There is nothing more confusing than trying to choose good health care coverage. People often ask, “Which insurance is good?” Not only do consumers want quality medical care and coverage for it, they often desire coverage for alternative therapies like chiropractic, massage, acupuncture, and naturopathy. But often, patients are surprised to learn of tight restrictions on alterative therapies with their chosen plan. Some plans allow only specific service providers; others allow only for a specified number of visits per year, while others like Brown and Toland allow their patients to visit alternative health care practitioners only in San Francisco. Other carriers actually dissuade their members and practitioners from using their benefits, by not covering standard treatments, or weighing down both patient and doctor with bureaucratic paperwork and mandatory preauthorization, and then providing only low reimbursement. The carrier guiltiest of these practices is American Specialty Health Plans (ASHP). Beware of choosing a health plan that uses this middle-management company.
ASHP came on the scene of managed health care about 20 years ago, touting its promise to screen doctors, lower health care costs for employers, and offer employees topnotch care. It seemed utopian. Small at first, securing health care management of companies directly, eventually ASHP took its tactics to insurers themselves. Today, it is one of the largest management companies, servicing large carriers such as Aetna, Blue Cross, and United Healthcare. You will know if it is part of your health plan by looking on the back of your insurance card. You will see ASHP in tiny type. For the patient who seeks alternative health care, it can mean paying many out-of-pocket expenses or not getting the care you need. Why? Because ASHP pays for only very limited services. Any services outside its plan must be paid 100 percent by the patient. These are for regular standard-of-care treatment options, not obscure or experimental options.
Some would argue that ASHP goes as far as to discourage practitioners from giving full, adequate treatement to their patients. ASHP requires heavy paperwork, preauthorization, and low reimbursement. For example, ASHP will pay a prequalified doctor in its plan roughly $20 to perform a chiropractic adjustment. The patient would co-pay perhaps $10 or $15, which means the doctor’s office visit would total about $30 or $35. For that $35 the doctor must write a report, request a certain number of visits, perform an exam, report on that exam, all so that he or she can substantiate another four or five visits for the patient, which may or may not be approved. It is a large-scale game of Mother May I. Meanwhile, the fee is so low that doctors are tempted to overbook their calendars, with patients scheduled every five or 10 minutes, rushing them out of the treatment room.
So the next time you want to ask your doctor a few questions about exercises, or you would like additional treatment or service, but you feel they are rushing you out the door—they are. That doctor is not getting paid for the service you are asking for. Anything not covered on the plan must be paid for 100 percent by the patient. ASHP will demand that the patient complete paperwork acknowledging those fees and agreeing to pay for them out of pocket. If that seems like a hassle, it is. Your doctor really just wants to treat you and make you feel better. Believe it or not, he or she wants to do everything within his or her power to make that happen. Your doctor would love to be able to teach you those exercises and have your insurance pay for it. But ASHP has cut into alternative-care practictioners’ income already up to 50 percent or higher, forcing doctors to have a McDonald’s-fast-food approach, demanding high volume and little face time with patients. It may be permissable for a burger, but not for health care. Both patients and doctors lose out. Insist on something better.
Consider changing our health care system with your choice of carriers during your open-enrollment period at work. Consider avoiding ones that use ASHP and choose an alternative. Choose a carrier like Blue Shield of California, UMR, or United Healthcare PPO, which prescreen all of their doctors, offer a wide selection of services covered for alternative care, and deal directly with both patients and practitioners without handing it off to a middleman.
Please post this 2010 letter from California Coastal Commission staff to Joe Hurley, director of San Mateo County Transportation Authority (SMCTA), and copied to the City of Pacifica and Caltrans, as a matter of public record. On page 1, paragraph 2, CCC staff lays out the permitting role of CCC and the city. For some reason, this letter and its instructions have been left out of the highway-widening environmental impact report (EIR). Furthermore, the city seems to be in denial that it has a permitting role at all. Food for thought.
Contract change orders responsible for price overruns.
BY CAMDEN SWITA, PACIFICA PATCH Caltrans' Devil's Slide Tunnels project has run about $30 million over budget, the Half Moon Bay Review reported Wednesday. According to the Review, the cost overruns are a result of several contract change orders made by the state transportation agency over the past four years. The change orders have revised contracts for things such as steel reinforcements and repairs of cracks found by engineers. The extra $30 million brings the total price tag of the project, which would connect the Midcoast to Pacifica, to just over $300 million, the Review reported. Other recent project setbacks have cost both time and money, such as the discovery of "strange" soil patterns that will delay the opening of the tunnels to late 2012 and legal trouble between two area water districts earlier this year.
Six conservation groups are seeking a preliminary injunction in federal court against the San Francisco Recreation and Parks Department to stop illegal pumping of water from wetlands and prohibit harmful mowing and motorized golf-cart use on nine golf course holes near wetlands at the Sharp Park golf course in Pacifica. The injunction will help protect endangered San Francisco garter snakes and California red-legged frogs from these harmful activities.
“No more business as usual at Sharp Park — illegal pumping and mowing of wetlands stops now,” said Jeff Miller with the Center for Biological Diversity. “The best scientific experts on endangered species are calling for a moratorium on harmful golf course activities in and near wetlands habitat, and we hope the court agrees.”
The Wild Equity Institute, Center for Biological Diversity, National Parks Conservation Association, Surfrider Foundation, Sequoia Audubon and Sierra Club filed a motion for a temporary injunction on Friday on golf-course activities that are hurting endangered species. The injunction would last until a pending lawsuit is heard or the Recreation and Parks Department adopts an approved “habitat conservation plan” and obtains legal permits under the Endangered Species Act. The plaintiffs are represented by the environmental law firm Meyer, Glitzenstein & Crystal.
“These science-based restrictions will protect our most imperiled wildlife from harm while allowing golf on many of the course areas,” said Brent Plater, executive director of the Wild Equity Institute. “Their duration will provide us all an opportunity to evaluate proper permitting options and restoration activities at Sharp Park.”
Leading scientific experts on the red-legged frog and garter snake, with collective experience of more than seven decades of research and study of California amphibians and reptiles, submitted declarations in support of the requested injunction. These experts contend that golf course activities impair the long-term survival and recovery of the species and that the Parks Department’s alleged compliance plan is not being followed and is unworkable. See quotes below from these experts explaining why the injunction is justified.
Crumbling infrastructure, annual flooding problems, declining conditions and ongoing Endangered Species Act violations at the golf course require changing how Sharp Park is managed, but such changes are not financially feasible for San Francisco’s strained budget. The San Francisco Board of Supervisors will vote next month on legislation introduced by Supervisor John Avalos to repurpose the golf course and transition management of Sharp Park to the National Park Service’s Golden Gate National Recreation Area to improve recreation and public access, protect endangered wildlife and save San Francisco taxpayers money. The proposed partnership will end the city’s legal and financial liabilities and put the National Park Service in charge of protecting endangered species and providing public recreation, allowing San Francisco to reinvest its scarce resources back into city-based parks, recreation centers and golf courses.
For more information and background, visit: http://wildequity.org/sections/5
Quotes From Scientific Experts
Dr. Vance Vredenburg is an assistant professor in biology at San Francisco State University, research associate at the California Academy of Sciences and U.C. Museum of Vertebrate Zoology, and an expert on California amphibians and the red-legged frog.
“Sharp Park must have successful recovery actions implemented, or it will one day lose its red-legged frog population, and potentially jeopardize populations at nearby properties as well.”
“The city is not, and cannot, actually implement the Compliance Plan…making it virtually certain that California red-legged frogs will be taken unless the relief requested by the plaintiffs here is granted...San Francisco must be ordered to cease all pumping at Sharp Park.”
Dr. Marc Hayes is a biologist with four decades of experience studying reptiles and amphibians in California. He wrote the Department of Fish and Game’s “Amphibians and Reptiles of Special Concern in California” and submitted the petition that led to listing the red-legged frog as threatened under the Endangered Species Act.
“Unless golf-course operations that cause ongoing take of these species are halted, both populations at Sharp Park may be lost, and the San Francisco garter snake’s entire species will be in jeopardy.”
“The Recreation and Parks Department should be prohibited from operating the pumps at Sharp Park until a decision is rendered in this matter…the court should grant plaintiffs’ request to prohibit all mowing and golf-cart use within roughly 200 meters of the delineated wetland.”
Wendy Dexter is the principal biologist at Condor Country Consulting, with 20 years of experience in herpetology, particularly regarding the San Francisco garter snake and red-legged frog, and specializes in endangered species compliance and permits.
“The San Francisco garter snake’s habitat at Sharp Park has not been secured, and the subspecies has been taken, and will continue to be taken in the foreseeable future, by the continued operations and management of Sharp Park Golf Course…I am certain that undocumented deaths of snakes occur annually if not more frequently.”
“Unless the golf-course operations that cause take of the San Francisco garter snake are halted in areas where the snake is likely to be found, the Sharp Park/Mori Point population will continue to decline, increasing the potential for the population to become extirpated.”
Jeff Miller Conservation Advocate Center for Biological Diversity (415) 669-7357 351 California Street, Suite 600 San Francisco, CA 94104 www.biologicaldiversity.org