Wednesday May 22, 2013
Did you know that the Office of the Inspector General has a 10 Most Wanted list for health care fugitives?
No, health care fugitives aren't people who left the hospital before their treatment was done, or who refuse to get their yearly physicals. They're people who have been charged with health care fraud or related crimes, and remain at large.
The OIG profiles these fugitives and gives updates when they're captured. Although the whereabouts of most are unknown, some are suspected to have fled the country. In fact, most of the recent captures occurred when a fugitive attempted to re-enter the United States through an airport or border crossing. Other recent captures took place in foreign countries including Canada, Peru and Nigeria. The fugitive was then extradited to the United States to face charges.
I'm not thrilled about the prospect of spending my tax dollars feeding, clothing, and providing health care for people who may have stolen literally millions of dollars that were meant to pay for my father-in-law's heart surgery, my sister's chemotherapy, and my neighbor's bone marrow transplant. However, I do support bringing them back into the country and placing them on trial, and I hope our government is able to recover at least part of the money they stole from us.
To make sure your acupuncturist, home health nurse, medical equipment supplier, pharmacist, or physician isn't on it, check out the OIG's 10 Most Wanted list by clicking the photo below. You can read what each fugitive is charged with and his or her suspected whereabouts, if known, by clicking on his or her photo.
Tuesday May 21, 2013
Last winter, sitting on a driftwood log at a beach bonfire, I met a woman with health insurance worries. She had rheumatoid arthritis, and required a prohibitively expensive injectable biologic drug. Her health plan's drug coinsurance was several hundred dollars per month. She was fortunate that, with both herself and her husband working, she had the financial means to pay her drug coinsurance.
However, her health insurance was about to change. Her employer wasn't offering the plan that had decreased the real cost of her drug to "only several hundred dollars per month" out-of-pocket. She would be able to choose from a few different plans, but didn't like any of the choices. Although they all offered partial coverage for her medication, she said, "I'm going to blow through all the cost-sharing coverage and be past the out-of-pocket maximum with each of these plans before Easter!"
She was the perfect candidate for using one of the two techniques in "How To Save on Health Insurance if You Reach the Out-Of-Pocket Maximum." Designed specifically for people who know they'll reach their out-of-pocket maximum every year, the key to these techniques hinges on maxing out your cost sharing every year, and entering the 100% coverage benefit that can follow.
As more people use expensive biologic drugs, more people will reach their out-of-pocket limit each year. The increase in use isn't just because new biologics are gaining FDA approval and coming to market. Many of the diseases treated by these medications are chronic in nature. Because the drugs keep the disease in check, usually preventing disability but not curing the disease, someone who needs a biologic might be on the drug for the rest of his or her life.
Every year new people are diagnosed with rheumatoid arthritis, cancer, psoriasis and ankylosing spondylitis, adding to the roll of those taking biologics. Additionally, biologics are being used to treat more diseases. Crohn's disease, ulcerative colitis, multiple sclerosis, and even allergic asthma are sometimes being treated with these expensive drugs.
This means more people every year will be looking at their future healthcare costs and thinking, "I'm going to blow through the cost-sharing to the out-of-pocket maximum by Easter." If you, like my beach-bonfire friend, know that next year, and every year for the foreseeable future, you'll be reaching your health insurance out-of-pocket limit, please educate yourself about these two saving techniques and take advantage of the few opportunities you'll have to save on healthcare and health insurance.
image © Adam Gault/Getty Images
Wednesday May 15, 2013
The concept of an out-of-pocket maximum seems pretty simple, right? Once you've forked over enough money to meet your out-of-pocket maximum, you can put away your fork and close your wallet. For the rest of the year, your health insurance company pays for all of your care.
If you think that's true, check out the following scenarios:
- Between coinsurance, copays, and deductibles, you've already paid $6,000 this year. You think you've met your $6,000 out-of-pocket maximum. But, your insurance company tells you that you haven't reached it yet and you have to pay more.
- You're on an expensive medication, and even though it's only May, you've already paid $6000 in drug coinsurance. You think you've met your out-of-pocket limit and you won't have to pay anything for your next prescription. But, when you pick up your medicine for June, your pharmacy demands a 30% copayment.
- Your insurance company has told you that you've met your out-of-pocket maximum for this year. When you see the doctor a month later, your doctor's billing clerk says you owe a copayment for the visit.
Is something fishy going on here?
No. The health insurance company, the pharmacy, and the doctor's office may well be following the rules. If you don't understand how this can be correct, you're not alone.
"Out-Of-Pocket Maximum--How It Works and Why to Beware" will help you understand why, even though it seems like you've met your out-of-pocket limit, you may have to keep paying.
We all hope never to meet our out-of-pocket maximum. But, when you're hemorrhaging money, you need to know when the financial bloodletting will stop. And, when you're comparing health plans during open enrollment or shopping for health insurance, you need to understand how much financial protection each plan really provides if you find yourself in a worst-case scenario.
Thursday May 9, 2013
A Spanish restaurateur taught me a financial lesson that could help you use your health insurance more wisely.
Sitting down in a nice restaurant in Valencia, Spain, my niece and I were given menus, a wine list, a basket of bread, and two glasses of water poured from a nearby pitcher. We sipped our water and ate the freshly-baked bread while waiting for our meals.
When the bill came, it seemed larger than expected, so I carefully reviewed the charges. We'd been charged €5.5 for bread and €3 for each glass of water. Those unexpected charges made the bill €11.5, (about $16), more than I had expected.
I asked about the charges, pointing out that we hadn't ordered either bread or water, and asking why we were being charged for something we hadn't ordered. The restaurateur replied that it's customary to assume you want bread and water, and they're not free. If you don't want bread or water, tell the waiter not to put them on the table.
In other words, if you allow them to sit the stuff on your table, you're implying that you wanted it and agree to pay $16 for it. I don't know if that's truly the custom, or if that's just a way to get another €11.5 out of tourists. But, for the rest of our time in Spain, we politely refused the bread-baskets that magically appeared on our tables as we sat down.
I took home this lesson: if you don't understand what you're being charged for and how the charging system works, you can't accurately predict what you'll owe.
Healthcare is really expensive, and you have to use your health insurance wisely to get the healthcare you need without going broke. You need to understand how things like deductibles, copays and coinsurance work in order to accurately predict what you're agreeing to pay when you use your health insurance.
The difference between copay and coinsurance is a common source of confusion, and it's important because it defines how much you'll owe. The FAQ, "What's the Difference Between Copay and Coinsurance?" will clear up the confusion.
If you were to get a bill for a $500 healthcare service, would you know how much you're obligated to pay vs. how much your insurance would cover? If you're not sure, this will help you figure it out. It's the difference between owing $30, and owing $150.
Don't get stuck with the healthcare equivalent of paying $16 for bread and water. Understand how your health insurance works before you use it, so you'll know what you'll owe.
image ©Elizabeth Davis