Below is a Q&A with Andrea Koskey from the SF Examiner on the challenges in working with the insurance system.
How do you navigate the insurance system?
I look at each case individually. I don’t make certain choices based on the algorithm or try to memorize insurance — that will get you in trouble. I’m more deliberate. I look at where a patient lives and what they need.
Who’s responsibility is it to “navigate insurance” — doctors or patients?
It’s a 50–50 split. The doctor’s role is increasingly becoming that they do research and make choices so there won’t be a delay in treatment, but more knowledge on both ends will help doctors and patients in the long run.
Why is the insurance system so hard to navigate?
They are absolutely banking on patients and doctors not knowing the system. They too have a series of algorithms that are so complex even some employees don’t know them.
Before you belly up to the bar for another beer or martini, consider this sobering news. In the United States, the overall cost of excessive drinking was estimated at $223.5 billion in 2006, according to a study published in the American Journal of Preventive Medicine in November 2011. That amounts to $746 per person, with the bulk of the cost attributed to binge drinking. Seventy-two percent of this tab came from lost productivity and 11 percent from increased health care costs. Here’s a breakdown of costs related to alcohol consumption when it comes to health, life, and auto insurance.
An estimated $24.6 billion in health care expenditures are attributed to alcohol, according to a study published in the American Journal of Preventive Medicine.
Of the $24.6 billion in health care expenditures attributed to alcohol, 43 percent came from specialty treatment for alcohol abuse and dependence, according to the study. Another 21 percent resulted from hospitalizations for other medical conditions stemming from excessive drinking.
If you are struggling with alcoholism or have a history of alcohol abuse, follow these guidelines for health insurance and treatment:
Talk to an agent. If you apply for individual health coverage on your own and you have a history of alcoholism, you may get denied — fast. In this case, a health insurance agent or broker can check with three to five health insurers on your behalf without divulging your identity. Together, you can compare options to find the best plan.
Know your coverage. Most major insurance companies cover alcohol addiction rehab, says Dr. Moshe Lewis, a pain management specialist in Redwood City, Calif. The amount of coverage can vary, depending on your plan and medical history. Check with your insurance provider to make sure you understand exactly where you stand regarding outpatient visits, inpatient visits and other rehab costs.
Consider other options. Some nonprofit recovery programs have sliding fee scales and flexible payment plans, Lewis says. Additionally, the county or city where you live may offer a program for free or at a low cost.
As noted in the American Journal of Preventive Medicine study, excessive alcohol consumption is responsible for an average of 79,000 deaths and 2.3 million years of potential lost life in the United States each year, making it the third-leading preventable cause of death in the country.
Accordingly, alcohol can play a minor — or major — role in buying a life insurance policy. “At a minimum, you’ll be paying higher premiums,” says Kevin Lynch, a certified financial planner and assistant professor of insurance at The American College. “The maximum effect is that you’ll be denied coverage.”
When filling out an application for life insurance, you’ll be asked questions related to alcohol consumption. Be honest when filling out an application, Lynch says.
A life insurance company usually will compare the information you provide on the application with your medical records. If the company notices a discrepancy — such as a history of alcohol abuse when you reported none — it most likely will ask you to change the information on your application. The company then could issue you a policy without any changes — the same amount for premiums and the same amount of coverage that you were offered before sharing information regarding alcohol abuse. It could charge you higher rates, offer less coverage, or deny your application altogether.
Insurance companies often check motor vehicle records during the life insurance application process. If you’ve had a DUI, it will be used to determine how much you pay for life insurance.
Of the costs related to excessive drinking, $13.7 billion came from crash-related costs from drunken driving, according to the study.
If you cause an alcohol-related crash and you harm a person, another car or a structure, your policy will provide coverage up to the limit you’ve selected, says Michelle O’Connor, president of O’Connor Insurance Associates Inc. in Charlotte, N.C.
Here are three additional insurance costs to be aware of when it comes to drinking and driving:
Liability issues: If you have an insurance policy with low limits, such as the state minimum, and the damage you cause in an alcohol-related crash exceeds those limits, you likely will be sued, O’Connor says. Higher limits will cover more damage and will reduce the chance that your other assets will be in danger. If you have optional collision coverage on your policy, any damage done to your car would be covered after your deductible has been met.
DUI drop: If you’re charged with drinking under the influence, some auto insurance companies will cancel your policy regardless of whether you’re convicted, O’Connor says.
Rate increases: If you’re convicted of DUI and your insurance company does not drop you, brace yourself for a big hike in your premiums. The exact amount of the rate increase will depend on factors such as the type of car you drive, your credit history — a better history can result in a lower rate even with a DUI conviction — and any other driving convictions you already have, O’Connor says. “It’s hard to say how much the insurance will increase, but I can guarantee a cab would have been cheaper,” she says.
This article was written by Rachel Hartman on InsuranceQuotes.com
Doctor visits typically increase as the year comes to an end. How many times have you been to the doctor’s office, been poked and prodded, leaving with a prescription, only to recall all of the things you didn’t ask? Or maybe there was something the doctor said you didn’t quite understand? Since many people are going to the doctor’s office to improve their overall health, the next time you go, make the most of the visit with a few strategic tips.
Ken McCoy recently interviewed me on his radio show. We had a great time discussing what pain management is, what pain management specialists do, and my philosophy regarding pain management in general. Click the play button on the audio player above to listen to our segment. Here’s an overview of what we talked about:
Trying to get patients to understand their medication: Medication is extremely important to many, but some forget what their medicine is supposed to be doing for them. Sometimes they no longer need to be taking it.
Ken McCoy and I also discuss how I got started as a pain management, physical medicine, and rehabilitation specialist. * We discuss how the holistic approach to treating patients and the future of medicine/health.
Our health care system isn't always easy to navigate or understand. As a doctor, I have to deal with insurance companies on a daily basis. Here are a couple of tips on how to get the most out of your health care insurance company.
1. Collaborate with your doctor about alternative approaches and complementary medicine
2. Ask for lower cost options, including generics and sample prescriptions
3. Negotiate for lower charges when paying cash, especially while trying to meet deductibles
4. Use the money in your Flexible spending account for complementary medicine and alternative treatments
5. Use a third party to order prescription refills
6. Stay Healthy
7. Stay in your Network
8. Use the ER for emergencies
9. Visit your insurance company's website to understand your benefits
10. Analyze your health plan at open enrollment to see if your needs are being met