tdap annual business plan

Trade Development Authority of Pakistan

Year shop planning (4144-3832), annual business plan (0466-3336), 'end-of-year report abp 3780-25'.

Trade Development Authorty of Pakistan 2th Floor, Block AMPERE, Finance & Trade Centre P.O. Box No. 9427, Shahrah-e-Faisal, Karachi 98392 Pakistan.

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If your extended family is getting a new bundle of joy, you may want to schedule the shot.

Jessica Migala

When you’re at the doctor for your annual wellness visit , they’ll take your vital signs, talk to you about your health habits and maybe order blood tests, too. But there’s another discussion you should have at that routine visit: Am I caught up on my vaccinations ?

“The older you get, the more important it is to make sure you’re up to date with your vaccines, especially if you have underlying heart or lung disease , which comes with a greater risk for severe infection. We have these wonderful tools to keep us healthy, and we need to be using them,” says Linda Yancey, M.D., an infectious disease specialist at Memorial Hermann Health System in Katy, Texas.

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And one of those important vaccines is Tdap.

Here’s what you need to know about the Tdap vaccine, including how it protects you and loved ones around you (like the grandkids) and when you need to roll up your sleeve to get it.

What is the Tdap vaccine?

Tdap stands for tetanus, diphtheria and pertussis. These are all illnesses that can be pretty brutal, but ones that many people today will no longer see in their lifetimes because of vaccines. According to the Centers for Disease Control and Prevention, these are the risks each illness brings:

Tetanus : An infection of the bacteria clostridium tetani , tetanus can enter your body through a contaminated cut, wound or burn. Once the bacteria course through your system, you can develop symptoms such as muscle stiffness, including lockjaw, trouble swallowing, seizures and cardiovascular complications like changes in your heart rate and blood pressure . 

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Though tetanus is still possible to acquire today, cases have plummeted by more than 99 percent in the U.S. since 1947 thanks to vaccination, according to the CDC.

Diphtheria : This is also a bacterial infection — this time from corynebacterium diphtheriae —  but it’s one that can be spread to close contacts, including people who live at home with you or a caretaker. The bacteria take hold of the respiratory system, impairing your ability to breathe and swallow, and they can spread into your bloodstream to cause heart, nerve and kidney damage, possibly leading to death.

Diphtheria once was a big health threat, infecting hundreds of thousands of people and causing more than 10,000 U.S. deaths each year, particularly among children, in the 1920s. With the advent of the vaccine in the 1940s, diphtheria has all but disappeared in the U.S. In fact, there have been just 14 cases and one death from 1996 to 2018, the CDC says.

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Pertussis : Also called whooping cough, pertussis spreads from person to person via the bordetella pertussis bacteria. The bacteria harm the cilia in your airways; these are hair-like structures that move like an escalator to keep debris and germs out of your lungs. Damaged cilia allow junk into your airways, making breathing difficult and causing a telltale cough that sounds like a whoop. If you’ve ever seen someone with whooping cough, you know how forceful and vicious their coughing fits can be. “I’ve had patients cough so hard, they vomit or have broken ribs,” Yancey says. The cough can linger up to three months, she adds.

Pertussis has been on the rise over the last several decades, according to the CDC, and it hits children — especially babies — hard. But adults are not immune to the illness. “It’s important not to believe that this is just a disease of children,” says June McKoy, M.D., a professor of geriatric medicine and preventive medicine at Northwestern Medicine in Chicago. “Pertussis in adults is not as common, but you might start out with a runny nose or sneezing and then develop a cough that becomes really severe.”

But do I really need a Tdap shot?

Experts say yes. You’ll always want to consult with your doctor about the vaccinations you need, but the CDC recommends getting Tdap if:

• You’ve never had Tdap.
• It’s been 10 years since your last Tdap shot. (And you should get the jab every decade for your lifetime, McKoy says.)
• It’s been five years since your last Tdap and now you have a dirty wound or burn. In that case, you need a tetanus shot, and your provider may recommend Tdap for more full coverage.

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In addition, you need to make sure you’re up to date on Tdap by asking your provider when your last vaccine was if you’re going to have a new bundle of joy in the family.

“It’s very common for pertussis to circulate in the population; and for babies who get pertussis, it can be deadly,” Yancey says. Half of children under 6 months of age who get whooping cough have to be hospitalized, according to the CDC. “Those close to the family may be asked to get a booster to protect the baby,” Yancey adds. Even if there isn’t a new baby, Tdap is also important if you have grandchildren. “We try to impress on grandparents to make sure that they’re vaccinated with Tdap to ensure protection against pertussis,” McKoy says.

Past research in the journal Clinical Infectious Diseases has shown that the Tdap vaccine is safe in adults aged 65 and older. The most common side effects people may experience include discomfort or redness at the site of the shot. You might also get a mild fever, a headache , or feel fatigued after Tdap vaccination.

If you’ve had allergies to any vaccine in the past, tell your doctor so they can ensure the components of the vaccine are safe for you and, if so, administer the vaccine in their office so they can keep an eye on you for any reaction, McKoy advises. Otherwise, you can safely get the Tdap vaccine at your local pharmacy. Should you feel sick on the day you plan to get the shot, postpone until you’re feeling better, McKoy advises.

Jessica Migala has written for  Marie Claire ,  Prevention  and more than 30 other publications.

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TDAP finalizes annual business plan

FROM MENAHILL RASHID FAISALABAD: The Trade Development Authority of Pakistan (TDAP) will finalize its Annual Business Plan in consultation with the Faisalabad Chamber of Commerce & Industry (FCCI) to make it progressive and result oriented, said Rana Shahzad Ahmad Khan, Director General TDAP Punjab. In a meeting with President FCCI, Mr. Atif Munir Sheikh, he discussed in detail the inherent potential of Faisalabad and said that a comprehensive strategy would be evolved for the diversification of exports from this city in addition to exploiting the available export opportunities in traditional and non-traditional sectors. Acknowledging the industrial, commercial, business and export edge of this vibrant city, he said that we must involve FCCI and other local trade bodies to give a boost to the export from this city. He said that we should change our strategy and discuss its activities that may have local, regional, national or international dimensions. He said that TDAP will organize a trade and investment conference and potential buyers from all over the world would be invited to participate in it. He mentioned the African model and said that TDAP had organized a made in Pakistan exhibition in Africa but its focus was on to showcase engineering products. He said that TEXPO would be organized in Karachi during the month of August. “It is a regular feature but we intend to club it with other non-traditional items so that a wide range of exportable surplus could be showcased during this event”, he said and added that trade officers have been posted in different potential markets and we must involve them to penetrate in these countries for sustained exports. He also stressed the need to explore non-traditional markets to expand our export portfolio. He said that webinars and online conferences could also be arranged to give much needed awareness to the young start-ups about the emerging trends and market potentials.

Mr. Atif Munir Sheikh President FCCI said that he was seriously working to transform Faisalabad from textile to a multidimensional export city by encouraging other segments of the economy. He particularly mentioned the Information Technology (IT) sector and said that it has recorded a robust growth of 47% and we must focus on it as there is no dearth of talented IT experts. He particularly mentioned the successful Pakistan Economic Conference (PEC) organized by the FCCI and said that the Prime Minister was to address its concluding session but due to political instability, it was deferred. He said that we have prepared 2-page recommendations on the economy exclusively for the Prime Minister. He also mentioned the new industrial estates being developed to attract maximum FDI with technology transfer. He said that 65 foreign companies have already established their units while many more are in the pipeline. He said that with the colonization of these industrial estates, the industrial landscape of Faisalabad would be entirely changed. He said that our textile exports have recorded a 28% increase but it is quite insufficient as our share of the EU market is only one percent. He said that we must focus on other sectors and in this connection; PEC will play a major role. He also appreciated the industrial incentive package and said that it was announced on the special request of FCCI and our 90% recommendations have been included in it.

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Business plan 2023-24: Pakistan to participate in 19 trade exhibitions in China

ISLAMABAD, Aug 28 (Gwadar Pro)- Aligned with the Trade Development Authority Pakistan (TDAP) Annual Business Plan (ABP) for the year 2023-24, Pakistani officials, experts, as well as importers and exporters, are poised to take part in a series of 19 promotional trade exhibitions and fairs hosted across various cities in China over this specified duration.

These exhibitions promise to encompass an array of themes, ranging from textiles and leather to agro and food sectors. Among the wide variety of attractive products, key exports such as mangoes and meat, which Pakistan is proud of, will receive high attention. But that’s not all-the authority’s ambitious agenda extends beyond exhibitions. Brace yourself for a whirlwind of export-promoting conferences, engaging webinars, immersive workshops, and dynamic delegations shuttling to and from Pakistan throughout this vibrant period.

As per the plan, the financial year began with the China-Eurasia Expo, Urumqi under the category of International Markets Development Division (IMDD) on August 25, followed by the China-Northeast Asia Expo in Changchun on August 23-27 under the same category.

Intertextile Shanghai Apparel Fabrics, under the category of Textile & Leather, is scheduled for August 28-30 in China while All China Leather Exhibition Shanghai under the same category is to take place on August 29-31.  

The Seafood and Fisheries Expo, China will take place on September 15-17 under the category of Agro & Food in Guangzhou. Pakistan experts have the opportunity to showcase Agriculture, forestry, food, and beverages. This will be followed by the China - ASEAN Expo, Nanning on September 16-19 in the category of IMDD.

The China International Import Exhibition will take place on November 5-11 in Shanghai in the category of IMDD and will be followed by China High-Tech Fair Shenzhen on November 15-19 in the category of IT and IT services.

Pakistani experts in the fields of tourism, travel, and hospitality in China outbound Tourism and Travel market Expo in Beijing on November 15-17.

On November 21-25, the China Yiwu Import Commodities Fair will take place in Yiwu with Pakistani experts to represent their country in the category of IMDD.

From March 21-24, Pakistani delegates will take art in APLF, HONGKONG to showcase leader products in the exhibition, and during the same month from March 19 to 21 APLF Fashion Access, Hong Kong will also take place.

On March 28-30, the Inter Textile Shanghai Fabric, China is scheduled in Shanghai. Pakistani team will participate in showcasing apparel and fabrics in the category of textile and leather.

The China Canton Fair will take place on April 16, 2024, in Guangzhou in the city. Pakistani team will participate in IMDD as per TDAP’s plan.

The Hong Kong Gift and Premium Fair, 2024 will take place April 27-29 in China’s Hong Kong where the Pakistani team will showcase sports goods.

The Xiamen Stone Fair, 2024 will be the last activity of FY 2023-24 which will take place in Xiamen and Pakistani experts will showcase marble products under the category of Engineering and mineral.

Other than the expos, a delegation from Lahore with expertise in Textile and Food will visit China in May 2024 to collaborate and link the buyers directly with manufacturers and to discuss B2B engagements.

Similarly, under the ‘International Markets Development Division’ a ten-member Chinese delegation is expected to visit Pakistan; another 5-member delegation will visit Pakistan to discuss quarantine regulations regarding meat with Pakistan officials. As per TDAP’s plan, dates for the visit of these delegations will be announced later.

In September 2023 a B2B interaction of Pakistani dry fruits and honey exporters with major buyers of China was scheduled to increase the exports of honey and dry fruits to China.

In December 2023, a webinar and B2B will conducted regarding exports of rice to China to Increase of exports of Rice to China which is one of the potential markets of rice

In June 2024, which will be the last month of the financial year, a B2B/interactive session with the mango buyers of China will be arranged by the Pakistani trade mission in China. The mango exporters of Pakistan and mango importers of China arrange the follow-up of the Mango Promotion Campaign by TDAP 2023-24. It aims to establish trade ties and connections on both sides to improve the market share of Pakistani mango in respective markets.

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AJK minster for industries, trade visits TDAP

KARACHI   -  Ms Kausar Taqadus Gilani, Minster for Industries, Trade and Travel, Azad Jummu and Kashmir visited Trade Development Authority, Government of Pakistan, Mirpur the other day. Purpose of the visit was to develop an understanding with stakeholders and create business friendly environment in the region. The meeting was attended by Divisional Officer, Small Industries Corporation, AJK, Deputy Director, Mirpur Development Authority and representatives from local business community. The Director TDAP, Mirpur (AJK) welcomed the distinguished minister in the office of TDAP. During the meeting, the director, TDAP, Mirpur (AJK) informed the minister about TDAP’s mandate, facilitation, promotional activities undertaken under the TDAP’s Annual Business Plan and the upcoming national and international exhibitions.

The minister informed that AJK region has potential in different sectors like handicrafts, medical herbs, tourism, gems & minerals and wooden furniture. She desired that TDAP shall organize training sessions and local exhibitions to provide opportunities to the local entrepreneurs to development their business and enter into the profitable business of exports to play their due role in the overall economic development of the AJK and the country. She has informed that a large number of the AJK citizens are working abroad. These overseas Pakistanis have a great contribution in earning foreign exchange for the country. Policies shall be devised at AJK government level and federal level to attract investment from the overseas Pakistanis. The Ministry of Small Industries and Trade has planned an exhibition to be held in the month of May, 2024 at Islamabad to provide an opportunity to the AJK traders to showcase their products and develop their linkages and promote their business.

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Tdap and Td Vaccines for Adults

Medically reviewed by Drugs.com. Last updated on May 6, 2024.

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What are the Tdap and Td vaccines?

Tdap and Td are shots given to protect you and others around you from tetanus, diphtheria, and pertussis (whooping cough). These are severe infections caused by bacteria. Tetanus bacteria are found in dirt, manure, and dust. The bacteria enter the body through open skin, such as puncture wounds and burns. Diphtheria and pertussis bacteria are spread from person to person.

Why may I need the Tdap vaccine?

• You did not get some or any of the recommended DTaP doses as a child.
• You did not get Tdap when you were 11 years or older.
• You are a healthcare worker who never got a dose of Tdap.
• You never got a dose of Tdap and will have close contact with a baby younger than 12 months. Get the vaccine within 2 weeks of the close contact, if possible.
• You have a severe cut or burn.
• You are pregnant. You need 1 dose of Tdap during each pregnancy, at 27 to 36 weeks.
• You just had a baby and did not get a dose of Tdap during your pregnancy.

What should I tell my healthcare provider before I get the Tdap or Td vaccine?

• You have a seizure disorder or a problem with your nervous system.
• You had severe pain or swelling after a dose of DTaP, DTP, or Td.
• You have any severe allergy.
• You have a history of Guillain-Barré syndrome.
• You had a fever of 105º F (40.5º C) after a dose of DTaP or DTP.

What are reasons I should not get the Tdap vaccine?

• You are allergic to any part of the vaccine.
• You had a severe allergic reaction to DTaP or DTP.
• You had seizures or a coma within 7 days of receiving DTaP or DTP, caused by the vaccine. You can still safely get the Td vaccine in this case.

When is the Td vaccine given?

The Td vaccine is usually given as a booster dose every 10 years. Td can also be given after 5 years if you have a severe wound or burn.

What are reasons I should not get the Td vaccine?

• You had an allergic reaction to DTaP, DTP, Tdap, or Td.
• You are allergic to any part of the Td vaccine.

Treatment options

The following list of medications are related to or used in the treatment of this condition.

• measles virus vaccine/mumps virus vaccine/rubella virus vaccine/varicella virus vaccine
• rotavirus vaccine

When should I wait to get the Tdap or Td vaccine?

Tell your healthcare provider if you have a fever or any illness on the day of your vaccine appointment. Your provider may wait to give the vaccine until the fever or illness is gone.

What are the risks of the Tdap and Td vaccines?

The area where the vaccine was given may be red, tender, or swollen. This should get better in 1 to 2 days. Rarely, you may develop severe shoulder pain that lasts longer than 2 days. You may develop a fever. You may have an allergic reaction to the vaccine. This can be life-threatening.

Call your local emergency number (911 in the US) if:

• Your mouth and throat are swollen.
• You are wheezing or have trouble breathing.
• You have chest pain or your heart is beating faster than usual.

When should I seek immediate care?

• Your face is red or swollen.
• You have hives that spread over your body.
• You feel weak or dizzy.

When should I call my doctor?

• You have severe pain, redness, and swelling in your arm where the shot was given.
• You have a fever or chills.
• You have a headache, body aches, or joint pain.
• You have nausea or diarrhea, or you are vomiting.
• You have questions or concerns about the vaccine.

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Does Medicare Cover the Tdap Vaccine?

Medicare provides many services and supplies to recipients who qualify due to age or disability, including preventive care that can help you maintain your health and wellness. Vaccinations are often associated with children’s care, but there are some vaccines that adults need later in life.

What is the Tdap Shot? Tdap stands for tetanus, diphtheria and pertussis. Immunization is intended to prevent these serious diseases. Tetanus, sometimes referred to as lockjaw, and diphtheria are rare in the United States, according to the Centers for Disease Control and Prevention. Pertussis, otherwise known as whooping cough, causes distressing coughing episodes, which can lead to other more serious complications. The three diseases result from bacteria; diphtheria and pertussis spread from one person to another while tetanus makes its entrance through cuts, scratches or wounds on the body. The CDC touts the success of the Tdap vaccine in disease prevention but also cautions about side effects. It is critical to talk to your doctor about potential risks based on your personal health history.

Medicare Benefits for Vaccinations As a reminder, Medicare Part A covers the cost of care in hospitals, skilled nursing facilities and hospice, and in some cases, at home. Medicare Part B covers the cost of physician services, outpatient care, medical equipment and preventive visits. Part D is for drug coverage. Neither Part A nor Part B cover the cost of the Tdap vaccine. Medicare suggests that recipients of Medicare benefits interested in this vaccine reach out to their drug plan provider to inquire about vaccinations covered under Part D. This is also true for the shingles shot.  There are a few immunizations that are considered to be medical benefits that fall under Medicare Part B, such as pneumonia and flu shots, and Hepatitis B shot for those at medium or high risk.

Part D Vaccination Coverage Whether you are enrolled in Part D or in Part C with a Medicare Advantage plan that includes outpatient prescription drugs, your provider’s customer service department should be able to clarify how the cost of the Tdap vaccine is covered. To prepare, it may help to understand how this generally works so that you know what questions to ask.

Part D vaccination coverage is comprised of two parts: Prescription medication and administration. The prescription is the vaccine medication itself. The administration refers to the medical practitioner giving you the vaccine. The distinction is important because some plans have separate coverage for these components.

What you pay may depend on where you receive the medication and who administers it to you. The possible scenarios that illustrate this are when you buy the vaccine at the pharmacy and have it administered on-site; get the vaccine at the doctor’s office where you receive the shot; or buy the vaccine at the pharmacy, and bring it to your physician who then administers it to you. Your responsibility for payment may vary across these situations from coinsurance and co-payment to the entire amount upfront, which you would then submit for reimbursement.

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'No one else seemed to care': Patients reach out to Public Investigator about medical billing issues with Ascension, insurers

In November 2022, Thiensville resident Kate Nelson saw her doctor at Ascension Columbia St. Mary's in Grafton for an annual wellness visit .

A benefit of her Medicare plan , these visits are covered as long as additional tests and services aren't performed. None were, according to Nelson and her husband, who also attended.

A year later, the 71-year-old unexpectedly received a $648 bill.

Her husband, Steve Nelson, said he didn’t expect it would take more than one phone call to clear up the miscommunication. But each time he called, he couldn’t make any progress.

“The person that you almost always get is someone who has neither the knowledge to know how to answer my question, nor the ability to change it,” he said. 

Every month, they would get the same bill in the mail. Each time, Steve Nelson would call Ascension to say the charges were incorrect.

“The last person I talked to at Ascension said, ‘Well, for now, ignore this bill. Just ignore it while we process it,’” Steve Nelson said. 

Ascension never explained what they needed to "process," he said. In March, after disputing the charge for five months, the Nelsons reached out to Public Investigator.

Reporters sent the bill to Ascension on April 1. Four days later, Steve Nelson got a call that the bill was dropped.

"Ascension called Katie this a.m.," Steve Nelson wrote in an email to Public Investigator. "One of the charges was coded wrong, the other was submitted by someone 'not credentialed.' Bottom line, the bill has been cancelled! Whew! Kudos to you ladies, and many, many thanks!"

The Nelsons' story is among dozens of emails and calls Public Investigator received from Ascension patients after publishing a story about a Milwaukee couple who spent months fighting a medical bill for a checkup . Most involved Medicare users or older adults, and all cited difficulties communicating with Ascension customer service regarding billing errors.

All patients who contacted Public Investigator experienced these issues months before Ascension fell victim to a ransomware attack this May.

In a statement, an Ascension Wisconsin spokesperson said Ascension is " committed to ensuring that all patients receive fair and accurate billing" and is continually improving its customer service. That includes ongoing customer service training and expanding access to customer service through "a variety of digital platforms."

The spokesperson also acknowledged the complexity of medical billing, caused by widely varying reimbursement and coverage policies across all kinds of insurance companies. Ascension resolves 85% of all billing inquiries during the first phone call, the spokesperson said.

Ascension declined to comment on specific patients' cases, even though the patients were willing to give the health care system permission to discuss their situations. However, Ascension agreed to investigate the cases included in this story.

Many older adults feel they're not listened to or taken seriously due to their age, said Emily Petersen, policy and advocacy manager for older adult services at the Milwaukee County Health department . She said navigating incorrect or confusing medical bills is a common problem.

"That is why this type of advocacy is so important and why federal law requires advocacy for older adults," Petersen said, "because these types of things are very prevalent."

Medicare can cause confusion between annual wellness visits and annual physical exams

In January, Milwaukee resident Carol Hioki, 68, visited the Ascension Columbia St. Mary's Family Health Center on North Avenue for her annual wellness visit, which Medicare had covered for her in the past.

But to her surprise, Hioki received two notices in the mail that said she owed $187.61 for her appointment.

Her routine visit turned into two months of calls to customer service.

When Hioki called the clinic, she said employees directed her to the billing departments of Ascension and Froedtert & the Medical College of Wisconsin, which employs physicians at the clinic.

Froedtert reviewed the charges and, two weeks later, called to insist they were valid, according to Hioki.

Meanwhile, Ascension's billing department said it would review the charges and get back to Hioki within 10 business days, but Hioki said they never called back.

Hioki contacted Public Investigator in February.

In early March, about two weeks after Public Investigator contacted Ascension about her bill, Hioki got a call from Ascension that all charges had been dropped.

But her relief was short-lived. Later that month, Hioki said Ascension left her a voicemail that said based on "additional information," her visit was not considered an annual Medicare wellness visit. Her bill was reinstated.

The Ascension representative said Hioki would receive a letter with more details, but Hioki said she hasn't received it yet.

When Public Investigator asked the Medical College of Wisconsin why Hioki's bill was reinstated, a spokesperson said Hioki's procedure was considered a routine physical exam, not a Medicare annual wellness visit.

"The physician's documentation specifically included a note that the patient would need to schedule the (annual wellness visit) for a future date," said the Medical College of Wisconsin spokesperson. "As such, it was determined that the billing is accurate for this date of service."

In a statement, Ascension acknowledged that routine physical exams and Medicare annual wellness visits are often confused .

The annual wellness visit is covered by Medicare and is meant to focus on questions about one's wellbeing and lifestyle and does not include a physical exam. On the other hand, routine physicals are hands-on examinations meant to address questions or symptoms, and must be paid for out of pocket.

"Medicare Annual Wellness Visits and physical exams are best scheduled for the same day, with the wellness visit occurring first," the Ascension spokesperson said. "We encourage patients to clarify whether they’re scheduling a Medicare Wellness Visit or a physical exam when making their appointments."

However, when Public Investigator relayed this to Hioki, she said her doctor didn't tell her this information.

"I went in for a scheduled Medicare annual wellness visit, and that is what should have been performed," Hioki said. "I was not notified what was being performed that took priority over my reason for the appointment and did not give consent to whatever was going on."

Ascension sends Cudahy woman's physical therapy bill to collections agency

Linda Figueroa was walking through the Cudahy Middle School library in June 2022 when she tripped and fell on her shoulder, fracturing her collarbone. The injury landed the 71-year-old student services specialist in an arm sling for six months.

Instead of surgery, Figueroa opted for physical therapy at Ascension Hospital in Oak Creek.

According to her employer, the School District of Cudahy, the physical therapy sessions would be covered by United Heartland, a worker's compensation organization based in Michigan.

But in February of last year, a $304 bill landed in Figueroa's mailbox.

For weeks, she said she called Ascension to clarify that her charges should be sent to United Heartland. Each time, she said she spoke to a different representative, which meant she had to re-explain her case.

Figueroa continued to receive bills for the next ten months, until December 2023, when Ascension notified her the bill would be sent to a collection agency if not paid immediately.

When Figueroa talked to United Heartland that month, a claims manager there said the organization had already sent Ascension her documentation and was waiting on Ascension to send back an invoice. Until the organization got the invoice, it couldn't pay the bill, United Heartland told Figueroa.

By January, Figueroa's bill had been sent to Frost-Arnett Company, a Kentucky-based collections agency.

The following month, United Heartland told Figueroa it could reimburse her "100%" if she paid the collections bill out of pocket. Instead, she contacted Public Investigator for help.

"Yes, I could pay it, but I don't know how many people have said, 'Oh, I will pay it,' and never get the money back," Figueroa said.

United Heartland did not respond to a phone call and email requesting comment in February and March.

Ascension declined to comment on Figueroa's case without a patient privacy release form. But just days after Figueroa submitted the form to allow Ascension to discuss her case with reporters, she logged into her account to find that her bill was $0.

At the time, Figueroa said she didn't know why. She had not heard any update from Ascension or United Heartland.

On April 18, a few weeks after her balance was zeroed out, Figueroa received an email from United Heartland stating it paid the bill.

Figueroa said she was relieved to have Public Investigator's help in resolving the situation.

"No one else seemed to care or help for well over a year," she said. "The lack of help and customer service with Ascension billing and United Heartland has been eye-opening. I do hope that if anyone is unfortunate to go through this experience, your article will help."

Tetanus vaccine appointment results in unexpected bill

Last April, at his doctor's recommendation, 78-year-old Robert Wezek received a tetanus and diphtheria booster vaccine at Ascension Wisconsin Health Center on Rawson Avenue in Franklin.

The appointment went as expected. However, since then, Wezek has received four notices stating that he owes $124 for the visit.

His insurance company, UnitedHealthcare, was billed for three different medical codes related to the vaccination and its administration. UnitedHealthcare agreed to pay only for the administration of the vaccine, but not for other costs.

When Wezek called Ascension's billing department to understand his charges, he was repeatedly left frustrated and without answers. Wezek said he called dozens of times without success.

"It's just ridiculous," he said.

In December, about eight months since his appointment, Ascension told Wezek that his previous request to review his bill was denied due to lack of information and asked Wezek for more details. The company told him it would review the bill again in seven to 10 days.

Regardless, in a letter reviewed by Public Investigator, Ascension said his bill would be sent to collections.

After Public Investigator contacted Wezek's insurance company and Ascension in April, representatives from the two companies called him to tell him they were reviewing his case.

"No one has returned information to me about whether they dropped the case or not. But it's been four months now," Wezek said. "As long as I don't hear anything from Ascension or hear anything from the collection agency, I'm satisfied."

Health insurance for older adults is confusing, but there are people who can help

As the policy and advocacy manager for older adult services at the Milwaukee County Department of Health and Human Services , Petersen helps older adults navigate programs like Medicare.

Petersen said Medicare causes confusion not only for patients, but also for medical providers and their staff. People have to keep up with the differences between a wide range of Medicare Advantage plans, and Medicare "does not make it easy to understand what is going on," she said.

"Every single year, they change what the codes are, what you're billing for, what is eligible to be billed for under Medicare, and it's very confusing," said Petersen.

The lengthy process to dispute a medical bill error doesn't help, she added.

"Whether that's the hospital or through the Medicare appeals process, that process takes a very, very long time," Petersen said.

Navigating issues related to medical bills and Medicare require a lot of self-advocacy, Petersen said, so no one should ever feel ashamed or afraid of asking for help.

Milwaukee County residents who are 60 and older can use the program SeniorLAW , which provides free legal assistance related to Medicare, Medicaid, social security insurance programs, and more. Petersen also recommends using the State Health Insurance Assistance Program (SHIP) website to locate nearby Medicare counseling resources.

Older adults can also go to the Wisconsin Department of Health Services website to find an elder benefits specialist near them. Not only will a specialist investigate an incorrect medical bill charge, but they can also help people sign up for Medicare and choose the right plan for them, she said.

Petersen said the most important thing people can do is hold on to all documentation from their health insurance and medical provider. Clients can sign a release to allow elder benefits specialists to help them collect these documents on their behalf.

"I know people get scared that they might have missed something," Petersen said, "and it can be confusing to know: What is an actual document from your doctor, and what is just junk mail?"

Editor's note, June 4, 2024: A previous version of this article incorrectly stated that the Ascension Wisconsin Health Center - Rawson Avenue location is closing. Only one group of physicians, in Suite 220, is retiring.

Quinn Clark is a Public Investigator reporter. She can be emailed at  [email protected] . Tamia Fowlkes is a Public Investigator reporter for the Milwaukee Journal Sentinel. Contact her at  [email protected] .

About Public Investigator

Government corruption. Corporate wrongdoing. Consumer complaints. Medical scams.  Public Investigator  is a new initiative of the Milwaukee Journal Sentinel and its sister newsrooms across Wisconsin. Our team wants to hear your tips, chase the leads and uncover the truth. We'll investigate anywhere in Wisconsin. Send your tips to [email protected] or call 414-319-9061. You can also submit tips at  jsonline.com/tips .

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Paramount leaders unveil “shared vision” amid takeover offer.

Amid the corporate uncertainty, the studio’s new co-CEOs outlined their plan for the company during their annual shareholder meeting.

By Etan Vlessing

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Paramount Global ’s new trio of co-CEOs laid out their vision for the Hollywood studio as the controlling shareholder, Shari Redstone, mulls a sweetened takeover offer from a buyer consortium led by Skydance and RedBird Capital.

Redstone addressed the investors as the meeting began, indicating the company’s most important goal was “driving value for all our shareholders,” which would come by reducing overall debt to strengthen the balance sheet and continue to invest in “best-in-class content.”

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This opened the way for the new trio of executives – George Cheeks, president and CEO of CBS; Chris McCarthy, president and CEO of Showtime/MTV Entertainment Studios; and Brian Robbins, president and CEO of Paramount Pictures – to outline a “shared vision” for the studio.

“Our plan looks forward to build back the best of Paramount by delivering higher revenue with lower costs, which translates to higher earnings and better returns,” Robbins told shareholders. He added the studio had a strength in franchises that did not rely on superheroes to address an increasingly crowded streaming landscape that was “frankly more confusing for the consumer.”

“What sets Paramount’s franchises apart from the rest of the industry is that we aren’t dependent on any one genre. We saw the downsides of betting on a single genre like superheroes and comic books. So we built our billion dollar brand strategy with a focus on real life heroes and, yes, a little yellow sponge named Bob,” Robbins told investors.

He added Paramount could hardly rest on its laurels. “We know we need to do more. We need to accelerate our path to profitability. And that’s why we’re hard at work on a plan that’s going to do exactly that, but first reducing our expenses, integrating our teams more closely and reducing redundancies,” Robbins explained.

That theme was also taken up by Robbins, who said “we’ll optimize our asset mix and use the proceeds to pay down debt. Taken together, these actions will drive shareholder value by improving profitability and returning the company to investment grade metrics over time.”

The meeting took place against the backdrop of Redstone and her National Amusements vehicle looking at a revised deal for the studio, and her own options. Cheeks, McCarthy and Robbins have led the studio since the previous CEO, Bob Bakish, left Paramount in April when the company began exclusive merger talks with Skydance.

If Redstone rejects the revised offer from Skydance, she could continue to have the new triumvirate run the company, look at other deals (like Sony/Apollo), or sell National Amusements outright to someone else and let the buyer figure out what to do with Paramount.

Jamie Morris, head of investor relations at Paramount, addressed the current takeover talks during the AGM. “We cannot comment on the speculation. What I can tell you is that the presentation that you just saw was built to improve the company’s balance sheets, to best set it up for growth and to drive shareholder value, regardless of the speculation,” he said.

McCarthy added during the Q&A portion of the meeting: “We’re aggressively pursuing all options to make the most of our content and drive the greatest value for the company, in both the short and long term.”

And Cheeks addressed the proposal for $500 million in annual cost savings. “Look, we’re prepared to move quickly on the cost reductions, we’re confident that the business can be run much more efficiently,” as he pointed to a management streamlining and reducing costs in real estate, technology, marketing and other studio roles.

Cheeks also talked up the benefits of streaming bundles after Paramount+ and Showtime were earlier packaged together. “Bundling our streaming and linear products has many benefits. It expands the reach and engagement of our Paramount+ ad-supported tier, lowers customer acquisition costs and yields much lower churn,” he argued.

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NCPA is calling on you to volunteer as a grader by Friday, June 7, for the annual Good Neighbor Pharmacy NCPA Pruitt-Schutte Student Business Plan Competition. Lend us your expertise and time by reviewing and grading two business plans, June 12-27, and help us celebrate 20+ years of this important competition. We’re using the digital platform Award Force, so it’ll be easy to access all materials and work from any screen. Questions? Email [email protected] for more information.

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Arlington approves Hawthorne’s project master plan

“We’re excited about what (Hawthorne) is going to mean to Arlington, right at the entrance of not just our town but Shelby County,” Mayor Mike Wissman said. (Greg Campbell/Special for The Daily Memphian file)

The overall plan includes up to 37 townhomes, 114 individually owned stacked flats, 600 rental apartments and more than 50,000 square feet of retail.

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