HealthCare Advocates' Blog

Couples counselors state that having sex after a fight signifies to the man that the issue is now resolved. Without sex, the man is unsure if the issue is truly resolved.

HealthCare Advocates is noticing a frightening trend in marijuana use. Anecdotal evidence indicates an increase in psychotic episodes in marijuana users. The increase was originally observed in the western United States but the shift seems to now be emerging in the eastern United States.

Why the psychotic episodes? It is believed that there is a link between laced-marijuana and the increase in the number of people experiencing a psychosis.

It is expected that in 2014 there will still be approximately 20 million uninsured Americans. While children may now be covered up to age 26, there are other demographics that are being affected. The first group consists of illegal immigrants (4 to 7 million); they can no longer receive Medicaid and they cannot buy private health insurance in the exchanges. The second group is the non-elderly (3 million) earning less that $9,500 per year. The third group (an estimated 7 million) are people who decide to pay the penalty instead of purchasing health coverage because the penalty is less expensive. The last known group are those who will qualify for Medicaid but choose not to enroll in Medicaid.

The recent healthcare reform law states that dependant children may remain on their parent’s coverage until age 26. While many are obtaining coverage, there are many still experiencing problems:

“… Since BCBS can’t cite pre-existing conditions any longer, they are now using the excuse that his applications are too confusing or being very nit-picky over things like a date on the application not being exact to something in his medical record, etc.”

Days after the Republicans took control of the House and added seats in the Senate, Americans are wondering what is going to happen to Obama’s Healthcare Reform Bill. The Republicans have long stated that they would seek to repeal the bill but because they do not control both the House and the Senate, it is not likely that they will be able to successfully achieve that goal.

A more likely goal, or tactic, would be the Republicans making changes to the Healthcare Reform Bill. It is not clear at this time what changes would be made – though one possible change would be addressing malpractice reform – but be sure there would be changes of a moderate nature. Another possible tactic that has been widely reported is the GOP blocking funds to carry out the law; but if not implemented correctly, this tactic could result in voter anger toward the GOP.

Whichever strategy the GOP uses, it is likely that the Healthcare Reform Bill will be changed, not repealed.

Six (6) months after the implementation of the Patient Protections and Affordable Care Act costs for healthcare are shifting:

What is causing healthcare costs to decrease?
• High deductible health plans. This is shifting more of the cost of healthcare onto the employee/patient.

• Coinsurance in increasingly replacing copays. This is shifting more of the cost of healthcare onto the employee/patient. Studies indicate that 40% of employers intend to shift more of the costs to the employee/patient.

• Generic drugs are replacing name brand medications.

What is causing healthcare costs to increase?
• The requirement to keep children on their parent’s health plans up to age 26 is resulting in a 1% premium increase for employers.

• Physician practices are merging with health systems. This is providing increased bargaining power with private insurers.

• Hospitals are shifting costs to private insurers as Medicare reimbursement rates are lowered.

• Providers are now being forced to incorporate electronic medical records. While it is anticipated that this will decrease costs over time, currently it translates into an expense driver for providers.

• The abolishment a lifetime maximum on coverage and pre-existing conditions clauses is predicted to increase insurers’ costs. Because of this insurers have instituted large premium increases in an effort to safeguard against future losses as a result of the new legislation. Estimates are that insures will increase premiums 9% for HMOs and 11% for PPO plans.

An easy way to save money is to seek treatment at a dental school instead of a private dental practice. The question most people ask is, what are the benefits and drawbacks?

Private dental offices have years of experience and master the craft of “butterfly hands.” Butterfly Hands means that the dentist knows how to perform the dental services with minimal pain and discomfort. Also, because they are in private practice, your treatment is completed as quickly as possible.

Dental schools operate on the basis that the student is being educated. Based on this a complete dental history, interview and exam is performed. After the initial exam, a treatment plan is created then treatment is started. This process results in multiple appointments each lasting hours – the completion of care could take months.

Many people are concerned that the care they receive will not be as good as a private dental office. While the student lacks the Butterfly Hands that a seasoned dentist has developed, their treatment is supervised by experienced dentist and utilize the latest technologies. One could argue that the benefit here is that you have a built-in second opinion. Yes, the student is learning but the students do challenge the view of the supervising dentist and viewing things differently is not a minus. One other clear benefit to a dental school is unnecessary care. We have all “heard” reports of medical treatments being done simply so the doctor can bill. While this practice is seldom, a dental school has no incentive to perform any unnecessary care.

Regardless if you use a dental school or a private dental office, always seek a second opinion.

Pluses of Private Dental Offices      

· “Butterfly Hands”                               

· Treatment is completed quickly

· Private Dental Offices are located in your area so they are easily accessed

Minuses of Private Dental Offices 

· Cost

Pluses of Dental Schools

· They are approximately ½ the price of a private dental office

· Multiple opinions

· No unnecessary care 

Minuses of Dental Schools 

· Multiple appointments that last hours

· A lack of “Butterfly Hands”

· There may not be a Dental School near you

Consumer Update: Are you under insured? A client has a health plan that has a $100,000 per year maximum payout. The problem was that she has cancer and the bills are much more than $100,000. Her life savings would have been wiped out if not for HealthCare Advocates.

What should you do? Review your policy and ensure that you have proper coverage in the event something happens.

United Healthcare (UHC) settled a class action lawsuit and you may be entitled to receive money from UHC if you were insured by them. This class action lawsuit pertains to payments made for care provided by out-of-network providers between March 15, 1994 through November 18, 2009. United Healthcare should be informing you but if they did not, we wanted to be sure that you knew.

As a result of the reform law, HealthCare Advocates is starting to see insurance companies closing their provider networks. What this means as a patient is that the number of in-network providers will be limited. Why are the insurance companies doing this? In an effort to control costs, the insurance companies need to provide greater oversight of their providers and to accomplish this, they must limit the number of providers in their networks.