Only You Are Your Best Advocate 

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As a patient in the U.S. health care system you will face many obstacles to getting safe, quality, and affordable health care. To overcome them, you must advocate for yourself and lead your health care team. You’ll get a big assist from many primary and specialty care practices transitioning into medical homes and providing patient-centered care.

You are the core of your health. You make the most of the choices that impact your health. You certainly feel or suspect that something may be wrong long before anyone else. You decide when and how to engage with the health care system.

The crucial steps when advocating for yourself are:

Continue reading “Only You Are Your Best Advocate “

The White House, HHS, and CMS Are To Slow Ensuring Patient Access to Medical Records

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Pretty much everyone agrees that helping patients understand and engage in their own health, well being, and health care is an important part of a safe, cost-effective, and high performing U.S. health system.

It makes no sense that despite the evidence that patients are still facing significant barriers to getting their own medical information., leading health care organizations, including the White House, U.S. Department of Health and Human Services (HHS), The Centers for Medicare and Medicaid Service (CMS), and leading payers sit on their hands when providers do not remove barriers and provide patients easy and affordable access to their own medical information.

The solutions are not hard or technological. Today, with only a few exceptions, medical records are kept electronically, and the cost to transmit data is almost nothing.

Access would be opened and barriers lowered if these leading organizations would simply publicizing organizations not complying, reducing reimbursement payments, and assessing penalties for non-compliance.

Unfortunately for every American, the White House, Congress, HHS, CMS, and large commercial health insurance companies, have not taken much leadership in solving this long-standing problem. Sure, they’ll offer hundreds of millions of taxpayer dollars for health providers to convert to electronic medical records, and even announce new initiatives with great names, like “MyHealthEData,” intended to “trigger innovation, advance research to cure disease, and provide evidence-based treatment guidelines.” God forbid they actually helped Americans get the cost and medical information they must have to manage their own health.

Fortunately, even without leadership form these healthcare powers, some consumer driven organization like Apple or Amazon will eventually figure out how to give control of our medical records back to consumers and monetize providing consumers a simple, secure, and unobstructed digital service for collecting, storing, retrieving, and distributing their own health records.

Help with Unexpected and Expensive Medical Bills

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Take these steps when you get an unexpected or expensive medical bill.

  1. Contact the sender and request an itemized bill.
  2. Contact your insurance provider and find out if the sender is in your network. Ask your health insurance provider to explain your bill(s).
  3. If the bill is from a recent trip to a hospital emergency department contact your state health insurance department to find out the state laws against balance billing. Here’s the link to a list of state insurance regulators from the National Association of Insurance Commissioners: http://www.insurance.naic.org/state_web_map.htm

Many more options for handling unexpected and expensive medical bills are detailed in Lower Your Healthcare Bills and Medical Bill Financial Help.

These options include;

  1. Finding mistakes.
  2. Disputing the charges.
  3. Applying for charitable care.
  4. Appealing for insurance coverage.
  5. Negotiating payment discounts and plans.
  6. Public Funding

There are also free medical bill review and advocacy services available.

Medical bill review company CoPatient put together a step-by-step medical bill payment guide that’s very easy to use. You can also get free help from aPatientsPlace.com experts.

CMS Overhauls Medicare ACOs

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#CMS Overhaul of #Medicare ACOs which was announced by Secretary Verma today is well worth review. Buried in today’s rule is the flexibility for risk-based ACOs to offer new incentives to beneficiaries for taking steps to achieve good health and expand telehealth services. This is very encouraging to those  who believe that patient decisions must be factored into payment models to ensure that risk is aligned with the factors that determine health outcomes. CMS next step should be to allow beneficiary rates to be adjusted up or down based on the beneficiaries adherence to guidelines and best practices known to improve quality and lower cost. Access the CMS post at; https://www.cms.gov/blog/pathways-success-overhaul-medicares-aco-program

 

Accessing Treatments & Drugs with Limited or No Health Insurance

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Emergency rooms are expensive places to get non-emergency treatment. There are affordable ways to get good medical care, even if your uninsured and/or unemployed. We’ll discuss several options later in this article. If you do find yourself in a hospital emergency room go to the hospital’s billing office a soon as your released and discuss your situation with a service representative. Many hospitals give charitable care to patients who truly can not afford to pay.

Free Help

The Patient Advocate Foundation helps patients with chronic, life threatening, and debilitating diseases access care and treatment. Case managers and their Financial Aid Fund staff are available to talk to you from 8:30 am to 4:00 pm on weekdays. They are closed on weekends and most holidays. The phone number is (800) 532-5274. They help over 100,000 patients every year. There is also a long list of patient helplines available at aPatientsPlace.com. The helplines are organized by category, most popular, and disease.

Find a Free Clinic

If you’re not having an emergency, consider finding a free clinic. You can get both primary and specialty care at most clinics. There are over 1,400 clinics across the U.S. that provide free health care in their community. Here’s the link to find a free clinic.

Low Cost Medication

NeedyMeds.org is a non-profit organization that will help you find programs to pay for your medication. An alphabetical list and phone numbers for more than 100 organizations that provide financial help is available at aPatientsPlace.com.

Clinical Trials

Patients do not pay to participate in studies that test new treatments in development. You can search for clinical trials related to your disease at Clinicaltrials.gov. There are more than 290,000 public and private research studies in the U.S. and around the world currently listed as of Dec. 2018.

Insurance

Medicaid is a federal and state health insurance program for people with limited income.

Eligibility is determined by each state. Go to https://benefits.gov and click on “Healthcare and Medical Assistance.” Choose your state and category “Medicare and Medicaid” to learn about eligibility and how to apply.

Children’s Health Insurance Program (CHIP) provides health coverage for children in families with incomes too high to qualify for Medicaid, but who can’t afford private insurance. Call 877-543-7669 to find out if you qualify and to apply.

Money Saving Benefit Programs

There are thousands of programs that can help patients with medications, care, finances, food, housing, and more. You can easily find your benefits at BenefitsCheckup.org.

If you haven’t found the help you need, fill out the “Ask an Expert” box near the bottom of the home page of aPatientsPlace.com.

Guidelines for Diabetes Self-Management

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According to the Cleveland Clinic and a large body of research, lifestyle is the key to diabetes self-management. I see many posts on social media and in patient groups that mention diet or exercise as a solution to reverse diabetes. While both diet and exercise are important parts to the solution, it’s important to understand that scientific research confirms that while you can manage diabetes, it can not be reversed.

To successfully manage your diabetes you’ll need to develop, execute, track, and refine a diabetes management plan (DMP). This should be done with leadership and partnership from your primary care physician (PCP), and coordinated with any specialists and clinicians that you are working with; such as an endocrinologist.

Your plan should include nutrition, physical activity, stress, and medication management. The nutrition part of your plan should be developed and managed with input from a dietitian.

In order to be successful your DMP must be realistic. It must fit with your current lifestyle and your circumstances. Your DMP should also be documented in your medical record so you can stay on plan even if you change physicians, relocate, or find yourself with out insurance.

There are 8 behaviors that you should include in your DMP. They are;

  1. Physician Guidance
  2. Healthy Nutrition
  3. Physical Activity
  4. Blood Sugar Monitoring
  5. Medication Management
  6. Problem-Solving
  7. Coping Skills
  8. Risk Reduction

Physician Guidance

You physician and his/her staff should be experienced and comfortable helping you develop a diabetes management plan (DMP) and discussing it with you during and in-between appointments. Follow up with your PCP and/or the practice staff should be frequent and agreed to by you and your physician. If you are at a high risk for non-compliance your physician’s staff should help by directing you to local support services.

Tip: Medicare pays for 10 hours of diabetes education. An additional 3 hours of medical nutrition therapy is also available to patients. After the first year, 2 hours of additional training are available each year.

Healthy Nutrition

Start by working with your PCP and a registered dietitian to create a weekly meal plan. This should include eating a balanced diet with a variety of foods, including fruits, vegetables, whole grain foods, low-fat dairy products, and lean meat, poultry, fish, or meat alternatives.

Your meal plan should include a focus on the right amount of carbohydrates to control your blood sugar. This should be done in collaboration with a dietitian. Your meal plan should offer lower fat options and limit saturated fats, and it should emphasize using sugar in moderation. Other inclusions in your meal plan are 20-35 grams of fiber per day. Vegetables, beans, and whole grain foods are good sources. Drinking water throughout each day, avoiding high fat foods, and using less salt are also part of a good meal plan.

If you have type 1 diabetes your insulin dose can be adjusted based on level of carbohydrates in your meal.

Physical Activity

You can help control your blood sugar, slow the progression of your diabetes, improve your overall health, manage your weight, boost your brain activity, and help manage stress through physical activity. The type of physical activity that’s right for you should be discussed with your PCP, added to your DMP, and tracked for your use.

Tip: Life will get in the way on some days. It’s OK to miss a planned exercise or skip a day or two when you’re not feeling up to it. The keys to success are to;

  1. Get back on your physical activity plan when you do fall off.
  2. Track your activity every day no matter what.
  3. Discuss your plan regularly with your physician.
  4. Change your plan as needed to fit your life and health.

Blood Sugar Monitoring

How often you should test your blood sugar level depends on the type of diabetes you have and your diabetes management plan (DMP). According to the Mayo Clinic If you have type 1 diabetes it’s common to test before snacks, meals, and bet time, before and after exercise, and sometimes during the night.[i]   Some people treated with insulin may use a continuous glucose monitor (CGM). CGMs rely on a sensor placed under your skin to read your blood sugar levels. Some work automatically, and others require you to run a receiver over the sensor.

If you have type 2 diabetes, you will likely be testing less. The actual amount will depend on if you are taking insulin, and the type and amount of insulin you’re taking. If you’re taking multiple injections each day, testing is often recommended before meals and at bedtime. If you’re using a long-lasting insulin you may only test a few times daily before meals. If you are managing your diabetes without any insulin, you may not need to test your blood sugar every day.

In all cases, you should work with your doctor to identify what’s best for you, and set targets based on your personal circumstances. The factors your doctor use will usually include;

  1. The type of diabetes you have.
  2. Your age and life expectancy.
  3. How long you’ve had diabetes.
  4. Any diabetes complications.
  5. Your overall health, and other conditions.
  6. If you are pregnant.
  7. Personal considerations.

Tip: Medicare pays for monitors, test strips, lancets, testing supplies, and glucose control solution. Consult with your physician for limitations.

Taking Medication

If you have type 1 diabetes you are likely to take medication for the rest of your life. Yet, it is estimated that 20% to 30% of patients do not take their medications as advised by their doctors. If you experience negative side effects from your medication tell you doctor. In most cases there are other options.

Problem-Solving

Diabetes is both chronic and progressive. Since managing diabetes requires daily attention, you are solving problems related to your activity, diet, and stress. Learning how to respond to changes in your blood sugar and different situations requires you to find solutions that work for you. It’s important to note that over time this can also take a mental and emotional toll on you.

Coping Skills

Having skills to maneuver difficult or potentially embarrassing situations will help you to stay positive and engaged with your DBM. If you feel like you are failing, you are much more likely to let your disease dictate your life.

Risk Reduction

You can take preventive actions to minimize your risk of letting your disease make you feel lousy or incapacitate you. Following your DMP, having regular exams with you doctor(s), checking your blood pressure, and checking things like your feet, eyes, teeth, cholesterol, and other lab tests are all parts of your DMP that should be discussed with your doctors.

Barriers to Success

Many patients are not comfortable making decision about their care because they have relied on their clinicians to tell them what to do. The problem with that strategy if you are trying to manage your diabetes is that your daily decisions often have even a bigger impact on your success managing your disease than anything that happens in your doctor’s office. If you do not have affordable access to drugs, you are not satisfied with your clinicians, or you are unsure about any aspect of your care you should seek help from your doctors, insurers, community services, local area providers, and online support groups. Connections to resources and help with every aspect of your diabetes management plan can be found at https://aPatientsPlace.com.

[i] Mayo Clinic. Blood sugar testing: Why, when and how. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628

 

100% Discount for CA Patients Earning Up to 250% of the Federal Poverty Level

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Provisions in the California Department of Justice conditional approval of the proposed merger between Dignity Health and Catholic Health Initiatives, require the California hospitals of the new system, CommonSpirit, to offer 100% discount through their financial assistance policies to patients earning up to 250% of the federal poverty level, begining in 2019.

 

Pay attention to new, 2019 Medicare Advantage (MA) plan benefits?

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Consumers should pay close attention to new benefits in Medicare Advantage (MA) plans in 2019. New benefits may include transportation, and home health visits.

At the same time, CMS is beginning to consider Medicaid demonstration waivers covering short-term stays for acute care provided in psychiatric hospitals or residential treatment centers in exchange for expanding access to community-based mental health services.

HIV Patients Paid $500 to Lower Drug Costs

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Eligible United Healthcare members participate by;

1. Asking your doctor about lower cost prescription drug alternatives.
2. Filling an eligible prescription.
3. Activating your My ScriptRewards.
4. Continuing your medication for 6 months.

You should receive a $250 gift card in the mail, and another $250 gift card when you complete 6 months of your prescription. Self-insured customers should be added to the the list of participants in Nov. Stay tuned to see if this program is expanded to other high cost specialty medications in 2019.