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Archive for the ‘Health Care’ Category

Seeking out the right health care plan can often seem to be quite a puzzle, however, understanding exactly what you need and what you don’t can often help. Gaining the coverage you need does not have to be a confusing experience, nor does it have to be an expensive one, if you are careful to shop around in the beginning.

So much more goes into considering the health care plan that is right for you than simply pricing, but often, this is the first thing that people consider- you can save yourself a great deal of confusion by either deciding to change the doctor you use, or just making sure that the plans you’re looking at include the doctor that you already have. If you don’t mind switching doctors, then this is something that can eliminate some hassle and confusion. If you are currently using a specialist, making sure that doctor is in the network will also benefit you, as well as being sure that the plans are clear on second opinions and their policies.

Don’t assume that your pre-existing condition won’t cause a conflict, on the other side, don’t automatically assume that it means you can’t get coverage. When in doubt, ask first. Often, these limitations vary between plans and there may be some options that you aren’t seeing up front or realizing and simply asking first can help.

If you are a woman, or if you are also insuring a woman, or children, be sure that those areas of coverage are available under the plans you are looking through. Often, things like making sure that obstetrics and immunizations are overlooked, however, these are both very important considerations. Also, be sure to ask how many regular physicals and screenings are covered, as well as what sort of options are available for prescription drug coverage. Other services that you may want to make sure are covered are mental health care, nursing home care, alternative care, and drug and alcohol treatment options.

Emergency coverage, and more importantly just what constitutes an emergency by the limits of the policies you are looking through are also important to factor in. Some plans require that you contact your primary care doctor before you seek treatment, others don’t. There are many considerations, so be sure that the plans you look into do meet your needs and requirements here, as well.

Lastly, check through any exclusions and make sure that you are clear on just what you need, want and what you may need. Figuring out these key things before you price the plans may save you the disappointment of finding a plan and thinking it is a great deal- when in fact, it just won’t work for you. Making sure that you have a rough outline or checklist of what you want and need in a plan, and then pricing accordingly can save you a great deal of hassle in the future.

There are so many factors that come into play when one is deciding on what type of dental health plan they eventually will choose and you don’t have to sift through a large amount of information to decide on it but you do have to be prudent and study not only your dental coverage program but also how much coverage you will really need .

1. You need to check if your dental health plan has a maximum cap on the amount of coverage it will give to you. Most of these insurance plans seem to give you a maximum cap of 1000 dollars per year, so if you plan on having alot of cleanings and dental work done over this year it would be more prudent to opt for a discount dental plan as they don’t have any limit .

2. Most dental dental health plans only allow you to go to a dentist of their choice and most of these plans do not have a very eclectic selection of dental practitioners. Dental plans however have thousands of participating dentists that are easily accessible through your dental card that you just present at the dentists office.

3. Does your dental coverage plan have a waiting period before you can access it or will it allow you to use it as soon as you have paid for it. Many of these dental health plans have their waiting period in fine print so don’t underestimate going through all of your policy and asking the provider to explain it fully to you.

These are some basic tips that you should go through before purchasing any dental health plan. Remember , in anything especially when it comes to any type of insurance haste makes waste and prudence always wins the day.

In 2007, the governor of Minnesota proposed a mental health initiative and the legislature passed it. One of the more important components of the initiative was legislation amending Minnesota’s two programs for the uninsured – General Assistance Medical Care and Minnesota Care – to add to the comprehensive mental health and addictions benefit.

Who Is Covered?

General Assistance Medical Care covers those with income at or below 75% of the federal poverty level who meet one or more of additional criteria known as General Assistance Medical Care qualifiers. Qualifiers include waiting or appealing disability determination by Social Security Administration or state medical review team; or being in a homeless or live in shelter, hotel, or other place of public accommodation.

Minnesota Care covers children and pregnant women, parents, and caretakers up to 275% of the federal poverty level, except that parents and caretakers gross income cannot exceed $50,000. Single adults without children increased to 200% of federal poverty level by January 1, 2008 and will rise to 215% of federal poverty level by January 1, 2009.

What Services Are Covered?

For Minnesota Care, there are limits of $10,000 on inpatient care for any condition (physical, mental health, or addictions) for parents over 175% of federal poverty level and childless adults. For General Assistance Medical Care, inpatient benefits are fully covered. Both programs cover chemical dependency outpatient services. An intensive array of outpatient and residential mental health services are available.

What Is The Cost?

In Minnesota, the Medicaid Temporary Assistance for Needy Families population, General Assistance Medical Care and Minnesota Care are enrolled in comprehensive nonprofit health plans that are responsible to deliver and are at risk for the entire health benefit, including behavioral health. Adding mental health rehabilitative services (including adult rehabilitative mental health services individual and group rehabilitation services, assertive community treatment, intensive residential treatment and mobile and residential crisis services) to Minnesota Care was projected to cost $3.40 per person per month. For General Assistance Medical Care, which includes a homeless population, the cost was $7.01 per person per month. The additional targeted case management service was projected to cost $2.22 per person per month for Minnesota Care and $7.66 for General Assistance Medical Care.

The legislature appropriated a total of $1 million in additional state dollars in fiscal year 2008 and $ 3.5 million in fiscal year 2009 to add the adult rehabilitative services and case management in Minnesota Care. State funds previously targeted for case management were moved from the counties to the state in an amount of $4.4 million in fiscal year 2009.

What Led To Comprehensive Coverage?

The state collected data on the residents served by Minnesota Care, General Assistance Medical Care, and Medicaid managed care plans serving non-disabled populations, and discovered that an increasing number of individuals with serious mental illnesses were in these plans. Several insurance reforms – similar to those included in the national healthcare reform bill – modified the private market, including guaranteed issue in small and large group plans, broader rate bands, parity for mental health and chemical dependency services, medical loss ratios, high risk insurance pool, and others. A lawsuit by the attorney general called attention to health plan denials of payment for court-ordered treatment, for example for civil commitment or out of home placement for adolescents.

Health plans settled with an agreement that behavioral and mental health benefits would be covered by a health plan if the court based its decision on a diagnostic evaluation and plan of care developed by a qualified professional. In addition to the court-ordered services provision, the state contracts and capitation with prepaid health programs (Minnesota Care and General Assistance Medical Care) were amended to align risk and responsibility for services in institutions for mental illnesses, 180 days of nursing home or home health, and court-ordered treatment. There were also highly successful experiments reducing costs and improving outcomes for commercial and non-disabled Medicaid clients who were offered a more intensive community based mental health service that improved coordination with and linkages to behavioral healthcare, primary care, and other needed services.

These demonstrations produced a positive return on investment – $0.38/person/month – and gave the health plans tools to manage the increased risk that resulted from several insurance reforms, including parity, a statutory definition of medical necessity, and the court-ordered treatment provision.

The state supported comprehensive coverage because it sought to provide mental health and addiction services in Minnesota as part of mainstream healthcare. Minnesota’s mental health agency and other stakeholders desired to move mental illness from its historical treatment as a social disease requiring social services to an illness like any other. They wanted to foster earlier interventions and avoid shifting enrollees among different programs in order to access specific services. Operationalizing this change required rethinking medical necessity determinations, provider credentialing, contracting, procedure codes and other processes common to private insurance plans.

How Did It Get Through The Political Process?

Three factors significantly contributed to the political viability of a benefit expansion in the Minnesota Care and General Assistance Medical Care programs:

>> The governor of Minnesota and the administration provided strong leadership. The provisions to expand the mental health benefits in these plans were part of the governor’s mental health initiative, set forth in advance of the 2007 legislative session.

>> An extremely strong coalition of stakeholders formed a mental health action group. This group is co-chaired by a representative from the department of human services and included representation from the private insurance industry and organized and knowledgeable advocacy and provider communities.

>> There was strong support in the legislature for the expansion of benefits in Minnesota Care and General Assistance Medical Care, including from a member of the finance committee in the house, who has a son with schizophrenia. The creation of a mental health division in the health and human services policy committee also helped move the policy discussion forward.

Why Does This Approach to Healthcare Reform Work?

A recent survey of community behavioral health organizations found that on average, 42% of reimbursement for services came from private insurers. While this represents the average, the survey found that there was quite a range in reimbursement sources. For community behavioral health organizations that specialize in services such as Assertive Community Treatment or case management, Medicaid is the predominant reimbursement source, either through fee-for-service or managed care.

Reimbursement from private insurance and Medicaid managed care is uniformly better than Medicaid fee-for-service. In addition to higher rates, the private insurers and Medicaid managed care organizations have been willing to offer special contracts for packages of services for crisis care and hospital discharge plus aftercare.

The evolution of the information age is turning out to be an incredible boon for a single parent. Thanks to recent technology, a working mom can hold down her job, attend college online, and still be at home for her kids. One such way she can do this is by becoming a medical transcriptionist.

As it happens, the medical field is well aware of what the introduction of high speed modems and laptops can mean for them. They no longer have to have all their personnel report to their clinics or hospitals, fielding a lot of the work to free agents who actually appreciate staying in their houses. According to the Bureau of Labor Statistics, nearly 40% of all medical transcription is now fielded out in such a way.

What a transcriptionist primarily does is listen to dictated recordings from a facility’s medical professionals and transcribes them into reports, correspondence and other paperwork. One of their primary tools is a headset, so they can hear the dictation in detail. From there they key the text, editing as necessary. After they are done, usually all a physician should have to do is review and sign or correct and send back.

It should be made clear that a medical transcriptionist is not a secretary. The have to have a thorough knowledge of medical terminology, which is highly specialized. They must also know their way around medical reference sources, many of which can be accessed over the Internet. They must also know a specific style of writing, one that complies with local legal and ethical requirements for keeping patient information confidential. After all, a mistake on their reports – such as not noting an allergic condition – can lead to fatal consequences.

What has particularly affected the field, and thus made the job great for working mothers, is the advent of the Internet. The transcriptionist can now receive her dictation via e-mail or a specially sent up website, and then return it the same way. The system has become so simple it can be done on a PDA with the right apps. Speech recognition software is also growing.

Recruiters look to hire transcriptionists who have taken training in medical transcription. These courses are available at many on campus and online colleges. The course load should include legal issues relating to healthcare documentation, English grammar and punctuation and some sort of familiarity with the latest software. For working mothers, online colleges can be particularly handy because they take the courses from home and also can get familiar with the process of working remotely.

Transcriptionists tend to be hourly or per job workers. The rate averages over $15.00 an hour, dependent upon the place of employment and skill level. Top level personnel get as much as $21.00 an hour. One thing the Bureau notes is that once established, they never lack for work.

Our national, one-payer health care system called Medicare was signed into law by President Lyndon Johnson in 1965. When Medicare went into effect in 1966, over 19 million people enrolled.

Through the 1970s and 80s, changes to Medicare were relatively minor. The program was adjusted slightly to supposedly increase efficiency and reduce costs, and coverage was expanded to include permanently disabled people and people with end-stage renal disease in 1972. In 1988, the Medicare Catastrophic Coverage Act made sweeping changes that included prescription drug benefits. However, to pay for the expansion of Medicare, higher-income seniors had to pay higher premiums and deductibles. The high-income seniors refused to subsidize low-income seniors. This act was subsequently repealed.

The next major change came in 1997, when managed-care options were offered (Medicare + Choice, or Advantage Plans). This was part of a move to privatize some aspects of Medicare. In 2003, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed. In addition to adding the prescription drug plan, MMA links premiums to beneficiary income. An increase in government spending, however, will primarily pay for this expansion of Medicare.

From early disagreements about the type of national health care system the U.S. should adopt (the most popular alternative was a voucher system), to constant struggles with funding, program expansion and fraud, Medicare has always been controversial. Politicians often call Medicare a “third rail” — touch it and die. Seniors who depend on the system can react harshly to any changes.

Most of the current controversy stems from the new prescription drug plan (Medicare Part D). Critics say that the plan is costly to the government and confusing to seniors. Many opponents also claim that it was designed to boost the profits of pharmaceutical corporations rather than help seniors afford prescription drugs. The plan does not offer any price controls on drugs. The fact that private health insurers administer the various drug plans is another sore spot for some critics.

Medicare is available to those that have worked and contributed via their paychecks into the Medicare “system”. At retirement age, which typically has been age 65, but will be age 67 for me and increases for each subsequent generation. Currently the premium for Part “B” of Medicare is $96.40 monthly, deducted from your social security checks. Medicare, especially Part C (Medicare Advantage) is confusing, with acronyms like HMO, PPO, PFFS, and MSA.

This is a “snapshot’ of what a national health care plan would look like. Instead of starting at age 65, it would start at birth. The Medicaid program, another government program fraught with fraud, that insures the poor and working poor is broke as well, yet still a lot of people are falling through the “cracks”. While there is a need for an overhaul of our nation’s health care system at least as far as funding is concerned, the government has proven time and again it is not up to the task. There is little doubt that our physicians and medical facilities rival anything the rest of the world has to offer. We need to concentrate on access and funding. Why can’t the government work with the big insurance companies like Blue Cross, United Health Care, Aetna and the like to come up with a workable solution. Access to good health care should be a free right for American children, the poor elderly, and the disabled as well as legal aliens that fall into those categories.. Everyone else needs to “earn” their right to quality health care one way or another.

The topic of “Health care reform” is becoming increasingly popular in the US. In the light of an article published in New York Times, Americans are separated uniformly in number as to their approach regarding the issue. Despite the long-lasting debate over the hot issue, final decision to implement a nationally networked health record system was made in February 2009 with the American Recovery and Reinvestment Act Apart from Obama’s health care reform bill, Information technology is expected to positively influence the medical field.

Popularly termed as the ARRA, terms of the final bill that is now law requires $19 billion to be generally aimed at health information technology. Besides, a further amount worth $500 million needs to be invested in the training of a workforce through the Department of Labor for the implementation of the new technology. On the basis of the Obama Administration’s vigilant pursuit of post-secondary education reform and improved accessibility of education, such ideal opportunities for the advancement of one’s career or training for another career in the field of health information technology have never been before.

In accordance with the Bureau of Labor Statistics, the number of jobs in the field of health information will rise about 20%. According to experts, we still need more individuals with training in electronic medical coding and health information management. Under the new law, there’s a requirement of about 30,000 additional individuals who should not only be trained in universal medical coding but at the same time should have the knowledge of electronically implementing it.

Training for a job in the field of health information management covers a variety of possibilities, but eventually, companies will be considering applicants holding certification through the American Health Information Management Association, or AHIMA. Normally, achievement of a two-year health information management course from an AHIMA-accredited school is necessary to become eligible for taking the certification exam. The organization provides coder certification as well, which needs only 9-12 months before training.

With the increase in demand for training, educational programs in the field of health information technology will also increase. Currently, an ideal choice is accessible to those individuals who are seeking a degree or degree programs in this field. Several institutions provide program with accreditation in the way of online courses. With so many institutes offering online educational programs, enrollment numbers in these courses have also grown by 10% on a yearly basis.

With recession haunting just about every nook and corner of the world, only individuals ready to accept these changes can survive. With health care reform making its way into our lives, it is necessary to keep in mind that certain changes, though horrifying, can offer more solutions than might be immediately obvious. With better education funding opportunities, improved access to educational programs and the unevenness of economic focus at the national level, health care reform has just landed.