Thousands of people are expected to see new doctors in the new year thanks to health-care reform, and establishing a good doctor-patient relationship is key to staying in good health, experts say. “Asking questions opens the dialogue,” says Matthew Bernard, chair of family medicine at the Mayo Clinic. “It helps set expectations. Sometimes [doctors] assume people know everything, and that’s not the case.” He adds that patients should not shy away from asking questions and should always feel comfortable asking follow-up questions to become their own best health advocate.

Here are five questions experts suggest new patients ask their doctor to get the relationship started on the right foot:

Questions No. 1: Do you have flexible office hours?

If you have a busy work schedule, make sure to find a doctor’s office that offers evening, early-morning or weekend hours to accommodate your agenda. It’s also a good idea to inquire about the average patient wait time when seeing the doctor and how far in advance you need to make an appointment.

“Rather than waiting and being caught off guard, being proactive can make a lot of sense,” says Martin Rosen, co-founder of the health care advocacy firm Health Advocate.

Question No. 2: Who will be seeing me if I have an emergency?

The new health-care law mandates individuals have insurance next year, meaning thousands of people will be entering the health-care system and adding to doctors’ already-heavy patient load.

While experts say patients shouldn’t worry about routine check-ups, they recommend asking about emergency appointments. “You want to know how hard it is to get an appointment and if you get right in if there’s an emergency,” says Thomas DeBerardino, a sports medicine doctor in Farmington, Conn. Not only that, he also recommends asking who you will be seeing: a physician assistant, nurse practitioner or doctor. “Being pawned off isn’t a bad thing, but you want to know so you can expect it.”

Question No. 3 What does the doctor/practice specialize in?

Once you know the ins and outs of the office, it’s time to get to know your potential doctor and what happens if you need specialty care. Inquire about specialists in the office and if the doctor partners with others within the community. Bernard at Mayo says this means asking what hospital or hospitals the doctor or practice is affiliated with and which specialists the doctor uses when needed. “When you go outside, what’s the relationships like and how do I know what is happening” are things patients also need to ask, he says.

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5 Questions to Ask a New DoctorDonna Fuscaldo FOXBusiness | December 11, 2013

FOXBusiness | December 11, 2013

Question No. 4 Do you use electronic medical records?

Experts say electronic records make it easier to transfer to a new doctor and for specialists to communicate with each other when working together on a treatment plan. While you shouldn’t write off a doctor that doesn’t use electronic records, it’s something to take into account when picking a provider. If an office does use electronic records, be sure to inquire about the security as well as how billing data are handled.

“You want the bill processed efficiently.” You don’t want to end up with a wrong bill because of outdated insurance information,” Rosen says.

Question No. 5 How long until I can expect test results?

Setting expectations from the start limits confusion when it comes to getting test results and other medical information, says Bernard. “Doctors in general want to know as quickly as you want to know. If the patient expectations are set up front, it saves a lot of phone calls.”

The conversation between adult children and their aging parents about the possibility of moving into an assisted-living facility or nursing home can be tough and change family dynamics, but it needs to be happen. “Children can generally see clear warning signs when it is time for their parent to enter an assisted living home or a nursing home,” says Kevin Flynn, president of Healthcare Advocates. “The sad reality is that it often takes an adverse event to make the elderly parent realize that such a placement is needed.”

The earlier you can react to warnings signs the easier the transition can be on parents, so it’s important to know what signs to look out for and address. According to health experts, signs include forgetfulness when it comes to basic daily events like leaving the stove on, a lack of appetite or ability to eat, inability to food shop and constantly forgetting to take medication.

“When a parent is unable to care for himself/herself and needs help with everyday things like bathing, dressing and making meals, it may be time to consider a nursing home or an assisted living facility,” says Martin Rosen, executive vice president and cofounder of Health Advocate. “Other reasons for considering professional help for parent include if he/she has memory problems, has physical limitations and is prone to falls, and/ or has side effects from multiple medications.”

If warning signs are present, the next step is to figure the level of care options and approach your parents and family members about moving into a facility. According to Rosen, you’ll have to determine if it’s better to move the parent to a place or have a live-in nurse provide care in the current residence. Costs will be a major factor as will insurance

coverage and how much the family has to cover the expenses. “It’s important that family members agree before making the decision,” says Rosen. “If there are some disagreements, a geriatric case manager can help with the situation.”

When it comes to starting the conversation with parents, Flynn advises being as direct as possible. The main reason people resist the idea of a nursing home or assisted living is over fear of losing their independence. Some parents are also in denial about needing care and help, which can also make the conversation tough. Flynn says when talking about care options, you should provide parents evidence of why they need help: Point out aimless wondering, forgetting to turn off the stove and the dangers that came with these actions.

It’s also important to make it clear to parents they are not a burden and that you are not trying pass off their care and simply want them to have the best options and lifestyle. Children should put forth a well-discussed and thorough plan to their parents that covers financials.

If possible, Rosen suggests asking parents what they want from a facility, including location and amenities, to get them involved in the decision. Same goes with at-home care. If they can, have them discuss who they would want to be the caregiver whether it’s a relative, friend or professional.

If possible, Flynn says it’s a good idea to take the parent to visit possible places to talk to the staff and residents. “If they say no at first, continue the conversation in a kind way,” says Flynn. “After an adverse event occurs, they will either be willing or be forced into such a situation.”

FOXBusiness | May 21, 2013

How to Talk to Aging Parents About Moving to a Nursing HomeDonna FuscaldoFOXBusiness | May 21, 2013

When Maria and Vadim Brodsky’s then 7-year-old daughter needed an MRI two years ago to examine a tumor in her head, they took her to a hospital in their health plan’s network and were dismayed to receive a $4,500 bill.

The couple had a $6,000 deductible on their family plan. And even though the bill was reduced to $3,000 — the price the provider and insurer had agreed to by contract — the Brodskys had to cover all of it.

The following year when their daughter needed another MRI, the Huntingdon Valley couple took her to a standalone facility and put the procedure on a credit card. The total bill: $600.

Welcome to the new world of health insurance where high deductible plans are growing more popular and the consumers in those plans often have an incentive to haggle with providers.

Although many plans still protect people from high out-of-pocket costs for care, these days an increasing number of consumers have cheaper, high deductible plans where they must cover the first $1,000, $5,000 or even $10,000 of care before insurance kicks in.

For this group, it pays to shop around, say experts. “It’s definitely worth it to look at different hospitals or outpatient services, because prices can vary dramatically,” says Carrie McLean, senior manager of customer care at eHealthInsurance.com, an online vendor.

Five years ago, 12 percent of workers faced a deductible of at least $1,000 for single coverage. Today more than a third do, according to the Kaiser Family Foundation’s 2012 survey of employer-sponsored plans. Increasingly, a high-deductible plan, often linked to a tax-advantaged health savings account, is the only insurance offered on the job, even at big companies that have long offered generous coverage.

Proponents of high-deductible plans say consumers will make more cost-conscious health care choices if they have to spend more of their own money. According to an analysis by the Robert Wood Johnson Foundation, consumers in such plans cut their medical spending by between 5 and 14 percent. But results were mixed on whether they cut back only on unnecessary care or on treatment that was needed.

As patients increasingly owe a bigger share of the bill, “providers and patients have gotten creative about paying out-of-pocket costs,” says Mark Rukavina, a principal at Community Health Advisors in Boston who consults for nonprofit hospitals. “The price that appears on an invoice may be fluid.”

Insurers in recent years have helped ease some of the burden by only billing consumers for the companies’ lower contracted rates just for the companies’ lower, contracted rates. And the Affordable Care Act takes some pressure off by requiring many health plans to cover preventive services without applying those charges to the deductible. Still, high bills are a fact of life.

When It Comes to Health Care, It Pays to Shop AroundMichelle AndrewsKaiserHealthNews.org | May 20, 2013

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KaiserHealthNews.org | May 20, 2013

One effective way patients can cut costs is by agreeing to pay cash at the time a service is provided. Many doctors and hospitals offer such “prompt pay discounts.” “If they’re willing to pay in cash and I don’t have to wait six weeks for reimbursement [from the insurer], I’ll reduce the bill by 10 to 25 percent,” says Dr. Joseph Mambu, a family physician in Lower Gwynedd, Pa.

Patients who pay hospitals within 30 to 60 days of billing — the time frames vary — can often get up to a 30 percent discount, adds Rukavina. It’s also worth asking a hospital about their financial assistance policies, says Rukavina. They’re not necessarily only for uninsured patients. “Many have policies for the uninsured as well as underinsurance and might provide relief for the amounts due after insurance has paid,” he says.

Paying directly, however, can have downsides because it bypasses the insurance claims process, advocates warn. For one thing, those immediate payments won’t be applied to the deductible, so if the patient has more medical expenses later in the year, he or she won’t get “credit” for the amount spent. And, if there’s an error in the bill, you may not find out about it.

“If you don’t use your insurance, the bill won’t be reviewed [by the insurer] for errors,” says Pat Palmer, the founder of Medical Billing Advocates of America, which helps consumers resolve medical billing problems. Some patients are willing to take those chances to snag a “cash” discount.

Typically, consumers’ medical bills are adjusted to reflect the contracted rate that the provider has agreed to accept from the insurer. This lower rate is applied even when consumers are paying 100 percent of the bill because they haven’t yet satisfied their deductible. That’s how the Brodsky family’s first bill was reduced.

Still, it doesn’t hurt to ask. “As consumers, we shop around for just about everything else,” says Martin Rosen, executive vice president at Health Advocate, a company in Plymouth Meeting, Pa., that gives consumers clinical and administrative help to navigate the health system.

Among other tips: You are more likely to negotiate a lower price for care that’s not covered by insurance or that’s done by an out-of-network provider, say experts. “Usually patients are very successful in appealing [higher charges for] any out-of-network providers that took care of them while at an in-network facility,” says Palmer.

Insurers often have different discount deals with different types of facilities, says Palmer. At a standard radiology practice, the discount for an MRI may be only 20 percent, she says, but it can be 40 percent at a standalone imaging facility. Charges at teaching hospitals are often higher than at other facilities, she says. “Look to have the service done outside the hospital or hospital-owned facility,” says Palmer. “It’s often going to be less expensive.”

Drug prices vary widely, even for generic drugs. A recent Consumer Reports analysis compared prices at 200 pharmacies for five common generic drugs. The variation between the highest and lowest priced stores was a hefty $749 for the five drugs. The takeaway: shop around.

Dawn Herbert, 41, of Philadelphia saves a $14 copayment each month by filling her prescription for generic birth control at Walmart instead of CVS. “Whatever the insurance is paying for that drug, Walmart is considering it payment in full,” she says.

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It’s not easy deciding which nursing home (or assisted-care facility) would best suit an aging loved one. Unfortunately, often times the person in question is no help at all. Many of us have been forced to undergo this difficult transition, however, and are willing to share their insights about weathering the process. Also, for those who find choosing a nursing home too daunting, there are professional services that can help, such as Aidin, Assisted Transition, SilverLiving, and HealthAdvocate. Here, then, are eight things you should consider when taking on this daunting experience – from people who’ve been there, and come out the other side.

Understand Your Needs

Geriatric Care Manager Angil Tarach-Ritchey, RN, says a basic understanding of what you need can drastically reduce the number of places to consider: “For example, does your loved one have memory loss? If so you’ll want to decrease your choices to only those with memory-loss units and programs. Do they like to socialize and take part in activities? If they like such things, you’ll want to find a place with appropriate programs.”

Talk with Your Community

Ritchey advises to ask around for referrals. “Ask the staff at your loved one’s doctor’s office,” she said. “Ask social workers at your local hospital or home-care agency where they would choose for their parents. Ask friends, co-workers, people at church or other organization you belong to. Attend a local caregiver support group and ask the family members to recommend a place.” RN Lucy Boyd suggests that when you visit a facility, “Privately ask a few of the patients, ‘Would my aunt like to live here?’ Their responses may be very enlightening.”

Check with the Regulators

Martin Rosen, co-founder of Health Advocate, suggests inquiring about the agency that oversees eldercare in your state: “Different states assign different agencies to oversee assisted living, typically Licenses and Inspections or the Department of Health. Check with the appropriate agency for information on the facility. When was the agency’s last survey? Can you see a copy?”

Ask About Costs

Rosen asks, “ Will your state’s public programs cover the bill – does your loved one qualify? Find out what’s included in your monthly fee: they can add up quickly, especially if services are a la carte. For example, make sure the basic fee covers essentials like three meals a day.”

Ask Probing Questions

Peter Mangiola, RN, MSN, suggests a few productive questions to ask about the key medical and safety issues that nursing homes are responsible for. These may be depressing to think about, but your elderly loved one has fragile health already, and needs to be in a protected and sanitary environment:

• How does the facility rank for their patients’ falling rate?

• Where do they rank with nosocomial (hospital-acquired) infections?

• What does the institution do to prevent the spread of staph infections?

• What’s their policy toward preventing patient-to-patient infections?

Eight Tips for Choosing a Nursing HomeArthur Comingsnerdwallet.com | May 16, 2013

nerdwallet.com | May 16, 2013

• What’s their record of maintaining patients’ ideal weight?

• What about when staffing’s tight?

Denise M. Brown. founder of CareGiving, asks, “How does the facility handle staffing shortages? Some facilities will use an agency. I’m not a big fan of this because the agency staff will be unfamiliar with resident needs. Some facilities will have administrative staff (those who are nurses) take a shift. Be sure to understand how shortages are handled – they will occur.”

Do Your Homework Before the Legwork

Ritchey counsels, “You should have no more than 3-5 facilities to check out after considering your needs, as well as costs, ratings and referrals. If you hear a facility is great from more than one person, put it at the top of your list.”

Make a Surprise Visit

Rosen suggests, “Visit the facility unannounced: The best way to make a decision is to see the it for yourself. Are they receptive to unannounced visits? If they welcome you, ask for a tour, take notes, and meet the staff.” Keep visiting once you’ve made your choice. Wendy Harris of Assisted Transition says, “Nothing is as important as continued advocacy from a loved one. Drop-in visits at varying times of day and night, and active questions about care plans, let the staff know that you care.” There’s no point in feeling overwhelmed: you only have to take this one step at a time. And now you know some of the important steps.

Health-care reform is ushering in an era of more coverage plan choices for patients, and while more options can be empowering, it can also be confusing when trying to find the right plan.

“Health-care reform provides insurance coverage for many people who may be locked out of the market today,” says Sean Kelly, chief medical officer at health care IT security company Imprivata. “However, even with the new reforms, insurers can still impose limits on the number of doctor’s visits, prescriptions and days spent in the hospital.”

Because of this, he says it’s very important for patients to consider all options and prices when choosing a health plan.

According to health-care experts, the first step to choosing a plan is assessing current health and financial circumstances. For instance, patients with a chronic condition should seek out a plan that covers numerous visits to doctors and specialists. For those planning on starting a family, they want to look for insurance that will cover prenatal care. “You don’t want to over insure or under insure,” says Martin Rosen, co-founder of Health Advocate. “If you consider yourself young and healthy take a plan that has less rich benefits.”

Kevin Flynn, president of HealthCare Advocates, suggests people with chronic conditions stay away from high-deductible plans and choose a larger insurer because they are typically better financed and are less likely to deny claims.

For young and healthy candidates, a high-deductible plan will save money on monthly premiums. Flynn says it’s a good idea for people to review their family health history and look for ailments like diabetes, cancer and hereditary diseases before choosing a plan. “If your family tends to get breast cancer at age 40, and you are a female nearing 40, be proactive and get a plan that protects you financially,” he says.

After reviewing health needs, the next step is to review which doctors are part of a plan’s network. Most insurance plans provide coverage as long as enrollees stay in network. Using out-of-network professionals creates hefty charges so patients should review who is covered under what plan.

“If you have a chronic condition, you don’t want to change doctors,” says Rosen. “Even if you are perfectly healthy and have a primary-care doctor you want to make sure you can continue to see that doctor.”

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How to Pick the Best Health-Care Plan for Your BudgetDonna FuscaldoFOXBusiness | April 2, 2013

FOXBusiness | April 2, 2013

The Patient Protection and Affordable Care Act, mandates plans offer certain options like preventative care at no cost, the deductible, co-pay and co-insurance will vary from plan to plan. Because of that, experts recommend consumers calculate what they can afford before picking a plan. Frequent doctor visitors will want a plan that has cheaper co-payments. For those that rarely go to the doc, they are more likely to be able to afford the higher co-payment in exchange for lower monthly premiums. It’s also important to consider the costs of prescription drugs and what drugs are and are not covered under a plan.

Employees with employer-sponsored health insurance worried about the ramifications of choosing a high-cost plan, Flynn advising working with human resources to pay for an individual plan instead.

“The strategy is, by taking the expensive people off the company plan and putting them on their own private policy, the company saves a lot of money on premiums. Working with your employer to this goal will endear you to the employer. For those taking this route, Flynn recommends choosing a not-for-profit health insurance plan because surveys show they are cheaper than for-profit plans. “Investors want a return on their investment and this cuts into claims payouts. So choose a not-for-profit company.”

As you spruce up your home during your annual spring cleaning ritual, don’t forget to dust off your insurance policies.

It’s worth taking the time to put your auto, health, home and life insurance plans in order. As life circumstances change, so do insurance needs. For example, you may need to buy more life insurance because of a growing family. Or perhaps there’s a new driver in your household to add to your car insurance policy. Here are four tips for making sure your insurance is as neat and tidy as your home.

1. Wash and wax your car insurance policy.

Check to see whether your car insurance needs a tune-up, says Ron Moore, a senior product manager at MetLife Auto & Home. He suggests making sure your collision and comprehensive cover fits your needs. A collision policy pays to fix your own vehicle after a crash, while comprehensive pays for damage not caused by collisions. A comprehensive policy covers losses from such things as theft, fire, vandalism or storms.

Having collision and comprehensive policies is important if you drive a newer vehicle that would be costly to replace or repair, Moore says. However, if the cost of repair exceeds the vehicle’s value, you may be better off without the coverage. If your aging car is totaled, he says, your insurer won’t pay more than its current worth.

While checking your car insurance, make sure you get all the discounts you’re entitled to. If you have a teen driver on your policy, he or she may qualify for a good-student discount. If your teen is going away to college and won’t be using your car during the school year, you may qualify for a premium reduction.

2. Give your health policy a check-up.

Martin Rosen, co-founder of Health Advocate Inc., a Pennsylvania company that helps people navigate the health care system, says it’s common to overinsure for health, whether you have an individual policy or an employee-sponsored plan. “Some people have a tendency to think, ‘It is a health insurance policy, I want the best,’” he says. “That often translates into the most expensive.” You may be paying too much if you choose a policy with a low deductible, he says. Low deductibles are good if you frequently need medical care. However, if you’re young and healthy, it may be wiser to choose a high deductible, such as $2,000. That way, he says, you’re covered for catastrophic illnesses without paying high insurance premiums.

If you have a serious medical condition, you may want a health insurance plan that gives you several options for care, even if it costs more. You may not want to keep a plan that restricts you to doctors within a single health care system or requires referrals to see specialists.

4 Tips for ‘Spring Cleaning’ Your Insurance PoliciesEmmet Pierceinsureme.com | March 13, 2013

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3. Brush cobwebs off your homeowner’s policy.

When updating your homeowner’s policy, Moore says, the first thing to do is make sure you’ll have enough insurance to replace your home if it’s badly damaged. Replacement value is not the same as the market value, which can fluctuate greatly. You’ll need enough money to pay for the labor and the materials needed to restore your home to its former condition.

Insurance agents or local contractors may be able to help you determine your home’s replacement cost. Also, several websites can help you estimate the cost. Moore also suggests creating an updated inventory of home possessions. That way you’ll be able to give an accurate account of what was lost in a fire, natural disaster or burglary. If you’ve acquired valuables that exceed your home policy limits – such as paintings, jewelry or collectibles – ask your agent about adding a rider.

Tully Lehman, a spokesman for the nonprofit Insurance Information Network of California, says one way to cut home insurance costs is to “bundle” your home and car insurance coverage with one insurer.

4. Polish your life insurance.

Cindy Gentry, chair-elect of the nonprofit Life and Health Insurance Foundation for Education (LIFE), says updating life insurance beneficiaries is important. For example, if you’ve divorced, you may need to remove an ex-spouse from your policy.

If you have term life insurance – with a guaranteed annual premium for the duration of the policy – make sure you’re aware of when the term ends, so you’ll have time to shop for another policy if necessary, says Brian Ashe, treasurer of LIFE. Otherwise, you could face a major premium hike.

Moore suggests making sure the amount of your life insurance policy is appropriate. Not everyone views life insurance as a way to leave large gifts to heirs or charitable organizations, he says. “Some people want just enough to cover burial expenses,” Moore says.

insureme.com | March 13, 2013

If you’re lucky enough to survive a heart attack or stroke, you may face another serious challenge: dealing with the medical bills. Strokes and heart attacks can financially devastate people who lack adequate health insurance, says Stephanie Mohl, government relations manager for the American Heart Association. “Unfortunately, what we hear all too often is consumers don’t realize until after they have a heart attack or stroke that their insurance coverage may not be adequate,” she says.

Dr. Polly Galbraith, vice president and chief medical director at Assurant Employee Benefits, an insurance provider, says the lifetime cost of treating less severe heart attacks can reach $760,000. For a severe heart attack, the cost can reach $1 million. The figures include indirect costs, such as lost productivity, as well as direct costs, such as hospitalization.

The costs of treating strokes vary more, depending on the length of care required, Galbraith says. If a long-term stay in a nursing home is necessary, the lifetime cost could reach $2 million. Accurately predicting the cost to survive a stroke or heart attack is difficult, as so many variables pop up, says Dr. Thomas Wolk, senior medical director at Health Advocate Inc., a company that helps consumers navigate the health care system. It depends on how much care you need. Estimating your final expense, he says, is like trying to hit a moving target.

Breaking down costs

At University Hospital in Newark, N.J., The Stroke Center has estimated the average short-term cost of care for stroke patients. It reports that the cost for up to 90 days of treatment after a stroke is $15,000. For 10 percent of patients, however, the cost during that period reaches $35,000.

During the first 90 days of treatment, the center says, initial hospitalization makes up 43 percent of the cost of care. Rehabilitation costs make up 16 percent of the bill, followed by physician costs, 14 percent; hospital readmission, 14 percent; and medication and other expenses, 13 percent.

In the fall of 2012, the American Heart Association released a report on the costs of treating acute coronary syndrome, an umbrella term that includes heart attacks and chest pain.

The study analyzed medical costs, drug costs, and short- and long-term disability claims from 2007 to 2010 to calculate direct and indirect costs for more than 37,000 workers and their dependents. It found that the annual health-care cost for each worker, including out-of-pocket expenses, was $8,170. Of that total, $7,545 went toward hospitalization and medical care, and $625 went toward prescription drugs.

The Costs of Surviving Cardiovascular Disease: It’s Enough to Give You a Heart Attack!Emmet Pierceinsureme.com | March 6, 2013

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How good is your health insurance?

Tony Steuer, director of financial preparedness for the United Policyholders consumer group, says stroke and heart attack patients who have health insurance frequently must reach into their own pockets to cover all of their medical costs. How deeply they reach depends on the quality of their coverage. “It depends on the deductibles and caps on their insurance and their co-pays,” Steuer says. “Sometimes there are caps on certain types of care. People who purchase individual policies have to be careful. Most employer plans are fairly comprehensive, but it does happen that employers go for the cheapest plan.”

Not all stroke victims are covered adequately for long-term care, says Maura Loughlin Carley, president and CEO of Healthcare Navigation LLC, a health care advocacy and consulting company. “People who have had a stroke are more likely to have issues if they remain impaired.”

Inadequate health insurance is the reason cardiovascular disease is a leading cause of medical bankruptcy, Mohl says. She notes that a 2007 study of people going through bankruptcy found that among common ailments, cardiovascular disease

had one of the highest out-of-pocket medical costs. The average annual cost for stroke patients was $23,380; for heart disease patients, it was $21,995.

Reducing risks

The best way to avoid the expenses associated with strokes and heart attacks is to live a healthy lifestyle, Mohl says. “Eighty percent of heart attacks and strokes are preventable,” she says.

Here are your key risk factors for heart problems:

• High blood pressure.

• High cholesterol.

• Lack of exercise.

• Too much body fat.

• A diet with too much fat, cholesterol and salt.

• Smoking.

According to the Mayo Clinic, regular exercise is vital because it helps control weight, blood pressure and cholesterol. It also reduces stress, which often is a factor in heart disease. Smoking is one of the most significant risks, since it can damage your heart and blood vessels. “Probably the most important thing is to stop smoking,” Wolk says. “That is crucial.”

insureme.com | March 6, 2013

Before you get that next surgery, it’s not your spouse or best friend who may ask you to get a second opinion — but your employer.

Companies are increasingly encouraging workers to seek additional medical opinions before proceeding with expensive medical treatments — and they’re using both financial carrots and sticks. For example, getting a second opinion before surgery might earn someone a lower deductible on their health insurance; failing to get one could mean higher premiums or lower reimbursement.

While employers say they want their workers to make informed medical decisions, experts say the second opinions also often convince people to choose less invasive or cheaper treatments. So called second-opinion companies like Advance Medical and Best Doctors provide additional medical opinions to health-plan members at dozens of big companies—and say they recommend an alternate treatment in 60% of cases. While the new recommendations aren’t necessarily cheaper, they often suggest more conservative options that don’t include surgery or other big-ticket procedures — many of which would be unnecessary, the companies say.

These second-opinion services, which employers provide to employees for free, ask independent specialists to remotely review medical case files and recommend a course of treatment. In most cases, employees never see the doctor at all. While experts say the programs stop short of “prior authorization,” which insurance companies commonly require as justification before covering expensive procedures, the monetary incentives may force employees to reconsider.

The second-opinion programs aren’t new — several companies, hospitals and health insurers began offering them as far back as the late 1980s — but experts say employers have increasingly begun integrating them as part of their employee benefits programs in just the last few years. The second-opinion companies say their programs are designed as an antidote to America’s rampant misdiagnosis problem, and that their additional opinions save patients — and the employers who pay their health claims — thousands of dollars in needless health spending. “We’re catching errors,” says Gary R. Yeamans, executive vice president for Advance Medical. “Employers say, ‘I want to make sure this doesn’t happen to my employees,’” says Evan Falchuk, vice chairman of Best Doctors.

More employers are looking to second opinions as a potential solution to their onerous health bills, as well as a way to keep workers healthier. Best Doctors signed 37 corporate clients in 2012, including Red Bull North America and International Paper, according to the company, which also increased revenue 24% to more than $150 million that year. Health insurer Cigna also began offering second opinions to some of its U.S. plan members through a trial partnership with the respected Cleveland Clinic in 2008, but has continued the program due to positive feedback. “Our medical directors are frankly quite high on it,” says Joe Mondy, a Cigna spokesman.

Employers determine whether and how they will incentivize employees to seek second opinions, and experts say rewards for doing so have been more effective than penalizing those who don’t. For example, a company may designate six conditions

When Your Boss Doesn’t Trust Your DoctorJen Wiecznermarketwatch.com | February 12, 2013

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for which employees are required to complete an online education course about their treatment options or pay more. Others reward employees for seeking additional opinions before proceeding with surgery in the form of money deposited into their health savings account.

Some health experts question whether changing a treatment plan or recommending less treatment necessarily means better care. The third-party opinion companies sell their services to employers based on their value, so they may be biased when choosing doctors to review employees’ cases. “If you were running a second-opinion program and you had to recruit specialists and physicians to participate in it, would you have a tendency to recruit physicians who are more conservative or less?” says Francois de Brantes, executive director for the Health Care Incentives Improvement Institute. (Cigna, for its part, says its MyConsult program has not resulted in high rates of treatment switching, and the doctors providing the second opinions are all hired by the Cleveland Clinic — not recruited by the insurer.)

Health plans and companies counter that their aim is to help employees get the best possible medical treatment — even if studies and anecdotal evidence show that second opinions often result in cheaper, more conservative care. Second-opinion service WorldCare, for example, cites an independent study showing that second opinions canceled 73% of surgeries at the Elizabeth Wende Breast Clinic — saving $984,000 when patients opted for less invasive treatments. Advance Medical cites the case of a patient whose doctor recommended spinal-fusion surgery, but not to have it after seeking a second opinion through the company: “It illuminated a surgery that the patient didn’t have to have and saved the employer money,” says Yeamans. See: The Value of Second Opinions

Short of mandatory second opinions, some employers are requiring that employees with certain conditions go through an online program to explore their options before surgery — or else pay more for the procedure or in premiums. An employee

with chronic low back pain, for example, might be taught that they could go to a chiropractor or physical therapist, or that exercise or an ergonomic overhaul of their office workstation might help. The employers’ point: “They felt that they could forestall the more interventional procedure,” says Martin Rosen, co-founder of Health Advocate, a company that provides wellness coaching and services to health plan members.

Health experts say they don’t fault employers for encouraging employees to explore their options and take more control of their own health care — and better yet if everyone saves a little money in the process. “They’d rather do that than cut benefits, right?” says Andrew Webber, president and CEO of the National Business Coalition on Health.

A spokesman for International Paper says the company chose to provide Best Doctors’ services to its employees as a voluntary resource to “help ensure they are making educated decisions around health care.” P&G did not respond to requests for comment, but Sandra Morris, who designs the company’s benefits, says Best Doctors is one of the top programs she’s brought to P&G, according to a testimonial on the opinion service’s website. “It’s not a question of less, it’s a question of what’s right,” Falchuk says.

Still, the second-opinion services say it can be hard to convince employees that they might be better off with a treatment plan other than the one their doctor recommended. “How do you convince someone who thinks they need back surgery that the best thing to do is lose a little weight, or do exercises, in a world in which someone says look, you’re just trying to do this to save money?” says Falchuk. And employees generally don’t expect or trust their company to make medical decisions for them: Only 2% believe their employer is a completely trustworthy source of health information, according to a 2011 survey of employee attitudes by the National Business Group on Health. “We don’t want to make it the kind of requirement that triggers employees thinking this isn’t in their best interest, because it is,” Falchuk says.

marketwatch.com | February 12, 2013

Many Americans who visit the doctor this year are in for some unexpected pain. A growing number, many of them in employer-sponsored health plans, are enrolled in high-deductible health insurance plans that typically have lower premiums but require consumers to pay thousands of dollars in out-of-pocket expenses before coverage kicks in.

The elderly and the very sick have long battled to have medical procedures and prescriptions covered by private insurers and Medicare. But people in traditional employer-provided plans with $10 or $20 co-pays for medical treatment have been shielded because they do not typically see another bill.

Now it can take almost all year for healthy people to meet a large deductible, which often is two or three times higher than what they are used to paying.

As the high-deductible plans increase in popularity, more people will have to navigate a bill-paying system that’s often fraught with errors and confusion.

“It can get overwhelming to consumers,” said Victoria Veltri, the Connecticut Healthcare Advocate, who is in charge of the state agency that helps consumers with healthcare coverage issues. In 2012 she fielded hundreds of queries on high-deductible health plans. “It means lots and lots of just straight-up bills because somebody went into the doctor’s office for a problem.”

More High-Deductible Plans

High-deductible plans have been around for almost a decade, but more individuals and companies are turning to them in an effort to curb rising healthcare costs. Almost 20 percent of U.S. workers are in the plans, up from 13 percent two years ago, according to the Kaiser Family Foundation. While estimates vary, some benefits experts say that could more than double by 2014.

Consumers typically pay lower premiums for the plans, but the deductible can be as high as $3,250 for a single person and $6,450 for a family in 2013. Paying those upfront costs is supposed to encourage consumers to shop around for comparable, lower-priced care. A 2011 study by the RAND Corporation showed that people in these accounts cut medical spending by an average of 14 percent during the first year after switching.

Another reason the plans are getting more popular is that the president’s healthcare reform requires them to include free preventive services. That will be enough for many people, especially young, healthy individuals.

The U.S. Patient Protection and Affordable Care Act, more commonly known as Obamacare, has also introduced new insurance appeals processes that require outsiders to review disputed claims for all insurance plans. The law also created grants for state agencies such as Veltri’s to help consumers cope with the changes.

Bills, Bills, Bills Replace the Co-Pay, Sapping Time and MoneyCaroline HumerReuters.com | January 30, 2013

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Most often, Veltri said, consumers are calling with questions about why their plans are not covering appointments they believed would be free. People who need help with billing errors and “balance billing,” in which doctors bill patients for the portion of their bill that the insurer has not paid, are the next most popular calls.

In and Out of Network

Disputes can arise from in-network and out-of-network visits. After an in-network high-deductible-plan visit, the doctor sends a bill to the insurance company, which sets the price. If the insurer has a contract with the doctor, the patient is billed for the agreed-upon amount. Charging patients for the unpaid balance is against insurance law in most states.

Meeting the deductible can take a while, even in-network. In recently created health plans, preventive services such as vaccines, well visits for children, annual checkups for adults and cholesterol screenings are free. In family plans with health savings accounts, members pool their qualifying payments and must meet the entire deductible before insurance kicks in.

If the problem is at the insurer and not at the provider, then the insured can appeal to the insurer. For people in insured plans that are paid for by the insurers, the next step is the state insurance regulator.

Harvey Sigelbaum, 75, a retired healthcare executive who lives in New York City, has already had a taste of the hassles ahead for people wrangling with high-deductible plans. Most of his doctors have stopped participating in his private insurance plan over the past decade and no longer deal directly with Medicare, he said. Instead, they bill him directly. “It’s very complicated, and it takes a lot of paperwork,” he said. “There was a time the doctor would take care of the claim for you and they would get reimbursed.” Sigelbaum and his wife use an outside group, Health Advocate, to help handle his medical bills and reimbursements.

When there are no pricing agreements, consumers should enlist their insurers to help bring down high bills and straighten out mistakes, according to James Wrynn, a former deputy superintendent in the New York State Financial Services Department who is now a lawyer at Goldberg Segalla.

They may be surprised to find that the insurer can be an ally. “To an extent the insurance companies are aligned with the patient, even with high-deductibles, because they don’t necessarily want to see the patient go through the deductible because then they are on the hook,” he said.

Reuters.com | January 30, 2013

If you’re among the millions of young adults who have stayed on their parents’ health insurance plans, you’ll need to find new coverage. The Patient Protection and Affordable Care Act lets a young person stay on a parent’s health plan up to age 26. Whether the coverage ends on your birthday or at the end of the policy year depends on the plan. “Most plans are at least extending it to the end of the month or to the end of that policy year,” says Steve Wojcik, vice president of public policy for the National Business Group on Health. As your 26th birthday approaches, your parent should contact his or her employer’s human resources department to find out when coverage will end. “It’s important to plan ahead instead of waiting until the last minute,” says Martin Rosen, a co-founder of Health Advocate in Plymouth Meeting, Pa., a service that helps individuals and employers navigate the health care system. Here are health insurance options to explore when you’re kicked off a parent’s plan: Enroll in your own employer’s plan

If you have a job that offers health insurance, let your benefits administrator at work know you’d like to enroll in the health plan. Normally, you sign up for health insurance at work during open enrollment, which typically takes place in the fall for the following year. But under federal law, you’re eligible to sign up outside of the open enrollment period if you’ve lost coverage on a parent’s plan.

Coverage through spouse’s plan

If your spouse or domestic partner has employer-based health insurance, see if you qualify for coverage on his or her plan. Most employers that provide health insurance to employees extend health benefits to spouses, and a growing number of employers extend benefits to domestic partners. Don’t procrastinate. Under federal law, your spouse or partner has 30 days after you lose coverage to ask the employer to add you to the health plan. Consider COBRA

COBRA is short for the Consolidated Ominius Budget Reconciliation Act. The law gives families a safety net if they lose employer-sponsored health insurance because of unemployment, divorce, death of a spouse or loss of eligibility for coverage as a dependent. Under COBRA, you can continue to receive health insurance benefits under your parent’s plan for up to 36 months. This might be your best bet if you have a health condition that would make qualifying for an individual insurance policy difficult. There’s one big catch, though: You have to foot the premium, plus an administrative fee of up to 2%. Your parent’s health plan administrator should notify you about your eligibility for COBRA continuation coverage, Wojcik says. You will have 60 days to decide whether to elect coverage.

Kicked Off a Parent’s Health Plan: Now What?Barbara Marquand money.msn.com | January 28, 2013

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money

Comparison-shop for an individual policy

You might find coverage that’s more affordable than COBRA by shopping for an individual health insurance plan. An independent health insurance broker can help you sort through the options. Think about the level of health care you’re likely to need, then compare premiums. Generally the higher the deductible, the lower the premium. Other out-of-pocket costs include co-payments for doctor visits and coinsurance - the percentage of health care bills you pay after the deductible is met. Consider how much health care you’re likely to need and plan accordingly. Dig into the details about what plans cover before you select one. “Do the math and do your homework and make some sort of evaluation,” Rosen says. “People tend to overinsure. Why would you pay an extra $400 or $500 a month for a low-deductible plan if you only go to the doctor two or three times a year?” Starting in 2014, you’ll have to have health insurance by law, and you’ll be able to shop for plans through a state insurance marketplace called an exchange. Insurers won’t be allowed to deny you coverage or charge higher premiums because you have a health condition.

But until then, you might have trouble qualifying for an individual health plan if you’re already ill. Or an insurer might sell you a policy but exclude coverage for the pre-existing condition. Other options

If you make little or no money, check whether you qualify for Medicaid, the federal and state program for low-income individuals and families. If buying health insurance is simply out of the question, look for ways to save on health care. Community clinics offer services on a sliding scale, and most health care providers are willing to negotiate costs for uninsured patients. Also, comparison shop prescription drug prices. Retailers such as Wal-Mart and Target offer one-month supplies of many generic prescription drugs for $4. “The Healthcare Survival Guide” by Rosen and Dr. Abbie Leibowitz features other tips and is available online for free at healthcaresurvivalguide.com.

money.msn.com | January 28, 2013

You’ll need to do more than make a wish for good health when you blow out the candles on your 26th birthday. If you’re among the millions of young adults who have stayed on their parents’ health insurance plans, you’ll need to find new coverage.

The Patient Protection and Affordable Care Act lets a young person stay on a parent’s health plan up to age 26. Whether the coverage ends on your birthday or at the end of the policy year depends on the plan. “Most plans are at least extending it to the end of the month or to the end of that policy year,” says Steve Wojcik, vice president of public policy for the National Business Group on Health.

As your 26th birthday approaches, your parent should contact their employer’s human resources department to find out when coverage will end. “It’s important to plan ahead instead of waiting until the last minute,” says Martin Rosen, co-founder of Health Advocate in Plymouth Meeting, Pa., a service that helps individuals and employers navigate the health care system. Here are health insurance options to explore when you’re kicked off a parent’s plan.

Enroll in your own employer’s health plan

If you have a job that offers health insurance, let your benefits administrator at work know you’d like to enroll in the health plan. Normally you sign up for health insurance at work during open enrollment, which typically takes place in the fall for the following year. But under federal law you’re eligible to sign up outside of the open enrollment period if you’ve lost coverage on your parent’s plan.

Married? Get coverage through your spouse’s health insurance plan

If your spouse or domestic partner has job-based health insurance, see if you qualify for coverage on his or her plan. Most employers that provide health insurance to employees extend health benefits to spouses, and a growing number of employers extend benefits to domestic partners. Don’t procrastinate. Under federal law, your spouse or partner has 30 days after you lose coverage to ask the employer to add you to the health plan.

Consider COBRA

COBRA is short for the Consolidated Ominius Budget Reconciliation Act. The law gives families a safety net if they lose employer-sponsored health insurance because of unemployment, divorce, death of a spouse or loss of eligibility for coverage as a dependent. Under COBRA, you can continue to receive health insurance benefits under your parent’s plan for up to 36 months. This might be your best bet if you have a health condition that would make qualifying for an individual insurance policy difficult. There’s one big catch, though -- you have to foot the premium, plus up to a 2 percent administrative fee.

Your parent’s health plan administrator should notify you about your eligibility for COBRA continuation coverage, Wojcik says. You will have 60 days to decide whether to elect coverage. Know your COBRA rights.

Kicked Off Parent’s Health Insurance: Now What?Barbara MarquandTheStreet.com | January 24, 2013

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TheStreet.com | January 24, 2013

Comparison shop for an individual health insurance policy

You might find coverage that’s more affordable than COBRA by shopping for an individual health insurance plan. An independent health insurance broker can help you sort through the options.

Think about what health care you’re likely to need and compare premiums. Generally the higher the deductible, the lower the premium. Other out-of-pocket costs include copayments for doctor visits and co-insurance - the percentage of health care bills you pay after the deductible is met. Consider how much health care you’re likely to need and plan accordingly.

“Do the math and do your homework and make some sort of evaluation,” Rosen says. “People tend to overinsure. Why would you pay an extra $400 or $500 a month for a low-deductible plan if you only go to the doctor two or three times a year?”

Starting in 2014, you’ll have to have health insurance by law, and you’ll be able to shop for plans through a state insurance marketplace called an exchange. Insurers won’t be allowed to deny you coverage or charge higher premiums because you have a health condition.

But until then you might have trouble qualifying for an individual health plan if you’re already ill. Or an insurer might sell you a policy but exclude coverage for the pre-existing condition.

Other options

If you make little or no money, check whether you qualify for Medicaid, the federal and state program for low-income individuals and families.

If buying health insurance is simply out of the question, look for ways to save on health care. Community clinics offer services on a sliding scale, and most health care providers are willing to negotiate costs for uninsured patients. Also, comparison shop prescription drug prices. Retailers such as Wal-Mart and Target offer one-month supplies of many generic prescription drugs for $4. Read about how to get free prescription medicines.

“The Healthcare Survival Guide: Cost-Saving Options for the Suddenly Unemployed and Anyone Else Who Wants to Save Money” by Rosen and Dr. Abbie Leibowitz features other tips and is available online for free.