In addition to the various types of health care coverage health insurance has its own unique terminology which can be very difficult to understand.
I will try to explain some of the terminology to make it easier to understand your policies.
Coinsurance
This is the amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if your health insurance company pays 80 percent of the claim, you pay 20 percent.
Coordination of Benefits
This is a system to eliminate duplication of benefits when you are covered under more than one group plan. For example if a husband and wife have family coverage at work they can not bill both polices for the full fee and receive additional funds in excess of the charge. Benefits under the two plans usually are limited to no more than 100 percent of the claim.
Co-payment
This is another way of sharing medical costs in addition to the insurance covered by your employer or under a basic policy. You pay a flat fee every time you receive a medical service (for example, $5 for every visit to the doctor). The health insurance company pays the rest.
Covered Expenses
Most health insurance plans, whether they are fee-for-service, HMOs, or PPOs, do not pay for all services. Some may not pay for prescription drugs. Others may not pay for mental health care. Covered services are those medical procedures the insurer agrees to pay for. They are listed in the health insurance policy.
Customary Fee
Most health insurance plans will pay only what they call a reasonable and customary fee for a particular service. If your doctor charges $1,000 for a hernia repair while most doctors in your area charge only $600, you will be billed for the $400 difference. This is in addition to the deductible and coinsurance you would be expected to pay. To avoid this additional cost, ask your doctor to accept your health insurance company's payment as full payment. Or shop around to find a doctor who will. Otherwise you will have to pay the rest yourself.
Deductible
The amount of money you must pay each year to cover your medical care expenses before your health insurance policy starts paying for covered eligible expenses.
Dependant
A person for whom the insured has some legal obligation to. For most plans, it is the insured's spouse and/or children. Some plans also allow non-traditional spousal relationships (significant other, life-partner, etc.) to be considered a dependent with some additional certifying paperwork.
Exclusions
Specific conditions or circumstances for which the policy will not provide benefits.
Maximum Out-of-Pocket Expenses
The most money you will be required pay a year for deductibles and coinsurance. It is a stated dollar amount set by the health insurance company, in addition to regular premiums.
Non-cancelable Policy
A policy that guarantees you can receive health insurance, as long as you pay the premium. It is also called a guaranteed renewable policy.
Premium
The amount you or your employer pays in exchange for health insurance coverage.
Provider
Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.
Third-Party Payer
Any payer for health care services other than you. This can be an insurance company, an HMO, a PPO, or the Federal Government.
Claim
This is a request for payment for medical services under the terms of an insurance policy.
Exclusions and Limitations
Conditions, situations and services that are not covered by the health plan.
Health Care Provider
This is anyone who delivers medical or health-related care such as a doctor, hospital, laboratory, or nurse.
Health Savings Account HAS
The newest choice in health insurance for the self-employed, also called Medical Savings Accounts (MSAs) allow you to build up a tax-free savings account to pay for routine medical expenses You must have a high deductible medical plan (catastrophic health plan) that includes a tax deferred savings account. A HDHP is an inexpensive health insurance plan that generally doesn’t pay for the first several thousand dollars of health care expenses but will generally cover you after that. Your HSA is available to help you pay for the expenses your plan does not cover. The money from the HAS savings account can be used to help meet the deductible, help pay early hospitalization/medical expenses or used towards personal retirement savings.
Indemnity plan
This is also called a fee-for-service plan. It is a health insurance plan that allows the insured to use any medical provider that he or she chooses. As such, there are no networks to utilize.
Insured
This is the person whose health is insured under an insurance policy. This person may also be referred to as a member.
Major Medical Insurance Plan
This is a type of traditional medical expense coverage that provides substantial benefits for hospital surgical expenses and physicians' fees.
Network
A group of doctors, hospitals and other health-care providers contracting with a health plan, usually to provide care at special rates and to handle paperwork with the health plan.
Out-of-Network
Health care services received outside the group of health –care providers affiliated with the HMO, POS or PPO network.
Out-of-Pocket expense
This is any medical care costs that is not covered by insurance or which must be paid by the insured.
Preferred Provider Organization PPO
This is an organization where providers are under contract to an insurance company or health plan to provide care at a discounted or negotiated rate. Typically, you can see any doctor in the PPO network without requiring special approval, and you usually do not need to choose a primary care physician. Most PPOs will also allow you to seek care outside of the PPO network; however, the benefits are usually reduced and the insured has a greater out-of-pocket expense.
Pre-admission certification
This is a component of utilization review under which the utilization review organization determines whether an insured's proposed non-emergency hospital stay or some other type of care is most appropriate and what the length of an approved hospital stay may be.
Pre-existing Condition
According to most individual health insurance policies, this is an injury that occurred or a illness that first appeared or manifested itself before the policy was issued and that was not disclosed on the application for insurance. According to most group health insurance policies, this is a condition for which an individual received medical care during the three months immediately prior to the effective date of his coverage.
Short-term Disability
This type of coverage pays a percentage of your salary if you become temporarily disabled, meaning that you are not able to work for a short period of time due to sickness or injury (excluding on-the-job injuries, which are covered by workers compensation). The per-week amount is usually 50, 60 or 66 2/3 percent of your weekly salary, and lasts for a period of time specified by the plan.
Usual, Customary and Reasonable Fee
This is the maximum dollar amount of a covered expense that is considered eligible for reimbursement under a major medical policy. In other words if the average cost for a doctor’s visit across the country is $ 50. If your doctor charges $100 per visit only $ 50 is covered as the usual, customary and reasonable fee.
Friday, January 18, 2008
Sunday, January 13, 2008
Health Care Coverage Basics
One of the main reasons I started this blog was because of the desperate cries of people lost in the health care system. Most people are unaware of what options are available or where to seek assistance.
There are a lot of resources out there to help you understand the health care system. But you need to take stock in what you have and what you need. I will try to address some of the main concerns in this and subsequent blogs.
Basics on Health Care coverage
Health insurance is insurance that pays for all or part of a person's health care bills. The purpose of health insurance is to help people cover their health care costs. Health care costs include doctor visits, hospital stays, surgery, procedures, tests, home care, and other treatments and services.
There are three basic plans available to cover the costs of health care:
Private Health Insurance- coverage by a health plan provided through an employer or union or purchased by an individual from a private health insurance company. ex. Blue Cross/Blue Shield, United Health Care, or Aetna.
Government Health Insurance- plans funded by the federal, state, or local government ex. Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), military health care, state plans, and the Indian Health Service.
Worker’s Compensation Insurance- Insurance that covers medical and rehabilitation costs and lost wages for employees injured at work; required by law in all states.
Private Health Insurance
Many employers offer group health plans to employees and their dependents as a benefit of working with that particular employer (medical benefits). The employer may pay for part or all of the insurance cost (premium).Group and individual plans can be further classified as either fee-for-service or managed care.
Fee-for-service is traditional health insurance in which the insurance company reimburses the doctor, hospital, or other health care provider for all or part of the fees charged. Fee-for-service plans may be offered to groups or individuals. This type of plan gives people the highest level of freedom to choose a doctor, hospital, or other health care provider. A person may be able to receive medical care anywhere in the United States and, often, in the world.
Managed care plans are also sold to both groups and individuals. In these plans a person's health care is managed by the insurance company. Approvals are needed for some services, including visits to specialist doctors, medical tests, or surgical procedures. In order for people to receive the highest level of coverage they must obtain services from the doctors, hospitals, labs, imaging centers, and other providers affiliated with their managed care plan.
Types of Health Care Plans
Health Maintenance Organization (HMO)
An HMO is a type of managed care called a prepaid plan. This type of coverage was designed initially to help keep people healthy by covering the cost of preventive care, such as medical checkups. The patient selects a primary care doctor from a list of physicians participating in the HMO program. This doctor coordinates the patient's care and determines if referrals to specialist doctors are needed. People pay a premium, usually every month, and receive their health care services (doctor visits, hospital care, lab work, emergency services, etc.) when they pay a small fee called a co-payment. The HMO has arrangements with caregivers and hospitals and the co-payment only applies to those caregivers and facilities affiliated with the HMO. This type of coverage offers less freedom than fee-for-service, but out-of-pocket health care costs are generally lower and more predictable. A person's out-of-pocket costs will be much higher if he or she receives care outside of the HMO unless prior approval from the HMO is received.
Preferred Provider Organization (PPO)
A PPO combines the benefits of fee-for-service with the features of an HMO. If patients use health care providers (doctors, hospitals, etc.) who are part of the PPO network, they will receive coverage for most of their bills after a deductible and, perhaps a co-payment, is met. Some PPOs require people to choose a primary care physician who will coordinate care and arrange referrals to specialists when needed. Other PPOs allow patients to choose specialists on their own. A PPO may offer lower levels of coverage for care given by doctors and other professionals not affiliated with the PPO. In these cases the patient may have to fill out claim forms to receive coverage.
Point-of-Service Plans (POS)
Many HMOs offer an indemnity-type option known as a POS plan. The primary care doctors in a POS plan usually make referrals to other providers in the plan. But in a POS plan, members can refer themselves outside the plan and still get some coverage. If the doctor makes a referral out of the network, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you will have to pay coinsurance.
Government Health Plans
Medicare and Medicaid are the two main health plans offered by the U.S. government. They are available to individuals who meet certain age, income, or disability criteria. TRICARE Standard, formerly called CHAMPUS, is the health plan for U.S. military personnel.
Medicare
Medicare was created in 1965 under Title 18 of the Social Security Act and is available to people who are 65 years or older , or younger individuals who have disabilities or end-stage renal disease (permanent kidney failure)
Medicare is divided into four parts.
Part A is hospital insurance and helps cover the costs of inpatient hospital stays, skilled nursing centers, home health services, and hospice care.
Part B helps cover medical services such as doctors' bills, ambulances, outpatient therapy, and a host of other services, supplies, and equipment that Part A does not cover.
Part C provides the option to choose from a package of health care plans
Part D helps provide coverage for medication.
Enrolled individuals must pay deductibles and co-payments, but much of their medical costs are covered by the program. Medicare is less comprehensive than some other health care programs, but it is an important source of post-retirement health care.
Medicaid
Medicaid was created in 1965 under Title 19 of the Social Security Act and is a federally funded state run program of public assistance for persons regardless of age whose income and resources are insufficient to pay for health care.
This program covers hospitalization, doctors' visits, lab tests, and x rays. Some other services may be partially covered.
State Children’s Health Insurance Program Summary (SCHIP)
The State Children's Health Insurance Program was created as part of the Balanced Budget Act of 1997 title XXI, to address the growing problem of children without health insurance. SCHIP was designed as a Federal/State partnership, similar to Medicaid, with the goal of expanding health insurance to children whose families earn too much money to be eligible for Medicaid, but not enough money to purchase private insurance.
Tricare
Tricare is the United States military's health care plan for military personnel and their dependents. The Tricare program is managed by TRICARE Management Activity (TMA) under the authority of the Office of the Assistant Secretary of Defense for Health Affairs (OSD/HA). Eligible military families may enroll in Tricare Prime, which is an HMO; Tricare Extra, which offers an expanded choice of providers; or Tricare Standard, which is the new name for CHAMPUS.
Workers' Compensation
Workers' compensation covers health care costs only for an injury or illness related to a person's job. Medical conditions that are unrelated to work are not covered under this plan. In some cases an evaluation is done to determine whether or not the medical condition is truly related to a person's employment.
For additional information
http://www.cms.hhs.gov/default.asp?
There are a lot of resources out there to help you understand the health care system. But you need to take stock in what you have and what you need. I will try to address some of the main concerns in this and subsequent blogs.
Basics on Health Care coverage
Health insurance is insurance that pays for all or part of a person's health care bills. The purpose of health insurance is to help people cover their health care costs. Health care costs include doctor visits, hospital stays, surgery, procedures, tests, home care, and other treatments and services.
There are three basic plans available to cover the costs of health care:
Private Health Insurance- coverage by a health plan provided through an employer or union or purchased by an individual from a private health insurance company. ex. Blue Cross/Blue Shield, United Health Care, or Aetna.
Government Health Insurance- plans funded by the federal, state, or local government ex. Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), military health care, state plans, and the Indian Health Service.
Worker’s Compensation Insurance- Insurance that covers medical and rehabilitation costs and lost wages for employees injured at work; required by law in all states.
Private Health Insurance
Many employers offer group health plans to employees and their dependents as a benefit of working with that particular employer (medical benefits). The employer may pay for part or all of the insurance cost (premium).Group and individual plans can be further classified as either fee-for-service or managed care.
Fee-for-service is traditional health insurance in which the insurance company reimburses the doctor, hospital, or other health care provider for all or part of the fees charged. Fee-for-service plans may be offered to groups or individuals. This type of plan gives people the highest level of freedom to choose a doctor, hospital, or other health care provider. A person may be able to receive medical care anywhere in the United States and, often, in the world.
Managed care plans are also sold to both groups and individuals. In these plans a person's health care is managed by the insurance company. Approvals are needed for some services, including visits to specialist doctors, medical tests, or surgical procedures. In order for people to receive the highest level of coverage they must obtain services from the doctors, hospitals, labs, imaging centers, and other providers affiliated with their managed care plan.
Types of Health Care Plans
Health Maintenance Organization (HMO)
An HMO is a type of managed care called a prepaid plan. This type of coverage was designed initially to help keep people healthy by covering the cost of preventive care, such as medical checkups. The patient selects a primary care doctor from a list of physicians participating in the HMO program. This doctor coordinates the patient's care and determines if referrals to specialist doctors are needed. People pay a premium, usually every month, and receive their health care services (doctor visits, hospital care, lab work, emergency services, etc.) when they pay a small fee called a co-payment. The HMO has arrangements with caregivers and hospitals and the co-payment only applies to those caregivers and facilities affiliated with the HMO. This type of coverage offers less freedom than fee-for-service, but out-of-pocket health care costs are generally lower and more predictable. A person's out-of-pocket costs will be much higher if he or she receives care outside of the HMO unless prior approval from the HMO is received.
Preferred Provider Organization (PPO)
A PPO combines the benefits of fee-for-service with the features of an HMO. If patients use health care providers (doctors, hospitals, etc.) who are part of the PPO network, they will receive coverage for most of their bills after a deductible and, perhaps a co-payment, is met. Some PPOs require people to choose a primary care physician who will coordinate care and arrange referrals to specialists when needed. Other PPOs allow patients to choose specialists on their own. A PPO may offer lower levels of coverage for care given by doctors and other professionals not affiliated with the PPO. In these cases the patient may have to fill out claim forms to receive coverage.
Point-of-Service Plans (POS)
Many HMOs offer an indemnity-type option known as a POS plan. The primary care doctors in a POS plan usually make referrals to other providers in the plan. But in a POS plan, members can refer themselves outside the plan and still get some coverage. If the doctor makes a referral out of the network, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you will have to pay coinsurance.
Government Health Plans
Medicare and Medicaid are the two main health plans offered by the U.S. government. They are available to individuals who meet certain age, income, or disability criteria. TRICARE Standard, formerly called CHAMPUS, is the health plan for U.S. military personnel.
Medicare
Medicare was created in 1965 under Title 18 of the Social Security Act and is available to people who are 65 years or older , or younger individuals who have disabilities or end-stage renal disease (permanent kidney failure)
Medicare is divided into four parts.
Part A is hospital insurance and helps cover the costs of inpatient hospital stays, skilled nursing centers, home health services, and hospice care.
Part B helps cover medical services such as doctors' bills, ambulances, outpatient therapy, and a host of other services, supplies, and equipment that Part A does not cover.
Part C provides the option to choose from a package of health care plans
Part D helps provide coverage for medication.
Enrolled individuals must pay deductibles and co-payments, but much of their medical costs are covered by the program. Medicare is less comprehensive than some other health care programs, but it is an important source of post-retirement health care.
Medicaid
Medicaid was created in 1965 under Title 19 of the Social Security Act and is a federally funded state run program of public assistance for persons regardless of age whose income and resources are insufficient to pay for health care.
This program covers hospitalization, doctors' visits, lab tests, and x rays. Some other services may be partially covered.
State Children’s Health Insurance Program Summary (SCHIP)
The State Children's Health Insurance Program was created as part of the Balanced Budget Act of 1997 title XXI, to address the growing problem of children without health insurance. SCHIP was designed as a Federal/State partnership, similar to Medicaid, with the goal of expanding health insurance to children whose families earn too much money to be eligible for Medicaid, but not enough money to purchase private insurance.
Tricare
Tricare is the United States military's health care plan for military personnel and their dependents. The Tricare program is managed by TRICARE Management Activity (TMA) under the authority of the Office of the Assistant Secretary of Defense for Health Affairs (OSD/HA). Eligible military families may enroll in Tricare Prime, which is an HMO; Tricare Extra, which offers an expanded choice of providers; or Tricare Standard, which is the new name for CHAMPUS.
Workers' Compensation
Workers' compensation covers health care costs only for an injury or illness related to a person's job. Medical conditions that are unrelated to work are not covered under this plan. In some cases an evaluation is done to determine whether or not the medical condition is truly related to a person's employment.
For additional information
http://www.cms.hhs.gov/default.asp?
Wednesday, January 9, 2008
Cancer and the Uninsured
According to a new American Cancer Society report examining the impact of health insurance status on cancer treatment and survival, uninsured Americans are less likely to get screened for cancer, more likely to be diagnosed with an advanced stage of the disease, and less likely to survive that diagnosis than their privately insured counterparts.
"This report clearly suggests that insurance and cost-related barriers to care are critical to address if we want to ensure that all Americans are able to share in the progress we have achieved by having access to high-quality cancer prevention, early detection, and treatment services," said Otis Brawley, MD chief medical officer of the American Cancer Society.
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Report_Links_Health_Insurance_Status_With_Cancer_Care.asp?sitearea=NWS&viewmode=print&
For all cancers combined, the ACS researchers found that uninsured patients were 1.6 times as likely to die within 5 years compared to individuals with private insurance.
An earlier article by the American Cancer Society reports” People without health insurance and those on Medicaid are more likely to be diagnosed with advanced stages of cancer than those with private health insurance,”
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Uninsured_More_Often_Diagnosed_with_Advanced_Cancer.asp
It's important to note that although variations in health insurance coverage likely contribute to racial and ethnic disparities in cancer outcomes, those disparities persist for several outcomes even when differences in insurance status are accounted for," said Elizabeth Ward, PhD.
People with lower incomes were less likely to have insurance, the report found. And those without insurance were less likely to use certain health services. About 54% of uninsured patients aged 18 to 64 did not have a usual source of health care. About 26% delayed care due to cost, while nearly 23% did not get care because of cost. An estimated 23% did not get prescription drugs because of the expense.
"For too many hardworking 'average Americans' paying for cancer treatment means not paying rent, mortgage (resulting in foreclosure or eviction), or utility bills, or even going hungry," wrote Elmer Huerta, MD, American Cancer Society president, in an accompanying editorial.
These statistics are true and uninsured and underinsured are more at risk than Americans with better health care coverage. However free and low cost services are available to assist the uninsured and underinsured.
It was mentioned in the article those uninsured or on Medicaid were more likely to be diagnosed in later stages. Yet Medicaid covers cancer screening and treatment and the Department of Health for each state has set up programs in conjunction with the Centers for Disease Control and Prevention for free or low cost screening.
The Centers for Disease Control and Prevention (CDC) initiated a nationwide program in 1990 aimed at reducing deaths from cancer through education, outreach, and screening.
http://www.cdc.gov/cancer/nbccedp/
http://www.cdc.gov/cancer/colorectal/basic_info/screening/
http://www.cdc.gov/cancer/screening.htm
http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp
Most of these programs are run by the Department of Health for each state such as in Pennsylvania by Adiago Health
http://www.fhcinc.org/pages/healthcare/cancer.htm
or Illonois
http://cancerscreening.illinois.gov/
California
http://www.dhs.ca.gov/cancerdetection/
Rhode Island
http://findarticles.com/p/articles/mi_qa4100/is_200309/ai_n9272104
New York
http://www.freecancerscreening.com/2007/07/manhattan-ny-free-cancer-screening.html
The American Academy of Dermatology also offers free skin cancer screening
http://www.aad.org/public/exams/screenings/index.html
The article also stated that the people with lower incomes were most likely to be uninsured due to the cost for health insurance and whereas this may be true assistance is available for treatment. There are many programs for low income people to receive free or low cost medication. Many of the individual drug manufacturers as well offer programs to cover their medications as well.
http://www.healthfinder.gov/news/newsstory.asp?docID=611094
http://www.health.gov/
http://www.freemedicinerevolution.com/?gclid=CMP0xo3Mt5ACFUWoGgodGnvnKg
https://www.pparx.org/Intro.php
http://www.needymeds.com/
http://www.merck.com/merckhelps/
http://www.themedicineprogram.com/
http://www.nami.org/Content/ContentGroups/Helpline1/Prescription_Drug_Patient_Assistance_Programs.htm
http://www.pharma.us.novartis.com/about-us/our-patient-caregiver-resources/pap-enrollment.jsp?usertrack.filter_applied=true&NovaId=2229644997704410576
http://www.edhayes.com/indigent.html
http://www.phrma.org/
http://www.qdrug.com/sf/
http://www.familiesusa.org/404.html
http://familiesusa.org/issues/uninsured/about-the-uninsured/
Cancer Care has programs to assist with financing treatment and care.
http://www.cancercare.org/get_help/assistance/index.php
I do agree with the American Cancer Society that the uninsured and underinsured do have higher incidents of advanced cancer and may not receive the proper treatment but I also feel that we need to explore and eliminate other causes as well.
As it has been mentioned earlier many people without insurance are low income or unemployed. Poor nutrition and bad health care habits such as smoking and sun exposure may be factors also. Many are poorly educated and maybe unaware of symptoms or uncertain of treatments. or not follow the prescribed treatment as ordered. Many immigrant groups may also have cultural or religious beliefs against treatments.
http://www.cbcrp.org/research/PageGrant.asp?grant_id=1803
http://jnci.oxfordjournals.org/cgi/reprint/jnci%3b96/1/10.pdf
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1618773
There are many options available for care no matter your income or coverage but I believe that education is necessary to let people know what is available and how they can help themselves.
Most importantly emphasis should be made to instruct on:
Good Health Habits to prevent cancer- No smoking, good nutrition, medical follow up
Instruction in warning signs and symptoms, treatment options
Free and low cost screening and treatment is available and where it can be obtained.
Additional resources
http://coloncancer.about.com/od/screening/a/Uninsured.htm
http://www.cancer.gov/cancertopics/factsheet/support/financial-assistance
"This report clearly suggests that insurance and cost-related barriers to care are critical to address if we want to ensure that all Americans are able to share in the progress we have achieved by having access to high-quality cancer prevention, early detection, and treatment services," said Otis Brawley, MD chief medical officer of the American Cancer Society.
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Report_Links_Health_Insurance_Status_With_Cancer_Care.asp?sitearea=NWS&viewmode=print&
For all cancers combined, the ACS researchers found that uninsured patients were 1.6 times as likely to die within 5 years compared to individuals with private insurance.
An earlier article by the American Cancer Society reports” People without health insurance and those on Medicaid are more likely to be diagnosed with advanced stages of cancer than those with private health insurance,”
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Uninsured_More_Often_Diagnosed_with_Advanced_Cancer.asp
It's important to note that although variations in health insurance coverage likely contribute to racial and ethnic disparities in cancer outcomes, those disparities persist for several outcomes even when differences in insurance status are accounted for," said Elizabeth Ward, PhD.
People with lower incomes were less likely to have insurance, the report found. And those without insurance were less likely to use certain health services. About 54% of uninsured patients aged 18 to 64 did not have a usual source of health care. About 26% delayed care due to cost, while nearly 23% did not get care because of cost. An estimated 23% did not get prescription drugs because of the expense.
"For too many hardworking 'average Americans' paying for cancer treatment means not paying rent, mortgage (resulting in foreclosure or eviction), or utility bills, or even going hungry," wrote Elmer Huerta, MD, American Cancer Society president, in an accompanying editorial.
These statistics are true and uninsured and underinsured are more at risk than Americans with better health care coverage. However free and low cost services are available to assist the uninsured and underinsured.
It was mentioned in the article those uninsured or on Medicaid were more likely to be diagnosed in later stages. Yet Medicaid covers cancer screening and treatment and the Department of Health for each state has set up programs in conjunction with the Centers for Disease Control and Prevention for free or low cost screening.
The Centers for Disease Control and Prevention (CDC) initiated a nationwide program in 1990 aimed at reducing deaths from cancer through education, outreach, and screening.
http://www.cdc.gov/cancer/nbccedp/
http://www.cdc.gov/cancer/colorectal/basic_info/screening/
http://www.cdc.gov/cancer/screening.htm
http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp
Most of these programs are run by the Department of Health for each state such as in Pennsylvania by Adiago Health
http://www.fhcinc.org/pages/healthcare/cancer.htm
or Illonois
http://cancerscreening.illinois.gov/
California
http://www.dhs.ca.gov/cancerdetection/
Rhode Island
http://findarticles.com/p/articles/mi_qa4100/is_200309/ai_n9272104
New York
http://www.freecancerscreening.com/2007/07/manhattan-ny-free-cancer-screening.html
The American Academy of Dermatology also offers free skin cancer screening
http://www.aad.org/public/exams/screenings/index.html
The article also stated that the people with lower incomes were most likely to be uninsured due to the cost for health insurance and whereas this may be true assistance is available for treatment. There are many programs for low income people to receive free or low cost medication. Many of the individual drug manufacturers as well offer programs to cover their medications as well.
http://www.healthfinder.gov/news/newsstory.asp?docID=611094
http://www.health.gov/
http://www.freemedicinerevolution.com/?gclid=CMP0xo3Mt5ACFUWoGgodGnvnKg
https://www.pparx.org/Intro.php
http://www.needymeds.com/
http://www.merck.com/merckhelps/
http://www.themedicineprogram.com/
http://www.nami.org/Content/ContentGroups/Helpline1/Prescription_Drug_Patient_Assistance_Programs.htm
http://www.pharma.us.novartis.com/about-us/our-patient-caregiver-resources/pap-enrollment.jsp?usertrack.filter_applied=true&NovaId=2229644997704410576
http://www.edhayes.com/indigent.html
http://www.phrma.org/
http://www.qdrug.com/sf/
http://www.familiesusa.org/404.html
http://familiesusa.org/issues/uninsured/about-the-uninsured/
Cancer Care has programs to assist with financing treatment and care.
http://www.cancercare.org/get_help/assistance/index.php
I do agree with the American Cancer Society that the uninsured and underinsured do have higher incidents of advanced cancer and may not receive the proper treatment but I also feel that we need to explore and eliminate other causes as well.
As it has been mentioned earlier many people without insurance are low income or unemployed. Poor nutrition and bad health care habits such as smoking and sun exposure may be factors also. Many are poorly educated and maybe unaware of symptoms or uncertain of treatments. or not follow the prescribed treatment as ordered. Many immigrant groups may also have cultural or religious beliefs against treatments.
http://www.cbcrp.org/research/PageGrant.asp?grant_id=1803
http://jnci.oxfordjournals.org/cgi/reprint/jnci%3b96/1/10.pdf
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1618773
There are many options available for care no matter your income or coverage but I believe that education is necessary to let people know what is available and how they can help themselves.
Most importantly emphasis should be made to instruct on:
Good Health Habits to prevent cancer- No smoking, good nutrition, medical follow up
Instruction in warning signs and symptoms, treatment options
Free and low cost screening and treatment is available and where it can be obtained.
Additional resources
http://coloncancer.about.com/od/screening/a/Uninsured.htm
http://www.cancer.gov/cancertopics/factsheet/support/financial-assistance
Friday, December 28, 2007
Long Term Health Care/Custodial care
As a follow up to my blog of November 15th, I would like to discuss custodial and long term care. As I had mentioned earlier the cost of providing basic care to meet the daily needs for yourself or a loved one can be quite exorbitant. Unless you have an involved family that is able and willing to provide care, or have enough financial resources available the cost of providing care for yourself or a loved one is very difficult indeed. This custodial care could include assistance at home with activities of daily living, bathing, dressing, meal preparation, housekeeping, laundry or shopping or attention to these same basic needs in a nursing home or assisted living facility.
This is particularly difficult because when you are disabled or older and income is limited the greatest need is for long term custodial care. Most long term care is provided by families but few families today can sustain the financial and emotional burden of long term care and contrary to popular belief Medicare does not cover all medical costs and only covers about 2% of long term care.
To determine the average cost for Medicare please check the Medicare Rights Center
http://www.medicarerights.org/newmedicarecosts.html
To be eligible for limited nursing home coverage from Medicare certain criteria must be met:
- You must be in an acute care hospital for 3 days prior to entering a Skilled Nursing Facility. An acute care hospital is licensed by the state to provide skilled care.
- The Skilled Nursing Facility must be Medicare certified to provide care by or under the supervision of licensed personnel.
- Your care under Medicare must be skilled care not custodial. Most nursing home care is custodial not requiring licensed personnel for skilled treatment such as intravenous infusion or skilled rehabilitation.
As indicated in my earlier blog the average yearly nursing home cost exceeds $77,000. The cost at average of $19 per hour for home health aide services added onto costs for medication, deductibles, medical supplies or equipment as well as costs to maintain a household can quickly deplete savings when living on a fixed income.
Medicaid, a national program for individuals and families with low incomes and resources is another alternative to paying for long term care. Medicaid is jointly funded by the states and federal government, and is managed by the states. Medicaid is the largest source of funding for medical and health-related services for people with limited income. While Congress and the Centers for Medicare and Medicaid Services set out the main rules under which Medicaid operates, each state runs its own program. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.
Over 42 million people a year receive assistance from Medicaid but Medicaid guidelines are based on the poverty levels and to qualify for Medicaid, you must meet income and asset limits set by your state. In most states, income must be below $851 a month (individuals) or $1,141 a month (couples). In some states, you can also qualify if health care costs reduce your income to the state limit. Call your State Health Insurance Assistance Program to find out the Medicaid rules for your state and to check eligibility.
Most people when they reach their 50s should consider adding a long-term care policy to their insurance coverage. Long term care insurance can be costly but can provide you with a payout to cover nursing home costs as well as a variety of in-home health care expenses.
It is however difficult to consider paying these high rates at 50 for insurance you may or may not need for another 25 or 30 years. However if purchased later you will face much higher premiums, as well as run the risk of being denied coverage if you have a pre-existing condition. We all look forward to our retirement and believe we will be able to continue to be healthy and independent well into our later lives. People don’t want to think of getting old and disabled. We buy car insurance on the chance of an accident when only one in 240 will use their car insurance, yet at least one in three will use their long term care insurance.
Many things need to be considered when buying long term insurance:
- Cover the catastrophic need. Lifetime coverage is most desirable, since you will not outlive the benefits.
- Know which policy benefits are important to you.
- Pick a long term care company that is financially strong enough and large enough to be around in 20 or 30 years when you need it.
- Consider Cost of Living Adjustment (COLA) Rider to allow your benefits to keep pace with inflation.
- Pick a premium you can afford and purchase a Long Term Care Insurance plan based on your budget. Remember 50% coverage is better than no coverage. It's important to select a policy where you will be comfortable paying the premium not just today but 20 or 30 years from today.
Long-term care insurance is meant to merely supplement your other income sources such as 401k’s, Social Security and retirement accounts.
For more information check AARP report on long term care.
http://www.aarp.org/research/longtermcare/costs/fs27r_ltc.html
Monday, December 17, 2007
Good Health Habits to Prevent colds and flu
The best way to prevent seasonal flu and pneumonia is to get vaccinated each year.
There also are flu antiviral drugs that can be used to treat and prevent the flu but good health habits like covering your mouth when you cough and washing your hands often can help prevent respiratory illnesses like the flu and colds.
Many people equate the cold winter weather with colds and flu and feel that being cold and wet from the chill of winter is what makes people catch colds and flu. This myth must be true because everyone gets sick in the winter, right? No.
Although the cold wet weather of winter is very uncomfortable and the stress of getting around in the snow and ice may reduce our immunity or resistance, it is not the weather that causes our colds and flu. It is germs, bacteria and viruses that cause our misery. As the weather gets colder we spend more time indoors, children return to school and with vacations over more people are huddled closer together as activities move indoors.
This proximity to one another leaves us vulnerable to passing and sharing infections with each other. As the children play at school they pass around germs which they bring home to the family. Cramped buses and trains leave us no where to escape as a sick passenger unwittingly passes germs with each sneeze or cough. At work we cover our mouth when we cough or sneeze but each time we answer the phone, touch the employee coffee pot, our keyboard or the handle to the rest room we share our germs with our coworkers.
Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by coughing or sneezing.
There also are flu antiviral drugs that can be used to treat and prevent the flu but good health habits like covering your mouth when you cough and washing your hands often can help prevent respiratory illnesses like the flu and colds.
Many people equate the cold winter weather with colds and flu and feel that being cold and wet from the chill of winter is what makes people catch colds and flu. This myth must be true because everyone gets sick in the winter, right? No.
Although the cold wet weather of winter is very uncomfortable and the stress of getting around in the snow and ice may reduce our immunity or resistance, it is not the weather that causes our colds and flu. It is germs, bacteria and viruses that cause our misery. As the weather gets colder we spend more time indoors, children return to school and with vacations over more people are huddled closer together as activities move indoors.
This proximity to one another leaves us vulnerable to passing and sharing infections with each other. As the children play at school they pass around germs which they bring home to the family. Cramped buses and trains leave us no where to escape as a sick passenger unwittingly passes germs with each sneeze or cough. At work we cover our mouth when we cough or sneeze but each time we answer the phone, touch the employee coffee pot, our keyboard or the handle to the rest room we share our germs with our coworkers.
Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by coughing or sneezing.
According to the Center for Disease Control, between 10% and 20% of people in the United States become ill with the flu each year. Infants, the elderly and those with immune system conditions are usually at risk but these organisms can have an impact on seemingly healthy folks. About 3 to 6 million people are affected each year.
The World Health Organization estimates that cost of influenza to the U.S. economy in terms of health care costs and lost productivity can range from $71 billion to $167 billion a year.
Below are some basic good health habits to help keep you and your family healthier this holiday season. These are simple things we each can do daily to protect our selves and others.
• Cover your mouth and nose.
Cover your mouth and nose with a tissue when coughing or sneezing and dispose of the soiled tissues properly. Teach your children to use tissues and be sure they have tissues in their schoolbag. If you have no tissues do the sleeve sneeze. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands..It may prevent those around you from getting sick.
• Clean your hands.
Washing your hands often will help protect you from germs. Wash with soap and water or Clean with alcohol-based hand cleaner.
• Avoid close contact.
Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
• Stay home when you are sick.
If possible, stay home from work, school, or activities when you are sick. Just as you try to avoid being near sick people to prevent You will help prevent others from catching your illness.
• Avoid touching your eyes, nose or mouth.
Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Don’t use the phone, computer, or desk supplies of a sick coworker. Advise children not to share drinks or toys with sick friends.
• Practice other good health habits.
Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. All of these actions help maintain your immunity to fight off illness. See your doctor for regular checkups, vaccinations, and appropriate treatment to decrease the duration of symptoms.
For additional information see :
http://www.cdc.gov/flu/
Friday, December 7, 2007
Advance Directives for Health Care
Advance directives are documents signed by a competent person giving direction to health care providers about treatment choices in certain circumstances. As a competent adult, you understand your condition and the results your decision may have. Advance directives allow you to verbalize your wishes while you are in a position to make health care decisions. These advance directives tell your doctor what kind of care you would like to have if you become unable to make medical decisions, such as if you are in a coma. If you have not given any instructions, no one will know what you would have decided.
The Patient Self Determining Act requires many Medicare and Medicaid providers such as hospitals, nursing homes, hospice programs, home health agencies, and Health Maintenance Organizations (HMO’s) to give adult individuals, at the time of inpatient admission or enrollment, certain information about their rights under state laws governing advanced directives.
These include:
· the right to participate in and direct their own health care decisions
· the right to accept or refuse medical or surgical treatment
· the right to prepare an advance directive
· information on the provider’s policies governing the utilization of these rights.
The act also prohibits institutions from discriminating against a patient who does not have an advance directive and requires institutions to document patient information and provide ongoing community education on advance directives.
There are two types of advance directives:
· A durable power of attorney for health care which allows you to name a patient advocate or proxy to act for you and carry out your wishes.
· A living will allows you to state your wishes in writing, but does not name a patient advocate.
A living will is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.
A durable power of attorney (DPA) for health care identifies whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A durable power of attorney for health care is a signed, dated, and witnessed legal document commonly called a “health care proxy”. This document differs from other durable powers of attorney in that it is specifically limited to health care and medically related decisions. It might be necessary to also have a durable power of attorney assigned to handle financial issues as well. A financial DPA can access your accounts to assist in payment of your bills when you lack capacity and are unable to do so.
A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. An example would be a do not resuscitate (DNR) order. Advance Directives can also say that you want a certain treatment no matter how ill you are. An example would be to continue feedings.
Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.
Any person 18 years of age or older can prepare an advance directive which allows you to make your preferences about medical care known before you're faced with a serious injury or illness. People who are seriously or terminally ill are more likely to have an advance directive injury or illness to express their wishes and spare their loved ones the stress of making decisions about their care when they are dying. Even if you are in good health an accident or serious illness can occur suddenly and if you already have a signed advance directive, your wishes are more likely to be followed.
Ask your doctor, lawyer or state representative about the law in your state.
Additional information and forms can be obtained from:
AARP Advance Directive Information
601 E Street NW Washington, DC 20049 1
888-OUR-AARP
email: http://www.aarp.org/bulletin/yourhealth/resources_wills.html
U.S. Living Wills Registry
523 Westfield Ave., P.O. Box 2789 Westfield, NJ 07091-2789
1-800-LIV-WILL
email: http://www.uslivingwillregistry.com/
http://www.caringinfo.org/stateaddownload
or call your local health department or state department on aging to get a form.
Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care.
Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.
You may change or cancel your advance directive at any time, as long as you are still able to think rationally and communicate your wishes in a clear manner. Any changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them.
It is a good idea to review your advance directive each year to be sure it still says how you want to be treated and names an advocate you trust.
The Patient Self Determining Act requires many Medicare and Medicaid providers such as hospitals, nursing homes, hospice programs, home health agencies, and Health Maintenance Organizations (HMO’s) to give adult individuals, at the time of inpatient admission or enrollment, certain information about their rights under state laws governing advanced directives.
These include:
· the right to participate in and direct their own health care decisions
· the right to accept or refuse medical or surgical treatment
· the right to prepare an advance directive
· information on the provider’s policies governing the utilization of these rights.
The act also prohibits institutions from discriminating against a patient who does not have an advance directive and requires institutions to document patient information and provide ongoing community education on advance directives.
There are two types of advance directives:
· A durable power of attorney for health care which allows you to name a patient advocate or proxy to act for you and carry out your wishes.
· A living will allows you to state your wishes in writing, but does not name a patient advocate.
A living will is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.
A durable power of attorney (DPA) for health care identifies whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A durable power of attorney for health care is a signed, dated, and witnessed legal document commonly called a “health care proxy”. This document differs from other durable powers of attorney in that it is specifically limited to health care and medically related decisions. It might be necessary to also have a durable power of attorney assigned to handle financial issues as well. A financial DPA can access your accounts to assist in payment of your bills when you lack capacity and are unable to do so.
A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. An example would be a do not resuscitate (DNR) order. Advance Directives can also say that you want a certain treatment no matter how ill you are. An example would be to continue feedings.
Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.
Any person 18 years of age or older can prepare an advance directive which allows you to make your preferences about medical care known before you're faced with a serious injury or illness. People who are seriously or terminally ill are more likely to have an advance directive injury or illness to express their wishes and spare their loved ones the stress of making decisions about their care when they are dying. Even if you are in good health an accident or serious illness can occur suddenly and if you already have a signed advance directive, your wishes are more likely to be followed.
Ask your doctor, lawyer or state representative about the law in your state.
Additional information and forms can be obtained from:
AARP Advance Directive Information
601 E Street NW Washington, DC 20049 1
888-OUR-AARP
email: http://www.aarp.org/bulletin/yourhealth/resources_wills.html
U.S. Living Wills Registry
523 Westfield Ave., P.O. Box 2789 Westfield, NJ 07091-2789
1-800-LIV-WILL
email: http://www.uslivingwillregistry.com/
http://www.caringinfo.org/stateaddownload
or call your local health department or state department on aging to get a form.
Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care.
Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.
You may change or cancel your advance directive at any time, as long as you are still able to think rationally and communicate your wishes in a clear manner. Any changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them.
It is a good idea to review your advance directive each year to be sure it still says how you want to be treated and names an advocate you trust.
Monday, December 3, 2007
The Patient's Health Care Bill of Rights
Do you know what to expect from a Health Care Provider or a Health Care Facility?
Do you know your rights as a patient?
Do you know your rights as a patient?
In 1997 the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry set up a set of principles that have been adopted by many health care facilities and organizations.
The basics include:
- Respect and Nondiscrimination. You have a right to considerate, respectful and nondiscriminatory care from all health care providers, including your doctors, hospital or medical facility staff or health insurance representatives.
- Information Disclosure. You have the right to know by name all health care providers and to accurate and easily understood information about your health care providers, health care professionals, and health care facilities and health plans. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance must be provided to allow you to make informed health care decisions.
- Choice of Providers and Plans. You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care. This means you can change doctors or hospitals or health care agencies. You can also change health plans or insurance.
- Access to Emergency Services. If you have severe pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.
- Participation in Treatment Decisions. You have the right to receive from your physician your diagnosis, prognosis, and treatment options and any information necessary to give informed consent prior to the start of any procedure or treatment. You have the right to be informed of any alternative or experimental protocols. You have the right to refuse to refuse treatment or to refuse participation in research programs, and you have the right to be informed of the medical consequences of these actions including possible dismissal from a study and discharge from a health care facility or physician’s care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.
- Confidentiality of Health Information. You have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician change your record if it is not accurate, relevant, or complete. You have a right to access your medical records and this information must be kept confidential unless disclosure is authorized by you. This is the basis of the Health Insurance Privacy and Portability Act (HIPPA).
- Complaints and Appeals. You have the right to a timely and objective review of any complaint you have against a hospital or health care agency, health care insurer, doctors or other health care personnel. Your individual appeal is usually evaluated by a physician or peer group of health care reviewers that are not affiliated with those involved.
Additional information can be found:
President’s Advisory Commission on Consumer Protection and Quality in the Health CareIndustry
http://www.hcqualitycommission.gov/
But as per any right there are also responsibilities. These are the responsibilities suggested by the president’s commission. :
- Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
- Become involved in specific health care decisions.
- Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans.
- Disclose relevant information and clearly communicate wants and needs.
Use the health plan's internal complaint and appeal processes to address concerns that may arise. - Avoid knowingly spreading disease.
- Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
- Be aware of a health care provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
- Become knowledgeable about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
- Show respect for other patients and health workers.
- Make a good-faith effort to meet financial obligations.
- Abide by administrative and operational procedures of health plans, health care providers, and Government health benefit programs.
- Report wrongdoing and fraud to appropriate resources or legal authorities
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