Surprise Billing for Out-Of-Network Medical Costs – Patient Protections on the Horizon

In January of this year New Jersey joined the 22 states that are working to prevent surprise bills to patients. The “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act”, presented to the New Jersey State Assembly addresses the long-standing issue that has been garnering attention for the past several years. In short, its intent is to protect consumers from the out-of-network costs that insurers routinely charge patients. Though not entirely comprehensive, it makes a path to alleviate the burden on the patient, especially in emergency care situations where care decisions take precedent over choice.

Naturally, patient advocates support this act which ultimately provides for transparency and accountability for all parties. The hope is that out-of-network costs would no longer cause financial ruin for the patient, who in good faith has a health insurance plan.

The safety net that health insurance provides is completely negated when the companies are eager to deny payment, causing the patient high out-of-pocket expenses. Primarily in emergency situations, patients are not in the condition to assess the insurance status of the care they’re being given. Also, the direct care providers do not take it into consideration either while caring for a patient.

In addition to emergency care, there are many involuntary scenarios that arise where a patient may be in an in-network facility but care is provided by an out-of-network physician. One example is a necessary surgery where the hospital and attending physician are in-network, but the anesthesiologist provided is not. The surprise bill would be financially devastating to most patients.

Most notably, the measure also protects patients from collection agencies and catastrophic financial outcomes while the disputes between the provider and insurance company are being resolved.

With a broad base of support from AARP, the New Jersey Business & Industry Association and public and private unions there are still detractors that doubt the mediation process proposed and the historically low re-imbursement formula provided by Medicare. But they concur the sound reasoning and process of the bill.

Since initially conceived eight years ago and officially introduced in June of 2015, the bill is currently in the State and Assembly Appropriations Committees awaiting a call to a vote in legislative session.

Eliminating surprise billing will be a major milestone for patient rights, as we work ever closer to an equitable single-payer care system.

http://www.consumerreports.org/health-insurance/states-work-to-limit-out-of-network-medical-bills/

http://www.njspotlight.com/stories/16/10/13/advocates-push-legislative-leaders-to-move-on-plan-to-curb-surprise-medical-bills/

Contact Jackie O’Doherty at 908-832-0417 or visit http://myhealthcareconnect.com.

#PatientRights #PatientAdvocate #HealthInsurance

Posted in Care management, Geriatric Care Managers, Healthcare Advocates, Patient Advocates, Patient Navigator | Leave a comment

Health Care Support Staff – Unsung Heroes

So much of our Health Care decisions and stress focuses around the primary care physicians and specialists. We often forget that the immediate care is provided by the facility support staff. Unsung heroes that provide a multitude of services and immeasurable caring for patients in all care settings.

This month, we recognize two of them, the Certified Nursing Assistant and the Social Worker. We honor and thank them for their caring and support.

Most patients, families and caregivers will not argue that doctors and nurses are the front line in medical care. Their expertise and knowledge can be the matter of life and death when it comes to not just acute care, but also long term care.

However, I recently had Facebook send me a memory from a few years ago, which reminded me of a Certified Nursing Assistant (CNA) that I had the pleasure of knowing at Rhode Island Hospital. She was an amazing caregiver, filled with compassion and empathy and the ability to listen and reassure.

The reminder helped me realize that there are many unsung heroes. They are the support staff that provide everyday patient care, directly impacting patient well being. Support staff range from social workers, dieticians, transport, med techs and CNA’s. They are the backbone of every medical facility.

Today I want to focus on social workers and CNA’s, due to their direct impact to patient care and overall case management. These individuals work tirelessly to assist families and patients in their time of need. As a patient advocate, I take care to identify their roles and how vital they are to the entire health care experience.

The Certified Nursing Assistant (CNA) works under the direction of the nursing staff. The CNA is often responsible for assisting the medical staff with patient care, including cleaning and changing dressings and documenting observations as well as maintaining cleanliness and sanitization of patient areas. Their role is vital to communicating a patient’s condition to the medical staff, because of the extensive daily contact they have with a patient.

In my experience, a caring CNA is able to reach a patient with their compassion and understanding, when the attending physicians and RN’s are often not able to. They also can bridge the non medical information gap, bringing things to a humanistic level and provide a life-line for the family and the patient. I have seen their positive impact and empathy give the patient a path to wellness that is often overlooked.

The other unsung hero, usually unseen by the general public, are medical and healthcare social workers. I often seek out the facility social workers to gather as much information as I can for my clients. But, many patients never see them at all since they are only called in as a referral from a doctor or nurse. If you request a social worker, one will gladly be provided for you and I encourage all to do so.

Social workers know how the health care system works and the resources available both on a general basis, but also at a particular facility. If needed, they provide patients and families the support to cope with chronic, acute, or terminal illnesses. Advising family members and care givers, they also take part in patient education and counseling. I have found that they can assist with decoding patient consent forms and legal documents, a big relief to patients and families.

CNA’s and Social Worker are vital health professionals that work with the senior medical staff to provide quality care to every patient. In working together as a team, we help families navigate the complex world of health care. In short, I cannot imagine a health care setting without the amazing social workers and CNA’s I have had the pleasure to work with.

Contact Jackie O’Doherty at 908-832-0417 or visit http://myhealthcareconnect.com.

Posted in Patient Advocates | Tagged , , , , , , | Leave a comment

Jaw-Dropping Doctor’s Response

Recently I attended a doctor’s appointment with a new client.

Because she was a new client, I spent most of the time listening, in order to get up to speed with her health issues.

One of her complaints was that she was suffering with a UTI. She was prescribed a two week course of antibiotics.  After doing this for six weeks, (script renewed every two weeks with the same antibiotic, three times) she still had the UTI.  I was curious as to why the antibiotic had not been changed, so I asked the doctor.

And here is her jaw dropping, stunning response.

“It is not my job to teach you medicine”

Actually Doc it is.

It is your job! It is your job to make sure the patient understands what is going on with their illness and disease. It is your job to answer questions and respond truthfully.  It is your job to explain why the treatment is not working and what you think may or may not work. And if you don’t know, that’s ok, just say so.

It is your job to give the patient a clear understanding of their treatment options, so THEY can decide how they want to proceed. It is your job to explain all the risks and benefits of that treatment. It is your job to educate the patient so they can be informed decision makers about their health.

How can you do any of that if you don’t “teach medicine”?

The majority of doctors are natural teachers.  Most will explain, take the time to answer questions, and I’ve even known some to draw a picture. All to ensure the patient understands what is going on with their health and can make informed educated decisions.

So if you ever find yourself in an office with a doctor who tells you she is not there to teach you medicine, look around and find the nearest exit sign. Then walk out that door.

Please reach out to us if you or a loved one is in need of a patient advocate to attend doctor visits and make sure the important questions get answered.

Whose role is it?

Doctors and patient advocates work together to ensure appropriate healthcare decisions.

DOCTOR’S ROLE:

Licensed to maintain human health through accurate diagnosis and treatment of ailments and acute illness.

Refer, where appropriate, to healthcare specialists.

Clearly explain all treatment options including risks and benefits to patients and their caregivers.

Prescribe medications and check for drug interactions.

Explain all prescribed medications and their side effects to patients and caregivers.

Advise patients how to stay healthy.

Keep up to date by reading medical journals, continuing education and conference attendance.

….and most importantly…..Educate the patient so they can be informed decision-makers about their health.

PATIENT ADVOCATE’S ROLE:

Coordinate and act as liaison with medical professionals to ensure a patient centered approach to healthcare.

Accompany clients to doctor visits and advocates on your behalf.

Acts as a second set of eyes and ears, clarifying and probing, to make sure your questions are answers and your concerns are recognized.

Ensure you understand your healthcare options.

Clarifying options for diagnostic tests, procedures or treatment choices, ensuring informed consent.

Facilitate communication among all your doctors, caregivers, hospitals and rehabilitation facilities.

Locate specialists and treatment facilities for your specific illnesses.

Manage discharge planning, next steps and transitional care.

Facilitate rehabilitation and follow up care.  Help families understand acute and subacute rehabilitation, skilled nursing facilities, homecare and long term care options.

Contact Jackie O’Doherty at 908-832-0417 or visit http://myhealthcareconnect.com for additional information.

 

 

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL1.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL2.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL3.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL4.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL5.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL6.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL7.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL8.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowTL9.png

Click to Visit our website.

Click to learn more about Jackie.

Jackie O’Doherty
Health Care Connect LLC

https://imgssl.constantcontact.com/letters/images/1101116784221/T.pngRecently I attended a doctor’s appointment with a new client.

Because she was a new client, I spent most of the time listening, in order to get up to speed with her health issues.

One of her complaints was that she was suffering with a UTI. She was prescribed a two week course of antibiotics.  After doing this for six weeks, (script renewed every two weeks with the same antibiotic, three times) she still had the UTI.  I was curious as to why the antibiotic had not been changed, so I asked the doctor.

And here is her jaw dropping, stunning response.

“It is not my job to teach you medicine”

Actually Doc it is.

It is your job! It is your job to make sure the patient understands what is going on with their illness and disease. It is your job to answer questions and respond truthfully.  It is your job to explain why the treatment is not working and what you think may or may not work. And if you don’t know, that’s ok, just say so.

It is your job to give the patient a clear understanding of their treatment options, so THEY can decide how they want to proceed. It is your job to explain all the risks and benefits of that treatment. It is your job to educate the patient so they can be informed decision makers about their health.

How can you do any of that if you don’t “teach medicine”?

The majority of doctors are natural teachers.  Most will explain, take the time to answer questions, and I’ve even known some to draw a picture. All to ensure the patient understands what is going on with their health and can make informed educated decisions.

So if you ever find yourself in an office with a doctor who tells you she is not there to teach you medicine, look around and find the nearest exit sign. Then walk out that door.

Please reach out to us if you or a loved one is in need of a patient advocate to attend doctor visits and make sure the important questions get answered.

Warmly,

Jackie

Whose role is it?

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL1.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL2.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL3.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL4.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL5.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL6.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL7.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL8.png

http://img.constantcontact.com/letters/images/1101116784221/PT_MFANRD_OuterShadowBL9.png

http://img.constantcontact.com/letters/images/1101116784221/S.gif

Doctors and patient advocates work together to ensure appropriate healthcare decisions.

DOCTOR’S ROLE:

  • Licensed to maintain human health through accurate diagnosis and treatment of ailments and acute illness.
  • Refer, where appropriate, to healthcare specialists.
  • Clearly explain all treatment options including risks and benefits to patients and their caregivers.
  • Prescribe medications and check for drug interactions.
  • Explain all prescribed medications and their side effects to patients and caregivers.
  • Advise patients how to stay healthy.
  • Keep up to date by reading medical journals, continuing education and conference attendance.
  • ….and most importantly…..Educate the patient so they can be informed decision-makers about their health.

PATIENT ADVOCATE’S ROLE:

  • Coordinate and act as liaison with medical professionals to ensure a patient centered approach to healthcare.
  • Accompany clients to doctor visits and advocates on your behalf.
  • Acts as a second set of eyes and ears, clarifying and probing, to make sure your questions are answers and your concerns are recognized.
  • Ensure you understand your healthcare options.
  • Clarifying options for diagnostic tests, procedures or treatment choices, ensuring informed consent.
  • Facilitate communication among all your doctors, caregivers, hospitals and rehabilitation facilities.
  • Locate specialists and treatment facilities for your specific illnesses.
  • Manage discharge planning and next steps and transitional care.
  • Facilitate rehabilitation and follow up care.  Help families understand acute and subacute rehabilitation, skilled nursing facilities, homecare and long term care options.
Posted in Patient Advocates | Tagged | Leave a comment

Geriatricians: What They Do and How They Help

I am often approached by families in need of finding a geriatrician in their community and they simply don’t know where to turn for help.  Caregivers turn to me in frustration, especially if they feel there is a lack of coordinated care between doctors as their loved one ages.  They are overwhelmed with trying to manage every detail of multiple doctor visits and the myriad of medications prescribed.

A recent article in the April 2016 issue of AARP Bulletin points to a shortage of licensed geriatricians in the United States.  There are just over 7,000 currently licensed geriatricians in the U.S. and it’s projected that we’ll need more than 23,000 by the year 2030 (source:  American Geriatrics Society).

As a medical doctor who can help oversee all aspects of care for older adults, geriatricians can help you if you suffer from multiple health issues at the same time.  They design care plans to deal with the whole person. Geriatricians are board certified doctors, typically in either family medicine or internal medicine.  In addition, they’ve completed additional training certifying them in geriatric medicine.

Here are some indicators that a geriatrician might be right for you and your family:

  • You have multiple, chronic health problems and you are dealing with several doctors.
  • You have a decline in strength, balance or memory.
  • You display “geriatric syndromes” such as falls, unexplained weight loss, delirium, sleep problems, and bladder incontinence.
  • You are a caregiver feeling overwhelmed.

Perhaps you don’t need a geriatrician, but a bit more help would give you peace of mind?  We have a solution for you.  Consider our “Co-ordicare” option.  It’s an affordable care management plan for seniors.   It’s ideal for families who live long distance from their loved ones or for people who find themselves in the “sandwich generation”.

If you or a loved one is struggling with your health care options, please reach out to us today.  As Patient Advocates, we are focused on making sure you find the best options and the best care available.  Think of us as your health care quarterback. We help you find the appropriate medical care across the continuum….. not just your geriatric needs.

Contact Jackie O’Doherty at 908-832-0417 or visit http://myhealthcareconnect.com.

 

 

Posted in Patient Advocates | Tagged , , , , , | Leave a comment

The Power of Gratitude

Gratitude jar

In this country, most people focus their attention on gratitude in the month of November when we celebrate Thanksgiving.  But, what if you could channel those positive feelings year-round by adopting an attitude of gratitude and finding something to be grateful for each and every day?  Feeling and expressing gratitude, even in life’s tiniest pleasures, has been scientifically proven to boost your physical and mental health.

This may seem easier said than done.  As we age and find ourselves feeling lonely, facing health challenges, and feeling the loss of loved ones, we need to make a concerted effort at gratefulness.   Evidence suggests that we can actively choose to practice gratitude—and that doing so raises our own happiness.

Here are some suggestions to get you started.  This is by no means an exhaustive list and I welcome hearing from you on how you incorporate gratefulness into your everyday lives.

  • Keep a daily gratitude journal.  Make a point of writing in this journal each evening to reflect on the simple joys (or great big joys!) that you experienced that day.
  • Turn an unused cookie jar into a Gratitude Jar. Write a one-line sentence on a small piece of paper and put this into the jar.  At Thanksgiving or on New Year’s Day, open the jar….read all the notes and see all the beauty the prior year brought you.  I have a colleague who does this and encourages the entire family to drop notes into the jar throughout the year.
  • Thank others with a note, email or phone call. Not only will you lift your own mood, but you’ll be enhancing the mood of the person receiving your thanks.
  • Use the power of prayer to ground you in the present moment.
  • Cultivate opportunities for joy and happiness in your life by surrounding yourself with positive, upbeat friends who bring laughter into your life. Also, look back at your life and reflect on those people in your past who brought a smile to your face.  Be thankful that they touched your life in some way.

It takes as little as 21 days for a newly formed habit to stick.  Are you willing to try an attitude of gratitude for 21 days?  What have you got to lose?  The way I see it, you have everything to gain!

 

Posted in Patient Advocates | Tagged , , , | Leave a comment