Just in Time for Open Enrollment: Navigating the Medicare Website

Open enrollment for Medicare recipients began November 31 and ends on December 31. During this time, people with Medicare can add, drop or change their prescription drug coverage. They can also select a health plan for their 2010 coverage.

Whether you are new to Medicare, and feeling bewildered by the choices you have, or if you’ve had the same plan for years but are curious about what else is out there, the Medicare.gov website is a great tool. Using customized searches, Medicare recipients can search for a health and drug plan that’s right for them.

Pam Mann of the Morgan County Library and Bibi Hahn of Hahn and Nelson Family Medicine will conduct a workshop at the Library on December 9 from 1-3 pm on using the Medicare website. This workshop is meant to raise the comfort level of using the website so that participants can make an informed decision on their own. In order to use the personalized searches, participants will need to bring a list of their prescriptions, their Medicare number, and the name of their preferred pharmacy.

Please call the Library at (304)258-3350 to register for the workshop. The workshop is free of charge and will be limited to 10 participants.

A Bitter Pill or a Better Choice? Is a Concierge Practice Right for You?

There has been a lot of news about a new type of primary care practice, sometimes called a "concierge" practice. In this type of practice, a patient pays somewhere in the neighborhood of $1000 a year for access to a primary care provider. The patient in turn, is guaranteed coverage of all primary care routine visits, with no co-pay. I have to disagree with the link's headline that it has to be a "bitter" choice. For a relatively healthy person, paying $1200 a year for personalized basic healthcare dictated by that patient and his/her doctor vs paying thousands of dollars to an insurance company that really, only cares about the bottom line, might make sense. For $1200 a year, I can go to my primary care doctor for routine blood pressure checks, occassional colds or allergy shots, and not have to face an office co-pay. Nor will there be any unpleasant surprises in the mail if my insurance company decides it shouldn't have to pay for something like a a flu vaccine.

The physician, with the assurance of a steady income rather than being bogged down by the fits the insurance claim process can cause, can take the time that a primary care provider should devote to every visit. Most patients don't understand how long it actually takes to bill for that $88 office visit. To them, they may be with the doctor for 20 minutes. But behind the scenes, the work starts even before the patient arrives in the office. Does the patient still have insurance eligibility? Once the patient gets into the office, the provider then has to spend time trying to decide how to "code" the visit so the claim gets paid. Should that wart removal be a surgery, or something else? Will we get paid for the EKG by this insurance company, or should we just bill for a more comprehensive visit? If the claim is rejected, someone has to figure out what went wrong. This often means countless time on the phone with a claim representative. The claim is resubmitted, hopefully, to get paid this time. Patients often don't realize that it's not just their insurance company the provider is dealing with; it's often 20 or 30, many of them with different rules and nuances.

Time and other resources should be spent on the treating the patient, not worrying about how to get paid. Time spent with a patient is especially important in the Family Practice, where the emphasis is on treating the whole patient rather than specific body systems as in a specialized practice.

So, would a concierge practice, perhaps backed by a lower-cost catastrophic insurance policy, be right for you? One of our friends, Dr. Shawn Moyer, offers his Pinchot Plan to his patients. It's also a great idea for small businesses. What do you think? Would this be right for you and  your family? In this age of rising premiums, and minimal healthcare reform in the future, maybe it's time to think of alternatives.

Coming Soon: Navigating the Medicare Website Workshop

Just in time for Open Season! The Morgan County Library and Hahn and Nelson Family Medicine will conduct workshops for seniors interested in learning how to navigate the Medicare website, especially during Open Enrollment season. Stay tuned to this blog for times and places. Call (301)678-7007 or email if you're interested in attending.

Medicare Open Enrollment Begins

Beginning November 15, our patients eligible for Medicare coverage can review their plan and update it according to their needs. For many, this can be bewildering. However, if you're able to read this blog, you're already on your way to some helpful information.

I went straight to the Medicare website and found some helpful links. First of all, if you want a primer on using the page itself, the Help link on the upper right hand side of the page will get you started. On the right side of the page, you can find general topics such as "Original Medicare" and "Medigap Policies." This is great information especially to those new to Medicare. Be aware that if you choose to "Learn More," your browser will want to open a pop-up window so be sure you have your pop-up blocker off. Note that the pop-up window is divided into tabs, so you can look at a Glossary, learn how a plan works, or even learn more about how to choose a plan.

One very useful tool is found on the left side of the page. Find the section headed Learn More about Health Plans and Medigap Policies in Your Area. You can open the listbox within, choose your state and click View Plans. A chart displays showing you all the plans available in your state, and you can easily see how much the premiums are, and what is covered. You can also see how it's rated. There are links to plan websites, and phone numbers for further contact.

Take your time, ask questions, and talk to friends before choosing your plan. Consider cost, convenience (can you use your local pharmacy and physician?), quality and performance, and benefits. You have until December 31st.

earn More About Health Plans and Medigap Policies in Your Area

United, more.

Yep. I am seriously going to consider shopping around for insurance... I currently carry United, and now I'm wondering: why am I paying these people $600 a month?

• They are living proof of why we need a public plan. Why can the government afford to pay us more than they do?
• They denied a claim of Willa's because her problem occurred within 6 months of buying the policy. Too bad for her. She should've waited to get sick!
• They refuse to realize that we do not participate in their capitated plan: which means I have a small pile of rejected claims. Each of these takes approximately 20 minutes on the phone. I've spoken to the provider representative at least twice, and called about each mis-calculated claim to the claims department.
• See my previous insurance rant.
• Now I've been on the phone for 20 minutes for an $88 claim that was rejected because, supposedly, the member's plan "does not cover this visit, consultation, evaluation and management." I was able to find the member online on United's website (which is actually, surprisingly, quite good.) and find that her coverage is 100%. But, I couldn't find her claim status anywhere. So I reluctantly picked up the phone. The phone number on the top of the EOB was, I find out after sifting through the voice response system, only for customers. I was connected to the provider number and got a very nice young man who could, after awhile, finally pull up my patient. But he couldn't find any claims matching the one that we have that was rejected. He looked and looked -- we used every number on the EOB that could conceivably be used to retrieve a patient's records. Nothing. He put me on hold. He looked some more. Finally he decided to transfer me to a "claims specialist" who he was sure would be able to resolve the problem. I sat on hold for about 2 minutes, and then -- I was disconnected.

Ooooof. So now what do I do? Is it worth $88 to start all over again? Do they want me to just forget it, and maybe bill the patient?

Let me state here that every single person I've talked to at United Healthcare has been very nice. I have nothing against them personally. But they need to do something about this mess they call "healthcare."

1000 strong! AND H1N1 vaccine is HERE!

11/5/2009 5:05 pm: Hahn and Nelson Family Medicine, after being open for barely four months, registered our 1000th patient! We can't reveal the name of the patient because of HIPAA regulations, but let's just say she was happy to receive the bouquet of beautiful flowers that were presented to her.

We'd like to say right now that every single one of our patients is special to us, no matter when we registered you. We love and care for you all.

Actually, we care about everyone regardless of patient status. In fact, we're getting a shipment of H1N1 vaccine that we are happy to administer to anyone in the community. We prefer that you meet the criteria specified by the CDC and preference will be given to those who meet it. Just call us at 301-678-7007 or email us at hnfm @ verizon.net (you'll have to type this into your email software -- we're not linking to it because of spammers) to make sure we have some left and to find out the best time to stop by. We will be charging a small $10 fee to administer the vaccine -  the vaccine itself is free. You will need to fill out a form.

OK, that's enough good news for now! Stay healthy.

Ode to the Front Desk Staff

Next time you go to your doctor's office, take a really close look at the people sitting behind the desk. They probably appear fairly calm, although they may be surrounded by paperwork, ringing phones, and a computer demanding that they click something.  I never really thought much about what goes on there until this week. Robin is this minute somewhere on a cruise ship, probably enjoying one of those round-the-clock buffets and endless fancy drinks, while I've been attempting to fill in for her and help Lindy run the front office.
Monday could best be compared to sitting in a room with 5 tiny babies. As soon as one of them goes to sleep, another starts to cry. As you pick up the crying baby, another one needs its diaper changed, and another one rolls off of the changing table. It goes like this: The phone is ringing, sometimes 2 or 3 lines at once. Someone is waiting to check in and pay a co-pay, someone else is waiting after their appointment to schedule another appointment. Then, just as you think it's quieting down, someone walks in and wants to register as a new patient.  Or one of the doctors needs to be shown how to do something on the computer, or asks you to make a phone call.
I'm used to working in the back office, calling insurance companies about claim denials, posting payments (when we're lucky enough to get a check!), calling patients with appointment reminders, creating billing statements, and lots of other little tasks. I enjoy working on one thing at a time, with occasional breaks to stretch my achy neck. Working up front was a shock to this extremely introverted soul!
I tried to recall any time when either Lindy or Robin had seemed overwhelmed, cross, or even mildly upset. I wasn't able to summon up one negative peep out of either one of them! As I cruised through my mental image library, all I could see were two calm, usually smiling faces, talking gently to patients, answering the phone professionally and politely. How do they do it?
I think it's because they genuinely care about doing a great job, and because they really love our patients.  I hope it's also because they've found a place where they feel valued and like they're making a difference. Because they are.