Stipulation for Healthcare Understanding
Posted by Sheri Harris on Monday, March 29, 2010
Argument
Those who have healthcare are fortunate. Although the system is riddled with flaws and imperfection. There is however a mystery in the understanding of health insurance and what its provisions mean to each and every person who has health insurance. Many people do not get involved in the aspects surrounding what their healthcare package or booklet contains as it attempts to inform the subscriber regarding their actual plan. Indeed, it only seeks to answer basic questions and does not define instances that could arise regarding errors that can occur. Thus creating a situation whereby benefits are covered but not paid for by the insurance company. This could also exist in that a subscriber thinks her or she is covered for a particular service under their plan and infact find out certains serivces are non-covered, meaning that it is payment that a subscriber must make out of pocket.
Understanding of Healthcare Provisions
Upon implementation of health plans manditory seminar and discussion to be conducted as a need has arisen for the consumer understanding of health insurance and the differences in what plans offer and cover will be placed into effect.
Topics of Discussion
What a copay is and how it is applied toward insurance payment for a visit?
When is a copay required?
What is a referral and when is one needed?
Why do some plans require one and others do not?
A furthur explanation of pre-certifications- what procedures require prior authorization and what procedures do not.
Also included: Diagnosis necessities and ailments required for approval of certain tests. If a patient or subscribers test under a physicians order is rejected what can a patient do to suggest that a test be performed. Is this something a health insurance advocate can assist with regarding a patients or subscribers health if such a test is still deemed no necessary by physicians?
What is a deductible and how is that amount calculated for every visit and year?
What is co-insurance and how much does a patient or subscriber pay afterwards of insurance payment?
When is a physician script necessary?
How many yearly and specialty visits are covered?
What is a second opinion and it it covered by my insurance?
What am I required to bring to the doctor, hospital or surgeon for a visit or pre surgical procedure ie. blood results, X-rays, digital images ect.
Inpatient vs. Outpatient care
Maternity care, Nursing and home care
Prescription Drugs
The explanation of brand and generic drug coverage.
Providing patients with the correct information for drugs offered under their plan by discount and where a patient can go to obtain that information as it is updated.
The suggestion of a pharmacy kiosk system that will allow patients who do not have regular internet access as a way to select their insurance by insurance name, plan type and then typing in their own name and insurance identification number or by swiping their insurance card to obtain a printout of medications that are offered in brand or generic which will list the price that includes the copay amount for each medication received on a monthly or three month basis, and the amount a subscriber will have to pay without insurance. Patients can also research medications recommended to them and alternatives available. Similar to atm's in stores these kiosk systems will be provided to educate the patient on what types of medications are available as they are updated and then a patient can contact their physician if there is a problem with a particular medication being covered as the pharmacist is responsible for potential reactions with other medications.
Diabetic supplies, Sleep apnea
What medical insurance covers and how much does it pay per claim and on a yearly basis?
Physician visits
Hospital visits
Included are diagnostic testing: X-ray, Ct scan, MRI, MRA, Nuclear Imaging, Density Studies, Mammogram, Ultrasound
Laboratory and Culture testing
Dental (cleaning, fillings, crowns, root canals,braces, periodontal, cosmetic and jaw disorders ect.)
Vision (eye exam, surgery, glasses, contacts, lasix) the difference between an opthalmologist, optometrist and optometry.
DME equipment and the necessity for crutches, leg braces, canes, walkers, wheelchairs, beds, breathing apparatus ect.
Dialysis, Chemotherapy
ENT and Hearing Aids
Physical Therapy
The implementation of the undertanding of coverage and what it does for the patient should be required by the insurance company once a patient or subscriber has enrolled. When the time arises that the insurance is utilized the patient will have a full understanding of what is covered and needed for each subsequent visit.
Dated: March 28, 2010 Attest: A. Sadiq
On Behalf of Pieces
Those who have healthcare are fortunate. Although the system is riddled with flaws and imperfection. There is however a mystery in the understanding of health insurance and what its provisions mean to each and every person who has health insurance. Many people do not get involved in the aspects surrounding what their healthcare package or booklet contains as it attempts to inform the subscriber regarding their actual plan. Indeed, it only seeks to answer basic questions and does not define instances that could arise regarding errors that can occur. Thus creating a situation whereby benefits are covered but not paid for by the insurance company. This could also exist in that a subscriber thinks her or she is covered for a particular service under their plan and infact find out certains serivces are non-covered, meaning that it is payment that a subscriber must make out of pocket.
Understanding of Healthcare Provisions
Upon implementation of health plans manditory seminar and discussion to be conducted as a need has arisen for the consumer understanding of health insurance and the differences in what plans offer and cover will be placed into effect.
Topics of Discussion
What a copay is and how it is applied toward insurance payment for a visit?
When is a copay required?
What is a referral and when is one needed?
Why do some plans require one and others do not?
A furthur explanation of pre-certifications- what procedures require prior authorization and what procedures do not.
Also included: Diagnosis necessities and ailments required for approval of certain tests. If a patient or subscribers test under a physicians order is rejected what can a patient do to suggest that a test be performed. Is this something a health insurance advocate can assist with regarding a patients or subscribers health if such a test is still deemed no necessary by physicians?
What is a deductible and how is that amount calculated for every visit and year?
What is co-insurance and how much does a patient or subscriber pay afterwards of insurance payment?
When is a physician script necessary?
How many yearly and specialty visits are covered?
What is a second opinion and it it covered by my insurance?
What am I required to bring to the doctor, hospital or surgeon for a visit or pre surgical procedure ie. blood results, X-rays, digital images ect.
Inpatient vs. Outpatient care
Maternity care, Nursing and home care
Prescription Drugs
The explanation of brand and generic drug coverage.
Providing patients with the correct information for drugs offered under their plan by discount and where a patient can go to obtain that information as it is updated.
The suggestion of a pharmacy kiosk system that will allow patients who do not have regular internet access as a way to select their insurance by insurance name, plan type and then typing in their own name and insurance identification number or by swiping their insurance card to obtain a printout of medications that are offered in brand or generic which will list the price that includes the copay amount for each medication received on a monthly or three month basis, and the amount a subscriber will have to pay without insurance. Patients can also research medications recommended to them and alternatives available. Similar to atm's in stores these kiosk systems will be provided to educate the patient on what types of medications are available as they are updated and then a patient can contact their physician if there is a problem with a particular medication being covered as the pharmacist is responsible for potential reactions with other medications.
Diabetic supplies, Sleep apnea
What medical insurance covers and how much does it pay per claim and on a yearly basis?
Physician visits
Hospital visits
Included are diagnostic testing: X-ray, Ct scan, MRI, MRA, Nuclear Imaging, Density Studies, Mammogram, Ultrasound
Laboratory and Culture testing
Dental (cleaning, fillings, crowns, root canals,braces, periodontal, cosmetic and jaw disorders ect.)
Vision (eye exam, surgery, glasses, contacts, lasix) the difference between an opthalmologist, optometrist and optometry.
DME equipment and the necessity for crutches, leg braces, canes, walkers, wheelchairs, beds, breathing apparatus ect.
Dialysis, Chemotherapy
ENT and Hearing Aids
Physical Therapy
The implementation of the undertanding of coverage and what it does for the patient should be required by the insurance company once a patient or subscriber has enrolled. When the time arises that the insurance is utilized the patient will have a full understanding of what is covered and needed for each subsequent visit.
Dated: March 28, 2010 Attest: A. Sadiq
On Behalf of Pieces