Understanding Your Medical Claims

When Do You Need to Change Your Doctor?

2017-03-29T17:37:00.001-07:00

Have you ever just stuck with your doctor because it was convenient? I know I have. I don't know whether I'm afraid of change, or it's because my doctor's office if close by, but I am guilty of this. I have decided though that it's time to change my doctor, and I'll tell you why.

I've only seen my doctor twice in the three years that I've been her patient. She's very pleasant to talk to, but doesn't seem to interested in follow-up appointments. There was an 18 month gap between my first appointment and next appointment with her. I never heard from her in between appointments, and she refilled my prescriptions, no questions asked. I'm only on a blood pressure medication, but I think after a year she would have said I needed to come in and be rechecked. My last appointment was last October. I scheduled a physical and it took six weeks to get this appointment. Three days prior to my appointment, I ruptured my Achilles tendon and I asked her to look at it. She examined it, which took maybe a full minute and said to keep on what I was doing. She asks me routine questions about my health, then looks at her watch and says she only has a few minutes left to finish my exam! At this point I was perplexed!!! She did the female portion of the exam and nothing else. No listening to my heart, lungs, looking at my throat or ears. Nothing. Oh, she did order annual lab work.

To this day I still can't believe that I didn't say anything to her. I've worked in doctors offices. I know what a physical is. I was just so dumb-founded when she made that comment, that I didn't think to respond.

I have an HMO for insurance, so it's pretty easy for me to change doctors. All I have to do log on to their website, find doctors that I'm interested in, then see if they are accepting new patients. I've also used YELP to look at reviews of doctors as well, and to see what other people/patients have commented about them. If I see someone who looks good, but after reading reviews see that he/she is frequently behind schedule, I probably wouldn't choose them.

Now, not all people have the luxury of changing doctors as easily as I do. With Obama Care now, more and more doctors offices are feeling the impact of additional patients and having a hard time keeping up with the ones that they already have. Also, you may have to call around and see if the doctor you have in mind accepts your insurance. Not all doctors take every insurance that is out there.

If you are thinking about changing doctors, ask yourself these questions?

Do I like my doctor? Is he/she pleasant and does he/she listen to me?
How easy is it to get an appointment?
Are same day appointments available for urgent issues?
What are her/his policies when they're unavailable?
What is his/her refill policy?
Are they on time or frequently run behind?
Is their office staff pleasant?
Do they call you back if you have a question?
Does he/she feel rushed when you see them?
Do they take family members?
Do they accept and bill my insurance?
Do they have positive patient reviews?

These are just a few of the questions I would ask. I would also ask friends and family members for recommendations. As a consumer, you have the right to the best medical care possible and shouldn't accept anything less.

How to Get the Most out of your doctor appointment

2017-02-25T12:24:00.000-08:00

Have you ever gone to a doctor appointment, only to leave and forgot to ask questions or forgot what was told to you at your appointment? Well, you're not alone. Most appointments last, (or are scheduled) for only 15 minutes, and you usually have to cram as many questions and receive suggestions, prescriptions and additional information to act upon. Unfortunately, a lot of this is forgotten as soon as you get home. It's not that you've intentionally forgotten it, it's that a lot is done in a short amount of time, and you're not wired to recall that much information. I too have experienced this first-hand; not only after working in a medical office for several years, but as being the child of an aging parent who easily gets facts confused.

I have come up with a list of suggestions to make your appointment easier for both you and your doctor.

Carry a medical notebook with you

On the first section, write down your name, address, phone number, emergency contact information and insurance name. Include illnesses, previous surgeries, and all your prescriptions that you take and any allergies that you have. Make sure you include the milligrams, (strength) and how often you take it. Also note which provider prescribed it for you. Also include a list of vaccinations that you had and the date you had them. Next, include important family history that your doctor should be aware of. Now, make a list of all your providers, including their names, specialty, address and phone numbers.

Make a list of your appointments and who you see

This should resemble the list of chapters in a novel, but you keep adding to it with each appointment.

Keep a separate section for each provider that you see

Write (again) the providers name, address, and phone number at the top of their section. Always write a date and time of appointment for each visit. Keep it in chronological order, just like you would do with a diary. In the provider section, write down any questions and answers that you have when you have an appointment. Make sure you include any changes and tests that have been ordered. Also attach any copies of orders or records that they have given to you that day.

Hopefully this will give you some ideas on what will help you gain the most from your medical appointments for both you and your providers. I know that it's been a big help for both myself and my family members.

Sports Injuries in Seniors!!!

2017-01-02T15:14:00.002-08:00

I've always liked to be active. I am not much for going to the gym and working on the weights, but I do like to participate in classes and sports. Now mind you, I'm not a spring chicken anymore. In fact, this year I'll turn 60, but I don't believe in stopping what you love because of your age.

This brings me to sports injuries. Never in my wildest dreams did I ever think that I would be in my first cast in my late 50's!

I was playing pickleball (I call it tennis for old people), at the local YMCA. I had been playing twice a week for quite sometime now. I was probably an hour into playing, (you take turns, so I did have some down time), when I went after a routine ball and it felt like someone came up from behind me and hit me in my right calf and I heard a loud pop. I immediately went to the ground, (more to protect myself than anything), and knew instantly that something was wrong. I was helped over to a bench where it was apparent that something was seriously wrong with my achilles tendon.

I ended up getting a ride to urgent care where I was misdiagnosed with a sprain and put in a walking shoe. Three days later I saw my own doctor, who examined it, but didn't suggest anything else. I finally asked for a referral to an orthopedist as my leg was swelling.

I saw the orthopedist 16 days after my initial injury where he thought that I ruptured my achilles tendon. Neither the urgent care doctor or my physician knew they correct way to test for this. I ended up having an MRI which verified his diagnosis and was put in a cast for four weeks. I recently had it removed and now am in a air cast/boot with wedges that have to be removed weekly. This will go on for about five weeks, then lots of physical therapy. Did I mention this was my right foot? That means NO DRIVING which is driving me crazy!!!! Not only can I not drive, I also have to have help taking a shower.

If you think you've been misdiagnosed, trust yourself and get a second opinion immediately. If I had, I probably would have been on the road to recovery sooner and possibly have a better resolution to my overall healing. Sports injuries can happen at any age. Even if you think you know your limits and are doing all the appropriate things, (stretching, diet, etc), it can still happen to you. And always, check with your medical provider to make sure you are healthy enough to participate in any physical activities before you start.

RIP Dad, You're the Best!

2016-09-10T15:42:00.001-07:00

My father passed away on July 28th. He was 84 years old and had been in declining health for quite awhile. He had lung cancer, (was a long-time smoker, but had quit 20+ years ago), went through radiation, (which gave him an additional 6+ months), but succumbed to a heart attack, as his cancer was putting pressure on his already weakened heart. He spent his final days at his summer home in Brookings, Oregon, and unexpectedly passed 3 days after he came back to his permanent home in Northern California.

My parents were proactive a few years back and planned for their deaths. My father was a Korean War Veteran and requested a memorial service at the local funeral home first, followed by internment at a nearby Veterans Cemetery. His wishes included the 21 gun salute, bugle, and the flag folding ceremony with all the bells and whistles.

My mother has since found out that all your best pre-planned arrangements may not go as smoothly as hoped. To start off with, both my parents signed up for a pre-paid cremation service. That was fine, but since my father passed at home, (after family members paid their final goodbyes and hospice was notified and had come and gone), we called the cremation organization to pick up his body. Little did my parents realize, that the organization they signed up with was two hours south of them. They first had to get a team in place, then drive up and pick up his body. Next, another surprise was the length of time that it actually takes to get the cremation done. They first need a signed death certificate from the physician, which can take up to 5-7 days, then they seemed to need additional paperwork faxed over from my mother. They indicated the whole process could take up to 15 days! Lastly, the cremains were to be shipped back to my mother with the proper permits and such for burial.

My mother was hoping to have the local memorial service and internment all at the same time, but due to the uncertainty of the cremation timeline, she did the memorial first. Next, we had to plan a time for the internment. As the Veterans Cemetery has only certain days that they do services and also have to rely on retired Veterans to do the gun salute, we were at another standstill. We finally were able to get all the pieces in place, and the actual internment took place a month after his death. It was a lovely service and actually FREE to military members. My mother will also be interned next to my father, but as she was not a Veteran, there will be a cost of ~ $750.00 for her.

This brings me to what a nice benefit the Veterans have for their loved ones passing. The Cemetery we went to was nicely kept and very professional. They did a nice service and all expectations were met. You can actually have the full service at the Chapel at the Veterans Cemetery, but as I previously mentioned, my father wanted a separate one at the local funeral home first.

If you have a love one that served in the military and hasn't made their wishes known, it might be time to have the "talk" with them. It's a great benefit for their service to their country and one that families may not be aware of.

Ca Veterans Cemeteries

Kevin MD - A Great Site to Visit

2016-07-02T14:29:00.002-07:00

I'm going to keep my blog post short and sweet today. I have found a blog called KevinMD.com that is a wealth of information from a physicians point-of-view. It talks from everything from abuse by patients using the Emergency Department as their personal physician, to people going broke because they can't afford care.

Please take the time to check this very informative blog out. It's great to see that there is a MD that is rooting for patients and patient care. Oh, and have a happy and safe 4^th of July!

http://www.kevinmd.com/blog/

Have Healthcare Changes Impacted Your Life?

2016-05-20T20:03:00.002-07:00

Healthcare has changed significantly over the last several decades. It used to be that you had a Primary Care Physician (PCP), which may have been referred to as your "Family Doctor", that took care of all of yours and your families health care needs. He (and in rare circumstances she), would see you for the common cold, deliver your baby, and possibly make a house call if you were too sick to come to their office. And, if you had to be admitted to the hospital, your PCP would most likely be the one who cared for you the entire time.

Nowadays, it's a new ball game. You may have a PCP, but if you need specialized care, you will most likely have a different physician for that. For example, my daughter had a perinatologist for her entire pregnancy care. (I had my Family Doctor.) When it came time for her to deliver her baby, her perinatologist wasn't on call. It was actually a midwife that delivered her baby. Her perninatologist never even saw her during the time she was in the hospital. She did see her for her six-week postpartum check up, and that will be her last visit with her. Also, if you get admitted to the hospital, you might have a hospitalist to take care of all, (or most), or your medical needs and never see your PCP. You also will probably have a barrage of doctors to take care of your different healthcare needs.

I'm also sure that you're used to having to pay a co-pay or your portion due now at the time that you're seen. It used to be that you could pay when you received your doctors bill in the mail, and if need be, make payments on it.

Also, remember when your doctor could just order a test if you needed it? Now it usually has to go through a whole pre-authorization process with your insurance company, and even at that, it could get denied.

What do you think? Do you like all the health care changes or would you rather see it go back to the "Good 'ol Days"? I for one, prefer the way it used to be. I had my family doctor from the time I was two years old, until the time he retired. He took care of four generations of my family and was not only my doctor, but a friend as well.

What to Expect if a Relative Goes Into a Nursing Home

2016-04-12T21:44:00.000-07:00

My eighty-eight year old father-in-law recently fell at home, (he was by himself), and broke his hip.

Unfortunately, his Life Alert alarm was in his nightstand drawer, and his fall took place in his living room. It took him two hours to make it to a phone. He called his daughter and son (who lived about twenty minutes away), to come over and help him BUT, unfortunately once they got there, neither of them had a key to his house. When they both arrived, they both came prepared with screwdrivers in hand, hoping to find a window that they could budge.

To make a long story short, they were able to crawl in through an unlocked window and call an ambulance. At the hospital, it was determined that his right hip was broken. He ended up having surgery that night, where he had a rod and three screws placed. After surgery, he was transferred to the ICU, (Intensive Care Unit), then shortly moved to a regular room. He ended up staying four days in the hospital, then he was transferred to a SNF, (Skilled Nursing Facility), for rehabilitation. At this point, his insurance covered his first twenty days in rehab.

Situation	Is my SNF stay covered?
You came to the Emergency Department (ED) and were formally admitted to the hospital with a doctor’s order as an inpatient for 3 days. You were discharged on the 4th day.	Yes. You met the 3-day inpatient hospital stay requirement for a covered SNF stay.
You came to the ED and spent one day getting observation services. Then, you were formally admitted to the hospital as an inpatient for 2 more days.	No. Even though you spent 3 days in the hospital, you were considered an outpatient while getting ED and observation services. These days don’t count toward the 3-day inpatient hospital stay requirement.

Now, this is where it gets tricky. His orthopedic surgeon told him that due to the severity of his break, he would have to remain completely non-weight bearing on his broken hip, for up to four months. According to Medicare guidelines, they will only pay the first twenty days of rehab. After that, if you don't have a supplemental that picks up the balances, (he has Vetrans insurance), you are reponsible for $161.00/day for days 21-100. This is exactly where he fell; paying $161.00/day.

Your costs in Original Medicare

You pay:

Days 1–20: $0 for each benefit period.

Days 21–100: $161 coinsurance per day of each benefit period.

Days 101 and beyond: all costs.

Medicare Guidelines

Thankfully, he was able to go home after about two weeks of paying $161.00/day. His daughter was able to make arrangements for caregivers to be with him basically 24 hours/day. It's actually costing more than the SNF for now, but he is at home and mentally doing much better.

If you are of Medicare age, or have parents or relatives that have Medicare, PLEASE take the time to review your supplemental insuance policies. It was quite shocking to find out how much money a serious injury can cost you, and not all people are prepared for this expense. You may even need to talk to your insurance agent to see if there are any supplemental policies that cover instances like this.

Is Your Provider Billing You Correctly?

2016-03-03T16:57:00.005-08:00

One of my relatives have recently had three disputes regarding her insurance bills/claims with her medical providers. One was at a specialists office and the other two with her primary care provider.

First off, she had a MRI at a radiology clinic. She was told up front what her portion of the fee would be. She paid that at her time of visit. Now, we know that most times this is only an "estimate". The amount owed can go up or down a little. When I worked in a radiology office, we always called the patients insuance company to find out what their deductible was, their out-of-pocket and how much had been met so far. This would give us a guildeline for what the patient owed. We usually nailed it exactly, but if there were outstanding claims that the insurance company got before ours, sometimes the patients portions were met, but just didn't show up on paper yet.

Anyway, my relative went to a preferred provider, so that she got the best possible benefit from her insuance. She was quite surprised when she received a bill for a substanial amount of money. After reviewing her EOB (Explanation Of Benefits) with what was paid, adjusted and what she paid, she figured that she owed nothing. She called the radiology office and gave them her payment information with them, and went over her EOB. In the end, it sounds like they didn't take the correct adjustment and billed her for this, after she made her original payment. Had she not known to look into this and just paid it, she would most likely have been out hundreds of dollars.

The same thing happened with her doctors office. Same scenario. She paid her portion due at the time of service and was billed again for a substantial amount of money. Not only did they do this once, but twice!

How many unsuspecting people do you think overpay their bills and think nothing of it? I know from experience, that unless you advocate for yourself and keep track of your claims, no one else will do it for you.

Have you had any similiar experiences? Have you ever had to question any bills? Do you have any outstanding bills that you feel you don't owe on? If so, maybe I can help. Just email me your questions, (you don't need to give me any personal information, numbers or anything like that). I can tell you what to look for, and how to go about getting it corrected.

I hope this never happens to any of you, but if you think you have been billed in error, don't be embarrased to call and ask questions. After all, you probably pay a lot of money for your insurance in the first place, and having to pay extra, just doesn't make sense!

YOU are the best Advocate for your Medical Care

2016-02-09T22:13:00.000-08:00

I have come to theconclusion that You are the best advocate for your Medical Care. This comes after all the trials and tribulations that my own mother has gone through after recently being diagnosed with breast cancer. Let me give you the scenario -

My mother had a mammogram, which came back stating that she needed additional testing. Her physician called her and ordered an ultrasound to further diagnose any suspicious areas. Seems pretty by-the-book so far, doesn't it? Well, now is not the time to get too confident on physician follow up or referals. As a side note, she has Medicare as her primary insurance and Blue Cross secondary. Not a HMO or Medi-Caid type of insurance that would need to go through a lengthy referral/authorization process to order tests.

My mother had the ultrasound, then nothing. No call from her doctor or the radiology clinic where she had the ultrasound. Makes you say hummmm, what's going on?

After close to after two weeks have lapsed, my sister and I convinced her that to call her doctor's office to find out what's going on. She finally called and was told that she had a suspicious area and needed a breast biopsy.

Now chapter two of the waiting game begins. Her doctor was going to send in a referral to a place to have this done. Another week passes and my mother hasn't heard anything. She calls to the office where she had her ultrasound and they don't have any orders. She calls back to the doctors office and the doctor "blames" this on the the new computer system that she's using. Personally, I don't see how that factored into anything, but the doctor says she'll send the order to a town thirty miles north of where she lives for the biopsy.

Chapter three: A couple weeks have passed again and there is no word from the biopsy office. My mother is eighty-three years old, and is under the impression that the radiologist needs to review her previous films first, and just figured that everything must by "okay", since no one called her. My mother finally called them and, my sister called them and they both get the run-around. I finally get frustrated, (I live 600 miles south of my mother), and call her primary care doctors office. I tell them that someone has dropped-the-ball and nothing has happened. This message miracuously gets to her doctor and gets the ball rolling. Next thing we know, the place where she is supposed to have the biopsy have the order and have her scheduled.

To make a long story short, the biopsy comes back positive for breast cancer and she gets referred to a breast specialist who does a lumpectomy. After the lumpectomy she has eight weeks of radition, and now is on an oral cancer medication. And most importantly, she seems to be doing pretty well.

I'll reiterate the moral of this story. Like I said in the beginning of this blog;

You are the best advocate

for your Medical Care!

I hope that you or your loved ones never have to go through something like this, but if you do, assume nothing. If you don't hear back from your physicians office, make the call. Don't assume that they will call you. You need to speak up and be proactive.

Emergency Rooms.....Emergency or Not?

2016-01-03T14:18:00.000-08:00

I've recently been volunteering at our local emergency room. I sit behind the window and help visitors when they come to visit patients in the Emergency Room. Whoa, why is this? You mean people actually need visitors when they're at the ER to get immediate help? Yes they do, and I'll explain why.

Where I volunteer, there can be up to more than 100 patients in the ER at a time. This includes the waiting room, patients that are in rooms, and patients that are having other services (x-rays, labs, etc), while waiting to be seen. I have seen patients that have been in the ER in excess of 6 hours from the moment they came through the front door, to when they left.

It seems to me that the Emergency Room is one of the most abused services that I've ever seen. When I think of an emergency, I think of something that needs urgent attention and doesn't happen during regular doctors office hours. Well, apparently this is where my thinking is misguided. People come to the emergency room when they have had a sprained ankle for two weeks to needing pain pills refilled! Ughh. Of course, there are the patients that do need emergent care, but the number of abusers far outweigh the ones that truely need it. Patients also think that if they come in via an ambulance that they will get moved to the front of the line and treated first. This is not so either. Once the patient has been triaged, and off-loaded off the stretcher, they can end up in the waiting room just like everyone else.

Also, a lot of people think that the ER is a full-service hotel. I've had family members of patients ask me to get them a sandwich because they're hungry. They are not even the patient! There is a fully-stocked cafteteria down the hallway, but people feel entitled to a free meal while they're waiting. Of course we feed the patients if necessary, but can't cater to the whole family and their friends.

Another reason why they may choose the ER over urgent care over their doctor.....money! The ER can ask to collect co-pays and money due up front, BUT they can not force anyone to pay. The ER can NOT turn anyone away for non-payment up front, where as your doctor's office may turn you away if you don't have the correct funds to give them as the time-of-service.

Thank goodness there is a system in place that protects the patients that are truely in need of emergent care vs the ones that do not. This is called TRIAGE.

tri·age

(trē-äzh′, trē′äzh′)

1. A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment. Triage isused in hospital emergency rooms, on battlefields, and at disaster sites when limited medical resources must be allocated.

2. A process in which things are ranked in terms of importance or priority:

tr.v. tri·aged, tri·ag·ing, tri·ag·es

To sort or allocate by triage: triaged the patients according to their symptoms.

Triage nurses carefully determine the severity of the illness and are able to "rank" the patient in order of urgency, not first come, first served.

I personally would not want to go to the ER if it were not a true emergency. You have no idea what you are being exposed to in the waiting room. Though there are masks available for people that are coughing, or people to protect themselves, not everyone that should have one uses one.

Lastly a great article to read is this... To the Woman who doesn't understand why I was seen before her at the ER. /http://themighty.com/2015/11/to-the-woman-who-doesnt-understand-why-i-was-seen-before-her-at-the-er/

It helps explain from a patient's point-of-view what goes on in the Emergency Room.

HIPAA, HIPAA, HIPAA.....Oh My!!!!

2015-10-09T00:03:00.002-07:00

By now, everyone has probably heard about HIPAA, and have an understanding of what it stands for. If not, it's an acronym for Health Insurance Portability and Accountability Act, which is the federal law that protects the privacy of personal health information.

Did you know, that if you were to work in a medical office and violated the HIPAA law, that both you and your employer could be fined up to $250,00.00 each if you were proven guilty of violating this law? Which brings me to three personal stories of violation of HIPAA that happened within my own family.

A close relative had a suspicious mammogram and ultrasound and needed a breast biopsy. There was a lot of mis-communication with the doctor's office ordering the test, and the radiology office where this test was to be preformed. Another relative has written permission to speak with medical providers on the patient's behalf. A good week has gone by and no one has heard from the radiology office. The patient calls and is told that they will call her after certain parties have reviewed the referral and prior films to determine what needs to be done. They will call her back the next day. Nothing happens. Another few days go by. The relative calls the radiology office and when she gives the patient's information; not only does she give the wrong birthdate, but the receptionist corrects her! UGHHHH As soon as incorrect information was given, the correct information SHOULD NOT have been volunteered by the radiology staff. I don't even believe that they verified that "the relative" had permission to speak with them either.

Violation #2. This one personally happened to myself recently. I needed to get copies of my shot records for MMR and Chickenpox, as I am going to be doing some volunteer work at a hospital. I called the medical office where I had the vaccinations, but didn't expect much as I hadn't been there in over twenty years. I knew it was a long shot that they might have records on me still, but I thought I'd give it a shot. I called the medical records department and gave them my name. They couldn't find any records on me, (no surprise there), but did volunteer the names of my mother-in-law, sister-in-law, brother-in-law and two neices that are still patients there. I knew that all of these people went to this clinic, but the medical records clerk didn't know that I knew this. She should have never given me their names. She should have merely said, "We don't have you in our system anymore", and left it at that.

Lastly, another realative saw a physician and he ordered a blood test. He sent the order to the printer, and handed it to her. She took it to the lab, and looked to see what he ordered. Ummm, he forgot to check the name on the order before he grabbed it off the copier, and just handed her the first one he grabbed; which belonged to someone else! She handed the paper to the lab tech, and told her it wasn't her. The lab tech was able to get her order and do the correct lab work, BUT she folded the wrong order in half and asked my relative to take it back to the doctor. OOPS She should have just taken care of it herself!

I realize that HIPAA is still fairly new, but by now health care workers should have had it drilled in long enough to be uber-careful about it! Let's hope things happen in three's, and this won't happen again to any of my family members or you and your family.

You can read more of my posts about insurance on my blog at http://healthclaimshelp.blogspot.com/

Helping my Daughter with her EOB's/Bills

2015-06-03T14:21:00.002-07:00

I recently went to visit my daughter in North Carolina, where proceeded to hand me a stack of medical bills. She couldn't make heads or tails out of them. One of the "bill's" was actually a statement from her insurance company showing total charges (for 2015), adjustments, payments and her balance. All she saw was the first number, $1632.00 and freaked out! She thought she owed this. I took everything back to California with me and told her I would sort it out.

First, I went to her insurance website, logged in and matched the bills with the charges.
Next, I made sure there were no "missing" bills.
Then I verified that the billed amounts due from her, were correct with the EOB's online.

Doing this, I found that one item on one of her bills had been denied by her insurance company. It looked like it was rebilled, yet, I didn't have a bill for it. The balance according to the webite should have been $25.45. I called the billing office to pay this. Since I wasn't the patient, (HIPPA privacy law), I had to have my daughter call and give the medical billing office permission to speak with me. The balance that I saw that was due was for an office visit copy ($25.00) and co-insurance $.045. This was for a February visit, but had just been paid by the insurance company in May. When I spoke with "Tianna", she stated the balance was $41.25, She indicated that the balance was past-due and sent to collections, so had fees added to it. This infuriated me! Just because they billed incorrectly and didn't get payment for 90 + days, they figured my daughter was in arrears. I asked to speak with a supervisor, as it wasn't my daughter's fault that they billed incorrectly. In a nutshell, I got this bill taken out of collections (it was just submitted the end of May), and only owed the original co-pay.

In conclusion, always look over your bills from your providers and match them up with the EOB's you get from your insurance company. If something doesn't seem right, call right away. Don't wait until it's too late and your providers place you in collections. Hopefully my daughter has learned a lesson from this!

When a Spouse Passes away and the insurance was under his/her name (Obama Care)

2015-01-14T14:12:00.001-08:00

One of my good friends (I'll call him Mike) passed away in September from cancer. It was quick-coming, and unfortunately, my friend didn't didn't share with his wife how their health insurance was set up. His spouse (I'll call her Joan) has had nothing but problems with her health insurance (not to mention other things), since his passing.

Mike and Joan were self-employed, live in California and have "Covered California" (Obama care) health coverage. Mike was the subscriber, so any changes to the plan had to be done under him. Now here's where it gets ugly. When Mike passed away, Joan tried contacting her insurance company to cancel the plan and get on her own plan. Since her social security number was tied up to Mike's plan, this was impossible to do. She even tried going on the Covered California webite to do this, but unfortunately Mike hadn't shared his user name or password with her.

Joan went phyically and talked with insurance agents. All they did, was give her misinformation. I even tried to help. I did an online chat with Covered California and they gave me some steps to try. First off, Joan was to fax (and she also mailed) them a copy of Mike's death certificate. This supposidly would flag their account and give Joan a special circumstance to start up new coverage. She did this in November, and is still getting bills/premiums for Mike. Hopefully, she'll start calling them and bugging them everyday until this gets resolved.

The purpose of this is to let you know that spouses need to share account information and passwords. Had Joan had this, she would have not gone through the extra stress that it's taken on her to get this sorted out. This doesn't pertain to just health insurance, but bank log-in information, credit cards, On-Star (another one she's having problems with), life insurance documents, etc. Absolutely anything that you can possibly think of that a surviving spouse may need to know about in the event of an umtimely death.

Had Mike done this before it was too late, Joan would have been able to have one less thing to have to worry about and deal with.

October is Breast Cancer Awareness Month

2014-10-14T19:42:00.000-07:00

I posted this a couple of years ago, but can never stress how important of an issue this is. I thought I'd re-post it again, since it is such an important subject.

As many of you know, October is Breast Cancer Awareness Month. This is an annual campaign to increase awareness of the early detection, cause, effects and treatment of breast cancer. Not only will one in eight women will be diagnosed with breast cancer; approximately 70 thousand men (yes men can get breast cancer too), as well as women ages 15 -39 will be also be diagnosed with the disease in the US.

One of the ways to detect breast cancer is by doing a monthly BSE (Breast Self Examination). Forty percent of diagnosed breast cancers are detected by women who found a lump, so it is of the utmost importance that an individual becomes familiar with their own breasts and notify their medical provider immediately if they find any unusual changes or lumps. This in conjunction with an annual clinical breast exam is an essential tool for early detection.

Another tool for detecting breast cancer is a mammogram. Most people are familiar with mammograms, but are uncertain as to what is involved. When you call to make your mammogram appointment, the scheduler will ask you if you are having a “screening mammogram” or a “diagnostic mammogram”. Screening mammograms are used to check for breast cancer for patients who have no symptoms or signs of disease. These are usually referred to as your annual or yearly mammogram. Diagnostic mammograms are for patients who have found changes in their breast such as a lump, pain, disfiguration or discharge.

Mammograms are essentially an x-ray picture of the breast. There are different types of mammograms: analog mammograms, digital mammograms and 3-D mammograms. Analog mammograms are when the breast is pressed between two plates and a fixed x-ray is taken on film and then developed. The process is similar during a digital mammogram, though a digital mammogram takes about half the time, there is less radiation exposure, and the images are viewed and stored on a computer, which can be printed out on film. 3-D (three dimensional ), breast imaging, also known as breast tomosynthesis, is a type of digital mammogram where the x-ray tube and imaging plate move from different angles during the exposure. It creates a series of thin slices through the breast and computer software can reconstruct the image. Mammograms can also use a CAD (Computer Aided Detection), software that searches for abnormal areas of density, masses or calcifications that may indicates the presence of cancer. The CAD program highlights areas of concern on the images, further alerting the radiologist for additional examinations or testing.

If your radiologist, (the physician who reads the mammogram), suspects there may be an area of concern, he or she may suggest that you have further studies. One may be an ultrasound of the breast. An ultrasound uses sound waves to make a picture of the tissues inside the breast. It uses an instrument called a transducer which is passed back and forth over the breast and images are captured. It does not use radiation like the mammogram. Your radiologist may also suggest an ultrasound-guided breast biopsy. This is performed by taking samples of some of the cells (usually through a hollow needle) from a suspicious area of the breast, then sending them to the pathologist to be studied under the microscope. The ultrasound helps guide the physician to the site of the area of concern.

Another test is an MRI (magnetic resonance imaging) scan. This uses powerful magnets and radio waves to create detailed pictures of the breast and surrounding tissues that are difficult to see clearly on a mammogram or ultrasound. These pictures can show the difference between normal and diseased tissue and provide the radiologist with information that is not found on a mammogram. An MRI may be done in conjunction with a mammogram and an ultrasound, but is not a replacement for a mammogram. MRI’s do not use radiation (x-rays). Breast MRI’s are not routinely done and must warrant a diagnosis to perform this test. They are much more expensive than traditional mammograms and most insurance companies will need justification (such as checking for more cancer after cancer has been diagnosed) to authorize this test.

There is also a type of x-ray called a CT scan, (computerized tomography) of the breast. This uses 2-dimentional slices or cross-sections from many different angles. The images are sent to a computer where they are put together to create detailed pictures. CT’s of the breast are not routinely used to evaluate the breast. This is another exam where your insurance will need justification to authorize it be done.

An additional test is a PET scan (positron emission tomography. During the PET scan, you are injected with a substance made up of sugar and a small amount of radioactive material. Cancer cells seem to be more active than healthy cells and as a result absorb more of the radioactive sugar. A special camera scans the body to pick up any highlighted (sugary) areas on a computer screen. The highlighted areas help the radiologist determine areas that may indicate cancer. Although, this test has only a limited ability to detect small tumors, it can be useful for evaluating people after breast cancer has been diagnosed. It gives the physician information to determine where the cancer has spread to lymph nodes and other parts of the body and to see if the cancer may be responding to treatment. Sometimes this is done in conjunction with a CT scan; PET/CT. Again, this is a very expensive test and insurance companies will need justification to authorize it.

Lastly, there is a blood test called the BRCA that analyzes two genes (BRCA1 and BRCA2) to see if you have inherited any abnormal changes that might increase your risk for certain types of cancer. This blood test is usually done on women that have a strong family history (parent, sibling or child) of breast and/or ovarian cancer or who have had breast or ovarian cancer themselves at a young age.

Mammograms charges can vary from place to place in price. Most private insurances cover the cost of a “screening” mammogram with no co-pay or deductible. Always verify this with your insurance company, as not all plans are the same. Also keep in mind, if you call for an appointment and have a lump or problem, this will change from a “screening” mammogram to a “diagnostic” mammogram and you will most likely owe towards your deductible and out-of-pocket expenses. During the month of October, a lot of radiology offices offer a reduced price screening mammogram. This is usually for women who don’t have insurance and couldn’t otherwise afford a mammogram. Lastly some state and local health programs provide mammograms free or at low cost. Information about free or low-cost mammography screening programs is available for the NCI’s Cancer Information Service@ 1-800-4-CANCER (1-800422-6237) and from local hospitals, health departments, women’s center, and the American Cancer Society. Don’t discard your physician as well. They may know of community groups that have programs to assist with mammogram fees.

For more information, please go to:

http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

How Much Do You Exercise Everyday?

2014-09-23T13:27:00.000-07:00

How much do you exercise everyday? Do you make it a priority? Are you consistent? Do you change up your routine, so you're not exercising the same muscle groups over and over and not ignoring other muscles?

The average citizen doesn't make exercise a priority. If you had cancer, would you make your chemotherapy and radiation treatments a priority and block out a time each day to receive these?
If you answered yes, then exercise should be a priority as well. There are a lot of illness created by being overweight; diabetes, heart disease, elevated cholesterol, and hypertension, (high blood pressure), just to name a few, and yes, even being overweight can cause certain types of cancer.
I challenge you to prioritize exercise like it's a life or death decision. Just take thirty minutes a day, and if you feel like it, add more. And I'm not counting the day-to-day activities either, such as housework or chasing after the kiddos. It has to be something that you carve a time out for yourself, just to exercise.
I've attached a link for a great article I read online. It's called the 7 Workout Habits You Should Drop Now. It's all about exercising the "right" way, though I think that any exercise is better than none. Good luck and report your progress.

http://news.health.com/2013/10/15/7-workout-habits-you-should-drop-now-2/

Does Your Medical Provider Have a Website?

2014-08-13T15:15:00.000-07:00

Do you know if your medical provider has a website? If so, have you taken the time to become familiar with it?

I belong to a very large HMO. I've signed up for a user account, and can go online and do a number of things, such as ~

Choose a Primary Care Doctor
Make appointments (non-emergency type)
View upcoming and past appointments
Send a message to my doctor
Fill prescriptions
Review my medical records which may include

I can also review my health insurance plan/coverage and costs, as well as pay medical bills.

Some sites will inform you what services they have to offer, other than just seeing your physician. These may include ~

*Health and Wellness sections

*Programs and Classes

*Information about Diseases and Conditions

*Drug and Medication information

Insurance plans may also have their own websites as well. You can look up your EOB's (Explanation of Benefits) as well as email your plan with questions you may have. You can also look up providers in your area to make sure that they are covered on your plan.

If you haven't done already, take advantage of this service. It's a great tool to add to your arsenal and can help you with a variety of things.

David Sayen: When a Doctor Doesn’t Take Medicare

2013-06-07T09:50:00.002-07:00

I have seen this article twice now, and felt it was important to pass it on. I have not changed the format in anyway what-so-ever. This is very good information for Medicare patient's to have.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

David Sayen: When a Doctor Doesn’t Take Medicare

David Sayen

What does it mean when a doctor tells you he or she has “opted out” of Medicare?
An opt-out doctor is one who doesn’t accept Medicare. Doctors who have opted out of Medicare can charge their Medicare patients whatever fees the physicians choose. These doctors don’t submit any health-care claims to Medicare. In addition, opt-out doctors aren’t subject to Medicare laws that limit the amount they can charge their patients.
More than 1 million health-care providers throughout the United States — the vast majority of them doctors — accept Medicare as payment.
But when you visit a doctor who has opted out of Medicare, you pay the entire cost of your care, unless it’s an emergency or you need urgent care. Generally, Medicare doesn’t pay for health-care services you receive from an opt-out doctor.
If your doctor has formally opted out of Medicare, he or she must have you sign a private contract stating that you agree to receive care from a doctor who doesn’t accept Medicare. This private contract only applies to services provided by the doctor or other provider who asked you to sign it.
You don’t have to sign a private contract. You can always go to another provider who does take Medicare. If you do sign a private contract with your doctor or other provider:
» Medicare won’t pay any amount for the services you get from this doctor or provider, even if it’s a Medicare-covered service.
» You’ll have to pay the full amount of whatever this provider charges you for the services you get.
» If you have a Medicare Supplement Insurance (Medigap) policy, it won’t pay anything for the services you get. Call your insurance company before you get the service if you have questions.
A physician or other provider must tell you if Medicare would pay for the service if you get it from another provider who accepts Medicare. Your provider also must tell you if he or she has been excluded from Medicare.
And keep in mind that you can’t be asked to sign a private contract for emergency or urgent care.
You may want to contact your State Health Insurance Assistance Program (SHIP) to get help before signing a private contract with any doctor or other health care provider. Your local SHIP number is available by calling 800.MEDICARE (800.633.4227).
Most doctors, providers and suppliers accept Medicare, but you should always check to make sure. (You can always get services not covered by Medicare if you choose to pay for them yourself.)
Providers who participate in Medicare have signed an agreement to accept the Medicare-approved payment for all Medicare-covered services. In other words, they “accept assignment.”
Here’s what it means when your doctor, provider or supplier accepts assignment:
» Your out-of-pocket costs may be less.
» Your provider agrees to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share.
» Your provider has to submit your claim directly to Medicare and can’t charge you for submitting the claim.
If you have a Medicare Advantage plan, also known as a Medicare private health plan, you should see doctors within your plan’s network. You typically pay the least if you go to a doctor who’s in the plan network. Check with your plan to see what rules apply.
— David Sayen is Medicare’s regional administrator for California, Arizona, Hawaii, Nevada and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 800.MEDICARE (633.4227).

http://www.noozhawk.com/article/051613_david_sayen_when_a_doctor_doesnt_take_medicare/

Medicare and the New Health Care Law — What it Means for You

2013-04-26T08:59:00.002-07:00

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare and the New Health Care Law —

What it Means for You

A Message from Kathleen Sebelius, Secretary of Health & Human Services

The Affordable Care Act passed by Congress and signed by President Obama this year will provide you and your family greater savings and increased quality health care. It will also ensure accountability throughout the health care system so that you, your family, and your doctor—not insurance companies—have greater control over your care. These are needed improvements that will keep Medicare strong and solvent. Your guaranteed Medicare benefits won’t change—whether you get them through Original Medicare or a Medicare Advantage plan. Instead, you will see new benefits and cost savings, and an increased focus on quality to ensure that you get the care you need. This brochure provides you with accurate information about the new services and benefits to help you and your family now and in the future. The Centers for Medicare & Medicaid Services (the federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Program) will continue to provide you with up-to-date information about these new benefits and will ensure that your personal information is safe.
Remember—rely on your trusted sources of information when it comes to accurate information about Medicare, and don’t hesitate to call 1-800-MEDICARE or go on-line at Medicare.gov if you have questions or concerns. Don’t give your personal Medicare information to anyone who isn’t a trusted source.

HEALTH CARE LAW What Stays the Same The guaranteed Medicare benefits you currently receive will remain the same. During open enrollment this fall, you will continue to have a choice between Original Medicare and a Medicare Advantage plan. Medicare will continue to cover your health costs the way it always has, and there are no changes in eligibility. But, there are some important benefits that you and your family can take advantage of starting this year. Look for more details in your Medicare and You Handbook coming this fall. Improvements in Medicare You Will See Right Away More Affordable Prescription Drugs
• If you enter the Part D “donut hole” this year, you will receive a one-time, $250 rebate check if you are not already receiving Medicare Extra Help. These checks will begin mailing in mid-June, and will continue monthly throughout the year as beneficiaries enter the coverage gap.
• Next year, if you reach the coverage gap, you will receive a 50% discount when buying Part D-covered brand-name prescription drugs.
• Over the next ten years, you will receive additional savings until the coverage gap is closed in 2020. Important New Benefits to Help you Stay Healthy
• Next year you can get free preventive care services like colorectal cancer screening and mammograms. You can also get a free annual physical to develop and update your personal prevention plan based on current health needs. Improvements to Medicare Advantage
• Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare. These additional payments are paid for in part by increased premiums by all Medicare beneficiaries—including the 77% of seniors not enrolled in a Medicare Advantage plan.
• The new law levels the playing field by gradually eliminating Medicare Advantage overpayments to insurance companies.
• If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits.
• Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure that at least 85% of every dollar these plans receive is spent on health care, rather than administrative costs and insurance company profits. HEALTH CARE LAW Improvements in Medicare You Will See SoonBetter Access to Care
• Your choice of doctor will be preserved.
• The law increases the number of primary care doctors, nurses, and physician assistants to provide better access to care through expanded training opportunities, student loan forgiveness, and bonus payments.
• Support for community health centers will increase, allowing them to serve some 20 million new patients.Better Chronic Care
• Community health teams will provide patient-centered care so you won’t have to see multiple doctors who don’t work together.
• If you’re hospitalized, the new law also helps you return home successfully—and avoid going back—by helping to coordinate your care and connecting you to services and supports in your community. Improvements Beyond Medicare That You and Your Family Can Count On Improves Long-Term Care Choices
• New tools and resources in the Elder Justice Act, which was included in the new law, will help prevent and combat elder abuse and neglect, and improve nursing home quality.
• The new law creates a new voluntary insurance program called CLASS to help pay for long-term care and support at home.
• Individuals on Medicaid will receive improved home and community-based care options, and spouses of people receiving home and community-based services through Medicaid will no longer be forced into poverty. Helps Early Retirees
• To help offset the cost of employer-based retiree health plans, the new law creates a program to preserve those plans and help people who retire before age 65 get the affordable care they need. Helps People with Pre-existing Conditions
• The new law provides affordable health insurance through a transitional high-risk pool program for people without insurance due to a pre-existing condition.
• Insurance companies will be prohibited from denying coverage due to a pre-existing condition for children starting in September, and for adults in 2014.
• Insurance companies will be banned from establishing lifetime limits on your coverage, and use of annual limits will be limited starting in September.Expands Health Coverage for Young People
• Young people up to age 26 can remain on their parents’ health insurance policy starting in September. HEALTH CARE LAW For More Information 4 CMS Product No. 11467 The New Law Preserves and Strengthens Medicare New Tools to Fight Fraud and Protect Your Medicare Benefits
• The new law contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars.• It reduces payment errors, waste, fraud, and abuse to make Medicare more efficient and return savings to the Trust Fund to strengthen Medicare for years to come.
• You are an important resource in the fight against fraud. Be vigilant and rely only on your trusted sources of information about your Medicare benefits.
• Call 1-800-MEDICARE if you have any questions or want to report something that seems like fraud. Keeps Medicare Strong and Solvent
• Over the next 20 years, Medicare spending will continue to grow, but at a slightly slower rate as a result of reductions in waste, fraud, and abuse. This will extend the life of the Medicare Trust Fund by 12 years and provide cost savings to those on Medicare.
• In 2018, seniors can expect to save on average almost $200 per year in premiums and over $200 per year in co-insurance compared to what they would have paid without the new law.
• Upper-income beneficiaries ($85,000 of annual income for individuals or $170,000 for married couples filing jointly) will pay higher premiums. This will impact about 2% of Medicare beneficiaries. For more information about the new health care law now, visit www.medicare.gov.

If you have any questions, call 1-800-MEDICARE (1-800-633-4227) or your State Health Insurance Assistance Program (SHIP). Visit www.medicare.gov or call 1-800-MEDICARE to get their telephone number. TTY users should call 1-877-486-2048. If you need help in a language other than English or Spanish, say “Agent” at any time to talk to a customer service representative. Visit the Eldercare Locator at www.eldercare.gov to find out how to access home- and community-based services and benefits counseling, transportation, meals, home care, and caregiver support services. You can also call 1-800-677-1116. The Eldercare Locator, a public service of the U.S. Administration on Aging, is your first step for finding local agencies in every U.S. community

** This was copied verbatim from another website. I did not add any additional information of my own.**

2013-03-20T09:11:00.000-07:00

Follow me on Etsy......

I've got some great items up for sale. I'll also be adding excerts from my Ebook that are available for purchase. Enjoy

It's All About the Service People

2013-02-09T09:59:00.001-08:00

It’s ALL About the Service PEOPLE!

I have worked in several jobs throughout the years. Be it be an gas station attendant, or working hand-in-hand with a physician, there is one rule that applies to all……It’s all about the service.

Last night was an example about BAD service. My husband and I decided to go to a “commercial” restaurant for dinner. We don’t do this very often, but this place had an awesome deal on a prime-rib dinner. I should have been suspicious when we walked in, the place didn’t seem extremely busy, but the waitress handed us our menu’s and told us to “go over here and choose and table”. Dilemma: Table #1, still dirty. Table #2, still dirty. Table #3, still dirty. Score, Table #4 appeared to be cleaned off, so we took it!

Next after some time had passed, she came over with a wet cloth and wiped our table. Okay, maybe I guessed wrong, it wasn’t clean, but at least it “kind of” was now. Then she took our orders (from our sticky, yes sticky menus). We both ordered prime rib, baked potatoes with EXTRA butter and the fixings that go along with it; steamed vegetable and your choice of bread. I ordered a smaller end cut so that I could also have shrimp with my dinner. Now I don’t claim to be a professional cook, but prime rib is usually cooked ahead of time (no additional prep needed, other than just slicing and plating it), and baked potatoes are also cooked, kept in a warmer and ready to be served. This was a pretty uncomplicated order and shouldn’t take much to get it out.

Key the Jeopardy final question music. It is taking forever for our dinner to arrive. I get out my cell phone and even play Words with Friends with my husband who is sitting across from me. The restaurant still isn’t that busy. Did I mention there are at least two other servers as well and that we didn’t even get there until almost 8 pm? Not exactly rush hour for dinner time. Okay, I’ll cut to the chase, finally after a minimum of 30 minutes (in reality it was probably longer), we finally get our meal. The gal doesn’t bring our bread, and forgets the shrimp. (We gently remind her of this.) She goes back and looks like she has to place the order for shrimp. About 10 minutes later my shrimp shows up, along with an extra order that we didn’t place for my husband. The meat was surprisingly pretty good, but the vegetables could have been “nuked” just a tad bit longer. Oh yeah, we have to remind her about the extra butter again.

Now it seems that she has served us, we are completely off her radar. No coming back to see how we are doing. No refilling out water glasses. It’s like she disappeared off the face of the planet. Now the wait begins. We have finished our meal. Key the Jeopardy final question music again. No waitress, no bill. I would like a doggy bag as I have extra shrimp to take home. Wait….there’s the waitress. She’s at the table in front of us, and doesn’t even look our way and she’s flitting back and forth between a few other tables and chatting with the cook. I see her walk right past us and completely ignore us again. Apparently the table behind us (the man appeared to be a regular as everyone knew him, or possibly a manager) waves her over and tells her to take care of us. He was in my husband’s view, and my husband said this man had to waved at her at least four times to get her to come over to him. Now we have our waitress back. We get our doggy bag and bill and abra cadabra she’s gone again. Sure, maybe we would have ordered dessert, but she didn’t ask. We wait a bit, but decide to just walk to the cash register and pay our bill. (We weren’t given instructions if she would take care of it, or if we needed to.)

Moral of the story, no matter how good (or sometimes) bad your end product is, rather is be the most awesome doctor on the planet, (but he consistently runs and hour late for his appointments), or a good meal (with an inattentive waitress), unless your service is good, chances are you won’t be going back. It is always important to give good service, but in this economy, it’s extremely important to give GREAT SERVICE to keep the customer coming back.

Happy New Year - 2013

2013-01-01T10:50:00.004-08:00

Happy New Year

and here's a cute thing I found on Pinterest today ~

http://www.livelaughrowe.com/new-year-resolutions-printable/

365 Days of -----------

2012-12-18T08:43:00.002-08:00

I’m a recent fan of Pinterest. I swore up and down I wasn’t going to get started on this as I figured it would be just another tool to suck my time mindlessly on the internet. Did this ever prove me wrong! Sure, I admit I roam around looking at my home page and viewing other people’ pins, and I’ve even repined several myself. What I didn’t realize was how many clever and creative people are out there. And there are so many times that I say to myself, “Why didn’t I think of that”? I’ve even made recipes that other people post and made a few crafty items. Now this brings me to today’s post.

365 Days

Someone posted that in the year 2013, they are going to take a photo a day for365 days. This got me to thinking. Sure, I would like to take a picture on my SLR camera every day, but maybe there is something else that’s more important to me that I should do. I’ve come up with a short list of things that I may pursue.

*Eat healthy (that means no processed sugar)

*Exercise in some shape or form

*Learn a new language

*Track my spending

*Recycle

*Say I Love You to someone

*No t.v.

*Sew or work on a craft project

*No shopping (other than for groceries and household items)

*Do something that involves music

*Do something “green” everyday

*Blogging (Not going to happen here)

*Journaling
*Do something nice for someone (without them asking)

*Take a picture

*Meditate
*Be Greatful
*Smile at a Stranger

*No personal driving (I can ride with my someone else, but otherwise must bike, walk or take public transportation)

These are just a few ideas. I think I’ll probably try one or two on a daily basis, and practice the others year round (but not daily). How about you? Are you up for the 365 day challenge? Why wait until 2013? I challenge you to start today!

*I've also found a website with other great ideas. Maybe I'll try a few of them as well. You can find it at http://the365daychallenge.com/the-list/

MORE REASONS TO REVIEW YOUR COVERAGE

2012-11-14T19:15:00.000-08:00

My neighbor sold a truck today to pay off his deceased wife’s medical bills. He said he just got a bill from the ambulance company and his portion was $800.00. I asked him if he had his Explanation of Benefits from the insurance company and if it agreed with the bill. He replied he didn’t know where it was, but he was sure he owed this. He went over the bill with me over the phone. From the best I could tell, he read off the billed charges, and the amounts paid by his insurance company. The exact balance was what he thought he owed. He didn’t indicate to me if there were any adjustments on the bill. Hmmm. I of course asked him what his deductible and out-of-pocket was. His reply was, “Don’t really know – couldn’t really tell ya”. Wow, so he’s just going to pay his bill! He didn’t really want any “help” because the ambulance gave them good service. REALLY!!!! I told him if he wants me to go over his bills and make sure they’re correct I would. I could do this even after he paid them, just in case he’s due a refund. I also mentioned that lots of places will set up monthly payment plans with you, and some will even discount the bill if you agree to pay a lump sum right away. Again, he didn’t really care. This seems pretty scary to me, especially since he wife was in the hospital for 3 ½ weeks and had two more trips via the ambulance that he hasn’t received bills for yet. Enough said……

Skilled Nursing Facilities: Medicare Qualifications

2012-11-05T15:17:00.000-08:00

My little aunt passed away on Halloween. Everyone pretty much expected this, she had been in failing health for several years and her body just could not hold on anymore. She would have been 89 years old on Nov 14.

She had been living at home for the last few years with the assistance of her daughter and son. A few days before she passed she became unresponsive and more lethargic than usual. She was taken to the hospital and was admitted. It was determined that she had suffered a stroke and had a bladder infection. She was in the hospital for two days, then discharged back home under the guidance of home health and hospice. Even though she was in very poor condition, the hospital would not keep her. They sent her live out her final days at home.

I do not live in the same town as her, but asked my mother why she wasn’t transferred to a Skilled Nursing Facility (SNF). Apparently, one has to meet certain criteria to be admitted to an SNF. She did not qualify because she had to be an inpatient in the hospital for three consecutive (and not just for observation), days before Medicare will approve SNF care.

For those of you who are not familiar with SNF’s, they are where patients go for medically needed long-term care or rehabilitation and they have the required staff (Registered Nurses, Licensed Practical and Vocational Nurses, Physical and Occupational Therapists, Speech-language pathologists and Audiologists.), to manage, observe and evaluate such care. They are able to give medications, IV’s, injections and physical and occupational therapy. Sometimes theses are referred to as “nursing homes”.

Medicare will cover certain skilled services that are needed daily on a short-term basis (up to 100 days) and will only cover it if you carry Medicare Part A (hospital insurance). In addition, there are several other requirements that you must meet in order to qualify for SNF care. Some (but not all), of these are ~

■ You must have days left in your benefit period.

■ You must have a qualifying hospital stay, (three consecutive days or more, starting with the day the hospital admits you as an inpatient, but not including the day you are discharged). If you were “under observation” in the hospital for any of this time, it will NOT count toward your 3-day qualifying hospital stay.

■ You must enter the SNF within a short period of time, (generally 30 days), of leaving the hospital

■ You require skilled care on a daily basis and can only be provided in an SNF as an inpatient.

Obviously, there are many other guidelines to be admitted to an SNF, but these are just a few. Each patient’s case is unique and will have to meet the criteria for his individual circumstance.

How long can you stay in an SNF? Medicare uses a benefit period-of-time to keep track of the number of days you use in an SNF and how many are still available. This starts on the day you start using the SNF coverage in a benefit period. You can get up to 100 days in a period. Once you use those 100 days, your current benefit period must end before you can renew your SNF benefits. There is no limit to the number of benefit periods you can have, however once a benefit period ends, you must meet Medicare requirements before you can get up to another 100 days of SNF benefits. If at some point you no longer qualify for Medicare coverage, you (or if someone is acting on your behalf), must be given a written “Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage”. This notice informs you that the SNF believes you no longer qualify for SNF services paid my Medicare. It has to state:

■ When your Medicare coverage will end and when you must start to pay.

■ The reason why your stay is no longer covered.

■ Your right to request that the SNF submit a claim to Medicare so you can receive an official payment decision from Medicare.

■ That if you request to have a claim submitted to Medicare, you are not required to pay for your current SNF stay until you are informed of Medicare’s decision, (but you will still be required to pay any coinsurances and for services not covered by Medicare).

■ Where you should sign to show you got the Notice.

If you do not agree with the decision, you can file an appeal. You will be responsible for SNF charges if Medicare denies the appeal and determines you do not meet the requirements for additional SNF care. One such option is a fast (expedited), review or an immediate appeal. During this process, an independent reviewer called a Quality Improvement Organization will look at your case and decide if your health care needs to be continued. The SNF should give you information on how to contact them within the allotted timeframe. Be prepared to supply information (evidence), why you think you need the additional stay.

Lastly, you can also choose to pay for SNF costs yourself when your Medicare coverage ends. Long-term care is quite costly and many patients use other resources to help cover these costs. Always check with your state or county to see if you qualify for additional benefits (such as Medi-Cal in the state of California). You would be surprised to find out that there may be other options to help you pay with these costs.

RIP Aunt Alvera. Give Grandma and Grandad a big hug and kiss for me and tell them that I miss them and think of them often.

October is Breast Cancer Awareness Month

2012-10-15T14:52:00.003-07:00

For more information, please go to:

http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

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Situation

Is my SNF stay covered?

You came to the Emergency Department (ED) and were formally admitted to the hospital with a doctor’s order as an inpatient for 3 days. You were discharged on the 4th day.

Yes. You met the 3-day inpatient hospital stay requirement for a covered SNF stay.

You came to the ED and spent one day getting observation services. Then, you were formally admitted to the hospital as an inpatient for 2 more days.

No. Even though you spent 3 days in the hospital, you were considered an outpatient while getting ED and observation services. These days don’t count toward the 3-day inpatient hospital stay requirement.

Your costs in Original Medicare You pay: Days 1–20: $0 for each benefit period. Days 21–100: $161 coinsurance per day of each benefit period. Days 101 and beyond: all costs.

Is Your Provider Billing You Correctly?

YOU are the best Advocate for your Medical Care

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tri·age

HIPAA, HIPAA, HIPAA.....Oh My!!!!

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October is Breast Cancer Awareness Month

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David Sayen: When a Doctor Doesn’t Take Medicare

I have seen this article twice now, and felt it was important to pass it on. I have not changed the format in anyway what-so-ever. This is very good information for Medicare patient's to have.

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David Sayen: When a Doctor Doesn’t Take Medicare

Medicare and the New Health Care Law — What it Means for You

It's All About the Service People

Happy New Year - 2013

365 Days of -----------

MORE REASONS TO REVIEW YOUR COVERAGE

Skilled Nursing Facilities: Medicare Qualifications

October is Breast Cancer Awareness Month

Your costs in Original Medicare

You pay:

Days 1–20: $0 for each benefit period.

Days 21–100: $161 coinsurance per day of each benefit period.

Days 101 and beyond: all costs.