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Choosing the Right Health Plan

With the recently passed health care reform legislation, millions of Americans will find themselves having to “purchase” health care coverage. Whether you’re getting coverage for the first time, evaluating Medicare options, shopping for individual insurance, or choosing a plan from options offered by your employer, the process can be complicated and confusing. Start by evaluating the following:

Your Budget

Even if you qualify for a subsidy, determine how much you can pay for health care on an annual basis. Questions to ask yourself:

Who will be on the plan? Just you? You and a spouse? What about children? The new bill allows for adult children up to age 26 to stay on a parent’s plan. This decision affects premium rates.
Which works better for you: a lower monthly premium with an upfront deductible or a higher premium with no upfront deductible?
What about co-pays? If you go to the doctor frequently, you might want a plan with lower co-pays, a higher monthly premium and little, to no, upfront deductible.
Think in terms of surgery and preventative care (physicals, colonoscopy, etc). Check the plan for out-of-pocket (meaning your dollars) costs for these services. Many benefit plans include preventative services. Explore this carefully as it could have significant impact when you need care.

The Network
Once you’ve determined budget issues, consider the network. Make a list of all the doctors and health care providers you and your covered family members have seen in the last 12 months. If you currently have coverage, register for and use the plan’s website to review your claims history. Using this information, assess your needs by answering these questions:

Do see certain primary care or specialty doctors on a regular basis?
Do you prefer a particular hospital?
Do you want to be able to obtain second opinions outside of your local area? If so, you might want a health plan that includes some level of coverage for non participating doctors.

When evaluating your needs, be sure to include health care professionals such as physical therapists, chiropractors or optometrists.

Next week Health Champion will explain how to evaluate benefit designs. If you have any questions — or issues you’d like covered — please leave a comment and we’ll address your concerns in an upcoming blog.

Where’s Common Sense When You Need It?

We’re offering a friendly challenge to the CEO’s of all health plans: leave your corner office and walk a mile in the shoes of people covered by your plan. What do you see? What touches your heart? What are you doing right? And what needs fixing? Notice a common theme in your walkabout: a lack of plain old common sense.

Here’s a case-in-point from an experience with Oxford, as we attempted to help our client through the health care maze. She engaged our services, signed a HIPAA form, as well as a form authorizing Health Champion as her representative. Because many health plans have their own authorization forms (wouldn’t standardization be in everyone’s best interests?), we immediately contacted Oxford. Here’s what ensued in our dealings with customer service:

O: Reading from the computer screen (no thinking necessary!): the completed form must be mailed to Oxford at their Bridgeport, CT address.

HC: Our client needs immediate help. Can we scan the signed form and email it?

O: No.

HC: Can we fax it?

O: No.

HC: If we overnight it, how long before the information becomes available to customer service reps?

O: About a month.

HC: Is there someway to move this along?

O: Nope.

HC: Our client needs help now. Isn’t there something we can do?

O: Well, you could get her on the phone with you, call in together so that she gives permission for the rep to answer your questions.

And you didn’t tell us that upfront?

We did just that. Our list of questions was long and the customer service rep was ill prepared to answer them, frequently placing us on hold to check with someone or something (a manual?). We reached the end of a long business day and our client was fading (remember, she’s dealing with health issues).

HC: Let’s finish this tomorrow. Can you note in the system that we received permission to speak to Oxford; can we continue the call in the morning without having to get our client back on the phone?

O: No.

HC: Why not?

O: We can’t do that. We are only allowed to get verbal approval for one call.

HC: But the call isn’t finished.

O: Sorry we can’t do that. The federal law, HIPAA, prevents us from doing that.

Since when? (When in doubt, quote the federal law, even if you’re wrong!) Now, there’s common sense in play!

CEO’s: are you paying attention? While health and clinical services are critical to accreditation from the National Committee on Quality Assurance, we suggest that, a common sense standard is just as critical.

Your thoughts? Post your experiences, comments and insights.

If you have your health….

A co-worker recently shared this story: “My mother is 84 and incredibly robust. Ever since I can remember, she’s had this one refrain: ‘If you have your health you have everything.’ Growing up, I figured this was merely a sentiment, designed to distract me from wanting all the material things they couldn’t afford. In fact, I couldn’t really internalize the value of that statement until I hit my 40’s (ah, the joys of middle age!). Now I get it.”

Listen closely to people edging toward the other side of middle age, or those challenged by illness or disability, and you’ll see a shift in values; they’re talking more about the state of their health than the status of their portfolio. They understand that things are just things. But if you have your health, you have everything.

As health care advocates, we’re reminded daily of how important our health truly is. In fact, it’s our greatest asset. Take care of it like you would your life savings: Invest in it. Manage it. Pay attention to it. Like your nest egg, once it’s gone, it’s not easily replaced.

As we look ahead to 2010, we hope the year brings you the blessings of good health. Happy New Year.

Advocating For Your Needs

Whether you’re trying to get through the health care maze on your own, or need to engage the services of a health advocacy group, such as Health Champion, one thing is certain: you need unbiased, credible, up-to-date information. That’s what you’ll find here.

Through this blog, our goal is to help you become an empowered health-care consumer. And, because we’re a private advocacy company — without ties to government or insurance companies — beholden to no one — you can count on us to be in your corner. We commit ourselves to honesty and integrity. We’ll share what we know, offer our opinions, help you find answers, and give you information you won’t easily find elsewhere.

Over the past few years, there has been a growing need for health advocacy, giving people somewhere to turn . . . someone who will support and promote their rights within the health care system. Health Champion is answering that call.

We’re a young company with passion and experience; all of our established health care professionals are dedicated to helping people navigate today’s complex system, finding the answers they need when they need them. We work with individuals and families on a variety of levels, privately or through their employer.

We’re excited about starting this blog, a natural extension of our commitment and outreach to health care consumers. Look for a new post every Wednesday, where we’ll write about everything from health care reform to making wise medical choices to getting the most from your benefit plan. Be prepared for topics such as Ten Stupid Things in Health Care Today, Shopping for Colonoscopies, and What Reform Will Mean to You.

We welcome your comments and look forward to a lively exchange in the months ahead

Health Champion Blog

"In Your Corner"

Choosing the Right Health Plan

Where’s Common Sense When You Need It?

If you have your health….

Advocating For Your Needs

Welcome to the Health Champion Blog

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