Captain Health USA

Making Health Insurance Great Again!


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When Should You Go to the ER? And, If You Do, Will You Be Stuck With the Bill?

You are experiencing excruciating pain in your abdomen.  You know there is something really wrong. Your first instinct is to rush to the hospital, it could be appendicitis but you are not sure.  It’s best to let the experts tend to you, right?  After all, they are doctors and you aren’t.  

The above scenario seems logical right?  

But it may not seem like the best course of action according to your insurance company.  

In the article titled: “An ER visit, a $12,000 bill — and a health insurer that wouldn’t pay” (link) describes a similar story and the insurance company didn’t agree that the symptoms, the pain and the final diagnosis weren’t severe enough to warrant an emergency room visit.  In fact, the insurance company deemed the ER visit in appropriate and denied the claim which caused the hospital to demand payment for treatment and tests.  In some cases, insurance companies have begun charging their clients with “penalty fees” for inappropriate ER visits. While some of the more draconian rules have not come to Florida yet, they are in other states and the number of states is growing.  The article suggests: “All of these policies suggest a new and controversial strategy for reining in health care costs: asking patients to play a larger role in assessing their own medical condition — or pay a steep price.”  It is unreasonable to expect patients to self-diagnose and do it accurately.  

What is being done about insurance companies denying emergency room claims?  Congress is getting involved and asking questions.  Specifically, the articles sites that Claire McCaskill (D-MO) sent Anthem a letter stating, her concerns that Anthem is requiring its patients to act as medical professionals when they are experiencing urgent medical events.  Emergency room physicians are also taking a stand.  They are exploring options that allow them to push back to insurance companies like Anthem who have ER policies in place like the one explained here. It doesn’t stop there.  Hospitals are engaging with patient advocacy groups, asking pertinent questions, pressuring legislators to take notice of what is happening in the system and demanding better solutions.

Review your policy to make sure you understand what your policies emergency room coverage is.  If you are unsure what your policy states, get in touch with the insurance company so they can go over it with you.   If you have any questions on it please reach out to me anytime.

To read the entire article referenced in this blog post from Vox, click here.

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You Have Health Insurance, Now What?

Now that open enrollment is over, you have picked a plan, what is your next step?  Your next step is to use the plan you selected! Make sure you take full advantage of your health care coverage.  

Getting A Checkup…

Getting a checkup is something you must schedule on your calendar every year!  A checkup helps to create a baseline or a range of normal that is specific to you and your overall health.  Our healthcare system is designed to offer preventive care.  Preventive care is a proactive approach to healthcare where you and your doctor work together to identify potential issues before they become major problems.  

Below is a list of preventative care that is covered for adults.  When you visit your doctor, it is a good idea to ask them to address these screenings during your visit.

  1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
  2. Alcohol misuse screening and counseling
  3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
  4. Blood pressure screening
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal cancer screening for adults over 50
  7. Depression screening
  8. Diabetes (Type 2) screening for adults with high blood pressure
  9. Diet counseling for adults at higher risk for chronic disease
  10. Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
  11. Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965
  12. HIV screening for everyone ages 15 to 65, and other ages at increased risk
  13. Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:
  14. Lung cancer screening for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  15. Obesity screening and counseling
  16. Sexually transmitted infection (STI) prevention counseling for adults at higher risk
  17. Syphilis screening for adults at higher risk
  18. Tobacco Use screening for all adults and cessation interventions for tobacco users

Please note that these services are free only when delivered by a doctor or other provider in your plan’s network.

Planning regular checkups and working together with your doctor is the best way to take proactive action when it comes to your health.

Do you have questions about your health plan and what it covers?  Schedule a FREE consultation with me by calling:  (813) 391-3448


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What is a Catastrophic Plan and are you Eligible?

When selecting health insurance during open enrollment, you may decide to select a “Catastrophic Plan.”  To do so, you must meet certain criteria in order to be eligible for this type of plan.

Defining a Catastrophic Plan

Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case health scenarios, like getting seriously sick or injured.

Most routine medical expenses are paid by you if you elect this type of plan.

You are only eligible for this plan if:

You are under 30 OR you are of any age and you have a hardship exemption or affordability exemption. These exemptions are based on Marketplace or job-based insurance is unaffordable.

What’s Covered?

  • Catastrophic plans cover the same essential health benefits as other Marketplace plans.
  • Catastrophic plans cover certain preventive services at no cost.
  • Catastrophic plans cover at least 3 primary care visits per year before you’ve met your deductible.

How much do they cost?

  • Monthly premiums for this type of plan are usually low,
  • Deductibles:  Deductibles are the amount you have to pay on your own for most services before the plan starts to pay anything.  These can be very high for this type of plan.  For example, the deductible for this plan during 2017, for all Catastrophic plans is $7,150. After you spend that amount, your insurance company pays for all covered services, with no copayment or coinsurance.

This can be very confusing and it may be difficult to make the best choice for you and your family.  The good news is, I am here to help!  Let me help guide you through the open enrollment process this year so that you can make an informed decision.

Schedule your FREE consultation by calling:  (813) 391-3448


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Making Open Enrollment An Easy Process

Open enrollment for 2018 health insurance coverage is right around the corner.  The enrollment dates are November 1, 2017, through to December 15, 2017.  All health insurance coverage, decisions, and selections you make during the open enrollment period will be valid beginning January 1, 2018.

Before open enrollment begins on November 1, 2017, there are some things you will want to gather before you speak with a qualified agent.  Your agent will need to know who will be covered under your plan and the type of insurance required.  

Below is a comprehensive list of the items you will need in order to make a sound and educated decision on your health care coverage.  

If you already are covered then it’s very easy. You just need to advise your agent if any of the items below have changed over the past year.

Pre-Open Enrollment Checklist:

  • Household size:  Make a list of the people in your household that will be needing health insurance during 2018
  • Current mailing address for everyone who is applying for coverage
  • Birth dates for all household members
  • Social security numbers for everyone who will be getting coverage
  • Information about how you file your taxes
  • Estimate of what your household income will be for 2018
  • A list of any major life changes for each member of your household getting coverage such as  Marriage, Income, Moving, Births, Divorce, etc.

After you have gathered all of the information listed above, call a health insurance agent who is well versed in the Affordable Care Act and understands the laws that surround it. If you do not have an agent and need help in making the best healthcare coverage decisions for you and your family, I am here to help!  Schedule your FREE consultation by calling:  (813) 391-3448


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Why It Is More Important Than Ever To Have A Knowledgeable and Reputable Health Insurance Agent

In an article I recently read, entitled “ObamaCare Advocates:  Hole Too Deep to Make Up Outreach Cuts” it states that the Trump Administration has cut 90% of the funding set aside for educating the population on their options for health care coverage.  What does this mean for you?  In short, you may be losing out on critical information you need to make an informed decision about health care coverage for you and your family.

It is speculated that this cut could result in fewer people getting the health care coverage needed due to not knowing or being aware of the open enrollment periods and deadlines, what types of coverage is available, how health care coverage works and how to navigate the system.  A recipe for disaster for the average American.

With this new cut, it is more important than ever to have a knowledgeable and reputable health insurance agent represent you to ensure you are getting the health care coverage you need and deserve, on time!  Not all agents are created equal!  When selecting an agent, select someone who is:

  • Professional and who is responsive and available to take your phone
  • Well educated when it comes to the Affordable Care Act
  • Informed and stays on top of Affordable Care Act current events
  • Understands the law
  • Will listen to your needs and will consult with you about your best options

If you are concerned about the upcoming open enrollment period, how much health care coverage you need for you and your family and how to avoid potential fines, I can help!  Visit my website for FREE valuable tools like “Dave’s Doctor Search” and a list of resource links.  Follow me on Facebook to learn about your healthcare options, breaking news and to get connected!

Do you have questions or need help navigating the health insurance system?  I am happy to help! Schedule your FREE consultation: (813) 391-3448

Doing my part in Making Healthcare Great Again!


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Do you really need an annual well visit and why is it so important?

What is the purpose of an annual well visit?

Your annual well visit or check up is something you should have each and every year.  Why?  Because it gives both you and your physician a baseline reading of your overall health while you are symptom free.  Having this baseline measurement can help your doctor detect potential health concerns before they progress – think of it as a warning system for your overall health. 

“An ounce of prevention is worth a pound of cure”

What can you expect during your annual well visit?

You can expect your physician to check the following during your next well visit

  • Health history
  • Height measurement
  • Weight measurement
  • Blood pressure reading
  • Body mass index assessment (BMI)
  • Counseling for obesity
  • Skin cancer and safety
  • Depression screening

During the overall visit with your doctor, he or she will determine if there is a need for additional tests, lab work, x-rays and other medially appropriate health screenings based on what the baseline measures report.

Embrace the opportunity you have to go for an annual well visit every year.  These visits can help you avoid potentially serious health conditions.  They can also provide early diagnosis for diseases that can be easily treatable if caught early enough – things like diabetes.  Allowing health concerns like diabetes to go unchecked for a prolonged amount of time can do serious, irreversible damage.

Curious to know how the Affordable Care Act’s annual check up has helped real people?  Check out the stories below!

All names have been changed.

Rich had not had a checkup in many years and after getting insurance for the first time in as many years he went for a checkup.  The doctor saw something irregular on his EKG and sent Rich for further testing. Turns out Rich had a blockage in a small artery and needed a procedure to open it up.  What was an outpatient procedure could have been life threatening if it went on undiscovered.

Samantha has had insurance for many years but had not had a checkup in about 4 years.  When she went this past February a small nodule was found in her breast that needed further study.  The nodule turned out to be nothing to worry about but its very important to have these things checked.

Don also had insurance for many years and had not been to a doctor in about 5 years.  After showing the doctor a mark on his leg, the doctor sent him for additional tests.  The spot turned out to be skin cancer that was easily removed at the stage that it was in.  Had it gone on longer, it could have been an issue.

Tips to make your upcoming well visit productive:

  • Be very specific when you call to schedule your appointment – indicate that you need an appointment for your annual well visit
  • Make sure the doctor’s office codes your visit properly so you do not get charged erroneously
  • If you think you have been charged incorrectly, ask to see the codes your doctor’s office uses for well visits
  • Make a list of questions and concerns you would like addressed during your visit
  • Know what is included in your annual well visit – visit a blog post I wrote earlier this year that outlines what is included HERE

Here’s to continued health!


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Are You Taking Advantage of Your 2017 Health Plan?

If not, you should be!  The Affordable Care Act is in place to help you be healthy and remain healthy throughout your life!  A BIG part of helping you stay healthy is through preventative health care practices.  The Affordable Care Act provides several preventative services as well as 1 wellness visit each and every year.

In this blog post, we are going to explore what is included in your well visit and showcase why it is important to take advantage of your it through real life stories.  The stories we share with you will illustrate how preventative care and well visits stopped devastating illness in its tracks.  The key to preventative health care is catching illness and disease before they manifest and fester into a larger more chronic or fatal outcomes.

So what exactly is “Preventative Care”?  It is the practice of evaluating your health when you are not sick or experiencing any sort of symptoms, providing a baseline or what is normal for you.  Once you have a baseline established for yourself, it makes it easier for healthcare professionals to identify illness and disease earlier.  This makes it easier to establish when something serious is brewing within your body.

Did you know there are at least 10 preventative services and 1 well care visit available to you during the calendar year under The Affordable Care Act?  Many people don’t!  These preventative services are made up of one well care visit as well as things like immunizations, tests, physical exams and lab work.

Captain Health USA Stat: The Affordable Care Act allows for 47 million women with private insurance to schedule mammograms without being charged a co-pay

Curious what you could expect during your annual well care visit?

Under The Affordable Care Act it is required by law that you have access to 10 main preventative care services.  Below is what is included in the “Adult” list.  Keep in mind, there are even more listed for women, children and seniors!

  1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  2. Blood Pressure screening for all adults
  3. Lab Tests such as Cholesterol screening and others
  4. Colo-rectal Cancer screening for adults over 50
  5. Depression screening for adults
  6. Diabetes (Type 2) screening for adults with high blood pressure
  7. HIV screening for everyone ages 15 to 65, and other ages at increased risk
  8. Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus
    • Influenza (Flu Shot)
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diphtheria, Pertussis
    • Varicella
  9. Obesity screening and counseling for all adults
  10. Tobacco Use screening for all adults and cessation interventions for tobacco users

Real Life Stories… (all Names Changed)

John……    Didn’t have insurance for many years due to the cost.  About 2 years ago he got coverage and decided to go for his physical.  The first physical in about 10 years.  At first all seamed well.  Then the lab work came back.  The labs showed that his blood sugar was way off from what it should be.  Turns out John was a diabetic and didn’t know it.  He simply ignored the symptoms.  Over time it could have been a huge medical issue however, since it was caught fairly soon, John got on medicine and should live a normal life.

Rick……  Rick had not had insurance for about 5 years.  Rick got a physical at the first chance he could and it was a good thing he did.  An issue with his prostate was caught in the early stages and was able to be treated with out major surgery.  Had it not been caught it could have cost him his life.

Joan…… To make a long story short, the non-compliant health plan Joan was on did not cover the cost of a mammogram .  Once she got good coverage, Joan had a mammogram (that cost nothing)  for this first time in 4 years.  A very small abnormality was found and removed.  Had it not been found early on, the treatment and results could have been much worse.

Health insurance is not just for when your sick, its also there to keep you well.