patient Advocacy: Healthcare on your side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Affordable Care Act:

Free Preventive Care Services for Adults

This is part 2 of a 3-part introduction to the provisions of The Affordable Care Act, regarding covered preventive services. At no cost to the patient, preventive services, screenings, educational resources and counseling became effective on Jan 1, 2014. These measures are mandatory, except in the case of grandfathered policies. 

Please note that, if any of these services is given as part of an office office relating to another condition, the primary diagnosis listed by the physician on the billing claim form will affect your final cost. For example, if you see a physician for pain relating to a bad knee, and a blood pressure reading is taken, this visit will not be free to you, as the primary reason for your visit is not to get the blood pressure screening.  If the physician bills 2 separate services, the one listing the screening will prompt no liability on your part. 

This week, we will explore the 1 Men-only and 16 Women-only measures.

For Men only 

1. AAA screening (Abdominal aortic aneurysm)

If you are a man over 60 who has ever smoked, or have a family history of aneurysm or heart disease, or have been diagnosed with high blood pressure, high cholesterol levels or obesity, this screening may save your life. Talk with your doctor about scheduling this free ultrasound screening.

For Women only 

1. Pregnancy related:

• Anemia screening: pre natal testing is vital for this often-diagnosed condition
• Bacteriuria screening: check for urinary tract and other infections, and receive information on how to avoid infections
• Breastfeeding: access to education, counseling and support is encouraged and guaranteed. So is access to supplies. 
• Folic Acid: your specific level requirement will be determined by your physician to ensure a healthy pregnancy and baby and education will be provided
• Gestational diabetes:  it develops in pregnancy in some women, putting their health and that of their unborn child at risk. Getting tested during week 24 to 28 of pregnancy is crucial in reducing risks and potential  harmful consequences.
• Hepatitis B: This serious disease is easily transmitted, and puts a baby at risk of chronic liver disease and possibly cancer. The risk of contagion is lowered by getting early medical care for the mother and specialized treatments for the baby right after birth.
• RH incompatibility screening: screening of the expectant motherʻs blood type is crucial to determine whether it might be negative, which may cause significant problems for mother, baby and in any subsequent pregnancy. 

You can also get help from your state to pay for medical care during pregnancy. These programs give medical care, information, advice, and other services important for a healthy pregnancy. To find out about the program in your state: Call 1-800-311-BABY (1-800-311-2229)

2. All Women:

• BRCA genetic testing: if you have a family history of breast or ovarian cancer, or are deemed "high risk", speak with your physician about this test, and on how to reduce your risks of getting those diseases
• Mammograms: getting tested every 1 to 2 years if you are over 40 will establish a baseline and may give you the best chances of remission if a cancer is found at the earliest stage.
• Breast and Ovarian cancer risk prevention: counseling for women at high risk (those with a family history of breast and/or ovarian cancer) will be available to discuss risk levels and strategize on reducing them. 
• Cervical cancer screennig: routinely known as a PAP smear, this test is done in the doctorʻs office, usually every 3 years. It reveals changes  in cervical cells before they turn into cancer, and help significantly raise the odds of a complete cure. Screening for HPV via a DNA test may also be done in women who did not get the vaccine, as HPV is one of the major causes of cervical cancer. 
• Contraception: education and counseling of contraceptive and sterilization methods will be provided to help you make the best choice.
• Domestic violence: Services for women at risk and those in abusive relationships will include education and counseling on recognizing the signs, protecting yourself, and getting the help needed to exit the situation. 
• Osteoporosis: women over 60, or those with higher risk factors, should ask their doctor for a bone density test. Establish a baseline, determine your risk of osteoporosis and develop with your doctor  a strategy to avoid bone loss. 
• STD screening: chlamydia, gonorrhea and syphilis should be screened for regularly, especially if you are pregnant or at risk.  Getting treated early  will save you from future health complications including sterility. 
• Well women visit: this yearly visit will keep you in good health with (1) screenings  which allow for early treatments and high curative results (2) preventive services such as immunizations and (3) educational resources and counseling to support you in making the best informed decisions, reducing your risks of serious or chronic disease,  and encouraging a healthy lifestyle. 

For more info on the ACA in your area: https://localhelp.healthcare.gov/

As the healthcare system adapts to the new regulations of the Affordable Care Act, the emphasis of quality of care versus the previous model of quantity, will likely change the way you and your physician relate. The way medicine has been prescribed until now is based on the cure of an established disease or too often, on the long-term management of a chronic condition. This reactive stand offers limited success, and its costs, based on a fee-for-service basis, have lead to an astronomical and unsustainable price tag. The shift toward prevention, early detection and treatment, education, support and risk lowering strategies should slow down the negative health trends of the US population, while giving the individual person the monetary incentive to get the services early, and make health-minded decisions and beneficial lifestyle changes. The system itself will adapt to the new paradigm: rewards for tangible, measurable and long-lasting results will soon be the norm. "The more the better" attitude and business plan that has brought us to this point is no longer working for individuals or the country. While the requirements of the ACA will likely lead to stress on a system that redefines itself while caring for many more patients, the average American should see positive improvements, better care, lower or no cost for many services including those listed above and last week, and a better chance at a healthy tomorrow. 

©  [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. 

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