So, if you live in the United States, you have just survived THE weekend that most exemplifies both the best and the worst of being an American. Thursday, we celebrated our national heritage and family with Thanksgiving. What started as a holiday to celebrate survival and the help white refugees got from Native Americans, has turned into an all you can eat day of football and parades.
We follow Thanksgiving with Black Friday, a day we used to use to Christmas shop for loved ones, but now often use it to buy stuff you don't really need just because it is ridiculously cheap. Originally a one day event, big retailers have now started Black Friday days ahead of time, and small retailers who cannot afford to discount their items that heavily, have responded with Small Business Saturday. Then online retailers added Cyber Monday. It's enough to make you wonder what happened to all that gratitude we had on Thanksgiving.
And then, not to be left out of the spending spree that is this 5 day nightmare, the non-profit world created Giving Tuesday! A push to get any extra money you might want to donate to a charity at the end of the year. (Not to mention the ongoing donation boxes, add a dollar at check out, and kettles in every store.) As Americans, we once again took a good idea and made it over the top.
But as the owner of a small non-profit seeking to improve the health outcomes of every New Yorker, I cannot afford to ignore it either. So today, I am asking you to consider making it a Giving Tuesday to Small Non-Profits Day. The big ones have already overwhelmed you with emails, social media posts, and pleas for donations. But it is the little non-profits who chug away on small donations, whose CEO's don't get paid, who can take a dollar donation and stretch it to be worth so much more, that really need your funds.
So please, consider donating to Health Literacy for All Inc, http://healthliteracyforall.org/ and click on the little donate button right under our logo. Or find another small non-profit you love and donate to them. And be generous, We the small non-profits of the country thank you!
Tuesday, December 1, 2015
Friday, October 9, 2015
Navigating the Health Insurance Choices
When I share that I make a living by teaching people how to navigate the health care system, the first comment I hear is "Wow that's so needed, no one seems to understand their health insurance!" Of course right now I am teaching on that topic as seniors have to select their Part B and D insurances in October and in November open enrollment starts for people picking on the Health Exchanges. So I thought I would give you a few key things to think about.
First, health insurance companies are tightly regulated by the federal and state governments. There are certain things they must provide (free annual exams, free mammograms for women over 50, free colonoscopies for everyone over 50, and vaccines are covered 100% for kids). They must also cover hospitalizations, medical testing, physical therapy, sick visits, and medications, but not at 100% coverage. They are required by law to explain how this works (some work primarily on a high deductible, some with co-payments or co-insurance, and some with a combo of both.) They are also obligated to their business plan to not pay for anything they said they wouldn't cover. This often means that extremely expensive or experimental treatments are not covered or that there are limits to the number of treatments they will pay for. It just doesn't matter how sad, desperate, or horrendous your story is, if they don't cover the treatment or all the treatments you need, they don't cover it. They would go bankrupt if they did and then they couldn't cover anyone. It is YOUR obligation to know what your insurer will or will not cover.
Secondly, health insurance is expensive. When you are looking at the cost of your health insurance, you must look at more than just the monthly premium. So you have an understanding in 2010, the average employer paid about $10,000 per employee per year for health insurance. Understanding that should help you understand the costs on the Health Exchange as well. On top of the premium, you may also need to meet a deductible (anywhere from $500 to $3000 per person). Then there will either be a co-payment (a set dollar amount based on the care you are receiving) or co-insurance (a preset percentage of the cost of the treatment ordered). Co-payments and co-insurance will be on medical treatments, doctor's appointments, use of the ER or hospital, and medications. You must estimate how many times you will interact with the healthcare system in order to get an idea of how much it will cost you over the next year. For frequent users of the health care system, or young couples who might have a child, it is often worth it to pay a bigger premium and less in deductibles and co-payments/co-insurances in the long run.
Finally, if you already have a favorite doctor or ongoing medical concerns, you will need to make sure that your health insurance company participates with your doctor and treatment center. Otherwise, you will find yourself having to find a new medical team or paying much higher costs to use a doctor who isn't part of their group. You should also look at any medications you use and check to see what the copays are for those as well. If you have a large family history of cancer, you may want to see if your insurance company will work with some of the large independent cancer treatment centers as well.
As you are going through the different health insurance options out there, here is a list of the words that mean you will have to pay money..... premium, deductible, co-payment, co-insurance, out of pocket, non-participating, not in network, usual and customary charges, non-formulary, and formulary list. Make sure when you see these words, you understand exactly what is being covered and what is going to cost you more.
Hopefully this helps you as you begin to look at health insurance. "I didn't know the speed limit" doesn't get you out of a ticket and "I didn't know that wasn't covered" doesn't make it covered. Go through your health insurance options carefully. Ask questions, of me, at the exchange, at the doctor's office, with your insurance provider. And remember, health insurance was never designed to cover everything but if you read through the policy carefully and you understand everything, it will go a long ways to making your trip through our system a bit easier.
First, health insurance companies are tightly regulated by the federal and state governments. There are certain things they must provide (free annual exams, free mammograms for women over 50, free colonoscopies for everyone over 50, and vaccines are covered 100% for kids). They must also cover hospitalizations, medical testing, physical therapy, sick visits, and medications, but not at 100% coverage. They are required by law to explain how this works (some work primarily on a high deductible, some with co-payments or co-insurance, and some with a combo of both.) They are also obligated to their business plan to not pay for anything they said they wouldn't cover. This often means that extremely expensive or experimental treatments are not covered or that there are limits to the number of treatments they will pay for. It just doesn't matter how sad, desperate, or horrendous your story is, if they don't cover the treatment or all the treatments you need, they don't cover it. They would go bankrupt if they did and then they couldn't cover anyone. It is YOUR obligation to know what your insurer will or will not cover.
Secondly, health insurance is expensive. When you are looking at the cost of your health insurance, you must look at more than just the monthly premium. So you have an understanding in 2010, the average employer paid about $10,000 per employee per year for health insurance. Understanding that should help you understand the costs on the Health Exchange as well. On top of the premium, you may also need to meet a deductible (anywhere from $500 to $3000 per person). Then there will either be a co-payment (a set dollar amount based on the care you are receiving) or co-insurance (a preset percentage of the cost of the treatment ordered). Co-payments and co-insurance will be on medical treatments, doctor's appointments, use of the ER or hospital, and medications. You must estimate how many times you will interact with the healthcare system in order to get an idea of how much it will cost you over the next year. For frequent users of the health care system, or young couples who might have a child, it is often worth it to pay a bigger premium and less in deductibles and co-payments/co-insurances in the long run.
Finally, if you already have a favorite doctor or ongoing medical concerns, you will need to make sure that your health insurance company participates with your doctor and treatment center. Otherwise, you will find yourself having to find a new medical team or paying much higher costs to use a doctor who isn't part of their group. You should also look at any medications you use and check to see what the copays are for those as well. If you have a large family history of cancer, you may want to see if your insurance company will work with some of the large independent cancer treatment centers as well.
As you are going through the different health insurance options out there, here is a list of the words that mean you will have to pay money..... premium, deductible, co-payment, co-insurance, out of pocket, non-participating, not in network, usual and customary charges, non-formulary, and formulary list. Make sure when you see these words, you understand exactly what is being covered and what is going to cost you more.
Hopefully this helps you as you begin to look at health insurance. "I didn't know the speed limit" doesn't get you out of a ticket and "I didn't know that wasn't covered" doesn't make it covered. Go through your health insurance options carefully. Ask questions, of me, at the exchange, at the doctor's office, with your insurance provider. And remember, health insurance was never designed to cover everything but if you read through the policy carefully and you understand everything, it will go a long ways to making your trip through our system a bit easier.
Tuesday, September 1, 2015
Is there a way to put the Fun in FundRaising?
As a human being with a heart and a budget, I personally get tired of all the
fundraising that happens at the end of the year. Besides the ever popular Zumbathons, walk/runs, golf tournaments, charity auctions, and just general pleas for funds, one could go broke donating to charities. And
now with crowd source fundraising, it has reached an all-time low. I
have seen legitimate uses (help us raise funds for our sick child), but
also some that make me groan (help me pay for my kid to go to college).
As the CEO of a non-profit though, I know how crucial fundraising is. More and more grants are tied to a non-profit's ability to fundraise. They insist we have matching funds in our accounts already, (Really? If we already had the money, we wouldn't need yours!) And the number of causes makes it hard to find the charities you really want to sponsor.
All that being said, there just isn't a fun way left to ask you to donate. And really, do you want the charity to spend most of it's time, energy, and money fundraising or spend it helping people? So I am just going to put it right out there, the no fun way. Because I would rather spend my money on the clients than on providing you with a t-shirt. (If you really want a t-shirt, send me an extra $20 and I will have one made for you!)
Health Literacy for All Inc currently has 18 agencies that would love for their staff or clients to learn about health literacy skills (how to navigate the health care system, how to make health choices, and how to respond in a public health crisis). Plus daily we get asked by individuals to help them with doctors, medications, references, safe housing, insurance, and healthy eating. We need to raise $15,000 just to meet the needs in front of us and our goal is to raise $50,000 so we can go after some of those big grants.
This plea is not coming with any type of fanfare. It just comes with a solemn vow that we spend every dime you invest to make sure people have access to the best health education they can get. Recently, we have helped a senior Steve find safe housing when his children could no longer provide adequate care, we provided a low income senior housing program a free stop smoking program when their building went smoke free, even in the apartments. We saved Avi's life by teaching her mom to keep pressing the medical team for better answers when the 7 week old was throwing up daily and losing weight. We helped an autistic young man navigate the stresses of college, and besides being autistic Marcus was the first in his family to even go to college! Our work changes lives, saves lives, and helps people reach the end of their lives having lived them fully. And that is FUN (at least for me!) So put the fun back in fundraising by making a tax deductible donation today at https://fundabilities.com/understanding-health-care.
As the CEO of a non-profit though, I know how crucial fundraising is. More and more grants are tied to a non-profit's ability to fundraise. They insist we have matching funds in our accounts already, (Really? If we already had the money, we wouldn't need yours!) And the number of causes makes it hard to find the charities you really want to sponsor.
All that being said, there just isn't a fun way left to ask you to donate. And really, do you want the charity to spend most of it's time, energy, and money fundraising or spend it helping people? So I am just going to put it right out there, the no fun way. Because I would rather spend my money on the clients than on providing you with a t-shirt. (If you really want a t-shirt, send me an extra $20 and I will have one made for you!)
Health Literacy for All Inc currently has 18 agencies that would love for their staff or clients to learn about health literacy skills (how to navigate the health care system, how to make health choices, and how to respond in a public health crisis). Plus daily we get asked by individuals to help them with doctors, medications, references, safe housing, insurance, and healthy eating. We need to raise $15,000 just to meet the needs in front of us and our goal is to raise $50,000 so we can go after some of those big grants.
This plea is not coming with any type of fanfare. It just comes with a solemn vow that we spend every dime you invest to make sure people have access to the best health education they can get. Recently, we have helped a senior Steve find safe housing when his children could no longer provide adequate care, we provided a low income senior housing program a free stop smoking program when their building went smoke free, even in the apartments. We saved Avi's life by teaching her mom to keep pressing the medical team for better answers when the 7 week old was throwing up daily and losing weight. We helped an autistic young man navigate the stresses of college, and besides being autistic Marcus was the first in his family to even go to college! Our work changes lives, saves lives, and helps people reach the end of their lives having lived them fully. And that is FUN (at least for me!) So put the fun back in fundraising by making a tax deductible donation today at https://fundabilities.com/understanding-health-care.
Tuesday, May 26, 2015
Hospitals, Seniors, and Safety
I have had a influx of people calling and seeking advice after an elderly relative was sent home from a hospital into what the family viewed as an unsafe situation. Over and over I heard, why would the staff kick my relative out when they are sick and weak to go home and be alone. It's cruel.
Today I want to address this from multiple sides.
First, let's look at the hospital's role. They have a patient that does not need to stay in the ER or in a room any more. There is nothing more the hospital can do for them. And keeping them in the hospital increases the risk of new infections. They ask the patient if they feel ready to go home and the patient says yes. So the hospital releases the patient to go home. The system works great for most everyone. Who would want, at age 40, to get the second degree from the hospital staff when you are ready to go home. New York State law says if the patient says they are safe to go home, then they can be sent home.
Second, let's look at your elderly relative's role. If they can live at home safely before they went into the ER, they should be safe when they go home afterwards. Frequently, they were not really safe at home alone to begin with. The illness or the fall or whatever sent them to the hospital was a result of the fact that they were not safe at home alone. But if the senior refuses to see that or act on that fact, then they will be discharged from the hospital back into the unsafe environment. We live in a state that allows elderly people to make their own decisions, even if they are totally the wrong, highly unsafe decisions.
Third, is there a role for the family in this mess? When your elderly family member entered the hospital, is there a reason a family member didn't take him/her and stay? No one would send a five year old to the ER alone and no senior should go either. The family must be proactive in sharing their concerns with their elderly loved one so that when he/she decides to seek treatment, the family knows and someone is headed to the hospital with him/her. This would allow the family to ensure that their senior is cared for, understands what is going on, and has a safe way to get home and be cared for.
From now on, let's try to stay calm when dealing with the health care system. No one went into medicine to put people into danger. Medical staff try their best to make sure everyone who comes in and out of the ER or hospital is safe, healthy, and treated with respect. While insurance companies don't want to pay for unnecessary time or treatments, they also don't want a senior returned to an unsafe environment where they will get injured or sicker. But they don't even get to talk to your loved one. They are relying on the hospital, senior, and family to make sure all is well.
One of the key pieces to this puzzle is the reality that, at some point, seniors are more concerned with being independent than with their safety and health. When "I'm independent" is all the family member hears, they need to put into existence a game plan to ensure health and safety needs are being met. Because the loved one is now incapable of making that call for him/herself. This includes having a plan for when something happens that sends the senior to the hospital.
The earlier people can begin to make a plan, the more likely the senior is to follow it when the brain says "I'm ok, I don't need my family right now." Use this blog post as a starting point in your family to have this discussion. Some of the questions you might need to answer are: who will the senior call when he/she needs to go to the hospital, are health care proxies and other forms filled out, does everyone understand what the priorities are for your senior's long term goals on life, and how often do we need to review these plans and have these discussions to ensure the right decisions are made in an emergency.
Aging is a tough reward for not dying. It comes with constant ever-changing challenges that need the most open lines of communication possible. Illnesses, safety issues, healthcare systems, and insurance providers don't make any of this easier. In fact, those problems often take a mild situation and turn it upside down, sideways, and inside out. Don't get caught in the blame game, it doesn't help anything. Make a plan. Be prepared. Help your senior live out the rest of their live in peace, comfort, and safety, but also make sure they are LIVING their life to the fullest.
Today I want to address this from multiple sides.
First, let's look at the hospital's role. They have a patient that does not need to stay in the ER or in a room any more. There is nothing more the hospital can do for them. And keeping them in the hospital increases the risk of new infections. They ask the patient if they feel ready to go home and the patient says yes. So the hospital releases the patient to go home. The system works great for most everyone. Who would want, at age 40, to get the second degree from the hospital staff when you are ready to go home. New York State law says if the patient says they are safe to go home, then they can be sent home.
Second, let's look at your elderly relative's role. If they can live at home safely before they went into the ER, they should be safe when they go home afterwards. Frequently, they were not really safe at home alone to begin with. The illness or the fall or whatever sent them to the hospital was a result of the fact that they were not safe at home alone. But if the senior refuses to see that or act on that fact, then they will be discharged from the hospital back into the unsafe environment. We live in a state that allows elderly people to make their own decisions, even if they are totally the wrong, highly unsafe decisions.
Third, is there a role for the family in this mess? When your elderly family member entered the hospital, is there a reason a family member didn't take him/her and stay? No one would send a five year old to the ER alone and no senior should go either. The family must be proactive in sharing their concerns with their elderly loved one so that when he/she decides to seek treatment, the family knows and someone is headed to the hospital with him/her. This would allow the family to ensure that their senior is cared for, understands what is going on, and has a safe way to get home and be cared for.
From now on, let's try to stay calm when dealing with the health care system. No one went into medicine to put people into danger. Medical staff try their best to make sure everyone who comes in and out of the ER or hospital is safe, healthy, and treated with respect. While insurance companies don't want to pay for unnecessary time or treatments, they also don't want a senior returned to an unsafe environment where they will get injured or sicker. But they don't even get to talk to your loved one. They are relying on the hospital, senior, and family to make sure all is well.
One of the key pieces to this puzzle is the reality that, at some point, seniors are more concerned with being independent than with their safety and health. When "I'm independent" is all the family member hears, they need to put into existence a game plan to ensure health and safety needs are being met. Because the loved one is now incapable of making that call for him/herself. This includes having a plan for when something happens that sends the senior to the hospital.
The earlier people can begin to make a plan, the more likely the senior is to follow it when the brain says "I'm ok, I don't need my family right now." Use this blog post as a starting point in your family to have this discussion. Some of the questions you might need to answer are: who will the senior call when he/she needs to go to the hospital, are health care proxies and other forms filled out, does everyone understand what the priorities are for your senior's long term goals on life, and how often do we need to review these plans and have these discussions to ensure the right decisions are made in an emergency.
Aging is a tough reward for not dying. It comes with constant ever-changing challenges that need the most open lines of communication possible. Illnesses, safety issues, healthcare systems, and insurance providers don't make any of this easier. In fact, those problems often take a mild situation and turn it upside down, sideways, and inside out. Don't get caught in the blame game, it doesn't help anything. Make a plan. Be prepared. Help your senior live out the rest of their live in peace, comfort, and safety, but also make sure they are LIVING their life to the fullest.
Thursday, January 22, 2015
Breast Cancer, Prostate Cancer and AIDS Vaccine All Now!!!
OK. I lied. None of them are available now. And if they were, I hope I am not the first place you are hearing about them.
But what if it were true? What if the CDC and National Institutes of Health announced breakthroughs in these vaccinations and that they would be available in your doctor's office starting Feb 1, 2015? Would you be calling your doctor for a chance to be the first to get the breast or prostate cancer vaccine? Would you be lining up at your favorite drug store for the AIDS one? Or would you wait until your next annual exam for them?
Or would you tell your doctor you are not interested in them? That they will probably not help, come with side effects, or be generally unsafe to take? Probably not. Why? Because you see the devastation that these diseases cause. Because you know personally someone who has been impacted by these illnesses.
And thus is the problem with the measles, polio, or rubella vaccinations. They have worked so well in the US, you may have no experience with how horrendous these diseases are. So when people who are not medical doctors (just because they have the title Dr. in front of their name, does NOT make them a medical doctor) tell you the vaccines are not safe, you have no reference for how unsafe being un-vaccinated is. All treatments have side effects and risks. And there is nothing wrong with knowing what they are. But use reputable medical reports and websites to get your information. Not a website sponsored by a celebrity or vitamin company.
One of the wonders of our generation is now that we have eliminated these killer diseases, we have gone on to create vaccines for illnesses that are serious but only life-threatening to some people. Chicken pox, the flu, and the HPV vaccines are some of these examples. These diseases haven't shown the same destructive capabilities as rubella, small pox, or the mumps, and so we tend to think it's ok not to take those vaccines, so it's ok not to use the others. But it's not. If you choose not to vaccinate yourself or your child, you need to know the full truth about the disease you are choosing to leave yourself vulnerable to. Especially in this age where people (and diseases) can spread quickly and easily among continents (think about the chaos from just a few people reaching our country in wake of the Ebola virus.) Think about the number of people complaining that not enough was being done to create a vaccination against the Ebola virus.
Let's try to be consistent people. If you are complaining the drug companies aren't working hard enough to find vaccines for our deadliest known illnesses of today, why would you risk exposing yourself or your kids to the deadliest known diseases of yesteryear by refusing the vaccines?
Think it through.... and play it safe. Vaccinate yourself and your kids. For their healthy future.
But what if it were true? What if the CDC and National Institutes of Health announced breakthroughs in these vaccinations and that they would be available in your doctor's office starting Feb 1, 2015? Would you be calling your doctor for a chance to be the first to get the breast or prostate cancer vaccine? Would you be lining up at your favorite drug store for the AIDS one? Or would you wait until your next annual exam for them?
Or would you tell your doctor you are not interested in them? That they will probably not help, come with side effects, or be generally unsafe to take? Probably not. Why? Because you see the devastation that these diseases cause. Because you know personally someone who has been impacted by these illnesses.
And thus is the problem with the measles, polio, or rubella vaccinations. They have worked so well in the US, you may have no experience with how horrendous these diseases are. So when people who are not medical doctors (just because they have the title Dr. in front of their name, does NOT make them a medical doctor) tell you the vaccines are not safe, you have no reference for how unsafe being un-vaccinated is. All treatments have side effects and risks. And there is nothing wrong with knowing what they are. But use reputable medical reports and websites to get your information. Not a website sponsored by a celebrity or vitamin company.
One of the wonders of our generation is now that we have eliminated these killer diseases, we have gone on to create vaccines for illnesses that are serious but only life-threatening to some people. Chicken pox, the flu, and the HPV vaccines are some of these examples. These diseases haven't shown the same destructive capabilities as rubella, small pox, or the mumps, and so we tend to think it's ok not to take those vaccines, so it's ok not to use the others. But it's not. If you choose not to vaccinate yourself or your child, you need to know the full truth about the disease you are choosing to leave yourself vulnerable to. Especially in this age where people (and diseases) can spread quickly and easily among continents (think about the chaos from just a few people reaching our country in wake of the Ebola virus.) Think about the number of people complaining that not enough was being done to create a vaccination against the Ebola virus.
Let's try to be consistent people. If you are complaining the drug companies aren't working hard enough to find vaccines for our deadliest known illnesses of today, why would you risk exposing yourself or your kids to the deadliest known diseases of yesteryear by refusing the vaccines?
Think it through.... and play it safe. Vaccinate yourself and your kids. For their healthy future.
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