As people become seniors, especially if they are dealing with various serious ilnesses, worry about end-of-life care. Their families worry about it, too. This is not just dealing with funerals. It is the cost of taking care of an individual and keeping them as healthy as possible as long as possible so that they can have a full life or at least a pain free life as the end nears.
Here are some of the latest health and medical news developments, compiled by editors of HealthDay:
Dying Hispanics and black Americans have much higher treatment costs than whites, because they get more costly, intensive treatments as they near death, say researchers who analyzed data from the last six months of life of almost 160,000 Medicare patients.
The average cost for Hispanic patients in those final months of life was $31,702, compared with $26,704 for blacks and $20,166 for whites. Compared to white patients, costs were about 30 percent higher for blacks and almost 60 percent more for Hispanics, the Associated Press reported.
The study was published Monday in the journal Archives of Internal Medicine.
The reason: studies show that throughout their lives, minorities are less likely than whites to get aggressive medical care. In addition, minorities have less access to adequate health care througout their lives and especially as they get older - for a myriad of reasons including transportation, lack of local neighborhood doctors, clinics and hospitals, and lack of funds. These findings suggest that medical resources for minority patients are far too often "misallocated over a lifetime," with minority patients receiving more treatment and more extensive and expensive treatment when their illness has become extreme due to lack of care and when there's little chance of improving or extending their lives.
Let us hope that putting partisan politics aside, lawmakers will work with the President and with each other to come up with a plan that helps everyone so that instead of suffering needessly at the end of life and spending enormous amounts of government/taxpayer's money, individuals will have heathcare that will help keep them healthier longer and allow them to die with dignity.
President Obama's budget chief has made it clear to health insurance executives that the fun is over and it’s time to get serious.
On Tuesday, White House Budget Director Peter Orszag said the government will no longer overpay companies that offer Medicare Advantage plans, the privately run portion of the government health program for seniors.
Companies like Humana Inc. and UnitedHealth have been defending their plans for over a decade, pointing out that in their opinion, they offer lower premiums and extra benefits compared with government-run Medicare. More than 10 million of the 44 million seniors enrolled in Medicare are signed up for Medicare Advantage.
The problem is that industry executives have long known that the government spends significantly more money on Medicare Advantage than its own plan. When private insurers first entered the Medicare program in the late 1990s, many lawmakers assumed companies would lower costs with their managed-care strategies. Instead, over a decade has passed and the government is spending about $1.30 per Medicare Advantage patient versus $1.00 per patients who are enrolled in traditional Medicare. The cost burden falls on taxpayers as well as patients in regular Medicare, who pay higher premiums.
"I believe in competition. I don't believe in paying $1.30 to get a dollar," Orszag told conference attendees, including representatives from Aetna Inc., WellPoint Inc. and Cigna Corp.
Orszag's address came less than a week after President Obama kicked off his health reform effort with a massive summit at the White House. Orszag showed little intention of compromising on the Medicare Advantage issue.
Under President Obama's recent budget proposal, Medicare Advantage companies would have to compete to offer their services in different parts of the country. The government payment for each region would be based on the average bid submitted by companies, saving $177 billion over 10 years, according to the White House. Under the existing system, payments are calculated annually using a preset formula.
Orszag reiterated Tuesday that the best chance to solve the country's current health care predicament is to eliminate billions of dollars worth of wasteful spending. He pointed out that different regions of the country spend vastly different sums on seniors in Medicare, without showing much difference in health outcomes.
Insurers are not the only group being asked to change how they do business. As part of his economic stimulus package, Obama provided $1.1 billion in funding for research comparing the effectiveness of various medical treatments. By rewarding physicians for using the most efficient practices, the administration hopes to reduce health care costs.
"We are pushing hard on changing incentives for providers so that we are rewarding better care and not more care," Orszag said.
Some quotes from The Associated Press.
RiskAnalyzer Incorporates Johns Hopkins ACG System for Provider Profiling, Predictive Modeling, Resource Management and Rate Adjustment
BIRMINGHAM, Ala., Feb. 19 /-- DST Health Solutions today announced the launch of its new Medicare risk adjustment software, DSTHS RiskAnalyzer(TM). RiskAnalyzer uses claims experience to determine where provider coding is not capturing disease conditions under the Centers for Medicare and Medicaid Services Hierarchical Conditions Category (CMS-HCC) model. It provides an objective set of rules to prioritize provider and member records for chart audit through identification of potentially incomplete or inaccurate patterns of coding -- either retrospectively or prospectively.
RiskAnalyzer is part of DST Health Solutions' CareAnalyzer(TM) analytics solution, which helps health plans identify high-risk members for care management. RiskAnalyzer and CareAnalyzer support appropriate member management with integrated report views of cost, quality and risk.
"In 2007, CMS completed the phase-in of risk-adjusted payments for Medicare Advantage plans based on the CMS-HCC model," said Amy Salls, Business Solutions Director for Decision Support, DST Health Solutions. "The goal of risk adjustment was to pay Medicare Advantage plans based not only on member demographics, but also on health status. This means that plans with the most effective risk adjustment optimization programs will have revenue that more accurately reflects their true risk."
RiskAnalyzer is designed to help health plans evaluate claims based on the likelihood of missed diagnosis codes. The software can also help plans identify mid-year variances while there is still an opportunity to appropriately document member risk factors.
RiskAnalyzer incorporates the ACG System, a peer reviewed methodology for provider profiling, predictive modeling, resource management, and reimbursement rate adjustment. The ACG System provides a robust application for capturing disease burden and risk from medical claims. It also incorporates a unique pharmacy model that relates prescribing practices to patient morbidity, providing another route to pick up diagnoses that may have been missed by medical claims. The ACG System was developed by The Johns Hopkins University Bloomberg School of Public Health, and is distributed exclusively by DST Health Solutions.
About DST Health Solutions
DST Health Solutions, LLC delivers systems and services that help improve efficiency, reduce operational costs, increase speed to market, facilitate medical cost management and price containment -- improving both member experience and service for commercial health plans, consumer-directed plans, government plans (Medicare Advantage, Medicare Part D and Medicaid) and physician practices. DST Health Solutions' enterprise applications and ASP and BPO services include claims processing, member and provider management, benefit plan Killer headache? Migraines hike stroke risk
Some sufferers have twice the chance of heart attacks, strokes, studies say
For more information about DST Health Solutions, contact 800.272.4799, e-mail inforequests@dsthealthsolutions.com or visit www.dsthealthsolutions.com.
Web Site: http://www.dsthealthsolutions.com/
Oregon Figures Out How to Spend Less and Give Better Care
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Most of us hope we and our loved ones won't end up in the hospital. In the event that we do, we have the hope that we will get through what we are in the hospital for and go home better off than we came to the hospital for.
The remarkable thing that many people don't know is that nearly 100,000 people per year get terrible infections in the hospital and die from them. One out of 20 patients get infections that they contracted in the hospital and some patients survive but have to be on medication for months or years, or even end up with long term or permanent illnesses or disabilities due to these infections.
What are some of the ways to avoid this situation? Several things have been suggested. A 2005 report showed that hospitals could charge the cost of health care-associated infections to third-party payers such as Medicare and Medicaid. Medicare has changed its rules in response to these concerns and will no longer reimburse hospitals for the excess costs associated with the care of patients who contract a hospital-associated infection. But now hospitals have no incentive to accurately report their infection levels. If Medicare were to provide hospitals with more resources for infection control, rather than just penalize them for caring for very sick patients who contract a hospital-associated infection, hospitals might perform better. Really? Why not just perform better and be more careful now?
Last month, the U.S. Department of Health and Human Services released a plan urging hospitals and other health care facilities to adopt increased use of sterile techniques and follow strict protocols to prevent such infections. These include guidelines on the proper insertion of catheters and disinfection of ventilators, as well as practices that minimize risk of infection before, during and after surgery.
The University of Maryland Medical Center screens all patients at high risk for MRSA when they are admitted. Screening includes patients in intensive care units and those who have been in another health care facility during the past year. The tests are repeated during the hospital stay. Isolation precautions are instituted for those who test positive for MRSA. During the past year, the hospital has performed more than 33,000 MRSA screening tests. This aggressive action has slashed the hospital's rate of MRSA infection by more than 30 percent and has saved lives.
Patients with health care-associated infections move among hospitals, other health care facilities and nursing homes, and can spread the infections regionally. That means that a specific hospital does not necessarily receive all of the benefits from its infection control activities.
What's the solution? Infection control efforts should be a coordinated effort involving hospitals and HHS and the Centers for Medicare and Medicaid Services. Hospitals could be provided with tools and incentives to work together so that they can coordinate infection-control measures. If regional coordination existed, infections wouldn't just be transferred from one place to the next.
Health care-associated drug-resistant infections are a complex problem. The overselling and overuse of antibiotics, as well as the lack of new antibiotics in the research pipeline, are driving the high rates of resistant infections. Timely prescribing of antibiotics can help reduce infections in hospitals, but we have to work to reduce overprescribing as well. Hopefully government and hospitals will work together to come up with a policy that will bring this situation under control.
There is more and more information being looked at regarding hospitals and their performance. Now it is being released to the public on various websites that show which hospitals do the best work and keep patients safest and which are not.
For example, one particular website, HealthGrades.com, includes valuable information about mortallity rates and complication rates about every U..S. hospital.
If your mom has a stroke, wouldn't you want to take her to the absolute best hospital available that would give her the highest chance of complete recovery? Of course you would. Why not look at some of the web sites that examine the hospitals and let those hospitals - and us - know how well they are doing taking care of their patients.
Written in everyday language, there’s also a wide array of information at your fingertips about stroke, heart attacks, hip replacement and just about every medical issue that your family could face.
In a recent study, HealthGrades carefully analyzed nearly 41 million Medicare hospitalization records from 2005 to 2007.
The study found that only 5 percent of U.S. hospitals meet quality clinical standards to receive a HealthGrades’ designation as a Distinguished Hospital for Clinical Excellence.
An estimated 152,666 lives could have been saved and 11,772 complications could have been avoided had all Medicare patients been treated at a Distinguished Hospital for Clinical Excellence, the study found. In addition, these elite hospitals have mortality rates that are on average 27 percent lower, and complication rates that are on average 8 percent lower, than the U.S. average.
If you had the choice to take your mother to a hospital where mortality rates are 27 percent lower than average, wouldn’t you take her there?
HealthGrades also provides “star ratings,” which are quality ratings of 26 procedures and treatments for virtually every hospital in the country. Each hospital receives a star rating based on its patient outcomes for mortality or complication rates for each procedure or treatment.
Do your homework. Make sure where the best hospitals are in advance.
This is a story about a man named Don. It really happened, and it really happened to Don.
Don really enjoys playing his guitar.
Tuning it, he says, is so much easier than getting into tune with his Medicare prescription provider, called Medco, (one of the largest Medicare medication distributors), which kept telling pharmacies Don's benefits had ended.
He recalls his first trip to the pharmacy this year.
"I gave them my card, they looked it up and they said that's been terminated."
Since Don needs seven different prescriptions every month for his heart, blood pressure, and diabeties, he started getting concerned, as those bottles were nearly empty. Many of us can relate to that situation. I get nervous when the number of pills I have left gets low , especially if my doctor is out of town, I don't have a new prescription or my check hasn't arrived. I take 6 different pills every day for heart, blood pressure and a few other issues.
Back to Don. He kept calling Medco. Over and over until it was ridiculous.
"I probably made 35 calls to them."
Medco kept telling Don he wasn't covered, while Medicare kept telling him he was.
"I was getting really frustrated about it."
Then he thought the frustration would finally end, when he got this letter from Medco, which said he was covered.
But despite that letter, the pharmacist said his records showed Don still wasn't.
"I call Medco and I fight with them on the phone about it, they keep telling me I'm terminated."
Now, Don really started getting worried. When you are in a situation like this it seems like you get stuck in the middle and everybody is going back and forth with no end in sight.
He says he certainly can't afford the $700 it would take every month to buy his meds without Medicare's help.
"I just figured I'm going to have to quit taking them and take my chances, whatever."
Most local news channels in every city and state have some sort of consumer problem solvers segment where the news channel will help you with your problem. Don definitely had a problem and it could have turned out to be fatal for him. With his pills running out, Don finally called the 2News problem solvers, and they contacted both Medicare and Medco.
Later that very same day, Medco called Don, to clear up his situation.
"They just wanted me to know that they had updated everything in my file and the card is now working and I could go pick up my prescriptions anytime I wanted to."
Finally, Don finds himself in perfect harmony, with his music, and his meds. If you find yourself in a similar situation, don't give up. Keep trying to deal directly with your drug company, medicare and your pharmacy. If that doesn't work, do what Don did and get extra help. There is usually a way to work it all out.
On July 1, 2006 the Deficit Reduction Act went into effect. The act required all immigrants to give proof of legal immigration or citizenship when they are applying for Medicaid for the first time. This applies to children, as well. Most legal immigrants cannot receive Medicaid benefits for the first five years that they are in the U.S. Undocumented immigrants can only receive emergency Medicaid services.
Once the bill became law, it also restricted citizens, as well. Medicaid enrollment has declined since the law was enacted, partially because even U.S. citizens are finding it difficult to locate some of the documents required to enroll for Medicaid services. This is because some of the documents need to be original documents, and it can be difficult to obtain original documents in many cases.
As far as Medicaid goes, they receive matching federal funds to help run the program and pay claims. As a result, even if they wanted to assist individuals without documentation it would be a problem for Medicaid both in a financial sense and in a legal sense.
The rules for Medicare and Medicaid are so stringent that CMS has instituted a rule that even requires child welfare agencies to document citizenship for children being placed into foster care. There are some issues where people receive extra time to provide documentation, however, they are limited and must adhere to very specific rules and time frames.
Once an individual has completed the documentation process and is approved for coverage, they will be covered retroactively to the date of the application or to the month of the application depending on the state they are living in and a few other variables. Trust me when I tell you that this can be a true adventure that seems to take forever. Just when you think you have sent in everything that is needed you get a letter or phone call asking for more. Just take a deep breath and send the requested paperwork in. Be prepared for at least a couple of follow-up requests. As long as you comply with the requests, you will get the coverage you applied for and qualify for.
The primary types of identification include a state driver’s license, Certificate of Naturalization, Certificate of Citizenship or a U.S. passport. Secondary types of identification for naturalized citizens include a U.S. Birth Certificate, data verification with Systematic Alien Verification for Entitlements (SAVE) documentation, or documentation and data match with a state verification agency, as well as other documents.
It is important to know the law, your rights, your responsibilities and your entitlements in order to receive the benefits you need. You can research them on the web by going to the CMS website.
As the new administration takes on the responsibility of fixing some of the issues left behind from the old administration, it has become apparent that this will be no easy task.
Everybody from people on main street to the people on Wall Street have known for quite some time that things have needed to change. Main street is just trying to survive, and as the economy has gotten worse many on main street are losing the battle of surviving financially.
Folks on Wall Street are not immune, either. They may not feel the pinch as much, but many of them have lost millions and more. Some of the wealthiest people in the world have committed suicide due to the fact that they lost so much money, yet they were still some of the very richest people in the world even after they lost the money.
One of te issues that begs to be cleaned up is Medicare and Medicaid. With general budgets out of control and lawmakers divided as to how to fix a number of programs, especially healthcare, this is a battle that will be hard fought.
As it is, people can barely keep up with various premiums and copays. Time will tell what affect lawmakers will have in trying to adjust benefits and premium so that people can still afford Medicare and Medicaid and not lose some of the services they need.
Even though there have been promises of non-partison ways to work on the many serious issues facing Congress, from the beginning there has been a tremendous divide between Republicans and Democrats. In fact, trying to fix the economy by passing a bill was a tremendous task. The President and many of the Democrats adjusted the proposed bill over and over to accommodate Republicans. In the end however no Republicans voted for the bill. In other words, the President and the Democrats could hav left the original bill the way they wrote it rather than take the time to give the Republicans the changes they asked for and not get any support anyway. That would have saved a lot of time and delivered a more solid bill, according to the Democrats.
The President and Congress are trying to fix the Medicare Mess as well as the entire financial situation that has gone from bad to worse. Here's hoping that this can be done sooner rather than later from Main Street to Wall Street.
If you are looking for Medicare Supplemental Coverage, there is a new website to visit called The Medicare Supplement Shop. Their new site compares all the plans in a fair way as far as what they cover, what they cost and how well they perform.
If you log onto www.MedicareSupplementShop.com you will find screens to easily sign into and allows you to click on the plans you wish to compare. In addition to this, there is a phone number (1-888-891-9280) to ask questions if you need further information or feel more comfortable on the phone rather than on a computer.
Some nice features of the website are that it shows browsers how to choose the best plan. The site allows you to take your time to be able to determine which companies cost the least and the most and which companies have the best and most coverage for the money. The site also helps you to figure out which coverage is best for you and will take care of your needs.
There are many sites that claim to help you look at the Medicare supplemental coverage that is available, but most of them are trying to guide you toward buying a particular type of coverage from a specific company.
The difference with The Medicare Supplement Shop is that it truly does compare companies that sell Medicare Supplements and lets the consumer make the decision as to which coverage would suit them best.
The site even has a learning center that can help you understand what to look for in good prescription drug coverage and other supplemental coverage. The new Medicare Supplement Shop website is a good place to search for the right coverage.
It seems that the Boomer generation is in a no man’s land when it comes to many things. Too old for this, too young for that. And Medical coverage is at the top of the list. Especially if you are ready to retire.
The issue is that if you retire early and try to keep your health insurance, it costs a fortune that most people cannot afford. On the other hand, finding your own individual plan can also cost an arm and a leg and provides less coverage than your medical coverage from work.
There may be a solution coming soon. Medicare may shortly have a buy-in for individuals between 55 and 64 years of age. This could solve a great many problems. The doctors and hospitals would get paid. The insured would be able to continue with their services and with their personal physician in most cases and the Medicare system would have money coming in to offset the expense of treating this group of people.
In addition, statistics show that people age 55 to 65 usually have less medical issues and less medical treatment than most people 65 and older. As a group, they have taken care of themselves better, they are healthier – or at least, the onset of serious health issues that come with age haven’t set in yet – and they tend to see the doctor less, using prevention rather than a cure.
The Medicare Buy-In may take a little time to put into place. Lawmakers are working out the details that would help cover the over 5 million boomers between age 55 and 64 who are uninsured. There would be premiums on a monthly basis to the tune of a few hundred dollars, but the premiums should be less than keeping up with payments for the insurance from the old job and COBRA.
Though the idea has been discussed for years, conditions right now are just right for a program like this to start. For questions, contact the Medicare office nearest you.
With age many people start to face problems like memory loss and mental disorders, causing concern to the family. Many old people are scared of reaching this phase of their life. Unfortunately avoiding what they fear is beyond their control.
With more and more seniors facing such old age illnesses, we should be grateful for the rapidly growing old age care centers. Ideally, a personalized program is essential in order to achieve a comfortable and relaxing environment or atmosphere for the elderly. This is exactly what Alzheimer’s care is about. Alzheimer’s care is an example of specialized care that is different from other nursing or elder care. Several care homes or facilities specialize in Alzheimer’s care and offer not only exceptional programs but also adopt diverse approaches keeping in mind the differing backgrounds and lifestyles of people.
Providing Alzheimer’s care is indeed a challenging task, nevertheless it is beneficial for old people suffering from mental illnesses. Alzheimer’s care uses innovative approaches to take care of different people with different stages of memory disorders. Alzheimer’s care centers provide general amenities like therapeutic activities, trained-skilled staff and living space. Highly personalized assistance is given to inmates according to their needs and mental conditions.
Providing specialized Alzheimer’s care to those who need it goes a long way in giving special care to your loved ones. It helps protect the welfare of old helpless people. The success of Alzheimer’s care rests in proper monitoring, care and attention to the old. This is extremely important for their well-being and to help bring improvements in their health conditions.
Most importantly, for the success of Alzheimer’s care, there needs to be cooperation between the staff, families and elderly people. If seniors are given access to proper programs and amenities, they will enjoy the highest quality of life. An Alzheimer’s care center can provide a safe shelter and will enable them to live their life in the best possible way.
If you are covered under Medicare, you will see that it doesn’t entirely cover all the expenses that you may incur during hospitalization or medical treatment. Because of this, you may want to purchase one of the Medigap plans that AARP has to offer.
Basically, Medigap is also known as Medicare Supplement Insurance. What this kind of insurance does is that it will be able to fill in the gaps that Medicare has. It will be able to cover the expenses you incur during medical treatment that Medicare does not cover. With it, you can be sure that you will be able to save a lot of money.
However, you need to remember that there are quite a lot of plans that AARP offers in their Medigap health insurance program. You need to know what kind of health insurance plan is right for you in order for you to save money and get the most out of your health insurance plan in case you need it.
There are basically 12 plans that AARP Medigap offers.
If you need basic benefits more than the extra benefits, you may want to get plans A to J. Here, you will benefit from Medicare Part A coinsurance plus 365 additional days after Medicare benefits.
For people who needs preventive health services, plans K to L is for you. Here, you will be able to benefit from Medicare Part A coinsurance and it will be able to cover 50 to 75 percent of hospice cost sharing, three pints of blood every year and it will also be able to cover 50 to 75 percent of Medicare Part B coinsurance.
These are the things that you have to know about AARP Medigap Plans. By choosing the right plan, you will be able to make use of the benefit and also save money on premiums.
Many people are confused about Medicare and Medicaid including the question of what the differences are between the programs. There are some major differences between the two, but they are easy to sort out.
Medicare is a program that is funded by the federal government as an entitlement program, which mainly focuses on the older population. It is a social insurance program for individuals age 65 and over and it also covers medical bills of many individuals with disabilities. Medicare also covers individuals of all ages with end stage renal (kidney) disease.
There are several parts to Medicare. Part A covers hospital bills, Part B covers medical insurance and Part D covers prescriptions. There are other parts, as well, and they act as supplements, however, that discussion is for a different article.
Medicaid is different from Medicare in several ways. Medicaid is also an entitlement program, however, Medicaid is not funded only by federal government, there is a state component as well, and in some states, counties pay part of the cost, too.
Medicaid is based on need and social welfare, with eligibility based on income. If a person has limited income and/or limited financial resources, Medicaid covers a broader amount of services than Medicare does. It usually covers children, pregnant women, parents of eligible children, seniors and individuals with disabilities. Though poverty is used to determine eligibility, a person must fall into one of the other coverage groups in addition to being determined eligible due to being in poverty. Medicaid benefits are paid directly to the provider of services. So, if you go to the doctor, the doctor gets the payment, if you go to the pharmacy, Medicaid pays the pharmacy directly. In addition to covering individuals who meet financial requirements, in some states Medicaid covers individuals who cannot otherwise afford insurance.
Some individuals qualify for coverage by both programs. For more information regarding Medicare and Medicaid, go to www.medicaid.gov or www.medicare.gov or simply go to Google or another search engine and type in Medicare or Medicaid and you will get pages of information.
Right now we are in the middle of open enrollment for Medicare. Open Enrollment will last until December 31, 2008, and it is important that you know as much as possible about Medicare coverage so that you can make good choices for the next year.
Medicare and Medicare Supplements, also called Medigap, have a number of parts and they are not always easy to figure out. In fact, determining how all these parts fit together and what you need for your situation can be totally confusing. This brief overview will give you information on the basic parts of Medicare and what is covered by them.
Medicare Part A and B make up the original Medicare. Part A basically covers in-patient services including inpatient rehabilitation and inpatient psychiatric care. Many services are covered completely, but you will have to pay a co-payment for some of the others.
Part B covers your doctor visits and other outpatient services determined to be “medically necessary” for you. It also covers certain tests to determine if you have an illness. There is a deductible, which is $135 for the year 2008, and there are also some copayments with it.
Medicare Part C is also called Medicare Advantage. The Medicare Advantage Plans are not part of the actual Medicare system, but they work with it. Medicare Advantage is an alternative to Medicare and the plans are run by private companies. There are a variety of plans that all work differently. Some plans work as HMO’s others charge a Fee for Service allowing you to go to any doctor as long as the doctor will accept payment from Medicare as payment in full. It is very important to research and find out whether the Medicare Advantage Plan you are choosing will actually work with your medical needs.
Part D covers Prescriptions. These are covered by private insurance companies approved by Medicare. This coverage is important, and you must determine what type Part D coverage you need. You should figure out what you need in advance so that you can enroll immediately when you are eligible. If not, you will be charged a substantial late fee. If you enroll in a certain Part D plan and feel it isn’t right for you, every year you will have an opportunity to change between November 15th and December 31st which is where we are right now. If you need to change plans, now is the time to do it.
That was the easy part. Now for the Supplements – the Medigap policies. There are 12 policies that cover services that are not otherwise covered. Each supplement is different and covers different things. In addition, it is possible to purchase these supplements from private insurance companies, get them from you or your spouse’s employer or from various government programs.
All Medigap Policies are standardized and approved by Medicare. This means that for policies E on up the alphabet, each lettered plan offers the same coverage no matter what company you purchase it from. An insurance company can charge whatever they want to charge, so compare companies and rates carefully. That way you won’t buy from a company that charges much more as another company for the same coverage.
So, do your research and determine which Medicare Supplemental Insurance is the best for you and find the best price. If you need information, check the web at www.Medicare.gov.
Many Medicare recipients have found themselves in situations where their physician feels they need a particular procedure but Medicare won’t approve it. When this happens, most people don’t know what to do.
There is a national nonprofit organization called the Medicare Rights Center. They advise that the best thing to do in this situation is to appeal the decision. Medicare is supposed to approve any medically necessary procedures, however, quite often Medicare doesn’t agree with the doctor’s idea of what is medically necessary.
According to the Medicare Rights Center, it is often easy to win appeals for a number of reasons. One thing that often happens is that the denial is based on an accidental coding error, which means that someone put the wrong number or letter into a computer, making the computer think that you are requesting something different than you actually are requesting, and you end up being denied.
The Medicare Rights Center also says that many people don’t know that they have the right to appeal, or they think that the appeal process is too difficult. Everyone has the right to appeal and the process is not too difficult.
To have a successful appeal the Medicare Rights Center suggests:
• Sign the back of the Medicare Summary Notice (MSN) and write on the front of it “Please Review”- send it back to the correct address by certified mail or with delivery confirmation;
• Include a letter with the MSN asking for an appeal and explaining why it should have been covered;
• Have the doctor write a letter explaining why the procedure is medically necessary and why it should be approved;
• Make photocopies of all written and oral communication, including notes, names and dates of phone calls;
• Do all of these things well within the 120 days allowed, so it does not end up too late to appeal;
• If you are in a private plan such as an HMO or PPO you only have 60 days to appeal and some of the steps may be different.
It can be frustrating to get a denial. This information can be helpful if you ever find yourself in this situation. Hopefully, this will not happen to you, but if it does, following these guidelines can assist you in obtaining a successful appeal.
Many cities and towns throughout the country are issuing warnings for seniors and individuals with disabilities about scams aimed at them – especially during this open enrollment period which lasts until the end of the year.
Some of these scams involve people calling Medicare recipients and telling them that they are from Medicare and they are calling to warn the recipient that their benefits will cancel in 30 days. The callers also tell recipients that in order to keep their Medicare benefits, they need to give the callers personal information bank account numbers, social security numbers and Medicare number. Callers will also say that updating this information is free.
These types of scams are becoming more and more common throughout the country. People prey on the elderly and on individuals with disabilities, and these people sound so authentic that they often get the information they are asking for. Once they have this personal information they use it in a fraudulent way.
No matter where you live, Do NOT give out ANY personal information – especially social security numbers, bank account numbers and Medicare or other information that should remain private and protected.
Actual Medicare or Social Security representatives will NEVER ask you for personal information and they will NEVER ask you to pay them over the phone. They may verify your information, but if they are authentic, they already have the information and are trying to make sure that you are who you say you are. In addition, they usually only ask for the last 4 digits of your Social Security number. Medicare sends out information about bills and statements to recipients if there are any amounts due. Most of the time the amount would be set up in advance to be deducted from your bank account and you would receive statement in the mail showing the deduction. Official Medicare, Social Security and banking information is usually sent to you in writing in a statement or letter. If they need information from you, they usually ask for it in writing.
If someone calls you trying to get information that is private, do not give it to them. Try to get their name and number and report them to your local police or sheriff’s department.
Keep yourself and your private, personal information safe. Don’t let scammers trick you into revealing and sharing information that should stay private.
The final Medicare physician fee schedule for 2009 is complete. Doctors are breathing a sigh of release knowing that many of them can now move forward and secure their salary and maybe even a raise for next year's work.
In July legislation reversed a 10.6% cut that took effect at the beginning of that month. Starting in January 2009, a 1.1% across-the-board increase will replace an additional roughly 5% cut that would have gone into effect if lawmakers had not acted, the Centers for Medicare & Medicaid Services said in the final pay rule issued Oct. 30.
"Medicare's new rule confirms that physicians caring for seniors would have faced a harsh payment cut of 15.1% next year if Congress had not stepped in," said American Medical Association President-elect J. James Rohack, MD.
The upcoming 1.1% boost is less than the CMS-projected 1.6% increase in the cost to physicians of providing care next year. Payment freezes and increases in recent years also have come in under the rise in costs. There are two bonus opportunities exist to more than quadruple the raise that doctors will get for the year.
Physicians who successfully participate in the Physician Quality Reporting Initiative will receive a 2% bonus on all of their Medicare payments for the year. Also, the program for the first time will award a separate 2% bonus to physicians who successfully prescribe medications electronically for their Medicare patients. This has been an issue on the table for quite some time and it is now a real possibility.
Bonuses will not be paid out until 2010 when all the bills are added up and the books are balanced, but they should result in about a 5% or more raise for doctors rather than doctors having to lose money and not be able to continue to serve their patients. The E prescription process is important so that there are less mistakes and less potential health complications to patients.
If you are on Medicare, you can breathe a sigh of relief. This new way of doing business will help you remain with your doctor, and help them remain in business.
After hours care by doctors for patients who are ill or who have an emergency has been a fact of life as long as there have been doctors and patients. After all, as any mother of a sick child knows or any child of a sick or elderly parent knows, the phone call usually comes in the middle of the night, and your child’s fever seems to go up after midnight. We have all spent too much time too late at night trying to get someone to feel better.
These days, most of us end up trying to tough it out all night or, in a more acute situation we end up at the emergency room. Sometimes, a friend or loved one is admitted to the hospital and has to stay. Usually, their doctors come to see them during regular hours, but there are provisions within Medicare that pay doctors extra if they need to see their patients after hours.
Most doctors use these provisions responsibly. It makes sense that once they go home from a day’s work, they really don’t want to return to the office or hospital to see a patient unless it’s a true emergency. There are legitimate times for doctors to make that trek. For instance, my daughter broke her leg and needed surgery which lasted for hours. She was doing well, asleep late at night when she woke up screaming in pain with a high fever. The doctor was called; he came in and found a problem. He corrected the problem that night. Had he not come in at that time, she could have ended up not being able to walk again. That was a legitimate after hours visit.
The problem that Medicare is looking at is the fact that there are some doctors that are billing for after hours visits that are not necessary – or are not actually taking place after hours. As a result, Medicare is considering changing the rules and making it harder for doctors to get paid for this often essential service.
If your doctor tells you in the future that he or she cannot see you after hours don’t be upset with them. You can thank the doctors who abused the system for jeopardizing or eliminating a service that doctors have provided for many years because they care about their patients and their profession.
Medicare is a program designed for seniors and for individuals with permanent disabilities who are younger than the 65 age requirement to sign up for Medicare benefits. Having Medicare benefits helps many millions of people offset medical expenses that they would otherwise have to pay themselves.
There can be issues regarding Medicare, however. With open enrollment period upon us for choosing the type of coverage and supplements that would be best for you, it is a confusing time. However, there is information and there are seminars available to help guide you through the process and help you to pick the most appropriate coverage.
There is another issue regarding Medicare which affects younger individuals who become disabled. The issue is the 2 year waiting period. The waiting period has been around for years and here is how it works.
At any time, about 1.5 million disabled people are waiting to qualify for Medicare coverage. About 40% of these individuals are uninsured during at least part of that wait and 25% percent do not have insurance for the whole 2 years. Some of the rest who are waiting to become eligible might get coverage through Medicaid, but many end up depleting their savings and assets on private insurance and medical bills because Medicaid will only pay if the person is nearly destitute and has no other way to pay for medical care.
A new bill is being sent to lawmakers to help change the situation. Several legislators presented a bill to begin shortening the waiting period gradually over the next 10 years until the waiting period is short enough and other assistance is in place so that people are not stranded without medical coverage. The reason for reducing the wait gradually is that if it was reduced all at once, it would be too taxing on the system.
This has been a long time coming and it may seem that gradually reducing the waiting period over 10 years is also a long time. That is true in some ways, but considering that the waiting period has been a huge issue for decades, at least there is progress. Maybe things will go faster now that serious attention is beginning to be given to the situation.
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