Insurance Companies are NOT your Doctor

By Michelle Flaat, Executive Director of the Emerald Coast Medical Association.

It’s that time of year again…Open Enrollment for Individual Health Insurance plans. Confusing information and sometimes empty promises will be made by a multitude of insurance companies about their plans. Medicare-eligible patients will be inundated with marketing materials that promise you can have the best care with a $0 premium. Younger people will be enticed with calls, emails, and advertising that promise good health if only you purchase the right insurance plan with their insurance company.

I want to provide you with insight and information to help you make your decisions with a dose of reality.

1. Your insurance company is NOT your Doctor. And when I say Doctor, I mean your physician, an MD or DO. Other health care providers with the title of Doctor hold a Ph.D. in their field of study such as Nursing or Physical Therapy and are not to be confused with the rigor it takes to become an expert and hold a degree in Allopathic (M.D.) or Osteopathic Medicine (D.O.).

2. Look carefully, ask questions and talk to your physician’s office before changing plans, the insurance company may give you a list of providers that include your physician’s name, but the list could be outdated. Nothing is more important than having a say in who your physician is and having the ability to see the specialists you need.

3. Understand that your physician will at times have to fight your insurance company on your behalf to get approval for the right medication or procedure to treat you. If your physician is employed by the insurance company do you think they will fight their employer on your behalf? There is a trend of clinics opening that are owned and operated by insurance companies, be aware and do your research. Nothing can compare to the relationship you have with your physician and their staff.

4. For Medicare patients specifically: It is always enticing to hear that you could get a supplement plan at no cost to you. Ask questions and understand the limitations of that coverage. These Medicare Advantage plans can be very restrictive and are based on cost you more out of pocket to utilize it. Many times, if you see a specialist for your condition, they will not be covered in that plan and your out of pocket costs for treatment will far outweigh the premiums you would have paid. The contract physician, in-network for your plan, may be 2 hours away.

5. Be realistic about your health status. Prevention is far more affordable than treatment. Again, you need to see an expert, a Physician, on a regular basis to stay on top of your health and prevent disease. As the mug in one of our member physician’s office says: “please don’t confuse my medical degree with your google search.”

6. Pharmacy benefits: If you know you need a specific drug look carefully at what the plan covers. You can never predict when you will need medication so again understand what your options are. I personally know stories of physicians calling and fighting the insurer on their patient’s behalf. The insurance companies hire physicians (not necessarily from Florida) to approve/deny exception requests for medications outside the approved drug list. You want your personal physician to be free to work on YOUR behalf in this process. Your insurance is a financial agreement and the physicians working for your insurance company to review claims and authorizations do not even have to be of the same specialty as your physician. Example: your Dermatologist is trying to get approval for a drug to treat your skin condition and the specialist they need to get approval from with your insurance company is an ophthalmologist. ECMA also partners with Florida RX card to offer medications at a discount. Go to our website http://emeraldcoastmedicalassociation.com/florida-rx-card/ to download the card and find out which pharmacies offer the best price on specific drugs.

7. Remember that an insurance company provides financial aid for the costs incurred for your health care. They may deny coverage, no matter the consequences, as it is not their responsibility to take care of you, just help pay the bills. Only you and your doctor are responsible for your health. An insurance company has a contractual responsibility to cover some health care items incurred and no more.

With all of that said I hope each of you are able to find a plan you can afford. If you don’t already have an established physician, I strongly recommend you choose a member of the Emerald Coast Medical Association. They are a strong group of physician leaders who spend countless hours outside of their own practice planning, advocating and learning to take the best possible care of you! Go to www.850docs.com to access our Doctor Directory or call and I’ll be happy to guide you to the best physician for your needs.

Give yourself the gift of good health in 2020 by choosing a physician and an insurance plan that will allow that physician to make the best medical decisions for you.

Telehealth: Seeing a Medical Professional From Anywhere Around the World

Some time ago, doctors would make house calls for patients who couldn’t get out of the house.

This is still practiced for special cases, but this “old-fashioned” practice is dying off.

Now, this practice has seen a new style of housecall. This virtual revival has doctors from all over being connected to patients at any time. We can already see that 76% of hospitals in the United States are consulting with patients and other practitioners by using video calls over the internet.

Telehealth is here to help both the patient and the medical professional. For the patient, this creates less stress, they won’t have to spend money on transportation, and quicker advice when it’s needed. For the professional, more patients can be seen in less time.

Telehealth can also bring healthcare to a patient who is incapable of traveling physically. This means that patients can get the care they need, regardless of their condition.

What does this mean for facilities management? Almost three out of every four urgent care and ER visits can be helped through a phone or video call. A study of results for 8,000 patients showed no difference in care quality between telehealth appointments and in-person visitations. Sometimes medicine for a patient can be received over the counter, and sometimes the patient may not need medical attention at all.

The future is in technology and in giving the best help the medical world can to its patients. This technology could see many more advancements that could help medical professionals provide even more accurate diagnoses to people in need. For example, the creation of Fitbits and smartwatches have already made a splash with assisting medical professionals in helping with monitoring of a patient’s heart.

Emerald Coast Medical Association understands that it is vital to have a voice in the community. We also know that you need to be up to date on the news in the medical community. If you become a member with us, we offer you a voice at our membership meetings which will spotlight essential topics and emerging trends in medicine. 

There are many more membership benefits than just that, though, such as a Group Health Plan, and Government Representation. Click below to learn more!

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A Decline in Overdose Deaths comes from a Decline in Opioid Prescriptions

The decline in opioid prescriptions has been a major force for the drop in drug overdose deaths. This is also the first time that the number of fatalities has dropped since 1990. 

The amount of drug overdose deaths in the United States fell in 2018 by 5.1 percent from 2017. This information comes from the Centers for Disease Control and Prevention’s (CDCs) release of the preliminary data in July. The percent might seem small, but the difference in numbers is almost 4000 people. 

Alex Azar, the Secretary for the Department of Health and Human Services, said the following about the results:

“America’s united efforts to curb opioid use disorder and addiction are working … Lives are being saved, and we’re beginning to win the fight against this crisis.”

He also pointed out that the number of patients that are receiving medication-assisted treatments has increased, distribution of overdose-reversing drugs is up, and nationwide opioid prescriptions are down. 

Another thing that has kept patients from overdosing is the lowering of pills per patient, which went from 26 to 18. Patients have reported taking fewer pills, which dropped from 12 to 9. While researchers say the study offers an essential reason for optimism, it shows how difficult it is to change prescribing habits. In May of 2018, at the study’s conclusion, the average number of pills prescribed passed the most up-to-date recommendations for all nine procedures.

However, Chad Brummett, M.D., co-director of Michigan OPEN believes there is more room to grow, stating “There is a misconception that this is all fixed.”

Brummett believes there are still frequent medical professionals who are overprescribing. The possibility of persistent opioid use rises with the number of pills and the length of time opioids are taken during recuperation from surgery. 

When doctors write prescriptions with a generous number of pills, there is a chance that patients do not take them all. Then that could lead to the unused pills to make their way from medicine cabinets, to streets or into the hands of other family members. So the with the fewer opioids being given out increases the chance of lower death numbers by overdose. 

Emerald Coast Medical Association understands that it is vital to have a voice in the community. We offer a safe place where you are allowed to share your opinion. If you become a member with us, we offer you a voice at our membership meetings which will spotlight essential topics and emerging trends in medicine. 

Click below to learn more about the benefits of joining.

Membership Benefits

Study Reveals TRICARE Families are Reporting Worse Care than Commercially Insured

The families who are covered by TRICARE have reported worse access to healthcare than those with private plans and even people who are uninsured. 

A research team led by the Children’s Hospital of Philadelphia (CHOP) analyzed nearly 85,000 children to see how the different coverage groups rated their access to care and the overall quality of care they get. In the study, only 34% of TRICARE enrollees described their care as “accessible,” while 51% went to private coverage and 37% toward the uninsured. 

Then to worsen the blow for TRICARE, 47% of enrollees described their care as responsive, whereas the commercially insured were at 52% and almost 51% for the uninsured. However, what makes TRICARE look even more poor to its counterparts is the acceptance rate by physicians:

-TRICARE: 67%

-Private Plans: 95%

-Medicare: 65%

Private plans are obviously the favored choice of care by users and physicians alike. The results also slumped for those who have special healthcare needs (which is very common with those who use TRICARE). 

Roopa Seshadri, M.D., a research scientist at CHOP’s PolicyLab and the study’s lead author, said, “These families may struggle to access needed specialty or behavioral healthcare services to meet those needs.”

The study was also done in part for the military to realize their personnel needs through better insurance procedures. 

“The researchers hope that the findings lead to additional consideration about how the military could most effectively ensure families that need it to have access to pediatric care and other specialty services.”

Findings like these should also advise the Department of Defense to recognize more why a provider would choose not to accept TRICARE coverage, and adjust policy to ease those barriers and enhance access.

Emerald Coast Medical Association is here for our medical community no matter what. We also offer our members access to Group Health Insurance, which provides better benefits with long-term security at lower rates. 

Interested in taking advantage of our Group Health Insurance? Click below to reach out today for more information.

Contact ECMA

How Fake News can Hurt Physicians and Patients

The internet is used for everything (medically) nowadays. Looking up symptoms, scheduling doctor appointments, and even looking at reviews of medical professionals. We’ve heard of people writing bad restaurant reviews for the craziest reasons. Unfortunately, these fake and irrational reviews can hurt medical professionals too.

One reason a physician could be given a “poor” review is because of their stance on vaccinations. Anit-vaccination groups have been known to “attack” medical professionals on multiple forms of social media. From what we have seen this past year from the worsening measles outbreak, maybe these groups should reconsider their stance. 

Another group that is known to aggravate the medical field is the National Rifle Association. After all the mass shootings going on in recent years, a lot of medical professionals have stated their opinions on gun laws. The NRA took to twitter stating:

“Stay in your lane.” 

However, a more recent law coming into fruition has caused a significant controversy in the United States. The new abortion laws that are being exercised in multiple states say that a mother or a medical professional could be imprisoned for aborting the unborn fetus. This has lead to people falling into three groups: the group who doesn’t want abortion, the group who wants abortion, and the group who doesn’t care. Unfortunately, if you are in the group who does not care, you are usually pressured into picking a side. No matter your opinion on the topic, however, either side will give a fake review or cause an uproar on social media because of a medical professionals stance. 

This is where things can get scary. Many of these fake reviews can hurt a medical professional’s reputation. These tasteless reviews can cause other people, who are looking for a person to care for their needs, to reject them because of the review. The most fortunate thing about this is that most review sites will actually evaluate some of the reviews and possibly remove them. One recommended option is that medical professionals hire reputation management companies for the sake of saving face. 

However, Emerald Coast Medical Association understands that it is vital to have a voice in the community. We do recommend that you think before you post and that you understand that people can be offended by anything. For you though, we offer a safe place where you are allowed to share your opinion. If you become a member with us, we offer you a voice at our membership meetings which will spotlight essential topics and emerging trends in medicine. You can also comment on our blogs and tell us how you felt about the piece or an opinion we spoke about in the blog. We are here to hear you out, don’t be scared around us. We want to hear your voice; we care about your voice. 

Trump Administration Helping the Medical Community: Kidney Transplants

The Trump administration is doing more work for the medical community again. This time it is for an increase of access to kidney transplants and to encourage the use of in-home dialysis. 

Politico reported that the Department of Health and Human Services (HHS) will announce new payment methods toward kidney care and Trump is considering an executive order for these plans. 

The HHS will also unveil an agency-wide program that will enhance the prevention and screening for kidney diseases. However, the final bits of the plan are still in the making. 

The Administration officials have hinted at the steps in recent months. The Secretary of the HHS, Alex Azar, gave a speech in March at the National Kidney Foundation’s Kidney Patient Advocate Summit, discussing how the sector is ripe for change. 

Alex Azar also pointed out, “Today, Medicare covers most patients with kidney failure, but we don’t begin spending a great deal on these patients until they’re already sick” … “It is the epitome of a system that pays for sickness rather than health, and this administration is intent on shifting these priorities.” 

Fortunately enough though, the White House has faith that these changes will extend the lives of people in need of kidney care and that it could save the government billions of dollars in payments for expensive dialysis treatments. 

The administration also says that about 17,000 additional kidneys could be made available for transplantation through its plan to reduce the waste of potentially suitable organs. It could also get 11,000 more hearts, livers, lungs, and other organs that are needed for transplant. 

President Trump and his administration are making the correct moves for the health of the people and whenever news like this sprouts up we, Emerald Coast Medical Association, will report it to you. We will make sure you are kept up to date with the critical medical news. Nevertheless, if you become a member, you can go to the ECMA member meetings. Where as a member, you are invited to participate in a spotlight of hot topics and emerging trends in medicine. 

Medicare Part D Is On The Rise – But Are Drug Costs Going Down?

Since 2006, the amount of people who are enrolled in Medicare Part D has doubled — totaling a little over 45 million people. That would mean that 70% of all Medicare beneficiaries are registered in the drug coverage plan (data found by the Kaiser Family Foundation or KFF). 

In 2006, when Medicare Part D first began, about half of the enrollees were in the drug coverage program. For the first time, the enrollment in standalone drug plans has decreased, while the registration in Medicare Advantage (MA) drug plans has increased. 

Juliette Cubanski, the associate director of the program on Medicare policy at KFF, had this to say about the matter:

“At this rate, I think we’ll see more enrollees in Medicare Advantage drug plans than in standalone drug plans in the next few years.” Last year, we witnessed MA prescriptions drug plans (MA-PDs) go up by 9%, and prescription drug plans (PDPs) dropped .3%.

The way the numbers break down now looks like this:

-46% of Part D Enrollees are in standalone PDPs 

-39% in MA-PDs

-15% in employer or union group plans

Now let’s talk about money. When it comes to out-of-pocket costs, most Part D enrollees have low prices for preferred drugs. However, there are higher costs for generics, not on the preferred list. Also, about 25% of Part D enrollees do not pay any money for preferred generic drugs. Whereas many pay ten dollars or more for the drugs that are not on the preferred list. 

Almost a month after all the above data was posted, we’ve found that generics are more expensive than the branded drugs on Part D. 

This new study finds that some seniors pay up to $1,000 or more for certain generic drugs compared to brand-named versions in Medicare Part D. 

The study posted in the journal Health Affairs said that brand-name manufacturer discounts in Medicare Part D had created a “perverse incentive” for seniors to choose a branded drug rather than a generic one. The shift away from generic drugs could discourage manufacturers from pursuing generic competition. 

However, the 2018 Bipartisan Budget Act demanded brand-name companies to increase their mandatory discounts from 50% to 70% for Part D drugs that are allowed in the gap between the initial coverage phase and the catastrophic coverage phase, also known as the “doughnut hole.” The Act also required the biosimilar drug could not be more expensive than the brand-named biologic drug it resembled. 

Some concerns to put into consideration would fall with the risk that companies could begin to shy away from making generics because of the lowering of branded prices. 

Another issue with this would be with patients who live in states with generic substitution laws, which would require a generic drug to be dispensed by a pharmacist and would be unable to take advantage of the cost savings from a cheaper branded drug.  

In all, we want to see help get to patients at more affordable costs. However, we also wish for the drugs or medications to do their job correctly in helping the patient.