Loma Carrie Case Study

In 2012-2013, Mr. Carl Heastie, Assembly man for the North-East Bronx, was instrumental in restoring the budgetary costs to cover the Elderly Pharmaceutical Insurance Coverage (EPIC) program. Prior to his involvement, seniors enrolled in the EPIC program, were forced to pay up to 25% of the cost of each medication. With his input in the decision making, the co-pay, was decreased to &20,00 for payment for each prescription. This paper will attempt to show, his commitment towards this health care issues, intended to be depicted during a set interview with him.

The process of receiving and affording healthcare was, at the time, out of reach. Once my family was able to attain healthcare insurance, doctor visits were unpleasant. The physicians struggled to comprehend my parents’ needs, while my parents simultaneously struggled to understand the diagnoses provided by the physicians. These instances led to the frustrations of the physicians because of the communication barrier, which led to their inability to do their job at their full potential. Due to this dilemma, our visits to the doctor were few and far between.

The deposition of Dr. Joe Gonzales occurred on March 16, 2016. Dr. Gonzalez was retained by Plaintiff as an expert in this case and was requested to prepare a life care plan for Plaintiff’s future medical care needs. Dr. Gonzales has served as a life care planner since 1988, when he received is license to practice medicine. He became a certified life care planner in 2006. He is a medical doctor in San Antonio who is board certified in physical medicine and rehabilitation, pain medicine, and occupational and environmental medicine. Half of his work consists of treating patients and the other half consists of preparing life care plans related to litigation. When he does life care planning work, 85-90% of that work is on behalf of the plaintiffs in the respective litigation. He sees on average 20-50 patients a week in his medical practice. He has not practiced in a hospital in at least 10 years.

Patients with long-term, chronic illnesses like Mr. Davis’s, care can be very costly, especially when the patient is unable to maintain routine medical care or visits and medications. Without routine medical care and maintenance medications, patients like Mr. Davis tend to have more frequent emergency room visits and hospitalizations; increasing costs for state and local government as well as tax payers. Though Mr. Davis is able to receive care during an emergency room visit, the providers are not fully aware of his health history and are only able to provide a temporary fix of his symptoms and not address his health care needs.

This case is about Dave Armstrong, a 29 year old second year MBA student of Harvard Business School. Immediately after his graduation from a small liberal arts college in Texas, he started working for Thorne Enterprises as a computer Programmer. After eighteen months in the job, he quit to go into life insurance business in Amarillo. He applied to Harvard Business school but hadn’t considered what he would do, once accepted, he decided to go there as he and his wife wouldn’t have to compromise on their lifestyle as he would still be receiving renewal income from his old policy holders.

Medical costs are getting too expensive. Ever fought with your insurance providers because they refused to pay for care, or struggle to find an “in-network” provider? I know a woman whose name I will change for her privacy and the struggles she is going through are a perfect example of an issue many people face when dealing with insurance; Nancy’s (name changed for privacy) story is a perfect example of how our healthcare system is no longer working for the people. Nancy is this woman whose husband recently passed away. Nancy used to work for county and county workers cannot receive social security; and Nancy is too

In Maryland, insurance policies are generally construed in the same manner as contracts. Collier v. MD-Individual Practice Ass 'n, Inc., 327 Md. 1, 5, 607 A.2d 537 (1992). An insurance contract, like any other contract, is measured by its terms unless a statute, a regulation, or public policy is violated thereby. Pac. Indem. Co. v. Interstate Fire & Cas. Co., 302 Md. 383, 388, 488 A.2d 486 (1985). We do not follow the rule, adopted in other jurisdictions, that an insurance policy is to be construed most strongly against the insurer. Collier, 327 Md. at 5; Cheney, 315 Md. at 766. We construe the instrument as a whole in order to determine the parties’ intent. Pac. Indem., 302 Md. at 388; Collier, 327 Md. at 5; Aragona v. St. Paul Fire & Marine Ins. Co., 281 Md. 371, 375, 378 A.2d 1346 (1977). In order to determine the intention of the parties, “Maryland courts should examine the character of the contract, its purpose, and the facts and circumstances of the parties at the time of execution.” Pac. Indem., 302 Md. at 388 (citations omitted). In doing so, we give the words their usual, ordinary, and accepted meanings. Id.; Mut. Fire Ins. Co. v. Ackerman, 162 Md. App. 1, 5, 872 A.2d 110 (2005) (citing Nationwide Mut. Ins. Co. v. Scherr, 101 Md. App. 690, 695, 647 A.2d 1297 (1994)). The test is what meaning a reasonably prudent layperson would attach to the term. Pac. Indem., 302 Md. at 388.

To conclude this report, there are four considerations of a legal and valid insurance contracts that patients may present at the provider’s office or clinic. The guide to understand and remember are as follows: (a) the patient or person insured must be a mentally competent adult and should not be under the influence of drugs or alcohol; (b) the insurance company must have a signed application and offer the policy to the patient, then the patient or person should accept the issuance of the policy without misrepresentation of facts on the application of the person being insured; (c) the services produced and sold or the exchange of value and the first premium payment should be submitted with the application considered must be presented together; and (d) there should be a legal purpose which is an insurable interest in the case of a person’s healthcare insurance policy. These are good guidelines to know and understand for the success of an administrative life cycle of a physician-based claim (CMS

On Tuesday, September 29th my partner and I had the opportunity to interview a 55-year-old patient named Tom at LA County Hospital, admitted nine days prior for injuries he sustained after being struck by a city vehicle. His injuries were quite apparent the moment we sat down with him: his right foot bandaged up, having been crushed by the vehicle’s tires, abrasions and bruising all over his lower limbs and worst of all, a broken pelvis. Yet despite the bad shape he was in, Tom was kind enough share his life story with us and provide the limited knowledge he had about his insurance history.

Latasha Willis, an intern at River Valley Area Agency on Aging, is currently at Troy University to obtain a Masters in Social Work (MSW).Latasha will be interning with the agency until July 2016 which is when she graduates with her Masters degree. She has earned her undergrad in Social Work (BSW) as well from Troy University in 2014. After graduating with her BSW, she worked with the Division of Family and Children Services as a CPS investigator in Butler, Ga. She also worked at the Division of Child Support Services as a Child Support Agent 2 in Columbus, Ga. She plans to continue working with seniors after her gained experience with interning at the agency.

This worker went out to meet the mother on the Walter case. This worker introduced this worker to Lamyia Walters. This worker gave Lamyia this workers contact information.

“LaRita Jacobs resident of Seminole, Florida, who gets insurance through the job of her husband. She has an annual family income of 70,000 dollars. She says 7,500 dollars per year in out-of-range costs kept her from dealing with an arthritis-related neck problem until it got so severe that she could not lift a spoon. She is now holding her shoulder surgery off because her family is struggling with paying bills.” (Laura Ungar and Jayne O'Donnell, USA TODAY)

In this article the writer, Greg Silver, starts out by talking about a 25 year old waitress who has broken her arm, and has no insurance or money for the medical bills. Due to these reasons her arm healed on its own but healed crooked. This has caused it to be painful for her to hold a tray while working. She asked the writer what was she supposed to do. Greg Silver has been a primary care physician for 30 years now and he’s heard so many stories from Americans who don’t have insurance or the money for their medical bills, so they suffer in pain. “Even with the affordable care act we leave 28 million people without any coverage.” He talks about how we need a streamlined single-payer program that would provide universal coverage for everyone, “such as Rep. John Conyers’ House Resolution 676 and Sen. Bernie Sanders’ Senate Bill 1804.”

In, filmmaker, Michael Moore’s “Sicko” basic struggles between people and health insurances are pointed out. There is a centralized focus on how difficult insurances make the acceptability of their coverage. The slightest past history that the insurance deems within their ineligibility criteria, makes a person, in need of health coverage, suffer under thousand of dollars procedures. There was a patient in the documentary who needed two of his digits reattached but was given a choice of one which costed approximately $40,000 or the other which was only $12,000. Some people have even resorted to doing their own sutures in their unclean, unsterile homes. A patient was also denied care for a treatment for cancer because the hospital, that the patient’s

Going through the selected policies. Policies are legally binding. There are consequences in case a party fails to adhere to terms and conditions. Going through terms and conditions of selected covers will help you determine if it suits you or not. A person should go ahead and sign an insurance policy if the terms favor him.