Patient Advocacy: Healthcare on your side

Tuesday, April 1, 2014

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

by Martine G. Brousse,

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Travel Insurance: Saving
Money & Sanity

As the first spring flowers begin unrolling a petal or two, overseas summer vacation trips, weekend getaways and out of state family celebrations are sure to come to our attention soon enough.

While planning any out-of-town trip, one aspect is often overlooked. Yet it may have serious financial consequences if you are unlucky enough to require medical care on your journey. Those with chronic or potentially serious conditions should especially make sure they take all the appropriate steps before their departure.

Trip insurance not only covers lost or stolen luggage, cancelled trips or delayed flight costs, but also provides payment for medical care, either emergencies or for those risks your regular carrier will probably not cover.

Medicare patients are usually not covered outside of the US. A travel insurance policy might allow them to become travelers with better peace of mind.

Consider the following:

1. Education is key

Like many Americans in January, your plan has probably changed or been updated, you might have a new insurer altogether or have signed up through the ACA ("Obamacare") for coverage. Chances are you put away that thick benefit plan and description of benefits you were sent in the mail. Mine is called a "booklet", and has almost 200 pages, legal sized.

You should of course, have given it a look and determined its major benefits and restrictions. But who does that, except maybe as a cure for insomnia... or until you get that denial Explanation of Benefit or doctor's bill.

Before any trip though, it is imperative you check out the policy coverage under tabs labeled "emergency services", "covered benefits", "exclusions" " ambulance services" and "urgent care". They will give you a basic idea of your potential liability.

Call your insurance customer service with specific questions including:

conditions of coverage for emergency care abroad or out of state
conditions of coverage for medical services abroad or out of state that are not emergency but are advisable or to rule out a serious condition (i.e. acute allergic reaction, intestinal distress etc)
coverage for ER visits for acute symptoms which turn out not to be life-threatening or usually considered an emergency (chest pains that are digestion-related, broken ankle that is only sprained etc)
If you have a chronic condition or under treatment (diabetes, chemotherapy, asthma etc) and may require medical intervention, would those services be payable?
What exactly would constitute medical necessity or emergency?
What about transportation back home, or arrangements for your loved ones to stay at your side if you cannot return immediately?
If you subscribe to a policy from a major carrier (Aetna, United Healthcare, Cigna, Blue Cross/Blue Shield) ask whether any contracted (or "in network") provider in your home state or another state would be considered a preferred provider for your specific plan, minimizing your liability. Blue Cross/Blue Shield (separate entities in CA but linked in other states) has a country-wide program named "Blue Card", extending in-network coverage and preferential costs to out of state patients.

2. Prepare!

A little preparation ahead of time can save you a lot of problems or money later:

If you take a specific prescription, make sure you have enough for your whole trip. Getting a refill filled in another state, let alone abroad, will be a painful lesson in frustration. You might miss several doses or have to shell out big bucks to get it.
Pack a few extra pills in case your return is delayed
Contact your insurance and ask for an early refill delivered to your home. Don't count on getting it shipped in the mail to your destination; it will probably not arrive on time, if at all.
Bring an up-to-date medication/condition list with you. Some apps can help you create a list, and help you manage it with timely reminders.
Keep a list of known allergies handy, and on you at all times. Laminating a small index card works great. Include your physician's name and contact info.
Find out more about the healthcare system in the countries you will visit abroad. If your destination is touristic, or in a developed country, access to medical care should be easy. If not, make sure to bring with you any remedy, prescription or over the counter, you may need. Planning for any eventuality now could mean not having to cut your trip short.
Be familiar with the 911 number or calling-for-emergency process in the particular country you plan to visit.
Get your vaccinations in order, and consult health advisories at http://wwwnc.cdc.gov/travel/
Become more familiar with potential local illnesses and their symptoms, and how to address them.
Consult the U.S. Passports & International Travel website at: http://travel.state.gov/content/passports/english/go/checklist.html for general info, medical advice, travel tips and news related to your planned destination.

3. Consider Travel insurance

Exclusions on your policy, even if you have confirmed emergency and evacuation costs are indeed included, may bring you closer to considering purchasing a separate travel insurance. Those include:

Some activities considered high-risk (skydiving or scuba diving for example) might not be covered.
Patients enrolled in HMO plans, and who require a pre-authorization from the Primary Care Provider before any medical service is rendered, are likely to be paying bills themselves, unless they can prove a true emergency has taken place.
Even under a less restrictive PPO plan, locating an in network provider may turn out to be frustrating in another state, and futile overseas.
Medicare enrollees (or Medicaid for that matter), are on their own as their coverage does not extend out of the US (except for limited and specific emergency conditions). Medicaid patients' out of state bills will also be very hard to get reimbursed, and will require a lengthy and complicated process.
Injuries related to terrorism or acts of war, due to travel to an area either restricted or advised against by the Department of State, are usually non covered benefits.
You will be asked to pay all costs up front while overseas, then file with your insurer for reimbursement whereas a travel insurance already has offices, established contracts and processes in place, ensuring you are not "held hostage" until payment in full is received.

The U.S. Department of State maintains a list of U.S. based travel insurance companies.

http://travel.state.gov/content/passports/english/go/health/providers.html for reference.

Your travel agent may be able to refer you to a trustworthy and proven insurer. Inquire about specific needs or potential known risks when applying for a policy, as coverage for pre-existing conditions may be excluded or reduced.

For a last piece of advice, sign up with STEP, the Smart traveler Enrollment Program offered by the U.S. Department of State. Updates on travel conditions to the country(ies) you plan on visiting will be sent to you, and you will be registered with the local U.S. Embassy.

In case of an emergency, local assistance may be provided, including evacuation home. It will also be helpful in other instances: lost or stolen passport, civil unrest or nature catastrophe, or when your loved ones need to get in contact with you but are unable to.

Learn more at: http://travel.state.gov/content/passports/english/go/step.html

Bon voyage!

© [2016] Advimedpro.

© [2016] Martine G. Brousse.

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

Tuesday, March 25, 2014

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

by Martine G. Brousse,

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Checklist before

your next Dr's Appointment

Following the entrance of millions of new insurance subscribers into the healthcare system since 2014, the implementation of new ACA ("Obamacare") guidelines and mandates, and the reduced networks of participating providers in the various state insurance marketplaces, finding a physician who is not under great time pressure and with an open schedule will likely be an exercise in patience and determination.

Now more than ever, good preparation and a little homework on the part of the patient BEFORE going to a medical appointment will pay off in terms of improved communication, increased partnership, lower rate of errors, more accurate (and faster) diagnosis, higher rate of treatment success and monetary savings. Asking the right questions while in the exam room can minimize mistakes, inefficiency and misunderstandings, and can help promote more successful, quicker results.

Here are some guidelines every patient should consider before their next appointment, and going to an appointment. These are especially important when meeting a new provider for an initial consultation.

A. Ahead of time

1. Check the insurance coverage

Having an insurance card unfortunately does not mean the end of worry or financial liability. In many cases, it may actually be the beginning of issues, especially when the provider turns out not to be "in network".

It is imperative that patients confirm (preferably in writing) with any medical provider they wish to see, that the physician or facility is a contracted provider for their specific insurance plan. One may be participating in an insurance PPO plan, but not in the HMO network you belong to.

Even if a referral is given by your "regular" physician, you might be left with a large liability if you do not make that call ahead of time.

It is also advisable for patients to contact their insurance company and ask if a specific provider is "in network". Again, any written or downloaded confirmation could turn out to be very useful in case of an appeal.

Inquire also as to whether an authorization or referral is required before your appointment. You do not want to be liable if it was not obtained.

2. Make a list of concerns and symptoms

Considering the short amount of time patients get one-on-one with medical providers, it makes sense for them to prepare a short list of the specific concerns that prompted them to make the appointment. In many cases, a diagnosis was already established, and a referral made to a specialist.

In any case, writing down a list of symptoms and describing their severity, impact or other relevant facts (when do they start, what helps, what has been tried in the past etc) will help bring along a more accurate diagnosis, and may eliminate wasting more time and money on expensive further testing.

3. Write a brief medical history

Without getting into too many details, do bring a timeline of major health-related events to date. Any surgical intervention, procedure, major illness, unusual circumstances, abnormal screenings should be included. Recording every instance of having the flu since birth may be irrelevant, but do mention any allergy you are aware of, especially if relating to medications.

If major or serious conditions have affected close family members, do include that information.

4. Bring a detailed medication list

There are quite a few websites offering free medication list templates. Here are two:

http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/UCM095018.pdf

http://www.npsf.org/wp-content/uploads/2014/02/The-Patients-Toolkit-for-Diagnosis.pdf

Include any prescribed drug, over the counter medication, vitamin, supplement, herb or remedy that you take regularly or on occasion.Dosage and frequency of use should be included. Indicate the symptoms or conditions they treat, and who prescribed or advised them to you. Evaluate their usefulness, and length of time used.

Don't forget to list any pharmacy you would like your prescriptions sent though. Your insurance can help you locate a pharmacy "in network" or with preferential savings.

5. Bring previous medical records

It is always preferable to have any office holding current and/or relevant medical records forward those over to your new or treating physician before your appointment. Even if your physician does not review them before meeting you, they will be readily available while you are in the exam room.

Bringing them with you is better than not having them, even though they may not be indexed or copied into your chart fast enough.

Obtaining records can often take days, and any delay may prevent your physician from establishing a final diagnosis or prescribing a proper course of treatment. A follow up visit might be necessary (costing you more time and money) with mounting anxiety until then.

At a minimum, have the name, address, phone and fax numbers available where those records can be obtained.

B. At the Office

1. Insurance matters

Bring your ID and insurance cards, as they must be checked and copied into your chart by the terms of HIPAA laws to prevent identity theft. This is a good time to verify the physician belongs to your plan network, that all necessary authorizations have been obtained (if this is the case).

2. Hand over your lists

Many offices prefer indexing any medication or symptoms list, or any other document you may bring, before the doctor enters the room. Saving time and efforts, it will result in more face-to-face time with you. Mention those lists to the medical assistant or nurse leading you to the room.

3. Your diagnosis

During your exam, answer any question accurately and as shortly as you can. Don't dwell into irrelevant details, time is short.

If a diagnosis has been established, ask if it is final or if there might be other alternatives. Is this a chronic condition? How severe is it? Can the condition be reversed and cured?

Find out what you should know and do, where to get further information or who can help get you answers.

Ask if you need further testing, visits to other physicians, or specific instructions, especially if lifestyle changes or an upcoming procedure or surgical intervention are involved.

3. Course of Treatment

Be clear about the course of treatment, impact on your daily life and anticipated results. Do you have all the information you need to make an educated, informed decision?

Is the treatment curative? What are the odds of success, relapse, worsening of symptoms? what should you expect short and long term? When and how will you know the treatment is working?

If medications are prescribed, write down administration orders, and ask if they might interfere or replace any current prescription. Does any have side effects you should be aware of?

Now is a good time to ask about cost, and whether generic or less costly alternatives are available. Is a more radical course of action is advised, ask if less invasive treatments can be used first. Make sure you are in complete agreement, or express any doubts or concerns. Understanding your role, expectations and responsibilities in the healing process is as important as those of placed on your physician.

4. Follow up

Do not leave the office without a clear idea of the next steps.

Find out when labs, tests or imaging screenings are to be done, and when or if a follow-up appointment is necessary. Ask under which circumstances you should contact the office or seek emergency care.

If a referral is made to another facility or provider, mention you will do so once you verify they are contracted with your insurance plan. Even though doctors prefer to refer to a small group of other doctors they are more familiar with or close to, it is rare that only one specialist can address your condition. There almost always is an alternative (contracted) provider if the first one is not.

Conclusion:

Spending some time preparing for an upcoming office visit or initial consultation makes sense from a clinical point of view, but also financial and emotional.

Going over symptoms one-by-one clarifies their importance, while listing all meds and supplements highlights a possible need to clear out the pharmacy cabinet. It also shows what is being taken out of habit rather than need, or because no one said to stop it even if it is no longer indicated. Some of the prescriptions may be the cause of a present symptom. In many cases, changing a dosage or prescription will take care of further complications.

Financial savings can be achieved by asking questions relating to cost, effectiveness, likely results and alternative options of a treatment. Establish a healthy communication with your physician, who can then take into account any impact of a prescribed course of action on your financial circumstances, professional situation, family or daily life. While severe conditions may call for a unique or aggressive response, many others offer a range of options which you can help your physician define.

Dealing with the medical system, especially while under stress or anxious about symptoms or a determined condition can bring a heavy toll to patients, their caregivers and loved ones. Assisting them in this process is the establishment of priorities, expectations, goals, and means. Describing and defining a list of symptoms may shed light on their perceived versus real significance. The process may also highlight areas of strength, achievement, challenge and need. "Divide and conquer' may well be, in such cases, a worthwhile piece of advice.

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

www.advimedpro.com contact@advimedpro.com

Monday, March 17, 2014

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

by Martine G. Brousse,

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Women's Health in France: Major

Differences vs. US Healthcare System

Born and raised in France and living in the States for over 3 decades (but still French at heart when it comes to cheese and pastries), I recently came across an article in a French magazine that peeked my interest.

The article cast a light on midwives, a profession well established in France, but whose scope I was not aware of. Further research highlighted the vast disparity of coverage, cost and social rights between "socialized" medicine and the US healthcare system.

Though French citizens have the choice to opt out of the state-sponsored insurance system, and use private physicians or clinics in much the same way a patient here can go "out of network", their medical coverage, unlike that in the US, will not be reduced or penalized them in such exorbitant ways.

Let us go over some major differences:

1. French women use midwives

It is estimated that 70% of all births in France are performed by midwives, whether in private clinics, public hospitals (those under the state-sponsored system) or at home.

This number speaks not only of the competence of and respect for midwives, but also of a system which places great emphasis on expanding access to care while effectively managing risks with fewer resources and at a lower cost.

Doctors are not routinely part of the childbirth process, unless complications arise, or in high-risk cases. This explains why the rate of C/sections is much lower in France than in the U.S. It also highlights a type of medicine which does not consider childbirth an illness, thus not extending the vast amount of resources and money the US system does.

A profession too little used in the US, midwives are the main destination for French women when it comes to their reproductive and sexual health. Well-respected as a profession, students' education starts with the first year of medicine classes that future MDs also attend, then continue thorough 4 years of specialization and training.

Further studies in acupuncture, haptonomy (bounding with Baby), tobacco cessation or homeopathy for example add to their long list of competence.

2. A widespread reach

Usually associated with childbirth, French midwives have been entrusted with a vast variety of responsibilities:

Preventive screenings such as Pap smears, and other general gynecological consultations
Education and supervision of puberty-related issues
Contraception education and evaluation
Prescription of contraceptive methods, insertion of IUD or implant
Sexuality-related issues or questions at all ages
STD prevention, detection, and treatment
Yearly well-woman visits including screening labs
Pregnancy supervision and preparation to childbirth
Echography
Pre-natal tests and screenings
Childbirth and delivery
Breast feeding support and supervision
Postnatal care for Mom
Initial baby evaluation and care
Parental education on how to care for Baby at home and about new family dynamics
Perineal reeducation after birth and throughout life
Education on child-proofing the home, and on developmental stages
Home visits after birth to check on health and progress (up to 12 days after birth)

A referral to a physician is usually only made under specific circumstances: complications, serious health issues, disability lasting over 2 weeks, or the need for more advanced or specialized care such as pre-determined need for a C-section.

Midwives also offer the listening skills, easier access, emotional support and knowledge of social services that physicians are too often not able to provide.

3. Talk about lower costs!

As of 9/1/3013, the set price for a consultation with a midwife is 23 Euros, or about $ 30.00 (the same as a visit with a French G.P.). Pre-natal or perineal reeducation classes are less. A home visit will cost a few euros more but services are usually covered at 100%. An echography costs about $ 4.00.

A regular delivery is priced at about $ 407.00, twins a little higher at about $ 500.00. There is a $ 52.00 surcharge for night deliveries. These charged are usually covered at 100% by the French government-issued insurance.

Prices for the facility and for the anesthesiologist are separate. Hospital costs are covered at 100%, unless services are rendered in a private or non-participating clinic. New mothers will enjoy a 3-day stay after birth, and 5 days minimum after a C/section.
When I had my twins in the US 25 years ago, I was scheduled to be sent home 12 hours after the birth; an additional day was only authorized by my insurance because of complications. At that time, my sister stayed hospitalized one full week for a regular birth!

4. Women Health in the US

With the implementation of the ACA guidelines in 2014, women are now able to receive some of the same benefits as their French counterparts.

Multiple preventive services are now covered at no cost to patients. Those include:

for pregnant women: screenings for anemia, folic acid, gestational diabetes, Hepatitis B, Rh incompatibility, syphilis, urinary tract and other infections as well as breastfeeding support and counseling.

for all women: mammography screenings, cervical cancer screenings, STD prevention and detection, domestic and interpersonal violence evaluation, contraception education and methods, sterilization, tobacco use intervention and well-woman visits.

For those at risk: Breast cancer genetic test counseling, breast cancer chemo prevention counseling, HIV testing, HPV DNA testing, osteoporosis evaluation.

For Women and Men: Screenings for alcohol misuse, blood pressure, cholesterol, colorectal cancer, depression, diabetes, obesity, tobacco use. Also included are immunizations and diet counseling.

While childbirth is still treated as a disease, along with menopause, we are seeing a small shift toward using a less radical (and less costly) approach.
Nurse practitioners are taking over some of the physicians' duties, especially where routine or screening visits are concerned. A shortage of physicians may contribute, especially is some areas, to turn more to Nurse practitioners and Physician Assistants to handle those duties, thus widening the range of services women can get access to.

As more ACA mandates are implemented, and as the planned shift in administration, methods and results in medicine develops, we can hope that American women can get as attentive, professional and efficient a care as their French counterparts, for much less than its current cost.

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

www.advimedpro.com contact@advimedpro.com