Here are all the articles I wrote during August, 2016. I hope they're useful to you.

August 17th, 2016

“What’s Up, Doc?” Blog Series Part 11: All Better… But OUCH, This BILL!!

Oodles of gratitude for taking this virtual trip to the doctor with us!  Here’s even more in the series “What’s Up, Doc?”  Catch up with parts one, two, three, four, five, six, seven, eightnine, and ten.

And now, our last in the series… “All Better… But Ouch, THIS BILL!!”

  1. Your doctor is IN-network right?    The doctor’s office MUST submit the bill (aka “the claim”) directly to your insurance company.
  2. The IN-network doctor CAN ask you for the office visit co-pay at the time of the visit.    But, for medical services done during the visit…
  3. The IN-network doctor canNOT charge you until after the insurance company applies the IN-network discounts (the negotiated rate).
  4. When you get a bill from the doctor’s office, be sure that the IN-network discounts have been applied.   How do you know?
  5. … because you got an Explanation of Benefits (EOB) from the insurance company!   Check the EOB against the provider’s bill, and THAT’s how you know you’re getting the right discounts.
  6. If the doctor is OUT-of-network you’ll be submitting your own claims to your insurance company – and the doctor can charge you whatever she likes, there are no discounts.
  7. If you have an HMO, you must ONLY see a doc in your HMO group.  There are NO benefits in an HMO if you go to an out-of-network doctor.

Talk to me!  Was this helpful?  What was your fave piece of info?  Suggestions and thoughts are welcome.  And as always, reach out to us for any of your insurance needs.…

Read More…
August 10th, 2016

“What’s Up, Doc?” Blog Series Part 10: Fanks, Doc, I Pheel Bmuch Mbetter

Hi again, my friends!  Thank you so much for taking the virtual blog version of a doctor’s office visit with us.  Here is our tenth part in the series, How to make the most of your office visit- a multi-part series.”  Check out parts one, two, three, four, five, six, seven, eight, and nine.

 

And now, a segment we call “Fanks, Doc, I Pheeell Bmuch Mbetter.”  Your clothes are on and you’re out the door.  On your walk to the car, evaluate.  How did you do?  Did you get all your questions answered?  Did you already forget the answers?

 

  1. If you have follow-ups, don’t be shy!  Call the office and schedule a time to chat with the doctor OR email her OR have the nurse practitioner clarify.
  2. What’s next?  Do you need to schedule lab tests?  Do you need to see a specialist?  Make sure they’re IN-network and cross-reference with Yelp and https://www.ratemds.com/ for the best of the best.
  3. About those medications your doctor wants you to try… check out our blog, “Better Living Through (Cheaper) Chemistry!”
  4. Try finding the cheapest price at GoodRx.  Did you know … prices are different from pharmacy to pharmacy
  5. If the drug isn’t in your plan’s formulary, ask your doctor to call the insurance company for Prior Authorization.  If that doesn’t work, you can file an appeal but that takes a long time and doesn’t always work.
  6. If the drugs your doc prescribed are too pricey, go to Canada!  Not really, but check out Pharmacy Checker for discounted Rx costs.  Or you can find discount pharmacy cards online.  OR you can Google the name of the drug + coupons and try that on for size.  Often these options can be cheaper than the cost
Read More…
August 6th, 2016

Health Insurance Forecast for 2017– Are YOU Prepared?

Hello, Friends!

 

Are you ready for health insurance news for NEXT year??   Sit, get cawfee, or a cocktail and let’s tawk!

 

This interesting article from the NY Times and this one from the Free Beacon each have loads of important info, but here’s the gist….

 

The SAME news: the NEXT open enrollment period will be 11/1/16 through 1/31/17.

 

The HAPPY news: Obamacare will be rating health insurance plans based on how many doctors and hospitals are in their networks.  BUT (as I am your interpreter of bulls*#$) this doesn’t necessarily mean that doctor networks are going to improve for individual plans.  It just means there’s more transparency for you to make informed choices.

 

The PHEW! news: there’s a new thing next year called “continuity of care.”   What do you do if your doc leaves your network?  Often they leave or get dropped from the network without any heads up to YOU.  BUT in 2017, if you’re in an “active course of treatment,” you’ll be able to continue seeing the doctor if they leave the network.

 

The BAD news: out-of-pocket maximums are going up.  WAY UP!  In some states, they’ll increase from $6500 to $7150 for individuals, and from $13,000 to $14,300 for a family.

 

The YUCKY news: The Beacon article anticipates that deductibles in most states will see increases , too.

 

The WORST news: hold on to something…  premium increases are on the horizon for 2017.

 

The more you know, the more prepared you’ll be for 2017.…

Read More…
August 3rd, 2016

“What’s Up, Doc?” Blog Series Part 9: The Doorknob Moment… and Other Missed Opportunities

Welcome back to our series, “What’s Up, Doc?”  You can check out the first, second, third, fourth, fifth, sixth, seventh, or eighth parts by clicking the hyperlinks to get up to speed.  And now, “The Doorknob Moment… and Other Missed Opportunities.”

 

  1. Be your own team!  Prepare in advance for your visit.   Patients who take a more active role in their medical care have better physiological improvement.  Remember, this is a TEAM effort between you and the doctor… with you as the Team Captain!
  2. Ask your most important FAQs first!   Don’t wait until you’re dressed and leaving the office!  They say in psychotherapy the most impactful part of the session is usually the last 5 minutes.  Don’t take that approach with your medical doctor or you could miss talking about some important info.
  3. This tip is for the fellas:  speak up!  Don’t be macho, tell the truth.  If something is ailing you, it’s better for your doctor to know so she can help.   This visit is not the place to put on a brave face.    Statistically, women are better than men at asking questions about their medical issues.  Not that we’re better or anything (wink, wink), we just go to the doctor more often so we have more practice.
  4. ASK if the doctor will communicate by e-mail.   Often e-mails become a valuable part of your chart.   If you happen to forget to ask an important FAQ or need further clarification, having a doctor who uses technology is critical!
  5. If the doctor doesn’t use email, find out the easiest way to communicate with her after the visit… phone, fax, carrier pigeon, smoke signals?    For example, does she return phone calls after normal office hours?  What about in real emergencies?

 

Look at how smart …

Read More…