In a time when so many people are uninsured, partially insured and tightening our budget belts, it is more difficult for many to justify spending money for a physician visit when you are not ill. The problem with this issue is many serious health conditions can be festering inside our bodies only to erupt at a later time. When they do eventually begin to manifest in an outward way, the conditions could already have done damage that may not be reversible. Of course, there will be additional expenses to deal with these abnormalities.
Current patterns of health care utilization indicate a trend of people not using the healthcare system due to the state of financial uncertainty as well as other potential reasons. What are the consequences of this behavior? For the remainder of this discussion, we are going to assume that the previous frequency of health care utilization was for needed services and not just using the system because it was there, someone else was paying or you had a little more confidence in your individual financial situation. This is a rather large assumption and it is just that…an assumption.
What are the potential consequences of not changing the oil in your car or not maintaining the integrity of the roof on your house? The answer is pretty obvious…more serious problems that must be addressed or you may not have a car to drive or a roof over your head. And of course, it will be much more expensive than if you had just had the oil changed. I am talking about simple and inexpensive monitoring of your vital functioning. You can probably obtain the necessary care at no cost or a nominal fee.
The following items should be monitored on a regular basis and if one or more of them starts to change in an unfavorable direction, implement measures to correct or control. You have the power to control your baseline health. At a minimum, you should be monitoring and performing preventive maintenance of the following:
· Blood Pressure
· Cholesterol
· Blood Sugar
· Heart rate
· Breathing patterns
· Skin integrity
Your response in an effort to balance the above measures is an entire discussion for each one. There is a wealth of information at your finger tips to assist you in your effort.
How do you obtain the necessary monitoring and care?
1. If you have health insurance, check your policy for provision of “Preventive Health”. Many policies will cover these services with very little or no out of pocket expenses.
2. If you can’t afford these services, here are some options:
a. Check your blood pressure at the local grocery store or discount department store. Many of these businesses have machines available with no charge for the use. Look for them in the area of the pharmacy section. Check it at regular intervals and keep track of it in a log so you can see if a pattern develops.
b. Seek out community services. Most communities, employers or senior organizations will sponsor a “Health Fair”. Most of the time you can even obtain your cholesterol levels at no or little cost. Check your local newspaper, churches, hospitals, AARP or notices posted at your pharmacy or department store to locate these Health Fairs.
c. Often times in communities, free clinics may be offered. These often are sponsored by a healthcare organization (hospital, physician practice) or church. These clinics usually have physicians, nurses and sometimes dentists available. Search the same sources as mentioned previously.
So, you see there are options where you thought there were none. You might need to put a little effort into a search for these offerings, but it is well worth it. Maintain your physical systems like the well oiled machine that it is.
If anyone knows of additional sources or options, please comment so all the readers can benefit from your information. After all, that is what it is all about. Until next time…stay tuned.
Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts
Thursday, August 6, 2009
Tuesday, July 21, 2009
Covering the Un-insured?
It should be no surprise to anyone that a democratic bill, phased in over several years will reach the point of covering the uninsured in 2013. It will begin with collecting taxes on "the rich", banking the cash for pay-out in 2013. Can you spell Social Security?...Medicare?...bankrupt? Enough of the sarcasm for now. This is really a serious subject. What are people to do between now and 2013?? or longer?? We really can't expect things to change over night...the mess didn't develop over night.
There are some options within the current quagmire of health care. You may need to work around some things, through other things/providers and work WITH providers. I told a friend recently (who is uninsured) that if I could advise on 1 item, it would be to negotiate with healthcare providers (Doctors, hospitals, etc). However, you cannot expect it to be like the good doctor making a house call for a dozen eggs. But...this concept/strategy is worth a try. It will not be easy with negotiations because providers in this healthcare market are generally paid to provide more care (needed or not). The market will move toward an end in which this negotiation is more attractive. Just think...you could arrange with a physician to pay a certain amount (cash or services) for a visit, procedure, etc...at a discount of full price (of which is always over-priced). What is the incentive for the doctor? No paperwork, insurance forms, the time spent for billing, coding, re-billing. This, of course is only useful if you do pay your negotiated part and up-front.
Do you provide a service that could be useful to the provider? Plumbing, electric, drafting, cleaning, yeard work?? Perhaps, you could trade services. Think about other services that may be of potential use for bartering. Please share your thoughts and suggestions about this topic. Kind of an interesting way to approach your healthcare? Think about it...share with us.
Until next time... Simplify Your HealthCare with Alice@ezhealthcareonline.com
There are some options within the current quagmire of health care. You may need to work around some things, through other things/providers and work WITH providers. I told a friend recently (who is uninsured) that if I could advise on 1 item, it would be to negotiate with healthcare providers (Doctors, hospitals, etc). However, you cannot expect it to be like the good doctor making a house call for a dozen eggs. But...this concept/strategy is worth a try. It will not be easy with negotiations because providers in this healthcare market are generally paid to provide more care (needed or not). The market will move toward an end in which this negotiation is more attractive. Just think...you could arrange with a physician to pay a certain amount (cash or services) for a visit, procedure, etc...at a discount of full price (of which is always over-priced). What is the incentive for the doctor? No paperwork, insurance forms, the time spent for billing, coding, re-billing. This, of course is only useful if you do pay your negotiated part and up-front.
Do you provide a service that could be useful to the provider? Plumbing, electric, drafting, cleaning, yeard work?? Perhaps, you could trade services. Think about other services that may be of potential use for bartering. Please share your thoughts and suggestions about this topic. Kind of an interesting way to approach your healthcare? Think about it...share with us.
Until next time... Simplify Your HealthCare with Alice@ezhealthcareonline.com
Friday, November 21, 2008
"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/
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/
Sunday, November 16, 2008
"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,
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,
Saturday, November 8, 2008
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
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
Thursday, October 9, 2008
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.
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.
Sunday, September 28, 2008
Health Insurance Application
Hi everyone. It is time to get this blog up and going again. The first thing I want to tell you about is completing a health insurance application. If you are applying for coverage, most likely, you will need to provide a health history. It is of utmost importance that you include absolutely everything. They will likely ask for a complete history for the past 3 years, maybe 5 years. Include all medications, Dr. visits and any health conditions or injuries. It is very difficult to remember every little thing, but that is what you will need to do. If you don't include everything, and it surfaces at a later time, it could result in non-coverage or even rescinding your policy for non-disclosure.
No one wants that to happen, but that is how it works. My suggestion to you is to start a list now. Do this even if you don't think you will not need it. Going to a new physician, you will need to answer these type requests. Start your list now and every time something changes, update your list. Make a list of any medications you are taking or have taken in the past five years. Include even an antibiotic or sinus pill. Add the reason for taking each and the approximate dates. Do the same thing with any illnesses you may have or have had and any visits to a doctor.
Being proactive in keeping a personal health record now, will save you time and accuracy in the future. This gives you time to account for everything. As you remember something, add it to your log. Do this, and you will be prepared for the next time you are required to submit health information. You will find examples of blank logs on my web site: www.EZHealthCareOnline.com
No one wants that to happen, but that is how it works. My suggestion to you is to start a list now. Do this even if you don't think you will not need it. Going to a new physician, you will need to answer these type requests. Start your list now and every time something changes, update your list. Make a list of any medications you are taking or have taken in the past five years. Include even an antibiotic or sinus pill. Add the reason for taking each and the approximate dates. Do the same thing with any illnesses you may have or have had and any visits to a doctor.
Being proactive in keeping a personal health record now, will save you time and accuracy in the future. This gives you time to account for everything. As you remember something, add it to your log. Do this, and you will be prepared for the next time you are required to submit health information. You will find examples of blank logs on my web site: www.EZHealthCareOnline.com
Tuesday, November 6, 2007
Health Insurance: To Buy or Not to Buy? That is the question
Hi everyone!
I am back to continue our discussions.
Many of us are fortunate enough to have employers who provide a significant portion of our health insurance coverage. Today I am very grateful for that but that has not always been the case. I need to tell a story. Being a nurse, my employment options have always been fairly solid, i.e. among other things my Health Insurance policy has always been provided with very little out of pocket expense. Not to long ago I was transitioning out of one job/employer with the intent to take a break and “find myself”. My little break meant I would be paying my own health insurance. I could not believe how much it cost! This was just for myself (but it was very good coverage)…I really couldn’t even guess what it might have cost if it was a family policy…Oh My Gosh! So, I am paying my way and there is no income…you can imagine this might not last very long. I also ran up some additional expenses. Suddenly I ran out of money and didn’t have another job lined up at the moment. I depleted my entire savings, had an excessive amount of revolving debt and had More Out-Go than In-Come. I was riding a very thin financial line.
All this story to say that at that point, if a large expense occurred I would have absolutely no resources to manage. I could easily see how the middle management, middle aged person can end up sleeping in a cardboard box down by the river. I was very fortunate to be able to secure another position (one that is right for me) that provided benefits. I managed to get my revolving (credit cards) debt down while I checked on other options. I could see the abyss and it was scary. I can now see how people could let themselves be without insurance. Similar decisions as to whether to take the dog in for her yearly vaccinations or pay the electric bill are somewhat common at my house these days.
Now, we can finally get to the question of can you go without insurance??? My opinion is a big fat NO!
What do you guys think about this topic? Let me hear from you. I will return later and continue...unless you guys give me something else to talk about.
Alice
I am back to continue our discussions.
Many of us are fortunate enough to have employers who provide a significant portion of our health insurance coverage. Today I am very grateful for that but that has not always been the case. I need to tell a story. Being a nurse, my employment options have always been fairly solid, i.e. among other things my Health Insurance policy has always been provided with very little out of pocket expense. Not to long ago I was transitioning out of one job/employer with the intent to take a break and “find myself”. My little break meant I would be paying my own health insurance. I could not believe how much it cost! This was just for myself (but it was very good coverage)…I really couldn’t even guess what it might have cost if it was a family policy…Oh My Gosh! So, I am paying my way and there is no income…you can imagine this might not last very long. I also ran up some additional expenses. Suddenly I ran out of money and didn’t have another job lined up at the moment. I depleted my entire savings, had an excessive amount of revolving debt and had More Out-Go than In-Come. I was riding a very thin financial line.
All this story to say that at that point, if a large expense occurred I would have absolutely no resources to manage. I could easily see how the middle management, middle aged person can end up sleeping in a cardboard box down by the river. I was very fortunate to be able to secure another position (one that is right for me) that provided benefits. I managed to get my revolving (credit cards) debt down while I checked on other options. I could see the abyss and it was scary. I can now see how people could let themselves be without insurance. Similar decisions as to whether to take the dog in for her yearly vaccinations or pay the electric bill are somewhat common at my house these days.
Now, we can finally get to the question of can you go without insurance??? My opinion is a big fat NO!
What do you guys think about this topic? Let me hear from you. I will return later and continue...unless you guys give me something else to talk about.
Alice
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