Healthcare is a Team Game

 By Marc Manor

Healthcare is a team game that includes everyone from the client/patient, to the provider, their staffs, coders, insurance companies and others. When one member of the team, drops the ball, it can result in wasted money and resources and undue stress on the part of the client/patient. Even the most talented doctor or dentist may lose client trust and waste their time (time is money) if they do not have a staff that can handle claims and referrals in an accurate and expeditious way.

Recently, I received a call from a client telling me his primary care provider referred him to a specialist. When he arrived at his appointment, he was told that the specialist was not in network and they would not accept his insurance. This exemplifies a break in the client’s “chain” of care that should never happen. Healthcare is a team game where every decision should be made with the client/patent’s best interest in mind. As a result, the specialist wasted an appointment slot, the client was inconvenienced, and the primary care provider ended up losing a patient!

In this case, the breakdown likely occurred somewhere in the office staff (team) at the primary care provider because of a broken link in the administrative chain when processing a referral or insurance claim. Clients or patients are not healthcare professionals and therefore, do not normally anticipate breakdowns in the system. I have contacted medical and dental offices about this in the past and been told “it is the clients responsibility to make sure these referrals are in network” - a totally unacceptable answer in my view. Fortunately, we were able to use our local resources and find another provider for our client in the above example (and others) who has an established track record for client centered care with efficient claims and referral processing.

 Here are some tips for putting together a strong healthcare team:

 - Seek the assistance of a local healthcare insurance agent to review your healthcare insurance plan. Your local agent can not only help you choose the right healthcare (also applies to Medicare and dental insurance) plan with your needs in mind. An experienced local agent will have knowledge of the local medical groups and hospital networks.

 - When you receive a referral from your provider, ask them if the specialist or other provider they referred you to are in your insurance network. If they don’t know or tell you to call them; red flag 🚩 - they should know.

 - If you have to call to make an appointment where your are referred, ask them if they accept your insurance as “in network.” If they say no or “I’m not sure”; red flag! 🚩

 - Call your insurance company “member” or “customer” service line. While the company may not have the insight or experience with the local providers, they will be able to let you know who is in network for your plan. If they don’t know; red flag 🚩 - call your local agent immediately!

 One last note on networks. Don’t worry about networks if you have an emergency. Go to the nearest emergency room or call an ambulance.

Doctors and medical staffs are people just like the rest of us. Most are dedicated professionals and many are extraordinary and go the extra mile for their patients.  In fact, their heroism has never been more evident than during the current pandemic. By-enlarge, medical professionals are some of the most competent and honest hardworking people in our community. We are blessed to have some of the best here in Northeast Florida. Just like a winning sports team, your healthcare team should operate like a smooth running machine; with you in the drivers seat.

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Make Your Lab Life Easy

by Marc Manor

A trip to the lab can be stressful, especially if you have a fear of needles!  The last thing you need is to skip breakfast and show up to the lab, only to find out there is a hitch with your lab order or insurance coverage.  Here are a few tips for a smooth trip to the lab:

Photo by Karolina Grabowska
from Pexels

- Make sure you use a lab that is in-network.  Whether you have a Preferred Provider Organization (PPO) or Heath Maintenance Organization (HMO) insurance plan, you will usually save money if you use an in-network lab provider.  You can check this by calling your insurance carrier or agent.  If you have an online account with your healthcare insurance provider, you can usually find in-network lab there.

- Take a printed copy of your lab order to the lab.  Many healthcare providers send faxes and use other methods to send your lab orders over but sometimes there are glitches and the lab may not receive your order.  Without your order you may have to contact your healthcare provider and have them send it over causing long waits.

- Make an appointment if possible.  Some of the major chain type labs have websites where you can make an appointment.  There are a number of labs that require fasting.  These you will want to schedule early in the morning.  If there is no appointments available and you have to fast, show up early.  People usually start queuing up 30 minutes prior to the lab opening.  Some labs open as early as 6am so show up early to avoid waiting while you are hungry.  If fasting is not required for your labs, it is better to show up late morning or afternoon after the "fasting crowd" has cleared out.

Co-pays associated with lab tests can be hard to predict.  It depends on how they are coded and ordered.  You can ask the lab when you check in what your co-pay will be based on your lab order.  If they have your lab order sent over to the lab ahead of time, you may be able to call the lab to find out.

These simple steps can save you time, money, and a little stress when it comes to trips to the lab.

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Drug Not Covered...Try Using a Formulary Exception Request!

By Marc Manor

From time-to-time, I receive a call from a client who was prescribed a medicine that is not covered by their Medicare Prescription Drug Plan.  This can happen for any of a number of reasons but most of the time it is either because the drug is not on the plan's formulary; or it was not prescribed for use in a way that is approved by the Food and Drug Administration (FDA), or Medicare.  In most cases like this, you can request a "Formulary Exception Request".

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The Formulary Exception Request is usually a form that the prescription writer (doctor or other authorized professional) will fill out to request coverage on the drug that is prescribed.  In some cases there may be a generic or other brand name equivalent that can be prescribed; in this case, the insurance plan may have the doctor write the prescription for another covered drug, or request "step therapy" to transition the patient into the covered drug.  If there are no other alternatives, the insurance plan might make the "exception" and allow the drug to be covered.

Some drugs are very expensive and could be cost prohibitive without insurance coverage.  The Formulary Exception Request could be a real life saver in those situations.  If you find yourself in a situation where you do not have coverage, I recommend at least trying the Formulary Exception Request.  They are not guaranteed to be approved, but it could save hundreds or event thousands of dollars if they are.

So what if the Formulary Exception Request is not approved?  There are a number of reputable drug discount plans and other resources we can recommend to help ease some of the expense, including government programs.  Call us for a no-cost, no obligation consultation and we would be happy to work with you on a solution!

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Prescription Drug Readiness

Courtesy of Pexels.com

by Marc Manor

If you take prescription drugs, it would be wise to take inventory of your medicine cabinet and make sure you have adequate supplies to get you through the worst-case scenario. Most insurance plans offer mail-order options with online refill requests and some pharmacies are helping with delivery as well. A 90-day supply can be requested on some prescriptions. If you take meds that have quantity limits you can request your insurance plan and pharmacy to waive those requirements during the crisis.

Doing things like cutting pills and skipping days may be harmful to your health and should be avoided if at all possible. People taking drugs for diabetes are especially at risk.

If your prescriptions are expensive, call us at 904-222-0698 and we can help direct you to discount prescription drug or government programs that may be able to help.

Here is an article from "EverydayHealth.com" that has more helpful information:

https://www.everydayhealth.com/infectious-diseases/coronavirus-and-prescription-medications-should-you-stock-up/

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Medicare Prescription Drug Growing Pains 2020

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Have a new Prescription Drug Plan for 2020? If so you may be experiencing some "growing pains" associated with moving to a new plan. Plans sometimes have different formularies and there are other requirements such as pre-authorization (PA) and Quantity Limits (QL) that may be required that cause delays on processing your prescriptions. Be sure to put your first fill/refill in with a least 5 working days in advance of your need to allow these requirements to process. Call us at 904-222-0698 or email marc@marcmanor.com if you have questions!

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Happy Medicare Advantage New Year!

Happy New Year and Congratulations if you have a new Medicare Advantage Plan for 2020!  I am very excited for the new year and I resolve to make sure all my clients make the most out of your Medicare Advantage Plans this year and beyond!  Here are some tips to help you make the most out of your benefits:

Photo by Jill Wellington from Pexels.com

- Be sure to let your providers know if you have a new plan for 2020 so they can properly process your claims.

- Be sure to stay in network!  PPO plans offer out of network coverage; however you will pay more so when you make your appointment, you should double check.  Most providers will "take" a PPO plan so be sure to ask if they are "in network".  If you have an HMO you must stay in network.  Your provider should know when they refer you as long as they have your updated insurance information.  HMO plans do not normally have out-of-network benefits so being sure you are in network is more important for you.

Prescription Drug Prices Are Enough to Make You Sick!

by Marc Manor

There are many divisive social and political hot button issues but one I think most people would agree on is the issue of the high cost of prescription drugs in America.  I believe Medicare is a great system but it falls woefully short when it comes to prescription drug coverage for higher cost drugs.  Private insurance companies follow a model provided by Medicare but that is simply not enough.  Sometimes I talk to people who take two or three high tier drugs and I can’t help but to feel somewhat angry about what they are having to deal with to maintain good health.  

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I know I’m not the first person to bring this up, but I am piling on because I think that we all need to keep the pressure up on the government and the pharmaceutical companies to protest just how insane these costs really are.  To illustrate just how ridiculous the price of prescription drugs can be, I created an example we will call “Joe”: