Health Insurance Open Enrollment: Trick or Treat

Some people think of October as Trick or Treat time; Patient Advocates see it as the kickoff of health insurance open enrollment for the coming year, whether employer-sponsored, individual, and/or Medicare.

It may not be as playful as donning a costume or carving a jack o’lantern, but approaching your open enrollment period with the right spirit can certainly help you from getting tricked the next year.

So you’re not in the dark:

  • Assess how much financial risk you feel comfortable with. This might be influenced by how much savings you have, how often you need healthcare, and especially your personality. Some of us are more inclined to take chances; some of us protect ourselves against every possible negative outcome we can.
  • Understand what health insurance is and isn’t. It doesn’t eliminate your risk of getting sick or hurt, and it doesn’t protect you from all financial risk if those things happen. Health insurance is a way to lessen your risk from the cost of illness and injury (which can be substantial), and how much it protects you depends on several things in your control.
  • Keep this rule of thumb in mind: When you look at your insurance options, the lower your monthly payment for insurance (the premium), the more out of pocket expenses you’ll incur if you get sick or hurt. In other words, it’s important to balance the monthly expense against what you can afford to lose overall. A lower monthly expense may not be the best overall financial choice for you.
  • Staying in the network for your insurance can be a bit like figuring out who’s really in that ghost costume at the party. It can be really confusing. But it may be the most important aspect of making your insurance work for you. If you’re changing plans from the previous year, and if staying with your doctors and hospitals are important to you, it’s critical that you check to see if they’re in network for a new plan.
  • Full disclosure: Virtually none of us (OK, I know a select few) actually read their full insurance contract until they have to. But if you don’t read anything else, it’s important to look carefully at the provisions for emergency care. If you never leave home, it may be less important for you, but many plans have coverage limits outside their geographic service area or special requirements for emergency care to be covered. This has important implications to consider if/when you’re traveling.

And if this all feels a bit too tricky, call us for a 15 minute consultation and we’ll help you put the light back in your open enrollment jack o’lantern. read more

Truth in Pharmaceutical Drug Advertising

Used with permission. Copyright: 18percentgrey / 123RF Stock Photo

There are Reasons to be Suspicious about drug ads on TV

Like many people I often stream TV on my own time. Some Sundays ago I realized that “Madame Secretary” was going to be airing real time in a few minutes so I decided to tolerate commercials I couldn’t fast forward through and experience network TV live. (Secret confession: I want to be Tea Leoni in my next life!)

While there are certainly commercials in streaming television, I must confess I wasn’t prepared for what I saw. During literally every break there was some kind of pharmaceutical advertisement (clearly the demographic for this show isn’t young healthy people), a drug for diabetes, a drug for irritable bowel syndrome, a drug for high blood pressure. Smiling people promised that the product being advertised was the best thing since sliced bread for their condition and might even help you lose weight. read more


Emergency. defines it this way: “a sudden, urgent, usually unexpected occurrence or occasion requiring immediate action. “

In my healthcare experience lifetime, perhaps nothing has changed more than the role of the hospital emergency room. In my youth the hospital had two roles: caring for very ill or post-surgery patients needing nursing care until they could be released home, and attending to accidents (think someone getting their hand injured by machinery or being in an auto accident).

As a variety of things have changed in our healthcare system over the years, there are some common beliefs about emergency rooms that we should take a closer look at. read more

Your Decisions Matter… Or Do They?

Healthcare Directives and Planning

The call came late on a Thursday. The husband of a long married couple had suffered a stroke 2 weeks earlier. He had lost the ability to swallow and the doctor at the hospital had urged surgery to place a feeding tube directly to his stomach before transferring him to a skilled nursing facility, where it was expected he would remain for the rest of his life.

By his wife’s report, she didn’t feel she had been given an option; the doctor simply told them this was the next step in his care so he could be discharged from the hospital. Now in the skilled nursing facility she had time to see the situation more clearly and realized this wasn’t what her husband had told her he wanted if he was in this situation. read more

When the Bill is Just Wrong

Health care bills have mistakes, sometimes lots of them.

The figure most often quoted is that up to 80% of medical bills have errors. I’ve looked for the original source of that statement without success, but I did find one medical bill review company, Medical Billing Advocates of America, who noted that in their practice 3 out of every 4 bills they review have errors. (Caveat: Theoretically only people who think they have a billing issue would be submitting their bills for review, so this may create a falsely high rate.)

Still, you probably look over your restaurant bill and ask the waiter about charges you see that don’t look right before you pay it, right? The same applies for medical bills – and even though you may not fully understand everything that was ordered for you, asking about what’s on the bill you don’t recognize before you pay it is just smart. read more

In or Out, Round About – Navigating Out of Network Providers

Stethoscope and hundreds of American dollars

Health insurance is complicated and healthcare costs a lot. If you’re not up for a complicated read, here’s the short version: Don’t use out of network providers if you can avoid it. If you think healthcare is expensive, out of network healthcare is very expensive! But if you want to dig a bit deeper, read on.


Maybe your doctor has recommended you see a certain specialist who’s not in your insurance network. Maybe you’re in an accident and the closest hospital isn’t in your insurance network. What then? read more