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 Children

This is part 3 of a 3-part introduction to the provisions of The Affordable Care Act, regarding covered preventive services. Preventive services, screenings, educational resources and counseling are covered benefits as of Jan 1, 201, at no cost to the patient. Except in the case of grandfathered policies, even if a patient's deductible or out of pocket liability has not been completely met, the insurance will be responsible for the payment in full of these charges to medical providers.

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 may affect your final cost. For example, if your child sees a physician for an ear infection, and a vaccine booster is given, this visit will likely not be free to you until your deductible has been met, as the primary reason for your visit is not to get the vaccination. The cost of the shot will however not be your responsibility. If your child is seen for a "well child" visit, you should have no liability. 

A. For all Children

• Behavioral Assessments: will be performed at regular intervals. 
• Blood Pressure: your pediatrician will take a reading at each visit, and offer education and counseling for those at risk.
• Dyslipidemia: screening will be offered for children at higher risk of lipids disorder. 
• Fluoride: treatment will be available to children whose water supply does not contain supplementation.
• Height, Weight, BMI: these measurements will be part of any medical visit.
• Hematocrit/Hemoglobin:  screening for this common nutritional iron deficiency will be available.
• Immunizations: twelve immunizations and booster shots from infancy to age 18 will be covered: 

1. DTP (Duphteria, Tetanus, Pertussis)
2. Haemophilus Influenzae b
3. Hepatitis A
4. Hepatitis B
5. HPV (Human Papillomavirus)
6. Polivirus
7. Flu shot
8. MMR (Measles, Mumps, Rubella)
9. Meningococcal
10. Pneumococcal
11. Rotavirus
12. Varicella

• Iron: supplementation will be given to those whose screening reveals anemia.
• Lead: testing to determine lead levels is recommended for every child, and especially those at higher risk due to inhalation or swallowing of lead particles through old paint dust, toys, furniture finish and other sources.
• Medical History: updated at each visit, it will document a child's development, conditions, family history, environment situation and more.
• Obesity: early screening and education are keys to optimal weight health. The medical provider will also provide information on healthy eating habits, recommend physical activities and advise on a weight-loss regimen if necessary.
• Oral health: an assessment of your child's oral health and education on proper oral hygiene will be provided.
• Tuberculin: screening should be performed every few years, and especially in those at higher risk of tuberculosis.
• Vision: the physician will check your child for possible vision loss, as well as conditions such as lazy eye (amblyopia) or crossed eyes (strabismus).

B. For Newborns and children up to 3

• Autism: screening will be performed between the ages of 18 and 24 months.
• Development: evaluating your child's language and other progress will help make sure there is no need for further specialized intervention.
• Congenital Hypothyroidism: Growth and development can be negatively affected by this hormonal imbalance.
• Gonorrhea: a mother carrying the disease puts her baby at risk of blindness, blood infection and runs the risk of early labor. Medicated drops will be given to all babies after birth as a preventive measure. 
• Hearing: babies will be tested within their first 30 days. Hearing impairment or loss may lead to speech and language difficulties.
• Phenylketonuria: known as PKU, this condition prevents babies from processing certain foods and may lead to mental retardation. Special formula must be given if this diagnosis is established after birth. 
• Sickle Cell: this blood disease can be serious; an early diagnosis will ensure early treatment and long term monitoring.

C. For Adolescents

• Alcohol and Drug Assessment be provided to all teens, especially those at risk.
• Cervical Dysplasia: known as the PAP Smear, this routine screening should be a part of every sexually active female wellness strategy, ensuring the early diagnosis of abnormal cells which may lead to cancer. 
• Depression: your teen should be evaluated as a wellness measure, and definitely if signs are present. Many treatment and counseling options are available.
• HIV: regular testing should be performed, especially for those with high risk behavior. Educational and counseling resources will be made available. 
• STD: Chlamydia, gonorrhea and syphilis are sexually transmitted diseases which may cause serious problems, and which may be transmitted to a newborn. Regular screening in those sexually active is a covered benefit.

While most if not all of these steps were already enacted by your pediatrician, the goal of the ACA lies in getting all children to see a physician at regular and recommended intervals, without fear of cost, inexistent or inadequate insurance coverage or lack of awareness.  Reaching out to parents to bring their children for well care visits is expected to save lives, money and resources, by providing education and counseling for those at risk and by the early diagnosis and treatment of conditions which may have become chronic and serious otherwise. For parents, knowing their child is healthy, monitored and  that they not need to be ill in order to see a physician should bring peace of mind, especially if they have little or no liability. 

©  [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

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. 

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

Affordable Care Act:

Free Preventive Care Services

The  provisions of The Affordable Care Act, which became effective on 1/1/14 are becoming more scrutinized. Starting with the coverage, at no cost to the patient, of preventive services, screenings, educational resources and care for adults and children, the goal here is to focus on the matters that impact your life positively, and can help you and your family achieve better health and gain a greater peace of mind. 

One of the ACAʻs main objectives is to shift the current state of our healthcare system from curative and reactive to preventive, in order to save lives, money and resources. This overhaul of the healthcare system is intended to radically change the way medicine now works, away from paying for the quantity of services and treatments given to patients, often unnecessarily, to rewarding medical providers and facilities for successful, long lasting, better managed and therefore less expensive outcomes. The following provisions will become a patientʻs right, to be covered at no cost, not even an office copay, even if the yearly deductible or out of pocket have not been met in full.

A word of caution: if a screening is done as part of an office visit relating to another condition, the primary diagnosis listed on the claim 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.  

Here are the main areas of no-cost coverage for adults (check this blog in coming weeks for Women Only, Men Only and for Children related guidelines). 

1. Alcohol Use screening and counseling

Screening and evaluation services are covered under the ACA. Counseling, treatment and resources to help you reduce or stop misuse should be made available at no or reduced cost. 

2. Aspirin Use

If you are a woman between 55 and 79, or a man between 45 and 79, or if you are considered high risk for cardiovascular disease due to your personal or family history, this  service is intended to provide you with an evaluation and the education you may need to lower your risk or manage your current health situation. 

3. Blood Pressure screening

Checking your blood pressure is recommended every 2 years, and more often after age 40. Many severe conditions such as strokes, heart disease, kidney disease can be avoided or safely managed when hypertension (high blood pressure) is diagnosed early and controlled. Let your physician advise you on risks and treatment options. 

4. Cholesterol screening

Screening for and treatment of high cholesterol are paramount to avoid a heart attack or chronic heart disease. Any adult with risk factors should be periodically tested. These include smoking, hypertension, diabetes, obesity, or a family history of heart disease. Men over 35 should also get checked regularly. 

5. Colorectal Cancer screening

For adults over 50 (or those younger with a family history of colorectal cancer), this screening should be done every few years. It may involve simple tests such as a fecal occult blood test or more extensive ones done in a facility such as a colonoscopy. Your physician will recommend the most appropriate testing method based on your risk factors: history of polyps or growths, smoking, alcohol abuse, family history, obesity, lack of physical activity, personal history of inflammatory intestinal disease such as Crohnʻs disease or ulcerative colitis. 

6. Depression screening

Depression affects millions of people. A proper and timely diagnosis is the first step to a healthier, happier you. Treatment options are available to manage and overcome it. Do contact your physician for a screening if you are feeling hopeless, have thoughts of suicide, have lost interest in activities you used to enjoy, if your sleeping habits have drastically changed or if you feel "down" for more than a couple of weeks. 

7. Diabetes screening

Type 2 diabetes is a serious disease which may lead to neuropathy, kidney and heart disease, blindness and other life threatening conditions. As many people do not have symptoms or are not aware of what they mean, choose this screening tool to evaluate your risk and get management advice from your physician. Receiving lifestyle choices information is a good way to lower your risks. 

8. Diet Counseling

Giving you personalized nutritional advice, helping you make the best diet choices, supporting you in creating and implementing a food plan, are ways your physician can help you succeed at building a healthier lifestyle, lowering your risk factors or better managing your present conditions. 

9. HIV screening

Every person age 15 to 65 should be tested at least once, as well as pregnant women. Those with high risk factors, and those whose present behavioral circumstances show they may be at risk, should be tested regularly and often. Your doctor will help evaluate your risk level and provide advice and educational resources. 

10. Immunizations and Vaccines

There are a dozen immunizations about to be covered under the ACA at no cost to patients. Some are given yearly (flu for example), others every few years or once a lifetime (tetanus, shingles, Hepatitis A or B etc). Based on your personal history, age and risk factors, your physician will recommend the necessary and most appropriate vaccinations for you.  

11. Obesity

Screening and counseling are covered under the ACA. Whether to evaluate your BMI (Body Mass Index), lower your health risks, or help you lose weight, many services and educational tools are available as of January 2014.

12. Sexually transmitted diseases prevention counseling

Every sexually active person should be tested periodically for STD such as chlamydia, gonorrhea and syphilis. Pregnant women can also pass a disease to their unborn child. These are treatable and curable diseases; getting an early diagnosis will also help guarantee that no long-term health problems such as sterility develop. 

13. Tobacco use screening

Smoking is the most preventable cause of disease and death in the U.S. The range of higher risk factor levels for a smoker include all major classes of diseases, from cancer to heart disease to breathing problems to strokes. Stopping cessation success depends on many factors which your doctor will help evaluate and manage. Guidance, support and educational tools will be provided. 

Some important points: 

a. You must use medical providers that are part of your Marketplace plan or network. 

b. If you are covered under a grandfathered plan, these guidelines may not apply to you. Please check with your plan administrator, HR department, insurance company or broker. 

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

©  [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