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Renuka Rayasam | (TNS) KFF Health News In April, just 12 weeks into her pregnancy, Kathleen Clark was standing at the receptionist window of her OB-GYN’s office when she was asked to pay $960, the total the office estimated she would owe after she delivered. Clark, 39, was shocked that she was asked to pay that amount during this second prenatal visit. Normally, patients receive the bill after insurance has paid its part, and for pregnant women that’s usually only when the pregnancy ends. It would be months before the office filed the claim with her health insurer. Clark said she felt stuck. The Cleveland, Tennessee, obstetrics practice was affiliated with a birthing center where she wanted to deliver. Plus, she and her husband had been wanting to have a baby for a long time. And Clark was emotional, because just weeks earlier her mother had died. “You’re standing there at the window, and there’s people all around, and you’re trying to be really nice,” recalled Clark, through tears. “So, I paid it.” On online baby message boards and other social media forums , pregnant women say they are being asked by their providers to pay out-of-pocket fees earlier than expected. The practice is legal, but patient advocacy groups call it unethical. Medical providers argue that asking for payment up front ensures they get compensated for their services. How frequently this happens is hard to track because it is considered a private transaction between the provider and the patient. Therefore, the payments are not recorded in insurance claims data and are not studied by researchers. Patients, medical billing experts, and patient advocates say the billing practice causes unexpected anxiety at a time of already heightened stress and financial pressure. Estimates can sometimes be higher than what a patient might ultimately owe and force people to fight for refunds if they miscarry or the amount paid was higher than the final bill. Up-front payments also create hurdles for women who may want to switch providers if they are unhappy with their care. In some cases, they may cause women to forgo prenatal care altogether, especially in places where few other maternity care options exist. It’s “holding their treatment hostage,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation . Medical billing and women’s health experts believe OB-GYN offices adopted the practice to manage the high cost of maternity care and the way it is billed for in the U.S. When a pregnancy ends, OB-GYNs typically file a single insurance claim for routine prenatal care, labor, delivery, and, often, postpartum care. That practice of bundling all maternity care into one billing code began three decades ago, said Lisa Satterfield, senior director of health and payment policy at the American College of Obstetricians and Gynecologists . But such bundled billing has become outdated, she said. Previously, pregnant patients had been subject to copayments for each prenatal visit, which might lead them to skip crucial appointments to save money. But the Affordable Care Act now requires all commercial insurers to fully cover certain prenatal services. Plus, it’s become more common for pregnant women to switch providers, or have different providers handle prenatal care, labor, and delivery — especially in rural areas where patient transfers are common. Some providers say prepayments allow them to spread out one-time payments over the course of the pregnancy to ensure that they are compensated for the care they do provide, even if they don’t ultimately deliver the baby. “You have people who, unfortunately, are not getting paid for the work that they do,” said Pamela Boatner, who works as a midwife in a Georgia hospital. While she believes women should receive pregnancy care regardless of their ability to pay, she also understands that some providers want to make sure their bill isn’t ignored after the baby is delivered. New parents might be overloaded with hospital bills and the costs of caring for a new child, and they may lack income if a parent isn’t working, Boatner said. In the U.S., having a baby can be expensive. People who obtain health insurance through large employers pay an average of nearly $3,000 out-of-pocket for pregnancy, childbirth, and postpartum care, according to the Peterson-KFF Health System Tracker . In addition, many people are opting for high-deductible health insurance plans, leaving them to shoulder a larger share of the costs. Of the 100 million U.S. people with health care debt, 12% attribute at least some of it to maternity care, according to a 2022 KFF poll . Families need time to save money for the high costs of pregnancy, childbirth, and child care, especially if they lack paid maternity leave, said Joy Burkhard , CEO of the Policy Center for Maternal Mental Health, a Los Angeles-based policy think tank. Asking them to prepay “is another gut punch,” she said. “What if you don’t have the money? Do you put it on credit cards and hope your credit card goes through?” Calculating the final costs of childbirth depends on multiple factors, such as the timing of the pregnancy , plan benefits, and health complications, said Erin Duffy , a health policy researcher at the University of Southern California’s Schaeffer Center for Health Policy and Economics. The final bill for the patient is unclear until a health plan decides how much of the claim it will cover, she said. But sometimes the option to wait for the insurer is taken away. During Jamie Daw’s first pregnancy in 2020, her OB-GYN accepted her refusal to pay in advance because Daw wanted to see the final bill. But in 2023, during her second pregnancy, a private midwifery practice in New York told her that since she had a high-deductible plan, it was mandatory to pay $2,000 spread out with monthly payments. Daw, a health policy researcher at Columbia University, delivered in September 2023 and got a refund check that November for $640 to cover the difference between the estimate and the final bill. “I study health insurance,” she said. “But, as most of us know, it’s so complicated when you’re really living it.” While the Affordable Care Act requires insurers to cover some prenatal services, it doesn’t prohibit providers from sending their final bill to patients early. It would be a challenge politically and practically for state and federal governments to attempt to regulate the timing of the payment request, said Sabrina Corlette , a co-director of the Center on Health Insurance Reforms at Georgetown University. Medical lobbying groups are powerful and contracts between insurers and medical providers are proprietary. Because of the legal gray area, Lacy Marshall , an insurance broker at Rapha Health and Life in Texas, advises clients to ask their insurer if they can refuse to prepay their deductible. Some insurance plans prohibit providers in their network from requiring payment up front. If the insurer says they can refuse to pay up front, Marshall said, she tells clients to get established with a practice before declining to pay, so that the provider can’t refuse treatment. Related Articles Health | Which health insurance plan may be right for you? Health | California case is the first confirmed bird flu infection in a US child Health | Your cool black kitchenware could be slowly poisoning you, study says. Here’s what to do Health | Does fluoride cause cancer, IQ loss, and more? Fact-checking Robert F. Kennedy Jr.’s claims Health | US towns plunge into debates about fluoride in water Clark said she met her insurance deductible after paying for genetic testing, extra ultrasounds, and other services out of her health care flexible spending account. Then she called her OB-GYN’s office and asked for a refund. “I got my spine back,” said Clark, who had previously worked at a health insurer and a medical office. She got an initial check for about half the $960 she originally paid. In August, Clark was sent to the hospital after her blood pressure spiked. A high-risk pregnancy specialist — not her original OB-GYN practice — delivered her son, Peter, prematurely via emergency cesarean section at 30 weeks. It was only after she resolved most of the bills from the delivery that she received the rest of her refund from the other OB-GYN practice. This final check came in October, just days after Clark brought Peter home from the hospital, and after multiple calls to the office. She said it all added stress to an already stressful period. “Why am I having to pay the price as a patient?” she said. “I’m just trying to have a baby.” ©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.jili369 app download apk 。

Liverpool's Brazilian forward, Roberto Firmino, has been a vital player for the club since his arrival in 2015. Known for his versatility, work rate, and technical ability, Firmino has endeared himself to fans with his relentless work ethic and ability to score crucial goals. As Liverpool strives for success in both domestic and European competitions, Firmino's mindset and belief in the team's capabilities have been instrumental in their journey towards achieving greatness.FERGUS FALLS, Minn. (AP) — A jury convicted two men on Friday of charges related to human smuggling for their roles in an international operation that led to the deaths of a family of Indian migrants who froze while trying to cross the Canada-U.S. border during a 2022 blizzard. Harshkumar Ramanlal Patel, 29, an Indian national who prosecutors say went by the alias “Dirty Harry,” and Steve Shand, 50, an American from Florida, were part of a sophisticated illegal operation that has brought increasing numbers of Indians into the U.S., prosecutors said. They were each convicted on four counts related to human smuggling, including conspiracy to bring migrants into the country illegally. “This trial exposed the unthinkable cruelty of human smuggling and of those criminal organizations that value profit and greed over humanity,” Minnesota U.S. Attorney Andy Luger said. AP AUDIO: 2 convicted in human smuggling case after Indian family froze to death on US-Canada border AP correspondent Ed Donahue reports on a court case involving the border with Canada. “To earn a few thousand dollars, these traffickers put men, women and children in extraordinary peril leading to the horrific and tragic deaths of an entire family. Because of this unimaginable greed, a father, a mother and two children froze to death in sub-zero temperatures on the Minnesota-Canadian border,” Luger added. RELATED COVERAGE Prominent figure from Canada’s trucker protests against COVID-19 restrictions found guilty Mexico acknowledges Canada’s concerns about a Chinese auto plant, but says none exists Human smuggling trial witness says he was separated from a family hours before they froze to death The most serious counts carry maximum sentences of up to 20 years in prison, the U.S. Attorney’s Office told The Associated Press before the trial. But federal sentencing guidelines rely on complicated formulas. Luger said Friday that various factors will be considered in determining what sentences prosecutors will recommend. Federal prosecutors said 39-year-old Jagdish Patel; his wife, Vaishaliben, who was in her mid-30s; their 11-year-old daughter, Vihangi; and 3-year-old son, Dharmik, froze to death Jan. 19, 2022, while trying to cross the border into Minnesota in a scheme Patel and Shand organized. Patel is a common Indian surname, and the victims were not related to Harshkumar Patel. The couple were schoolteachers, local news reports said. The family was fairly well off by local standards, living in a well-kept, two-story house with a front patio and a wide veranda. Experts say illegal immigration from India is driven by everything from political repression to a dysfunctional American immigration system that can take years, if not decades, to navigate legally. Much is rooted in economics and how even low-wage jobs in the West can ignite hopes for a better life. Before the jury’s conviction on Friday, the federal trial in Fergus Falls, Minnesota, saw testimony from an alleged participant in the smuggling ring, a survivor of the treacherous journey across the northern border, border patrol agents and forensic experts. Defense attorneys were pitted against each other, with Shand’s team arguing that he was unwittingly roped into the scheme by Patel. Patel’s lawyers, The Canadian Press reported , said their client had been misidentified. They said “Dirty Hary,” the alleged nickname for Patel found in Shand’s phone, is a different person. Bank records and witness testimony from those who encountered Shand near the border didn’t tie him to the crime, they added. Prosecutors said Patel coordinated the operation while Shand was a driver. Shand was to pick up 11 Indian migrants on the Minnesota side of the border, prosecutors said. Only seven survived the foot crossing. Canadian authorities found the Patel family later that morning, dead from the cold. The trial included an inside account of how the international smuggling ring allegedly works and who it targets. Rajinder Singh, 51, testified that he made over $400,000 smuggling over 500 people through the same network that included Patel and Shand. Singh said most of the people he smuggled came from Gujarat state. He said the migrants would often pay smugglers about $100,000 to get them from India to the U.S., where they would work to pay off their debts at low-wage jobs in cities around the country. Singh said the smugglers would run their finances through “hawala,” an informal money transfer system that relies on trust. The pipeline of illegal immigration from India has long existed but has increased sharply along the U.S.-Canada border. The U.S. Border Patrol arrested more than 14,000 Indians on the Canadian border in the year ending Sept. 30, which amounted to 60% of all arrests along that border and more than 10 times the number two years ago. By 2022, the Pew Research Center estimates more than 725,000 Indians were living illegally in the U.S., behind only Mexicans and El Salvadorans. Jamie Holt, a Special Agent with Homeland Security Investigations, said the case is a stark reminder of the realities victims of human smuggling face. “Human smuggling is a vile crime that preys on the most vulnerable, exploiting their desperation and dreams for a better life,” Holt said. “The suffering endured by this family is unimaginable and it is our duty to ensure that such atrocities are met with the full force of the law.” One juror Kevin Paul, of Clearwater, Minnesota, told reporters afterward that it was hard for the jurors to see the pictures of the family’s bodies. He said he grew up in North Dakota and is familiar with the kind of conditions that led to their deaths. “It’s pretty brutal,” Paul said. “I couldn’t imagine having to do what they had to do out there in the middle of nowhere.” ___ Goldberg reported from Minneapolis.

The decision to consider selling Rashford represents a significant shift in the club's strategy and long-term planning. While Manchester United has a rich history of nurturing young talents and building successful teams around them, the current management is reportedly exploring ways to reshape the squad and address areas of weakness.Zomato said last week that it received a notice from the goods and services tax authorities demanding Rs 803 crore in unpaid tax including penalty and interest for the period between 2019 and 2022. This issue pertains to a contention between food delivery platforms and the government, on whether the aggregators are liable to pay tax on the delivery fees collected by them. ET explains: What is the latest development? The tax demand came after the GST authorities sent a show cause notice to Zomato in December last year , seeking reasons on why it should not be taxed the amount. 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The GST authorities are of the view that delivery is classified as a service and so the fees collected by Zomato during this period is liable to be taxed. Discover the stories of your interest Blockchain 5 Stories Cyber-safety 7 Stories Fintech 9 Stories E-comm 9 Stories ML 8 Stories Edtech 6 Stories At the heart of this issue is Section 9 (5) of the Central GST Act, which stipulates that platforms across sectors such as food delivery, ride hailing and ecommerce that aggregate businesses are responsible for collection and payment of the indirect tax on behalf of the suppliers of goods or services. Under GST laws, delivery of food is a service liable to be taxed at 18%, and the government is of the view that since the platforms have been collecting a service fee, they must pay the tax. What is the point of contention? Aggregators say that while they collect delivery fees from customers, it is passed on to the gig workers fulfilling those deliveries. “In a large number of cases, customers are charged no delivery fees or discounted fees...but the delivery partners are still paid as per a standard per km fee basis. That’s the burden the platform takes to drive growth,” a food delivery executive said. How long has this issue been in the making? Starting January 1, 2022 , online food ordering platforms that aggregate restaurants and arrange for food deliveries have been liable to collect and deposit GST on behalf of restaurants for sales made through them. However, at the time, no clarity was provided on the delivery fee component. Companies and industry bodies have been seeking clarity from the GST Council on the delivery fee component, on whether it is covered under the tax ambit. But nothing has emerged so far. How does this tax demand impact Zomato? The company said it will contest the tax demand. It will first appeal in the GST Appellate Tribunal, following which the matter could end up going to the courts. “This will be a long-drawn battle before any material outcome emerges,” a tax expert said. To put things into perspective, the tax demand of Rs 803.7 crore is more than the total profit made by Zomato since it became profitable in the April-June 2023 quarter. In the fiscal year 2024, Zomato posted a net profit of Rs 351 crore . For the first six months of the ongoing fiscal year, it posted a profit of Rs 429 crore. What could be the broader implications? While the final outcome of this matter could take time as the company as well the authorities undergo a likely appeals process, a legal precedence on paying tax for delivery fees collected on behalf of gig workers could open the gates for other services that employ gig workers for deliveries, such as online groceries, e-pharmacies, and hyperlocal logistics to be taxed. Is it just Zomato that has come under the tax scanner on this issue? Zomato’s Bengaluru-based rival Swiggy was also served a show cause notice last December on the same matter amounting to unpaid tax of Rs 326.8 crore. Swiggy is understood to have not received a demand notice yet.

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After weeks of fear and bewilderment about the drones buzzing over parts of New York and New Jersey , U.S. Senator Chuck Schumer is urging the federal government to deploy better drone-tracking technology to identify and ultimately stop the airborne pests. The New York Democrat is calling on the Department of Homeland Security to immediately deploy special technology that identifies and tracks drones back to their landing spots, according to briefings from his office. Javascript is required for you to be able to read premium content. Please enable it in your browser settings.Former Director-General of the Labour Party Presidential Campaign, Doyin Okupe, has insisted that the 2023 presidential election was not rigged by the ruling All Progressives Congress. Mr. Okupe stated this in a statement on Thursday in Lagos State. He argued that there might have been possibility of rigging, but no presidential mandate was stolen from anyone. Okupe emphasized that if LP’s mandate was stolen as claimed by its supporters, he asked that how did the party’s candidate, Peter Obi won Lagos, the home of APC’s candidate, President Bola Tinubu. He said: “If Peter Obi (2023 LP presidential candidate) or the Labour Party says APC rigged elections, how come Obi was able to win in the home base of President Bola Tinubu? “How come APC lost the election in the home base of the sitting president (Muhammadu Buhari)? How come APC lost the election in the home base of the secretary to that government? “So, the accusations about rigging do not hold water; they do not hold water at all. “The truth of the matter is that under the best of conditions, the results we got may not have been the exact results, but they will have that ratio. READ MORE: Criminals Hack Doyin Okupe’s WhatsApp “I was in the Labour Party; we couldn’t have done better than we did. I know that for some reasons, but that is a discussion for another day. “There’s nothing like that. No presidency was stolen. I am not saying there was no rigging. “There was no election that we have done in Nigeria since 1960 till date that was not rigged one way or the other. Not one. “Perhaps an exception was MKO Abiola’s election because of the unique nature of the voting pattern. You know it was Option A4; people were counted. Apart from that, every other election was rigged.”

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By ADRIANA GOMEZ LICON FORT LAUDERDALE, Fla. (AP) — President-elect Donald Trump promised on Tuesday to “vigorously pursue” capital punishment after President Joe Biden commuted the sentences of most people on federal death row partly to stop Trump from pushing forward their executions. Related Articles National Politics | Elon Musk’s preschool is the next step in his anti-woke education dreams National Politics | Trump’s picks for top health jobs not just team of rivals but ‘team of opponents’ National Politics | Biden will decide on US Steel acquisition after influential panel fails to reach consensus National Politics | Biden vetoes once-bipartisan effort to add 66 federal judgeships, citing ‘hurried’ House action National Politics | A history of the Panama Canal — and why Trump can’t take it back on his own Trump criticized Biden’s decision on Monday to change the sentences of 37 of the 40 condemned people to life in prison without parole, arguing that it was senseless and insulted the families of their victims. Biden said converting their punishments to life imprisonment was consistent with the moratorium imposed on federal executions in cases other than terrorism and hate-motivated mass murder. “Joe Biden just commuted the Death Sentence on 37 of the worst killers in our Country,” he wrote on his social media site. “When you hear the acts of each, you won’t believe that he did this. Makes no sense. Relatives and friends are further devastated. They can’t believe this is happening!” Presidents historically have no involvement in dictating or recommending the punishments that federal prosecutors seek for defendants in criminal cases, though Trump has long sought more direct control over the Justice Department’s operations. The president-elect wrote that he would direct the department to pursue the death penalty “as soon as I am inaugurated,” but was vague on what specific actions he may take and said they would be in cases of “violent rapists, murderers, and monsters.” He highlighted the cases of two men who were on federal death row for slaying a woman and a girl, had admitted to killing more and had their sentences commuted by Biden. On the campaign trail, Trump often called for expanding the federal death penalty — including for those who kill police officers, those convicted of drug and human trafficking, and migrants who kill U.S. citizens. “Trump has been fairly consistent in wanting to sort of say that he thinks the death penalty is an important tool and he wants to use it,” said Douglas Berman, an expert on sentencing at Ohio State University’s law school. “But whether practically any of that can happen, either under existing law or other laws, is a heavy lift.” Berman said Trump’s statement at this point seems to be just a response to Biden’s commutation. “I’m inclined to think it’s still in sort of more the rhetoric phase. Just, ‘don’t worry. The new sheriff is coming. I like the death penalty,’” he said. Most Americans have historically supported the death penalty for people convicted of murder, according to decades of annual polling by Gallup, but support has declined over the past few decades. About half of Americans were in favor in an October poll, while roughly 7 in 10 Americans backed capital punishment for murderers in 2007. Before Biden’s commutation, there were 40 federal death row inmates compared with more than 2,000 who have been sentenced to death by states. “The reality is all of these crimes are typically handled by the states,” Berman said. A question is whether the Trump administration would try to take over some state murder cases, such as those related to drug trafficking or smuggling. He could also attempt to take cases from states that have abolished the death penalty. Berman said Trump’s statement, along with some recent actions by states, may present an effort to get the Supreme Court to reconsider a precedent that considers the death penalty disproportionate punishment for rape. “That would literally take decades to unfold. It’s not something that is going to happen overnight,” Berman said. Before one of Trump’s rallies on Aug. 20, his prepared remarks released to the media said he would announce he would ask for the death penalty for child rapists and child traffickers. But Trump never delivered the line. One of the men Trump highlighted on Tuesday was ex-Marine Jorge Avila Torrez, who was sentenced to death for killing a sailor in Virginia and later pleaded guilty to the fatal stabbing of an 8-year-old and a 9-year-old girl in a suburban Chicago park several years before. The other man, Thomas Steven Sanders, was sentenced to death for the kidnapping and slaying of a 12-year-old girl in Louisiana, days after shooting the girl’s mother in a wildlife park in Arizona. Court records show he admitted to both killings. Some families of victims expressed anger with Biden’s decision, but the president had faced pressure from advocacy groups urging him to make it more difficult for Trump to increase the use of capital punishment for federal inmates. The ACLU and the U.S. Conference of Catholic Bishops were some of the groups that applauded the decision. Biden left three federal inmates to face execution. They are Dylann Roof, who carried out the 2015 racist slayings of nine Black members of Mother Emanuel AME Church in Charleston, South Carolina; 2013 Boston Marathon bomber Dzhokhar Tsarnaev ; and Robert Bowers, who fatally shot 11 congregants at Pittsburgh’s Tree of Life Synagogue in 2018 , the deadliest antisemitic attack in U.S history. Associated Press writers Jill Colvin, Michelle L. Price and Eric Tucker contributed to this report.As authorities race against time to uncover the truth and bring the perpetrators to justice, a daunting challenge looms large in the quest for closure: the recovery of the influencer's body from the depths of the sea. The vast and unpredictable nature of the ocean presents a formidable obstacle in the search efforts, with the chances of locating and retrieving her remains growing slimmer by the day.