Case Management

Case Manager Advice On Health Insurance

Posted on by Dominick Flarey

Case Management Advice and Health Insurance

Health insurance is something many people avoid as they find the costs too high. Do your research to make sure you choose the right health insurance plan to meet all your needs. In this article, you will learn more about the different kinds of health insurance that are available so that you can better find a policy that works for you.  In some cases, if you are dealing with difficulties during a hospital stay, it may also be wise to seek the Case Manager Advice.
When evaluating your employer’s health coverage options, decide based on your own condition, as well as the health status of your family members. If you don’t forsee any health issues, then a cheaper health insurance policy is probably what you will choose. While this may be cheaper initially, this could cause risks if problems develop.
If you or your family has vision problems, you will want to consider coverage for this. The insurance covers all or most of your check-ups plus contacts or glasses. Vision insurance isn’t mandatory, so some people spend less cash by not having this kind of coverage.
Do a quick check annually to verify what prescription medications your policy will continue to cover. Every year, when you re-enroll in your insurance plan, your insurance company has the right to change the plan terms. Read all the paperwork when you re-enroll and ask your insurance agent to clarify anything you’re confused about. In particular, keep an eye on the prescription drugs covered by your plan and note changes that may occur from year to year. When your daily meds are dropped by your health insurer, then start the hunt for a new plan right away.  Tips from a qualified case manager can also help you find a better program for your needs.
When a health insurance company calls you as part of the application process, never volunteer information. Give them only the information they directly request, nothing more. When you volunteer too much information, the result could be an increase in your premiums, or at worst, a complete denial of coverage.
Generic drugs will always save you money regardless of the type of health insurance coverage you have. Odds are, most of the time you’ll be able to get generics, and research has regularly demonstrated that they only difference in these drugs is their brand name.
Make the decision on a health insurance plan that is best for you. Different options that you are going to have are POS, PPO and HMO. They’ll have various options you should research before making a selection. If you like your present doctor, make sure with any policy you choose there is an option to stick with him.
Check with your health insurance carrier to know what prescriptions are covered under your policy. This list changes from year to year so check the list when you re-enroll, to make sure that you are not going to be surprised when you go to refill your prescription. Again, a certified case manager can help you in this area.
Check with physicians and medical care providers that you use routinely to be sure that they will accept whatever health insurance you may be purchasing. Your insurance company should have a website devoted to important benefit information.
You should consider that certain companies will have a surcharge for having a spouse on a health insurance policy if your spouse can access insurance from an employer. It may sometimes be more economical for you and your spouse to obtain individual insurance plans through your employers, so compare costs under both circumstances.
Health Savings Accounts (HSAs) are a great idea for someone who rarely visits the doctor. This is an alternative to health insurance where you save money in a tax-deductible account in order to pay for health services.
If you deal with a pre-existing health condition, check with a number of companies prior to enrolling with one for health insurance. There are many companies who won’t give you coverage if you already had a medical condition before signing with them, or they will charge you significantly more. Doing research is a great way to get the best rate possible.
Health insurance has many factors that require you to be organized and prepared when picking a policy. When you first start the process, have any needed documents. You should also be ready to discuss your needs and wants when it comes to health care. Don’t just go to any company, look into a few before you sign anything.
Keep in mind that insurance companies are money-motivated businesses that will capitalize on consumer ignorance whenever possible. For this reason, it is important for you stay informed. Remember what you have learned from this article, and you may be able to find a health insurance policy that can save you money.
The above tips are all important in understanding the nature of health insurance.  Case managers also need to be well versed in this area if they hope to help their clients to the maximum.
If you are interested in health insurance  and case management or wish to take courses in case management, then please review the program.

AIHCP

Health Care Management Reimbursement Systems.

Posted on by Dominick Flarey
health care management
health care management

The article, “How Do Medicaid, Medicare and Private Insurance Reimburse for Telehealth?”, by BHM states

“Telehealth is rapidly increasing in popularity. The major challenge is the varying methods of reimbursement, if they exist at all.”

American Institute Health Care Professionals‘s insight:
With new technologies in health care management, comes new ways to manage them.  Telehealth is an innovate way to visit the doctor without leaving your home.

See on www.bhmpc.com

Top 5 Case Management Program Trends.

Posted on by Dominick Flarey
Case Management Program
Case Management Program

Healthcare Marketing is Changing. Find out what the strongest emerging trends will be in 2013.

American Institute Health Care Professionals‘s insight:

Case managers will be become more involved with these marketing trends as the future progresses.  It may be well advised to become acquainted with them now.   If you are looking for a good case management program then please feel free to check out AIHCP.  They have an online case management education that can lead to case management certification.

 

See on www.bhmpc.com

Case Manager Solution to Claim Denials.

Posted on by Dominick Flarey

case manager

How can a case manager help their patients with claim denials?The article, “7 Steps To Reduce Claim Denials and Recoup Lost Revenue”, by BHM states

“Denied claims are one of the largest areas of lost revenue for health care organizations. They are also one of the simplest things to quantify, address and correct.”

American Institute Health Care Professionals‘s insight:

A good article for case managers on reducing claim denials.  A case manager can work for the patient in this cases.

 

See on www.bhmpc.com

Basic Concepts of Health Insurance

Posted on by Dominick Flarey

Case Management: Insurance Basics

In many cases, Case Managers have to deal with health insurance companies on an everyday basis in regards to their patients care and coverage.

Below is is health insurance 101 for individuals who need to grasp a better understanding of what health insurance is from the patient end.

Living without health insurance can be risky if you develop a serious illness or undergo trauma, especially if you get an injury or if you get very sick. Having a proper health insurance policy is key to keeping yourself healthy, and these tips can help you get the most coverage for your money.

 

If you are employed by a large enough business, you can get health insurance through your job. If you are 26 or under in age, your parents can still have you under their plan, or you can research personal health insurance policies.

 

Many companies offer benefits for employees to have their health and lifestyles assessed. You may be able to join a fitness program afterwards, which will help the company to save money on their insurance coverage, and possibly lower your premiums.

 

If you need glasses, or vision problems exist in your home, then vision insurance proves a smart buy. The insurance will cover a percentage of your check-ups and eyeglass or contact purchases. You don’t have to carry vision insurance, and some choose to save money by not buying this coverage.

 

Health insurance companies like to change what medications they are willing to cover, so be sure not to enroll in a plan that won’t cover your prescriptions. If medication that you need to take every day is suddenly dropped from your coverage, you may need to find a policy with a different company.

 

Health insurance is great for saving money on your taxes.Any money you spend to cover your deductible, co-pay, or any visits that your insurance doesn’t cover can also be deducted from your taxable income. Be sure to check on the separate guidelines for state and federal tax differences.

 

Expect health insurance policies to have loopholes within the fine print. Read the policy completely, so you won’t be surprised when the company tells you that something isn’t covered.

 

Do not volunteer personal information if you get a phone call from an insurance company. Answer only questions that are directly asked. If you give any extra information, it will be recorded and can be used to raise the premium, or even deny you insurance coverage at all.

 

You need to find out which health insurance plan is best suited for you. You can choose from PPO, HMO or PPO. Each has disparate benefits that you will need to research and decide on before purchasing a policy. Be sure you’ve got the option to keep seeing your current physician.

 

Read over your health insurance coverage to find out which medications are covered by it. The prescriptions that are covered change on a yearly basis, so read it over each time you renew your policy to see what is and isn’t covered.

 

It may actually be more affordable to have separate coverage through your respective employers, so compare costs under both circumstances.

 

The best way to avoid high individual rates is to join a trade organization that provides membership discounts in insurance premiums.

 

Pay very close attention to each aspect of your bills. Even if you have a good health plan, expenses can get costly, particularly for prescriptions. Some doctors only prescribe brand-name medication without thinking if a cheap generic is available. The price of medication may vary between different at each pharmacy.

 

Avoid these issues by taking the time to double check the form.

 

If you are overwhelmed when trying to choose your health insurance, get an insurance broker to help. An insurance broker can assist you in finding the best health insurance at a good price. They will also know all about the regulations specific to your jurisdiction. Compare your prices between brokers before you choose one.

 

You might qualify for a discount card, reducing the cost of your insurance policy as well. These cards let you to see doctors that offer low cost care for those lower income families.

 

If you trust and get along with your current doctor, you will have to make sure that your health insurance policy will permit you to keep seeing him. Ask your doctor if he is currently partnered with any insurance company.

 

Group health insurance is often cheaper than private health insurance, which is why many employers can offer benefits.There are professional groups or associations that you can join like the Freelancers Union.

 

You are entitled to an annual copy of the records at no charge every year for free.

 

Health insurance should be purchased for all family members, but also for your children. You must insure the kids so that they always have the health care as well as illnesses and injuries.

 

It is very important to have health insurance; you never know when you might need it. You could contract a disease or get hit by a car anytime. So utilize these tips when shopping for health insurance to make sure you find the plan that is most suitable for your family at the best price.

If you would like more information on handling insurance as a case manager, then click here.

 

AIHCP

Learning more about Case Management with Obamacare!

Posted on by Dominick Flarey

Case Managers and Understanding Obamacare

Case Managers need to understand future implications of Obamacare on alternative medications.

WMBFnews, a NBC affiliate writes that other forms of medicine once considered alternative could be covered under Obamacare.  This topic is covered in the article, “Obamacare to Cover Acupuncture, Alternative Medicine”

“Under the Patient Protection and Affordable Care Act (ACA), otherwise known as “Obamacare,” what is now called alternative medicine may become as accessible and as widely accepted as conventional medicine.”

To read the entire article, please click here

If you are interested in learning more about case management, then please click here
AIHCP

Nursing Case Management: A Focus on Advocacy

Posted on by Dominick Flarey

Nursing Case Management

Nursing case management is becoming more important in overall health care delivery. A nurse case manager must wear many hats and juggle many tasks at once in order to be successful at his or her job. Perhaps one of the most important aspects of being a case manager, however, is acting as a patient advocate. This is such an ingrained part of being a case manager that many nurses act as an advocate without even realizing it by doing things like noticing a prescription medication error. There are many other aspects to the role of the nurse case manager as patient advocate, however. Below we’ll highlight some of them, with an emphasis on how nurses advocate for their patients to receive care and social support.

What is advocating?

There are many different definitions of patient advocating. They may depend on a nurse’s personal philosophy or the setting in which he or she works. In general, advocating means standing up for your patient and your patient’s rights. To advocate properly, a nurse case manager must set his or her personal preferences aside and realize that excellent health care is focused on the patient’s needs instead of the needs of her caregivers.
Advocating may involve speaking up in order to get the best care for your patient, but it also may simply involve being an understanding and accepting caregiver. For example, many patients have personal or religious qualms about giving or receiving blood. Being a patient advocate involves not judging these patients or condemning them for not making the medically “appropriate” choice. Advocacy involves supporting their choice while at the same time educating them about their options.

Advocacy isn’t always comfortable

There are times when advocating can put a nurse at odds with his or her employers. The number of nurses, however, who ignore these difficulties in order to provide their patients with optimum care is staggering. For example, at a hospital in Texas, two nurses came forward to identify a physician who they felt was negligent with patients. They believed this physician put some patients at risk and they told the administrator at their hospital. When the administrator failed to act, they went to the Texas Medical Board with their complaints. They were fired and then charged for misusing official information. Eventually the charges were dropped against one of the nurses and the other was quickly acquitted. Their defenses were paid for by donations raised by the Texas Nurses Association.
Although these two nurses went through an extremely difficult ordeal, they did it because of their drive to act as a patient advocate. This is perhaps the ideal example of working for your patient’s rights as these two ignored potential threats to their own careers in order to get the best care for their patients.

The benefits of advocacy

A nurse may benefit from advocacy as it makes him or her feel better about the job they are doing. Most who enter healthcare professions do so because they are concerned about their fellow human beings. Advocacy truly allows for the expression of that motivation.
The true benefits of the nurse case manager as patient advocate appear as benefits to the patient, however. Nurses are the main system of support for patients, and are responsible for easing their transition through the different levels of treatment in a hospital (such as emergency, surgery, etc.). They are also the ones who provide patients with emotional support and often do the same for the families of those patients. Without the support offered by nurses, many patients would have a frightening, confusing, and overwhelming medical experience.
Many healthcare facilities are beginning to recognize the importance of the patient advocacy. They have begun instituting ways to protect nurse’s from repercussions if they are simply advocating for their patients. There have even been some nurses who have taken their skill for advocating and turned it into a full-time career. Private and public groups, whose primary duty is advocacy, have sprouted up in recent years. These groups help patients navigate through the daunting decisions inherent in a healthcare process.
Advocacy is an often overlooked, but critically important part of nursing. Without it many patients would be lost to navigate a complex healthcare system on their own. Patient advocacy is one of the more selfless acts we see in healthcare, and it’s part of what makes the nursing profession special. To learn more about nursing case management, click here.

Care Management and Health Insurance Dos And Don’ts: Pitfalls And Bonuses

Posted on by Dominick Flarey

Care Management Tips

Sometimes, the health insurance market can feel like a minefield. It doesn’t have to feel that way, though. There is plenty of advice available that can help you get the best deals and the best treatment out of the money and time you put into dealing with health insurance companies. Read on for some handy tips in care management
To save money on your health insurance plan, do not be fooled by plans with offers that are too good to be true. For instance, some plans may not require any fees for particular everyday preventative care, but do not have the benefits that many other health insurance plans offer.
If you have an adult child who does not have their own health insurance, you can keep them on your policy until they are 26 years old. This means that they do not have to forgo health insurance or pay for their own policy while trying to get established in a career.
You need to know what the terms are in your coverage when getting ready to switch health insurance policies. This is especially true of the rates. The rate refers to the amount a provider is paid for your policy. You need to get the most cost-effective rate you can. Make sure to weigh the cost of the rate with your income, deductible, annual medical costs, and coverage.  Sometimes a case manager can help with this.
Get to know the three major types of health insurance policies: the HMO, the POS, and the PPO. Research these three types to find out how their coverage, policy rates and programs differ. Use this information to figure out which one would be best for you and your family.
If you fear being laid off from your job, you may consider enrolling in a plan with a low premium. Since the government program that offset much of the cost of COBRA has ended, continuing your insurance coverage in the event of a layoff would come entirely from your own pocket, which could prove very difficult if your premium is high.
If you’re looking for an insurance broker for health insurance, ask your friends and relatives for a referral. There are many brokers with a license out there, but not all of them are going to do the best job for you. Online reviews can easily be faked, so they’re not very reliable, either.
One important feature of any insurance plan is prescription drug coverage. Be sure to scrutinize all the details of your prescription drug plan so that you are familiar with how your healthcare insurer handles prescriptions. It’s especially important to understand how they cover different classes of drugs, and whether they offer generics for the prescriptions you normally take.
Understand the differences between a PPO policy and a HMO policy if you want to receive the best possible level of care with your health insurance. You not only have to think about what’s best for you, but also what’s best for your children – if they should happen to fall ill or suffer an accident.
Depending on the demographic makeup of your office, employer based insurance may not be the best for you. Insurance plans are built upon spreading out the risk. If you are the youngest person in an office, working with a group of people nearing retirement, you will pay more for your insurance to cover for them. Always check with outside insurance before choosing to go with your employers.
A vital health insurance tip is to never abandon your claim just because it has been initially denied. Filing an appeal is always an option, and it is important to note that the denial could simply have been the result of a data error in the insurer’s computer system. By appealing unexpected denials, you have the power to receive every bit of coverage your policy is meant to provide.  Again a care manager can aid you in overcoming denials.
No matter what, make sure you have some sort of health insurance. The bills that pile up from an emergency when you don’t have insurance, can cause you to go into bankruptcy or spend the rest of your life paying for one accident or health issue. The cost of uninsured medical bills is too high to risk. Get coverage no matter what.
If you are committed to finding the best deals, this is just the beginning of your health insurance education. Hopefully, a few of these ideas will be helpful to you. There are more where they came from; keep learning to zero in on the very best health insurance you can find.
You can seek the advice of a care manager or learn about care management by reviewing our program.  To review and become a certified care manager, click here.

Richard Green

Nursing Case Management is an Exciting Field!

Posted on by Dominick Flarey
A nurse checking a clipboard
A nursing case management professional hard at work!

In the field of nursing case management is a skill set that continues to become more and more important. With the current state of health care, the ancillary issues – those that do not relate directly to treatment – have been multiplying, and sorting through them without professional assistance has become more of a challenge. Learning about and becoming certified in the field of case management allows nurses to offer that professional assistance to their patients. A nurse who is also a competent case manager can help resolve treatment conflicts, coordinate treatment provided by different specialists, sort out the serious financial ramifications of health care, and, generally speaking, minimize the bureaucratic hassles a patient experiences. The value of this skill to patients makes it a valuable skill to health care providers, too. A nurse that takes the time to cultivate case management skills will find that his or her value to employers will rise significantly.