic function. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.

Sufferers as Educators

I learn, with curiosity, your article concerning the difficulties that adults with Down syndrome face within the medical world (“Folks With Down Syndrome Are Dwelling Longer, however the Well being System Nonetheless Treats Many as Children,” April 17). I would add that this type of factor is an issue for adults with developmental disabilities normally. As an autistic grownup, I can positively relate.

I’ve truly discovered myself generally having to coach docs about my situation. It’s as if they don’t count on to see developmental disabilities amongst their sufferers. Whereas I’m able to advocate for myself, I’m very involved about those that can’t. One other vital level that your article makes is the necessity for medical professionals to deal with developmentally disabled adults straight. They need to additionally converse to them as fellow adults and never as kids. Whereas we could have a developmental incapacity, we’re additionally nicely conscious of the truth that we’re adults.

Lastly, your article mentions the problem of getting assist for folks over age 30. It is a drawback not just for these with Down syndrome however for folks with developmental disabilities normally. I’m 58 and was identified with autism at age 37. Whereas I’ve benefited significantly from the assistance I have obtained, I’ve additionally discovered it very irritating to be turned away from potential avenues of self-betterment simply due to after I was born. It’s by no means too late!

Thanks very a lot for this well timed article about adults with developmental disabilities.

— Elizabeth Avery, Weymouth, Massachusetts

Our well being system is not ready to take care of adults with developmental disabilities — Folks with Down Syndrome Are Dwelling Longer, however the Well being System Nonetheless Treats Many as Children https://t.co/vjHxtM6JrK through @kffhealthnews

— Ellen Andrews (@cthealthnotes) April 17, 2023

— Ellen Andrews, Hamden, Connecticut

I needed to take a minute and thanks for the article that was additionally printed on CNN about individuals who have Down syndrome who’re dwelling longer with out the medical neighborhood maintaining. My aunt has Downs and might be 71 this June!

She has endured so many ups and downs from the medical neighborhood since she was born within the Fifties to the place we are actually. Listening to tales of the previous, there are occasions I simply can’t consider she’s nonetheless alive. My dad and mom and different aunt assist take care of her in a rural space in Wisconsin and it’s been extraordinarily tough for everybody as she has gotten older. I despatched this text on and so they felt heard, for the primary time.

I respect you for bringing consideration to this not solely as a niece who loves her aunt, but in addition as a particular schooling instructor!

— Jennifer Pearce, Excelsior, Minnesota

Reminder for everybody to test the names in your medical payments, this occurs rather a lot. I simply had my son’s ER facility invoice are available in with my identify because the affected person. Straightforward dispute for us, cleaned after a single letter. https://t.co/Sr2rdI6MFQ

— pj (@pjsantoro) March 31, 2023

— PJ Santoro, Los Angeles

When Is an Insurer Not an Insurer?

I write to deal with what could also be an inaccuracy in your March 29 Invoice of the Month report, “ER’s Error Lands a 4-12 months-Previous in Collections (For Care He Didn’t Obtain),” which maybe will not be too materials to your protection (though it could possibly be if the dispute endured). However I feel it’s vital for KFF Well being Information to symbolize it accurately since your newsroom and KFF are extremely regarded sources of knowledge round well being care cost.

You repeatedly referred to UnitedHealthcare because the affected person’s “insurer.” To be an insurer, the entity, UnitedHealthcare, should assume the monetary threat of a declare, and on condition that HCA Healthcare is the employer, that’s extremely unlikely. Likely HCA is self-funded, straight assuming all monetary threat for its worker profit plan. UnitedHealthcare is probably going only a supplier of administrative companies to the employer and its lined workers, in what’s sometimes called an “ASO” association, that means administrative companies solely.

Why does this matter? Many causes, however first, UHC and related organizations like folks to consider them because the insurer as a result of it enhances model power in increasing their very worthwhile function as an middleman in well being care transactions. Within the “C suite,” nonetheless, well being plan executives and buyers are completely happy to keep away from the monetary uncertainty of well being care utilization, as an alternative having fun with the predictability of administrative earnings, together with by the supply of Rx advantages. UHC is actually a really massive ASO, as is Cigna, CVS, Elevance (previously Anthem), and lots of the bigger Blue Cross and Blue Defend entities. These corporations get to entry the shoppers’ funds to fund well being care in advancing their market-share enterprise aims.

Second, the opposite two key events in most three-way medical transactions, sufferers and suppliers, are fairly often unaware of this, which muddies the problems that come up in disputed claims, and broader well being care coverage. Self-funded advantages will not be analogous to insurance coverage in lots of vital respects, and using the phrase “insurance coverage” interchangeably has led to confusion and unintended coverage penalties. KFF Well being Information is nicely positioned to right this key misunderstanding. Your work on affected person billing dilemmas is a superb place to deal with this. Within the article about Sara McLin (if I’ve accurately surmised that UHC is the administrator and never the insurer), UHC might merely be recognized because the administrator. Most readers and NPR listeners would grasp that delicate however vital distinction.

KFF supplies a superb, clear image of business employment-based well being care profit financing within the annual “Employer Well being Advantages Survey.” As famous on this yr’s report, 65% of workers are individuals in self-funded plans. This quantity continues to extend.

My dive into this considerably esoteric nomenclature subject may be seen as a bit obsessive. In my 35-plus-year profession in well being care cost, nonetheless, I’ve repeatedly seen how this misunderstanding has fueled battle on the affected person/supplier degree and resulted in misguided public coverage. I hope you and your readers discover these feedback of some use.

— Marc Marion, Oklahoma Metropolis

We’d have all handled one thing like this. Irritating as each a doc and affected person. Extra ironic since household employed by HCA. https://t.co/xqrQjqBoUY

— Philip Chen (@DrPhil_ENT) April 8, 2023

— Philip Chen, San Antonio

KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Study extra about KFF.

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