However, It really is a gift to yourself as well as to those you love to make your wishes known and designate someone to carry them out for you. Ask anyone who had to go through this situation without knowing the other person’s wishes and you’ll hear stories of guilt, fear, sadness, and often, irreparable harm done to family relationships.
One important document you need is a Health Care Power of Attorney - allows you to designate someone to serve as a your proxy or agent in case you are unable to make medical decisions on your own. This is the link for the form for Illinois. It’s critical to not only fill this out, but make sure the person you designate is comfortable taking on this role and talk to that person about what decisions you would want them to make, if needed. You can fill out the form without consulting a lawyer, it just needs to be witnessed, not notarized.
To help you have the conversation with your health care proxy and other loved ones, this Five Wishes booklet is helpful. Five Wishes is a national document accepted by almost all states. It includes a form to list your Health Care Power of Attorney but also includes an easy-to-use way for you to let people know what kind of care you would want.
Advance care planning puts you in control. Aging and being diagnosed with a serious illness generally brings so much uncertainty and fear, so anything that gives us a sense of control can be comforting. It’s the perfect time to think about your wishes and who you want to be in charge of carrying them out for you.
Please, if you haven’t done this yet, put it at the top of your to do list!
Choosing the right health insurance plan can be overwhelming. It may be tempting to just keep the plan you currently have rather than look at spreadsheets and dense, hard-to-decipher descriptions of coverage options.
That’s a mistake. Whether you’re over 65 and inundated with advertising about Medicare open enrollment options or getting your insurance through the Marketplace or working for a company whose annual open enrollment is taking place this fall, it’s imperative that we review our current plan and see what our options are for 2023.
Here are some things to keep in mind regardless of where you get your health insurance:
Medicare Open Enrollment started October 15 and you can’t watch TV these days without seeing commercial after commercial about different Medicare insurance options. During Medicare Open Enrollment you can:
A few tips:
Health Insurance Marketplace and Employer Health Plans
Bottom line: Be sure you understand your options, get your questions answered, and know your preferences (cost, access, convenience, willingness to accept risk, etc.) before you make a decision. Contact me if I can help answer questions or conduct an analysis for you.
We know that providers should use plain language when speaking with patients, yet we also know from experience that that is often not the case. Providers may often rush through instructions as well. And not every provider’s office gives you an after-visit summary or provides a plain-language after-visit summary.
What is teach-back? According the Agency for Healthcare Research and Quality, “the teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health. It is a way to confirm that you have explained things in a manner your patients understand. The related show-me method allows staff to confirm that patients are able to follow specific instructions (e.g., how to use an inhaler).”
While teach-back is actually a method that providers should be trained in and use, we also know that they usually don’t. As patients, we can initiate a “teach back” moment ourselves!
After your doctor tells you something, such as your diagnosis or treatment plan, repeat it back in your own words. That way, they can determine if you understood the instructions and it gives them an opportunity to make corrections.
For example, suppose you have diabetes and monitor your blood sugar level at home. The doctor explains to you what to do if your blood sugar is low or high. After they explain this to you, they should ask you to repeat it back to check for understanding. This understanding should include what range is low, what range is high, and what to do in each case. If the doctor doesn’t ask you to repeat it back, you could initiate the teach-back yourself: “Dr. Smith, I just want to be sure I understood correctly. If my blood sugar is low [give number], then I should eat or drink [give example]. If my blood sugar is high [give number], then I should [give example].” If you get this wrong, the doctor knows that they need to repeat the instructions, perhaps using different language or approach.
Teach-back is not a quiz for patients; it’s actually puts the onus on providers to explain information clearly. However, since I’ve rarely seen it used in practice, I recommend that we, as patients, take this into our own hands and use it for ourselves!
Bottom Line: We need to advocate for ourselves. One way to be sure that we understand information correctly is to use the teach-back method.
A few months ago, my friend’s daughter, a freshman in college, had a health scare. Fortunately, everything turned out okay! But my friend hadn’t had her daughter fill out any of the necessary forms to allow the doctor and hospital to release information to her or even to speak to her about her daughter’s medical concerns. Trying to get a busy (and uninterested) college student to fill out the necessary forms while in another state in the middle of a semester was not quick, easy, or painless.
There are privacy laws (HIPAA) that restrict what a health care provider can share about any adult 18 years or older. Yes, this applies even if your adult child is still on your health insurance plan and even if you are paying the bills. Please refer to this article with advice about what forms you should have your 18+ year-olds sign. You can complete these forms on your own or meet with an estate planning attorney.
Briefly, the four important documents are:
If your adult child is attending college in another state, it may be safest to fill out forms for each state. Some colleges have their own forms as well (e.g., the University of Illinois has this authorization to release confidential health information form); this is something worth asking about at parent orientation.
Note that it is never - regardless of the person’s age - enough to just write the name of the person who you want to be your health care power of attorney. It’s critical to first ask them if they are willing to take on this role, if needed, and then have an in-depth conversation about your wishes.
Once you’ve filled out the forms, keep them in a secure place. Also, be sure to scan them so you can easily access them from your phone as well as from your child’s phone.
Bottom Line: while you’re checking towels, sheets, comforter, etc off of your college packing/to do list this summer, please add “fill out important forms!"
I think we’re all aware that there is a mental health crisis in this country. As a result, it can be REALLY difficult to find a therapist who has availability, much less a therapist with availability who is in your health insurance network. Are you stuck paying out-of-pocket for the entire amount? Maybe not!
In the past couple months, I helped a client with her network gap exception request as well as advised a friend how to request one. In both cases, these exception requests were approved.
So, what does this mean and how do you get your request approved?
Suppose you have a child with anxiety who needs to be seen by a mental health provider. You request a list of in-network providers from your insurer. You call each provider who is located within a reasonable distance and are told that none of them have any availability for new patients… or perhaps they are taking new patients but only self-pay patients. Your child needs help, so you end up finding someone who will see your child and you pay 100% out-of-pocket.
Now, you should be thinking: I’m going to call my insurer and request a network gap exception!
Call the customer service number on the back of your health insurance card. Tell the representative that you’d like to request a network gap exception. This is the information that you’ll need before you make that call:
What happens if you are approved?
While, I am focusing on mental health providers here, you can request network gap exceptions for any type of provider.
As always, any time you call a health insurance company, take notes and ask for the representative’s name and a reference number for the call.
Good luck with your network gap exception request!
Bottom line: It never hurts to ask!
I had a great win for a client recently! Award-winning investigative journalist/author Marshall Allen decided to write a "Victory Story" about it. Read about it here. Contact me if I can help you with your insurance/billing issue!
Scenario: Dad had a stroke. He can’t speak. To complicate matters, this happened while he was on a business trip in another state and he is in an HMO. Daughter needs to find out information from the health insurance company about where he can go for skilled nursing/rehab care after discharge from the hospital. Daughter calls insurance company and, of course, they don’t want to speak to her because there is no authorization form on file (and to get one on file can take 2 weeks for processing). The customer service representative will speak to the daughter if her dad gets on the phone, provides his contact information, and gives verbal permission… but daughter had already told representative that HER DAD CAN’T SPEAK as a result of the stroke.
How could this inconvenience and aggravation have been avoided? By having a release of information form completed and on file. Take the time this weekend to print out your health insurer’s “Authorization to Release Information” form, fill it out, and send it in. Then call your insurer in two weeks and make sure they received it.
Here are links to the forms for some health insurers:
Blue Cross and Blue Shield of Illinois
While this is not the most exciting topic, it is incredibly important and could save you some hassle in a crisis situation.
Also, a reminder that when you call your health insurer, always keep detailed notes from the call and ask for the representative’s name and the reference number for the call. This could come in handy if there’s a dispute later about what you were told.
Holidays are often a time when we see family we may not have seen in a while. This may be even more true this year after dealing with Covid for the past 20 months. You may notice physical or cognitive declines in older family members. Be sure to take note of these changes and thoughtfully raise issues of health, safety, and living situation if it’s warranted.
While we like to think of the holidays as a time to relax and catch up, they also offer an opportunity to take care of important health and financial planning. Here are some things that are important to have put in order before there is a health crisis:
I know that sounds like a lot to do, But if and when the time comes, you’ll be happy that you’ve done all this prep work!
Please contact me if I can help with anything.
My kids always talk about how they didn’t learn practical stuff in school - such as how to file their taxes. This summer, I saw the perfect sign in a store: “Good thing I learned about parallelograms in school instead of how to do my taxes. That really comes in handy during parallelogram season!” I modified the sign a bit in the photo to the left.
I wish there was a required class to learn about health insurance and Medicare! It sure would make open enrollment season a lot easier for health care consumers!
Some of the calls/emails I’ve received in the past few weeks:
I can’t stress enough how important it is to take some time to learn about how your health insurance works and how Medicare works! A few tips about using your health insurance:
#1 STAY IN-NETWORK. That’s pretty clear. Know your network. Choose doctors and hospitals that are in the network. Don’t rely on the online provider directory from your health insurer’s website - those are notoriously out-of-date and filled with errors. Call your provider to confirm and call the health insurer to confirm. Take notes about who you spoke with and ask for a reference number for the call to the insurance company.
#2 Look over the plan documents and understand what’s covered, what isn’t, and what your costs are in different situations - e.g., going to immediate care vs. the emergency department.
#3. Generics can save you money on prescriptions.
#4. Make sure you understand the rules for pre-authorization. Err on the side of caution: call your health insurance company to confirm even if your provider tells you you don’t need pre-authorization or they took care of it for you.
#5. When a test or procedure is recommended, ask questions. Why do I need this? What will it cost? What information will it give you that you don’t already have? Imaging tests (e.g., MRIs, CT scans) are generally most expensive in the hospital versus an outpatient facility.
#6. For elective tests and procedures, be strategic about when you get them - before or after the new year depending on whether you have met your deductible or not.
Specific to Medicare:
#1. DO NOT switch plans - or switch from Original Medicare to Medicare Advantage - without having someone you trust look over the information. While you can switch between Original Medicare and Medicare Advantage each fall during open enrollment, you may not have “guaranteed issues rights” to get a supplemental policy at that time or at a later date. Tell everyone you know who is on Medicare not to switch plans without careful consideration and a second opinion from a family member or friend (or patient advocate!)
#2. Medicare does not pay for long-term care. Period. It will pay for UP TO 100 days in skilled nursing/rehab in specific situations. After that, you’re on your own.
#3. Medicare’s annual fall open enrollment season starts October 15th. The commercials, mailings, etc from insurance companies/agents are about to ramp up exponentially. Remember: if something sounds too good to be true, it usually is. Please do not make any changes to your Medicare without reviewing your options with someone you trust - some changes have lifetime ramifications!
There’s so much to know about Medicare. I have a great presentation which helps people to understand their Medicare coverage. Contact me to schedule this presentation for your organization or even for a group of your friends.
Bottom line: We aren’t taught about health insurance in school or anywhere else. It’s up to us to learn how the system works. But you still need to understand parallelograms to pass geometry.
Has ANYONE ever looked at an EOB (Explanation of Benefits) and thought “oh, this is easy to understand?” I bet very few people would say that. EOBs are definitely not written in plain language. There are codes, there are a bunch of numbers in different categories, sometimes the numbers do not even add up correctly. When you try to compare it to the billing statement from your health care provider, the terms used aren’t identical and the billing statement generally has very limited detail. How do you know if your claim was processed correctly and if you are paying the right amount?
Estimates are that up to 80% of medical bills have an error. Therefore, it’s important to look at your bills and your EOBs and make sure that everything is correct.
Also, know that an EOB is NOT a bill. Wait to receive a bill from your provider before making any payment. But be sure to look at the EOB before paying the bill.
Here’s an example of an EOB (with identifying information blacked out):
Bottom line: Compare your EOB and billing statements; request an itemized billing statement from your provider. If you have questions, call the customer service number listed on the EOB or the back of your health insurance card. I’m happy to help as well!
Write something about yourself. No need to be fancy, just an overview.