March 13th, 2017

Is TrumpCare my Care??

The Insurance Mom is back to blogging after a very busy Open Enrollment!  Thank you to all our followers and lovely clients who sent along referrals.  We are very grateful for you!

 

It’s been an interesting end of 2016 and beginning of 2017.  With that, we are seeing a TON of proposed changes that could affect your health insurance.    But, we probably won’t know for quite some time.   Remember, it takes a while to un-law a federal law!

 

But what’s it all mean, Mom!?  My brain hurts with all the HSA, tax credits, tax penalties, cross-border, stuff!
Well, that’s why I’m here, sweetie!  To take your hand, and tell you to take a deep breath because it’s going to be a long time before we see any changes take places.  And so far, no one can seem to get close to agreeing what those changes will be.  Now that we’re all feeling a little better, let’s get back to our health insurance education.

 

Here’s a great article from the fabulous team at Vox which does great work at explaining things in a simple way.  But the gist is this… Trump proposes these things:

 

  1. Pre-existing conditions will not affected.
  2. The tax credit thing is going to change, likely based on age not income.
  3. Trump and the GOP really like Health Savings Accounts (HSAs).
  4. He wants to remove the plan restrictions.  So that whole metallic thing will likely go away and companies can design their own plans again.
  5. Trump is a little unclear about the Medicaid situation, but the GOP seems to want to decrease Medicaid enrollment.
  6. Trump would like to reduce costs of insurance and drugs.

 

Here’s the Insurance Mom’s takes on these things, by the numbers:

 

  1. Goodie.
  2. The GOP’s current proposal called the American
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October 3rd, 2016

Open Enrollment is almost here– Are YOU Ready!?

 

Calling all insured and soon-to-be-insured!  Open Enrollment is JUST AROUND THE CORNER…. November 1 through January 31st.  Have you made an appointment to talk to your Insurance Mom?

We posted this back in August in preparation and wanted to remind you what’s new for 2017.  Please review!

——————————————————————————————————————————————

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 might be more transparency for you to be able to make informed choices.

The PHEW! news: there’s a new requirement 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 (hopefully!) 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 families.

The YUCKY news: The Beacon article anticipates that deductibles in most states will see increases , too.   No, we don’t know what the increases will be… yet.

The WORST news: hold on to something…  premium increases are on the horizon for 2017.   No, we …

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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.…

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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
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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 …

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July 27th, 2016

“What’s Up, Doc?” Blog Series Part 8: A Cure For What Ails You

Hello again, my avid readers.  Hugs for reading the first, second, third, fourth, fifth, sixth, and seventh of our series, “What’s Up, Doc?”

 

Last time, we left you sitting on the slab as the doctor came into the room.   And now a segment we call “A Cure for What Ails You” and is a continuation of advice from last week on what to do once you have their ear.

 

First and foremost, I like the concept that the doctor works FOR YOU!   Not the other way ‘round.   You are paying that person… she works for you!   You deserve her time and FULL attention.   Remember, you get a vote.   And not just any vote.. you get THE vote on how things proceed!!

 

  1. If you need tests, remind the doctor to use ONLY an in-network lab.
  2. If you need meds, ask if the generic is available.   YOU control how you spend your money!  The docs generally don’t think twice about prescribing expensive brand name drugs.
  3. Did the doctor advise seeing a specialist?  Ask for their IN-network referrals for a trusted doc before you leave.   But it’s still up to YOU to verify that the new doc is IN-network!
  4. If you need a follow-up visit, make the appointment before you leave!
  5. Remember to request a copy of the chart notes from today’s visit.
  6. ASK if the doctor will communicate by e-mail.   Often e-mails become a valuable part of your chart.

 

Who is your fave doc?  What have they done that makes them your fave?  Always love the shares from friends of The Insurance Mom.…

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July 20th, 2016

“What’s Up, Doc?” Blog Series Part 7: The Doctor is in! Now What?!

Look at you, friend of The Insurance Mom!  You’ve learned so much from our first, second, third, fourth, fifth, and sixth parts of our series, “What’s Up, Doc?” Don’t you feel well-informed and powerful!?
Here’s the next revelation, “The Doctor is In!  Now What?”

 

  1. Remind Doc Hollywood of any important medical history.   Do NOT assume they remember everything about you.  If you’re seeing this doctor for the first time give a brief summary of important medical history.
  2. As I mentioned in the second part of our series, always have a current copy of your medical records.   Before seeing a new doc for the first time, email a copy of your chart FIRST.    Hopefully, this will get your new doc up to speed before you get there.
  3. If you’re there for a physical (aka check-up, aka preventive care), remind the doctor that’s the ONLY purpose for your visit.    I want YOU to give explicit permission to the doc if she’s going to do additional tests or treatments that are NOT included in your free physical.  The Insurance Mom also recommends referencing this website which lists all of the stuff that has to  be covered by your insurance (it’s part of the Affordable Care Act!)… so you know your rights!
  4. Ask LOTS of FAQs.   There is always another question to ask!   So ASKAsk for clarification if you need it.  Ask the doctor WHY she is recommending this particular course of treatment or prescription.  Ask about side-effects.  Ask about likely outcomes.    Ask what alternative options may be available.   Just because a doctor makes a suggestion, doesn’t mean it’s a recommendation… or the best recommendation.

Thanks for following along to our virtual tour of the doctor’s office!  Now, talk to me.  Share your funny / interesting …

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July 13th, 2016

“What’s Up, Doc?” Blog Series Part 6: Cold and Alone, Wearing Paper… Make the Most of the Exam Room

You get a gold star for adult-ing, my friends!  Thank you for tuning in to “Cold and Alone, Wearing Paper: Make the Most of the Exam Room.”  Check out the first, second, third, fourth and fifth parts of our series, “What’s Up, Doc?” to get caught up to speed!

 

OK, you’re finally in the exam room.  While you’re shivering in the paper gown and bored of looking at Highlights Magazine, contemplate how you can get the most bang for your buck.

 

  1. Think of the most important thing you’re concerned about for THIS visit.   Start with this topic!   Narrow down the focus so you can use the doctor’s time to your advantage.
  2. Studies show that a doctor stops actively listening after about 30 seconds before she starts taking notes or typing.   I like to make sure the doctor is looking at me and having a dialogue before she starts charting her impressions!
  3. Remember that list of important questions you made before the visit?  Now’s the time to whip it out!
  4. Did your friend come with you?  Remind them what you’d like to accomplish.  And buy them a Starbucks when you leave. 🙂  Don’t have a BFF available to attend the visit?  Use the voice memo app on your phone.   Technology is great when we use it, am I right?
  5. Heads-up… before you leave ANY doctor’s appointment, ask for a copy of that day’s chart notes for your records!   I’ve never had a doc refuse my request.
  6. Be absolutely sure that what the doc wrote in your chart is REALLY what you talked about and reflects the tests or treatments or medications to which you’ve explicitly
  7. Correct any mistakes in an email and fax to the doctor!

 

Learning lots?  Now teach me what you know!  I …

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July 6th, 2016

“What’s Up, Doc?” Blog Series Part 5: Make the Most of Your Waiting Room Time

OK, family!  You’re in it to win it.  Thanks for tuning in for our first, second,  third, and fourth parts of our blog series, “What’s Up, Doc?”   We’re giving you tips starting from the first little inkling of the need to see a doctor to a diagnosis.

 

Today, we’re on our fifth part in our series, “Make the Most of Your Waiting Room Time.”  You’ve arrived at the doctor’s office and they’ve taken your name.  So now what, Insurance Mom?  Here you go…

 

  1. On the day of your appointment, call and ask if the doctor is running on time.  If they’re running late, sometimes the receptionist can give you a heads up that you can arrive a bit later.  Less waiting in waiting rooms when you’re feeling under the weather!
  2. Look at your insurance ID card so you know what your IN-network office visit co-pay is.    Remember, that the office visit co-pay is what the doctor charges you just for showing up!   Sometimes the office visit fee is all you’ll pay for a consult.  But sometimes, you will also pay for any medical services the doctor does to/for you.
  3. On ALL plans that comply with the ACA (ObamaCare), you get one FREE check-up a year with an IN-network provider – NO co-pays required!.    If you’re seeing the doc for your annual physical, know ahead of time exactly WHAT services are covered.   And make sure you do not get charged for the visit.
  4. For a list of what’s covered, see this webpage for guidelines.   Take the list with you so you can show it to the doctor.   You’d be surprised how much the doctors don’t know about the ACA!!

 

Please keep me posted on any thoughts or questions that come up while reading.  …

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