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Caring For Your Mental Health

If you — or someone you love — is struggling with mental illness, you already know the health care system is broken. At its best: disjointed and inadequate. At its worst: inaccessible to folks desperate for an appropriate diagnosis and treatment. The majority of individuals needing help fall between the cracks of long established requirements around age, income and insurance coverage.

Will Health Care Reform change all that?

In reality, there are very few provisions directly addressing mental health in the legislation recently approved by the House and the Senate.

But don’t be discouraged. There’s actually some good news. According to the American Psychiatric Association, the approved legislation extends mental health parity to individual and group policies purchased through government-sponsored health exchanges.

In basic terms, this legislation . . .

  • Mandates that these policies provide equal coverage for mental and medical conditions; they cannot differentiate between the two in establishing coverage limits. This is major!  The original (2008) mental health parity legislation applied only to large employer plans in the private marketplace.
  • Bans companies from denying health insurance based on pre-existing conditions, including mental health diagnoses.
  • Eliminates lifetime limits on coverage.
  • Prohibits insurers from varying premiums based on an individual’s health status, one of the most frustrating issues faced by people with mental health diagnoses.

These provisions alone have the potential to extend health insurance coverage, including mental health, to approximately 30 million currently uninsured individuals and families.

Now that’s a good start. But it’s not perfect.

Like anything destined to change the way we think and do business, health care reform requires continued insight, input and evaluation. As health care advocates, we support this process and champion the inclusion of enriched mental health benefits as part of our re-designed system.

What do you think? We invite you to post comments; join the conversation on this critical issue.

January 27, 2010 | Tags: , , , , , | 3 Comments »

You Know What You Know

And you Know What You Don’t Know!  That’s the important — and tricky — part.

“I have a Harvard MBA and I can’t figure this stuff out!”

That was the frustrated cry from a prospective client during an initial consultation. She came in, plopped a stack of papers on the conference room table, took a deep breath and blew out her embarrassment with those few telling words.

We weren’t surprised. But we were compassionate and reassuring. There’s no reason to be embarrassed. Frustrated? Yes. Overwhelmed? Yes. But not embarrassed.

Navigating the world of clinical decisions, medical bills, claims, and benefit explanations is a daunting task. Having an advanced degree doesn’t necessarily simplify matters. In fact, the majority of our clients are well educated and successful in their chosen fields. But it doesn’t mean they have the time, energy or inside knowledge to tackle the health care system.

Back to our client. During a medical crisis, she lost control of the edges. The mound of paperwork was staggering: she didn’t know what had been paid, what should have been paid and what needed to be submitted to her insurance company for reimbursement. We untangled the bills for her and helped establish a system for future use.

Here are some tips for staying organized:

  • Register as a member on your health plan’s website. Use their tracking tools to see what claims have been received, paid, and in what amount.Be particularly diligent when seeing out-of-plan doctors, even if you have coverage. Expect to pay the provider and submit a receipt for reimbursement.
  • Watch for claim filing limits (the amount of time you have to submit the receipt to your health plan). This information can usually be found in your member handbook or plan documents in the section on claims submissions or filing.
  • Keep a copy of your benefits summary handy so you can compare out-of-pocket responsibilities against the benefit summary from your health plan.

The key to success is knowing what you know and seeking expert advice for the rest.

January 20, 2010 | 1 Comment »

C is for COBRA — Critical Coverage During Hard Times

If you’re on Cobra, coverage information is as critical to your wallet as it is to your well-being. But, like most folks, you probably have so much on your plate these days, you’re missing important updates.

Last week, for instance, we received a call from one of our small business clients. Their office manager thought she read that COBRA received another extension. But she wasn’t sure. Was it true?

The answer is YES. On December 22, 2009, President Obama extended federal subsidy of COBRA for an additional six months.

Some Background:

The first federal subsidy, signed into law earlier in 2009 as part of the economic stimulus package, helped fund COBRA premiums for employees who were laid off between September 1 and December 31, 2008 — “involuntarily terminated” was the eligibility language. Eligible employees paid 35%  of the COBRA premium, while employers paid the remaining 65% and received a tax credit.

The premium reduction was also made available for group health insurance, which is required by State law to provide comparable continuation coverage (such as some “mini-COBRA” laws).

Good News. The Recent Extension . . .

  • Adds two months to the COBRA premium reduction eligibility period, which now ends February 28, 2010.
  • Increases the maximum period for receiving the subsidy, adding an additional six months, taking it from nine to fifteen months.
  • Allows for an extension of the typical grace period for those individuals whose subsidy ended before this extension was passed and couldn’t afford COBRA without it. You must pay your portion of the COBRA premium at the reduced rate by the new grace period. (Contact your carrier or speak to your Human Resource Department for specific information.)

Important Considerations. . .

  • If you paid 100% of the COBRA premium in December, after your subsidy expired, you are eligible for a credit or reimbursement of the overpayment. Contact your plan administrator for further information.
  • Be on the lookout for “notice” requirements that must be provided by plan administrators to all individuals who have qualifying events from September 1, 2008 through February 28, 2010.

Information changes rapidly and it comes at us from all sides. That’s why it’s helpful to have a reliable resource, like this Blog. We’ll work hard to give you critical, updated news and helpful links. For additional COBRA information, including helpful questions and answers, check out the Department of Labor’s website at:

http://www.dol.gov/ebsa/faqs/faq-cobra-premiumreductionEE.html

January 13, 2010 | Tags: , , , , , , | No Comments »

We’re New And We’re Here to Stay

“You’re a WHAT? And you do WHAT?”

It’s a typical a response from physicians who haven’t scanned the forest of health care lately to see there’s a new animal in their midst. That animal goes by the general name of “health care advocate” and the specific name of Health Champion. Our general nature is to help, guide and support individuals lost in the maze of decisions, diagnosis and insurance benefits.

Here’s an example —

The Call:  We were recently retained by a family to help navigate their sister’s s journey through multiple myeloma. They called as she was recovering from surgery, having experienced the disease’s wrath in the form of bony metastases.

The Need:  On a very basic level, they were seeking clarity about their sister’s condition, needing a greater understanding from the surgeon and oncologist regarding  prognosis and overall treatment plan.

The Approach: We quickly established contact with their sister’s  medical providers, providing each office with signed HIPAA and Representative forms, so that physicians could speak freely with us. The goal was to collect information from the various sources and then connect the dots for our client, explaining complicated information in a clear, accessible manner.

The Result: Our client and her family felt fully informed and, thereby, empowered to make smart decisions regarding the recommended treatment plan.

The Response:  Because we’re newcomers, medical colleagues are often surprised by our presence. Who are we . . .where did we come from . . . what’s our intention? But, seeing that we come in peace, they’re collaborative, professional and open to the concept of advocacy. And then there are those few defensive physicians, wary of our intentions, certain our goal is to undermine and undercut, to add an unneeded layer to an already complex system. That is so not so!

They’re right about one thing: The health care system is definitely layered and complex. It’s fragmented, confusing and overwhelming. It isn’t easy being a physician in today’s insurance-based model. And it’s not easy being a patient or consumer. That’s exactly why we exist.

Our role is to support our clients and their health care team by closing gaps in communication and planning, by explaining and reinforcing the difficult messages they have may have been told, but didn’t understand, and were too embarrassed to ask for clarification.

While health care reform may be upon us, it isn’t going to fix the very things that health care advocates are hired to do. We’re on the scene, and we’re here to stay.

January 6, 2010 | Tags: , , , , , , , , , , , , , | No Comments »