2010 February

Renewing Your Individual Health Plan Policy

Do you carry your own health insurance policy?

Is it time to renew?

If so, don’t do it blindly. And don’t take anything for granted.

Before signing on the dotted line or sending in that premium, you need to know what, if any, policy changes will take place in the coming year. Specifically, check for the following:

Provider networks & physicians: have hospitals been removed from the list of participating facilities; is your doctor still in the network?
Co-pays: will you have higher coinsurance or deductibles?
Benefits: check for benefits that are important to you, whether it’s mental health coverage, physical therapy or visits to specialists. What’s changed? Can you live with the changes?
Pharmacy Benefits: what drugs have been added or changed tiers? Will you be paying more for your meds?
Lifetime maximums: If you’ve been in the plan for awhile, are you hitting up against lifetime maximums? Often your expenses against lifetime maximums are not easily discerned from the Explanation of Benefits you receive when a claim is paid. Find out how much you have used and what’s left for specific services. Better to know upfront than find out too late you’ve had treatments that are no longer covered.

Buyer be aware. You may be glad just to have the coverage and assume that year after year changes will be minimal. Caveat Emptor – that isn’t always the case.

And if you’re having trouble figuring out your coverage, call your plan’s representative; be persistent or turn to a specialist who can help you understand your benefits.

Where’s Common Sense When You Need It?

We’re offering a friendly challenge to the CEO’s of all health plans: leave your corner office and walk a mile in the shoes of people covered by your plan. What do you see? What touches your heart? What are you doing right? And what needs fixing? Notice a common theme in your walkabout: a lack of plain old common sense.

Here’s a case-in-point from an experience with Oxford, as we attempted to help our client through the health care maze. She engaged our services, signed a HIPAA form, as well as a form authorizing Health Champion as her representative. Because many health plans have their own authorization forms (wouldn’t standardization be in everyone’s best interests?), we immediately contacted Oxford. Here’s what ensued in our dealings with customer service:

O: Reading from the computer screen (no thinking necessary!): the completed form must be mailed to Oxford at their Bridgeport, CT address.

HC: Our client needs immediate help. Can we scan the signed form and email it?

O: No.

HC: Can we fax it?

O: No.

HC: If we overnight it, how long before the information becomes available to customer service reps?

O: About a month.

HC: Is there someway to move this along?

O: Nope.

HC: Our client needs help now. Isn’t there something we can do?

O: Well, you could get her on the phone with you, call in together so that she gives permission for the rep to answer your questions.

And you didn’t tell us that upfront?

We did just that. Our list of questions was long and the customer service rep was ill prepared to answer them, frequently placing us on hold to check with someone or something (a manual?). We reached the end of a long business day and our client was fading (remember, she’s dealing with health issues).

HC: Let’s finish this tomorrow. Can you note in the system that we received permission to speak to Oxford; can we continue the call in the morning without having to get our client back on the phone?

O: No.

HC: Why not?

O: We can’t do that. We are only allowed to get verbal approval for one call.

HC: But the call isn’t finished.

O: Sorry we can’t do that. The federal law, HIPAA, prevents us from doing that.

Since when? (When in doubt, quote the federal law, even if you’re wrong!) Now, there’s common sense in play!

CEO’s: are you paying attention? While health and clinical services are critical to accreditation from the National Committee on Quality Assurance, we suggest that, a common sense standard is just as critical.

Your thoughts? Post your experiences, comments and insights.

Everyone Has A Story: Alzheimer’s — Up Close and Personal

There are times when we will use this blog to share a personal story, one we hope will resonate in a universal way even as the details are singular and specific. By sharing experiences, we learn we are not alone. We learn there is healing and hope along the way.

In her own words, here is such a story — from Ellen Sue Moses, a pharmacist and member of the Health Champion team . . .

My father has Alzheimer’s. In truth, his dementia is probably a mixture of vascular dementia and Alzheimer’s disease. But that doesn’t matter to him. Or to me. Naming his dementia doesn’t change its reality.

I’ve heard that the definition of Alzheimer’s is not when you lose your keys; it’s when you forget what your keys are for. According to the Alzheimer’s Association, as many as 5.3 Americans are living with the disease. It’s the sixth leading cause of death in the U.S.

About my dad: it’s hard to know when it started. By the time my mother died, either his disease had progressed significantly or my siblings and I were noticing it more. Ordinary activities were confusing and complicated. He couldn’t remember how to navigate the streets he had driven his whole life. He started getting frightened and having terrifying nightmares, this rock of a man who never seemed to have fear.

Then one day I noticed blank checks stuffed into his pockets; he couldn’t answer the simplest of questions without overwhelming frustration. Even with 24/7 care, he could no longer live in his apartment. To my joy, we moved Dad closer to me, into a wonderful facility dedicated to memory-impaired adults.

As we go through life, our feeling of safety is based upon lessons learned from past experiences. Dad lives in a world with no memory of the past — of what worked for him and where danger lies. Remarkably, he has adapted to this life where every day, everything is new.

All of the things Dad accumulated as he traveled through life no longer hold any value. What matters most to him is spending time with people. Not long ago he told me that he didn’t know who I was but knew I belonged to him. Caring for Dad has changed my perception of life, aging and death. From him, I am learning to live in the present; I am learning every day what matters most.

Do you have a story you’d like to share? We invite you to post your comments or send us a longer story by private e-mail. And if you need help, we’re here to guide your journey through the health care system.

Read Your Plan Documents

How was I to know that my health plan didn’t cover this?…

With over 25 years each working within the health care system, you can only imagine how many times we at Health Champion have heard this question. Whether receiving a unique or experimental treatment, seeking care from a state-of-the art facility, or simply seeing a doctor who happens to be outside of your health plan’s network, you can easily find yourself in a frustrating and expensive situation if you don’t know what your health plan covers.

Health insurance is a valuable benefit especially in today’s times. Unfortunately, too many people really don’t know much about their plan and don’t seek to learn about their coverage until they are in the midst of a crisis.

Fortunately, there are numerous resources available to health plan members. Health plans go to great length to provide information to their members. Benefit summaries, membership agreements and other coverage documents are typically available in hard copy or on-line. Members can contact their health plan’s customer service line or refer to the plan web site to learn how to access this information.

Health plan members should review their coverage and make certain they understand how their health plan works. And most importantly, Health Champion strongly encourages members to review their health plan before seeking care and whenever they have a question about whether a service is covered.

Prior to seeking treatment ask yourself, “Am I 100% certain these services are covered by my health plan?” If not, reach for your membership documents or call customer service! Many employer plan years begin in January. Now is a great time to review your health coverage!

Health Champion Blog

"In Your Corner"

Renewing Your Individual Health Plan Policy

Where’s Common Sense When You Need It?

Everyone Has A Story: Alzheimer’s — Up Close and Personal

Read Your Plan Documents

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