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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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Open Enrollment & Obamacare Changes YOU Need to Know About!

Healthcare Open Enrollment is RIGHT Around the Corner! 

There are LOTS of Changes YOU Need to Know About!

yocg-tuesday-9-6-16-canvaHealthcare open enrollment begins on November 1, 2016 and runs until January 31, 2017 and it won’t be business as usual.  There will be several carrier changes for 2017. 

Before we get into the specific changes, there are some dates you need to put on your calendar for the open enrollment period:

  • November 1, 2016:  Open Enrollment Begins
  • December 15, 2016:  Meet this enrollment deadline to ensure coverage begins on January 1, 2017
  • December 31, 2016:  Coverage ends on this date.  If you have NO changes to your plan, your plan will be auto-renewed
  • January 31, 2017:  This is the VERY LAST day you can apply for 2017 healthcare coverage

If you miss these deadlines, you cannot enroll again until November 1, 2017 unless you have special “life event” changes take place.  Life event changes include:  having a baby or losing your job.

Did you know?

If you do not enroll in Obamacare or have an approved form of health insurance during 2017, you will be fined 2.5% of your income or $695 per adult – whichever is higher.  Please note that the amounted listed is only an estimation as the higher 2017 dollar amount has not been released as of yet.

Those living at poverty levels can enroll at any time in the Medicaid or CHIP (Children’s Health Insurance Program).  These programs do not have a specific enrollment period or timeframe to adhere to.  Please note, there are some restrictions to adhere to such as income restrictions.

Changes…

yocg-wednesday-9-1-16-canvaAt the beginning of this article, I noted there were going to be changes in the Florida Marketplace.  There will be some carriers leaving and some new additions too!

Let’s first say good-bye to:

  • United-Healthcare
  • Aetna

Say Hello to:

  • Cigna – they exited the Florida Exchange in 2015 but are coming back in 2017
  • Molina – They are expanding from South Florida to the Tampa Bay area
  • Harken Health (a subsidiary of United Healthcare) is planning to enter the exchange in the Miami and and Fort Lauderdale area

Of Note:

Humana plans to scale back it’s participation in the Marketplace but will remain in the Florida Exchange system. 

Other changes coming down the pike in 2017 include rate changes that have not been approved by the state yet.   

Other Obamacare changes people can expect to see in 2017 are:

MORE INFO!

When you select a healthcare plan, there are usually two things you ask:

1)  How much is it going to cost me

2)  Is my doctor or the hospital I prefer in my plan

A common complaint last year was inaccurate doctor and hospital information.  The new rules mandate that:

  • Insurance providers are required to give consumers a 30-day notice when a doctor is being removed from a network
  • If a doctor/provider is being removed from a network and a patient is in active care/treatment with the physician being removed, the insurance company must allow for up to 90 days treatment under the physician’s care

Reduction in “Surprise” medical bills from out-of-network providers

Many patients have complained about receiving unexpected invoices and bills from out-of-network doctors, even when the patient thought the doctor was in network.  The new rule calls for:

  • Ancillary care amounts to be applied towards a patient’s yearly out of pocket maximum expenses

Note, this rule only applies to those instances where the insurer has not given patients the correct notification that they will be receiving care from individuals outside of the network.  The general rule is that a patient must be notified that they will receive care from an out of network provider within 48 hours.

Better Explanation of Out-Of-Pocket Expenses/Costs

During 2017, insurers are to offer plans with a standard set of coverage costs (deductibles and copays).  With this information easily attainable, the patients will better understand the out-of-pocket fees associated with the plan they select.

Do you have specific questions about open enrollment and how the 2017 marketplace changes could affect you?  Contact me, Your Obamacare Guy!  I can be reached at:  (813) 391-3448 or email address:  dave@YourObamacareGuy.com


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Physician Referrals, YOU Have A Choice!

Physician Referrals, YOU Have A Choice!

Health care and visiting the doctor has become increasingly complicated to navigate. Rules are always changing.  Life is busy which makes it hard to keep up with the changes.  Good news!  I am here to help!  So, let’s dive in!!!

Wednesday 7 6 16When do I need a referral?

Referrals are generally required when you need to see a specialist for a condition that your regular primary care physician cannot treat.  Not all specialists need a referral.  The services that DO NOT require referrals are:

  • In network:
    • Obstetrician/gynecologist
    • Urgent care centers or walk in clinics
    • Eye examinations
    • Mental health disorder and substance abuse services
    • Pathologist
    • Radiologist
    • Anesthesiologist
    • Emergency room visits/admissions
    • Non-physician services such as:
      • Outpatient labs
      • Diagnostics
      • Physical Therapy
      • Durable medical equipment

How do I obtain a referral for a specialist?

Once your primary care physician determines a specialist is needed, to help you with your condition, a referral is given.

A Referral is an authorization for you to see a specialist.

In some cases, your physician may give you a recommendation of who to see along with his referral.  A recommendation is exactly what it sounds like.  It is a suggestion of who you might want to consider seeing for treatment, not a mandate.  This is great news!  Why?  For many reasons!  Check them out:

  • Many times, your primary physician may recommend a specialist who is not in your network.  This can be a very expensive option for you.
  • You have the opportunity to research and find the perfect specialist for you within your health insurance network
  • In some cases, referrals are generated due to a quid pro quo arrangement between doctors.

Now that you have your referral in hand, it is time to select your specialist.  One of the first things you should do is fire up your computer and search for the doctor in your insurance plan’s database.  Not sure who is in your carrier’s database or where to even find the database?  No worries, use this handy tool:  Dave’s Doctor Search.  Here you will find all of the doctor’s listed in the each of the major health insurance carriers.

Select at least three specialists you are interested in possibly using for treatment and learn more about them.  Some of the things you will want to look for are:

  • Is the doctor licensed?  You can verify this by visiting your state’s physician licensing board
  • Is the physician board certified?  A board certified physician is one who demonstrates exceptional expertise in a specialty or subspecialty.  They are certified and recognized by the ABMS Member Board.  Qualifications to be recognized by this board includes rigorous testing and peer evaluations.  These evaluations and tests are engineered and administrated by other specialists in the same field of specialty.
  • Consider the age of the doctor.  Are they older and considering retirement, are they younger and have a passion for cutting edge technology and techniques or have they been practicing a long time giving them ample experience to treat your condition well?
  • Discover how long the doctor has been practicing by visiting online doctor listing sites.
  • Have there been interruptions in their practice and why?
  • What hospitals is the doctor affiliated with and how are those hospitals ranked?
  • Has the doctor experienced any reprimands or malpractice suits?
  • Consider researching doctor ratings sites and review sites.
  • Has the doctor authored any papers, studies or conducted research in the field you are looking to get treatment in?

There is so much to consider when selecting a doctor and a specialist!  The most important thing to remember is that YOU get to make the choice on who treats you.  Take control of your health and your healthcare by selecting the physician that makes the most sense for you and your health goals.

Remember, the referral you receive from your primary care physician (PCP) is the authorization you need to go to the specialist.  The name of a doctor they give is a recommendation only.  Do your homework and find the right fit for you.

Do you need help navigating your way through today’s healthcare arena?  I can help!  Contact Dave, Your ObamaCare Guy for more information at: (813) 391-3448 or email me at dave@YourObamacareGuy.com.


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Obamacare, Preventive Care and YOU!

Obamacare, Preventive Care and YOU!

Obamacare Guy 08 26 15 CANVADid you know?  Obamacare (a.k.a. The Affordable Care Act) is focused on your overall health and well-being.  Many people are not aware that the Obamacare plan includes preventive care with NO out-of-pocket costs on most of the plans.

As a matter of fact, instead of focusing on treatment and cures, Obamacare’s FREE preventive services focus on overall well-being by:

  • Focusing on wellness
  • Promoting early detection
  • Practicing Prevention

Did you know?  Major Medical Plans purchased after 2014 include the following without copays and co-insurance when used within network to avoid cost sharing:

  • 1 wellness visit
  • 14 FREE preventive services

Defining Preventive Care:

Preventive care takes a look at who you are as “healthy you”.  A homeostatic or baseline of how you present when you are healthy and symptom free.  Preventive care’s aim is to provide routine screenings to help detect the early onset of health issues.  The idea is to to identify health issues early and resolve them before they become larger, more serious health concerns.

Preventive care includes such things as: immunizations, shots, screenings, tests and 1 FREE annual wellness visit.

Thursday 8 13 14 Your Obamacare guy CanvaWho Is Eligible for Preventive Care?

The Affordable Care Act or “Obamacare” requires most health plans to cover certain services at no out-of-pocket costs.

Who Gets What…

Below is a list of the number of preventive care services that are allotted in each group listed

  • Adults Receive 15
  • Women Receive 22
  • Children Receive 26

The chart below displays all the preventive services available by category.

If your current plan does not provide these preventive care benefits, contact me immediately for help at (813) 391-3448.

Your Obamacare Guy Preventive Care Chart

For more information or to see if you qualify for cost assistance on a new marketplace plan or to learn more about ObamaCare’s new benefits, rights and protections, please contact Your Obamacare Guy; Dave Taylor at:  (813) 391-3448.