In this blog, I am just going to offer links that assist in acquiring Health Insurance through the Exchange, or signing up for your state's Medicaid MCO.
If you don't think you qualify for government covered insurance, shop the Marketplace.
https://www.healthcare.gov/
What is the Marketplace?
HIX, or the Health Insurance Exchange, is the place where you can find out how much your coverage will cost, shop different plans, and learn what's available.
I keep hearing MCO-What does it mean and how does it impact me?
MCO stands for Managed Care Organization. Each state awarded a handful of insurance companies this contract. It is for people on or applying for Medicaid under the new guidelines.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Managed-Care/Managed-Care.html
It's actually pretty cool. The insurance providers who were given the contract had to come up with Value Added Benefits which are in addition to the required list of covered services. You can benefit from Preventive Medicine, Vision, Dental, and in some states Native Medicine Men/Women and Curanderas/Curanderos (or traditional healers) and several others.
How do I apply?
Low Income-http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/By-State.html
Fill out the application for Medical Assistance. If they feel your income is too high, you will be directed to the Marketplace, listed above.
There is no reason to fear the ACA. For the first time in American history, your health is in your hands. For the first time, many people who were never covered, can take control and get the coverage they need to stay healthy. I am a cheerleader for self-empowerment in the healthcare industry, and this is a great stride in the right direction. For the first time, Insurance Companies are forced to work FOR you.
Good luck, and happy shopping!
Sunday, November 3, 2013
Tuesday, October 29, 2013
Hospitalization-terrifying, but bearable
There are many reasons for hospitalization, very few are pleasant. I hope this quick tip guide will help you get through it more smoothly.
Emergency Room-Most of you already know this, but ER's are required to screen and stabilize you, even if you can't pay or don't have insurance. You can read more about this at http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=4770007463
Hospital Stays:
Recovery from Surgery-You will often remain in the recovery area until the anesthesia has worn off. If it is a day surgery, some hospitals will (unfortunately) release you before this is the case. You and your loved ones have the right to request further observation and care, until you feel comfortable enough to go home.
If you are kept overnight, I suggest that you have someone there with you, as hospital stays can quite often involve some heavy duty painkillers. Allies are awesome. Good hospitals will provide a "sleeping chair" if your loved one wishes to stay through the night. Don't be afraid to ask.
The call button is there for a reason. Don't be afraid to push it if you are in pain, thirsty, stuck in a strange position, have to pee-whatever ails you. Don't allow yourself to be ignored. You will recover faster if you are comfortable.
If you are placed in a room with a person who is recovering from a contagious disease, you CAN demand to be placed in a different room. Your body will be in a weakened state, and this kind of exposure can lead to a number of Hospital Acquired Infections.
Being ignored? Not okay. Hospital workers are on overload, but it is their job to make sure you're taken care of. A night in a hospital can be and often is equivalent or higher cost than a luxury hotel. You pay this so that you are monitored, cared for and under supervision. There can be delays, but if they are ridiculously long, tell the nurse you want to speak to a Patient Advocate. Patient Advocates are there to protect the hospital from malpractice suits (truly, that's a big one) and this means better care for you.
Don't be bullied. Does morphine give you a headache? Ask for an alternative. Remember, personal empowerment in the healthcare setting can mean the difference between life and death. If they ignore your concerns, demand to see the Charge Nurse, Physician on Call, or a Patient Advocate.
Emergency Room-Most of you already know this, but ER's are required to screen and stabilize you, even if you can't pay or don't have insurance. You can read more about this at http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=4770007463
Hospital Stays:
Recovery from Surgery-You will often remain in the recovery area until the anesthesia has worn off. If it is a day surgery, some hospitals will (unfortunately) release you before this is the case. You and your loved ones have the right to request further observation and care, until you feel comfortable enough to go home.
If you are kept overnight, I suggest that you have someone there with you, as hospital stays can quite often involve some heavy duty painkillers. Allies are awesome. Good hospitals will provide a "sleeping chair" if your loved one wishes to stay through the night. Don't be afraid to ask.
The call button is there for a reason. Don't be afraid to push it if you are in pain, thirsty, stuck in a strange position, have to pee-whatever ails you. Don't allow yourself to be ignored. You will recover faster if you are comfortable.
If you are placed in a room with a person who is recovering from a contagious disease, you CAN demand to be placed in a different room. Your body will be in a weakened state, and this kind of exposure can lead to a number of Hospital Acquired Infections.
Being ignored? Not okay. Hospital workers are on overload, but it is their job to make sure you're taken care of. A night in a hospital can be and often is equivalent or higher cost than a luxury hotel. You pay this so that you are monitored, cared for and under supervision. There can be delays, but if they are ridiculously long, tell the nurse you want to speak to a Patient Advocate. Patient Advocates are there to protect the hospital from malpractice suits (truly, that's a big one) and this means better care for you.
Don't be bullied. Does morphine give you a headache? Ask for an alternative. Remember, personal empowerment in the healthcare setting can mean the difference between life and death. If they ignore your concerns, demand to see the Charge Nurse, Physician on Call, or a Patient Advocate.
Saturday, October 26, 2013
What about the Drugs?
Medications play a vital role in our physical upkeep, and for the most part are safe...but after working for a Class Action Attorney, who specialized in lawsuits pertaining to drug related injuries and death, I have found that these tips have helped immensely.
1. Everyone makes mistakes-before begininning a new medication, call your local pharmacist. Pharmacists can be a wellspring of information, and as medications are their specialty, they play a vital role in keeping us safe.
2. Sometimes a new medication gives the direction of "at bedtime", in which most pharmacies are closed. I do not endorse, and am not in any way associated with Walgreens, but there seems to be one on every corner. http://www.walgreens.com/storelocator/find.jsp Even if there is not one in your area, you can find one on the list to call with questions. They're pretty helpful, and it doesn't matter if your prescription was filled there or not.
3. Call and ask for the pharmacist. Tell them you've been prescribed a new medication, and have concerns about possible interactions or side effects. Ask them about what to watch for, indications of a bad side effect-ie. rash, blurred vision, increased heart rate...there can be many. Tell them what other medications you currently take-even over-the-counter meds like Aspirin or Benadryl.
4.Look before you leap! When I arrive home with a new medication, I always log onto http://www.webmd.com/pill-identification/ to make sure that the pills in the bottle are the right ones. Sometimes your insurance will insist that you be given a generic pill instead of a brand name. This can get tricky, as generics come in all shapes and sizes. This website allows you to enter shape, color and imprint. It will list the brand names, and what the pill is for, and what dosage it is.
5. Crap, it's Saturday and my prescription for Thyroid pills has no refills. Relax. If it is a non-narcotic, the majority of pharmacies will give you an "emergency dose" to get you through until Monday, when they can contact your physician. There's no harm in asking, and they are often free.
6. Insulin. No refills on my insulin ,it's the weekend, and I don't have the cash to pay out of pocket (Many insurance companies will not cover even life-saving drugs without a prescription). Call your clinic, if it's large enough, there will be a message with a number or a prompt to press 1 for the on-call physician. The beauty of EMR, is that a doctor, even if it is not your own, can look up your record and call in a prescription on behalf of your doctor. This can work on test strips and syringes as well.
7. You are in control of your health. Do not let a doctor "bully" you into taking a pill. If you feel uncomfortable, get a second opinion. Research your options. Make sure the pill is safe.
8. As mentioned in my previous blog, keeping a list of your medications, dosages, and frequency of use in your wallet is an amazing time saver. When following number 3, you can easily read off the list instead of juggling multiple bottles.
1. Everyone makes mistakes-before begininning a new medication, call your local pharmacist. Pharmacists can be a wellspring of information, and as medications are their specialty, they play a vital role in keeping us safe.
2. Sometimes a new medication gives the direction of "at bedtime", in which most pharmacies are closed. I do not endorse, and am not in any way associated with Walgreens, but there seems to be one on every corner. http://www.walgreens.com/storelocator/find.jsp Even if there is not one in your area, you can find one on the list to call with questions. They're pretty helpful, and it doesn't matter if your prescription was filled there or not.
3. Call and ask for the pharmacist. Tell them you've been prescribed a new medication, and have concerns about possible interactions or side effects. Ask them about what to watch for, indications of a bad side effect-ie. rash, blurred vision, increased heart rate...there can be many. Tell them what other medications you currently take-even over-the-counter meds like Aspirin or Benadryl.
4.Look before you leap! When I arrive home with a new medication, I always log onto http://www.webmd.com/pill-identification/ to make sure that the pills in the bottle are the right ones. Sometimes your insurance will insist that you be given a generic pill instead of a brand name. This can get tricky, as generics come in all shapes and sizes. This website allows you to enter shape, color and imprint. It will list the brand names, and what the pill is for, and what dosage it is.
5. Crap, it's Saturday and my prescription for Thyroid pills has no refills. Relax. If it is a non-narcotic, the majority of pharmacies will give you an "emergency dose" to get you through until Monday, when they can contact your physician. There's no harm in asking, and they are often free.
6. Insulin. No refills on my insulin ,it's the weekend, and I don't have the cash to pay out of pocket (Many insurance companies will not cover even life-saving drugs without a prescription). Call your clinic, if it's large enough, there will be a message with a number or a prompt to press 1 for the on-call physician. The beauty of EMR, is that a doctor, even if it is not your own, can look up your record and call in a prescription on behalf of your doctor. This can work on test strips and syringes as well.
7. You are in control of your health. Do not let a doctor "bully" you into taking a pill. If you feel uncomfortable, get a second opinion. Research your options. Make sure the pill is safe.
8. As mentioned in my previous blog, keeping a list of your medications, dosages, and frequency of use in your wallet is an amazing time saver. When following number 3, you can easily read off the list instead of juggling multiple bottles.
Getting the most out of your doctor visit-tips and tricks
Doctor's offices are intimidating to most people, and many times people will do everything in their power to avoid them. If you enter with confidence and remember that YOU control your healthcare needs, it will give you a great advantage in your pursuit of health.
Preparation for a symptom driven doctor visit:
Doctors are very hardworking, busy creatures, and often a bit rushed due to their case load, here are some tips to get the most out of your 5-15 minute visit.
1.Make a list of everything you want to discuss, ie. ear aches, pain in the joints, frequent urination, dizzy spells, insomnia, unexpected weight gain/loss, fatigue, blurred vision, strange cough, allergies-whatever ails you. This can cut down on the number of times you need to see your doctor every year. We often forget certain ailments because of the apprehension and anxiety that goes along with seeing our doctors.
2.Keep a list of your medications, dosage, and how many times daily the medication is taken, in your wallet. This is not only a good practice for doctor's visits, but in case of emergencies as well. (It also saves time when filling out the forms prior to entering the exam room)
3.As the problems on your list are addressed, cross them off of your list.
4.Allergic? List your allergies on the back of your medication list, this will help ensure that you do not receive a prescription that will create an interaction or allergic reaction.
5. Be firm. You know your body better than anyone. If you have had bad experiences with codeine, for example, ask your doctor if the prescription he/she is writing for you contains this element.
6. Don't let them dodge an issue that is important to you. If you have a concern about something that is not their specialty, ask for a referral, or a "pre-auth", this can help get you into a specialist faster, and can, in many cases, reduce your out of pocket expense.
7.If the doctor is disparaging, condescending, or refuses to listen to your concerns, ask for the clinic manager. If the clinic manager does not assist you, inform them that you will address your concerns with the AMA.
8.Do your research. Web MD is a great resource. It is not intended to diagnose, but if all of your symptoms match a certain ailment, you can save you and your doctor time by asking him/her to rule out that ailment. Make a list of possibilities.
9. If time runs out, return to the receptionist and make another appointment. Follow-up appointments are usually easier to get while still at the office, as opposed to calling in later.
10. Many clinics hold a certain number of "crucial" appointment slots open. For example, if you feel that you have strep throat, and don't want to go to urgent care, try calling your doctor's office early in the morning, just as they open. This will give you an advantage in getting one of these most coveted same day appointments. If your doctor isn't available, ask if there are any other doctors in the clinic with open appointments. Most clinics are on an EMR (Electronic Medical Record) system, and therefore, a different doctor can pull up your medical history with the click of the mouse. If nothing is available, then suck it up and go to Urgent Care.*IMPORTANT: if your symptoms are frightening, chest pains, etc, don't pass go, call 911 or go to the ER.
11. Need help on how to address your doctor, or to determine whether a visit is necessary? You can call a nurse line. Most states have 24 hour nurse hotlines (which I will list in a future blog).
12. Don't be afraid, they work for YOU.
Preparation for a symptom driven doctor visit:
Doctors are very hardworking, busy creatures, and often a bit rushed due to their case load, here are some tips to get the most out of your 5-15 minute visit.
1.Make a list of everything you want to discuss, ie. ear aches, pain in the joints, frequent urination, dizzy spells, insomnia, unexpected weight gain/loss, fatigue, blurred vision, strange cough, allergies-whatever ails you. This can cut down on the number of times you need to see your doctor every year. We often forget certain ailments because of the apprehension and anxiety that goes along with seeing our doctors.
2.Keep a list of your medications, dosage, and how many times daily the medication is taken, in your wallet. This is not only a good practice for doctor's visits, but in case of emergencies as well. (It also saves time when filling out the forms prior to entering the exam room)
3.As the problems on your list are addressed, cross them off of your list.
4.Allergic? List your allergies on the back of your medication list, this will help ensure that you do not receive a prescription that will create an interaction or allergic reaction.
5. Be firm. You know your body better than anyone. If you have had bad experiences with codeine, for example, ask your doctor if the prescription he/she is writing for you contains this element.
6. Don't let them dodge an issue that is important to you. If you have a concern about something that is not their specialty, ask for a referral, or a "pre-auth", this can help get you into a specialist faster, and can, in many cases, reduce your out of pocket expense.
7.If the doctor is disparaging, condescending, or refuses to listen to your concerns, ask for the clinic manager. If the clinic manager does not assist you, inform them that you will address your concerns with the AMA.
8.Do your research. Web MD is a great resource. It is not intended to diagnose, but if all of your symptoms match a certain ailment, you can save you and your doctor time by asking him/her to rule out that ailment. Make a list of possibilities.
9. If time runs out, return to the receptionist and make another appointment. Follow-up appointments are usually easier to get while still at the office, as opposed to calling in later.
10. Many clinics hold a certain number of "crucial" appointment slots open. For example, if you feel that you have strep throat, and don't want to go to urgent care, try calling your doctor's office early in the morning, just as they open. This will give you an advantage in getting one of these most coveted same day appointments. If your doctor isn't available, ask if there are any other doctors in the clinic with open appointments. Most clinics are on an EMR (Electronic Medical Record) system, and therefore, a different doctor can pull up your medical history with the click of the mouse. If nothing is available, then suck it up and go to Urgent Care.*IMPORTANT: if your symptoms are frightening, chest pains, etc, don't pass go, call 911 or go to the ER.
11. Need help on how to address your doctor, or to determine whether a visit is necessary? You can call a nurse line. Most states have 24 hour nurse hotlines (which I will list in a future blog).
12. Don't be afraid, they work for YOU.
Co-Pay against my will?
Interesting Fact: Many Health Insurance companies provide a free yearly exam/check-up
Unfortunate Fact: Many people will end up paying for it
When you schedule your yearly exam, depending on what your insurance covers, you will get basic lab work, a stethoscope to the chest, a flashlight shoved in your ears, and a number of other fun goodies.
Once a year, it's free.
Or is it?
Many people complain about receiving a bill for a co-pay after their yearly, run-of-the-mill exam. The reason this happens, is that doctors can be tricky. When you enter the exam room, follow these tips to ensure a free, insurance covered exam.
1. As soon as the doctor enters the room, state that you are there for your yearly physical. Speak first, take charge of your own health.
2. If the doctor asks what current health concerns you have, repeat that you are there for a physical. If you discuss your sore knee, or a bad case of allergies, you have just moved into an office visit, and have voided your free physical.
3. If you develop health concerns shortly before your physical, tell the receptionist that you need to postpone your physical, but still need to see the doctor. Pay your co-pay, and reserve your free visit for later.
4. Make sure to read your insurance company's definition of a physical. Make sure the physician covers everything on that list, but nothing more. If you have further concerns,that aren't urgent, make another appointment.
It's all in the code. Medical coding is what creates unwarranted bills, or prevents them. Ask your doctor or physician's assistant what code he/she has entered for your visit. Some doctors will code the visit themselves, while others have coders in their office, or contracted ones out of state. When your visit is transcribed, the coder will use what the doctor has written to determine the level of care. You want the code to begin with 993, not 992. It will be a six digit code depending on your age.
What if they find something abnormal?
Sometimes they will find something that denotes a less than perfect state of health. It's okay. That's why you are there, for Preventive Care. If something is wrong, they will send you on for further testing, much of which may be covered by insurance.
Don't be afraid to call your insurance company and ask about Services that are covered by your current plan. Most insurance cards have a phone number listed.
Important: If the doctor is concerned about something he/she finds, don't cheap out. Get it checked.
Remember: Physicians work for you. They are body mechanics. You have control over your own health.
Coming up..."Getting the most out of your doctor visit", and "How to get crucial prescriptions refilled, even on weekends"
Unfortunate Fact: Many people will end up paying for it
When you schedule your yearly exam, depending on what your insurance covers, you will get basic lab work, a stethoscope to the chest, a flashlight shoved in your ears, and a number of other fun goodies.
Once a year, it's free.
Or is it?
Many people complain about receiving a bill for a co-pay after their yearly, run-of-the-mill exam. The reason this happens, is that doctors can be tricky. When you enter the exam room, follow these tips to ensure a free, insurance covered exam.
1. As soon as the doctor enters the room, state that you are there for your yearly physical. Speak first, take charge of your own health.
2. If the doctor asks what current health concerns you have, repeat that you are there for a physical. If you discuss your sore knee, or a bad case of allergies, you have just moved into an office visit, and have voided your free physical.
3. If you develop health concerns shortly before your physical, tell the receptionist that you need to postpone your physical, but still need to see the doctor. Pay your co-pay, and reserve your free visit for later.
4. Make sure to read your insurance company's definition of a physical. Make sure the physician covers everything on that list, but nothing more. If you have further concerns,that aren't urgent, make another appointment.
It's all in the code. Medical coding is what creates unwarranted bills, or prevents them. Ask your doctor or physician's assistant what code he/she has entered for your visit. Some doctors will code the visit themselves, while others have coders in their office, or contracted ones out of state. When your visit is transcribed, the coder will use what the doctor has written to determine the level of care. You want the code to begin with 993, not 992. It will be a six digit code depending on your age.
What if they find something abnormal?
Sometimes they will find something that denotes a less than perfect state of health. It's okay. That's why you are there, for Preventive Care. If something is wrong, they will send you on for further testing, much of which may be covered by insurance.
Don't be afraid to call your insurance company and ask about Services that are covered by your current plan. Most insurance cards have a phone number listed.
Important: If the doctor is concerned about something he/she finds, don't cheap out. Get it checked.
Remember: Physicians work for you. They are body mechanics. You have control over your own health.
Coming up..."Getting the most out of your doctor visit", and "How to get crucial prescriptions refilled, even on weekends"
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