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Does Health Insurance Cover Concierge Medicine?

Does health insurance cover concierge medicine? Are there strategies for getting the most out of your health insurance with respect to concierge medicine?

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The answers are: sometimes, and yes.

How Concierge Medicine Works

Concierge medicine is a heath care model in which a patient pays a fee – monthly, biannually or annually – directly to their doctor for the practice’s services. Under this model, consumers have access to their doctor or another physician in the practice whenever they want. Patients can make same-day appointments with little or no waiting.

This framework is similar to an arrangement of a client who keeps an attorney on retainer. Such clients can obtain legal services whenever they need them and don’t pay by the hour or case.

Concierge Medicine Costs

As for costs, the annual fee to subscribe to most concierge medicine practices ranges between $1,200 and $3,000, according to conciergemedicinetoday.org. Some high-end concierge medicine practices that provide services to well-off patients can cost tens of thousands of dollars a year, experts say.

Most concierge medical practices don’t take health insurance.

Here is the breakdown of payment options that concierge medicine practices accept, according to conciergemedicinetoday.org:

  • Cash only, 51%
  • Medicare or some insurance, 29%
  • Medicare but no HMO or PPO plans, 14%
  • Insurance but no Medicare, 6%

What Health Insurance Does and Does Not Cover

Here are the ways you can use health insurance for concierge medicine:

Gallery: 7 common recurring bills you can renegotiate (Mediafeed)

Medicare or some insurance. If you have Medicare or other health insurance, you can join a concierge medical practice, but you’ll have to pay the membership fee yourself. Regarding Medicare, a concierge medical practice “can’t include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service,” according to Medicare.gov. In those situations, your physician must give you a written notice, known as an “Advance Beneficiary Notice of Noncoverage,” listing the services and reasons why Medicare may not pay. In such situations, a concierge practice may seek to impose additional fees for services not covered by Medicare, says Michael Seavers, the program lead in Healthcare Informatics at Harrisburg University of Science and Technology in Harrisburg, Pennsylvania. He notes that Medicare isn’t only used by older people. Individuals under age 65 with certain medical conditions, like renal failure, may also qualify for Medicare.

Similarly, if you have private health insurance, you must pay the fee yourself to become a patient in a concierge practice, says Dr. Amna Husain, a pediatrician and the founder of Pure Direct Pediatrics. That’s a concierge practice in Marlboro, New Jersey. “This fee will include the normal care you received from a non-concierge doctor with the added personal medical amenities the concierge practice offers,” she says.

You may be able to use Medicare or other health insurance to pay for items and services the concierge practice doesn’t provide, which can include:

  • Prescription medications.
  • Lab work.
  • Imaging.
  • Emergency department visits and hospitalizations.

Doctors who accept

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medicine

Does Health Insurance Cover Concierge Medicine? |U.S. News

Does health insurance cover concierge medicine? Are there strategies for getting the most out of your health insurance with respect to concierge medicine?

(Getty Images)

The answers are: sometimes, and yes.

How Concierge Medicine Works

Concierge medicine is a heath care model in which a patient pays a fee – monthly, biannually or annually – directly to their doctor for the practice’s services. Under this model, consumers have access to their doctor or another physician in the practice whenever they want. Patients can make same-day appointments with little or no waiting.

This framework is similar to an arrangement of a client who keeps an attorney on retainer. Such clients can obtain legal services whenever they need them and don’t pay by the hour or case.

Concierge Medicine Costs

As for costs, the annual fee to subscribe to most concierge medicine practices ranges between $1,200 and $3,000, according to conciergemedicinetoday.org. Some high-end concierge medicine practices that provide services to well-off patients can cost tens of thousands of dollars a year, experts say.

Here is the breakdown of payment options that concierge medicine practices accept, according to conciergemedicinetoday.org:

  • Cash only, 51%
  • Medicare or some insurance, 29%
  • Medicare but no HMO or PPO plans, 14%
  • Insurance but no Medicare, 6%

What Health Insurance Does and Does Not Cover

Here are the ways you can use health insurance for concierge medicine:

Medicare or some insurance. If you have Medicare or other health insurance, you can join a concierge medical practice, but you’ll have to pay the membership fee yourself. Regarding Medicare, a concierge medical practice “can’t include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service,” according to Medicare.gov. In those situations, your physician must give you a written notice, known as an “Advance Beneficiary Notice of Noncoverage,” listing the services and reasons why Medicare may not pay. In such situations, a concierge practice may seek to impose additional fees for services not covered by Medicare, says Michael Seavers, the program lead in Healthcare Informatics at Harrisburg University of Science and Technology in Harrisburg, Pennsylvania. He notes that Medicare isn’t only used by older people. Individuals under age 65 with certain medical conditions, like renal failure, may also qualify for Medicare.

Similarly, if you have private health insurance, you must pay the fee yourself to become a patient in a concierge practice, says Dr. Amna Husain, a pediatrician and the founder of Pure Direct Pediatrics. That’s a concierge practice in Marlboro, New Jersey. “This fee will include the normal care you received from a non-concierge doctor with the added personal medical amenities the concierge practice offers,” she says.

You may be able to use Medicare or other health insurance to pay for items and services the concierge practice doesn’t provide, which can include:

  • Prescription medications.
  • Lab work.
  • Imaging.
  • Emergency department visits and hospitalizations.

Doctors who accept assignment can’t charge you extra for Medicare-covered services. (In the context of Medicare, “assignment” means your health

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dentist

Dentist Says Virus Caused Property Damage In Insurance Suit


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Email Daphne Zhang


href=”https://www.law360.com/#”>Daphne Zhang

Law360 is providing free access to its coronavirus coverage to make sure all members of the legal community have accurate information in this time of uncertainty and change. Use the form below to sign up for any of our daily newsletters. Signing up for any of our section newsletters will opt you in to the daily Coronavirus briefing.

Law360 (November 9, 2020, 4:19 PM EST) —
A Minnesota dental office said more courts across the country have rejected insurers’ bids to dismiss COVID-19 business interruption suits for policies without a virus exclusion, telling a Texas federal judge that it has sufficiently pled physical damage.

Christie Jo Berkseth-Rojas, who runs Rojas Family Dental in Minneapolis, said Friday that a greater number of courts have axed insurers’ dismissal motions in suits involving policies that don’t contain a virus exclusion like the one her office held with Aspen American Insurance Co.

The dentist cited data from the University of Pennsylvania Law School’s virus-related litigation tracker, which listed that courts have denied the insurers’ dismissal bids in 10 cases while granting them in eight cases concerning policies that do not have a virus exclusion. There have been over 1,200 business interruption suits filed so far, according to the school.

In Friday’s response, the dentist said that the “courthouse could no longer serve the administration of justice as it had before,” because grand jury proceedings, public trials and in-person depositions are limited for cases like hers, claiming that her office incurred physical loss of use because of COVID-19 just as courts across the country have.

The Minneapolis dental office hit Aspen with a proposed class action after the carrier denied coverage for her business losses stemming from government closure orders in March. In September, Aspen urged the federal court to follow the “daily growing” number of rulings that have said insureds don’t need to show their property was tangibly altered to claim physical damage.

On Friday, the dental office said it successfully pled physical damage from its lost use of its property. The office said Aspen can’t argue that physical damage always requires structural change, because it never changed coverage requirements from “direct physical loss of or damage” to “physical alteration” or “structural alteration” in the policy.

“The insurance industry has left this language substantively unchanged for decades,” the dental practice said.

Even if direct physical damage means structural alteration, the office has sufficiently claimed it because the virus will “infest property and stick to its surfaces, alter the structure of those surfaces and the air within the property, and lead to claims of business interruption losses,” the practice added.

Additionally, courts have ruled on multiple occasions that property infiltration “by microscopic entities” like COVID-19 constitutes direct physical loss or damage, according to the suit. The practice also cited case law, saying that the Minnesota court of appeals ruled “direct physical loss can exist without actual destruction of property or structural damage to property.”

Aspen’s contention that

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medicine

Go Insurance and Indiana University School of Medicine Team Up to Boost Car Safety for Kids

Go Insurance and Indiana University School of Medicine Team Up to Boost Car Safety for Kids

App-based auto insurance company launches car seat giveaway for Indiana families in need, as report finds Indiana is the fourth least safe US state for child passengers

Go Insurance, an auto insurance company revolutionizing insurance by using data analytics to make roads safer and save customers time and money, announced today that it is teaming up with Indiana University School of Medicine to provide free car seats for families in need. This giveaway is part of Go Insurance’s newly launched national child passenger safety program, which works to ensure every caregiver in America is equipped with the best tools to safely transport the children they care for in a secure, properly installed car seat.

Go Insurance is launching the program in collaboration with child passenger safety experts in three states with high rates of injuries and fatalities for child passengers. The company is granting a total of $40,000 to Indiana University School of Medicine in Indianapolis, Children’s Hospital Los Angeles, and Cook Children’s Medical Center in Fort Worth, TX, to distribute brand new car seats to local families in need.

To kick off the giveaway, there will be a car seat distribution event on Saturday, November 7 in Hobart, IN, at Hobart Fire Station #1, 401 East Tenth Street — the first of two in the state this month. Car seat distributions will continue in Indiana into 2021.

Go Insurance’s child passenger safety initiative was created in response to a report released by the nonprofit Go Safe Labs, showing that Indiana is the fourth least safe state in the nation for children traveling in passenger vehicles. Between 2015 – 2018, Go Safe Labs found that 383 children were injured or killed in traffic accidents in the state, with 73 percent of accidents occurring in rural areas and 27 percent in urban areas. The group analyzed publicly available data from government sources involving over 300,000 people involved in fatal accidents to find the top states with the most child injuries or fatalities.

“Providing car seats to families in need is part of Go Insurance’s commitment to keeping everyone safe on the road in Indiana and across the nation,” said Kevin Pomplun, Co-Founder and CEO of Go Insurance. “Car seats save lives. Every family should have access to a properly installed, high quality car seat to keep their kids safe. Go Insurance is thrilled to work with Indiana University School of Medicine to advance our shared goal of increasing safety for kids in cars.”

“The Automotive Safety Program at the Indiana University School of Medicine works to keep families safe across the state of Indiana. With Go Insurance’s support, we will be able to get car seats to hundreds of families,” said Marsha French, Director of the Indiana University School of Medicine Automotive Safety Program. “Our work is especially important now as the weather is worsening and families are preparing to travel by car this holiday

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medicine

Go Insurance and Indiana University School of Medicine Team Up to Boost Car Safety for Kids – Press Release

SAN FRANCISCO–(Business Wire)–Go Insurance, an auto insurance company revolutionizing insurance by using data analytics to make roads safer and save customers time and money, announced today that it is teaming up with Indiana University School of Medicine to provide free car seats for families in need. This giveaway is part of Go Insurance’s newly launched national child passenger safety program, which works to ensure every caregiver in America is equipped with the best tools to safely transport the children they care for in a secure, properly installed car seat.

Go Insurance is launching the program in collaboration with child passenger safety experts in three states with high rates of injuries and fatalities for child passengers. The company is granting a total of $40,000 to Indiana University School of Medicine in Indianapolis, Children’s Hospital Los Angeles, and Cook Children’s Medical Center in Fort Worth, TX, to distribute brand new car seats to local families in need.

To kick off the giveaway, there will be a car seat distribution event on Saturday, November 7 in Hobart, IN, at Hobart Fire Station #1, 401 East Tenth Street — the first of two in the state this month. Car seat distributions will continue in Indiana into 2021.

Go Insurance’s child passenger safety initiative was created in response to a report released by the nonprofit Go Safe Labs, showing that Indiana is the fourth least safe state in the nation for children traveling in passenger vehicles. Between 2015 – 2018, Go Safe Labs found that 383 children were injured or killed in traffic accidents in the state, with 73 percent of accidents occurring in rural areas and 27 percent in urban areas. The group analyzed publicly available data from government sources involving over 300,000 people involved in fatal accidents to find the top states with the most child injuries or fatalities.

“Providing car seats to families in need is part of Go Insurance’s commitment to keeping everyone safe on the road in Indiana and across the nation,” said Kevin Pomplun, Co-Founder and CEO of Go Insurance. “Car seats save lives. Every family should have access to a properly installed, high quality car seat to keep their kids safe. Go Insurance is thrilled to work with Indiana University School of Medicine to advance our shared goal of increasing safety for kids in cars.”

“The Automotive Safety Program at the Indiana University School of Medicine works to keep families safe across the state of Indiana. With Go Insurance’s support, we will be able to get car seats to hundreds of families,” said Marsha French, Director of the Indiana University School of Medicine Automotive Safety Program. “Our work is especially important now as the weather is worsening and families are preparing to travel by car this holiday season.”

Company Description: Go Insurance is an innovative insurance company revolutionizing a vital industry by harnessing the power of data analytics to help drivers enjoy safer roads and to save money. The Go Safe Map now analyzes 10 trillion miles

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dentist

Dentist’s COVID-19 Insurance Suit Put To Sleep By Fla. Judge


By Archive



Email Craig Clough


href=”https://www.law360.com/#”>Craig Clough

Law360 is providing free access to its coronavirus coverage to make sure all members of the legal community have accurate information in this time of uncertainty and change. Use the form below to sign up for any of our daily newsletters. Signing up for any of our section newsletters will opt you in to the daily Coronavirus briefing.

Law360 (November 3, 2020, 5:37 PM EST) —
A Florida federal judge on Monday tossed a dentist’s lawsuit seeking to compel Hartford Casualty Insurance Co. to cover his practice’s COVID-19 related losses, agreeing with the insurer that the dentist’s losses weren’t covered by his policy as they did not constitute a physical harm to the property.

Two businesses associated with dentist Raymond H. Nahmad sued in May claiming the insurance company was breaching a contract by declining to cover the dentist’s losses following orders from the governor of Florida and the mayor of Miami-Dade County in March to suspend non-emergency or elective dental care to help stop the spread of COVID-19.

U.S. District Judge Beth Bloom dismissed the lawsuit with prejudice, ruling that the insurance policy covers a physical loss to the property and not a loss of revenue. The judge also said that even if a loss of revenue could be construed as a physical loss, there is a specific virus exclusion in the policy.

“As an initial matter, business income is not included within the list of covered property under the policy,” the judge said. “In fact, money and accounts are expressly excluded from the definition. But more importantly, the complaint itself alleges that there were no physical harms to the insured premises because plaintiffs’ injuries are purely economic.”

The judge added, “Federal courts in Florida that have examined whether economic losses caused by COVID-19 business closures or suspensions constitute a ‘direct physical loss’ or ‘physical harm’ have rejected plaintiffs’ arguments.”

Among the cases cited by the judge was the Southern District of Florida’s 2020 ruling in Malaube, LLC v. Greenwich Ins. Co. , where a restaurant sought coverage for losses from COVID-19. The court found there was no allegation COVID-19 was physically present on the premises, and also cited other rulings in Florida that found emergency government orders were insufficient to state a claim for COVID-19 looses because “there must be some allegation of actual harm.”

Judge Bloom also said that even if she assumed “for argument’s sake that plaintiffs had alleged facts triggering coverage under the policy, the virus exclusion would still apply to bar coverage for plaintiffs’ losses.”

The judge added, “Upon consideration, the court does not agree that plaintiffs’ distinction between the government orders versus the virus as the immediate cause of their losses avoids the plain language of the virus exclusion.”

A second claim seeking declaratory judgment was also dismissed by the judge, who said it was “duplicative” of the breach of contract allegation and also failed to state a claim.

Counsel for the parties did not

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health

Supreme court to hear Obamacare case that may lead to 20m losing insurance

For more than a decade, Republicans have sought to destroy the signature achievement of the Obama administration – the Affordable Care Act, better known as Obamacare.



a group of people standing in front of a crowd: Photograph: Lynne Sladky/AP


© Provided by The Guardian
Photograph: Lynne Sladky/AP

Exactly one week after election day, they might succeed.

After an election season like no other, in the middle of a pandemic, the supreme court will hear a case that could result in 20 million Americans losing their insurance, along with a raft of other insurance benefits disappearing from American life. Or not.



a group of people holding a sign: Adelys Ferro holds a sign in support of Obamacare on 24 October 2020 in North Miami, Florida.


© Photograph: Lynne Sladky/AP
Adelys Ferro holds a sign in support of Obamacare on 24 October 2020 in North Miami, Florida.

All of us have benefited from the act, even if we cannot see it

Abbe Gluck, Yale Law School professor

“This is the one issue now that is causing me tremendous panic,” said Daniel Dawes, author of 150 Years of Obamacare, an attorney and director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

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“I have been a cup-runneth-over type of guy, very optimistic in this country, I’m not sure I can even see the cup as half full right now when it comes to the life of the ACA,” Dawes said.

Better known as Obamacare, the ACA expanded government-sponsored health insurance for the poor, required insurance companies to cover a list of benefits such as pregnancy and preventive care, and even required chain restaurants to display calorie counts on their menus. It is intimately intertwined with what Americans think of as health insurance.

“All of us have benefited from the act, even if we cannot see it,” said Abbe Gluck, Yale Law School professor and faculty director of the Solomon Center for Health Law and Policy. Overturning the law would cause “chaos” and “on-the-ground impacts on Americans” that Gluck said “cannot be overstated”.

The ACA was passed on a party-line vote in 2010, and has been loathed by Republicans ever since, viewed by many conservatives as a government intrusion into healthcare. For eight years, Republicans have sought to “repeal and replace” the law.

They failed to repeal the law legislatively after Trump’s election, despite controlling all legislative levers of government. They did, however, take the teeth out of one hated provision, called the “individual mandate”.

The individual mandate clause required all Americans to obtain health insurance or pay a tax penalty. The penalty was repealed in Trump’s 2017 tax law that primarily benefited the rich. Soon after, officials in Texas sued, arguing the entire law was unconstitutional because the individual mandate was such a central tenet.

Texas’s argument has been supported by the Trump administration, which argued because the tax penalty was eliminated, the, “rest of the ACA must also fall”.

Whether the court will overturn the law or eliminate only one provision stands on a question of “severability”, a legal doctrine that allows judges to, in the words of Chief Justice John Roberts, take “a scalpel rather than a bulldozer” to statutes.

“What is highly unorthodox

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health

Open Enrollment for Health Insurance Marketplaces Begins November 1

Beginning on November 1, 2020, individuals (including families) may apply for new health insurance, re-enroll in their current plan, or switch to a different health-care plan through a Health Insurance Marketplace. 

The open enrollment period for 2021 coverage ends on December 15, 2020.

If you don’t act by December 15, you can’t get 2021 coverage unless you qualify for a Special Enrollment Period. Plans sold during Open Enrollment start on January 1, 2021.

You can preview 2021 plans and prices now and complete your enrollment starting November 1.

In this video, Jae Oh, author of Maximize Your Medicare, describes what you need to know about enrolling in a Health Insurance Marketplace plan during this year’s open enrollment period. 

If you need help deciding which plan is best for you, you can contact a professional, such as Oh, for a consultation. Here’s a link to request a consultation with Oh.

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health

Census Bureau: Young adults make up the largest share of those without health insurance

Young adults ages 19 to 34 have the highest uninsured health care rates in the country, according to census data — and Nicholas Williams hopes not to enter into that category.

He’s anxious, though. That’s because Williams will turn 26 next month, making him ineligible to remain on his parents’ health insurance plan under Affordable Care Act regulations.

“Twenty-six is the end of the road for me,” Williams said, referring to his current ACA plan. “I’m definitely nervous. … You’re cut off. I’ll be on my own.”

Before implementation of the ACA in 2010, health insurers set the age limit, which varied.

Williams, who lives with his family in East Islip, is frantically job hunting, with multiple interviews lined up, he said. Williams said he has a degree in social studies from St. Francis College and is interested in a job in customer service.

His health insurance needs are not far from his mind, he added, noting he is a Type 1 diabetic, something he said he’s been since he was 15.

“I’m on an insulin pump, and I also have a blood glucose monitoring system that tracks my blood sugar every five minutes. These devices make my life easier. It helps me manage my diabetes,” said Williams, who has worked part time and in temporary jobs that didn’t offer insurance. The cost “is manageable with insurance. I can’t imagine how much that would cost without insurance.”

According to the 2019 American Community Survey from the U.S. Census Bureau released Oct. 26, people ages 19 to 34 were the largest share of uninsured of any age group in the United States, at 15.6%, 0.4 percentage points higher than in 2018. That compares with 5.7% for those under 19, 11.3% for adults ages 35 to 64, and 0.8% for individuals 65 and older in 2019.

And the uninsured share of 26-year-olds was the highest among any single-year age, at 18.3%, which was 3.6 percentage points higher than the uninsured rate for 25-year-olds, the bureau said. Twenty-seven-year-olds had the next-highest uninsured rate, at 17.5%, in 2019.

The census bureau report said, “All adults may receive coverage through their employer, through public coverage or through purchase on the health care marketplace. However, young adults may be less likely to purchase health insurance coverage, and therefore more likely to be uninsured than other age groups.”

Daniel Lloyd, 34, founder and president of Minority Millennials, a grassroots nonprofit that works to represent minorities and millennials in policies, said health insurance coverage is on the minds of many in his group.

“A lot of members are focused on entrepreneurship, and many stay with jobs only because of health insurance,” Lloyd said. “So that impedes their desire to establish their own businesses.”

Lloyd, who also works for the Babylon Industrial Development Agency, recalled how a similar

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health

Younger Americans more likely to lose health insurance during pandemic

Roughly 3 out of 10 younger Americans say their health insurance coverage has been affected by the ongoing Covid-19 pandemic, according to a recent survey from TransUnion. 

About 33% of Gen Z (defined here as those born during 1995 or after) and 29% of millennials (those born between 1980-1994) had their health insurance impacted by the pandemic, including losing coverage, according to a survey TransUnion Healthcare conducted last month of more than 3,000 people who visited a hospital, health-care clinic, doctor’s office or health-care organization in the last year. 

Only about 12% of baby boomers experienced an impact because of Covid-19.

Beyond losing health-care coverage, about half of Americans say the current state of the economy has affected how they seek medical care, TransUnion’s survey finds. Within that, a higher percentage of Gen Zers and millennials reported a difference. 

Yet overall out-of-pocket cost trends have not changed dramatically, TransUnion finds. The average consumer spent about $485 on emergency room visits and $5,002 on inpatient care this year, which is a decrease of 7% and 5%, respectively, from last year.

More from Invest in You:
Author shares what investors should be doing during pandemic
‘Don’t leave money on the table’: 7 things to consider during open enrollment this year
How to prepare for a family member with Covid-19

That may be due to fewer Americans seeking care. About 44% of employed Americans have put off medical care during the pandemic, according to a Willis Towers Watson survey released Wednesday. Of those that deferred care, 61% said it was because of Covid-19 fears and 42% cited cost concerns. 

Additionally, 47% of Americans have used virtual care services in place of in-person appointments this year — almost three times more than last year (17%), Wills Towers Watson finds. 

An average telehealth visit costs about $79, compared with about $146 for an office visit, according to a research paper published in May. But while telehealth could increase access and potentially replace an expensive urgent care visit with a virtual assessment, these appointments typically led to additional medical use, the researchers found. Only about 12% of telemedicine visits completely replaced an in-person provider visit, which could increase out-of-pocket costs overall. 

However, many times, telemedicine visits may be provided for free by your employer or your insurer, making it a “smart thing” to look into using before heading into the doctor’s office, says Tracy Watts, a senior consultant with Mercer.

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