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It’s no secret: health insurance has made everything more complicated and more expensive. Most of the time, we just pay our deductibles and our co-pays and let the insurance take care of the rest. But behind the scenes, a whole host of tricks and tactics take place between health insurers and providers that most of us don’t even think about.

One such arrangement is the use of the contractual DRG, or the “Diagnosis Related Group.” The DRG was originally developed by Medicare in an effort to simplify payments and – supposedly – to make reimbursement more fair. It works like this: instead of counting up all of the individual pieces of treatment, equipment used, and medication administered to a patient, Medicare figured out the average cost to treat each patient with the same condition. For instance, for any patient with the flu, Medicare figured out the average amount of money it costs to take care of a flu patient. Then, it decided to pay hospitals that same amount for each flu patient it treated – regardless of how much the hospital actually spent on that patient’s care. This means that, if a hospital could take care of a flu patient for less than the average cost, it made a profit. On the flip side, if the patient was “more expensive” than the average patient – that is, if he or she required more advanced treatment or a longer hospital stay – then the hospital had to eat any extra cost above and beyond the payment it received.

There are two problems with this model. The first is obvious: it encourages hospital to devote as few resources as possible to any given patient. If the hospital is getting paid $3,000.00 to take care of a patient, but can get away with releasing her after only $1,500.00 worth of treatment – why wouldn’t it take advantage of that? Under this model, it’s easy to see how hospitals can become too intent on maximizing profit in exchange for doing the bare minimum to treat their patients.

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Advice to Help You Win Your Personal Injury Case

Car accidents happen suddenly and without warning. Your world is turned upside down in the blink of an eye. If you have been injured in a car accident, the following steps can help you legitimize and prove your claim, ultimately positioning your case for maximum recovery.

  1. Seek medical attention immediately. Prompt medical care is imperative to your personal well being, as well as the well being of any potential personal injury claim you may have. Information provided by your medical provider will be essential to your claim, and is often used in court. Be honest about your injuries and medical history and don’t be tempted to either inflate or conceal the severity of harm.
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awholey.jpgLocal nurse attorney Alison Wholey Briggs was recently appointed to the Board of Directors of New Hope for Women, located in Rockland. New Hope for Women offers support to people in Sagadahoc, Lincoln, Knox and Waldo Counties affected by domestic violence, dating violence, and stalking, and provides educational resources to assist communities in creating a safer and healthier future. Services are offered to assist women, men, their children, friends, family and all people affected by domestic and dating violence, along with such help as a 24-hour domestic abuse hotline, emergency shelter, support groups and other resources.

New Hope for Women also provides aid in educating the community, providing awareness and preventing domestic and dating violence through a variety of programs.

Alison has participated in multi-million dollar verdicts and settlements on behalf of patients and their families, drawing on her experience as a Registered Nurse.

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Mainers:  Just Hang Up and Drive!  That should be a bumper sticker, and here’s why:  A cellphone user in traffic has the same reaction time as a drunk.  Don’t think so?  There’s scientific proof.

Check this out:

Have a safe trip home for the Holidays.

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Is there anything worse than saying “Have a good time–be back by midnight!” to your teen, then hearing a knock at the door at midnight.  The State Police Trooper says it all without saying a word.  If you look up Aleisha Sonksen on the Internet, you will see that she died in an accident early today, around midnight.

But the Internet shows that Aleisha Sonksen is more than just a name in a newspaper report of a teen death.  She was a runner– Look at her race times.  She was a writer–a Semi Finalist in the 2007 Letters About Literature Contest.  She was a Knox County girl that couldn’t be protected from death.  Or could we have done something?  Did anyone see a little sports car speeding or being driven in a less than safe way?  Do we say “Tsk, Tsk, none of my business” because we don’t want to get involved, be nosy or intrusive?  Recently, my teenage daughter’s boyfriend was grounded from driving for two weeks.  The reason:  A mom saw him pull out of the school parking lot going too fast.  She called the boy’s mom.  A discussion ensued.  A grounding followed that.  I am so grateful to both moms, and to anybody who looks out for my child–a teenager still is that, a child–in the only way we can.  Please don’t be afraid of being labeled intrusive or nosy when you see a driver doing something you wouldn’t want done if your child was on board. Save a life.  Speak up.

Alison Wholey Briggs Mynick

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When a part of a building collapses, as it did late last Saturday night at the Rack at Sugarloaf, serious injuries can occur.  It’s been reported that folks standing on exterior decking fell when the flooring collapsed.  Injuries from a height of 15 feet or so can range from bumps and bruises, to fractures, ligament tears, crush injuries, and even death.  No one died in the collapse at the Rack, but when the reporters move on to the next story, what happens to the injured?

The National Institutes of Health explains the process of healing when a bone breaks or a ligament tears:   “At the moment of injury: Chemicals are released from damaged cells, triggering a process called inflammation. Blood vessels at the injury site become dilated; blood flow increases to carry nutrients to the site of tissue damage.Within hours of injury: White blood cells (leukocytes) travel down the bloodstream to the injury site where they begin to tear down and remove damaged tissue, allowing other specialized cells to start developing scar tissue. Within days of injury: Scar tissue is formed on the skin or inside the body. The amount of scarring may be proportional to the amount of swelling, inflammation, or bleeding within. In the next few weeks, the damaged area will regain a great deal of strength as scar tissue continues to form.Within a month of injury: Scar tissue may start to shrink, bringing damaged, torn, or separated tissues back together. However, it may be several months or more before the injury is completely healed.”

How could you help  if someone you love has been injured at a restaurant or tavern property? First, you need to make sure your friend or family members gets the best possible medical care.

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Another fatal car crash along a Maine road.  Another family, or a number of families, confronted with a loss too.

News accounts of passengers in a crash that are “young and from the area” mean that an entire group of families are suffering.  The losses are so enormous that words haven’t been invented to describe the impact of a lost child.  The fact that the lost child was on the verge–the verge of graduation, perhaps- the verge of joyful opportunities that young adulthood holds- makes the pain the families bear all the more difficult.  When a car skids out of control and kills a teenager, the entire family’s life skids out of control too.

In the midst of a loss so tremendous, how is a family supposed to marshal the resources to protect against an insurance company that can take advantage of the loss and try to write off the child’s life with a quick and easy insurance release ?  In Maine, except in medical malpractice cases, a family has only two years from the date of death to sort things out and bring a Wrongful Death lawsuit.

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Slugger the SeadogWe love the outdoors. We get through the Maine winter, tell ourselves its spring on Opening Day for the Seadogs–no matter what the temperature is–and stay outside as much as we can until the summer is over and we start to gear up for winter again.

Being healthy is especially important for enjoying the Maine outdoors.  If you’ve hurt your knee, shoulder or your back in a car accident in Maine, arthritis that develops after the injury can ruin summer fun for decades.  Ifyou’re a car accident victim in your thirties,  did your lawyer discuss with you that one very real problem isn’t going to “blossom” until much later?

Osteoarthritis can follow  injury to a joint. For example, a young person might hurt his knee badly playing soccer. Or someone might fall or be injured in a car accident. Then, years after the individual’s knee has apparently healed, he might get arthritis in his knee joint.

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WHAT TO DO IF YOU ARE IN AN AUTOMOBILE ACCIDENT IN MAINE Any automobile accident is a traumatic experience. Even when damage to the persons or vehicles involved is minimal, the event can still be upsetting. Thus, this information sheet was designed with helpful guidelines for you to follow in the event of an accident. Many problems can be avoided or lessened if you know what steps to take.

If you are Involved in an Accident

1) STOP!! The law requires that the driver of any vehicle involved in an accident must stop. Pull your vehicle over to the side of the road or other safe place, away from traffic, if possible.

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