On Tuesday, October 8, MEMA staff visited the Marion Police Department and facilitated a tabletop exercise with participants from the police and fire departments, Department of Public Works, Council on Aging, Public Information, Board of Health, Sippican Elementary School, and Community Emergency Response Team.

            A tabletop exercise is a part of MEMA training that tests emergency response plans using a hypothetical event. This can also assess the level of readiness through discussion.

            Marion’s exercise involved a weather-related event, specifically a snowstorm, which tested the town’s emergency response plans. Officials were tasked with responding to a real-world situation based on current town plans, policies, and procedures.

            “These exercises are valuable to assess our emergency response plans and help us identify possible areas for improvement,” Chief Nighelli said. “Town officials are committed to ensuring we are prepared for any situation, and we see value in these discussion-based activities.”

            The scenario evolved through three modules.

            Module one focused on the incoming storm and preliminary forecast, the possible resulting conditions such as power outages and storm surges, and the needed preparations.

Module two added new and evolving circumstances such as high wind gusts and quickly accumulating snow, a vehicle crash with leaking fuel, power outages and phone problems, impassable roadways, a structure fire, carbon monoxide emergencies, and downed live wires and trees throughout town.

Module three focused on the aftermath when the inclement weather had passed but added factors, including blocked roadways preventing emergency access to facilities and ongoing power outages.

During each module, participants were asked to consider their agency’s current priorities, sheltering operations and logistics, staffing and agency resources, public works services and resources, communications with the public, and possible challenges.

            Overall, the exercise was meant to help town officials put emergency response plans to the test to evaluate their effectiveness and identify possible areas for improvement.

            “These tabletop exercises and discussions provide a valuable opportunity to implement and evaluate our emergency response plans,” Town Administrator Gorman said. “They help us ensure that our policies and procedures are effective and efficient, enabling us to achieve the best possible outcomes in various emergency scenarios.”

            “Tabletop exercises are an integral part of preparedness and education,” said a spokesperson for MEMA. “They provide an opportunity for a community to test and validate plans and policies including a municipality’s Comprehensive Emergency Management Plan (CEMP) using a hypothetical event. CEMPs detail how a town or city can mitigate, respond to and prepare for different emergency incidents or events. The plan identifies specifically how the city/town will coordinate resources during a disaster or other event, the necessary tools that can be utilized, and how the community can recover from an emergency. Tabletop exercises also address best practices, strengths, weaknesses, and possible areas for improvement.”

We are living in an era, in the U.S., when the insurance company often overrides your doctors’ decisions. Less often with traditional Medicare but more with commercial health insurance and Medicare Advantage plans, you may find that a test or procedure your physician ordered is refused payment by your insurer and you are stuck with a huge bill.

            A recent report by the Kaiser Family Foundation found that in 2020, 18% of in-network claims were denied by commercial insurers. Don’t passively accept this decision! The denial letter is just the start of the process, not the end.

            It has been shown that many of these denials are arbitrary and unjustified. A well-know example is the physician reviewer who admitted in court that he never even read the documentation but rubber-stamped nurse reviewers’ denials.

            The denial may be based on a wrong diagnosis code being submitted or a failure of the insurer to consider changing medical standards.

            While very few people challenge these denials, almost half the appeals succeed.

            What can you do?

            First, carefully read the denial letter to try to understand the reason coverage was denied. Yes, the prose is dense, but the insurer must explain its reason for denial.

            You may find that before they pay for C, they want you to try A and B first and you have already tried A and B without getting any benefit. You may find that the test or procedure is not considered appropriate for condition X and you have condition Y.

            If they have the facts correct and simply refuse payment, you will need to get the ordering doctor involved. They will have to write a letter explaining why they chose to do the test or procedure.

            Your first point of contact should be the insurance company’s customer service line. Be sure to get the name of the person with whom you speak. For simple mistakes, they may be able to reverse the denial, but don’t count on it.

            Your next step is to write a letter or an email requesting the denial be reversed and saying why. The process should be outlined in the denial letter. If not, it will be on the insurer’s website.

            If the response is to still deny the claim, persist. Request an appeal. Indicate in your request that you plan to file a complaint with your state’s consumer protection bureau if the claim is still denied (and do so!).

            Finally, outside help is available through the Patient Advocate Foundation and similar organizations.

            Illegitimi non carborundum! Don’t let the bastards grind you down!

            Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.

What Does The Doctor Say?

By Dr. Edward Hoffer

The Muppet character Count Von Count on Sesame Street must have been inspired by the federal government. Let me explain. The United States government is obsessed with numbers, just like the Count. There is the U.S. Census Bureau which is charged with counting every resident in the country, plus all manner of other data. With a country of 345,426,571 people at last count, Count Von Count would be in numbers heaven.

            When the Dracula-like Muppet finishes crunching those numbers, he can reckon with those of the National Vital Statistic System (NVSS), formerly known as U.S. Bureau of Vital Statistics (USBVS), which counts the number of births and deaths in the country. USBVS is part of the U.S. Department of Health and Human Services (HHS) which also includes the Centers for Disease Control and Prevention (CDC) which also counts how many people are sick. The states are represented in the federal government by the National Association for Public Health Statistics (NAPHSIS).

            Got all that?

            As you can see, the government is also obsessed with letters. There is also the National Aeronautical and Space Administration (NASA), the Environmental Protection Agency (EPA), the Federal Emergency Management Agency (FEMA), the Department of Energy (DOE), and the Department of Transportation (DOT). Not to mention (but I will) the Federal Aviation Administration (FAA), the Federal Bureau of Investigation (FBI), and everyone’s favorite, the Internal Revenue Service (IRS), and many, many more.

            All of these come under the Executive Office of the President of the United States (POTUS), who is under the control of FLOTUS (the First Lady of the United States).

            Often, sometimes inadvertently, these acronyms spell words, like DOT (Department of Transportation), DOE (Department of Energy) and, in Massachusetts, the office of Public Safety and Security (PSS). Oops, that’s not a word, it just sounds like one when said out loud.

            Even our town government has its share of letter salads. In fact, our distinguished Town Administrator, Mike Lorenco recently presented a seminar on municipal finance terminology for newly elected Finance Committee (FINCOM) members.

            Lorenco started by explaining that the DLS (state Division of Local Services), a division of the DOR (Massachusetts Department of Revenue) provides important information to the public and municipal leaders. He went on to says that PILOT (Payment in Lieu of Taxes) is an agreement that require entities that are not subject to pay taxes to…well, pay taxes.

            Any money left over after budgets are completed…the amount of taxes refunded to the taxpayers (just kidding) …is known as “Excess Capacity.” It could be called EXCAP for clarity. If you are a retired town employee your “post-employment benefits,” like health insurance, are called OPEB’s. (Where did the “O” come from?). And BAN is a Bond Anticipation Note. I think that means money the town needs to borrow if the FINCOM thinks there will be a shortfall. But I may be wrong.

            I believe using acronyms for other town board would go along way to clarify government to the populous. How about we call the Selectboard SELBO (pronounced like elbow. They could use a nudge once in a while). The Capitol Planning Committee (CAPLA) and the School Committee (SCHOCOM) sound very bureaucratic, as does PLABO for the Planning Board and RESFU for the Reserve Fund.

            I think these would be a great addition to the municipal vocabulary.

            Don’t you agree?

            Mattapoisett resident Dick Morgado is an artist and happily retired writer. His newspaper columns appeared for many years in daily newspapers around Boston.

Thoughts on…

By Dick Morgado