empowered health care advocate

NINE WAYS TO TAKE CHARGE OF YOUR HEALTH CARE DOLLARS IN 2012

Now more than ever, watching and budgeting for health care is important. Being organized around your health care dollars is one way to avoid spending unwisely.

1. Know thy health plan – Familiarize yourself with your health plan documents; knowing what is not covered is as or more important than what is covered. Nothing is worst than having a test/lab procedure or seeing a specialists only to find out your health plan won’t cover it!

2. Keep your health plan and medical information in an accessible place. Get a binder to place all your important medical and health plan related information.

3. Be aware of any changes in your plan for this year, you may find that changes have been made to services you have received in the past.

4. Discard of all of our old health plan cards.

5. If you have more than one health plan, are you sure you know who pays first?

6. Remember to take your new cards to all doctor appointments and to the pharmacy.

7. If you plan includes an up front deductible, take advantage of those services you can obtain prior to reaching the deductible. Preventative services such as mammograms and flu shots may be covered at no charge.

8. Make it a habit to check your Explanation of Benefits when they arrive for accuracy to be sure you are being charged appropriately for your medical care.

9. If you’re caring for your senior parents or relatives, prepare for emergencies by having their list of current medicines, legal documents and copies of their health insurance cards available to grab and run.

Being vigilant will save you time, angst and money.

Choosing home care services for the loved one in your life

Making the decision to hire a home care service to provide care for your loved one is an important decision and can, at the same time, be very difficult. If an illness or recovery from surgery requires nursing care or physical therapy, a physician may order skilled home care services that provide both skilled providers and personal aides. Your decision is then based on the obvious medical determinations made by the doctor. But what if you as the family caregiver must determine the extent of care needed without the help of a doctor?

Each home care situation is unique. In the beginning, family or friends step in to help with simple tasks and support for aging seniors who want to stay in their homes. As long term care needs progress, more time is required to manage those self-directed funds needs. Physical and mental conditions change with aging making usually routine hygiene and daily living activities difficult for an aging individual. Even with the healthiest of seniors, the ability to drive a car, shop for groceries or do general housekeeping eventually needs to be relinquished to the responsibility of another person. How you determine what type of home care is best for your situation and which home care provider is right for your loved one is critically important to achieving and creating a successful supportive environment for your loved one. Here is a link to an article with some helpful advice.:http://www.planforcare.org

Of course, sometimes bringing in a geriatric care manager or health care advocate who can assist in navigating the choices and decisions is the better approach.

Medicare – Enrollment

“Now What” Series

At Health Champion, we hear the phrase “Now What?” from our clients so often, we have decided to create a series of “Now What” blogs.

We hope that these posts will provide you the insight and advice you need to become a successful health care consumer.

Our first “Now What” blog pertains to the following scenario:

You are turning 65, still working and plan on continuing to work. Now what should you do about Medicare, if anything?

If you have health benefits from your employer and you are continuing to work, you should sign up for Medicare Part A. You should also speak to your human resources department to determine whether or not to sign up for Medicare Part B. If you decide to enroll in Medicare Part B, then the question is, which of your insurances is the primary payer of your health care? In general, the size of the employer group determines who is primary payer for “the working aged”. (Could we please replace that phrase with something like “HIP Older Person?). Ask your human resources department who your primary payer is.

If you have worked 40 or more quarters you are eligible for Medicare Part A when you turn 65. Medicare Part A covers inpatient hospitalizations, skilled nursing, home health and hospice care and some selected outpatient services. If you have worked the 40 or more quarters there is no cost for Medicare Part A. Most individuals who are receiving Social Security will be automatically be enrolled in Medicare Part A – on the first day of the month you turn 65. If you are not receiving Social Security at age 65, you are still eligible for Medicare, but you will have to enroll yourself by contacting Social Security.

Medicare Part B, which covers physician costs among other types of services, is an option that you must elect. You should enroll in Part B 3 months before the month you turn 65, but can also enroll the month you turn 65 and 3 months after your 65 birthday. You do that by contacting your local Social Security office or on the Social Security website.

If you chose to continue to work past your 65^th birthday, and you are receiving employer sponsored health insurance, you can defer your enrollment into both Parts A and Part B. When your employer coverage ends, you can elect Part A and enroll in Part B. This is called a “special enrollment period.” The 8-month “special enrollment period” begins the month after the employment ends or the group health plan coverage ends, whichever happens first.

A word of caution, if you fail to take advantage of the special enrollment period, you risk paying a penalty later. www.medicare.gov is good resource for general overview of enrollment periods.

For more information go to:

Medicare: www.medicare.gov

Social Security Administration: 1-800-772-1213 or www.ssa.gov.

Your friend at Health Champion,

Ida

Choosing Your Health Care Advocate

Going it alone is NEVER the best choice when it comes to health care. Especially if you have time-sensitive treatments, a complicated diagnosis, or insurance issues to consider. When you need someone on your side — supporting your well-being, getting medical appointments, managing treatments plans or fighting for your benefit rights — you need a health advocate.

A relatively new response to today’s complicated health care system, health advocacy is considered a critical service by CNN and other news sources. Knowing when to hire an advocate, and how to choose one that’s right for you, is key to a successful outcome.

What’s the Problem?

Define your needs before looking for someone to help resolve issues. For example:

Do you need someone to oversee care being provided to yourself or a loved one?
Are your needs related to developing a plan of care for a particular diagnosis?
Is it an insurance issue? Are your benefits being denied?
Do you need help researching the latest technologies and treatments for a disease?
Are you worried about mom and dad living alone?
Will you need the advocate to be onsite at a hospital or facility?

Locating a Private Advocate

An internet search, using the key words “health care advocate” will direct you to advocate websites. Review their areas of expertise; narrow your choices and examine how their services meet your defined needs. Ask for referrals from friends, family members and physicians (use the terminology “case manager”).

Consider the Fit

Like physicians and health problems, advocates come in all shapes and sizes. Some have a “take charge” style” others are more laid back. Finding the right fit is critical. Things to consider:

Have they helped clients with similar issues?
If so, what do they consider a successful outcome?
How many client cases do they work on at the same time?
Do they have a resource network?
How easily can you reach them during the week? Off hours? Holidays?
How do they keep clients apprised of progress?
How does the advocate charge for services: hourly or set rate?

Health advocacy is typically private pay, with fees ranging from $100 – $200/hour. The right advocate will guide you through the health care maze and so that you get the benefits and treatments you need when you need them. And that’s priceless.

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.

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

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.

Health Champion Blog

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