Judge: Private Insurance Firm In W.Va. Must Cover Transgender Health Care

Charleston Gazette-Mail: Federal Judge Rules Private Insurance Company Is Subject To Anti-Discrimination Provision Of Affordable Care Act
A federal judge last week ruled that The Health Plan of West Virginia is subject to compliance to a specific provision under the Affordable Care Act that prohibits sex discrimination, including against transgender Americans. The Health Plan of West Virginia is a private company that provides health insurance services for the state. U.S. District Judge Robert Chambers on June 28 denied a motion from The Health Plan to dismiss a lawsuit from two transgender men who say their state-funded health insurance won’t cover hormone replacement therapy solely because they are transgender. Christopher Fain and Zachary Martell filed a lawsuit challenging blanket exclusions of coverage for gender-confirming health care in West Virginia’s health plans, the state’s Medicaid program and the Public Employees Insurance Agency, or PEIA, in November 2020. (Pierson, 7/5)

In other health care industry news —

Stat: For Sickle Cell Patients, Specialized Centers Offer Far Better Care Than The ER
People with sickle cell disease who were experiencing acute pain crises received far better care at specialized infusion centers than emergency departments, with faster access to pain medication and lower rates of hospital admissions, researchers reported Monday. Their new study, published in the journal Annals of Internal Medicine, highlights how the barriers to quality treatment in emergency rooms can lead to worse outcomes for patients with sickle cell disease. (Joseph, 7/5)

Dallas Morning News: Plano Home Health Services Company Signs Deal With United Healthcare
Plano-based Resilient Healthcare announced Thursday that it has partnered with United Healthcare, making its services in network for United Healthcare patients. The company specializes in home health care for patients with serious illnesses. The services include physician services, nursing care, therapy, social work, dietitian services, IV infusions, telemonitoring and X-rays. Resilient says it’s the first health care company that specializes in home-based, interdisciplinary care to partner with United. “We’re the first in the country with that type of an agreement with United Healthcare,” said Jackleen Samuel, Resilent’s president and CEO. “And definitely the first provider in Texas to be bringing that level of care to patients’ homes. (Gonzales, 7/5)

Philadelphia Inquirer: Health-Care Workers Cope With Burnout, Fractured Community As COVID Pandemic Wanes
Patients with COVID-19 aren’t filling hospitals anymore. Fears of bringing the virus home and infecting loved ones has largely passed. For Bill Engle, though, a nurse at St. Mary’s Medical Center in Langhorne, the emotional wounds inflicted by the pandemic remain close to the surface. “If I start talking about it, and I start to think what it was like, then it affects me,” he said, his voice cracking. “Every day going in to work and knowing I was going to be in that N95 and seeing these people struggle and how scared they were and the physical toll that they took, it was next level.” He is hardly unique. (Laughlin, 7/6)

KHN: Rural Ambulance Services Are In Jeopardy As Volunteers Age And Expenses Mount
Vern Greyn was standing in the raised bucket of a tractor, trimming dead branches off a tree, when he lost his balance. He fell 12 feet and struck his head on the concrete patio outside his house in this small farming town on the central Montana plains. Greyn, then 58, couldn’t move. His wife called 911. A volunteer emergency medical technician showed up: his own daughter-in-law, Leigh. But there was a problem. Greyn was too large for her to move by herself, so she had to call in help from the ambulance crew in Power, the next town over. (Bolton, 7/6)

In updates on teletherapy —

Modern Healthcare: Teletherapy Startups Gain Momentum As Payers, Employers Sign On
So far this year, Kristen Engleman has cycled through three therapists in six months. Engleman, 41, signed up for Talkspace in February, after breaking up with her partner, contracting COVID-19 and facing an unexpected pregnancy the year before. She had heard about the teletherapy provider through friends and decided to give it a try. Because the fine-dining restaurant where Engleman works does not offer insurance, she paid $275 per month for access to a Talkspace therapist. (Tepper, 7/6)

Modern Healthcare: Teletherapy Apps Promise Increased Access. Could They Actually Deepen Care Disparities?
A key piece of teletherapy companies’ value proposition is their ability to increase access. But some experts wonder if these startups will eventually make it harder for individuals to see mental health providers in person. “It would be ironic, right, that these technologies that have the potential to bring equity to mental health could actually do the opposite,” said Dr. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston. (Tepper, 7/6)