Field Notes: The First Lady who shared her cancer news when even the word "breast" was taboo
Plus toxic receipts and how insurance company doctors are declining claim requests without even opening the patient files
Hello, dear friends! Here is my weekly (more or less) Field Notes, six things that have crossed my inbox, my desk, my mind lately …
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them — This new ProPublica investigation is shocking, even within the scope of egregious health billing (Kaiser Health has a whole Bill of the Month series). ProPublica reports: “The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show.” The strategy, horrifically, seems to rely on the fact that most patients won’t appeal a claim denial.
WNYC’s “The Takeaway” radio show spotlighted First Ladies for Women’s History Month, and the section on Betty Ford and her health was fascinating. Author Lisa McCubbin, who wrote a book on the First Lady, said: “Outspoken and surprisingly candid, Betty Ford was refreshingly relatable, and as it turned out, she was exactly what America needed. She had been divorced, which was scandalous back then. She said she wasn't going to change who she was just because her husband had become president. She said, I'm not the president, I can say what I want to say.” In 1974, Betty was diagnosed with breast cancer, a time when “you couldn’t say the word ‘breast’ on television.” The family decided to be open about it with the public. “Betty was still in the hospital when the very next day after they made this announcement that she had had her breast removed, people were lined up outside of women's clinics to get breast exams,” Lisa explained. “It had an impact overnight on women's health. It was amazing how women finally started talking about it, and men were talking about it. Because Betty Ford was so open about it, suddenly, this national conversation grew. That's when all the research money started pouring into women's health and breast cancer in particular.”
This op-ed in The New York Times about Britain’s National Health Service was disturbing and eye-opening: You Don’t Have to Be a Doctor to Know How Much Trouble the N.H.S. Is In. Among the troubling bits: “There are 7.2 million people in England, more than 10 percent of the population, on waiting lists for treatments like hip or knee replacements, back surgery or cataract operations.”
I was stunned to learn that receipts are a high carrier of BPA or BPS, chemicals that can be harmful to reproductive systems and have been linked to various disorders. (Did you know this already?) Yes, receipts, like the one right now in your purse or pocket from the grocery store. The Minnesota Pollution Control Agency advises: “Regular receipt handling may be of particular concern to pregnant or nursing women or women of childbearing age and adolescents of any gender who are still developing” and “Never hand receipts to babies or toddlers” and “do not put thermal receipt paper in your recycling or compost bin.” I have since been trying to avoid handling receipts, and they are everywhere! At the library, the post office with the tracking number, the coffee shop. Ack!
An intriguing take on ChatGPT from Meghan O’Rourke, who wrote The Invisible Kingdom: Reimagining Chronic Illness:
“Your problems adjust to their true level of importance after a hard workout and a good night of sleep.” — James Clear in his terrific newsletter. (If a hard workout isn’t possible, let’s say sleep and any bit of movement.)
I hope you have a lovely weekend and spring ahead!
To our journeys,
Brianne