tag:blogger.com,1999:blog-54827386166482380012024-03-05T10:30:17.719-08:00Patient Advocacy: Healthcare on your sideAnonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.comBlogger52125tag:blogger.com,1999:blog-5482738616648238001.post-85204650910632685902016-09-13T18:48:00.001-07:002018-02-12T17:50:54.410-08:00Jan 26<!--[if gte mso 9]><xml>
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<div align="center" style="text-align: center;">
<b><i><span style="font-family: "" "arial" "" , "serif"; font-size: 14.0pt;">Asked to pay your unmet Deductible now? </span></i></b></div>
<div align="center" style="text-align: center;">
<b><i><span style="font-family: "" "arial" "" , "serif"; font-size: 14.0pt;">Consider this...</span></i></b></div>
<div align="center" style="text-align: center;">
<br /></div>
In recent years, it has become common practice among medical providers to
request the payment of your unmet deductible or out of pocket in advance,
either for appointments early in the year, or before receiving services at a
facility.<br />
<br />
1. There are several reasons:<br />
<br />
High deductibles and out of pocket liabilities (the amounts a patient must
pay before an insurerpays medical costs in full) have become prevalent as ever
larger costs are shifted to individuals and employees.
<br />
<br />
Changes mandated by the ACA ("Obamacare") profoundly affect the
way medicine is to be practiced. Transforming this vast, complex and
well-established system into a cost-effective, result-based model creates
financial disruption. Uncertainty about the future of healthcare has created major
anxiety, as many medical providers feel their livelihood and existence might be
in jeopardy.<br />
<br />
Reassessments of fee schedules by Medicare and commercial insurances, the
downward federal budget allocation trend, rising operating costs and payment
delays due to widespread technical system implementation issues have resulted
in a shortage of income for many offices. Making do with less has become a
daily game, finding new revenues an endless challenge.<br />
<br />
2. The office point of view<br />
<br />
Every billing department knows that, early in the year, patients pay off
holiday credit card bills and taxes first. As an office cannot legally and
ethically refuse to treat patients with open balances, getting advance payments
guarantees a minimum income during those leaner months.<br />
<br />
Some specialties such as oncology have suffered significant reductions in
reimbursements in recent years. Smaller practices in particular don't receive
the bulk discounts from suppliers, extended payment deadlines or preferential
insurance contract rates that larger entities enjoy. While waiting for
patients to pay their balances, many must rely on lines of credit or savings to
make ends meet.<br />
<br />
Every January brings new insurance plans, changes in regulations and a
significant amount of new patients, especially since the ACA implementation.
The addition of staff to absorb this workload causes increased labor costs.<br />
An important ACA requirement is the mandated use of EHR (Electronic Health
Records). Monetary incentives have been offered to medical providers to purchase
new systems and upgrade their software. As they are based on payments made by
Medicare in previous years, these incentives were negligible for those not
catering to seniors. <br />
Costs surged too due to a major change last fall. The diagnosis-coding system
was updated to a vastly expanded version; becoming fluent challenged staff and
physicians and affecting all aspects of billing.<span style="mso-spacerun: yes;"> </span>For at least one year, providers and insurers
must use two different systems.<br />
<br />
3. When to say no<br />
<br />
If you have government issued coverage (Medicare, Medicaid),
do not pay in advance! CMS, the governing administrator, has ruled that a
patient may not be asked for any upfront payment before a claim has been
processed and the specific liability determined.<br />
<br />
The only exception is the set office copay for Medicare Advantage or Tricare
plans, due when services are rendered.<br />
Patients covered under a commercial plan and only scheduled for a minor
office visit or service, should wait until they receive a statement, as it is
unlikely they will meet their deductible. If the office cannot financially
survive without that early contribution, better management might be in order.<br />
<br />
Explain that you have already met your responsibility, or charges for other
prior services are in process, to stop these demands. <br />
<br />
4. In
conclusion <br />
<br />
If you agree to pay, ask for a cost estimate and offer a lower amount.<br />
<br />
Always confirm the refund policy. Will any overpayment be held until applied
to another open balance or be refunded? How fast would this take? Will it be
automatic or will you have to ask?<br />
<br />
When in doubt, or if you need help getting the office to back off, contact
your insurance company. This behavior is frown upon, and sometimes prohibited
by contract. A phone representative will call and demand they stop.<br />
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objective is to offer you, the patient, concrete and beneficial
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trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: small;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: small;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="font-size: small;"><span style="color: blue;"></span></span></div>
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<span style="font-size: small;"><span style="color: blue;"><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; text-decoration: none;">www.advimedpro.com</span></a><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; text-decoration: none;">contact@advimedpro.com</span></i></a></span></span></div>
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<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-63707121020398522852014-11-13T17:31:00.000-08:002016-09-14T15:24:20.401-07:00Healthcare: Patient Advocacy on your side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<!--StartFragment-->
</div>
<div class="MsoNormal" style="text-align: center;">
<br />
<b><span class="Apple-style-span" style="color: red; font-size: large;">Save on medical costs: </span></b><br />
<b><span class="Apple-style-span" style="color: red; font-size: large;"> Alternative Options</span><span class="Apple-style-span" style="font-size: 19px;"><span class="Apple-style-span" style="color: red;">*</span></span></b><span class="Apple-style-span" style="color: #444444; font-weight: bold;"> </span></div>
<div class="MsoNormal" style="font-weight: bold; margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">As I negotiate down expensive
facility bills for my clients, or fight insurance companies for higher
reimbursements, I am often struck by the number of patients who thought the ER
or the specialist's office were their only choices. Minor episodes end up
costing thousands of dollars, when more affordable options were available. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br />
Consider these options: </div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="color: #444444;">Please note this is given for informative purposes only, does not
intend to provide or constitute medical care or advise. It neither endorses nor
promotes any mentioned service or provider. <o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="color: #444444;"><b>ALWAYS call 911 or go the
Emergency Room if you are having a life-threatening emergency or if your health
may be at serious risk by delaying care. </b><o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 0.5in; margin-right: 10pt; margin-top: 0in; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">1.
Urgent Care Centers<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Staffed
by MDs, they treat less severe emergencies that require immediate attention. Services
include sutures, prescribing medications, chronic condition management, health evaluations, imaging, stabilization
until your next doctor appointment and more.
<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Urgent
care centers are found in many cities and neighborhoods. Appointments are not
necessary. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">2. Retail Health Clinics <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Addressing minor concerns such as
allergic reactions, minor infections, wound care and skin conditions, they are
staffed with nurse practitioners licensed to prescribe medications and perform
simple medical procedures. This is a good alternative to a doctor's visit for general
and school health exams or for vaccinations.
<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Located in drugstore chains (i.e.
CVS) or retail stores (i.e. Wal-Mart), they contract with most major insurers.
Their services are fairly priced.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">3. Nurse helpline<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">This free service, staffed by
nurses 24/7, from your insurance can save you the cost of a doctor's visit.
Find the number on your card or on the insurance website. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Call to determine if you need to
go to the ER, to find the nearest "in network" urgent care, to ask
what remedy is best for minor symptoms, to treat an illness or to get first aid steps that do not require the ER.
These nurses can provide answers when the office is closed, help coordinate medical
care if you are away from home, or order urgent prescription refills when your
doctor is unavailable. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 0.5in; margin-right: 10pt; margin-top: 0in; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">4. <span style="mso-spacerun: yes;"> </span>Free or low cost clinics</span></div>
<div class="separator" style="clear: both; text-align: center;">
<span class="Apple-style-span" style="color: #444444;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxapNR3jXGoxWsE61CEM0Z6JuNjo8OH-iOGZGcMZZG3NMAKi42THarOmAtz5dmsOm4upyT_JaBI0qSuMjdQaOEMeTR_-4V6QtwAZ_khCB7lVW088CpzUwdVZsT21kNRy978RV-CCTBbGuI/s1600/Money+and+pills.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxapNR3jXGoxWsE61CEM0Z6JuNjo8OH-iOGZGcMZZG3NMAKi42THarOmAtz5dmsOm4upyT_JaBI0qSuMjdQaOEMeTR_-4V6QtwAZ_khCB7lVW088CpzUwdVZsT21kNRy978RV-CCTBbGuI/s200/Money+and+pills.jpg" width="200" /></a></span></div>
<span class="Apple-style-span" style="color: #444444;"> <o:p></o:p></span><br />
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Offering a variety of services, they should not be your first
choice in case of an emergency. Administered by the County, privately run or
belonging to teaching universities and hospitals (services are rendered by
students under the supervision of fully-experienced doctors), waits can be long
but prices worth a look. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Some
specialize in a specific illness (HIV/AIDS clinics) or services (women's health clinics). Exams, prescriptions, tests and
more are provided at significant savings.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">5.
Labs<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Depending on the test, you may
need to consult your Dr first. Many common tests can be obtained without a
prescription, or at a lower cash cost than in the office, directly from these labs:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="text-align: left; text-indent: -0.25in;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #444444;"><a href="http://www.saveonlabs.com/" target="_blank">· http://www.saveonlabs.com/</a><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: left; text-indent: -0.25in;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #444444;"><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><a href="https://www.directlabs.com/">https://www.directlabs.com</a>/<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="text-align: left; text-indent: -0.25in;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #444444;"><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><a href="http://www.questdiagnostics.com/home/patients/get-results.html">http://www.questdiagnostics.com/home/patients/get-results.html</a><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">6. Chiropractors<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">If you have a minor sport injury or joint pain, or want to avoid surgery, consulting a chiropractor is
a less costly option than an orthopedic MD. Specializing in bones, muscles and
joints, they use more conservative, less drastic treatment methods (spinal
manipulations, physical therapy, medical massages) to get you back in shape.
They can order scans and limited labs. Expect to pay $ 50.00 to $ 100.00 per visit
(including all modalities). This is often a covered insurance benefit.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">7. Pharmacists<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-right: 10pt; text-align: left;">
<span class="Apple-style-span" style="color: #444444;">Ask the pharmacist at your local
drugstore or pharmacy for a recommendation on what over the counter remedy is
best for minor ailments, to check on possible negative interaction with current
prescriptions, or advise on a minor allergic reaction.<span style="mso-spacerun: yes;"> </span>Local and
chain pharmacies also offer low cost flu shots, and other vaccinations.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">8. Online <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #444444;">An increase in the number of online MD visits has been
observed, and is likely to continue this upward trend. Sites such as
www.memd.me, www.interactivemd.com or the-online-doctor.com propose virtual
encounters for set prices, and at convenient times for patients. <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #444444;">In Conclusion:<o:p></o:p></span></div>
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<br /></div>
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<span class="Apple-style-span" style="color: #444444;">Remember to ask any healthcare
provider or clinic you may consult if they are part of your insurance network.
Choosing one who is contracted with your insurer will significantly lower your cost. You may need to send the bill directly to your insurer; getting a
"superbill" (specialized medical bill) is essential. If you are
self-pay, this receipt or statement will be useful come tax season. <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #444444;"><u>Never jeopardize your health
by denying yourself access to urgent or necessary medical care whenever
necessary.</u> Though more limited after the
facts, solutions can still be found to help lower high medical bills.</span><span class="Apple-style-span" style="color: red; font-weight: bold;"><o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #444444; font-size: xx-small;"><br /></span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: xx-small; line-height: 18px;"><b><span class="Apple-style-span" style="color: blue;">* Previously seen on NerdWallet</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial"; font-size: x-small;"><b><i><br /></i></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial"; font-size: x-small;"><i>My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-12546786992150216852014-10-20T15:15:00.001-07:002016-09-14T19:09:57.137-07:00Patient Advocacy: Healthcare on your Side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<b><span style="font-family: "times"; font-size: 18.0pt;"><br /></span></b>
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<b><span style="font-family: "times"; font-size: 18.0pt;">Medical
Bills Management: a few tips*<o:p></o:p></span></b></div>
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<br /></div>
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<span class="Apple-style-span" style="font-weight: 800;"><br /></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">I am often asked about how
best to manage mounting medical bills while
patients must face serious health issues, undergo treatment, keep their job and
maintain their daily activities. Who has the energy, time and will to deal with
financial paperwork? How do you negotiate a bill or even know for
sure that a statement is due? <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">While patient advocates specializing in billing issues can assist in this task, they can only do so based on the
documentation they receive. Here are some tips that may make a difference for
you and for them.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">1. Be mindful of time
limits<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Patients usually have 30
days to make a payment on their account, or inform the office they contest a balance. Delaying may mean collection action (sometimes
in as little as 60 days), or added interest. If more time is required, make
a small payment to keep the account current and to show good faith. Make your call early for clarification purposes. If you disagree with a balance, indicate so in writing as
soon as possible. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="font-family: 'Helvetica Neue'; text-align: left;">
<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Insurance companies place time
limits on filing a first grievance or second-degree appeal.
Ninety days from the date on the Explanation of Benefit ("EOB") or
the determination letter are the norm. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">2. Communicate!<o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Report any
arrangement, payment plan or settlement you have in place to your advocate to
avoid misunderstanding and wasted efforts. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Always follow the policy guidelines about filing written appeals. You
usually only have two: use them well! <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">A phone call asking for an
explanation may count as strike one, even if you are unclear with the representative
about your intention. Asking the adjuster to reprocess the claim "because the insurance did not pay enough" is a sure denial in the making. </span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">3. Play the matching game<o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Keeping accurate records will
prove worthwhile when filing for medical expenses tax credits with the IRS or seeking reimbursement
from your HSA account. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">I recommend matching every bill with the corresponding insurance Explanation Of Benefit. Confirm the amounts billed to you are justified, and that every
medical service has been submitted to your insurer for payment. Discrepancies,
errors or issues should soon become apparent. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">I recommend an Excel spreadsheet to keep track of statements, EOBs and amounts paid. Keeping
it updated on a weekly or monthly basis costs little effort, with great reward.
This is the way I keep track for my clients. You don't need to itemize every charge, but each date of service and provider should have an entry.<o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">4. Details count<o:p></o:p></span></span></div>
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<span class="Apple-style-span" style="color: #444444;"><u><br /></u></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Small details make the
difference between success and wasting time and $ on losing efforts. Winning an appeal may
well depend on them. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Some examples: an error on
the hospital's part caused you to have to stay longer; the provider was in
network but canceled his contract with your insurance in middle of treatment; the
patient signed a financial agreement while still under the influence of anesthesia
or without an interpreter; the office sent your samples to an out of network
lab because the Dr needed the results ASAP. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">All of these are routine denials, yet each one can be the reason for winning your appeal. </span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">In conclusion: <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Managing medical bills,
establishing the best strategy and getting to the best outcome depend
on basic matching and minimum organization skills. While hiring a billing
advocate can mean peace of mind, not every patient can afford this service. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">A small investment of time
can save you money by recognizing errors and having
them reversed. <o:p></o:p></span></span></div>
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<span style="font-family: "times";"><span class="Apple-style-span" style="color: #444444;">Blindly paying every bill
you receive, or sticking them on the growing pile u</span><span class="Apple-style-span" style="color: #444444;">ntil you can (or want to) get to it are neither cost-efficient nor advisable.</span></span><span class="Apple-style-span" style="font-size: 13px;"><b></b></span></div>
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<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: xx-small; line-height: 18px;"><b><span class="Apple-style-span" style="color: blue;">* Previously published on NerdWallet</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">All rights reserved.</span></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial"; font-size: x-small;"><i>My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">www.advimedpro.com</span></a><span style="font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">contact@advimedpro.com</span></i></a></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-13879794212117101372014-10-08T07:27:00.003-07:002016-09-14T15:45:44.851-07:00Patient Advocacy: Healthcare on your Side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt;"></span></b></div>
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</b></span></div>
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<br />
<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: large;"><b>Medical Necessity:</b></span></div>
<div align="center" class="MsoNormal" style="color: red; text-align: center;">
<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: large;"><b><br /></b></span>
<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: large;"><b>Filing Successful Appeals*</b></span></div>
<span class="Apple-style-span" style="font-family: "helvetica neue";"><b>
</b></span>
<br />
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<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: 13px;"><b><br /></b></span></div>
<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: 13px;"><b>
</b></span><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: 13px;"><b>
</b></span><br />
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b><span class="Apple-style-span" style="color: #0b5394;">"Medical
necessity", used so often in denials of claims or athorizations takes on diverse meanings, based on who claims it. <o:p></o:p></span></b></span></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b>
</b></span></span>
<br />
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b><span class="Apple-style-span" style="color: #0b5394;">Eventually the final word rests with your insurance, its guidelines, the terms of your health
policy and the documentation supporting your claim. <o:p></o:p></span></b></span></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b>
</b></span></span>
<br />
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b><br /></b></span></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b>
</b></span></span>
<br />
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b><span class="Apple-style-span" style="color: #0b5394;">Here are some tips to help you conquer those hard-to-win
appeals.<o:p></o:p></span></b></span></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b>
</b></span></span>
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b><br /></b></span></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b>
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<span class="Apple-style-span" style="color: #0b5394;">1. Standard medical practice appeal<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">It is imperative that your physician) must show that the normal,
well established standard of care has been followed. In a nutshell, you have
been prescribed the gentler, cheaper, usual, most common course of treatment, and
this is not working. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">Let's say your prescription is brand name, but over the
counter alternatives are available. You are liable for a higher or total share
of cost for the brand name. Medical necessity would be justified if the OTC
version or generic prescriptions had been tried over a certain amount of time,
resulting in no improvements, a worsening of the condition, a serious side
effect, or were counter-indicated. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">When a surgical or invasive intervention is recommended, proving
medical necessity requires records that demonstrate prior conservative, pharmaceutical
or non-invasive therapies are not longer effective.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">2. Insurance guidelines appeal<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">This appeal will be more difficult to win, but all hope is
not lost. Because the terms of a contract are at play, the room to maneuver is
tight. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">Medical necessity would be established if conservative
measures have been used and become ineffective to the point of causing
irreparable damage to your health. Detailed explanations of the negative impact
on your daily life, professional activities, and/or on your mental or emotional
state if the prescribed treatment were not administered must be presented. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">Say that you have intense back pain due to an old
injury. Your policy will not cover surgery as your condition is neither acute
nor hazardous to your life. It will cover pain management modalities, physical
therapy and supplies such as a brace. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">Exposing potential risks (addiction to pain pills), reduced
quality of life (loss of mobility), inability to do your job (can't sit or
drive) or onset of new related conditions (depression) would have a chance of
success. The medical records would need to list unusual and serious
circumstances justifying the prescribed approach. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: left;">
<br /></div>
<div class="MsoNormal" style="text-align: left;">
<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #0b5394;">3. FDA based appeal<o:p></o:p></span></b></div>
</b></span></span><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: x-small;"><b><div class="MsoNormal" style="display: inline !important;">
<br /></div>
</b></span></span><span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: 13px;"><b><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">We are now entering a world where cooperation from your
physician is indispensable. <o:p></o:p></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">If your treatment has been denied as "off-label"
(not approved by the FDA) or inappropriate for your diagnosis, you are unlikely
to win an appeal unless highly technical clinical documentation is presented.
Many specialized sources in the US are only available to physicians, while
looking for supportive information elsewhere will test your research and
linguistic skills.<o:p></o:p></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal">
<br /></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">If a prescribed treatment has a proven and effective off-label
use abroad, in US drug trials (at least stage II) or as part of peer reviewed
studies, it might be up for consideration. If literature supporting the
physician's decision has been published in medical journals, can be located
from reputable sources or is listed in the drug NCCN compendia (the "Bible
of medications"), your insurance may be convinced to cover it. <o:p></o:p></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">Your physician must have the justification and be ready to
hand over details, articles and research papers. His reasoning, supported by
established facts and reasoning, should be extensively detailed in the medical
records as it is out of established and standard guidelines. If not, ask
yourself: on what medical grounds was the treatment prescribed?<o:p></o:p></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRLWLmiouIf7Em7Psz9Ir0Ecu6YFyfQEYpnAfuldflMPz0LOhRbNmQ0HHtlcPqp-Iwwm7PGXHoQQ99salEEvp4tSupYYLXz6ED_2Ch0Td3rRO0mGcO0tRXJYD1bLxb_Y-2hHhka2-sXDO_/s1600/solution.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRLWLmiouIf7Em7Psz9Ir0Ecu6YFyfQEYpnAfuldflMPz0LOhRbNmQ0HHtlcPqp-Iwwm7PGXHoQQ99salEEvp4tSupYYLXz6ED_2Ch0Td3rRO0mGcO0tRXJYD1bLxb_Y-2hHhka2-sXDO_/s1600/solution.jpg" width="200" /></a></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">This type of appeal is rarely done by patients, due to the
complex nature of the evidence and the restricted access to resources. <o:p></o:p></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #0b5394;">In conclusion<o:p></o:p></span></b></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;">Records from other physicians, demonstrated impact, detailed
past treatments and their results should be on file in your chart. The <span style="font-family: "helvetica neue";">industry's </span>rule for payment is: " if it is not in the medical records, it did not
happen". Every other insurance follows this reasoning. Unless a member of the
medical profession noted it, or unless you have written proof, saying it means
little. Old explanations of benefits would do, as would a history print out
from a pharmacy. A letter from someone in the office, or unsigned by the
physician h<span style="font-family: "helvetica neue";">olds</span> no value.<o:p></o:p></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394;"><span style="font-family: "helvetica neue";">Fi</span>ling an appeal requires two things<span style="font-family: "helvetica neue";">:</span> <span style="font-family: "helvetica neue";">s</span>tat<span style="font-family: "helvetica neue";">ing</span>
exactly why a claim should be reprocessed or a denial overturned, and prov<span style="font-family: "helvetica neue";">ing</span>
your point with as much relevant, legitimate documentation as you can get.</span><span style="color: red;"> </span><span class="Apple-style-span" style="color: red;"><o:p></o:p></span></div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal">
<div style="color: red; text-align: left;">
<br /></div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: blue;">* Previously seen on NerdWallet</span></div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: blue;"><br /></span></div>
</div>
<!--EndFragment--></b></span></div>
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<i><span style="color: #df5050; font-family: ""arial"","serif";">My objective is
to offer you, the patient, concrete and beneficial information, useful tips,
proven and efficient tools as well as trustworthy supportive advice as you
deal with a system in the midst of sweeping adjustments, widespread
misunderstandings and complex requirements</span></i><span style="color: #df5050; font-family: ""arial"","serif";">.</span><br />
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-23322451604773392782014-10-08T07:20:00.000-07:002016-09-14T15:43:22.734-07:00Patient Advocacy: Healthcare on your Side<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRcgzsOCAwLWqjt1q9ANIMd0SSf4DAqzt6r86eo0dQrA6bZikFBnQ-YiJhEOQdmD6_3iiIWSEmZV6UFW8gq2ctT7tIkUKfTBSE4NACzIawiWbE93m4k5a2-t3w5sKocpo5zdtTTOUP5JOQ/s1600/log+++jpego.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRcgzsOCAwLWqjt1q9ANIMd0SSf4DAqzt6r86eo0dQrA6bZikFBnQ-YiJhEOQdmD6_3iiIWSEmZV6UFW8gq2ctT7tIkUKfTBSE4NACzIawiWbE93m4k5a2-t3w5sKocpo5zdtTTOUP5JOQ/s1600/log+++jpego.jpg" /></a></div>
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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</span></span><br />
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<br />
<span class="Apple-style-span" style="font-family: "helvetica neue"; font-size: small;"><span class="Apple-style-span">THE 411 ON
"MEDICAL NECESSITY"*</span></span><br />
<span class="Apple-style-span" style="font-family: "helvetica neue";"><span class="Apple-style-span"><br /></span></span></div>
<span class="Apple-style-span" style="font-family: "helvetica neue";"><span class="Apple-style-span">
</span></span>
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span class="Apple-style-span" style="font-family: 'Helvetica Neue'; font-size: x-small;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Few insurance denials are more frustrating
that those issued for "lack of medical necessity". If your doctor
prescribed a treatment or procedure, it must be medically necessary, right? <o:p></o:p></span></span></span></span></div>
<span class="Apple-style-span" style="font-family: "helvetica neue";"><span class="Apple-style-span"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">It depends. "Medically necessary" has different
meanings. Understanding which one applies to your case determines your appeal
options and chances of success. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;"><u>1. Standard medical practice says</u><o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">The most common definition is that "the
service/procedure/treatment is reasonably expected to prevent the onset of a
condition, reduce or ameliorate the effects of an illness or condition, or help
an individual obtain or maintain maximum functional capacity". <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">From the insurance point of view, the most economical, least
invasive, most efficient way of achieving the above is the preferred option. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Let's say your prescription is brand name, but over the
counter or generic alternatives are available. In most cases, medical necessity
for the more expensive drug would not be justified.<o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">When a surgical or invasive intervention is recommended, medical
necessity means no other pharmaceutical, more conservative or non-invasive
therapies are indicated. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<u><br /></u></div>
<u><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span></u><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;"><u>2. Your insurance (policy) says</u><o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Coverage of the same procedure or drug may vary from insurer to insurer. It is advisable
to always confirm a service or prescription is covered under your policy to
avoid costly surprises. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Restrictions are often found on procedures that have cheaper
or less radical alternatives, or those deemed "elective". If the
insurer can argue that the life or welfare of the patient are not in immediate
danger, or that the condition can be managed via a more conservative approach,
the medical necessity for more drastic measures is often rejected. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">A good example is knee replacement: your physician may
recommend immediate replacement surgery, but your insurer may impose physical
therapy and pharmaceutical pain management until the condition turns more
serious or for a certain length of time without improvement. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;"><u>3. The FDA says</u><o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">If it is not FDA approved for use or not indicated for your
specific diagnosis ("off label"), it is not medically necessary...
unless accepted exceptions apply. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">The most important is the listing in the drug NCCN compendia
(the "Bible of medications"). If an off-label use is published there,
your insurance may accept to cover it. Though not FDA approved, it indicates
that it has become an accepted use within the medical community. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2BoT05AG24X8PYfQpjxXgBddAk5HGTpi2SsWRQAYK3MxvrDQ-PVm9uXkcilB3qRtZEWhAU12-pUelCZbFzKqmQ6bV0m9e3MMD41gLxmEMkxV1fLqaRQgkS_JMCbDSJH5NZcmQP5IIUXMs/s1600/tablet.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2BoT05AG24X8PYfQpjxXgBddAk5HGTpi2SsWRQAYK3MxvrDQ-PVm9uXkcilB3qRtZEWhAU12-pUelCZbFzKqmQ6bV0m9e3MMD41gLxmEMkxV1fLqaRQgkS_JMCbDSJH5NZcmQP5IIUXMs/s1600/tablet.jpg" width="200" /></a><o:p><span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;"> </span></o:p></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;"><u>4. The physician says</u><o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Based on professional experience your treating physician
might prescribe a stronger prescription than the over the counter version,
bypassing the standard protocol. He might also disregard a longer-term approach
for a quicker but more drastic solution based on medical and other criteria. Medical records should and must explain this decision.<o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
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<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;"><u>5. You say</u><o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">As a billing manager, I have seen my share of cases where
convenience and personal preferences were the basis for requesting a specific
prescription or treatment. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">While a young mother choosing to undergo a gentler but
longer type of chemotherapy when the norm is a less costly, shorter but
debilitating treatment can be justified, requests based on marketing ads,
advise from friends and family members or indiscriminate internet research will
not. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Medical providers might be tempted to prescribe a certain
drug, or order a test or scan to please (and keep) their patient. Relying on unverified
statements by the patient, they may be led to advise serious interventions when
not truly indicated. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Unsupported by sound, appropriate medical records, it will
be difficult to prove medical necessity in such cases. <o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;"><u>In conclusion:</u><o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-size: xx-small;">Depending on the point of view, medical necessity takes many
forms. It usually follows established protocols. When your insurance issues a
denial, it does so based on specific reasons, published policies, FDA
guidelines or standard medical practices. Other valid explanations include a
lack of medical records, insufficient justification or a missing authorization.<o:p></o:p></span></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<br /></div>
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span style="font-size: x-small;">
</span></span><div class="MsoNormal" style="text-align: left;">
<span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span class="Apple-style-span" style="color: #0b5394; font-size: x-small;">Until evidence is given supporting the need for an
out-of-the-norm service in your specific case, expecting a change of decision
might be a </span></span><span class="Apple-style-span"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><span class="Apple-style-span" style="color: #0b5394; font-size: x-small;">lost cause. </span></span><u style="color: red; font-size: 19px; font-weight: bold;"><o:p></o:p></u></span></div>
<div class="MsoNormal" style="color: red; font-size: 19px; font-weight: bold; text-decoration: underline;">
<br /></div>
<!--EndFragment--></span></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif; font-size: x-small;"><b>* previously published on NerdWallet</b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2014] AdviMed.<o:p></o:p></span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2014] Martine G. Brousse.</span></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">All rights reserved.</span><span class="Apple-style-span" style="font-size: xx-small;"><o:p></o:p></span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial"; font-size: xx-small;"><b><br /></b></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial";">My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal </span></span></div>
</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial";">with a system in the midst of sweeping adjustments, widespread misunderstandings </span></span></div>
</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial";">and complex requirements. </span></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-size: small;"><b><i><u><span style="font-family: "arial";">Quote of the week</span></u></i></b></span><br />
<span class="Apple-style-span" style="color: #0b5394; font-size: small;"><b><i><u><span style="font-family: "arial";"><br /></span></u></i></b></span></div>
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<span class="Apple-style-span" style="color: #0b5394;"><span style="font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px; text-decoration: none;">"The flower of consciousness needs the mud out of which it grows." Eckhart Tolle</span></span><br />
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<b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="color: #ff7c00; font-family: "arial"; font-size: 18pt;">i</span></b><b><i><span style="color: #00c6ff; font-family: "arial"; font-size: 18pt;">Med</span></i></b><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span><span style="color: #535353; font-family: "arial"; font-size: 13pt;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-48044973033363347182014-09-29T06:52:00.003-07:002016-09-14T15:49:40.927-07:00Patient Advocacy: Healthcare on your SIde<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<span class="Apple-style-span" style="color: red; font-family: "helvetica neue";"><b><u><span style="color: red; font-size: 14pt;">Five Tips about Medicare Advantage *</span></u><span style="font-size: 14pt;"><o:p></o:p></span></b></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">As a billing manager, I often found many senior patients were misinformed about their Medicare coverage. A lack of basic understanding would translate into delays, higher costs and added stress. Understanding five basic points could help <span style="font-family: "times" , "times new roman" , serif;">seniors</span> obtain appropriate and prompt care, and save them money and sanity.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">1. There is more than one<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">At the beginning was Medicare. Called "straight" by those in the medical field, this Original Medicare (OM or MCR) consists of</span><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-family: "times" , "times new roman" , serif;">:</span></span><br />
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<li><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif; font-size: x-small;"><span style="font-family: "times" , "times new roman" , serif;"> </span>Part A: hospital, nursing and hospice care</span></li>
<li><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif; font-size: x-small;">Part B: physicians, labs, tests and Durable Medical Equipment</span></li>
<li><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif; font-size: x-small;">Part D: prescription drugs (dispensed out of a hospital or office)</span></li>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">Patient involvement is minimal. Healthcare providers render services, send a bill and get paid quickly, a perfect example of the "Fee for Service" (FFS) process <span style="font-family: "times" , "times new roman" , serif;">in the news lately</span>. The Federal Government administers OM. <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">Created a few years ago to lower costs, Medicare Advantage (MA) plans are administered by private insurance carriers. This is also called Part C. <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">2. Is it MCR or MA?<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">Knowing which coverage you have is essential. Assuming and telling the office that you have "Medicare" is incorrect if you have a MA plan. In the industry, "Medicare" means Original Medicare, it NEVER means Medicare Advantage.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><i>Once enrolled in a Medicare Advantage (MA) plan, you turn your Original Medicare (OM) benefits over to a private insurance company, which in turns provides coverage, administers your plan and pays your claims. </i>You now have the equivalent of a commercial policy, subject to specific guidelines, requirements and limitations. Your doctor may need a direct contract with this insurer, or authorizations required before services are rendered.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">Your Medicare card (with your social security followed by a letter) is no longer valid for payment of claims, only the one issued by the private insurance carrier is.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">3. Conditions of coverage vary<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">MA plans are not based on the same easy "get-paid-easily-as-long-as-you-follow-basic-and-well-publicized-guidelines" protocol used by MCR, although they are required to cover the same benefits.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">Vision, dental and hearing coverage are not covered under OM. You may often purchase these options separately.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><span class="Apple-style-span" style="color: #0b5394;">Note that MA plans may cost more than the premiums you already pay to Medicare.</span><span class="Apple-style-span" style="font-size: x-small; font-weight: bold;"><span class="Apple-style-span" style="color: #0b5394;"> </span><span class="Apple-style-span" style="color: #444444;"><o:p></o:p></span></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCsFbd6E6LvDjbFNuBUTz3TZipo9wZZDsZjni0E_xqaUWAMB5puwh7lhWf7_Aw7lhuiwlIsWdFgo7xOdrtGJd4-RZX5SK1-cpNnykUeWkz-pNd4j96wy9bGW2FeEEuWFdHOnou9FViuWmY/s1600/soup.jpg" imageanchor="1" style="clear: right; float: right; font-size: 13px; font-weight: bold; margin-bottom: 1em; margin-left: 1em;"><span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCsFbd6E6LvDjbFNuBUTz3TZipo9wZZDsZjni0E_xqaUWAMB5puwh7lhWf7_Aw7lhuiwlIsWdFgo7xOdrtGJd4-RZX5SK1-cpNnykUeWkz-pNd4j96wy9bGW2FeEEuWFdHOnou9FViuWmY/s200/soup.jpg" style="cursor: move;" width="200" /></span></a><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">There are 2 basic MA plans:</span></div>
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<li><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> <span style="font-size: x-small;"> </span></span><span style="font-size: x-small;">HMO patients must receive services through an exclusive network. Subscribers are assigned to a local IPA (Medical Group) and a PCP (Primary Care Physician) who oversees your overall care and issues mandatory authorizations. Part D coverage must be purchased from the same HMO.</span></span></li>
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<li><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif; font-size: x-small;">·<span style="font-family: "times new roman"; font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Non-HMO (FFS or PPO): this type of plan seems to indicate that restrictions do not apply. Beware: your final liability may increase if your medical provider has no contract with your health plan or if an authorization was not obtained. Because a provider is a PPO provider does NOT imply he is willing or able to accept MA patients. PPO plans are by definition commercial, caution is warranted when using the term "PPO" or "FFS" in the Medicare context. </span></li>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">4. It may cost you<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">Too many patients switch to a MA policy only to discover that they cannot continue seeing their physician or have significantly higher financial liability in January. While prescription discounts, no 20% copay and a limit on the yearly share of cost are great reasons to choose a MA plan, other financial concerns may unexpectedly and negatively affect your bottom line.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">Most of the MA plans carry office copays, deductibles and out of pocket limits, which must be met before claims are paid in full. Certain services may be subject to unlimited co-insurance liability.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">5. Help is available<o:p></o:p></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><br /></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">To learn more about Medicare choices, costs, coverage and options, visit: <a href="http://www.medicare.gov/">http://www.medicare.gov</a>/ <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">In California, free counseling and information on Medicare is available at: <a href="http://www.cahealthadvocates.org/HICAP/">http://www.cahealthadvocates.org/HICAP/</a>.<o:p></o:p></span></div>
</div>
<div class="MsoNormal" style="text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><br /></span></div>
</div>
<div class="MsoNormal" style="text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">In conclusion:<o:p></o:p></span></div>
</div>
<div class="MsoNormal" style="text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><br /></span></div>
</div>
<div class="MsoNormal" style="text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">MA plans work well for a large number of seniors, but doing research prior to enrolling remains advisable, as your choice is locked in for the next year. <o:p></o:p></span></div>
</div>
<div class="MsoNormal" style="text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><br /></span></div>
</div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><u>Remember:</u> You can join, switch or leave a MA plan during the Open Enrollment Period between Mid-October and Early December. You may only join a MA plan during the year if it has a 5 star rating, or if you just qualified for Medicare coverage. You may only request disenrollment and return to OM between January 1st and February 14th each year. <span class="Apple-style-span" style="font-weight: bold;"><o:p></o:p></span></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="font-weight: bold;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><br /></span></div>
<span style="color: blue;"><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;">* previously published on NerdWallet</span></span><br />
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">All rights reserved.</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial"; font-size: x-small;"><b><i><br /></i></b></span></div>
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<div style="line-height: normal; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial"; font-size: x-small;"><i>My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial";"><br /></span></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">www.advimedpro.com</span></a><span style="font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">contact@advimedpro.com</span></i></a></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-2903409766112397212014-09-23T14:27:00.003-07:002016-09-14T15:52:59.513-07:00Patient Advocacy: Healthcare on your Side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<!--StartFragment-->
</div>
<div align="center" class="BodyA" style="text-align: center;">
<span style="font-size: small;"><b><span class="Apple-style-span" style="color: cyan; font-size: medium;"><br /></span></b></span></div>
<div align="center" class="BodyA" style="text-align: center;">
<span style="font-size: small;"><span style="color: blue;"><b><span class="Apple-style-span" style="color: cyan; font-size: medium;">APPLYING FOR FINANCIAL
ASSISTANCE: <o:p></o:p></span></b></span></span></div>
<div align="center" class="BodyA" style="text-align: center;">
<span style="font-size: small;"><span style="color: blue;"><b><span class="Apple-style-span" style="color: cyan; font-size: medium;"> TIPS FOR CANCER PATIENTS</span></b></span></span><span class="Apple-style-span" style="color: #cc0000; font-weight: 800;"><o:p></o:p></span></div>
<div class="BodyA" style="color: #cc0000; font-weight: 800;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">The
major cause for the high cost of cancer treatment is that of chemotherapy
drugs, oral or infused. Many treatments, also called </span><span style="font-size: 12pt;">“</span><span style="font-size: 12pt;">regimens</span><span style="font-size: 12pt;">”</span><span style="font-size: 12pt;">, include generic
options, but the promising outcomes of new patient-directed therapies, and the
growing use of leading-edge targeted drugs often come at a hefty price. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">The
cost of one or two brand name drugs can often meet your deductible and/or out
of pocket liability at the first cycle (the time between your first
chemotherapy treatment and the next one). The facility or office providing the
drug will appreciate your prompt payment ... in full, as drug purchase is the
number one expense in an oncology practice.</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">Solutions
are available but getting approved is not enough. Unless certain conditions are
met, the largest grant will not help you pay the oncologist or the pharmacy.
Here are some tips:</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="margin-left: 16.5pt; text-align: left; text-indent: -16.5pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12pt;">What</span><span style="font-size: 12pt;">’</span><span style="font-size: 12pt;">s out there?</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">There
are three major sources of financial assistance: </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="margin-left: 9pt; text-align: left; text-indent: -9pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]--><span style="font-size: 12pt;"><u>no-cost donations
from drug manufacturers</u>: office-dispensed free samples and free doses of
infused drugs for the uninsured. Patients with insurance policies that do not
offer coverage for the treatment may also qualify. </span><o:p></o:p></span></div>
<div class="BodyA" style="margin-left: 9pt; text-align: left; text-indent: -9pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]--><span style="font-size: 12pt;"><u>Copay assistance</u> from
those manufacturers for insurance patients with high shares of cost, in the
form of direct payments to your pharmacy or oncologist, discounts cards or
reduced fees.</span><o:p></o:p></span></div>
<div class="BodyA" style="margin-left: 9pt; text-align: left; text-indent: -9pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]--><span style="font-size: 12pt;"><u>Grants</u> from
charitable organizations to help cover your cost.</span><o:p></o:p></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">Please
note: Medicare and government-issued insurance policy holders are prohibited by
law from receiving direct assistance from manufacturers, so apply directly with private
organizations. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEht6QGSYFq6NKU4iUEtoG4l768LGrZTFK2ewr8j-WuixXlHSwz6m6hFOba1p4N218Yue1Tw4H5xSNDtg3hCuPP4K0q9x2L6WFINNOPy7sneweWUHfSGQdIgWNA-cag_bYUOoNc3J-vjrGJy/s1600/help+puzzle.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="131" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEht6QGSYFq6NKU4iUEtoG4l768LGrZTFK2ewr8j-WuixXlHSwz6m6hFOba1p4N218Yue1Tw4H5xSNDtg3hCuPP4K0q9x2L6WFINNOPy7sneweWUHfSGQdIgWNA-cag_bYUOoNc3J-vjrGJy/s1600/help+puzzle.jpg" width="200" /></a><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">The
off-label (non FDA-approved) use of a drug is rarely eligible for donations or
financial aid from any entity. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">Get
the list of your prescribed brand name
drugs and the associated diagnosis code</span><span style="font-size: 12pt;">, then check the list of available
programs at: </span><a href="http://www.nccn.org/reimbursement_resource_room/default.aspx"><span class="Hyperlink0"><span style="font-size: 12pt;">http://www.nccn.org/reimbursement_resource_room/default.aspx</span></span></a><span style="font-size: 12pt;"> or </span><span class="Hyperlink0"><span style="font-size: 12pt;"><a href="http://www.moasc.org/drug-assistance-programs.html">http://www.moasc.org/drug-assistance-programs.html</a></span></span><span style="font-size: 12pt;"><a href="http://www.moasc.org/drug-assistance-programs.html%20http://www.moasc.org/drug-assistance-programs.html" target="_blank"> </a>or </span><span style="font-size: 12pt;"><a href="http://www.cancerfac.org/members.php" target="_blank">http://www.cancerfac.org/members.php </a></span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">Start
with the manufacturer, as most offer specific assistance, then contact charitable
organizations. Genentech and Amgen have exceptionally well-run and generous
programs, as do private Healthwell and CancerCare. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">Eligibility
guidelines, documentation requirements and application forms<span style="font-family: "times" , "times new roman" , serif;"> are available online.</span></span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="margin-left: 16.5pt; text-align: left; text-indent: -16.5pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12pt;">Apply
early</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">You
may apply for financial assistance covering your specific diagnosis, or
specific drugs or both. Many private funds routinely run out of money, it is
best to apply between the first and 5th of each month (or ask about a waiting
list). Make sure you attach all required documentation with your application.
If you financial circumstances have changed this year, add a letter of explanation
as most applications are based last year</span><span style="font-size: 12pt;">’</span><span style="font-size: 12pt;">s
tax return and income. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">Apply,
if possible, before you first treatment. If you deductible or out of pocket are
met before you are approved, you are wasting your time. Grants are NOT retroactive, except for CancerCare (60 days). </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="margin-left: 16.5pt; text-align: left; text-indent: -16.5pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12pt;">Separate
Diagnoses</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">You
should apply for each diagnosis and/or drug separately. One program is unlikely
to cover expenses related to another prescription or condition. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">A
good example is Neupogen or Neulasta, expensive drugs used for chemo-induced
neutropenia (low white blood count). These are not considered chemotherapy, and
always require a separate application from a different fund. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">You
may apply for assistance for the same drug or condition from more than one
entity. </span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="margin-left: 16.5pt; text-align: left; text-indent: -16.5pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12pt;">Talk
to Billing</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">It
is imperative you inform the billing manager about your grant. The billing
process will need to be radically altered in order to accommodate your
situation, causing an insurance denial, payment delays, additional work and
stress. This sounds complicated because it is! But unless an Explanation of
Benefit from the insurance showing the liability applied toward the drug charge
is provided, no payment can be made by the assistance program. This is the time
to become best friends with the Billing department staff. Your financial fate
literally depends on their good will!</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="margin-left: 16.5pt; text-align: left; text-indent: -16.5pt;">
<!--[if !supportLists]--><span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12pt;">Keep
on top of things</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="color: #0b5394; font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;">Grants
expire after a certain number of months or $ amount. Keep track of and renew
your application as needed. Don</span><span style="font-size: 12pt;">’</span><span style="font-size: 12pt;">t assume you will
be notified, this is your responsibility, as is that of notifying all parties
of any changes.</span><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="BodyA" style="text-align: left;">
<br /></div>
<div class="BodyA" style="text-align: left;">
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><span style="font-size: 12pt;"><span class="Apple-style-span" style="color: #0b5394;">Because
available funds have decreased, and demand growing, do notify the program when
you no longer need your grant money. It can then be dispersed before the year
is up or the limit reached. Someone in a needy situation will <span style="font-family: "times" , "times new roman" , serif;">thank you</span>!</span></span><span style="color: #cc0000; font-size: 12pt;"><o:p></o:p></span></span></div>
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<span style="color: blue;"><span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><span class="Apple-style-span" style="color: red;">* A seen on NerdWallet</span></span></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial"; font-size: x-small;"><i>My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">www.advimedpro.com</span></a><span style="font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">contact@advimedpro.com</span></i></a></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-17933293299307961612014-09-17T10:01:00.000-07:002016-09-13T19:01:34.603-07:00Patient Advocacy: Healthcare on your Side<!--[if gte mso 9]><xml>
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<!--StartFragment-->
</span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;"><span class="Apple-style-span" style="color: #444444;">Scenario: You recently had surgery, or ended up in the
ER. One (or more) physician evaluated you. Not all are part of your insurance
network, and you are now receiving outrageous fees. You did not choose
them or directly request their services. How can you get out of paying
these bills? <o:p></o:p></span></span></div>
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;">
</span><br />
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;"><br /></span></div>
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;">
</span>
<br />
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;"><span class="Apple-style-span" style="color: #444444;">This is routinely happening in our times of restricted
insurance coverage, smaller networks, reduced choice
of in-network providers and growing trend among physicians of opting
out of all contracts. <o:p></o:p></span></span></div>
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;">
</span>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;"><br /></span></div>
<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif; font-size: x-small;">
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">Appeals made by patients are often rejected. Reasons
range from "it is the patient's responsibility to use in network
providers" to "the policy has a strict exclusion for all out of
network services". <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">Understand that you may have to pay something for the
services rendered to you. But know that you do have options, and rights, at
your disposal before taking out your credit card. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">1. Get the insurance to pay<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">If the hospital is "in network", but the
insurance paid a provider at the out of network rate, file an appeal and demand
they pay the higher contracted rate <u>based on the preferred contracted status
of the facility</u>. Other arguments should include: You had no choice in the
matter, you went to the correct facility, services were medically necessary,
this was the only specialist available, or none of the specialists on call were
providers (often the case with anesthesiologists). <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">Ask that the insurance attempt to sign a one-time
agreement with the physician. Inform the office: such deals are routinely (and
gratefully) accepted. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">2. Invoke your rights <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">Your patient's rights include the rights to receive
timely, appropriate, adequate, qualified care. If the in-network or preferred
provider could not render the service soon enough, lacked the necessary
qualifications, expertise or training, was too far away from your location, or
if you could not trust him for specific reasons, your insurer must cover the out-of-network
cost of the provider you chose. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">If a service was rendered under emergency conditions,
specific policy guidelines and regulations kick in. <b>Public Health
Service Act (PHS Act) section 2719A</b> and the <b style="mso-bidi-font-weight: normal;">ACA</b> ("Obamacare") impose on health insurances to fully
cover emergency services in an emergency department of a hospital without
regard if the provider is out of network, and requires insurers to apply
the same financial liability to the patient as would have been if in
network. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">3. Call your State's Insurance Commissioner<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">If your appeal is still denied despite using these
arguments, consult your State's Insurance Commissioner's website for information
on how to submit a grievance against the health plan. Include a copy of all
relevant documents when filing. Some states offer free phone consultations to
determine whether you have a case. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">4. Deal with the provider directly<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">A provider may refuse an insurance agreement or to
write off your balance after an "in network" payment. Request to meet
the office manager to negotiate. Meanwhile, send small monthly payments to
avoid collection action. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">Your insurance representative may be able to help you
determine an acceptable settlement, as would a billing advocate. Remember that
a one-time "paid in full" remittance is more attractive than monthly
payments. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">5. Ask the referring physician<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">If all fails, contact your surgeon, explain the
situation and ask for assistance. A non-contracted provider, counting on more
referrals and work from his colleagues, may have to learn to be more flexible
and less greedy. Another physician is the best placed to explain this delicate
situation. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">The referring physician, or his office manager, may be
able to use his contacts with the facility's officers to get a bill reduced or an
application for financial assistance pushed through. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">If the provider belongs to a medical group, as
anesthesiologists and ER physicians often do, file a request for a review of
your case and ask for a fee reduction directly with the managing director. They
often are more sensitive to negative comments and potential backlash,
especially if you indicate a copy is being forwarded to the referring physician
and to the administrator of the facility.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">In conclusion: <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;">A negative response to an insurance appeal or the initial
refusal of a reduced fee should not deter patients from seeking other avenues
to get a better outcome. Patient satisfaction and the threat of public exposure
are growing factors forcing medical providers to "play nice". Knowing your rights and demanding they are
respected are powerful incentives, as are hiring a patient advocate or going up
the corporate ladder. </span><span class="Apple-style-span" style="color: blue;"><o:p></o:p></span><br />
<span class="Apple-style-span" style="color: #444444;"><br /></span>
<span class="Apple-style-span" style="color: red;">* A seen on NerdWallet</span></div>
<!--EndFragment--></span></div>
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<span class="Apple-style-span" style="color: blue; font-family: "times" , "times new roman" , serif;"><br /></span></div>
</div>
</div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
</div>
</div>
</div>
</div>
</div>
</div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
<span class="Apple-style-span" style="color: red;"><div align="right" class="MsoNormal" style="text-align: right;">
<i><span style="color: #00c6ff; font-family: "arial";"><span class="Apple-style-span" style="font-size: 13pt; font-weight: bold;"><o:p></o:p></span></span></i></div>
</span><span class="Apple-style-span" style="color: red;">
<!--EndFragment--></span><br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "helvetica"; font-size: 13pt;"><span class="Apple-style-span" style="color: red;"><br /></span></span></b>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "helvetica"; font-size: 13pt;"><span class="Apple-style-span" style="color: red;"><br /></span></span></b>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "helvetica"; font-size: 13pt;"><span class="Apple-style-span" style="color: red;"> </span></span></b><br />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "helvetica"; font-size: 13pt;"><span class="Apple-style-span" style="color: red;">Medicare Advantage Plans:</span></span></b></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "helvetica"; font-size: 13pt;"><span class="Apple-style-span" style="color: red;"> Unpopular with Medical
Providers</span><span class="Apple-style-span" style="color: #262626;"><o:p></o:p></span></span></b></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Created
a few years ago with the goal of improving efficiency, care and overall cost,
Medicare Advantage plans (part C) claim uneven success. While enrollment is
higher in some parts of the country, efforts at increasing the number of
subscribers have been met with obstacles, such as a low number of contracted
providers, or difficult access to care. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Before
blaming the cause on medical providers' greed or lack of caring, let's look
at things from their perspective:<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="color: #262626; mso-fareast-language: JA;">1.
Straight Medicare is great<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Consider
"regular Medicare": render service, send a bill, get paid. Follow well
published, simple instructions, and your payment will make its way into your
bank account within 14 days. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Advantage
plans are less transparent, more complex and obstructive. More resources, time
and manpower are needed for the same payment...in 30 days... maybe.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Disputed
claims, in general, are a minor reason for rejecting Medicare Advantage patients.
But there is no doubt that for each single appeal made to Medicare, there are
dozens made to Part C carriers. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Even
if the payment is eventually similar, the cost of the added paperwork, stress,
processes, appeals, calls and staff time bites through any profit, quickly
throwing a practice into losing money territory. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="color: #262626; mso-fareast-language: JA;">2.
It's complicated<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">The tedious
and often-delayed authorization process remains a major drain on resources and
staff time. Losing money (and patience!) on that end is common. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Fee
for Service or PPO (a misnomer as patients think providers are contracted with
Medicare when in fact it is with a specific plan administrator) plans are
more widely accepted. Less resources or staff time are required.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">HMO
plans are disliked throughout. Any service, visit, treatment requires prior
authorization. This routinely takes 3 to 5 days (if no emergency) and the
patient must return to receive care. Schedules are burdened, diagnoses and
treatments delayed, frustration rampant. The exceptions are autonomous and self-contained plans like Kaiser. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Because
of cost and unrelated contract requirements, simple tests or labs must often be performed
by an outside provider. An authorization must be requested, paperwork sent to
the lab (for example), blood drawn, reports sent to the office, before the
patient can be notified of results which may have taken a few minutes
otherwise. This waste of time causes hardship and anxiety for patients, while
the added office administrative costs are not reimbursed. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYZXdfC3Xvogs8nF51wsfjbm3vLnPlFAyjoDTYM16Zjg58LnqMwxST4vBEh1rIELlGMMkZpkkVIKUcDyhkM7qV4c1saVJ-IDAbx0mnmuLrTeH_z2JgjweArJlc_CnRNwsOfpWc1sxf5qXq/s1600/confused.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYZXdfC3Xvogs8nF51wsfjbm3vLnPlFAyjoDTYM16Zjg58LnqMwxST4vBEh1rIELlGMMkZpkkVIKUcDyhkM7qV4c1saVJ-IDAbx0mnmuLrTeH_z2JgjweArJlc_CnRNwsOfpWc1sxf5qXq/s1600/confused.jpg" width="200" /></a><span style="color: #262626; mso-fareast-language: JA;">I worked
with cancer patients whose HMO plan forced them to receive chemotherapy at
home. With no way of supervising the treatment, the stress on staff, doctors
and patients was crushing. Saving a relatively small amount of $ seemed the only
reason for the insurance to impose such a risky and potentially disastrous decision.
<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="color: #262626; mso-fareast-language: JA;">3.
Unpaid patient balances<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Another
element has become important in the decision-making process of medical
practices: straight MCR patients usually have a secondary insurance. Patient liability,
though growing in recent years, remains low and easily collected. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Medicare
Advantage policies often come with much higher deductible and out-of-pocket
costs. Some plans have no patient limit for certain items (chemo drugs for
example), causing patients to either forgo treatment altogether or drain their
savings. Without secondary insurance, many cannot afford to pay their bills.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="color: #262626; mso-fareast-language: JA;">4.
Unclear policies<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Straight
Medicare offers a vast range of guidelines, policies, webinars, educational
materials and contact methods to help offices determine whether a specific item
or treatment is covered, under what conditions, and at what price. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Commercial
carriers, the administrators of Part C plans, must offer equivalent coverage.
But they may impose which treatment to order (cheaper, non-surgical or less
drastic first), which drugs to prescribe (generic only), where and how patients get treated,
etc. Pre-authorization requirements vary, so calls must be made before any
treatment or service can be recommended or prescribed.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="color: #262626; mso-fareast-language: JA;">5. Patient Responsibility<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">If an
office bills incorrectly, or provides a non-covered service to a straight
Medicare patient, it must absorb the loss. Not always so with part C. Patients
are more likely to be hit with unpaid balances, especially if they see a
non-contracted provider or receive non-pre-approved care. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="color: #262626; mso-fareast-language: JA;">In
Conclusion: <o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span class="Apple-style-span" style="color: #262626;"><u><br /></u></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">Seniors
are caught in the middle. Between restricted access to medical providers, billing
surprises, treatment delays, widespread confusion and impositions of all sorts,
they are too often left to fend for themselves, with no way to change their
plan until the following January.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;">If you
are a Medicare Advantage patient, check and double check. Not doing so could
lead to bad and expensive surprises! <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #262626; mso-fareast-language: JA;"><br /></span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
<br />
<div align="center" class="MsoNormal" style="text-align: center;">
<b><br /></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<div style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: red; font-size: large;"> </span></b><span style="font-size: large;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: red; font-size: medium;"> </span></b></span></div>
<div style="text-align: left;">
<span style="font-size: large;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: red; font-size: medium;">ALL ABOUT 2nd OPINIONS</span></b></span></div>
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">If your situation is an emergency or dire, or your life is at
risk, do <b>seek</b> immediate treatment. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">Getting a second opinion is an option that should be
considered when your immediate survival and wellbeing are not threatened. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;"><br /></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">Provisions of the ACA ("Obamacare) give patients with
right to a second opinion, though insurance companies may interpret this as
only for serious conditions. Restrictions may lead you to providers within a
specific network or medical group. But patients should remember this option is
available, even recommended in particular cases:<o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;"><br /></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">a. Your diagnosis is uncertain</span><br />
<span class="Apple-style-span" style="color: #444444; font-size: x-small;"><o:p></o:p></span></div>
<div class="MsoNormal">
<br />
<span class="Apple-style-span" style="color: #444444;"><o:p><span class="Apple-style-span" style="font-size: x-small;"> </span></o:p><span class="Apple-style-span" style="font-size: x-small;">Why has your diagnosis not been confirmed? If the tests
results are inclusive, or if the doctor is unsure about their significance, you
may want to ask another opinion.</span></span><br />
<span class="Apple-style-span" style="color: #444444; font-size: x-small;"><br /></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">b. Your physician is intransigent</span><br />
<span class="Apple-style-span" style="color: #444444; font-size: x-small;"><o:p></o:p></span></div>
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<br />
<span class="Apple-style-span" style="color: #444444;"><o:p><span class="Apple-style-span" style="font-size: x-small;"> </span></o:p><span class="Apple-style-span" style="font-size: x-small;">When only one treatment is offered, if you are told
"this is the only way", or if your physician refuses to discuss
alternatives, it could be time to make that other appointment. Basic
internet research should help you determine if a prescribed treatment, therapy
or intervention is the only option.<span style="mso-spacerun: yes;"> </span></span></span></div>
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<span class="Apple-style-span" style="color: #444444; font-size: x-small;">Asking about other treatments is your right. Your doctor
should explain what criteria his decision is based on, and why one treatment is
better than another. No alternative or explanations? Get information ... elsewhere.
<o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;"><br /></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-size: x-small;">c. You don't trust the doctor or diagnosis</span><span class="Apple-style-span" style="font-size: x-small;"> </span></span></div>
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<br />
<span class="Apple-style-span" style="-webkit-text-decorations-in-effect: none; color: #444444; font-size: x-small;">Many years ago, an ER doctor misdiagnosed my symptoms.
Despite my strong intuition he was incorrect, I did not dare ask for another
opinion, nearly costing me my life. I could have avoided surgery and lifelong
side effects if I had listened to and expressed my gut feelings, and requested
to be evaluated by someone else.</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">If you feel, deep down, that what you are hearing is not
right, or does not make sense, seeking an outside consultation may be wise. Trusting your physician is essential to a positive outcome. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">d. Your insurance says no</span></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2BoT05AG24X8PYfQpjxXgBddAk5HGTpi2SsWRQAYK3MxvrDQ-PVm9uXkcilB3qRtZEWhAU12-pUelCZbFzKqmQ6bV0m9e3MMD41gLxmEMkxV1fLqaRQgkS_JMCbDSJH5NZcmQP5IIUXMs/s1600/tablet.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2BoT05AG24X8PYfQpjxXgBddAk5HGTpi2SsWRQAYK3MxvrDQ-PVm9uXkcilB3qRtZEWhAU12-pUelCZbFzKqmQ6bV0m9e3MMD41gLxmEMkxV1fLqaRQgkS_JMCbDSJH5NZcmQP5IIUXMs/s1600/tablet.jpg" width="200" /></a><span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="color: #444444;"> </span></span><br />
<span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="color: #444444;">Lack of coverage on your policy for the prescribed treatment
or intervention may drive you to seek another physician's evaluation. Another red
flag would be in the form of an insurance authorization denial, especially
labeled as "not medically necessary".</span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="color: #444444;">While insurance companies deserve some bad press about
denying prescribed services, they mostly base their determination on FDA
recommendations and guidelines, scientific information and performance or
outcome data. The insurance case manager can guide you through to a second
opinion, appeal or external medical review process.</span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">e. It's not working</span></div>
<div class="MsoNormal">
<br />
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">When the prescribed treatment is not translating into
improvements, and especially if your doctor is unwilling to address or
recommend a change without a good explanation, consider getting another
opinion. Seek a specialist if your unresolved condition is currently managed by
a general practitioner, or if you locate a medical provider more familiar with
your specific diagnosis.<o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444;"><br /></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">f. The cost is an issue:</span></div>
<div class="MsoNormal">
<br />
<span class="Apple-style-span" style="color: #444444; font-size: x-small;">If you are self-pay, or if your policy has a high deductible
or share of cost, getting another opinion may save you money in the long run.
While this is less a medical second opinion than a financial one, a similar
intervention or treatment may be more affordable around the corner. If you are
quoted a price and have a detailed list of covered items and services, why not
consult somewhere else and potentially receive the same for less? <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-size: x-small;">g. Your insurance policy says so</span><span class="Apple-style-span" style="font-size: x-small;"> </span></span></div>
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<span class="Apple-style-span" style="color: #444444; font-size: x-small;">Before any treatment, surgical intervention (even
outpatient) or imaging, contact your insurance to find out if (1) an
authorization is required and/or (2) if a second opinion is necessary. Some
cases, mostly those considered elective, not medically necessary or
experimental, require additional supporting medical documentation from another
professional before it is covered.<o:p></o:p></span></div>
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<i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="color: #444444; font-size: x-small;">In conclusion:</span></i><br />
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<span class="Apple-style-span" style="color: #444444; font-size: x-small;">Involvement on the part of your insurance is usually
required in order to be paid. Contact customer service before making any
appointment, especially with a HMO policy. <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #444444; font-size: x-small;">Ask for a referral outside of the medical group or office where
you are currently a patient. It is quite unheard of for one physician to
contradict a colleague in the same practice or group. Go up the administrative
ladder if such request is denied by your insurance, or ask your state's
department of insurance for assistance. <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-size: x-small;">If your insurance will not cover the cost, pay cash. Negotiate
on the price ($ 350.00 to $500.00 depending on the severity of the diagnosis)
and forward all records before your appointment so that the time allotted is best
spent going over options and discussing treatment options. </span><o:p></o:p></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">All rights reserved.</span></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial"; font-size: x-small;"><i>My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">www.advimedpro.com</span></a><span style="font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">contact@advimedpro.com</span></i></a></span></div>
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<!--EndFragment-->
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<b><u><span style="color: #1c73ba; font-family: "verdana";">Patient Advocacy: Healthcare on your side</span></u></b><b><span style="color: #535353; font-family: "verdana";"><o:p></o:p></span></b></div>
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<b><span style="color: #1c73ba; font-family: "verdana"; font-size: 10pt;"><o:p> </o:p></span></b><b><span style="color: #1c73ba; font-family: "verdana"; font-size: 10pt;"><o:p> </o:p></span></b></div>
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<b><span style="color: #1c73ba; font-family: "verdana"; font-size: 10pt;"> a weekly blog by Martine Brousse, </span></b><b><span style="color: #535353; font-family: "verdana";"><o:p></o:p></span></b></div>
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<b><span style="color: #1c73ba; font-family: "verdana"; font-size: 10pt;">Healthcare Specialist, Patient Advocate, Certified Mediator</span></b><b><span style="color: #535353; font-family: "verdana";"><o:p></o:p></span></b></div>
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<span style="color: #1c73ba; font-family: "arial"; font-size: small;"><span style="color: #00c6ff;"><i><b>AdvimedPro</b></i></span></span><b><i><span style="color: #00c6ff; font-family: "arial"; font-size: 13pt;"></span></i></b></div>
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<b><i><span style="font-family: "arial"; font-size: 13pt;"><b><span class="Apple-style-span" style="color: red;">WHEN FLEECING PATIENTS IS LEGAL<o:p></o:p></span></b></span></i></b></div>
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<span style="font-family: "arial";"><b><span class="Apple-style-span" style="color: red;">(Or how insurance allowances are killing us)*</span><span class="Apple-style-span" style="color: #00c6ff;"><o:p></o:p></span></b></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif; font-size: small; font-style: normal; font-weight: normal;">This is the story of Y.L., a patient stuck with an outrageous liability, all legal, yet unconscionable and unjustifiable. This is due to the contract rates between the facility in Walnut Creek, CA where Y.L. received services and Anthem Blue Cross CA, her insurance company. These contracted rates were set by the patient's employer, a national bank (known by its old-time carriage logo). Apparently, money is no object there.</span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">While the patient is eager to pay her share, the excessive allowances she has been made responsible for, prompted her to seek a patient advocate to negotiate them down.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">Her story is the story of so many others in this country. A spotlight should be placed on these practices, as they add to the burden of patients, as well as that of companies and the healthcare system in general.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjJlq-21cGBDTwkyvLaRF39N2OauPtpsLMYpFCy-VFn_iwznHy90niPeLyyBJoLvGMNBllZAd_m6dnae9Uu-NBl8VT5V23k6957oYO1eQGT7PEUu1GEDgrGuK8mUMpWsLFtqVxlv_pe5pC/s1600/piggy+bank+hammer.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjJlq-21cGBDTwkyvLaRF39N2OauPtpsLMYpFCy-VFn_iwznHy90niPeLyyBJoLvGMNBllZAd_m6dnae9Uu-NBl8VT5V23k6957oYO1eQGT7PEUu1GEDgrGuK8mUMpWsLFtqVxlv_pe5pC/s1600/piggy+bank+hammer.jpg" style="cursor: move;" width="132" /></span></a><span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">Consider the simple lab called the Comprehensive Metabolic Panel. Usually reimbursed at around $ 15.00 to $ 20.00 by Medicare and commercial carriers, it is as commonplace and basic as they come, and is widely and easily performed.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">Why then would Anthem issue an allowance of $ $808.99 in this case? Why would this hospital even charge $ 1,244.60 for this test? Why would this patient be required to pay over $ 800.00 for something the corner lab or doctor's office could have run <b>for 40 times less</b>?<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">Next is the shocking $ 42.02 allowance by Anthem for 1 dose of Zofran, a common (generic) drug. Billed $ 64.65 for one dose/unit, the Medicare reimbursement is $ 0.16, that of commercial carriers a few pennies more. Again, a shocking discrepancy.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">Whether such excessive rates may be in violation of Consumer laws has been asked. I am definitely not an expert on the subject, but settling the patient with $800.00 for a service that only costs $ 15.00 might seem a bit suspect to some.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">This bill has more similar charges. Yet this hospital is inflexible, categorically refusing to even consider adjusting balances down or extend commonplace discount (such as "prompt pay") that other facilities (legally) routinely offer to their customers. It is not the only one in this area, and is not a specialized care center.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">Billing representatives and supervisors brandished "the policy" as a shield, while higher executives never responded to messages. The media department proved unable to accept phone messages, not responding to online inquiries. Even Anthem's representative phone request for a review and a possible discount, was rejected.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">The sad truth reflected by this case, is that self-funded employers, the ones with final decision about the benefits and reimbursements to be included in their insurance contracts, may not have much experience in setting those prices. Maybe they don't have or understand the financial limitations their employees face, or care because the company can afford such rates. Do all employees enjoy the size of salary allowing them to pay such bills without a second thought? <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">After all, if this bank can easily afford to get fleeced for $ 42.02 on a $ 0.16 pill, should its voiceless and powerless employees?<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">Management should scrutinize such financial matters as long as employees have deductibles and out-of-pockets, Linking contract rates for a self-funded group to those of the average contract in a specific state is often done. Calculating reimbursements based on existing data, such as Medicare rates, ASP rates for drugs, Usual and Customary used by commercial carriers is not an insurmountable task. As a long time billing manager, I know that unions and smaller self-funded groups are well aware of all allowances on their plan. When money counts, one pays better attention.<o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">In the end, I had to give up. The Explanation of Benefit is a legal form, used to bill the patient according to the terms of the policy. There is no arguing that the facility acted within its rights. <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "times" , "times new roman" , serif;">The patient will now make small payments over 60 months. What is the cost to send so many statements? What about burdening the books for 5 years? Would a prompt pay settlement not have saved operating costs? Would this not be a smart business move, embraced by many others?<o:p></o:p></span></div>
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<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><span class="Apple-style-span" style="color: #073763;">I wish someone at J.M. Hospital had answered my multiple requests for a talk. I hope the patient will follow through with openly and visibly exposing these practices, letting public opinion make its own mind. Good luck to her.</span><span class="Apple-style-span" style="color: #00c6ff; font-style: italic; font-weight: bold;"><o:p></o:p></span></span><br />
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<span class="Apple-style-span" style="font-family: "times" , "times new roman" , serif;"><span class="Apple-style-span" style="color: #073763;">* As seen on NerdWallet</span></span><br />
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objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-67919661113543905732014-08-05T10:14:00.000-07:002016-09-14T16:08:16.287-07:00Patient Advocacy: Healthcare on your Side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<b><span class="Apple-style-span" style="color: red; font-size: large;">Paying for Prescription Drugs<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"> <span style="font-size: small;">Part II: Pharmacy Prescriptions*</span><o:p></o:p></b></div>
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Once mostly confined to providing oral medications, pharmacies have seen an influx
of infused or injected drug orders in recent years. Due to a shift made by private
insurers from Medical benefits to Pharmacy benefits (benefitting their
pocketbook), the average patient's share of cost has climbed accordingly and substantially. <o:p></o:p>Seeing a treatment through to the prescribed end is a struggle for many Americans: more than half never finish a treatment, mostly due to financial concerns.<br />
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But all is not lost, as several ways exist to reduce one's
liability in addition to the options that were discussed in Part I of this blog. </div>
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<o:p></o:p></div>
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<u>1. Be savvy<o:p></o:p></u></div>
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Few people pay full price when they know a good sale is
happening elsewhere for the same item. Consider your prescription the same way.
Your local pharmacy may not be the cheapest as your insurance contracted rates
and policy are inflexible in determining pricing. <o:p></o:p></div>
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<br /></div>
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Ask about cash prices, they may be lower. Check out Costco, Wal-Mart
and Target. Their prices are usually more affordable. Costco even offers $ 5.00
brand-name prescriptions. A membership is not required; by law the pharmacy service
is available to all. <o:p></o:p></div>
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<br /></div>
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Check <a href="http://www.needymeds.com/">www.needymeds.com</a> for
direct links to coupons, rebates, assistance programs and discount cards.<o:p></o:p></div>
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<u>2. Inspect your prescription<o:p></o:p></u></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZv_1iv1sCz0fDZUxEQyC9EP-WVHzohzAksk0ksqxYFL9ityIgkiMpmEXNqjMxwgIj8_mtxZagKr-boApuiJKwBODKrZ3PBG6IpLqLMJxHXKTqydq5RVZSTCtMoVV_r4V_IUB5kAVpoRvH/s1600/Money+and+pills.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZv_1iv1sCz0fDZUxEQyC9EP-WVHzohzAksk0ksqxYFL9ityIgkiMpmEXNqjMxwgIj8_mtxZagKr-boApuiJKwBODKrZ3PBG6IpLqLMJxHXKTqydq5RVZSTCtMoVV_r4V_IUB5kAVpoRvH/s1600/Money+and+pills.jpg" width="200" /></a><u><br /></u></div>
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Do you really need a 90-day supply? Could you safely replace
the more pricy prescription strength with 2 (or more) over the counter alternatives?
Is there a generic equivalent? Can leftover pills you did not use up for a
similar condition be taken instead? Ask your doctor!<o:p></o:p></div>
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Be aware of potential waste: can you start with a smaller
amount, and get a refill once effectiveness has been established or allergic
reactions ruled out? <o:p></o:p></div>
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<br /></div>
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A little research, and a call to your physician, may save you a trip to the pharmacy... and
a bit of change. <o:p></o:p></div>
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<u>3. Communicate with your physician/office<o:p></o:p></u></div>
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Your physician is unlikely to know your financial situation
unless you bring it up. Ask for samples, or for less costly generic options. Ask
if a drug manufacturer's rep can be contacted to bring in samples or help with
an assistance application. <o:p></o:p></div>
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Explain that a high price may force you to skip on doses,
stretch the supply by taking less than prescribed, or forgo getting a refill
until your next paycheck is in. The physician should work with you to find a
satisfactory solution. If your treatment must be altered or adjusted due to
circumstances, your physician is best to determine how. <o:p></o:p></div>
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<br /></div>
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Inquire if the office supports a patient donation program. At the oncology practice I worked at as billing manager, patients donated the expensive growth
factor drugs (in pre-filled syringes) they had purchased, and were not going to
use to those in need. <o:p></o:p></div>
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<br /></div>
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Work with the billing department to see if a prescribed oral
treatment may be cheaper if done as an infusion in the office. This is the case
for quite a few chemo drugs for example. Whereas the oral form is brand name,
the infused version may be generic, saving you thousands of dollars. If your
policy does not force you to use one form over the other, your (financial)
wishes should be their command.<o:p></o:p></div>
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<u>4. Check federal and state benefits<o:p></o:p></u></div>
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<u><br /></u></div>
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Patients with Part D have
access to federal and state programs to help them cover the cost of
prescriptions. For info on the Extra Help Program, PACE program or MTM program,
call the Medicare Helpline at <span lang="RO" style="mso-ansi-language: RO; mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">1-800-MEDICARE
(1-800-633-4227) or visit </span><a href="http://www.medicare.gov/">www.medicare.gov</a><o:p></o:p></div>
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<br /></div>
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<span lang="RO" style="mso-ansi-language: RO; mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">All patients can determine whether eligible for benefits by visiting </span><a href="http://www.benefits.gov/">http://www.benefits.gov/</a><span style="mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;"><o:p></o:p></span></div>
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<br /></div>
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<u><span style="mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">5. Use your HSA
or FSA account<o:p></o:p></span></u></div>
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<u><br /></u></div>
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<span style="mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">The IRS allows a number of prescriptions, and
over the counter medications to be paid with your HSA or FSA account. Your FSA
will be lost to you if not used in full by the end of the year, make good use
of it at your pharmacy. <o:p></o:p></span></div>
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<span style="mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">For more info visit <a href="http://www.irs.gov/publications/p969/ar02.html">http://www.irs.gov/publications/p969/ar02.html</a><span style="mso-bidi-font-weight: bold;"> or consult a tax professional as these expenses are usually considered medical, and might reduce your tax liability when paid out of pocket. </span></span></div>
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<br /></div>
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<u><span style="mso-bidi-font-weight: bold; mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">In Conclusion<o:p></o:p></span></u></div>
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<br /></div>
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Prescription drugs
are expensive, and finding a fair price may require time and research...on an
ongoing basis. Trusting your preferred local pharmacy for any and all your
prescriptions may be a thing of the past, replaced by the shopping around we
already are familiar with for so many other items and aspects of daily life. <span class="Apple-style-span" style="color: red; font-size: large;"><b> </b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
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trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-80799185892416420082014-07-21T14:47:00.003-07:002016-09-14T16:11:25.783-07:00Patient Advocacy: Healthcare on your Side<!--[if gte mso 9]><xml>
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<!--StartFragment-->
<br />
<div align="center" class="MsoNormal" style="text-align: center;">
<br />
<br />
<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: red; font-size: large;">Paying for Prescription Drugs<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: red; font-size: large;"> Part I: Infused or Injected *</span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Infused or injected treatments are common, ranging from a
32-cent B12 injection to thousand-of-dollars chemotherapy infusions. Due to
medical and liability reasons, these are mostly given in office or facility settings,
and are billed to Medicare under part A(inpatient) or B (outpatient or office),
and to commercial insurances under the Medical benefits portion of the policy. <o:p></o:p></div>
<div class="MsoNormal">
Many such treatments use brand-name drugs, often associated
with prohibitive costs. These medications are not covered or payable under the
Pharmacy benefits of your policy when administered in hospital or office settings.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are options to lower your costs. Here are some tips: <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>1. Visit the Manufacturer's website<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
Almost all manufacturers offer so-pay assistance programs to
self-pay patients, or those with a high share of cost. While income
maximums may be in place, they are not mandatory. Grants can be generous ($
24,000/yr for Herceptin from Genentech for example), but will not cover
off-label (not FDA approved) use. Ask the office for an application form. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Self-pay or cash patients might qualify for free drug
donations, based on criteria specific to each product. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Medicare, Medicaid or Tricare patients are prohibited by law
from applying directly for funds, but may qualify for indirect assistance (see
below)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>2. Public & private Organizations<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
Every disease or condition has likely created an
organization dedicated to its education and support. Cancer patients, for example, have access to various general federal agencies, as well as numerous private societies.There, should be listed general and focused charities,
offering financial assistance and free resources. Healthwell or Copays.org are such well-known programs.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Please note that private funds often run out of funds early
each month; applying the first week is best. Grants are not retroactive so
requests should be made before a treatment starts.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>3. Do it at home<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some infusion treatments, including those less complicated
such as IV iron, IVIG, zoledronic acid for osteoporosis (Zometa, Reclast), etc, can
be safely administered at home by a visiting nurse. Although the first regimen will be
given in the office or facility to rule out any allergic reaction, subsequent
home treatments may be cheaper. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Take too into consideration these hidden costs: time taken off work to go to the office, parking fees, the risk of infection in crowded waiting rooms, or the discomfort of leaving home when not feeling well (especially after a chemo treatment).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr-MJasBrlDbQuZ1-pExp9e3tl7y3i5Ln2W63VW8CBzBiYfd6-bak37Mp3UB8YFgta1aEurCgewC_e5cxghhP0tIwEdPtjtQW2-Dbm8LuDQGeC0UVzg_WX3wzVO62uM2ipSwFzIO19moUa/s1600/piggy+bank+hammer.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr-MJasBrlDbQuZ1-pExp9e3tl7y3i5Ln2W63VW8CBzBiYfd6-bak37Mp3UB8YFgta1aEurCgewC_e5cxghhP0tIwEdPtjtQW2-Dbm8LuDQGeC0UVzg_WX3wzVO62uM2ipSwFzIO19moUa/s1600/piggy+bank+hammer.jpg" width="132" /></a>Injections such as growth factors for anemia (Procrit,
Aranesp) or for neutropenia (Neupogen) for example, can safely be
self-administered (syringes come pre-filled and require no medical
background). Others like B12 injections can be administered at home via a home health agency.<span style="mso-spacerun: yes;"> In these cases, your pharmacy benefits, or Part D will be responsible for the authorization, delivery and payment of the drug. </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
Calling your insurance carrier to compare
costs, verify coverage and work the set-up is a must. As this option creates more paperwork
for your doctor, and extends his legal liability beyond his active control, he
is likely to be more supportive if most details, such as locating an in network
home health provider, have already been worked out. <span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
<u>4. Use specialized mail order pharmacies. <o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
If you are self-injecting at home without the help of a
health agency, your prescriptions will be filled at your local or mail order
pharmacy. Try contacting TNH or US Bioservices in such cases. They may
not be contracted with your insurance, but their staff is trained to locate and
apply for financial assistance on behalf of patients. This service can save you
$ and efforts. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>5. Question your physician<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Convenience and habit may lead to prescribing costly regimens and medications
when cheaper or generic alternatives are equivalent. Less expensive treatment
options are often available, with the added advantage of having proven their
value and effectiveness. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
An active dialogue with your physician, especially when
explaining your financial situation, can benefit both sides. After all, the
office has an incentive to help you in order to get paid promptly in
return. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>In conclusion:<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
There may be more help out there for you than you may
realize. I specialize in oncology, and know that for a fact for cancer
patients. Asking the office staff is the first step, doing basic internet
research is next. For those who are not computer-savvy, your local library,
church or teenage neighbor may be helpful. <o:p></o:p><br />
<br />
<span style="color: blue;">* as seen on NerdWallet</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<div style="text-align: center;">
<span class="Apple-style-span" style="color: #134f5c;"><b>Next week: Part II: Oral Prescriptions</b></span></div>
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<div class="MsoNormal" style="line-height: 18px; text-align: justify;">
<div align="center" class="MsoNormal" style="color: #666666; text-align: center;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div align="center" class="MsoNormal" style="color: #666666; text-align: center;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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</div>
</div>
</div>
</div>
</div>
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<!--EndFragment-->
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-38809355047423070322014-07-21T14:21:00.001-07:002016-09-14T16:13:54.809-07:00Patient Advocacy: Healthcare on your Side<!--[if gte mso 9]><xml>
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<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span style="color: #1c73ba; font-family: "arial"; font-size: small;"><span style="color: #00c6ff;"><i><b></b></i></span></span><b><i><span style="color: #00c6ff; font-family: "arial"; font-size: 13pt;"></span></i></b></div>
</div>
<br />
<b><span style="color: red; mso-fareast-language: JA;"><br /></span></b>
<b><span style="color: red; font-size: large; mso-fareast-language: JA;">4 Tips for Successful Insurance Appeals</span></b></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">In the mysterious world of insurance appeals, final determinations are
based on the merit of your grievance, your insurer</span><span style="font-family: "american typewriter"; mso-bidi-font-weight: bold; mso-fareast-language: JA;">'</span><span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">s
policy and your plan benefits. Following these tips may lead to better
outcomes.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">1. Know the Facts<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Providers should be initiating the vase majority of appeals. They have
the medical, coding, and technical knowledge to do so. If they
refuse, or are unable to do so, you should, at a minimum, receive all relevant
supportive documentation. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">If a claim was rejected for billing errors (incorrect codes, diagnosis
ID, etc), filing an appeal is a waste of time as only a processed and paid
claim can be appealed. Your doctor's billing person should resubmit corrected charges,
or provide your insurer with any requested documentation. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">If a charge is rejected as "non-covered, not a benefit of the plan,
not reimbursable under the insurance guidelines, experimental, off-label, not
medically necessary or out of network", a talk with the office manager at
your office is in order. Was this info known to the office but not communicated?
Were your benefits verified before services were rendered? Is it a simple clerical
error? <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Answers will determine whether this is now appeal material, an financial
issue between you and the provider, a third party responsibility (i.e. an
incorrect dx given to the lab whose claim was rejected) or your own error (i.e.
you did not share your new ID card). </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">2. Who should appeal? <o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">If the office is responsible, it should take immediate corrective steps, send
records, or update information. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Billing mistakes made by secondary providers (labs, imaging centers) are
common. Call them to give your new insurance ID or address. Many denials occur
when invalid or non-payable diagnosis codes are forwarded with the order or
prescription. Your MD cannot be expected to know each payable dx for every
outside service. Updating the order in your chart must be completed before the
appropriate biller can resubmit the charges with a payable code. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">If information was withheld from you, either deliberately or by
ignorance, insist the office appeal to your insurer with comprehensive
explanations and detailed clinical justification from accepted sources.
Best undertaken by both the patient and the provider, this process calls for
payment due to "medical necessity". <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">If you had no choice or option, and are being billed for services
considered "out of network" or "non covered", do file an
appeal, especially if these were rendered under emergency conditions. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">When in doubt, go ahead and file. You are within your rights to ask that
your claims be reviewed, and your financial responsibility confirmed. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u style="text-underline: #004282;"><span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">3. Be Clear and precise<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Why you are requesting the review of a charge? Asking your insurer to
reprocess a claim just "because they did not pay or not enough"
almost guarantees a denial of your request. Computers process claims, not
people. They seldom make mistakes (computers not people!). As an actual person
will review your appeal letter, the exact reason(s) of your request should
be clear. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Invoke your right to a "continuation of care" level of coverage
if your Dr cancelled his/her contract in the middle of treatment and
claims were paid "out of network". Demand payment of non-contracted
charges based on your emergency hospitalization as the law states. Demonstrate that "medical
necessity" was met for a prescribed treatment or procedure by using your medical
records, and supportive industry or Medicare guidelines. Ask for a reversal of
a denial based on specific and unusual circumstances. Brand drug manufacturers offer
ready-made sample letters to appeal coverage of their products. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u><span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">4. Attach relevant documentation<o:p></o:p></span></u></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Documentation is essential to any appeal. No or little documentation =
not much hope of success. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">While I would not recommend sending truckloads of papers to the reviewer,
ask the staff to provide the most appropriate clinical records to make your
case. Ask them to direct you to related websites, significant studies, important
links and online resources to add supportive documentation. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">You may need to request records from a third party, usually the physician
who ordered a specific lab, test or imaging service, in order to get medical
justification and prove medical necessity. Remember to include the
original order or prescription with your attachments.</span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Mail a copy of the appeal to the related provider, and ask for the
financial responsibility to be shifted back to the insurance during this
process. If the provider refuses, make small monthly payments to
keep your account current, show good faith and avoid collection action.</span><br />
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;"><br /></span>
<br />
<div class="MsoNormal" style="text-align: justify;">
<div class="MsoNormal" style="line-height: 18px; text-align: justify;">
<div align="center" class="MsoNormal" style="color: #666666; text-align: center;">
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
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</div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="color: #666666; font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">All rights reserved.</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial"; font-size: x-small;"><b><i><br /></i></b></span></div>
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<div style="text-align: center;">
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
</div>
</div>
<br />
<b><span style="mso-fareast-language: JA;"><br /></span></b>
<b><span style="mso-fareast-language: JA;"><br /></span></b>
<b><span style="mso-fareast-language: JA;"><span class="Apple-style-span" style="color: red; font-size: large;">5 Tips to get the Medical Office </span></span></b><br />
<b><span style="mso-fareast-language: JA;"><span class="Apple-style-span" style="color: red; font-size: large;"> Staff on your side</span><o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-align: center; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">The medical office staff member: they can be uncooperative, unfriendly
and even seemingly uncaring. How can you reconcile your needs and rights with
their schedule, training, orders...and attitude? Cooperation and a little
give-and-take are key!</span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">As the healthcare system is transforming under ACA
("Obamacare") implementations, medical providers have had to adapt to
a dizzying number of new requirements, technological upgrades, legislative
mandates and compliance deadlines. Sweeping changes are apparent: clinical
staff spend much face-to-face time typing away on tablets, automated phone systems are the norm, phone calls rarely lead to a live
person. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Cost-cutting measures brought on by the economic turndown, the ongoing
drive toward leaner financial operations, finding additional resources to cover
the price tags for new technology and lower insurance reimbursements have prompted
offices to employ fewer staff, while workloads have increased in complexity and
size. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Healthcare workers are too often overworked, understaffed and overwhelmed.
As a billing manager and primary patient contact for 20+ years, I understand
their frustrations but this is the career they chose. Here are some
tips to turn these employees into allies.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">1. <u style="text-underline: #0008EA;">Politeness goes a long way</u></span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">The old standard way of being demanding, using abusive language,
"showing who you are" may get you a result in the short term. But a
bit of caution: you will be tagged as "difficult". Perceived mistreatment
of one staff member gets around, and passive collective resistance applies. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">2. <u style="text-underline: #0008EA;">Required: a little
patience</u></span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Understand that the receptionist has no power over the doctor falling
behind on his schedule, or that your labs can't be drawn without a MD
signature. Pushing staff around will not get the doctor out of another exam room
faster. Electronic Health Records orders take more time to generate than a
scribble on a piece of paper. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Do reschedule if the wait is too long. As this is not your fault, the office should be
receptive. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<span style="mso-fareast-language: JA;"><o:p></o:p></span><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">3. <u style="text-underline: #0008EA;">Mistakes happen</u></span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Reporting a clinical error to the physician immediately is crucial. Bring
ongoing or un-rectified administrative errors to the attention of the office
manager. An occasional blunder should be corrected, blamed on a temporary
but uncommon lapse in efficiency and forgotten. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;"> </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">4. <u style="text-underline: #0008EA;">Do your share </u></span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">At your first visit, bring your ID and insurance card (legally required to
be copied into your chart). Give an up-to-date medication list and the name of
other treating physicians. Indicate the contact info of your preferred pharmacy.
Bring a translator if necessary, and one support person to take notes and help
you remember your questions. More is a crowd, and too disruptive.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Consider booking the first appointment of the day or after lunch for
follow-up visits. Fridays are usually lighter days; your wait time will be
shorter. Report any changes to your medication list, insurance coverage or
health history. Follow up on authorization requests, labs results or
prescription orders; waiting for a call may cause unnecessary delays. Confirm any
new physician you might be referred to, contracts with your insurance
network. </span><span style="mso-fareast-language: JA;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;">Collaboration is one of the Cs in Success (or is it cooperation??). Helping
the staff, with a minimum of effort on your part, will pay off, especially when
you ask for a favor or expedited action. But don't forget your rights and stand
by them!<o:p></o:p></span><br />
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;"><br /></span>
<span style="mso-bidi-font-weight: bold; mso-fareast-language: JA;"></span><br />
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<div align="center" style="line-height: 13.5pt; text-align: center;">
<b><span style="color: #666666; font-family: ""trebuchet ms"","serif";">©
[2016] Advimedpro.</span></b><span style="color: #666666;"></span></div>
<div align="center" style="line-height: 13.5pt; text-align: center;">
<b><span style="color: #666666; font-family: ""trebuchet ms"","serif";">©
[2016] Martine G. Brousse.</span></b><span style="color: #666666;"></span></div>
<div align="center" style="line-height: 13.5pt; text-align: center;">
<b><span style="color: #666666; font-family: ""trebuchet ms"","serif";">All rights reserved.</span></b></div>
<div style="line-height: 13.5pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<i><span style="color: #df5050; font-family: ""arial"","serif";">My objective is
to offer you, the patient, concrete and beneficial information, useful tips,
proven and efficient tools as well as trustworthy supportive advice as you
deal with a system in the midst of sweeping adjustments, widespread
misunderstandings and complex requirements</span></i><span style="color: #df5050; font-family: ""arial"","serif";">.</span><br />
<div style="line-height: 13.5pt;">
<br /></div>
<div style="mso-line-height-alt: 13.5pt;">
<b><span style="color: blue; font-family: ""arial"","serif"; font-size: 18.0pt; mso-bidi-font-family: Arial;">Advimed<i>Pro</i></span></b><b><span style="color: #1c73ba; font-family: ""arial"","serif"; font-size: 18.0pt; mso-bidi-font-family: Arial;"> </span></b><span style="color: #0009ff; font-family: ""arial"","serif"; font-size: 18.0pt; mso-bidi-font-family: Arial;"> </span><span style="color: #0009ff; font-family: ""arial"","serif"; font-size: 13.0pt; mso-bidi-font-family: Arial;">(</span><span style="color: blue; font-family: ""arial"","serif"; font-size: 13.0pt; mso-bidi-font-family: Arial;">424) 999
4705 or (877) 658 9446 fax (424) 226 1330</span><span style="color: #666666; font-family: Arial;"></span></div>
<div style="line-height: 13.5pt;">
<b><span style="color: blue; font-family: ""arial"","serif"; font-size: 13.0pt; mso-bidi-font-family: Arial;">
</span></b><span style="color: blue; font-family: ""arial"","serif"; font-size: 13.0pt; mso-bidi-font-family: Arial;">
</span><span style="color: blue; font-family: Arial;"><a href="http://www.advimed.us/"><span style="font-family: ""arial"","serif"; font-size: 13.0pt;">www.advimedpro.com</span></a></span><span style="color: blue; font-family: ""arial"","serif"; font-size: 13.0pt; mso-bidi-font-family: Arial;"> <i>contact@advimedpro.com</i></span><span style="font-family: Arial;"></span></div>
</div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-11872064607714190002014-07-07T14:57:00.003-07:002016-09-14T16:31:32.159-07:00Patient Advocacy: Healthcare on your side<!--[if gte mso 9]><xml>
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<b><i><span style="color: #00c6ff; font-family: "arial";"><o:p><span class="Apple-style-span" style="font-size: large;">Identifying Oral Medications</span></o:p></span></i></b></div>
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<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">This question was recently asked: <i>"</i><i>My husband and I have many prescriptions to take,
some for chronic conditions, some to use when needed. We are finding pills in
containers that are not the original ones from the pharmacy, like in a
traveling pill container. We are on a tight budget and cannot afford to throw
away and replace those pills we cannot identify. Do you have any tips?"</i></span></div>
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<!--StartFragment--><span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">The
price of prescriptions can be prohibitive, and I understand the concern about
throwing good pills away then paying hard earned money to have them filled.
However, safety should always be your first concern. <!--EndFragment-->Identifying
a pill is one thing, knowing how old it is is another. Expired medications are
ineffective at best, hazardous at worst. </span></div>
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<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
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<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;">Here are some things to consider in this process:</span></div>
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<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">1. Take
the pills you cannot identify to your regular pharmacist or doctor. Based on your
prescription history, he/she will be able to recognize and name them. </span></div>
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<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
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<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;">2. Contact your insurance to get an itemized list of the prescriptions you have purchased recently. This might help you, your doctor or your pharmacist determine the expiration date of your supply. </span></div>
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<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
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<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;">3. Use specialized websites:</span><br />
<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span class="Apple-style-span" style="font-family: "trebuchet ms" , sans-serif;"><span style="color: #073763;">The National institute of Health website allows you to upload an image of your medication for identification:</span><span style="color: #0c343d;"> </span></span></div>
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<a href="http://pillbox.nlm.nih.gov/index.html" target="_blank"><span class="Apple-style-span" style="font-family: "trebuchet ms" , sans-serif;"> http://pillbox.nlm.nih.gov/index.html</span></a><br />
<span class="Apple-style-span" style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">Others rely on your description:</span></div>
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<!--StartFragment--><br />
<div class="MsoNormal" style="text-align: left;">
<span class="Apple-style-span" style="font-family: "trebuchet ms" , sans-serif;"><a href="http://www.drugs.com/pill_identification.html" target="_blank">http://www.drugs.com/pill_identification.html</a><a href="http://www.drugs.com/pill_identification.html" target="_blank"> </a><!--EndFragment-->
</span><br />
<a href="http://www.webmd.com/pill-identification/default.htm"><span class="Apple-style-span" style="font-family: "trebuchet ms" , sans-serif;">http://www.webmd.com/pill-identification/default.htm</span></a><br />
<span style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">4. Use an app</span><br />
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">There are many apps, for Android and iTunes, with pill ID features. </span><br />
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">These are free: </span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirHc4cnxSLa3hanEFiimMGAYFXEnHHk6goSG7Xo32niLFDwGoU2gewEh270X0Qv_FSmK686nF1xGvKpraRN5JRXHrpgLTmEeKj4dbRIsqqcKsIk2u57ceNBH0LJ09Ch66OFgN6uph10vyy/s1600/ipharmacy.tiff" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirHc4cnxSLa3hanEFiimMGAYFXEnHHk6goSG7Xo32niLFDwGoU2gewEh270X0Qv_FSmK686nF1xGvKpraRN5JRXHrpgLTmEeKj4dbRIsqqcKsIk2u57ceNBH0LJ09Ch66OFgN6uph10vyy/s1600/ipharmacy.tiff" /></a></div>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><i><br /></i></span>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">iPharmacy</span></i><br />
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><i><br /></i></span>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><i><br /></i></span>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7WKmdKrEUNoKN8OcbAdx1ygZcfTFX7YwlQ8Qik0G92-kGpFcnH8a1BiMXbfB9pfHQmav8iwmumUQ9l0h6la-C-epeNv8waI0Y134h8VPjXgIFXhwJ4eGMp0J6xMh95tqNu2mBiHKXfK2Y/s1600/epocrates.tiff" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7WKmdKrEUNoKN8OcbAdx1ygZcfTFX7YwlQ8Qik0G92-kGpFcnH8a1BiMXbfB9pfHQmav8iwmumUQ9l0h6la-C-epeNv8waI0Y134h8VPjXgIFXhwJ4eGMp0J6xMh95tqNu2mBiHKXfK2Y/s1600/epocrates.tiff" /></a><i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i><br />
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">epocrates</span></i><br />
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOqRGdBszNWpqZn1hyphenhyphenbRFtIzAkdND5TSnhXdrOMPxzs0k6hAxF-Y1hPYEdEjcR_b1tBZ6i5xXpyow6JeOLJfs9PqEbGFBMkaYamJWpHEmgSOb286M7qmV5Z9kDWetQjOAIOyyO0Gz_YC7E/s1600/drugs.com.tiff" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOqRGdBszNWpqZn1hyphenhyphenbRFtIzAkdND5TSnhXdrOMPxzs0k6hAxF-Y1hPYEdEjcR_b1tBZ6i5xXpyow6JeOLJfs9PqEbGFBMkaYamJWpHEmgSOb286M7qmV5Z9kDWetQjOAIOyyO0Gz_YC7E/s1600/drugs.com.tiff" /></a><i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i><br />
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">drugs.com</span></i><br />
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><i><br /></i></span>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<i><span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></i>
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><i><br /></i></span>
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><i>In conclusion: </i></span><br />
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;"><b>Use caution:</b></span><br />
<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">
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<span class="Apple-style-span" style="color: #073763; font-family: "trebuchet ms" , sans-serif;">Be absolutely certain the medications have not expired or were never
subjected to conditions which may have affected them negatively. (i.e. lack of
refrigeration, exposure to light or humidity) before using them. When in doubt, consult your healthcare specialist, pharmacist or other medical professional before using any medication, over the counter or prescription. </span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><i><br /></i></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
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</div>
</div>
</div>
</div>
</div>
<div align="center" class="MsoNormal" style="color: #666666; text-align: center;">
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
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<span class="Apple-style-span" style="color: #666666; font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">All rights reserved.</span></b></span></div>
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-family: "arial"; font-size: x-small;"><b><i><br /></i></b></span></div>
</div>
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</div>
</div>
</div>
<div style="text-align: center;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="line-height: normal; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial"; font-size: x-small;"><i>My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-19218830447862887062014-06-23T11:33:00.000-07:002016-09-14T16:32:54.240-07:00Patient Advocacy: Healthcare on your Side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<span class="Apple-style-span" style="color: #cc0000; font-family: "arial"; font-size: large;"><b>Your Patient Right: </b></span><br />
<span class="Apple-style-span" style="color: #cc0000; font-family: "arial"; font-size: large;"><b> Right to an Interpreter</b></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">One of the lesser known rights patients are now enjoying since the implementation of the ACA ("Obamacare") is the right to an interpreter. This is your right in a doctor's office, when in communication with your insurance, or when receiving medical services of any kind. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">Yet, patients confronted with the need for translation often find that this right is not fully enforced in many instances. Whether a foreign visitor, elderly parent or new immigrant without command of the English language, here are a few tips to getting the help you need.</span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";"><u>1. Contact your insurance</u></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">When signing up for insurance, it is now customary that customers be asked and assigned a preferred language. Insurance companies are mandated to provide their subscribers with written and verbal translation services whenever appropriate or requested. While representatives fluent in Spanish might be more readily available than one speaking Hmong or German, every effort must be made to allow and encourage a proper and effective dialogue. </span><br />
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">Travel and foreign emergency insurances automatically provide translation support for their subscribers. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">When looking for a new doctor, call your insurer first. You can be referred to a provider both able to converse with you, and within your plan network, saving you $ in the process. Offices share their language capacity with insurers. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";"><u>2. Contact the staff</u></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">It is advisable to call the office before an appointment, and ask for an interpreter. This is probably where you will meet the most hurdles, as most offices do not have access to translators unless one of their staff member speaks your language. In such cases, advance notice will help lower the impact of this employee leaving her duties to assist you. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">Most practices will ask you to come with your own translator. Due to HIPAA regulations, and the need to protect your medical history and records, as well as cost, hiring an outside interpreter is unlikely on the office part. Hospitals are better able to provide such a service through a much larger staff pool.</span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";"><u>3. Ask a friend or relative</u></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">Rather than wasting time and effort communicating with your doctor via sign language, consider bringing a friend or relative with you, especially in serious or complicated cases. For routine exams or basic visits (to a lab, for Xray), calling someone on the phone </span><span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">who can translate </span><span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">might be enough. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";"><u>4. Contact your State</u></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">In CA, the Office of the Patient Advocate offers a variety of tools, resources, brochures and information on the healthcare system in several languages. English, Spanish, Korean, Vietnamese, Russian, Farsi and Hmong are some of the options. Information may be downloaded directly, or requested by mail. This agency also offers assistance with filing complaints or reporting violations. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial";">Call them at 888-466-8900 or visit <a href="http://www.opa.ca.gov/">http://www.opa.ca.gov</a></span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial" , "helvetica" , sans-serif;">Other states should offer similar services. Contact the insurance Commissioner's office for information. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial" , "helvetica" , sans-serif;">Giving up this right because of poor planning or unforeseen circumstances should not deter you from seeking medical care. In case of a true emergency, your local embassy or consulate may be able to help out, or refer you to a trustworthy translator for hire. </span></div>
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<span class="Apple-style-span" style="color: #0b5394; font-family: "arial" , "helvetica" , sans-serif;">Patient advocates may also be able to assist you. Many such as myself, are fluent in other languages, and are familiar enough with the system to provide you with this service, and with ethical and trustworthy privacy. </span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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objective is to offer you, the patient, concrete and beneficial
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trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-59034309814378618582014-06-16T08:56:00.003-07:002016-09-14T16:37:12.800-07:00Patient Advocacy: Healthcare on your Side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<span style="color: blue;"><span style="color: #1c73ba; font-family: "arial"; font-size: small;"><i><b></b></i></span></span><b style="font-weight: bold;"><i><span style="color: #00c6ff; font-family: "arial"; font-size: 13pt;"><o:p></o:p></span></i></b></div>
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<span class="Apple-style-span" style="color: red; font-size: large;"><b>The 411 on Patient Refunds*</b></span></div>
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As a billing manager for many years, and a patient advocate, the subject of overpaid accounts has come up all too often. If patients were truly aware of how much sits, not refunded to them, in the books of medical providers, they might gather pitchforks and descend onto offices to reclaim their money. </div>
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This is a ugly yet common practice in the industry. While it has worked well for many providers, it is time to let the public in on the deal, and come clean with patients who are, after all, customers. Does the clerk at the supermarket, or at any other business, require your formal request to hand over your change? Does your credit card company not send you a statement indicating you have a credit balance? </div>
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<u>1. Why is it happening? </u></div>
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Unlike any other business, insurance reimbursement will take a couple of weeks at best, months at worst. Paid charges may be appealed or disputed, payments recouped or claims denied or pended. Account balances remain fluid until fully settled, yet patients are usually billed after the first insurance notice. Even if the error or the fault for a denial lies with the medical provider, the patient will receive a statement of insurance non-payment. Threats of collection action will prompt your writing a check. </div>
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The other major side to this sad story is "office policy". Though rarely advertised (and for cause!), many practices have a "refund on demand" rule. Don't ask? Don't get!</div>
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The administrative burden of processing refunds as soon as a positive balance is noted is often cited as the main excuse. While it is a valid reason, a good compromise would be "refund on demand for sums under $ 50.00 or $ 100.00", and automatic reimbursements for larger overpayments. </div>
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<u>2. Common reasons for credit balances:</u></div>
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<li><span style="font-size: x-small;">Premature payment: your claim had not reached final processing before you received a doctor's bill.</span></li>
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<li><span style="font-size: x-small;">Pre-Payments: the office demands your payment up front, to cover a deductible, or if out of network. </span></li>
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<li><span style="font-size: x-small;">Double coverage: If you have two policies, especially primary, overpayments are more likely.</span></li>
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<li><span style="font-size: x-small;">Double payments: an assistance program may have made payment on a charge, or you may have paid the same bill twice. </span></li>
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<li><span style="font-size: x-small;">Billing error: an erroneous adjustment may have been posted or an inaccuracy in the billing process may have occured. If you have a common name, expect such errors. </span></li>
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<u>3. What can you do?</u></div>
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Keeping track of your bills, insurance explanations of benefits ("EOB") and payments is crucial. Any statement not matching an EOB should be questioned, and a call placed for confirmation or clarification. </div>
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Request a copy of your ledger, or itemized bill, at the end of each year, or after your last visit to a medical facility. Useful for tax purposes as well, it will allow you to scan for errors and check the balance. </div>
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Get receipts for any payments, especially if paying cash. At the time of payment, indicate on it whether this is an advance on a future liability, partial payment or payment in full. </div>
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Decline to make a payment in advance, even if you have not met your deductible or yearly liability. A contractual adjustment will reduce your bill, but it often is difficult to know how much before a claim is processed. If the facility is in network, they should not ask for any up front payment except for the set office co-pay.</div>
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At any suspicion or knowledge of an overpayment, contact the billing department and ask for a refund. While it is certainly unprofessional and deeply disrespectful of patients, expect to wait a while before a check is cut. Many offices are on top of billing patients but are reluctant, if not outright combative about refunding them. </div>
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Do not hesitate to contact the office manager or physician if you are given the run-around or further delay is unacceptable. A complaint to your insurer might be helpful too. </div>
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<u>In conclusion:</u></div>
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A French saying proclaims:" Good accounting makes for great friends". This goes for your medical providers and health practitioners. If you cannot trust the staff or the practices they follow, can you really trust the practitioner? </div>
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If transparency and patient satisfaction are two important cornerstones of the ACA ("Obamacare") reforms, then surely this practice must be ended. </div>
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* as seen on NerdWallet<br />
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Advimedpro.</span></b></span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-13500933666128849992014-06-11T08:13:00.003-07:002016-09-14T16:42:56.707-07:00Patient Advocacy: Healthcare on your Side<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRcgzsOCAwLWqjt1q9ANIMd0SSf4DAqzt6r86eo0dQrA6bZikFBnQ-YiJhEOQdmD6_3iiIWSEmZV6UFW8gq2ctT7tIkUKfTBSE4NACzIawiWbE93m4k5a2-t3w5sKocpo5zdtTTOUP5JOQ/s1600/log+++jpego.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRcgzsOCAwLWqjt1q9ANIMd0SSf4DAqzt6r86eo0dQrA6bZikFBnQ-YiJhEOQdmD6_3iiIWSEmZV6UFW8gq2ctT7tIkUKfTBSE4NACzIawiWbE93m4k5a2-t3w5sKocpo5zdtTTOUP5JOQ/s1600/log+++jpego.jpg" /></a><br />
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<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
<br />
<br />
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<b><i><span style="color: #00c6ff; font-family: "arial"; font-size: 13.0pt;"><o:p> </o:p></span></i></b><span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="color: blue;"> </span><span class="Apple-style-span" style="color: red;"><b>Should you trust (and pay) statements </b></span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="color: red;"><b> from your medical providers? </b></span></span></div>
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<span class="Apple-style-span" style="color: #444444; font-size: x-small;"><b><i><u><br /></u></i></b></span></div>
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<span class="Apple-style-span" style="color: blue;"><span style="font-family: "times";">In my professional career, I have observed that patients tend to fall into two opposite categories. The
"trusting" types always pay whatever amount is indicated, while the
"questioning" ones rarely do so until a final or collection notice is
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<span class="Apple-style-span" style="color: blue;"><span style="font-family: "times";">The common excuses of the
latter types are their lack of trust in the amount billed or their waiting for
explanations (they usually do not request). The former trusts the billing staff as they do their doctor. <o:p></o:p></span></span></div>
<span class="Apple-style-span" style="color: blue;">
</span>
<br />
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<span class="Apple-style-span" style="color: blue;"><br /></span></div>
<span class="Apple-style-span" style="color: blue;">
</span>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span class="Apple-style-span" style="color: blue;"><span style="font-family: "times";">Here are some guidelines to
help you determine when to pay and when to wait. <o:p></o:p></span></span></div>
<span class="Apple-style-span" style="color: blue;">
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u style="text-underline: #0009FF;"><span style="font-family: "times";">1.
Check your insurance policy<o:p></o:p></span></u></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Each January, find out
what amounts you can expect to ultimately be responsible for in the coming
year. What is your yearly deductible (the sum you pay first before your
insurer starts issuing payment)? What is your yearly out of pocket (your
percentage of the cost before your insurer pays 100%). Do you have an office
co-pay (set fee)? <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Contact your insurance if the
terms of your policy are unclear or confusing. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u style="text-underline: #0009FF;"><span style="font-family: "times";">2.
Verify and compare<o:p></o:p></span></u></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Every amount listed on your
provider's statement (doctor, facility, imaging center, lab etc) should match
your insurance Explanation of Benefit (EOB). You can also go online to check
whether a claim has been paid, and what is your total liability. If the
statement's balance matches the EOB's: you owe this amount.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "times";">A spreadsheet at the time of matching statements
and EOBs is a great visual help for you, and for your tax person during tax
season. </span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u style="text-underline: #0009FF;"><span style="font-family: "times";">3.
If you have not received an EOB<o:p></o:p></span></u></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Further research may be
required. <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-zXwAm-HNVm_KeoyeL9tvW75NTOt0gwYYLM8FvVMHSZmoIpZ2FgSZ8dhQLYjwxnGewHL-Ex4h1ttTHhITxb8snglK4Rji2Ptja8xHPmmUfE4ky3RT41tNkw04T16aOffHygbQ4BEbDb66/s1600/claim+form.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-zXwAm-HNVm_KeoyeL9tvW75NTOt0gwYYLM8FvVMHSZmoIpZ2FgSZ8dhQLYjwxnGewHL-Ex4h1ttTHhITxb8snglK4Rji2Ptja8xHPmmUfE4ky3RT41tNkw04T16aOffHygbQ4BEbDb66/s1600/claim+form.jpg" width="200" /></a></div>
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<span style="font-family: "times";">Has the claim not been
sent? More medical offices no longer handle claims, leaving it to patients
to mail them. If you have been handed a claim form or an itemized bill, make
sure to forward it to your insurance for processing. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">A first statement may
just be a notification or description of services rendered. Confirm a claim has
been processed before paying such a "notice".<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Does the provider have your
correct information? If you received a new card, forward a copy to the office:
an identifying number or claim address may have changed. Charges may have
been denied for the incorrect info. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u style="text-underline: #0009FF;"><span style="font-family: "times";">4.
If your EOB does not match</span></u><span style="font-family: "times";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Is the claim pending by
your insurance for additional information? The EOB will indicate what is needed.
It could be required from you (info regarding another possible primary coverage,
verification of a dependent status, or return of a health questionnaire or from
your medical provider (address update, medical records). In this case, forward
a copy of your EOB to the billing department and demand prompt handling. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Consider calling the
billing person, to verify contractual adjustments were correctly applied, or
ask for justification. After all, mistakes happen. You may also contact your
insurance for explanations. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Is the provider "out
of network", meaning not within the contractual network your policy
covers? If this is the case, you will need to negotiate a settlement as you are
liable for whatever amount is billed to you. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">However, if services were
rendered to you by an out-of-network provider at an in network facility or setting,
especially if you had no choice, an appeal to your insurance should be
fruitful. Your insurer, once informed you are being billed for the full amount,
would likely propose a financial settlement or issue additional benefits to
reduce, or cancel, your balance. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<u style="text-underline: #0009FF;"><span style="font-family: "times";">5.
What are your rights? <o:p></o:p></span></u></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">In case of any conflicting
or unclear paperwork, you are entitled, as a patient, to receive concrete explanations
from your insurance carrier. You may also file an appeal, and ask for a review
or reprocessing of any charge. Detailed steps and specific forms are available
in your policy booklet or online. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">As your creditor, the
medical office has the burden to detail and explain any liability billed to
you. Although many do not, by choice or lack of understanding or training on
the part of their staff, do not give up. A call placed to an office manager or
doctor will usually resolve such issues. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "times";">Filing complaint to the
insurance company, a grievance to your state commissioner's office or medical
board is next. <o:p></o:p></span></div>
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<u><span style="font-family: "times";">In conclusion: <o:p></o:p></span></u></div>
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<u><br /></u></div>
<div class="MsoNormal">
<span style="font-family: "times";">While ignoring a bill from your medical provider
is never a good idea, paying up without checking the amount billed to you is
not recommendable either. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "times";">Your insurance should be your primary guide when
determining if a bill is owed, and how much. Discussing charges with the
billing department is a right to exercise whenever appropriate. <span class="Apple-style-span" style="font-size: medium;"><o:p></o:p></span></span></div>
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objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-71608017927151334572014-06-03T10:05:00.000-07:002016-09-14T17:38:17.766-07:00Patient Advocacy: Healthcare on your Side<br />
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
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<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<span style="color: #1c73ba; font-family: "arial"; font-size: small;"><span style="color: #00c6ff;"><i><b></b></i></span></span><b style="font-weight: bold;"><i><span style="color: #00c6ff; font-family: "arial"; font-size: 13pt;"><o:p></o:p></span></i></b></div>
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<span class="Apple-style-span" style="color: red;"><b><span class="Apple-style-span" style="font-size: large;">Brown/White Bagging: A disturbing trend</span></b></span></div>
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Over the last few years, a disturbing trend on how insurance companies manage infused or injected medications has been spreading within the healthcare industry. Aimed at saving costs (theirs, not yours!), it is affecting patients undergoing treatments as easy and inexpensive as B12 injections to pricey, complex chemotherapy infusions, and anything in between. </div>
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The American Medical Association and various patient-centered organizations has decried this business move, and are sounding the alarm. Some of the main concerns include patients' access to treatments, safety, legal liability and costs. </div>
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<u>1. What is this trend?</u></div>
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Insurance companies are now shifting the financial burden of many infused or injected medications from the "medical" benefit portion of policies onto their "pharmacy" benefits. While access is usually still available, it is more complicated, expensive and possibly unsafe for patients to obtain office-based treatments. </div>
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Until recently, any medication which the nurse injected or infused in an office (or outpatient) setting was purchased by that medical practice and billed, along with the clinical services, to your insurance under your "medical" benefits. Reimbursed to the clinic or office, these medications were bought from a few reputable companies, and were shipped under appropriate conditions, guaranteeing safety and provenance. </div>
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Now, more and more insurance companies are forcing medical offices to stop this practice, and obtain drugs through specific mail-order companies they contract with ("white-bagging"). In some cases, patients must receive these drugs at home ("brown-bagging") then deliver them to their doctors. </div>
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<u>2. What is the big deal?</u></div>
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There are many unsettling aspects to this new business model. </div>
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<li><span style="font-size: x-small;"><b>Administrative hurdles</b>: instead of requesting one authorization for one course of treatment, offices now are required to do so for the general treatment aspect (from the "medical" utilization management unit) and one for each individual drugs (from the mail-order company or "Pharmacy" authorization unit). This creates delays, chances of errors, or potential denials.</span></li>
<li><span style="font-size: x-small;"><b>Pay up now!</b> Before a shipment is sent out, the mail order pharmacy will require the approval and full co-pay remittance from the patient. Whereas your doctor allows monthly payments on expensive treatments, and bills you after the facts, the pharmacy will not extend such niceties. No can pay? no delivery!</span></li>
<li><span style="font-size: x-small;"><b>Complicated scheduling</b>: your next treatment may not occur on the scheduled date if the shipment your doctor is waiting for has not been made. Coordinating the ordering, receiving and administration of your prescribed drugs may test the staff's (and your) patience. </span></li>
<li><span style="font-size: x-small;">Provenance: a big issue with the AMA, the origin of drugs cannot be traced further back than the mail-order company. Where, when and from whom were the drugs purchased? Neither you nor your doctor will know. </span></li>
<li><span style="font-size: x-small;"><b>Source of Manufacture</b>: your doctor may choose a certain manufacturer for a certain generic drug, based on experience or preference. In this scenario, he will not have any word in the matter, and may have to use drugs manufactured abroad rather than ones made and inspected in the US. </span></li>
<li><span style="font-size: x-small;"><b>Shortages</b>: a serious and growing issue, certain drugs of limited or focused use are in short supply. Offices are on alert for such instances, and either "stockpile" whenever possible or purchase more expensive alternatives to avoid delaying or canceling treatments. With mail order companies, any backorder will take as long as it takes to get filled, with obvious disregard to patients' needs</span></li>
<li><span style="font-size: x-small;"><b>Labeling</b>: even if you are not required to play this game by your insurance, nothing can assure you that your personal treatment is done being given using drugs which were meant for another patient, but, for scheduling purposes or due to improper labeling, are now given to you. Many offices don't have the manpower or workflow to track every delivery. Similar drugs (office-bought and insurance-delivered) are stored together, and given "as needed" not "as assigned". </span></li>
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<li><span style="font-size: x-small;"><b>Safety</b>: any shipment delivered to your home wile you are not there can be stolen, delaying your next treatment. What about a box full of sensitive drugs sitting on your front porch, in a warm day? Any ice will have melted, potentially compromising the contents...and your health. And how about storing it? Whereas your doctor's drug storage unit is at the appropriate temperature, and sounds an alarm if it is not, your fridge might be too cold or not enough, questioning drug stability and effectiveness.</span></li>
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<li><span style="font-size: x-small;"><b>Handling</b>: transporting any shipment from your home to the office also requires appropriate and safe conditions. Did you leave the package in your car while running errands? Is it packed in dry ice or just in the original package? </span></li>
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<li><span style="font-size: x-small;"><b>Liability</b>: your Doctor is legally responsible for any procedure rendered in the office, and for any product injected into you. In such cases, where does his responsibility start or end? Having lost control of the process, will he be covered by his malpractice insurance in case of a problem? Who can now determine whose fault is responsible for a negative outcome?</span></li>
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<li><span style="font-size: x-small;"><b>Costs</b>: even if you already have met your deductible and/or out of pocket liability for the year, you may have to pay additional fees for those "pharmacy" products. Your share of cost might be higher too, as many of these drugs are brand and therefore reimbursed at the lowest level. </span></li>
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<u>3. What can you do? </u></div>
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Your options might be limited. Based on your policy, you may be required to use a mail-order pharmacy to cover certain treatments or drugs. Appeals can be filed, and in case of a negative response, you may request a review by an outside medical doctor. </div>
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If you are being asked to receive and handle very sensitive or unstable drugs (such as chemotherapy agents) without training or proper knowledge, this could negatively affect your health and safety. Ask if a shipment can be sent directly to the office, that is better than a home delivery. Threatening to hold your insurance liable may help. </div>
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The medical office may also request a waiver due to specific circumstances. Drug manufacturers can often help in this process, as legal liability might ultimately be traced back to them. So might your HR department.</div>
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In some cases, paying cash might be the way to go. A B12 injection, for example, costs less than $ 1.00. Paying the office for it will save time and efforts, and will be gladly accepted by the grateful staff. </div>
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<u>In conclusion:</u></div>
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Be aware when your doctor prescribes a infusion or injection. Call your insurance to find out what are the requirements when using specific drugs, and whether the office can use their own stock. </div>
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Talk to the staff about any authorization requirement, or if they will even accept any brown or white bagging. Many office do not, citing legal liability and malpractice insurance guidelines. An alternative administration arrangement, at home or at an infusion center for example, will need to be made.<br />
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<span style="color: blue;">* As seen on NerdWallet</span></div>
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<span class="Apple-style-span" style="font-family: "arial";"><b><span style="font-family: "trebuchet ms"; font-size: x-small;">© [2016] Martine G. Brousse.</span></b></span></div>
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Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-39147609366780020322014-05-26T09:24:00.000-07:002016-09-14T17:41:22.522-07:00Patient Advocacy: Healthcare on your Side<!--[if gte mso 9]><xml>
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<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
<b style="font-weight: bold;"><i><span style="color: #00c6ff; font-family: "arial"; font-size: 13.0pt;"><o:p></o:p></span></i></b><br />
<!--EndFragment--><br />
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
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<b style="mso-bidi-font-weight: normal;"><br /></b></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-size: large;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: red;">Five Tips: when someone you know </span></b></span><br />
<span style="font-size: large;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: red;">has cancer</span></b></span></div>
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<br /></div>
<div class="MsoNormal">
Despite medical victories, millions of survivors and a sharp
decline in mortality rates, the C word still causes one of the most visceral
fears in the human community. We all breathe easier after a negative scan or
exam. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We all know someone batting or who had cancer. When we are
close to the person, how best to help is not in question. But what about a
friend, co-worker or distant relative we don't know so well? <o:p></o:p></div>
<div class="MsoNormal">
When the news is shared, how to react, how engaged to become,
or what to do? The generic statement: "call me if you need help"
makes us feel better, but how likely is the person to do so? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Without much information, we could assume difficult
treatments are in the near future. So might emotional turmoil, financial
worries and a reassessment of priorities.<o:p></o:p></div>
I propose five tips to guide you when you care enough about a
cancer patient, but don't know enough.<o:p></o:p><br />
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
<u>1. Offer concrete, specific help<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Based on your skills, aptitudes, experience or habits, you might
propose your services in one or a few specific areas. Detail what your
assistance would consist of, and how extensive it would be. A good example
would be to say: " I will do your grocery shopping every week on Saturday
mornings for the next month but could not make runs during the week". <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Other examples of useful services are medical billing support
(go through the bills, verify what is owed), running errands, bringing complete
meals, paying a cleaning lady, taking over carpool duties, or having your
teenage daughter babysit or help with homework. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>2. Be silent<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
Because there are many aspects of your friend's journey you
don't know about, avoid giving well meaning but possibly unhelpful (or even
offensive) advice unless prompted. <o:p></o:p></div>
<div class="MsoNormal">
Your uncle Joe's cancer experience or the article on
alternative treatments you just read, are only relevant if your friend asks for
them. Do assist with research if needed, but refrain from expressing your opposition
or disagreement at a decision. This is not your life or health, and if you were
to do things differently in the same situation does not make you right.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>3. Offer true friendship<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE1ssvSoiYqFRTWhGoSmBceg8IHF2zDQL-mErhvnyjoqfD4ql-irWLIbZHAcl8jNt7hXWq7aRShUhPRNfyzBisl1AxTXK-erlQ2y7DyOHBiHh8ONpixgbXdxmzRF0-lQtC8C6QFfCaWCba/s1600/buoy.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE1ssvSoiYqFRTWhGoSmBceg8IHF2zDQL-mErhvnyjoqfD4ql-irWLIbZHAcl8jNt7hXWq7aRShUhPRNfyzBisl1AxTXK-erlQ2y7DyOHBiHh8ONpixgbXdxmzRF0-lQtC8C6QFfCaWCba/s1600/buoy.jpg" width="200" /></a>Friendship has many meanings, but one I find very
appropriate is that of non-judgmental listener and supporter. Allow a dialogue
to go where it is needed, not where your agenda leads it to. Be aware of the
mood and of the best response, as they will change. Some times will call for humor
and laughter, others for reflection or inspirational words. <u><o:p></o:p></u></div>
<div class="MsoNormal">
Be there, only if as a strong shoulder for your friend to
cry on. Or be the leader she requires today to take her mind off things. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>4. Offer neutral gifts<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
If your involvement revolves turns general gift giving rather
than time, remember that changes in sensory sensibility are common. Pass on flowers
with a strong fragrance, on scented candles or perfumed body or bath items as
they will likely be discarded or go unused. Going scent-free is the best way,
or give a store credit instead. <o:p></o:p></div>
<div class="MsoNormal">
Selected self-help or cancer-related books may not be
welcome, but a gift certificate to a major or online bookstore probably will.<o:p></o:p></div>
<div class="MsoNormal">
Consider giving a gift of "escape": movie or
concert tickets, a few hours at a botanical garden or beach, a visit to a
museum, a drive to a favorite place or store. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>5. Be kind and understanding<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
Even the most responsible, emotionally stable person experiences
changes during such difficult times. Remember that emotional mood swings,
memory lapses, mental "flakiness" and changes in commitment or plans
might occur. Do not take outburst or late-minute cancellations personally. When
body and mind undergo such an out of control roller coaster, there might not be
any better alternative than just wait for it to pass. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>In conclusion<o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
Forgiveness and understanding, along with patience and
kindness, are valuable gifts. <u><o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
Often, small gestures are as appreciated as large-scale
ones, coming from the heart and not from a sense of obligation. Extending help
involving a personal connection or time donation because one wants to, not
because one has to, conveys respect and truthfulness. <o:p></o:p></div>
<div class="MsoNormal">
Keeping this in mind may direct you to a less personal (but
appreciated nonetheless) gesture such as a gift certificate. While not everyone
is able or willing to offer direct support, at least resentment or
misunderstanding will not be added to an already difficult situation. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">www.advimedpro.com</span></a><span style="font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">contact@advimedpro.com</span></i></a></span></div>
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<span style="mso-spacerun: yes;"><!--EndFragment--></span><br />
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-16922088236424499162014-05-19T14:17:00.002-07:002016-09-14T17:43:15.738-07:00Patient Advocacy: Healthcare on your Side <div class="separator" style="clear: both; text-align: center;">
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
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<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #000090; font-size: 14.0pt;">FREE SERVICES by </span></b></div>
<div class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #000090; font-size: 14.0pt;"> YOUR HEALTH INSURANCE POLICY<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;"><br /></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">When interacting with your insurance, it often feels like
the quickest way to a live representative is to want to pay your premium. Their usual default response to</span><span class="Apple-style-span" style="color: #0b5394;"> whatever question you were calling about is frequently to r</span><span class="Apple-style-span" style="color: #0b5394;">efer you back to your policy... and square one.</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">But what if your insurance policy provided real answers, and also free resources or
low-cost services that may not only save you money but also lower frustration
and confusion? <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Well, most if not all of them, do. Even though they vary in scope,
here are eight commonly accessible programs. Contact your insurer for the ones specifically
offered to you. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;">1. Case Manager/RN<o:p></o:p></span></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">More often used in case of a chronic, serious or
life-threatening diagnosis, a case manager works as a liaison between your
physician(s), insurance and pharmacy. Your assigned case nurse can educate
you on your condition, provide you with informative and educational material,
advise you on concrete steps toward recovery and answer clinical questions. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Your case manager can also review your insurance benefits, expedite the authorization process or inform you of your rights<span style="mso-spacerun: yes;"> </span>(to an appeal for example). You may call for
clarification on prescribed medications or treatment, or for questions that do
not require a visit to your doctor. You may also request a referral for a
second opinion consultation or other specialists. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">The case manager may also help with billing and claim
processing issues, especially if those delay your treatment or getting an
appointment. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;">2. Health Assessment <o:p></o:p></span></u></div>
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<u><span class="Apple-style-span" style="color: #0b5394;"><br /></span></u></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Online questions for your fitness evaluation may guide you
to learn more about what constitute normal levels and readings for your age
group. You might be directed to a physician or prompted to evaluate your
lifestyle for healthier choices. You might find out some vaccinations are
overdue, or that a preventive screening is in order. <o:p></o:p></span></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;"><br /></span></u></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;">3. Health Library<o:p></o:p></span></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">As insurers are never as happy as when you don't use their
services, you will find lots of health-enhancing articles and brochures online. In accordance
with the mandate of the ACA ("Obamacare"), preventive medicine and
patient education and involvement are now prioritized. Easy and direct access
to health information will become more and more the norm rather than seeking
medical care without discrimination. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Whether you need the cure for baby rash or the best way to
ease back pain without medication, the health library likely has an answer. Check
out fact sheets on all kinds of health topics there.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;">4. Nurse line<o:p></o:p></span></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Though not assigned case managers, the nurses at the 24/7 helpline
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or how soon medical attention should be sought. They may access your records,
order a refill, recommend over the counter remedies or give you basic first aid steps.<span style="mso-spacerun: yes;"> Ask them to recommend a specialist within your network or help with getting prescriptions through the preferred mail order company.</span><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;">5. Share of cost estimations<o:p></o:p></span></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Some systems might require a specific CPT (procedure) code, but
most have a listing of common services such as ER or office visits, imaging,
labs, surgical interventions, disease management or injury treatments. Based on
your Zip code and type of policy, the quote can be for a one-time event or a
yearly average. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Some systems list both "in network" and "out
of network" figures. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;">6. Store you health records<o:p></o:p></span></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Major carriers offer upload capacity for your health
records. You may indicate appointments, list medications and include personal
or family history. Available to you and your doctor via a sister app or online, records can be viewed
anywhere anytime. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Your claim history is available too. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;">8. Discount Programs<o:p></o:p></span></u></div>
<div class="MsoNormal">
<u><span class="Apple-style-span" style="color: #0b5394;"><br /></span></u></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">More or less extensive depending on the insurance, coupons
and discounts programs can be found on websites. From home blood pressure monitors to
contact lenses to gym memberships to wellness programs, these savings could be
worth a bunch. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Vision, hearing and dental services, even if not part of
your benefits, may be accessible at lower cost through preferred vendors. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Aetna uses the LifeMart shopping site, also proposing
non-health related products. Other insurers like Anthem offer coupons to be
used directly with each merchant. <o:p></o:p></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Check out prescription coupons too. Why pay full price when
a discount card or assistance program might be available? <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<br /><div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;">Whether you or your employer pay your premiums, why not take
full advantage of the many free or reduced-cost services your policy offers?
Start with creating an account on the insurance website, then check out all "patient"
tabs. Make sure you look up cost estimates and calculate your liability before
any major test or intervention. A good preparation can save you $ too!</span><o:p></o:p></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="color: #0b5394;"><br /></span></div>
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<br /></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">www.advimedpro.com</span></a><span style="font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">contact@advimedpro.com</span></i></a></span></div>
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<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-16635808172433782362014-05-12T08:07:00.001-07:002016-09-14T17:45:25.853-07:00Patient Advocacy: Healthcare on your Side<!--[if gte mso 9]><xml>
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<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div align="right" style="text-align: right;">
<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<b><i><span style="color: #00c6ff; font-family: "arial"; font-size: 13.0pt;"><o:p></o:p></span></i></b></div>
</span><span class="Apple-style-span">
<!--EndFragment--></span><br />
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<span class="Apple-style-span" style="color: #0b5394;"><span class="Apple-style-span" style="font-size: 21px;"><b><br /></b></span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 16.0pt;"><span class="Apple-style-span" style="color: #0b5394;"><br /></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 16.0pt;"><span class="Apple-style-span" style="color: #0b5394;">Your Treatment: Get Involved...the right way! *</span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The times, they are changing for sure. Another example is
the way we, as patients, now see the medical profession and relate to our
physicians. I still remember my parents and grandparents blindly surrendering
their health and life to the doctor, having placed him on a pedestal lower than
God, but definitely higher than everyone else. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Nowadays, the trend leads us to research, question, and
direct our medical care providers, sometimes at the cost of alienating them, treating
ourselves incompetently and sabotaging our health. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Getting patients involved in their care, and keeping them on
board is crucial to making a treatment or health protocol successful.
Non-compliance is a big issue, resulting in botched results, uncertain futures,
increased risks of complications or aggravation and waste of resources, especially
financial. Yet, many patients are turned off by the perceived arrogance and
lack of listening skills that too many physicians exhibit. Faced with derision,
rejection or dismissal, they might hinder chances at a successful cure by not
reporting potential important health facts or even stopping treatment. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So, is there a middle way? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There must be, as many are achieving it. Working side to
side, many patients have learned to listen and profit from the wisdom and
experience that comes in a white coat, while expressing feedback, preferences
and questions in a process based on mutual respect and acceptance. <o:p></o:p></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
<u>1. Research is necessary<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Getting the facts straight is the first step toward a successful
outcome. <o:p></o:p></div>
<div class="MsoNormal">
Before making or agreeing to any treatment, it always is recommended
that patients get acquainted with their diagnosis, its health repercussions, all course
of action options, costs and rates of success. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
General information and fact sheets can be obtained from
government-based health websites, from private organizations focusing on this
condition and from fact sheets published by teaching universities or medical
associations. These will get you started:</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-size: small;"><a href="http://health.nih.gov/">http://health.nih.gov/</a><span style="mso-spacerun: yes;"> </span></span></li>
<span style="font-size: small;">
</span>
<li><span style="font-size: small;"><a href="http://www.cdc.gov/">http://www.cdc.gov/</a></span></li>
<span style="font-size: small;">
</span>
<li><span style="font-size: small;"><a href="http://www.nlm.nih.gov/medlineplus/healthtopics.html">http://www.nlm.nih.gov/medlineplus/healthtopics.html</a></span></li>
</ul>
<br />
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<u>2. Questions are essential<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
You should evaluate the impact on your daily life by asking
your physician how this diagnosis personally affects you. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Ask about each treatment, its risks and benefits. What are
the expected results, side effects and severity? How will you know a treatment
is working? What would it take to recognize a change of regimen is necessary? What
is the timetable for any lab, test or imaging? <o:p></o:p></div>
<div class="MsoNormal">
What is the expected cost? Are there generic alternatives or
free samples for oral medications? Using an equivalent but less expensive
option might be beneficial if anxiety and stress due to financial concerns are
lowered. <o:p></o:p></div>
<div class="MsoNormal">
Comparing options will help guide you and your physician to take
the most appropriate decision. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If you have doubts, or decide treatment is not for you, it
is your right to express your views. If your doctor disagrees, it will be
indicated in his report, but you should nonetheless receive the supportive
measures, palliative care, pain management or other modalities you might
require. While some physicians still dismiss patients who refuse to endorse a
prescribed treatment, they might soon become dinosaurs. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
You might consider seeking a second opinion. Your insurance
can refer you to another specialist. Try and see another physician outside of
your current MD's medical group or practice, as colleagues would almost never
contradict each other.<span style="mso-spacerun: yes;"> </span>Most policies
cover the cost of a second opinion consultation. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>3. Communicate and participate<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLNchlZELdAXvhjuuAEWZ3FMYHKByAsaXJAMdZHe7QzGVjfaA-ox4qywCaTDpSEo7A9pYR7DKXN3J5CFAAo1vwfmrHQfN1dKG73pBrn0YWM4iScB7393J3If-4Cgobvyi9k9xD9TmP-Nuq/s1600/puzzle.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLNchlZELdAXvhjuuAEWZ3FMYHKByAsaXJAMdZHe7QzGVjfaA-ox4qywCaTDpSEo7A9pYR7DKXN3J5CFAAo1vwfmrHQfN1dKG73pBrn0YWM4iScB7393J3If-4Cgobvyi9k9xD9TmP-Nuq/s1600/puzzle.jpg" width="200" /></a>Once you have made an informed choice, possess all the
necessary information and facts, and understand what constitutes an emergency
and what is to be expected, ongoing communication with your doctor is of utmost
importance. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Indicate any change, sudden onset or new indications or
aggravations. Monitor side effects; report any symptom outside the established
norm. Consult the office about unexpected reactions, or any possible
interaction with newly prescribed drugs. Mention supplements and alternative
medicine remedies you might want to include in your treatment.<o:p></o:p></div>
<br />
<div class="MsoNormal">
Make sure you keep your scheduled appointments, and that
your medication list is up to date.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>In conclusion: <o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
In these days of hurried physicians, brief appointment times
and packed schedules, responsibility falls on patients to take a more active
role in their care. Working as a team has been shown to lower the risk of
medical errors, encourage patient participation and involvement, boost
compliance and bring about more successful outcomes. A balanced dialogue can
also reduce costs, lower stress and build trust. <o:p></o:p></div>
<div class="MsoNormal">
All are encouraging signs that old habits might be changing
for the better. <o:p></o:p><br />
<br />
<span style="color: blue;">* as seen on <a href="file:///http/::www.nerdwallet.com:blog:finance:advisorvoices:get-involved-your-healthcare:" target="_blank">NerdWallet</a></span></div>
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<br /></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-41403894079227789372014-05-06T11:19:00.000-07:002016-09-14T17:48:16.187-07:00Patient Advocacy: Healthcare on your Side<!--[if gte mso 9]><xml>
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<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
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<br /></div>
<div align="right" style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div align="right" style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
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<b><i><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b><b><span style="color: #4bacc6; font-size: 11.0pt; mso-themecolor: accent5;"></span></b></div>
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<br />
<div align="center" class="MsoNormal" style="text-align: center;">
<br />
<div style="text-align: center;">
<span style="color: red; font-size: 16.0pt;"><b>Five Questions for your Oncologist </b></span></div>
<div style="text-align: center;">
<span style="font-size: 16.0pt;"><b><span class="Apple-style-span" style="color: red;"> that might save you
Money</span><span class="Apple-style-span" style="color: #e06666;"><o:p></o:p></span></b></span></div>
</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
When faced with a cancer diagnosis, patients and their loved
ones soon come to realize that their fight will likely involve substantial
costs, rapidly raising the level of uncertainty and anxiety. Looking for ways
to pay the bills can become overwhelming, especially in a complex, and too
often, unmerciful healthcare system. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While insurance policies dictate patient liability, choosing
an "in network" or contracted oncologist will reduce costs. But all
too often, patients assume they have no options as relevant information is not
communicated, and as they do not know what to ask. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here are five questions to ask your oncologist, and that can
help you save money.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>1. Is there an equivalent less costly alternative to the
prescribed treatment?<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While I am, in no way, suggesting you question your oncologist's
expertise, it is often the case that, for early stages, more than one treatment
option can be considered. My previous boss once explained she based her
decision on three criteria: (a) effectiveness, (b) impact on the patient's
daily life and (c) cost to the patient. Not all oncologists take (b) or (c)
into account. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Explain that you must keep working to keep your insurance,
that you cannot afford a more expensive (and again equivalent) treatment, or
that you are the sole breadwinner, and get reassured that the prescribed
treatment is the most affordable.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>2. Is the pharmacy cheaper?<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some growth factor treatments (Neupogen, Neulasta, Procrit,
Aranesp, etc.) can be safely self-administered at home. After checking with
your insurance, you may find it more economical to obtain the prescribed
pre-filled syringes through a pharmacy rather than getting a shot at the
office. The nurse can instruct you on how to do this safely. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Convenience and habit may lead to costly brand name prescriptions.
Always ask if a generic version is available. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>3. What about samples?<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There may not be samples for chemo agents or growth factors,
but there are for anti-nausea or other supportive oral drugs. Emend, for
example, can be priced at hundreds of dollars per month. Samples should be
available in the office. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some offices may even accept unused oral or self-injectable
drugs from patients whose treatment ended, and who bring excess supplies for
others in need. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>4. What about financial assistance? <o:p></o:p></u></div>
<div class="MsoNormal">
<u><br /></u></div>
<div class="MsoNormal">
Every major drug manufacturer offers financial assistance
for brand name drugs, especially chemo-related. Ask about programs and how to
apply. Offices can sign patients up, or at least direct you to a website. <u><o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
You might be eligible for drug donations if you are
uninsured or underinsured, or if your insurance has denied an authorization. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Please note: By law, patients with a government issued
insurance (Medicare, Medicaid, Tricare) are not eligible for direct donations
or assistance from manufacturers. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Charitable organizations also offer financial assistance to
cover the cost of chemo or related drugs. Based on income, specific diagnoses
and clinical need, these grants can range from a few hundred to thousands of
dollars, and can be used to cover doctor or pharmacy bills. Above-mentioned
patients are eligible. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u>5. Are home treatments less costly?<o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some simpler treatments, including B12 injections,
bone-building or iron infusions, are sometimes prescribed as part of specific
chemotherapy regimens. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Contact your insurance and compare the cost at home via a
home health agency versus in the office. Though a B12 injection is quite
inexpensive, the costs of the visit, parking and lost time from work can add
up. If a nurse can come to your home, at your convenience, and for less, why
not ask your oncologist to set it up? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Do get a list of contracted providers from your insurance
first, and make sure the order goes out to the right agency, in a timely
manner. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><i>In conclusion: </i><o:p></o:p></u></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some oncologists may resist some of your requests, such as
setting up a home infusion or guiding you through a manufacturer assistance
program application. After all, these added tasks use up valuable staff time. <o:p></o:p></div>
<div class="MsoNormal">
Others may not welcome you questioning their decision, and
may interpret this as a criticism or lack of confidence in their ability as a
physician. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Do reassure your doctor that your goal is to get the best, most
appropriate treatment but while making the process as cost-effective as
possible. After all, the lower his bill, the faster you can pay it off. <o:p></o:p></div>
<div class="MsoNormal">
Remember: you have rights to the information and
explanations necessary to make informed, educated choices. Being an active
participant in your care can only help your oncologist help you.<br />
<br />
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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<b><span style="color: #666666; font-family: ""trebuchet ms"","serif";">©
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<i><span style="color: #df5050; font-family: ""arial"","serif";">My objective is
to offer you, the patient, concrete and beneficial information, useful tips,
proven and efficient tools as well as trustworthy supportive advice as you
deal with a system in the midst of sweeping adjustments, widespread
misunderstandings and complex requirements</span></i><span style="color: #df5050; font-family: ""arial"","serif";">.</span><br />
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<b><span style="color: blue; font-family: ""arial"","serif"; font-size: 18.0pt; mso-bidi-font-family: Arial;">Advimed<i>Pro</i></span></b><b><span style="color: #1c73ba; font-family: ""arial"","serif"; font-size: 18.0pt; mso-bidi-font-family: Arial;"> </span></b><span style="color: #0009ff; font-family: ""arial"","serif"; font-size: 18.0pt; mso-bidi-font-family: Arial;"> </span><span style="color: #0009ff; font-family: ""arial"","serif"; font-size: 13.0pt; mso-bidi-font-family: Arial;">(</span><span style="color: blue; font-family: ""arial"","serif"; font-size: 13.0pt; mso-bidi-font-family: Arial;">424) 999
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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<span style="color: blue;"><span style="font-family: "arial"; font-size: 13pt;"><b> </b> </span><a href="http://www.advimed.us/" style="text-decoration: none;"><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">www.advimedpro.com</span></a><span style="font-family: "arial"; font-size: 13pt;"> </span><a href="mailto:contact@advimed.us" style="text-decoration: none;"><i><span style="font-family: "arial"; font-size: 13pt; text-decoration: none;">contact@advimedpro.com</span></i></a></span></div>
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<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/11473996415780126952noreply@blogger.com0tag:blogger.com,1999:blog-5482738616648238001.post-4526578596964154532014-04-28T14:14:00.000-07:002016-09-14T17:54:05.091-07:00Patient Advocacy: Healthcare on your Side<!--[if gte mso 9]><xml>
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<div style="line-height: 13.5pt; text-align: right;">
<b><u><span style="color: blue;">Patient Advocacy: Healthcare on your side</span></u></b></div>
<div style="line-height: 13.5pt; text-align: right;">
<br /></div>
<div style="line-height: 13.5pt; text-align: right;">
<b><span style="color: blue;"> by </span></b><b><span style="color: blue; font-size: 11.0pt;">Martine G. Brousse</span><span style="color: blue;">, </span></b></div>
<div style="text-align: right;">
<b><span style="color: blue;">Healthcare
Specialist, Patient Advocate, Certified Mediator</span></b></div>
<div style="text-align: right;">
<b><i><span style="color: #4bacc6; font-family: "Times New Roman"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "MS 明朝"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast; mso-themecolor: accent5;">ADVIMEDPRO</span></i></b></div>
<div style="text-align: center;">
<div style="text-align: right;">
<br /></div>
<div style="text-align: left;">
<div style="text-align: right;">
<br /></div>
<span class="Apple-style-span" style="color: red; font-size: large;"><b>Avoiding Medical Mistakes: </b></span></div>
<div style="text-align: left;">
<span class="Apple-style-span" style="color: red; font-size: large;"><b> Be an Involved Patient</b></span></div>
</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
<br />
As reported during the recent National Patient Safety Foundation "Patient Safety Awareness Week", medical errors are costly to patients' health and wallets, and to the healthcare system as a whole. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
Due to a lack of accurate information from patients, difficult symptoms, inadequate diagnosis, improper treatment, dismissal of patients' complaints, test results inaccurately interpreted, poor or no access to other records, medical mistakes occur more often than previously thought. Read more here: <a href="http://www.npsf.org/wp-content/uploads/2014/02/Myths-and-Facts-About-Diagnostic-Error-Patient-and-Families.pdf">http://www.npsf.org/wp-content/uploads/2014/02/Myths-and-Facts-About-Diagnostic-Error-Patient-and-Families.pdf</a></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
As reported by Patient Advocate Martine Ehrenclou, MA, patients' involvement is crucial to help reduce errors and minimize consequences. At every step of the way, patients must be involved and informed by their physician, but also remain alert to and communicative of their own observations. While no process is full proof, patients' participation and understanding are essential.</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
Here are some recommendations to follow to bring about a more accurate diagnosis and treatment, and ensure a successful outcome. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>1. Keep your Med List current and accurate</u></div>
<br />
<div style="text-align: left;">
Please read more at: <a href="http://advimed.blogspot.com/2014/04/patient-advocacy-healthcare-on-your-side_478.html">http://advimed.blogspot.com/2014/04/patient-advocacy-healthcare-on-your-side_478.html</a></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>2. Keep track of symptoms</u></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
Without a complete and accurate narrative, your doctor may not be given all the relevant information in order to make the proper diagnosis. Before your appointment, make a list of every ongoing or new symptom, detailed description and occurrence, and any trigger or means of amelioration.</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
Throughout treatment, be alert to worsening or acute symptoms, new side effects and improvements. Be sure to contact the office for sudden or severe reactions, or whenever you have a question. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>3. Provide records and History</u></div>
<div style="text-align: left;">
<u><br /></u></div>
<div style="text-align: left;">
As related in this blog about your preparation to an office visit, you should present your doctor with a list of allergies, important health events, previous diagnoses and treatments, and the names and contact information of any physician you have recently or are currently seeing. </div>
<div style="text-align: left;">
For more about his topic: <a href="http://advimed.blogspot.com/2014/03/patient-advocacy-healthcare-on-your-side_6413.html">http://advimed.blogspot.com/2014/03/patient-advocacy-healthcare-on-your-side_6413.html</a></div>
<div style="text-align: left;">
A family history of relevant or serious medical conditions is also in order, especially if genetic or affecting several members. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>4. Ask Questions</u></div>
<div style="text-align: left;">
<u><br /></u></div>
<div style="text-align: left;">
Many errors could be avoided with appropriate and timely questions to your physician. Ask if a diagnosis is the only probability, or if others are possible. Question if a treatment prescribed is the only option or if a less severe/expensive/radical one is available. </div>
<div style="text-align: left;">
Without questioning every step your physician undertakes, ask the general necessity of a surgical intervention or procedure, and if it can be safely postponed at this time. </div>
<div style="text-align: left;">
Ask about expected side effects, effectiveness and anticipated time frame for a cure.<br />
Ask and understand your responsibilities: what to do, what to take, what to change, when to return, when to call, what constitutes an emergency. Be aware of diet restrictions, of impact on your daily and professional life, of specific requirements on your part, especially if following an oral medication regimen.</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>5. Communicate</u></div>
<div style="text-align: left;">
<u><br /></u></div>
<div style="text-align: left;">
Do not rely on a follow-up appointment down the line to indicate a worsening of your condition or the appearance of new problems. If the treatment is not as effective as you were led to understand, call to check on an alternative option. Do not miss a scheduled lab or imaging test. </div>
<div style="text-align: left;">
Repeat the doctor's instructions, or write them down so that you leave the office with full recollection and understanding of your involvement. </div>
<div style="text-align: left;">
Communicate any new treatment prescribed by another physician, even if seemingly unrelated. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>6. Do some research</u></div>
<div style="text-align: left;">
<u><br /></u></div>
<div style="text-align: left;">
Several federal agencies post up-to-date information on conditions, medications, nutrition and other health-related topics on their website. Consulting them to learn more about your diagnosis and most effective behavior can assist you on your journey to recovery. While your physician is always your primary source, his time to educate you may be limited. These websites might be valuable tools.<br />
Here are two good ones: <a href="http://www.nih.gov/">http://www.nih.gov/</a> and <a href="http://www.nlm.nih.gov/medlineplus/">http://www.nlm.nih.gov/medlineplus/</a></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>7. Be proactive</u></div>
<div style="text-align: left;">
<u><br /></u></div>
<div style="text-align: left;">
Set reminders for medications, appointments or to check your health status at regular intervals. Keep a chart or journal for observation of symptoms and self-administration of prescriptions. Forward any record from a new medical provider, or older ones that might be important. </div>
<div style="text-align: left;">
Contact the office before any planned intervention, medical or dental, as a drug you take or might be given may provoke negative side effects. </div>
<div style="text-align: left;">
Check about any refill several days before you run out. Authorizations may take a few days to clear, or for your pharmacy to get an unusual prescription in stock.<br />
Call for lab or test results if the office does not contact you. No news do not necessarily mean good news. Your results may not have been sent to the physician or your report could have been misplaced. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<u>8. Trust your gut feeling...to a point</u></div>
<div style="text-align: left;">
<u><br /></u></div>
<div style="text-align: left;">
A dozen years ago, I ended up in the ER with pains which I, with a high pain threshold, could not bear. Because of serious allergies to medications, taking care of my health with an emphasis on preventive care, was always a priority. Given a specific diagnosis by the ER DR, I kept insisting I "knew" this was not the case. My gut feeling and experience of so many years living in that body rejected that improbable diagnosis. Hearing "I am the doctor, you are not", I felt unheard and insignificant but accepted a discharge. It tuns out he was wrong, so wrong I had to have emergency surgery when it could have been avoided with a proper earlier diagnosis. </div>
<div style="text-align: left;">
I should have requested another physician, should have been more vocal, should have been more trusting of my intuition. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
If your physician is not listening, treats you like a body rather than a person, does not care about your questions or feelings, or expects you to follow directions without education or understanding, you may want to consider your options. Express your need (and right) to disclosure, trust and self-expression. Physicians are often so tied to a busy schedule that their communication skills take the back seat. You should be heard as your input is invaluable in helping establish a diagnosis, and adhering to the best prescribed treatment.</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<i>In Conclusion:</i></div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
All every step of the medical process, communication is essential. Nurtured by trust and mutual respect, the relationship between patients and doctors can only be optimum if all parties are equal participants.<br />
<br /></div>
<div style="text-align: left;">
The NPSF offers a patient toolkit to help you become as involved and educated as you can, and should.<br />
<a href="http://www.npsf.org/wp-content/uploads/2014/03/PatientsToolkitforDiagFINAL.pdf">http://www.npsf.org/wp-content/uploads/2014/03/PatientsToolkitforDiagFINAL.pdf</a></div>
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<br /></div>
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<span class="Apple-style-span" style="font-family: "arial"; font-size: x-small;"><b><i><br /></i></b></span></div>
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<span class="Apple-style-span" style="color: #666666; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; line-height: 18px;"><span style="color: #df5050; font-family: "arial"; font-size: x-small;"><i>My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal </i></span></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; font-size: x-small; line-height: 18px;"><i>with a system in the midst of sweeping adjustments, widespread misunderstandings </i></span><span class="Apple-style-span" style="color: #df5050; font-family: "arial"; line-height: 18px;"><i><span class="Apple-style-span" style="font-size: x-small;">and complex requirements</span></i>. </span></div>
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<span style="color: blue;"><b><span style="font-family: "arial"; font-size: 18pt;">Adv</span></b><b><span style="font-family: "arial"; font-size: 18pt;">i</span></b><b><span style="font-family: "arial"; font-size: 18pt;">med</span><i><span style="font-family: "arial"; font-size: 18pt;">Pro</span></i></b></span><b><span style="color: #1c73ba; font-family: "arial"; font-size: 18pt;"> </span></b><span style="color: #0009ff; font-family: "arial"; font-size: 18pt;"> </span><span style="color: #0009ff; font-family: "arial"; font-size: 13pt;">(<span style="color: blue;">424) 999 4705 or (877) 658 9446 fax (424) 226 1330</span></span><span style="color: blue;"></span></div>
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