Latest news with #Takacs
Yahoo
30-04-2025
- Health
- Yahoo
The Price of Life: The battle with health providers to keep their loved ones alive
NEW HAVEN, Conn. (WTNH) — Tackling the rising cost of health care can certainly put a financial strain on families. The emotional toll can be devastating when unexpected denials from health insurance policies pile up. In a News 8 special report, two separate families fighting to keep their loved ones alive shared their ongoing battle with health care providers. For them, the experience has sparked a major question: Who decides the price of life? Hartford Healthcare, University of New Haven, collaborating on approach to mental health It comes after United Healthcare CEO Brian Thompson was gunned down in New York City in December last year. The prime suspect, Luigi Mangione, faces serious charges in two states and at the federal level for the fatal shooting and has pleaded not guilty. In the federal case, Luigi could face the death penalty. The ruthless crime startled the nation and has spotlighted the health care system. 'I think we were all surprised at the public reaction, and it's something I think that those of us who deal in this world of helping people have recognized that there is a lot of frustration,' said Kathy Holt, the State of Connecticut Healthcare Advocate (OHA). Holt said the Connecticut OHA receives roughly 5,000 consumer calls a year, 40% of which are related to healthcare coverage 'and things we can resolve before something is denied.' Ethan Takacs is among those cases. The 19-year-old lives with spinal muscular atrophy, a degenerative condition similar to amyotrophic lateral sclerosis, more widely known as ALS. 'We were told to take him home, love him a lot, take a lot of pictures, and he most likely would die by the age of 1, maybe 2,' his mother, Kelly Greenwood, said. Takacs has surpassed his life expectancy nearly 20 times over, with his birthday this June. The family says he requires around-the-clock attention and can't walk, talk or breathe on his own. Inside Greenwood's home, Ethan is on a bed with several pieces of equipment around him, including a ventilator, feeding tube and other machines used to clear him of congestion. His mother tells News 8 her son's condition has declined over the years. In 2022, Takacs had to get a tracheostomy due to respiratory failure. 'Even with all those losses, he's still here,' Takacs's father, Jason, said. 'And one of those reasons is because of the women that help us take care of him.' Bernadette Gillot-Lamousnery is a nurse who has provided in-home care to Takacs for nearly 19 years. 'I would say I know Ethan more than my own children,' she told News 8. The family says the two have a special bond that has given Takacs the will to live. With Gillot-Lamousnery's long-term support, he has been able to celebrate key milestones, including having friends, graduating from school, and being a die-hard Yankees fan. Anthem Blue Cross and Blue Shield have covered Takacs's in-home nursing care for the duration of his life and have been funded through his father's career as a detective for the Fairfield police. The plan included Lamousnery's private duty nursing with AAA Nursing Care. The family tells News 8 that private nursing is critical to Ethan's survival as he has very specific and 'complex medical needs' requiring attention 24/7. Last March, the family said they were notified about a pay issue with AAA Nursing, with the company saying it was not getting paid its previously negotiated and approved rate. Then, in November, Jason says he was notified that his son no longer qualified for care altogether and that coverage would come to an end in April. A letter the family provided from Anthem deemed the services 'not medically necessary.' When asked if his son looks stable, Jason said, 'He's essentially on life support every day,' adding, 'If he doesn't qualify, who does qualify?' As for Ethan's mother, Kelly, she views the denial as 'for me to hear they want to take them away to me says they want to basically take away his existence…that's very hard to hear someone say that about my child.' The company reversed its decision after appealing through the state's Office of the Healthcare Advocate. Anthem Blue Cross and Blue Shield sent the following response to News 8 in a statement: 'Anthem Blue Cross and Blue Shield is committed to providing members with access to safe, effective, and clinically appropriate medical care. Our medical coverage decisions are guided by a rigorous, transparent, and evidence-based process focused solely on clinical merit and member benefits. AAA Nursing is an out-of-network provider for Anthem and our single case agreement with them for Ethan's care recently expired. As part of our normal process for reviewing authorizations for care, we determined his condition remained stable and he could transition to a maintenance level of support. After further reviewing Ethan's case and recent clinical notes, and recognizing the potential disruption to Ethan's care with a change in a different level of support at this time, we reversed our initial decision and approved the continuation of his private duty nursing care through the end of the year. However, the Town of Fairfield recently informed us that it is changing insurance carriers effective July 1, 2025. Due to this change, Anthem's approval will extend through the end of June. Effective July 1, 2025, benefits for care received by Ethan on and after that date will be the responsibility of the new insurance carrier.' The Town of Fairfield confirmed to News 8 that it 'intends to switch health plans July 1, 2025,' once again adding to the uncertainty over Takacs's in-home nursing care. Ethan's father tells News 8 the estimated out-of-pocket cost for his son's monthly care would be roughly $30,000. The battle with healthcare insurance companies is all too familiar to the Schipani family. Like Ethan, their 36-year-old son, Taylor, lives with a host of severe conditions, including cerebral palsy, seizure disorder and respiratory complications. He also has precise and complex medical needs, requiring suctioning multiple times a day and the use of a feeding tube. His father, Steve, tells News 8 he gets 8-12 cases of pneumonia annually. While Taylor was born with CP, his condition became much worse after a surgery in 2001 went wrong. 'He had spinal fusion because he had some curvature, and we were having issues with his eating. He was getting a lot of aspiration pneumonia from it, so we had the spinal fusion. Long story short, it went really badly,' Steve Schipani said. Steve says their provider, Quantum Health, has been trying to terminate his son's coverage since 2023. 'They just want you to give up and go away,' Steve Schipani told News 8. 'They feel like it's just not worth trying to keep him alive.' Every six months, when Taylor's coverage is about to end, a frustrating notice arrives, alerting them that the family services will not be renewed. One of the denial letters the family received from Quantum Health provided to News 8 states, 'The medical plan does not cover room, board, nursing care or personal care, which is rendered to assist a covered person who, in Quantum Health's opinion, has reached the maximum level of physical or mental function and will not make further significant improvement.' Steve says the company's conclusion highlights a frustrating paradox families like his face, where their loved ones can be denied for either being too ill or for making progress due to the care they've received. 'If the doctor says one visit, 'oh he's making good progress on his whatever,' all of a sudden that is a red flag to them that they can say, 'hey, we're not going to cover you,'' he said. 'There needs to be a stop on how many times an insurance company can do this,' said Taylor's mother, Pam. 'His life is worth something and I wish these people who work in insurance understood that. I wish they came to our house and met him and saw the joy he has, the joy he gives us. If you don't care for him, that won't be here any longer. He won't be here any longer.' News 8 reached out to Quantum Health multiple times for comment but did not get a response. We also reached out to Anthem, as a number of appeal and denial documents provided by the Schipanis show they were sent from the provider. Steve says Quantum has been managing Taylor's case, while Anthem is responsible for paying claims. When asked about the relationship between Quantum and Anthem and the company's involvement with Taylor's case, Anthem provided the following response: 'Quantum Health is not affiliated with or part of Anthem Blue Cross and Blue Shield. For the State of Connecticut health plan and the State of Connecticut Partnership Plan (municipalities that are covered under the state plan), Quantum Health was contracted by the state to provide customer service, utilization management, and case management services. Anthem is separately contracted by the state in these programs as the benefits administrator to manage the provider network and pay claims. Under these programs, Anthem would pay claims based on Quantum Health's decisions regarding approvals or denials of care.' The Schipanis have filed multiple appeals since Taylor started getting denial notices in 2023. So far, the family has won each time. However, Taylor's father says there have been issues getting claims paid from Anthem, so the family filed a complaint with the state's Insurance Department Consumer Affairs Division. Steve says the grievance helped resolve the matter. Based on his experience filing multiple appeals, Steve provided advice for families in similar situations. He says the process involves multiple appeals for each incident. 'Most people give up after the first rejection or denial,' he said. 'An even larger percentage give up after the second appeal. You have to get to the third appeal, which is the appeal that leaves the insurance company and goes to an outside reviewer made up of medical personnel,' adding this is the most crucial appeal level if families want a chance to succeed because it looks at the medical components of the case. He also advises against families appealing on their own. 'Even a conversation with the provider can be considered an appeal,' Steve said. 'Getting the correct info to the provider is the key to success and sets a precedent for future appeals.' The Connecticut Office of the Healthcare Advocate says that statistically, only about 1% of people appeal their case. Eighty percent of the time, those who appeal win until the next denial notice comes in the mail. The OHA says the appeal process can be long and exhausting. 'Some insurers have five levels of review. When you talk about Medicare, you can be denied and denied and denied again,' Holt said. 'The impact of not covering something is much bigger than just the singular individual who has to fight, and when you don't feel well when you're sick, fighting is even more difficult.' Holt is calling for legislative reform on the issue. 'They shouldn't have to constantly battle and constantly be denied and have to be re-approved. Once something's been approved, there should be a precedent to continue that authorization,' she told News 8. Holt says anyone looking for support in appealing coverage denial can contact the Connecticut Office of the Healthcare Advocate at 1-866-466-4446 or click here for more. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
New York Times
27-04-2025
- Entertainment
- New York Times
At 50, the Takacs Quartet Remains as Essential as Ever
Recently, the Takacs Quartet gave a recital at the University of Colorado Boulder. In many ways, it could have been perfectly routine: some Bartok and Beethoven before an adoring audience at the college where the group has taught in residence since 1986. But the Takacs simply does not do routine. The Beethoven was a perfect example, an exceptional account of the Opus 135 Quartet that was astonishingly vivid even when watched on a livestream. You could have taken any of its four movements and written pages in their praise. Perhaps what struck most, though, was just how constantly and generously each of the players — Edward Dusinberre, first violin; Harumi Rhodes, second violin; Richard O'Neill, viola; and Andras Fejer, cello — was physically and aurally in dialogue with the others, and through them, the listener. It's that ability to communicate, among many other talents, that makes the Takacs the essential quartet of our time. It's also one of the qualities that has kept the group so identifiably itself as time has passed: The quartet marks its 50th anniversary this year. As part of a season of celebrations, it appears with the pianist Jeremy Denk at the Frick Collection on Thursday. The name Takacs has become a synonym for assured, collective excellence, but its story is one of evolution, not stasis. Read either of Dusinberre's eloquent memoirs relating the history of the quartet, and it becomes clear that it has been a personal drama, played out through the scores that its members rehearse and perform. Time certainly has remade the Takacs. Only one of the four young Hungarians — Gabor Takacs-Nagy, Karoly Schranz, Gabor Ormai and Fejer — who stepped into their first lesson in communist Hungary, ready with a Mozart quartet, remains. Both Roger Tapping and Geraldine Walther, the violists who followed Ormai in turn, have come and gone. 'Changing a player in a string quartet is a trauma that must be played out under the watchful eye of an expectant public,' Dusinberre has written. Some of those traumas have been more painful than others, above all the death of Ormai from cancer, in 1995. Change, though, has also brought the Takacs renewal, adaptation, promise — and even, for the two current violinists, marriage. Along the way, the Takacs that once carried forward the great Hungarian tradition of string quartets has morphed into something else, entirely its own. 'It's interesting,' the Attacca Quartet violinist Amy Schroeder said admiringly, 'because they have such a unique voice that I can't really pinpoint whether it's European, American, a combination of both or just the Takacs thing.' The Takacs thing. 'They have always been one of the world's pre-eminent string quartets, and they have a unique approach to the repertoire,' said John Gilhooly, the director of Wigmore Hall in London. 'Whatever they have, they have it in abundance.' ORMAI AND FEJER were teenagers when they decided to form a quartet. In 1973, a year before they entered the fabled Franz Liszt Academy of Music in Budapest, they asked Takacs-Nagy to be their first violinist, but they had to content themselves playing trios for the two years it took them to find a second. Takacs-Nagy eventually found Schranz at a soccer match. Hear Takacs-Nagy and Fejer talk about their education now, and it becomes obvious how lasting its imprint has been. Their teachers — Andras Mihaly, Ferenc Rados and, intriguingly, Gyorgy Kurtag — tried to instill a sense of musical morality in their students. 'It was not aimed at chasing mistakes; they were looking for values,' Takacs-Nagy said. 'We knew that behind every bar, every note, there are gold mines, diamond fields.' Fejer recalled that they 'thought we knew, if not everything, most things, and these three wonderful teachers made that confident feeling disappear in a matter of hours.' 'That was the last time any one of us thought we knew anything,' he added. Despite the travel difficulties imposed by life behind the Iron Curtain, the Takacs rose quickly, winning a series of competitions. They studied Bartok with Zoltan Szekely, who had premiered the composer's Second Violin Concerto and still called his old friend Bela. They also found a mentor in Denes Koromzay, who, like Szekely, had played in the legendary Hungarian String Quartet. In time, Takacs-Nagy said, they became more aware of themselves as part of a distinguished national lineage. 'The Takacs offered all the virtues of Central Europe's string-playing tradition and only occasionally its defects,' Bernard Holland of The New York Times wrote after hearing them on their first U.S. tour, in 1982. Other quartets might be more precise, he went on, but with the Takacs, 'one felt always in the presence of music.' After a series of shorter stays in the United States, the Takacs members defected in 1986 and moved to Boulder, where Koromzay taught. The Hungarian String Quartet had once been in residence there, and the Takacs found a community proud to give personal and professional aid. One local philanthropist, Fay Shwayder, eventually bought it four new instruments; after Takacs-Nagy left the quartet with hand trouble in 1992, another benefactor offered Dusinberre, fresh from his studies at the Juilliard School, a loan to buy a house. The Takacs was already a fine quartet, with a lyrical, emotionally frank sensibility that rarely underplayed the character of a phrase. Soon after Dusinberre and Tapping joined Schranz and Fejer, though, critical admiration turned into critical adulation. In 1998, the Takacs released a set of visceral Bartok quartets on Decca that remains a reference today. Even more celebrated was a later Beethoven survey that the New Yorker critic Alex Ross judged 'the most richly expressive modern account of this titanic cycle.' Showered with awards, it showcased the kind of playing — daring yet secure, humane yet heaven-bound — that listeners could spend a lifetime with. Indeed, it shaped entire careers. 'I had their cycle, and I was just so amazed by it,' recalled O'Neill, who first auditioned for the quartet while he was a student at Juilliard two decades ago, before eventually replacing Walther after her retirement 15 years later. 'It started this lifelong obsession of wanting to play the entire cycle because of them.' HOW, THEN, HAS the Takacs so reliably stayed the Takacs? There are small things, like the way that the players sit a little farther apart than the norm, or the means they have found to conclude arguments, including sending a player out into a hall to give a verdict on a phrase. Perhaps more important is the Takacs's fundamentally inquisitive nature, a professed desire to stay humble in front of the music and one another. All great quartets have had a similar curiosity, but it remains remarkable that you can select almost any of the Takacs's recordings — especially those it has made since a savage Schubert 'Death and the Maiden' announced the group's move to the Hyperion label in 2006 — and find playing that takes nothing for granted. Stephen Hough, the English pianist and composer who wrote his first quartet for the group, recorded the Brahms Piano Quintet with the Takacs in 2007 and toured the piece again with the current foursome this year. 'Each of them was injecting new ideas, night by night,' Hough said of those concerts. Dusinberre felt something similar from the earliest hours he spent in Boulder, rehearsing during his audition. ''Playing it safe' didn't seem to form any part of the Takacs's musical philosophy,' he wrote of that experience. Rhodes cites the 'good, healthy danger' of Schranz's playing as one of the main reasons she decided to become a second violinist at all. When she first heard the quartet, she said, 'all the pieces had this feeling of exploration and adventure, and there was this overall feeling of mischief, like children having fun together.' Even if every new player subtly changes the character of the quartet, their predecessors are palpable through the scores they left behind. Still, that can work both ways. As a young, introspective player, Dusinberre found the thick markings on Takacs-Nagy's parts too intimidating to use, despite the respect he had for such a charismatic musician. O'Neill, however, has found the visual history of the quartet he has at his disposal more helpful, from the careful, almost mathematical precision of Ormai's red and blue pencil lines, to the creativity of Tapping's fingerings, to the single words with which Walther distilled hours of rehearsal debate. Over time, there has also been a shift in the music that the Takacs has chosen to play. It has always been more than the Bartok-and-Beethoven foursome of lore; consult its discography and you will find Franck, Dutilleux, Britten, Shostakovich and Dohnanyi alongside Haydn and Brahms. But its increasing interest in music by contemporary composers like Clarice Assad and Nokuthula Ngwenyama has been a welcome surprise, as have its superb recordings of scores by Amy Beach, Samuel Coleridge-Taylor and, on an album released last month with the pianist Marc-André Hamelin, Florence Price. 'If you look at our quartet, we're clearly a multigenerational group,' Rhodes said. 'We come from completely different cultures and backgrounds. I guess from my point of view, it would be weird if we weren't representing that in some way.' Eventually, there will come a time when Fejer departs and the transformation of the Takacs will be complete. Although the quartet is careful to promise nothing, Fejer suggested that it would be an 'extreme pity' if the Takacs did not endure, even without the last of its founding members. 'But luckily,' he added, 'we are not there yet.'
