Health

Getting Insurance To Pay For Preventive Health Under The Aca

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The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the “wellness visit” into a “sick visit.” The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the “free preventive health” visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.

Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than “routine preventive health screening,” the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.

This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone – those at risk as well as those facing no known risk – to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 – $2,500 cost, it will give people a strong financial disincentive to getting tested.

As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form “yes or no” in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.

The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.

To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forums

There is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.

The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don’t have that in health care.

I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the “preventive health visits” to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.

Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don’t think a letter writing campaign is the correct way to reform payment for the “preventive health visits.” If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor’s office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.

COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn’t there one?

There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.

The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.

But we are using the much less common colonoscopy example. Instead, let’s return to preventive care with a primary care doctor. Should a patient have the right to check a box and say “I want this visit to cover routine preventive care and nothing more”? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.

When I expect to receive a “zero cost to me” preventive screening, I do not imply that I am willing to accept a “bait and switch” change of procedure and payment due to the doctor from me. The “zero cost to me” induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a “zero price” for a visit, the doctor’s office better honor that price, or it amounts to fraud.

It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.

It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor’s billing practices match the patient’s expectations for a free preventive health office visit.

I investigated the web site http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html and discovered some inconsistencies. For example, the site purports to list the services covered under the “preventive health” coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer’s own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.

Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.

If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor’s office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.

It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.

For additional sections of this article, please see http://www.michaelguth.com/?p=743

Levive Juice The Super Health Drink

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The amount of antioxidants that you maintain in your body is directly proportional to how long you will lieve” , quoted by Dr. Richard Cuttler, Former Director of the Naitional Institute of Aging, Washington, D.C. USA . We are very sure that you would have, no you must have heard the buzz about Le’Vive juice also known to some people as the Power of 5 Antioxidant Drink. Le’Vive juice concentrates the power of the world’s top five antioxidant producing fruits in one product: Mangosteen, Noni, Acai Berry, Goji and Pomegranate. The combination of their juices leverages their synergic action in your body to the fullest, slowing your body’s cells’ aging process while preventing the occurance of terrible degenerative diseases.

Le’Vive juice is an inviting, enticing and great tasting fruity juice blend that is ideal for the whole family! Le’Vive Juice comes equipped with a number of healing properties and energizing benefits. Almost everyone who has ever tried the Le’Vive Juice, whether they be distributors, importers, healthcare professionals and customers, everyone has classified it as the most powerful and best tasting juice ever! According to the latest information by health care experts and herbalists, the Le’Vive Juice is the perfect solution for the common weight gaining issues, anti aging to fertility and sleep disorder problems.

Actually, there are 25 reasons to take Le’Vive Juice every day! And they are:

1) Decrease the levels of harmful free radicals, the cause of aging.
2) Keep your skin and hair healthy.
3) Fight funguses, virus and bacteria.
4) Increase your energy level.
5) Feel and look younger.
6) Prevent cancer.
7) Maintain a healthy blood pressure.
8) Control your blood’s sugar level.
9) lose weight.
10) Sleep better.
11) Improve your vision.
12) Enhance your sex drive.
13) Improve your digestion.
14) Prevent gastritis, reflux and ulcers.
15) Maintain a normal cholesterol level.
16) improve your memory.
17) Prevent diseases like Alzheimer’s and Parkinson’s.
18) Control inflammation and arthritis.
19) Prevent tumors.
20) Protect your kids’ health.
21) Keep your joints flexible and healthy.
22) Prevent respiratory conditions such as tuberculosis, bronchitis, emphysema and asthma.
23) Improve your fertility.
24) Keep your liver healthy.
25) Maintain an overall state of good balance health.

But where does this juice come from? Le’Vive juice comes from the 5 most powerful berries on earth:

1) Pomegranate – (Egypt & Asia). One of the oldest fruits known to man. Rich in vitamins A, B & C, potassium, phosphorous, magnesium, calcium, sodium and fiber.
2) Goji – (Himalayas – Tibet, Mongolia). Considered miraculous since ancient times. Rich in polysaccharides; with 18 amino acids, vitamins A, B, C & E, 21 minerals, proteins, fiber and Omega-3 and Omega-6 oils.
3) Acai Berry – (Amazon Brazil). Legendary fruit from the Amazon that contains 10 to 33 times more antioxidants than grapes used for red wine.
4) Noni – (Polynesian Islands, India). Used as a medicinal plant for thousands of years to cure different conditions. Contains polysaccharide-based nutrients, organic acids, vitamins and minerals.
5) Mangosteen – (Thailand). An Asian native that has caused a commotion with its splended flavor. Known as the “Queen of Fruits”, possesses high levels of xanthones.

Le’Vive juice berries are a gift of nature that has been consumed for its overall health and fitness benefits. The Le’Vive Juice berries are not a new product to mankind, however it is a new concept blending the most powerful 5 berries together yeilding super antioxidants and a delicious irristable fruity flavor! These berries are loaded with vitamins, proteins, minerals and recent studies and experiments have shown that Le’Vive Juice contains an extraordinary high content of antioxidants, more than any other single berry and berry drink that we consume today.

Le’Vive Juice is equipped with many health benefits and also contains various powerful antioxidants. Le’Vive Juice also works as a mood booster. It lowers cholesterol levels in our blood. The juice aids in neurological disorders. If you are worried because you have gained a lot of weight, Le’Vive Juice is a perfect option for you.

Le’Vive Juice is known to help in fighting various diseases and because the Le’Vive juice is a completely organic herbal product, naturally there are no side effects arising out of it. This means that the Le’Vive juice is not only safe but also healthy for the entire family…even pregnant women. Recommended consumption amount of Le’Vive juice is 2 ounces in the morning and 2 ounces 1-3 times a day, preferably before or with meals. However, this is a general rule of thumb and not an exhaustive prescription. The best place to buy Le’Vive Juice however, is at Levive-Juice.com. Levive-Juice.com is the most credible supplier of Le’Vive Juice, and all other types of natural organic juice products. For more information and to purchase the Le’Vive Juice visit there site at

To summerize, consuming nourishing supplements which contain antioxidants is the principal way to combat the harmful effects of contamination in the body. Eating a balanced diet of fruits and vegetables rich in antioxidants can have a positive impact on your future health. There is NO short term solution for long term health.

Prevent Bearded Dragons Illness and Health Problems With Few Tips

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Bearded dragon can be great pet for lizard beginners and knowledgeable reptile hobbyists, but they do require some dedicated care. Pet lizard bearded dragons are very submissive reptile that breed well in captivity. This pet would be one of the best choices for any pet owner that would like to take on a reptile. Bearded dragons health needs to be taken seriously to shield them from various types of disease. Even if they are living well in confinement; a certain degree of care and attention is required to curtail the illness that has struck them. There are several common health issues that are always connected with bearded dragons. Thus you need to plan in advance. Take proper prevention techniques and pay more attention on numerous symptoms that may relate to the bearded dragons health issues.

The most significant aspect of keeping your dragon lizard healthy is to provide a replicate natural habitat and a proper setup pet dragon cage. One of the most essential in housing is the setting up of reptile lizard cage for your bearded dragon before you bring them home. Get the enclosures set up and function at right manner, make sure the minimum requirement such as basking spots, temperature gradient, lighting, decors, substrate and water bowl are made obtainable.

Bearded dragons illnesses or sickness can arise from time to time if they are not taken care of properly. Even though they are brawny reptile, a good care is required especially at hatchling or young stage. Diagnose of health problems are somehow complicated and thus appropriate preventive methods should be done in advance in case the sickness arise.

Although there might be home remedies for certain bearded dragons issues, a veterinarian service is required if the pet dragon gets very sick. Always be geared up and locate the veterinarian that is an expert in reptile pet, especially bearded dragon because the best way is to seek for qualified help in analyzing if severe health issues arise.

Exploring for a qualified reptile veterinarian that can handle exotic pets and reptiles may be tricky but it will be worth the efforts. At least you will have an idea where to look for advice in case of the crisis because many diseases cannot be treated or diagnosed by the pet owner. It doesnt mean that all you have to do is to seek for the vets advice when your bearded dragon get sick, to be secure, at least a checkup is required once a year. If your budget is tight, then once in 2 years would also be fine.

Prevention is a must for bearded dragons health as an effort for being considerate towards them. You must put efforts into the housing temperature, lighting setup, and take a good balance on the bearded dragon diet. Poor temperature and lighting setup in the case may have an effect on the dragons health; inappropriate diet may lead to numerous illnesses.

There are numerous ways through which you can take good care of bearded dragons, especially the precaution and prevention methods. Always have a guideline for yourself as a pet owner if any health issues take place; this is vital for your bearded dragon health.

Health Benefit Options For Freelancers And Independent Consultants

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Freelance workers, independent consultants and independent contractors enjoy many advantages. Their schedules are flexible, they set their own agenda, and with a little planning, they can take extended time off. However, while these benefits can improve quality of life, there are other benefits that these workers do not receive, such as health insurance. Finding health insurance as a freelancer or independent consultant is one of the most challenging aspects of being a sole proprietor. A variety of insurance options are available to these workers, however finding a plan that the worker qualifies for and can afford is the difficult part. Of the many choices in insurance available, independent contractors and independent consultants may be surprised once they start shopping that some are unavailable to them, some are too expensive, and others offer poor or unnecessary coverage. By the time these workers narrow down the choices to the affordable insurers that will accept them, the list may be very short indeed.

Group Insurance

Group insurance coverage is undoubtedly the best insurance plan overall. In a group plan there is no need to qualify, no medical exams, no health questions to answer and the rates are the same for everyone and do not raise with claims. That being said, if you are self-employed, group health insurance is very difficult to find. Group health insurance is typically provided by employers, and, since an independent contractor works for themselves, there is no employer. If your spouse is employed, you have recently been employed and qualify for COBRA, or you can get your employment covered under an umbrella company, it may be possible to receive group coverage. If you can qualify for group insurance, you will probably find it to be the most affordable and most inclusive of the insurance options that you find.

Insurance through an Association or Chamber of Commerce

In their effort to ease the financial hardships for sole proprietors, many professional organizations and local chambers of commerce offer insurance to their members. These policies are not true group policies, but pooled risk policies. A pooled risk policy can still be affordable, particularly if you are young, have no serious medical conditions, and have low risk of an accident. Because you generally receive an individual insurance premium rate, members with pre-existing conditions or those in poor health may find that they pay a higher rate. Also, unlike in a group plan, your rate can, and will, change as a result of claims. Even those in good health that are in a pooled risk policy will usually pay more for coverage than someone with group coverage, but, overall, the insurance choices provided by professional organizations can be a good choice for self-employed workers.

Coverage through the State

Some states offer medical insurance benefits programs. In many cases, health insurance that is offered through your state is not a great choice. While each state offers its own plan and they vary widely, a state plan does not typically cover the full spectrum of preventative care and may be very limited with regard to prescription coverage. Coverage through the state is sometimes called catastrophic coverage, intended to prevent financial ruin if a self employed worker becomes seriously ill or injured. State coverage may also have income limits (intended for lower income individuals) or other qualifying factors. State coverage can be an option to explore, but you should also make sure that you have money in your savings to cover routine preventative office visits, the cost of medications, and reserve funds in case you need to come up with partial payments for something more serious.

Individual Coverage

Buying an insurance plan directly from the insurance company is an expensive way to get health coverage. If you have pre-existing conditions or are in poor health it may be impossible to find a company that will cover you affordably. Individual coverage is typically the last choice for independent contractors and freelancers because of the expense, the limits, and the aggravation of attempting to secure this type of coverage.

Getting the Coverage That You Want

Group health insurance is, hands down, the best all-around choice. Qualifying for a group plan as a self employed individual can be tricky, but there are ways to do it. The benefit is affordable coverage and the knowledge that you can protect your health and wellbeing affordably. If you cannot qualify for group insurance through your spouse or COBRA, and you are working as an independent consultant or freelancer, your best choice may be to get benefits coverage through employment by an umbrella company or “employer of record”. An umbrella company often offers benefits to their employees, such as insurance. The work you perform is not for the umbrella company however, it is for your existing clients. The umbrella company invoices the clients, and pays you. This allows your client to be free of maintaining your paperwork, while allowing you to receive benefits from the umbrella company.

Umbrella firms commonly employ only “white collar” professionals, so if you are an independent contractor in trucking, construction, or other more labor-oriented industries, then an umbrella firm may not be right for you. Also, it is important to ask many questions about the insurance and benefits provided by any umbrella firm. Many umbrella firms offer complete insurance packages that include health, life and disability coverage with a true group program. Other firms offer “group discount” health plans that may not be truly corporate group health. Find out who the insurance company is, and ask lots of questions to be sure – if you can get a cost estimate of the insurance premiums right away, then that can indicate a real group program, as everyone in a group program will have the same rates. If you have to give personal health information such as age or health conditions to get a rate quote, then chances are, the plan is not truly a group plan. While getting benefits through an umbrella firm is a good deal for many individuals who are a good fit for that kind of program, for those who only want health insurance, it may not be the best choice because these companies are not only providing health benefits, but a full suite of employer of record services.

For any independent consultant or freelancer, it is important to protect your physical and financial well being by having solid health insurance coverage. Even a short amount of time away from work due to an unforeseen health problem could be very damaging to a “company of one” – not to mention sky high medical costs if youre uninsured and the unthinkable happens. If youre working solo, make sure you have great coverage. Shop around, ask questions, and compare your options. Always look for a true corporate group health plan, – whether through a spouse, through COBRA coverage, or through an employer of record, as this is the safest and most stable option for great benefits protection.

How Much Does Health Insurance Cost Per Month

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For many non-insured people, the question of how much does a health insurance policy cost today can make or break their decision to pick a plan. It must be emphasized that insurance is a necessity in our times especially with the rising costs of health care.

Even if you have to take the cheapest plan with basic coverage, take it for indeed it is better to have health insurance to help shoulder the costs of medical care than to have no protection at all. Besides, many factors will affect the cost of your insurance plan such that you might be persuaded to think that indeed the premiums you pay are worth every penny.

Factors Affecting Costs

Health insurance plans are not islands unto themselves. Just like other aspects of modern life, it is dependent on varying degrees on the economic and political environment as well as on the applicant’s personal circumstances and preferences.

On one hand, economic and political factors include use of insurance plans amongst people and advances in medical science and medical technology. As modern medicine finds newer and better ways to prolong the lives of human beings, insurance costs will rise to meet the consumer demand. And with the proposed health care reform, we may see a shift towards greater burden on consumers of insurance plans.

On the other hand, personal circumstances will also affect the cost of the insurance policy. These personal factors will include:

– Age – As you age, your premiums will increase.

– Gender – Women will pay for higher premiums than their male counterparts

– Medical history – Your past and present health can either swing the favor of premiums for or against you.

– Lifestyle choices – Alcohol consumption, smoking habits, use of street drugs and obesity will affect the costs of the plan

– Place of residence – Each state has its own insurance laws especially where coverage and caps are concerned

– Types of plan preferred – Comprehensive plans are more expensive to pay for than scheduled benefits plans. Fee-for-service plans, preferred provider organizations, point-of-service plans and health maintenance organizations all have their costs.

The insurance company will evaluate all these factors before providing you with a quote.

Actual Costs

As can be expected, each individual’s insurance quotes will vary depending on the personal factors. If the 2008 figures for the United States is the basis, an average individual will spend around $5,000 while an average family of four will spend up to $18,000 on health insurance policies per annum.

Unfortunately, health insurance rates now cost more than compact cars. However, you have to remember that a compact car will not provide financial protection in times of medical emergencies, unlike the health insurance policy.

It cannot be denied that health insurance costs are on the slight rise. You may grumble about it but the fact still remains that health insurance is an essential part of modern life.