Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Five More Programs for Seniors you may never have heard of

                     (Part II: General Assistance/Info)

After exploring services and resources to help Seniors manage high prescription costs in this blog's previous issue, this week will focus on organizations and agencies which can help with general as well as specific assistance. 

Thanks to your tax dollars, several programs are in place to help seniors better locate and afford medically-related costs such as in home health services, long term care or legal advice. Others are offered by charitable organizations Checking them out may save you time, effort, money and may well bring you, and your loved ones, peace of mind. 

1. Eldercare.gov

This public service is the go-to website to locate local resources. Indicate your ZIP code and choose a topic, and you will be directed to relevant links, articles, videos and agencies. From managing health conditions, to helping caregivers cope and from applying for free transportation or meals to locating home health providers, this website's goal is to provide seniors with the relevant and useful information allowing them to live independently and safely in their homes and community as long as possible. 

For more info, visit: http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx  

2. Centers for Disease Control (CDC)

Better known for its relentless fight against diseases and pathogens, the CDC also promotes independence and well-being for seniors though its Health Aging program. Learn more about clinical prevention services, advance care planning or about the Healthy Brain Initiative when 

you visit: http://www.cdc.gov/aging/index.htm. 

Other areas of interest for seniors such as chronic care management, oral health and depression offer detailed information and advice. Advice for those traveling abroad, updates on the spread and severity of the flu virus or other localized threats (such as the ZIKA virus) and recommendations for immunizations are also available. 

3. Medline Plus

A combined service from the U.S. National Library of Medicine and the NIH, this service offers access to a medical encyclopedia covering an extensive number of age-related problems or changes. Learn to recognize, address and cope with them by reading clear but detailed articles on numerous subjects. In addition to the latest news and research, you can access a legal library, tutorials and videos, directories of organizations, an informative magazine, financial advice, health check tools and tests, and links to other relevant articles or websites. Any topic from exercise to end of life presents up-to-date information, useful suggestions, supportive advice and proven tips. 

For more info, visit: http://www.nlm.nih.gov/medlineplus/seniorshealth.html

4. National Institute on Aging (NIA)

The NIA is one of those agencies dedicated to improving and maintaining the health of seniors. Their website will provide you with the latest research, updates and resources related to health and aging. Check out videos of safe winter activities and exercises, peruse articles on the latest Alzheimer's research, learn about optimal nutrition, get answers about good cognitive health here. 
For more info, visit: http://www.nia.nih.gov/

5. National institute of Health Senior Health

The NIH Senior health website offers a variety of videos from how to cope with certain illnesses to dealing with common age-related conditions. Among many topics are included: "complementary health approaches", "long term care", "falls and older adults" and "participating in clinical trials". You can sign up for twice weekly free tips as well. 

For more info, visit: http://nihseniorhealth.gov/


We all too often rely on our medical providers for advice and information on aging-related matters as it should be, especially in case of a serious or acute situation. But, as insurance requirements and financial concerns have eroded the time spent with a Doctor to mere minutes, certain topics such as preventive measures, nutritional advice, near and long term expectations, or wellness and fitness plans implementations are not addressed in depth, if at all. 
Remembering that a vast amount of pertinent, accurate and useful information is available to seniors and their loved ones can be a valuable tool in understanding and evaluating changes, addressing concerns and getting ideas and tips. 
If your goal is living as healthy and independent a life as possible, while remaining at home or in a caring community, the above websites can support and guide you towards it, at no cost. 

©  [2016] Advimedpro.

©  [2016] Martine G. Brousse.

All rights reserved.

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. 

AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330

                                         www.advimedpro.com           contact@advimedpro.com

Patient Advocacy: Healthcare on your side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

 Three Programs for Seniors 

you may never have heard of

                               (Part I: Prescription Drugs)

It is neither news nor a surprise that prescription drug costs have reached levels that render them unaffordable for too many, and especially for Seniors. Pill cutting, the late renewal of refills, non-compliance due to the inability to pay the share of cost, have become all too commonplace, jeopardizing health, creating severe or more complications and forcing many to choose between paying a pharmacy or a utility bill. 

Eventually, all of us will pick up the tab, whether in accrued Medicare payments, in a rise in ER visits or for the longer treatments of conditions once easily treatable and now chronic. 

While assistance is available through manufacturers' programs, discount cards, charitable organizations, free clinics, samples and offers, its access, and information, are often too difficult and time-consuming to track. When a medication is needed right away, who has time to contact every pharmacy in town to get the better price? 

Thanks to your tax dollars, several programs are in place to help seniors better afford these costs. Others are offered by charitable organizations Checking them out may save you time, effort and cash. 

1. Low-Income Subsidy Program ("Extra Help")

If you are already receiving Medicaid (MediCal in CA) as your secondary coverage, you have already been enrolled in this program. If you are buying your own secondary or Part D coverage, or are receiving coverage through a past employer or the US Military, you may still be eligible for low-cost prescriptions, and assistance to cover the premiums. You may qualify, based on your income, even if you are still employed. 
Drug costs for most people on this program are set at a few dollars for generic or brand-name drugs. For some, financial assistance to cover premium and/or deductible costs will be available.  
Assets such as your home, car or life insurance do NOT count toward your eligibility, though investment accounts will. Your application will be processed by the social Security Administration, which will help you choose a Part D plan if you qualify. 

For more info, visit: http://www.ssa.gov/prescriptionhelp/  or http://cms.hhs.gov/Medicare/Eligibility-and-Enrollment/LowIncSubMedicarePresCov/index.html

2. Medication Therapy Management (MTM)

Every Part D insurer is required to offer you this service. Designed to lower costs, reduce the risk of dangerous drug interactions, avoid duplication of prescriptions and therapies, educate patients to benefits, alert them of possible reactions and confirm the effectiveness and need of each treatment, this service should be used by every eligible senior, once a year. 

A pharmacist will help create an up-to-date personalized medication list, which every one of your treating physicians you should get copied on. You will get detailed information on every prescription and over-the-counter medication, including use, dosage and curative intent. Advise on when and how to best take these medications will be provided. Unnecessary, similar and ineffective treatments will be pointed out, for your physician to review. Switching to a new generic version, or stopping an obsolete treatment will save you money. 

This is an excellent time for questions, and to make sure you are getting the most appropriate and cost-effective prescriptions.  

For more info, visit: http://www.medicare.gov/part-d/coverage/medication-therapy-management/medication-therapy-programs.html  or

http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/MTM.html

3. Patient Assistance Programs ("PAPs")

Visit this website to find out about programs available in your state of residency. Search for any program, state or corporate, for your expensive prescriptions and create a up-to-date, personalized list of resources. 
This website also maintains an extensive and detailed list of all manufacturers', co-payment and saving cards programs, and are not exclusive to seniors. 

For more info, visit: 
http://www.pparx.org/en/prescription_assistance_programs/list_of_participating_programs


While other options and websites are available, these 3 suggested programs should go a long way toward helping you cover your prescription drug costs. 

©  [2016] Advimedpro.

©  [2016] Martine G. Brousse.

All rights reserved.

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. 

AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330

                                         www.advimedpro.com           contact@advimedpro.com

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Tips on Five Common Labs 

As a Patient Advocate, I often encounter bills and statements showing commonplace labs performed in various settings (office, outpatient, inpatient). I keep getting surprised, and often outraged, by the differential in pricing for those simple tests.

Patients should realize that these are the some of simplest tests, often requiring minimal clinical experience to interpret and very inexpensive. Yet they routinely overpay. Even if the price is considered "acceptable", chances are they were  overcharged anyway. 

Here are some basic information on 4 common labs and their usual reimbursement rates. If your Dr sends your samples to a non-contracted lab, or if you are out-of-network due to unforeseeable circumstances, you will now be better informed when negotiating those fees down. Hint: never pay the full price unless it amounts to your insurance allowable and you are directed to do so by your Explanation Of Benefits. 

1. CBC (Complete Blood Count) Code 85025

This is probably the most common lab test, routinely used by General Practitioners and Specialists alike. This test gives the clinical staff an overview of the health of your blood, and can detect certain underlining conditions (anemia, neutropenia) or acute needs (infection). 

It usually covers these readings: 

• hematocrit
• hemoglobin 
• mean corpuscular volume (MCV) 
• mean corpuscular hemoglobin (MCH) 
• mean corpuscular hemoglobin concentration (MCHC); 
• red cell distribution width (RDW) 
• percentage and absolute differential counts 
• platelet count (RBC) 
• red cell count 
• white blood cell count (WBC)

Learn more about this test at: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm

The average reimbursement rate is around $ 15.00 to $ 30.00. You should never pay more than 
$ 40.00 for this test if you are paying cash. 

2. CMP (Complete Metabolic Panel) Code 80053

This test is more detailed and provides your physician with a clearer picture of your organs' health. These are tested: 

• Alanine aminotransferase (ALT/SGPT); 
• albumin:globulin (A:G) ratio; 
• albumin, serum; 
• alkaline phosphatase, serum; 
• aspartate aminotransferase (AST/SGOT); 
• bilirubin, total; 
• BUN; 
• BUN:creatinine ratio; 
• calcium, serum; 
• carbon dioxide, total;
• chloride, serum; 
• creatinine, serum; 
• eGFR calculation; 
• globulin, total; 
• glucose, serum; 
• potassium, serum; 
• protein, total, serum; 
• sodium, serum

Learn more about this test at: http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm

The average reimbursement rate if $ 20.00 - 40.00. You should never pay more than $ 50.00 for this test if you are paying cash. 

3. PT (Prothrombin Time) Code 85610

Those patients on blood thinning medication such as Coumadin or Warfarin are well acquainted with this test. It does not require blood to be drawn, and many patients can test at home via a device that sends the results to the lab and your physician. Used to monitor your blood's speed of coagulation, its long-term and regular use is necessary to adjust your medication dosage. 

Learn more about this test at: http://www.nlm.nih.gov/medlineplus/ency/article/003652.htm

The average reimbursement is $ 10.00 to 20.00. You should not pay more than $ 35.00 for this test if you are a cash patient.

4. Lipid Panel with LDL/HDl ratio (Cholesterol) Code 80061

Used as a screening tool for various conditions (hyperlipidemia, heart disease, obesity, renal or liver disease, and many others), this test is invaluable in evaluating risk factors as well as the effectiveness of a prescribed treatment. While they are more complex lipid tests, this is a most commonly used. 

To learn more about this test, visit: http://www.nlm.nih.gov/medlineplus/ency/article/003491.htm

The average reimbursement for this test is $ 25.00 to $ 40.00. You should never pay more than $ 60.00  for this test is you are a cash patient. 

5. Urinalysis (urine test) Code 81005

The most basic urine test, it uses special strips to detect bilirubin, and to screen for possible billiary, liver and other abnormalities and diseases. 

Learn more about this test at: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm

The average reimbursement is  less than $ 10.00. As a patient paying cash, you should never pay more than $ 20.00 for this test. 

NOTE: You may also be charged for a venipuncture (code 36415). Although most commercial insurance carriers deny payment as it is considered part of the service, Medicare allows reimbursement in the $ 4.00 range. You should not pay more than $ 10.00 if paying cash. 

Some of these tests do not require a MD to immediately review the results. For example, the ProTime test is routinely interpreted by nurses or medical assistants, who only consult the physician if the test results are out of the range that was determined at the time of the prescription of the medication. 

In any case, patients should not be put in a position of refusing or postponing a basic test such as those listed because of an exhorbitant pricing. Other labs can perform the same service, and many offices have the appropriate lab machines. Your PCP (Primary Care physician) may be able to perform a test prescribed by a specialist at low or no cost to you. It might be a good idea to ask when you are seeing that needle. 

©  [2016] Advimedpro.

©  [2016] Martine G. Brousse.

All rights reserved.

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. 

AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330

                                         www.advimedpro.com           contact@advimedpro.com