Insurance Essentials You Need to Know

Anyone who has ever attempted to get approval from a health provider to see a specialist or start on a new medication or treatment knows the overwhelming and frustrating challenges that can be encountered. It may be difficult, for example, for patients suffering chronic pain to obtain coverage for medical or alternative procedures such as acupuncture or guided imagery, or certain types of medications. The purpose of this article is to highlight some important things to know about your health insurance policy, as well as provide some tips for communicating with your insurance representative.

Whether you are requesting information about your current insurance plan or are applying or transferring to a new plan, it is essential to understand the benefits and limitations of your insurance policy. Although there are numerous pieces of information to review and questions to ask your insurance carrier, some of the conflicts, with insurance carriers, that individuals with chronic health problems have shared with me over the years, have led me to highlight a few of the most critical concerns.

Each year your insurance company can make major policy changes. These changes usually commence at the beginning of the calendar year, but occasionally could occur throughout the year. In addition, a specialist previously covered by your health plan that you have been considering making an appointment with could decide to discontinue their contract with the insurance carrier during the year due to a business change in their group practice. If you are considering going to a new physician, always review your insurance plan by checking their web site or by phone to check if this physician is still in your provider network.

One significant area frequently neglected by many people is remembering to keep up to date with your health insurance coverage plan and any policy changes that have taken place from one year to the next. For example, if there are any changes in your marital status, new dependents or any changes made to your plan during open enrollment at your work place, you need to contact your insurance company and ask how you would make these additional changes or revise your current health plan to ensure you will have the coverage you need and want.

In order to be prepared in dealing with health insurance providers, there are a few basic questions that need to be answered.

1. First, are the current medical providers and the hospital you currently utilize included in your plan’s network?
2. Second, do you need authorization from your Primary Care Provider to see a specialist?
3. Third, if you choose a physician outside the provider’s network, will you be covered?
4. And finally, can you change Primary Care Providers?

In addition, if you need to be admitted to the hospital or go to a clinic for a procedure, always confirm that all of the medical providers [i.e. anesthesiologist, radiologist, hospitalist, specialist…], including the facility is contracted with your health plan. The facility or the individual physicians may have their own billing system. If so, they need to be contracted with your health plan to be considered as an in-network provider.

Six Essential Items When Communicating with the Insurance Company

Despite the best efforts of most doctors, claims are frequently denied due to information that is inaccurate or missing from your medical forms/bills that are submitted by the doctor’s office to the insurance company. To help avoid unnecessary claim denials, have the following six items available for all written and phone communications, as well as hospital or health related visits.

1. Group insurance name and policy number.
2. Insurance identification number
3. Date of birth
4. Date health coverage commenced
5. Your social security number
6. The name, social security number and date of birth of the person who is the main policy holder

Reducing the Chances of Claims Being Denied

At the onset, it is fundamental to thoroughly understand your health insurance policy. Knowing what is covered and not covered will reduce the number of conflicts you will encounter with your provider. In particular, it is important to know the following information about your health insurance to reduce your chances of having a claim denied.

First and foremost, be aware of what conditions are covered, along with the limitations of your policy.

• Determine if an authorization is required for specialized services or an inpatient hospital stay.
• Know the maximum benefit coverage.

If you cannot find the answer in your policy or if you don’t understand the wording, contact the insurance company to clarify anything that is not clear or that you don’t understand.

Another good practice is to contact the doctor’s office before an appointment is made to make sure he/she still has a contract with your provider, since the web site or the printed sheet of listing physicians may not always be up to date.

Also, be aware that when you receive a written authorization for a specific procedure, surgery or physical therapy, there is usually a specific time frame given with a beginning and ending date. The authorization will not be valid and payments will not be made if you do not adhere this “window of time” listed in your authorization letter.

How Can I Mange my Aging Parents’ Health Care Information?

The complexities of health care problems in the aging adult can complicate communications with health professionals, due to the multiple and detailed diagnoses, symptomology, medications and treatment plans that can be part of their disease processes and daily life. Because elderly parents may not be able to effectively organize medical information, it is essential that we assist our parents’ in collecting and organizing their medical information. An easy and simple way to gather all of your parents’ health information is to compile a Health Care Journal.

The items listed below are essential to include in this journal: Your parents’ name, address, birth date, social security number, telephone numbers including parent, children and physicians, emergency contact, type of insurance, blood type and drug allergies.

• Name
• Address
• Date of birth
• Social security number: [You may want to keep this information in a separate area for confidentiality reasons]
• Telephone numbers: Parents, children, contact relatives and/or neighbors and physicians
• Children’s Phone Numbers: [Home, Work & Cell]
• Emergency Contact: Name, relationship and phone numbers: [Home, Work & Cell]
• Insurance Plan: Policy number and contact information
• Blood Type:
• Any allergies/negative reactions: (i.e., medication, foods, dyes etc.)
• Current Primary Care Physician: Contact information
• Specialists: Address and contact information

In addition, list the primary medical problems, surgeries and hospitalizations, in chronological order, with the most recent problem listed first. List the names of any procedures or surgeries with their corresponding dates. Include all the physicians, by specialty, who examine your elderly parents’ on an intermittent or regular basis, with their addresses, phone number, fax number and most important the name of a contact person in the medical office. This contact person could be a person who works in the physician’s office, an office assistant or the physician’s medical assistant.

Additional information that would be helpful to include:

> Medications:

1. A list of medications including prescription, non- prescription and vitamins. Include information on approximate date medications were started, dosage and frequency. If your parents can’t remember all of the medications they are taking, request a list from their primary care provider.
2. Name of a pharmacist that your parent or you can contact with questions.
3. If you are unclear about the type and number of over-the-counter medications being taken, contact your parents’ pharmacist to request a six or twelve month itemized list of medications.

> List the names and phone numbers of a couple of neighbors and friends to call that could stop by your parent’s house if needed.

> Keep the phone numbers for Meals on Wheels, transportation programs available for the elderly, the local senior program, the Elder Care program in your parent’s state of residence, The Visiting Nurses Association…

> Copies of your parents Durable Power of Health Care. Keep extra copies in your home as well. If your parent is admitted to the hospital, they will want a copy of the Durable Power of Health Care, which will give the health professionals in the hospital authorization to speak with you about your parent’s health problems and treatment plan. This is particularly important if your parent does not live within driving distance from you.

> Google senior services in your state to review what programs are available.

Gathering all of their health information in a concise and organized manner will save an enormous amount of time, when your parents’ or you need to respond to numerous health questions from physicians, filling out medical forms or under emergency circumstances. If your parents are ever brought to a hospital via ambulance, they will be asked specific health questions about their medical conditions and medications prior to being taken to the hospital and a Health Journal can assist them in retrieving this important information without added delays.

Keep all of the health care information on your parents in a bright colored folder that you can refer to when communicating with your parents or their health professionals. Keep an identical folder [the same color] in your own home that you can refer to when communicating with your parents’ or any other health professional. Suggest your parents keep this folder in an easy place for them to remember and in the same place at all times,

A Reminder List can be very beneficial if your parent is confused or starting to get forgetful. If your parents have trouble remembering important health information post a large calendar in their home or apartment, so they can write their physicians appointments and other important information.

What are some suggestions to improve the quality of my sleep?

A good night’s sleep is an important component in maintaining health and pain control. Insomnia is described as difficulty falling asleep or maintaining sleep throughout the night.

Those individuals with chronic health conditions are at a higher risk of insomnia, due to the number and different types of medications they are taking, their body’s physiological reactions to chronic pain, as well as the potential anxiety and stress caused by the chronic health issues surrounding their medical diagnoses.

Individuals who are sleep deprived may experience drowsiness, difficulty concentrating, remembering details and irritability. In order to be able to avoid the adverse effects of insomnia, it is a good idea to be able to identify the types of activities, medications taken and beverages and foods ingested that can interfere with sleep, so you can have an opportunity to modify your behavior and perhaps reduce your chances of experiencing insomnia.

Here are ten tips which will help avoid sleeping problems:

1. Reduce the Level of Stimulation before Bedtime

To improve the quality of your sleep, first start by decreasing the noise level in your bedroom or room you are spending the last one to two hours in prior to bedtime. Whether you are watching television or listening to music, start to lower the volume slightly at least one hour before bedtime. Also, begin to dim the lights around an hour before retiring. Trying both of these suggestions each night may start to decrease the amount of stimulation your senses and body are exposed to. It is also a good idea to avoid keeping or using a computer in your bedroom.

2. Establish a Regular Bedtime Routine and Adjust Bedroom Temperature

It is also a good idea to establish a regular time to go to bed, as well as getting up in the morning. In addition, if a bedroom is too hot or too cold, this may affect one’s ability to get to sleep. It is important to take into consideration that for some peri-menopausal and menopausal woman, a good night’s sleep is dependent on different temperatures throughout the night.

3. Avoid Foods and Beverages That Negatively Effect Sleep

The type of foods and beverages you consume both have an enormous impact on your ability to get to sleep.

In order to minimize negative impacts on sleep try the following food and beverage suggestions:

• Any food that is spicy, hot or has the potential to cause gastrointestinal upset should be avoided at dinner time.
• Avoid caffeine containing beverages [tea, coffee, diet pepsi, mountain dew or chocolate] at least eight hours prior to bedtime.
• Contrary to what you might think, alcohol can interfere with sleep. If you want an alcoholic drink, you may want try abstaining from alcohol two hours prior to bedtime.
• Ingesting protein prior to going to bed requires the body to work hard to metabolize this type of food interfering with the body’s ability to relax and induce sleep.
• Limit the amount of fluids you drink before retiring. If you have an overactive bladder, you may want to limit fluids 2-3 hours prior to bedtime.
• A light evening snack that contains Tryptophan may assist in relaxation and aid in falling asleep. Some examples of foods that contain Tryptophan are cheese, eggs, cottage cheese, milk, nuts, brown rice, bananas and turkey.

4. Avoid Medications That Interfere With Sleep

It is a wise idea to check the medications you are taking with your pharmacist to see if any of these prescription or non-prescription medications could be affecting your sleep. In addition, if you suffer from chronic pain, check with your physician to make sure that your pain medication is adequate throughout the night so bodily discomfort and pain is not contributing to your insomnia.

Some non-prescription medications that contain caffeine, which can interfere with sleep, include Darvon Compound, Fiorinal, Excedrin, and Midol. For a more extensive list go to http://wellness.uwsp.edu/medinfo/handouts/LAs/Caffeine.pdf

Some drug categories that negatively affect sleep quality are Corticosteroids, Diuretics, Antidepressants, Beta blockers, Nicotine and Alcohol.

5. Develop an Effective Exercise Program

Although a routine exercise program may reduce or help prevent insomnia, one should not engage in aerobic activity at least three hours before bedtime. Some individuals feel that gentle stretching exercises assist their body to relax if done 1-2 hours prior to bedtime. Progressive relaxation, imagery, meditation and certain relaxing breathing techniques have been reported as helpful for some people if practiced before bedtime.

6. Take a Bath to Relax Prior to Bedtime

Many people find a bath relaxing prior to bedtime. However, with some women, if the bath is within an hour of bedtime the warm bath water can trigger hot flashes, which can interfere with sleep. So plan your bath time accordingly.

7. Learn to Relax

Educate yourself about various relaxation techniques, including, but not limited to progressive relaxation, meditation or imagery 1-2 hours prior to bedtime. Remember to use your bedroom for sleep, relaxation and sex.

8. Do Not Concentrate on Mental or Emotional Problems

Along with relaxation techniques, remember that your thoughts and images prior to bedtime will also affect your sleep. If possible, try to establish a habit of not focusing or ruminating about problematic or painful emotional issues at least one hour prior to bed time.

9. Bed and Pillow Comfort

Check your mattress, box spring and pillows to make sure they are not worn out or have “lost their support”. Ask yourself if you have developed any neck, back, or hip pain over the past few months. If so, you may need to purchase a new mattress, box spring and pillows.

10. Keep a Sleep Diary

A sleep diary can be very helpful, revealing valuable cues as to some possible causes of your insomnia. With a sleep diary, you would document a record of some of your day time and evening habits that might reveal some habits that are thwarting your ability to fall asleep or stay asleep throughout the night. You can check with your health professional to see if they would prefer one week or one month of documentation.

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