Gift For Women

Great Gift for Women. It's not too late for guaranteed delivery in time for Christmas!

I have just received 200 copies of the most exciting book to hit the market in recent times. The book is published by Wake Up Women, a division of WakeUpLive... Wake Up has published a number of best-selling, team-authored books (paperback). To describe the format of the books I would say is similar to "Chicken Soup for the Soul". However, this long awaited book is written by Women for Women as a guide to enhance your life and truly Live a Life You Love. There are approximately 50 co-authors (women) from around the world, of which I am privileged to have been invited to participate. Each short story presents "golden nuggets" that you can immediately apply to your life...a little something for everyone.

I am offering a special for the holidays. Price is reduced. $14.00 including shipping.
You can start at my home page to direct you to the order pages www.EZHealthCareOnline.com or go directly to the order pages www.ezhealthcareonline.com/wakeupwomenbookandfreebonus

You have really got to check this out before it's too late!

"Know" Surprises with Health Insurance Plans-HMO

Today, the discussion is related to HMOs. Today's HMO has evolved over the years. Referring back to my previous post, you will recall that there was a battle between providers and the insurance companies which greatly contributed to cost increases (in my opinion). The payment for services was largely uncontrolled. In other words, as the cost of care increased so did the payment. It didn't take too many years until the payers began an attempt to control how care was delivered in order to control costs. The HMO and Managed Care was born.

The HMO (Health Maintenance Organization) in it's most strict time, placed heavy restrictions on the setting for care (hospital, MD office, home) as well as the cost. The concept was that an exclusive network of care providers was created by payers. The providers would accept deep discounts on their reimbursement in exchange for guaranteed steering of patients to them. The impact on you is that you MUST use providers within that network or you pay a much higher price. Additionally, each person was to have assisgned a "Primary Care Physician" who was considered the gatekeeper for directing what care you did receive, i.e. referral to specialists, etc. The philosophy is that there would be one person/physician that would be in a position to keep the pieces of your care coordinated. Did it work?? For the sake of discussion, no it did not. The ultimate result was that there was too many services, too few primary (family) doctors and too many specialists.

Ultimately, the Managed Care concept met too much resistance to actually contain costs. The care was still passed around to specialists and there was not much actual coordination of care...just control of care. Over time, care became more fragmented as new technologies and treatments continued to attract people to multiple specialists and increased the costs. It has become "Managed Cost resulting in Mangled Care".

The HMO still exists today, but really the only thing that resembles the original HMO is the network of contracted providers. You must use those providers or pay a higher cost. A primary physician is usually no longer required...why would it be...it didn't work anyway. In fact, the HMO doesn't really look all that different from other popular types of coverage plans such a PPO (Preferred Provider Organization). The KEY for you is to read your policy carefully...some items will be covered and some will not and circumstances may dictate whether care is approved. Let's be clear...the payors are not dictating whether you can receive certain care but whether they will pay for the care. That's another set of posts. In the meantime, stay Healthy and Happy. alice@EZHealthCareOnline.com http://www.ezhealthcareonline.com/

"Know" Surprises with Health Insurance Plans

I am going to discuss the different types of health insurance plans in the next few blog posts. If you have an employer sponsored health plan, there may be different options presented to you. If so, you really need to understand how they work so you can make the best selection for you. If you are purchasing individual insurance, it is really important to know what you are purchasing.

Today we are going to talk about the traditional "indemnity plan". This is what most people experienced in the early years of health insurance. Although it is not common to see this plan in today's healthcare market, it is good to understand how it works in order to help build the understanding of the evolution in health insurance. These plans are generally very simple. There is no restriction on the choice of doctor or hospital. For most encounters, you will pay a fixed percentage of the health bill. Common co-insurance (the part you pay) runs from 10% to 30% although it can be any number. Be sure you know what your co-insurance will be...a large bill could surprise you with a large part to pay.

On the other hand, the insurance company will pay either 90% or 70% respectively. While insurance companies have allways had contracts with health providers (as far as I know) to discount their services, the providers would increase their charges to off-set the discount. An example of this might look like this: a $500 dollar service would be discounted to $400. It would cost the insurance 80% ($320), cost you 20% ($80) and the provider collects the entire discounted $400. Then, so the provider can collect the total $500 for the same service the prices would be raised by 25%. The scenario then becomes 80% ($400) and 20% ($100) and the provider collects $500. Within these scnerios, note that your actual cost is higher. These scenarios have occured repeatedly through the years. The more the cost the more that the provider collected from you and the insurance company.

This cycle of increased pricing to off-set the insurance discounts, is in a big part the stimulus for creating other ways of negotiating and pay healthcare costs. That brings in the HMO and the term managed care. Refer back to the primary title of my blog as to how that played out. Our next discussion will be on HMO,

Keep Your Dollars in Your Pocket: Bargain With Your Doctor

A recent WebMD article was listing ways to save money on your healthcare. The timing on this is excellent, since this has been our main discussion topic for several posts. The suggestion was given to bargain with your doctor. This is a topic I typically have on my list of suggestions also. When is this appropriate and how do you accomplish it? If you are going to be paying the entire cost of your visit, procedure or test, this is prime time to ask for a discount. The physician’s office will usually ask about your insurance as they are scheduling your first appointment. I recommend taking a very proactive and positive response to this question. Rather than just stating that you do not have insurance, tell them you will be paying cash. Explain your situation. WebMD suggests saying “You’re not in my network, but I wouldn’t trust anyone else to handle this. Is there any way you can adjust your fee for me?” You just might be surprised at what you hear. If you approach it carefully, develop a positive relationship with the physician and the staff, there is a high chance you will have a positive outcome. The physician (and hospitals or surgery centers) can adjust their fee for you and still come out with a larger payment than if you did have insurance (usually). If they believe that you will pay, it is more likely they will be willing to discuss it. It is fairly routine for a health provider to give a 20% discount. Most can go less than that and still make a nice profit. When they negotiate with an insurance company, there are steep discounts plus the member’s co-pay of only 20-30 dollars. So now you know that you have some room for negotiation but don’t try to force a steeper discount or you may get none. Remember, a good relationship with the health care provider is your best negotiating tool.

One last reminder. If you are negotiating with a facility (hospital, surgery center) do not pay your bill up front. You can save more money by examining the detailed bill. There are companies or people that can help you with that task. I can hook you up, give me a call. alice@EZHealthCareOnline.com www.EZHealthCareOnline.com

Keep Your Dollars in Your Pocket- Managing a Chronic Illness

Save money on your healthcare by properly managing chronic conditions. Yes, I’m going to suggest that you actually spend some healthcare dollars. Let’s look at some statistics first:

1. More than 40% of Americans have one or more chronic conditions and people with chronic conditions account for 75% of healthcare spending in this country according to a recent study published in Health Affairs.
2. About 58 million non-elderly adults have at least one chronic condition.
3. About 65% of people with chronic diseases are working age adults.
4. Unfortunately, Americans with chronic conditions get the recommended care only 50% of the time and less than 50% have their disease satisfactorily controlled
5. Only 50% of those with chronic conditions take their prescribed medication, and the cost of poor medication adherence is more than $100 billion annually in the US.
   
   Let’s talk about these numbers for a minute. 58 million Americans have at least one chronic condition and we are not, or choose not to receive the recommended treatment. We will talk more about that recommended treatment at another time, but once again, the medication issue has surfaced. Over $100 billion is WOW! A lot of money! I can’t really comprehend that amount of money. But, once again it is critical that we take our medications as prescribed.
   
   Let’s use the example of Congestive Heart Failure. There are multiple specific interventions crucial to managing heart failure in a controlled manner. One of those interventions will likely be to take medications that will keep excess fluid from building (a diuretic) and a medication to help the workload your heart must endure. If you wait until you are short of breath to take your diuretic, it then increases the workload on your already failing heart. It will likely contribute to a needed trip to the doctor or worse to the hospital ER. Do you get my point? By spending the money to buy your diuretic and then take it as prescribed, you are reducing the likelihood of a more expensive intervention. An additional benefit is you feel better and can enjoy more of life. If you cannot afford to purchase your medication, refer to one of my previous posts on that topic.
   
   I hope you choose to live life to the fullest and not let a chronic illness take you down. Most of the time, it is a conscious decision. Until next time, stay happy and healthy. You can contact me at alice@EZHealthCareOnline.com
   

Some are Stopping Their Medications Due to the Economic DownTurn

A NY Times Headline reads: “Some Cut Back on Prescription Drugs in Sour Economy”. In the US, we have become a society of treating any ailment with a drug. A drug will fix anything. Consequently, the US is highest in the world on prescription drug spending which last year was estimated at nearly $286.5 billion. Now, for the first time in quite some time, people are trying to reduce the amount of prescription drugs utilized. The economic downturn has caused more people to choose between gasoline, food and medications.

I believe it is reasonable that expenses could be lowered by cutting out some medications…I don’t believe it should be undertaken lightly and certainly not without a joint plan with your physician. People are apparently stopping medications for high cholesterol, high blood pressure, etc. It seems to be primarily the drugs that do not produce a noticable affect such as that of pain pills. If you stop your pain pills you will feel bad therefore those will not likely be on your list to cut. If you stop your cholesterol medication, you probably don’t really notice a difference (at first).

Let’s talk about the consequences. Which is more cost effective: paying for the pill to keep your blood pressure under control or having a stroke, putting you in the hospital probably paralyzed, needing rehab and thus not being able to provide for your family or yourself. Sorry, but this is the harsh reality. If people stop taking the medications that are having a long-term benefit for your health, it will ultimately result in more severe illness and even higher medical expenses.

Below are my suggestions for approaching this dilemma:

1. Refer back to my previous post of ways to reduce the cost of your medications

2. Talk to your doctor about weaning from some of your medications

3. Many of the conditions being treated with pills can be controlled with diet and exercise. Examples are hypertension, diabetes (Type II) and high cholesterol.

4. DO NOT CHANGE YOUR PILLS WITHOUT TALKING TO YOUR DOCTOR!!!

5. Do not spread them out over a longer period or break them in half to take only half the prescribed treatment.

Please consider the longer term effects of your medications on yourself and your family. You do have options, please try them. Until next time, stay happy and healthy. alice@EZHealthCareOnline.com www.EZHealthCareOnline.com

Keep Your Dollars in Your Pocket (Part 2)

In this post, we will discuss how to save healthcare costs on your medications. Since it is the medication costs that are usually the portion of your care that is most likely to be an ongoing expense, we will start there. Many times people with chronic conditions can be on 6 or more medications. Due to the costs, there are often times when there is a decision between purchasing medications and putting food on the table. I have seen it many times that the medications will not be taken, the condition becomes worse and the person ends up in the hospital.Only recently have we begun to see ways to save on your healthcare costs. Most of the literature that suggests ways to lower you medication costs, generally cover the topic fairly well. However, I do usually have one or two items to add.
1. Generic drugs: When your doctor gives you a prescription, always ask to be sure there is a generic equivalent available. These are the same chemical structure, only much cheaper. Most meds that have been on the market for a while will have a generic counterpart. Beware of new medications on the market, they will usually be very pricey and no generic will be available.
2. Home delivery: For medications taken regularly, you can usually access your health plan's pharmacy benefit in which it can be delivered right to your front door. Besides saving on gas to frequent your favorite drug store, you can usually get three months at a time. To make it easier to switch to home delivery, call your doctor's office and ask the fax a prescription directly to home delivery pharmacy. They can then be scheduled on a regular basis so you will no longer have to remember to order your refill.
3. Drug List: Each health plan will usually have a list of drugs that are categorized into groups of which designate how much you will pay or how much the health plan will cover. It may be a difference in co-payment or some will not be covered at all. Take the list with you to your doctor and make sure any medications ordered are in the best category for your benefit i.e. your lowest cost.
4. Non-prescription drugs: Many medications that were once only available by prescription are now available without. They are usually less expensive than the same kind of drug by prescription. An example is the heartburn drug Prilosec. When purchased with a prescription it costs about $116 per month. The cost of a similar amount of the over-the-counter version is about $25. Be sure and check with your doctor if this could work for you.
5: Samples: One of the big ways that drug companies advertise their new drugs is directly with the physicians. In most doctor offices, there are frequent visits from drug salesmen. Most of the time, they will leave samples so the doctor can "try the drug" to see if it serves the purpose. Really, it keeps their drug in “top-of-mind” for prescribing. In some doctor offices, I have seen extensive amounts of sample medication...actual sample closets. If the doctor gives you a new prescription and there is not a generic ask if they have samples. I have been able to get a patient’s entire set of medications from samples. Unfortunately, with the economic situation of the past few years, even the drug companies have felt the pinch so it is somewhat more difficult to obtain samples in that quantity.
6. Different Drug: One of the things I usually include in suggestions for cost savings is to ask if there is a different medication that will accomplish the same thing, but be less expensive. There are times when the physician may not think about the cost of the drug. They will order the latest and greatest, or the one that the drug salesman recently spoke with them about. Whatever the reason, it does happen. Always ask if there is a less expensive drug. You can also talk to your pharmacist about alternative medications. Then your doctor will need to change your prescription.Hopefully these have been helpful tips to help you reduce your healthcare costs. Until next time, stay happy and healthy.www.EZHealthCareOnline.com alice@ezhealthcareonline.com

Keep Your Dollars in Your Pocket (Part 1)

As of late, there has been several articles addressing measures to reduce your healthcare costs. Recent health population studies indicate that our "senior" (>55) population is better equipped to do that than young adults (25-34). While 3 in 4 adults expressed concern about the cost of healthcare. What is ironic about the results of this study indicate that the seniors are more savvy at finding savings on healthcare costs than the young adults. Seventy percent of young adults stated that the economy has made it significantly harder to pay for healthcare expenses. Here's the kicker...more than half of those >55 stated the economic downturn had not impacted the ability to pay for healthcare at all. This is the opposite of what most people would have thought. It seems that the seniors are more experienced at reducing their costs.
The most prominate area of expense is with medication costs. The study indicated that while those <35 are in fact looking for ways to cut their medication costs but 1 in 5 say they do not know where to start. Only 3% of those over 55 answered the same.
In short, it appears there is an apathetic view of healthcare cost pervading the population...people either don't know where to start or simply feel it is a futile effort.
Well...let me tell you, it is not a futile effort! There are ways to cut your costs and streamline your care. Over the next few posts, I will be discussing some of those methods. Until then, stay healthy and happy.

Can You Obtain Health Insurance?

As statistics continue to indicate the increasing numbers of uninsured in the US, it is (or should be) of utmost concern to every American that the team we elect into the presidency as of January has a firm plan to reform health care. In my opinion, the health care system is in a state of turmoil akin to the economic crisis. They are going to go hand-in-hand. Today, WebMD published articles related to the uninsured which did reinforce what we have been told all along of the number of uninsured. Along with these statistics, a recent study by Consumer Reports was highlighted that indicated it has become increasingly more difficult for individuals to obtain insurance coverage.

Here's the link to the article: http://www.webmd.com/news/20071203/buying-health-insurance-on-your-own

In other words, if they do not have group coverage through the employer, it is difficult or near impossible to obtain it unless you are completely healthy. They told the story of a woman with Rheumatoid arthritis who lost her group insurance when her employer discontinued the plan. With her arthritis, the only thing that was keeping her from being completely disabled was a monthly injection of a medication costing $1400-$1700 per month. She has been turned down for most policy coverage or when accepted, it was to exclude any costs related to the rheumatoid arthritis.

I restate parts of the story to make a point. This situation is not an isolated one. I am fairly sure if I lost my group coverage, I would not be able to obtain coverage, or at least not anything I consider comprehensive and or affordable. In the above situation, she is actually considering not taking her injections (because of cost) until she is completely disabled again, then file for disability through the government systems. Now, is this what we want or need in a health care system? I think not, but it is not the fault of the insurance companies. I believe the insurance situation is a by-product of ever increasing costs of technology, drug research and development as well as the increase in the human life span. The attached link is to another article published on WebMD of items to consider and look for if you find yourself in the position of searching for health policy coverage.

It is extremely important that we demand of our legislators and the upcoming President of the US to implement a plan that will ensure every American is able to obtain health coverage regardless of current health conditions. We need to hold them responsible to first, implement a committee of health personnel and non-health care persons to identify what we actually do expect from our health care system. Then, do whatever it takes to find funding that will provide at least that basic requirement for every American. Now, I don't mean to imply that there is no personal financial responsibility.

As you can see, I am somewhat passionate about this topic. Due to that passion, I have provided some helpful resources on my web site (http://www.ezhealthcareonline.com/ ). I would also like to recommend a book recently published by a colleague. The book is "Healing Health Care" by Dr. Roger Howe. His analysis does give an interesting perspective of approaching a solution to this crisis...and yes, it is a crisis. That is my opinion.

National Case Management Week

It is National Case Management Week. EZHealthCare wants to acknowledge all the Case Managers in the various areas of care provision. We see and use Case Managers in virtually every aspect of the health care system. We see them in Acute Care Hospitals, Long term care facilities, home health services, physician offices as well as Rehab facilities. They can be found in clinics, managed care organizations (health insurance companies) and even on the internet. My entire web site and business is based on a community based case management model. In this sense, I can function as your case manager.

The Case Managers are the ones who act as a central point of care coordination along with your physician. In cases where your primary physician cannot or does not act as a central coordination the Case Manager can assist in this manner. The basis of Case Management is to “manage” the case/care…your case. This does not mean we provide hands-on-care for your illnesses…your doctor should do that. We can assist you in pulling the different pieces of the healthcare puzzle together. This helps eliminate gaps in care, duplication in care by more than one physician and to help you understand your conditions to better self-manage. This is usually a Case Manager’s goal with you…to assist you to become more independent with your care and that includes providing education and resources. There are times when you may need the services of a case manager for a prolonged or extended amount of time.

My services at EZHealthCare include that of Community Based Case Management. If you would like to know more about how I can help YOU, please contact me at alice@EZHealthCareOnline.com or check my web site: www.EZHealthCareOnline.com