Thursday, January 22, 2015

Improving Your Health and Well-Being

For many of us, the first month of the new year allows us to re-focus our goals and set resolutions going forward. Improving our health and exercise regiment are usually at the top of this list. While a great deal of our nation's debate around health continues to center around the Affordable Care Act and the broken healthcare system, there is one area that each of us can directly improve upon: Personal health maintenance.

Each of us have the ability to control what we do to our bodies. How we eat. How we sleep. How we exercise. Change is in our power.  And while there's still some cost associated with preventive care, it's still much less than treatment on things we could have easily avoided or at least, lessened our risk factor.

In 2011 the U.S. Department of Health & Human Services released a "National Prevention Strategy" which "envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society and work together to achieve better health for Americans." 

The report identifies 7 priorities:
Some of the findings are eye opening. We know tobacco products are bad for your health, but did you know tobacco is the leading cause of premature and preventable death in the Unites States? Most people identify weight gain with eating too much, but the reality is food is a factor in far more than just weight. The food you eat effects your heart, your blood pressure, your bones and many forms of cancer. Reproduction and sexual health are immeasurably tied to preventive care. Knowing how to prevent potential diseases and pregnancy issues are critical to your well-being.

Former President Bill Clinton's Global Initiative is an organization that recognizes the vital importance of "systematic health improvement throughout the United States." CGI holds its annual Health Matters Summit beginning Monday. You can live stream many of the sessions, including Clinton's opening remarks by going to their website.

The point of all this discussion and prevention is two-fold. One, if you take care of your body and your health, you're going to live longer and your day-to-day life will simply be easier and more satisfying. That's a fact.  And two, the financial burden of getting sick, which strains not only your bank account, but the overall economy is decreased. Medical expenses are the number one reason for personal bankruptcy filings in this country. The fact is a lot of health related debt could have been prevented.

Bottom line. As medical costs continue to spiral out of control, it's imperative we take care of ourselves now more than ever. Know what you can do to minimize your health risks - and do it!
The health of a nation depends on it.

Stay Informed. Stay Positive. Stay Healthy.
The Patient's Advocate
brought to you by 
Claims Security of America
The medical claims filing experts
www.claims-security.com










Wednesday, April 23, 2014

How much does Medicare pay your Physician?

A couple of weeks ago the federal government released some disturbing data figures regarding Medicare pay-outs to Doctors. The Wall Street Journal examined many of the issues now being hotly debated in Washington and around the country. You can review the article here:   


In an effort for more transparency, The Obama Administration shared this previously unreleased data based on 2012 reimbursements to over 880,00 health care providers. These payments totaled in excess of $77 billion. Note, the data reflects only Part B Medicare payments which includes doctor visits, lab tests and other treatments provided outside a hospital that encompassed surgical procedures, chemotherapy and radiation treatments performed by physicians.  If you add what Medicare paid directly to providers, and any additional money they received from patients for deductibles and coinsurance this brings the total payout to providers to $99 billion.

Reimbursements varied by physician specialty and geographically.  While no personal patient information was disclosed in the release, you can see the list of all physicians reimbursed and their respective amounts here: 


Reimbursement by specific states is also available:


The two highest paid doctors are already under government review for suspected improper billing. One is a Florida ophthalmologist who received in excess of $26 million, more than 61 times the average for that specialty, to treat fewer than 900 patients; and the other is a Florida cardiologist who received $23 million which was 80 times the average amount for that specialty. 

So, what can we deduce from this data?  

The obvious conclusion appears this is an excellent way to identify fraud and abuse in terms of excessive and unnecessary billing.  However, this may not be a correct assumption in all cases.  According to Jonathan Blum, Medicare's principal deputy administrator, "providing consumers this information will help them make more informed choices about the care they receive."  The physicians with some of the highest reimbursements, notably ophthalmologists and radiation oncologists, contend that the reimbursements relate to very high overhead due to the cost of drugs administered to patients, and the high cost of equipment used to treat patients. Larger reimbursements may also mean that these providers have sicker patients, that they specialize in complex care or that their practice is heavily skewed toward Medicare patients.

A more comprehensive take-away from these startling numbers is that health care costs continue to surge AND there's on-going fraud in the system. Both issues need to be seriously addressed by Congress, and soon.  Remember, ObamaCare primarily addresses ACCESS and not system reform. Unfortunately, Washington lawmakers continue to singularly focus on the costs of the government run system; rather than seeking a solution to curbing actual health care costs and re-forming medical billing practices. Until this issue resolves, it doesn't matter how many people sign up under the ACA and maintain health insurance. Without developing a more effective method to lower costs within the system, financial waste and misappropriation of funds will certainly continue.

The only certainty remaining is that patients must always be diligent. Every bill received from a provider, along with every explanation of benefits received from an insurance company should be thoroughly scrutinized.  Do not accept at first glance these amounts are correct.  Don't be afraid to question a bill. Double-check you received the actual charged service on the date posted and that the insurance company paid the appropriate amount.  Understanding your benefits is key to understanding whether you were reimbursed and/or charged properly.   If you are not able to do this on your own, there is help available from professionals, like myself, whose job is to review your claims and advocate on your behalf. Most people don't even realize they've been charged incorrectly or received improper reimbursements.  Bottom line, you should only pay what you truly owe. The problem is often identifying what that amount actually is, and that is not always so transparent. 

 
Stay Informed. Stay Positive. Stay Healthy.
The Patient's Advocate
brought to you by 
Claims Security of America
The medical claims filing experts
www.claims-security.com

Thursday, December 19, 2013

Healthy Resolutions for the New Year

While much of our nation's focus is on healthcare and insurance, the real root of the crisis is not getting enough attention. By and large, Americans are unhealthy. Most of us are overweight, overworked, overstressed and over-medicated.  That's the bad news. The good news is it's all fixable. It's just up to us, as individuals, to make the changes that will allow us to be healthier and lead more productive, happier lives. Yes, some medical issues and conditions are unfortunately hereditary and random facts of mortality; but a healthy lifestyle is absolutely, 100%, a choice.

Health.com compiled a comprehensive Top Ten list of simple, healthy resolutions for the New Year. Here are their recommendations in short. I urge you to read the full article (link is below) and to share it with loved ones. Your lives depend on it.
  1. Lose weight
  2. Stay in touch with friends, family
  3. Quit smoking (Natural and Electronic)
  4. Save money
  5. Cut your stress (there are ways!)
  6. Volunteer
  7. Go back to school (or continue to educate your mind)
  8. Cut back on alcohol
  9. Get more sleep (Everyone wants more...you just have to make it a priority. Remember the hours you keep is a CHOICE.)
  10. Travel
http://www.health.com/health/gallery/0,,20452233,00.html

Stay Informed. Stay Positive. Stay Healthy.
The Patient's Advocate
brought to you by 
Claims Security of America
The medical claims filing experts
www.claims-security.com

Wednesday, October 2, 2013

The Affordable Care Act Roll-Out

Demand for affordable health care was even greater than expected as millions of Americans overloaded the new health care exchanges the day they opened.  Federal officials said more than 2.8 million visitors between midnight and late afternoon yesterday contributed to long wait times for access to healthcare.gov  the website they are running for 36 states.  Officials in New York state, which is running its own insurance site, said an unanticipated surge of visitors in the first hours left the marketplace only partially functional. California said its website fielded five million page views by 3 p.m. local time.  Despite the computer glitches and over capacity usage, there's no denying people all over the country are desperate for health insurance. That's the good news. The bad news is, can the government handle the operation?  

Operating the ACA is a massive undertaking. A lot of folks will look at all the initial problems and blame the government. They'll argue it proves once again how inefficient the government is and they should not be running what needs to remain exclusively a private business. The reality is that even if the private health insurance industry had reformed its system on its own, there would be similar problems with the initial roll-out. And what business runs 100% smoothly on its first day of operation?

The most important thing to take away from the last couple of days is that people do want better coverage AND to maintain some patience with the early implementation. Let's remember that we are only in an enrollment period for coverage that does not take effect until January 1, 2014.  There's no early sign up discount or added benefits either. So, you can take your time with looking into your options. You have until December 15 to enroll for a January 1,2014 effective date.   However, you can enroll as late as March 31, 2014 at which time the open enrollment period ends for this year..

And for those who still have questions on how exactly the new system works, here's a simple to follow animated guide to the Affordable Care Act from the Henry J. Kaiser Family Foundation.



Stay Informed. Stay Positive. Stay Healthy.
- The Patient's Advocate 
A service provided by 
Claims Security of America
www.claims-security.com

Tuesday, September 24, 2013

President Obama discusses Health Care with President Clinton at Clinton Global Inititiative 2013

Several years ago, Former President Clinton created a world philanthropy organization called The Clinton Global Initiative (CGI), which addresses and looks to assist with the world's most pressing issues. Every year, Clinton joins business leaders, political figures and philanthropists from around the world for a week in New York City. These meetings and speeches are streamed live on the internet. Today, a week out from the official Affordable Care Act roll-out, President Obama sat down with Clinton to discuss all the provisions of the new law, how it really works and how it's really being paid for. It's an intelligent, truthful, easy-to-follow conversation between two of the most highly educated American Presidents in history. Think what you want about each man's politics, but this exchange between the two is not a political one. Rather, it's an educated one. Here's the nearly hour long discussion, along with a brief introduction from a woman who knows both men, personally and professionally very well, Hillary Clinton.


Stay Informed. Stay Positive. Stay Healthy.
- The Patient's Advocate 

A service provided by 
Claims Security of America
www.claims-security.com

Thursday, September 19, 2013

Medicare Open Enrollment vs Affordable Care Act Open Enrollment

October 1, 2013 is the beginning date for the "Open Enrollment" in the newly created Health Care Exchanges and Marketplaces that have been enacted under the Affordable Care Act (ObamaCare).  

Our blog from August 21, "What Are These Exchanges All About?" details the 2013 Health Care Marketplace for all insured and non-insured looking for new coverage. However, even if you are happy with your existing coverage, you may find the new system to be even better and offer additional coverage at a reduced rate. Everyone should be exploring all their available options now.

Unrelated to the Affordable Care Act, the Medicare population also has the opportunity to change their Medicare coverage during the Annual fall Open Enrollment (AEP) beginning October 15 until December 7,  for a January 1, 2014 effective date.  This is an area we previously addressed in our October 26, 2012 blog. 


So, how do you know whether to choose traditional Medicare with a Medicare Supplement that offers a Prescription Drug Plan or choose a Medicare Advantage plan with Prescription drugs included?  Asking the following questions could be helpful in making the most appropriate decision.
  1. Were you satisfied with your Medicare coverage this past year?  If you were satisfied with your Medicare coverage, perhaps you need not make any changes.  If, on the other hand, you had problems with accessing providers in your Medicare Advantage Plan or wished you could go out of network to see any physician you wanted, then you may want to consider a change.
  2.  Do you anticipate high utilization of services next year? (tests, procedures, surgery, etc.)   If yes, then a change from your present Medicare Advantage Plan to traditional Medicare may be warranted.  The cumulative cost of co-pays and co-insurance under Medicare Advantage Plans can be greater than the costs of a Medicare supplement and stand alone Part D drug plan. 
  3. Did you enter the prescription drug doughnut hole?  If you are presently enrolled in a stand alone Part D plan you should do an analysis of your present drugs to see which Plan is best for you. Plan D programs are very drug specific and what worked for you this year may not be beneficial for you next year. Formularies, co-pays and premiums are different from Plan to Plan.
  4. Are you planning to move from your present residence next year?  A move to another location could be a problem if you are enrolled in an Advantage Plan. Out of network services are generally not available. Check with you Plan to see if they have a program in your new area if you still wish to be enrolled in an Advantage Plan, rather than the traditional Medicare program.
The official Medicare website, http://medicare.gov/, gives excellent instructions on how to further best select the most appropriate Plan D option, evaluate Medicare plans and understand what Medicare covers. If you're enrolled in a Medicare Advantage and/or Part D Plan, you should  receive an Annual Notice of Change by September 30th.  This notice informs you if your current provider network and drug formula will change. These changes may help you decide whether or not to shop for alternate plans for the coming year.

Stay Informed. Stay Positive. Stay Healthy.
- The Patient's Advocate 

A service provided by 
Claims Security of America

Thursday, September 5, 2013

Ex-President Bill Clinton addresses Affordable Care Act

On Wednesday, the former President took to the podium at his Presidential Library in Little Rock, Arkansas to defend and further explain the Afforable Care Act.  Obama refers to Clinton as the "great explainer" and knows many Americans still have their doubts about universal health care. Clinton effectively breaks down the good, the bad and most importantly, why it's time to stop bickering about something we all desperately need to work. Clinton argues, rather than debating on if it's going to work, let's all focus on how we can make it work better.  Here's a the speech in its entirety..




Stay Informed. Stay Positive. Stay Healthy.
- The Patient's Advocate