Health

Getting Insurance To Pay For Preventive Health Under The Aca

Posted on by blogger

The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the “wellness visit” into a “sick visit.” The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the “free preventive health” visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.

Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than “routine preventive health screening,” the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.

This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone – those at risk as well as those facing no known risk – to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 – $2,500 cost, it will give people a strong financial disincentive to getting tested.

As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form “yes or no” in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.

The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.

To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forums

There is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.

The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don’t have that in health care.

I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the “preventive health visits” to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.

Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don’t think a letter writing campaign is the correct way to reform payment for the “preventive health visits.” If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor’s office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.

COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn’t there one?

There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.

The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.

But we are using the much less common colonoscopy example. Instead, let’s return to preventive care with a primary care doctor. Should a patient have the right to check a box and say “I want this visit to cover routine preventive care and nothing more”? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.

When I expect to receive a “zero cost to me” preventive screening, I do not imply that I am willing to accept a “bait and switch” change of procedure and payment due to the doctor from me. The “zero cost to me” induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a “zero price” for a visit, the doctor’s office better honor that price, or it amounts to fraud.

It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.

It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor’s billing practices match the patient’s expectations for a free preventive health office visit.

I investigated the web site http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html and discovered some inconsistencies. For example, the site purports to list the services covered under the “preventive health” coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer’s own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.

Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.

If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor’s office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.

It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.

For additional sections of this article, please see http://www.michaelguth.com/?p=743

Quite a Few People Suffer from Anxiety or Stress

Posted on by blogger

All of us experience some level of anxiety every now and then. It really is normal to experience stress in such circumstances. When there are not any immediate threats present then there are people who experience anxiety on a frequent basis, and feel stressed. This type of stress requires treatment.

Before we get into a number of the treatment choices, it is necessary to understand the way it occurs, and what stress is.

Stress occurs when the body responds to an imaginary danger like it were real. Our heart rate and breathing changes, adrenaline starts flowing, and as we go to the fight or flight response we sweat.

NOTE: Never assume chest pains are acceptable unless under the direct guidance of a doctor. Even if you have stress, the symptoms of the heart attack should never be ignored.

When it is causing a negative effect in your life although you may have the capacity to live with all the occasional bout of stress, you need to seek treatment. A negative impact is something that takes away from your quality of life, as well as your enjoyment of it. Not going to social events, remaining in due to a panic of the outside planet, never stepping out of your “safe zone” because you happen to be scared you won’t have the capacity to manage are some common examples.

One of many issues of diagnosing anxiety is that many of the symptoms may be related to other conditions. Thus, the sufferer may assume that they have another medical issue, when in reality they really have an anxiety disorder. Symptoms can include, but are not limited to: shortness of breath, nausea, strong pulse, chest pain, exhaustion, headaches, tummy pains, and sleeplessness. That’s considerably a list, isn’t it? Someone with a strong pulse and pain within their chest would be totally justified in believing they were having a heart attack, but it might simply be a panic attack.

A man who has an anxiety disorder thinks differently. For the sake of example, let’s say snakes make them worried. Our sufferer sees a picture of a snake, and then his body and head go into an alternate state. He sees the picture and thinks about how some snakes are noxious, and they’re able to bite. He continues by imagining being bitten, injected with venom, perishing, and leaving his family destitute due to his being dead.

However, his issue is how to prevent the snowballing effect of these thoughts once they happen. Most of the treatments for anxiety are intended to stop the thought process, and an impression of calm replaces the sense of anxiety.

Home Health Care Getting Better at Home

Posted on by blogger

Home health care is a type of care that relies less on a hospital and allows you to remain in your house while you recover. A surprising number of companies will provide this service. Benefits can include convenience and lower cost while retaining effective medical care. Think of recovering in your own home instead of a hospital.

The main purpose of home health care is to treat a sickness, injury, or other similar problem. Being able to remain in the comfort and familiarity of your home can be a very positive experience. A safe, well-known place to recover can allow visits from friends and family. Invite them over for coffee and to sign your cast.

Many services offered in hospitals can also be taken care of using home health care – physical, occupational, speech and nutrition therapy to name a few. Other options include patient education and regular injections. Not only are these medical jobs expected, but anyone taking care of you in your home will provide daily cleaning and cooking, as well.

You can find a plethora of companies that offer home health care. One thing to make sure is that your insurance covers this type of care; otherwise you may be surprised by a larger bill than you expected. Research the internet and any local health care agencies to find out exactly which services they offer.

What can a home health care agency staff member do for you? You can expect them to take care of general health monitoring, including meal preparation, blood pressure, temperature, heart rate, and checking for breathing problems. Any prescribed medicine or exercise will be under their close watch, as well. Making sure the environment is safe and comfortable is their job, too.

All of your needs and expectations are bundled into a term coined plan of care. Included are the services offered by the agency, which ones you require, how often they must be performed, any machines or equipment necessary, and any other expectations you have. Anyone providing home health care will review these with you.

Don’t feel like you can’t speak up and ask questions to your care provider, either. Any concerns and questions should be answered in order to give you the best care. If they are impolite, won’t explain things to you, or delay responses when you ask for something, report this to any other health care professionals.

Know more than you did before about home health care? If you need to know more, you can look up stories about those who have received this care in the past. They will give their feedback about good and bad experiences, whether or not it helped more than a hospital, and if they would recommend it to you.

Improve Penis Power With Superfoods

Posted on by blogger

Introduction:

The foods men eat may have a pronounced effect on the health of their penis. Foods containing vitamins and minerals specific to penis health support sexual function, nerve transmission and testosterone levels when consumed regularly. While it is possible to support penis health through eating specific superfoods, it can be hard to achieve every single day. Men should eat a balanced diet, use recommended nutritional supplements, and explore penis health crmes as ways of increasing vitamins and minerals for reproductive health.

Ginger: Ginger is a warming and invigorating plant that increases circulation to the extremities and the pelvic region, supporting healthy penile erections by improving blood flow. The root of the ginger plant is a rich source of essential oils, flavonoids and other plant chemicals, which open up blood vessels once ingested and also reduce platelet aggregation. In a study published in Food and Chemical Toxicology in 2010, researchers fed mice ginger root for 65 days. By the end of the study, the mice had increased testosterone levels, increased sperm count and motility, and increased sexual organ weight. Take ginger root as a superfood tea, purchase it as a herbal extract, or consume fresh root each day with your meals. If you are on heart or blood thinning medications, check with your doctor or pharmacist before using ginger products.

Nuts: Eat nuts for your nuts, and for your penis health. Nuts such as almonds, cashews, peanuts, brazil nuts and pecans contain dense amounts of nutrients essential for male sexual health. Magnesium for nervous system health, selenium for prostate health, protein for energy, chromium for lasting blood sugar levels, and essential fatty acids for nerve transmission. While nuts contain a variety of essential fatty acids, the most common fatty acid found in nuts is oleic acid. Nerves throughout the body, including in nerves in the penis, require oleic acid to form a protective coating around the nerve fiber. Without this protective sheath, known as myelin, nerve messages become confused and fail to transmit appropriately. Consume a small handful of mixed nuts each day to promote nerve health in your penis and boost energy levels.

Mushrooms: Mushrooms have been used for vitality, longevity and sexual health for thousands of years. While white button mushrooms are the most commonly consumed edible mushroom, the world is filled with hundreds of species of edible and medicinal mushrooms, some of which may be useful for penis health. A superfood and medicinal mushroom from the Himalayas, Cordyceps sinensis, has been extensively researched for its many health promoting properties, including sexual enhancement. Cordyceps has a positive effect on nitric oxide (NO) in the penis, acting in a similar way to the drug Viagra. It also increases testosterone levels and according to a study in 2009, Cordyceps has a beneficial effect on both sexual performance and fertility of animals. Find dried cordyceps from an Asian grocer or take Cordyceps in the form of a dried extract.

Fruits: Eating fruit may not sound very masculine, but most fruits are packed full of vitamins that will support robust sexual health. Oranges, nectarines, apples, red peppers, berries, rosehips, mangoes and kiwifruit are excellent sources of vitamin C and bioflavonoids for healthy circulation to the penis, effective connective tissue repair for the penis and foreskin, increased testosterone production, and antioxidant protection for the prostate. Tomatoes are also a source of vitamin A and lycopene for male reproductive health, and raisins contain magnesium which is essential for nervous system health. Watermelons, oranges and avocados contain the amino acid arginine, which supports erectile health and sexual performance. Eat a wide variety of fruits each day to benefit from their nutritional support.

Enhancing Penis Health with Nutrition

Vitamins, minerals and antioxidants are important for penis health and male virility. While there are many superfoods and herbal remedies out there which support the health of the male reproductive system, the best method to support penis health is always to eat a balanced and diverse diet. If you are on any medications or have health concerns, check with your pharmacist or other health professional for advice.

For increased nutritional support many men consider taking multivitamins and minerals. These Supplements are broken down and absorbed in the digestive tract to varying degrees in different individuals, but you can use a penis health formula (most health professionals recommend Man1 Man Oil) containing vitamin C, vitamin A, arginine and natural oils. Penis health formulas carry nutrients directly into the local blood stream, enhancing sexual function, connective tissue health and testosterone production quickly.

How Much Does Health Insurance Cost Per Month

Posted on by blogger

For many non-insured people, the question of how much does a health insurance policy cost today can make or break their decision to pick a plan. It must be emphasized that insurance is a necessity in our times especially with the rising costs of health care.

Even if you have to take the cheapest plan with basic coverage, take it for indeed it is better to have health insurance to help shoulder the costs of medical care than to have no protection at all. Besides, many factors will affect the cost of your insurance plan such that you might be persuaded to think that indeed the premiums you pay are worth every penny.

Factors Affecting Costs

Health insurance plans are not islands unto themselves. Just like other aspects of modern life, it is dependent on varying degrees on the economic and political environment as well as on the applicant’s personal circumstances and preferences.

On one hand, economic and political factors include use of insurance plans amongst people and advances in medical science and medical technology. As modern medicine finds newer and better ways to prolong the lives of human beings, insurance costs will rise to meet the consumer demand. And with the proposed health care reform, we may see a shift towards greater burden on consumers of insurance plans.

On the other hand, personal circumstances will also affect the cost of the insurance policy. These personal factors will include:

– Age – As you age, your premiums will increase.

– Gender – Women will pay for higher premiums than their male counterparts

– Medical history – Your past and present health can either swing the favor of premiums for or against you.

– Lifestyle choices – Alcohol consumption, smoking habits, use of street drugs and obesity will affect the costs of the plan

– Place of residence – Each state has its own insurance laws especially where coverage and caps are concerned

– Types of plan preferred – Comprehensive plans are more expensive to pay for than scheduled benefits plans. Fee-for-service plans, preferred provider organizations, point-of-service plans and health maintenance organizations all have their costs.

The insurance company will evaluate all these factors before providing you with a quote.

Actual Costs

As can be expected, each individual’s insurance quotes will vary depending on the personal factors. If the 2008 figures for the United States is the basis, an average individual will spend around $5,000 while an average family of four will spend up to $18,000 on health insurance policies per annum.

Unfortunately, health insurance rates now cost more than compact cars. However, you have to remember that a compact car will not provide financial protection in times of medical emergencies, unlike the health insurance policy.

It cannot be denied that health insurance costs are on the slight rise. You may grumble about it but the fact still remains that health insurance is an essential part of modern life.