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. 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. (Special thanks to Emily Rozwadowski of Spencer & Rozwadowski, LLP for reviewing this information.)

Briefly, the four important documents are:

1. 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 (Illinois form)
2. HIPAA Authorization - a document that allows health care providers (and others) to share specific health information with people who you designate to receive that information (sample form from the American Bar Association)
3. Durable Power of Attorney/Power of Attorney for Property - allows you to designate someone to act on your behalf for financial matters
4. FERPA Release (Family Educational Rights and Privacy Act) - permission to access educational records (more info and model forms here)

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.

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.

So, while you’re checking towels, sheets, comforter, etc off of your college packing/to do list this summer, please add “fill out important forms!"

 We all know that insurance and other financial incentives drive many health care decisions, but for a doctor to flat out, dispassionately admit to a private patient advocate that insurance was what was driving his medical decision-making? It was shocking.

The sad reality is that this happens all the time in our healthcare system. Insurers - private as well as Medicare and Medicaid - make decisions about what treatments they will cover, how long a patient can be covered in a hospital or skilled nursing facility, what medication can be prescribed, and more. Some of the common ways this is done is through prior authorization for procedures and step therapy for medication. Note that the decision of an insurer not to cover something doesn’t mean you can’t get it, it means that your insurance company will not pay for it. Yet the reality is that most people cannot afford to self-pay for expensive treatments. 

What can you do about this?

Know your insurance policy. Your insurance policy is a contract between you and the insurer. Of course it’s a unilateral contract that you have no ability to change - or even look at before enrolling, but it is a contract. It’s not fun reading, but you should know what it says. Use the language from the policy to make your argument for why something should be covered.
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Know what your rights are as a patient. The American Medical Association (AMA) has published physician and patient rights and responsibilities. Medicare beneficiaries have legal rights, including related to hospital discharge. Most major healthcare organizations have their own set of patient rights and responsibilities; you should be able to find this online. I recently worked with a family and the case manager at the facility was giving them the run-around about setting up a family meeting with the physician; after some back and forth, I ended up quoting directly from the facility’s patient rights document and - like magic! - a Zoom meeting was set up for later that afternoon.

Be persistent. I like to say that insurance companies are bigger and badder than us and are counting on us to feel overwhelmed, intimidated, and just give up. Stick with it. Know the facts: what does your policy say; what is considered best practice and what peer-reviewed evidence is there; what are your rights as a patient/member.

Advocate for yourself. Use the above tips to advocate for yourself or a family member. Be polite but firm and persistent. Enlist the assistance of your healthcare providers. Go up the chain of command. 

Please contact me if I can help

Regarding being prepared, think about these two questions:

• If you’re alone in the hospital, can you speak for yourself?
• Does anyone else know enough about your health to speak for you?

I’ve blogged before about the importance of creating a health information binder. It’s critical to do so AND to make sure that someone knows where it is so they can access the important information and advocate for you.
Communication is different as you may have to rely on phone and video communication when your loved one is in the hospital. Key points include:

• Ask about communication protocols - when is the best time of day to call? Who should you ask to speak to? When are shift changes (don’t call then!)? 
• Designate someone in advance to be the point person - generally, the staff at the hospital will only take calls from one person per patient. Figure out ahead of time who that person will be so that you can avoid family disagreements during a health crisis. (This is also a good reason for getting your Advance Care Directives done!)
• Have the information you need readily available when you call (this is why the health information binder is helpful) - allergies, names of specialists, medical history, medication list, etc. 
• Technology - make sure you and your family members know how to use FaceTime or some other video app. It’s literally a lifeline for staying in touch, being able to see how someone is doing, and allows you to see facial expressions and body language when speaking with doctors and nurses.
• Write everything down - keep all your notes in a notebook. Write down questions that you think of so you don’t forget to ask during your daily phone call with hospital staff.
• Find out the medication schedule - this is a good time to check in with your loved one so you can make sure they are getting the correct medication and can keep track of what medications they are taking.
• Discharge planning - many hospitals will allow someone to come in for the discharge planning meeting even if they don’t allow visitors. Be sure to take this opportunity. A lot of important information is provided during discharge and someone other than the patient should be there to listen to everything and ask questions.​

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 2021.

Here are some things to keep in mind regardless of where you get your health insurance:

• It’s not all about premiums. To get a sense of how much you may spend during the year, you need to look at all costs including deductibles, co-pays, co-insurance, out of pocket maximums. Click here for an article that defines these and other key health insurance terms.
• The provider network may or may not matter to you. It’s a personal decision whether you want to trade lower costs for having to switch doctors, travel further, or have a smaller network to choose from.
• Look at the health care services you think you’re most likely to need and try to find a plan that meets your specific needs. For example, if you know you’re going to need a lot of physical therapy (PT) next year, it may make sense to pay more in premiums for a plan that provides better coverage of PT visits.
• Do you have a second home in another state? Provider networks will be important in this scenario.

Medicare
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:

1. Switch from Original Medicare to Medicare Advantage
2. Switch from Medicare Advantage to Original Medicare
3. Switch from one Medicare Advantage plan to another Medicare Advantage plan
4. Switch from one Part D (prescription drug coverage) plan to another Part D plan

​A few tips:

• Be sure to check the formulary (list of covered medications) in your current Part D plan and any Part D plans you are considering to make sure your medications are included. You can do this on Medicare Plan Finder.
• If you’re in a Medicare Advantage plan, be sure to check whether your providers will still be in network next year.
• You can download the Medicare Open Enrollment guide from the Medicare Rights Center.
• This article, 3 Ways to Prepare for Medicare Open Enrollment, has helpful advice. 

Health Insurance Marketplace and Employer Health Plans

• Open enrollment for the Health Insurance Marketplace/Exchange is from November 1 - December 15.
• Open enrollment timing and options for employer-based plans vary. 
• For either, here is some helpful advice about Choosing A Health Plan from FAIR Health.
• More general advice about open enrollment for health insurance and other benefits can be found here and here.

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. 

Medicare is complicated. There are a lot of “parts” as well as rules, enrollment periods, etc. I’ve started making 1-2 minute videos to explain different aspects of Medicare including what is open enrollment, what isn’t covered by Medicare, Parts A, B, and D, what is IRMAA, and more. I'll be adding to this "Medicare collection" periodically so subscribe to my YouTube channel to stay up to date.

Thank you Betsy Phillips, Realtor, Baird & Warner, for having me on your "Let's Chat" series to talk about patient advocacy!

Medicare's annual open enrollment period starts this month and that means there are A LOT of commercials urging people to switch plans. Here are some of my thoughts after seeing yet another one of those commercials...
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