Author Archives: Zuzanna Walter

The Rise of Eco-Anxiety

April 22, 2020

Uncontrollable wildfires, heatwaves, rising ocean levels, and other climate change conditions are contributing to a surge in “eco-anxiety” – a new subset of mental illness that is characterized by an intense fear of environmental damage or demise. This sense of anxiety is largely based on the predicted future state of the environment as related to human-induced change. While not the same as clinical anxiety disorder, eco-anxiety can worsen or trigger preexisting mental health conditions.

Per recent data, about 70% of people in the United States are worried about climate change, while over half feel “helpless” about the situation. More evidence is emerging suggesting people are experiencing severe or chronic anxiety due to a feeling of lack of control; they are frustrated and afraid while also feeling guilty and anxious about their personal impact on the environment, causing the latest surge in eco-anxiety cases in the Western world.

What is Eco-Anxiety?

First defined in 2017 by the American Psychiatric Association as a “chronic fear of environmental doom”, the disorder remains under investigation. Although not currently listed in the Diagnostic and Statistical Manual of Mental Disorders, the condition is characterized by chronic or severe anxiety related to the current and future state of the environment.

The immediate effects of climate change – including damage to communities, food shortages, and reduced medical supplies – can not only harm physical wellbeing and displace populations, but can also prove to be a significant challenge on mental wellbeing. Gradual impacts of climate change, such as rising sea levels, warmer temperatures, and changes in seasonal patterns may lead to the development or worsening of chronic mental health symptoms. These can manifest as a mix of trauma and shock, post-traumatic stress disorder, anxiety, depression, substance abuse disorder, aggression, reduced feelings of autonomy, feelings of helplessness, and fatalism.

What Causes It?

For most individuals, eco-anxiety stems from experiencing or being at risk of experiencing climate-related consequences. The stress over losing housing or employment due to environmental changes can have a significant effect on an individual’s wellbeing, while chronic stress can raise the risk of several serious health conditions such as heart disease, hypertension, depression, and general anxiety disorder. This intensifying anxiety may also result from a growing awareness of the possibility of extreme weather events, the potential loss of livelihood or housing, fears for future generations, and increased feelings of helplessness.

Vulnerable Demographics

Some of the more vulnerable demographics for this condition include populations who reside in locations at risk for extreme weather – such as coastal towns and low-lying areas – and especially individuals who work in a field affected by environmental patterns such as fishing, tourism, and agriculture.

In addition, people who live in indigenous communities and rely on natural resources for their livelihood, tend to reside in more vulnerable geographic locations. They may face an increased fear of losing their housing, livelihood and cultural heritage which can be damaging to identity, belonging and a the greater sense of community.

First responders, emergency health care workers, and people who work in environmental jobs are more prone to developing eco-anxiety. Additionally, individuals with preexisting mental and physical conditions, children and young adults, people of lower socioeconomic status, and displaced or forced migrants may be more likely to experience the mental health condition.

As there is currently no clinical definition of eco-anxiety it may be difficult for health care practitioners to diagnose. However, if a patient is concerned about the environment to the point of interference with everyday activities or their ability to work or take care of themselves, they should be urged to speak to a mental health professional who may provide the necessary therapeutic support and be able to suggest effective coping mechanisms.

Experts in the field of eco-psychology, a branch of the medicine that evaluates psychological relationships with nature and their impact on identity, wellbeing and health, are working to better understand the newly-defined disorder and develop effective methods to alleviate its symptoms. A growing number of mental health practitioners are receiving training to help detect and manage fears related to eco-anxiety as its burden continues to increase. As part of this effort, the Climate Psychology Alliance is offering individual and group support for eco-anxiety sufferers as well as education for therapists, including free sessions over the phone or Skype.

What Private Practices Need to Know About the U.S. Relief Package

April 15, 2020

There is a dire need for financial support of healthcare providers and facilities as they continue to battle the COVID-19 pandemic, now affecting the United States the most drastically. In response, the President signed the bipartisan CARES Act on March 27, 2020, providing much-needed relief funds to hospitals and other healthcare providers on the frontlines of the fight against coronavirus. As part of the recently announced CARES Act, $100 billion will be appropriated to create a Public Health Social Service Emergency Fund with an ultimate goal of preventing, preparing for, and responding to the coronavirus outbreak both domestically and on an international scale.

Per the Act, funding will be dedicated to reimbursing healthcare-related expenses or lost revenue attributable to COVID-19 to alleviate some of the financial burden many providers are experiencing. Part of this relief payment will focus on ensuring that uninsured Americans have access to testing and treatment, and that medical professionals providing the care are reimbursed for their work. The Department of Health and Human Services has published detailed criteria for the process of distribution of funds under the Act as well as information about eligibility requirements, outlined below.

Immediate Relief Funding

Recognizing the urgent need for the delivery of financial relief, the HHS immediately infused $30 billion into the American healthcare system. Payments are slated to arrive via direct deposit beginning April 10, 2020 to eligible providers throughout the system. Note, these are direct payments, not loans and will not need to be repaid, the HHS emphasizes.

Eligibility for Immediate Relief Payments

Per guidance from the HHS, all facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible to receive payments from this initial rapid distribution. Payments to practices that are part of larger medical groups will be sent to the group’s central billing office, while all relief payments will be made to the billing organization according to its Taxpayer Identification Number (TIN).

In order to be eligible to receive these funds, providers must not seek to collect of out-of-pocket payments from a COVID-19 patient that are greater than what they would be otherwise had the care been provided by an in-network practitioner. If a practice had to halt business operations as a result of the COVID-19 outbreak, providers may still be eligible to receive funds if they provided diagnoses, testing, or care for patients with possible or confirmed cases of COVID-19. Per the HHS, “Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”

The immediate relief payments hope to alleviate providers in hard-hit COVID-19 areas and those who are struggling to keep their practice open due to delayed care and widespread cancellations of elective procedures.

Payment Distributions 

Payment distributions will be based on the provider’s or practice’s share of total Medicare FFS reimbursements for the year 2019; that year, the total FFS payments were approximately $484 billion. Providers can estimate their anticipated payment by dividing their 2019 Medicare FFS (excluding Medicare Advantage) payments – which can be obtained from their organization’s revenue management system – by $484 billion and multiplying that ratio by $30 billion. 

Receiving Payments

In partnership with UnitedHealth Group (UHG), the HHS will provide rapid payments to eligible providers, as described above, to distribute the initial round of funding. Providers will be paid via their Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS) and can expect to receive payments via Optum Bank with “HHSPAYMENT” as the payment description. Providers who receive reimbursements from CMS via paper check can expect to receive a paper check in the mail within the next few weeks.

Providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment within 30 days of receipt. The Terms and Conditions of the funding can be found on the CMS website. If the payment is not returned within 30 days, the HHS will view this as an acceptance of the Terms and Conditions. However, if a provider does not wish to comply with the Terms and Conditions, they must contact HHS within 30 days of receipt of payment and then return the full payment to HHS.

Different Types of Providers

All relief payments are being made to providers according to their tax identification number (TIN). Large organizations will receive payments for each of their billing TINs that bill Medicare, and should look to the part of their organization that handles Medicare billing to identify details on Medicare payments for 2019. Employed physicians should not expect to receive an individual payment directly; instead, their employer’s organization will receive the relief payment as the billing organization. Similarly, individual physicians and providers in a group practice are unlikely to receive individual payments directly; the group practice will receive the relief fund payment as the billing organization. Solo practitioners who bill Medicare will receive a payment under the TIN they use to bill Medicare.

The Remaining $70 Billion 

As part of the $100 billion guaranteed by the CARES Act, the remaining $70 billion will be comprised of targeted distributions focused on providers in areas particularly impacted by the virus, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, as well as providers requesting reimbursement for the treatment of uninsured Americans. More guidance is expected on the structure of these payments in the coming weeks.

COVID-19 Medical Expenses

The federal government is taking measures to ensure Americans are not surprised by medical expenses and are protected against financial obstacles that might prevent them from seeking care or getting tested and treated for COVID-19. A portion of the Provider Relief Fund will be used to reimburse healthcare providers at Medicare rates for COVID-related treatment of the uninsured. However, providers are prohibited from “balance billing” any patient for COVID-related treatment in order to be eligible.

In addition, the Families First Coronavirus Response Act requires private insurers to cover an insurance plan member’s cost-sharing payments for COVID-19 testing. Further, the government has secured commitments from private insurers – such as Humana, Cigna, UnitedHealthGroup, and the Blue Cross Blue Shield system – to waive cost-sharing payments for treatment related to COVID-19 for its members and make medical care more accessible.

Heavily anticipated by providers across the nation, the latest guidance helps to clarify eligibility, distribution, and payment concerns regarding the Provider Relief Fund. Eligible practices and providers may soon expect to receive payments from the immediate round of funding. In the meantime, medical professionals can access more information about and the latest developments concerning the CARES Act Provider Relief Fund here.

COVID-19 Insurance Coverage Changes

April 9, 2020

Requiring a coordinated response from the government, healthcare system, and private sector, the COVID-19 outbreak has placed an unprecedented burden and stress on countries across the globe. In the United States, federal policies are being updated rapidly in response to the shifting demands of the healthcare system as it fights to curb the virus. As such, insurance providers are playing a critical role in ensuring widespread access to care and have taken decisive action to help both patients and providers in combating the novel coronavirus.

From state insurance regulators, who are limiting the amounts patients can owe for COVID-19 care, to insurance companies and employers who have amended many rules to eliminate deductibles and co-payments, coverage changes have been occurring on a large scale. As the outbreak is developing and dynamically changing the medical landscape, below are some of the latest policies to go into effect in response to COVID-19.

COVID-19 Testing

Per the latest legislation passed by Congress, coronavirus testing is free for all individuals regardless of insurance status – as is the cost of a doctor’s visit or trip to the emergency room to receive the test. The recently passed Families First Coronavirus Response Act requires all group health plans and individual health insurance providers to cover testing and associated visits related to the diagnosis of COVID-19. In addition, several states, including California, New York, and Washington have implemented additional requirements on insurance companies to cover testing costs.

Both private insurance companies and employers have volunteered to waive the costs of testing. In addition, the Families First Coronavirus Response Act requires most private health companies to cover testing for COVID-19.

Medicare and Medicaid will also cover the costs of a coronavirus test, while the uninsured should also be able to get tested at no cost per the latest guidelines. Patients who recently lost their jobs may qualify for Medicaid or be able to sign up for a health plan under the Affordable Care Act to gain access to free testing.

COVID-19 Treatment Costs

In response to the COVID-19 outbreak, health insurance providers are waiving out-of-pocket costs for hospital visits and many are funding treatment of COVID-19 as well. Cigna and Humana have waived out-of-pocket costs for treatment, as have Aetna, Florida Blue, Harvard Pilgrim and UnitedHealth Group. One of the largest insurers in the nation, Blue Cross and Blue Shield, covers nearly 6 million individuals under its Federal Employee Program and has said it would waive co-payments and deductibles for medically necessary treatment.

Although, there are restrictions to the coverage of treatment costs as some insurers have waived cost sharing only for the upcoming two months while others have eliminated expenses only for hospital stays. In addition, it remains unclear how much patients may be required to pay out of pocket; the Kaiser Family Foundation estimates COVID-19 care can cost around $20,000, bringing potential out-of-pocket bills to around $1,300 depending on the patient’s plan, location of care, and disease severity.

COVID-19 Complications Care

Most private insurance plans will likely cover services needed to treat COVID-19 complications although, there is currently no federal guidance requiring them to do so. In addition to covering testing, Medicare will cover both outpatient and hospitalization services. During the COVID-19 crisis, Medicare patients are covered if they need to be transferred to skilled care regardless of previous hospitalization. However, the program does not cover long-term stays in long-term care facilities at this time.

Telemedicine Coverage

According to the latest policy changes, telehealth will now be covered under Part B for all traditional Medicare enrollees for services not limited to COVID-19 care. The definition of telemedicine will be expanded to allow patients to connect with healthcare providers from their homes via video conferencing or other digital methods. To further ease access to care, the requirement that telemedical care be provided by a medical professional the patient has seen within the last three years has been waived.

The widespread shift to telehealth has proven critical to easing the burden on the U.S. healthcare system by “allowing hospitals to care for people who need it most, while limiting the exposure of health care workers and patients to the disease,” explains a one-pager published by America’s Health Insurance Plans. “Telehealth is especially beneficial for patients who are at a higher risk when leaving the home to commute to the doctor’s office.”

Out-of-Network Bills

Despite the significant efforts made toward expanding insurance coverage at this time, patients may still be required to pay out-of-network bills, for example, when they are treated by an out-of-network physician. Data from the Kaiser Family Foundation indicate that nearly one in five patients admitted to the hospital with serious cases of pneumonia were faced with out-of-network bills after treatment. To further ease patients’ financial burden related to COVID-19, some hospital systems are pausing collections for the foreseeable future.

Alongside the aforementioned updates, many insurance coverage providers are proposing further changes to expand coverage and ease the financial burden during this COVID-19 crisis. Healthcare providers should remain current on the latest developments in coverage policies as they may affect both themselves as well as their patients.

For further assistance with navigating the changing insurance coverage landscape, the America’s Health Insurance Plans’ website offers a comprehensive list of providers and their responses to COVID-19, which can be accessed here.