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".

Photo by Julie Viken from Pexels

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

Photo by Kevin Bidwell from Pexels

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.  

Courtesy of pexels.com

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”:

Statements of Financial Responsibility

by Marc Manor

So, there you are at your pre-op appointment with your surgeon and you are asked to sign a “Statement of Financial Responsibility” or similar document.  This document is the “Cover Your Assets”/CYA insurance for the providers involved in the procedure.  Even the most minor surgeries can cost tens of thousands of dollars, so it is not surprising with the expense of healthcare these days, providers want some CYA.  I think they also do this to motivate patients to submit complete and current insurance information.  These acknowledgements are required by providers even if you have comprehensive healthcare coverage. Here are a few steps you can take to increase the chances your claims are properly processed.  

Courtesy of pexels.com

Here are some things you can verify with your provider and insurance company to make sure you have the required coverage:

Tricare For Life and Medicare Advantage

By Marc Manor

Until very recently, I believed that retired military personnel using their Tricare For Life benefits would not have a need for Medicare Advantage plans; however, because of the numerous additional benefits available in many Medicare Advantage plans, I have come to realize that Medicare Advantage may bring additional value and healthcare options to my retired Veteran brothers and sisters when used in conjunction with Tricare For Life.

Courtesy of pexels.com

First let’s talk about Tricare For Life.  Tricare For Life is a benefit earned by those career military personnel who are “retired” from the military.  It is considered “wrap-around” coverage for those retired military who have both Medicare Parts A and B.  While there is typically a monthly premium for Part B, there is no charge for the Tricare For Life wrap-around coverage for those who qualify.

While in many ways, Tricare For Life works similar to Medicare Supplement Plan F (the most comprehensive Medicare Supplement plans), yet it is different because one cannot use a Medicare Supplement plan in conjunction with Medicare Advantage (Medicare Part C).  Hence the term “wrap-around coverage”!  The reason this is so significant is because retired military members with Tricare For Life can use their benefit in conjunction with Medicare Advantage and therefore have three layers of Medicare insurance coverage!

Why have multiple layers of Medicare healthcare coverage you ask?

Avoiding the Medicare Penalty Box

by Marc Manor

Relative to most individual healthcare plans, many people find Medicare a significantly less expensive alternative with more coverage and lower deductibles.  After all, if you have been employed throughout your life, you have been paying into the Medicare system and have earned the Medicare Benefit!  If you have been employed for 10 years or more, it is likely your Medicare Part A will have no cost and your Medicare Part B will be only $135.50 per month* for most people (*Part B premiums are higher for higher income earners).   Medicare costs can be found here:  

https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance#collapse-4809

Courtesy of canva.com

To take full advantage of the value of your Medicare benefits, it is best to avoid late enrollment penalties.  There are late enrollment penalties for Medicare Part B and Part D and with so many low-cost options available, there are few reasons that would justify putting yourself in the Medicare “Penalty Box.”  Sometimes people seem surprised and are frustrated by the penalties.  They claim they just aren’t fair.  I understand how someone must feel but Medicare justifies these penalties because they base their rates and calculate their risk based on eligible beneficiaries in the pool of enrollees.  But you won’t care about why they penalize you for being late. So, let’s talk about the penalties and some ways you can stay within the rules and avoid them!

Seeking Healthcare Solutions Outside of Open Enrollment

by Marc Manor

Courtesy of pexels.com 

Navigating your way through an entire year with nothing to help you pay for medical bills can be a significant risk to your financial and personal wellbeing. Missing the Healthcare Marketplace Open Enrollment may not mean you have to go the rest of the year with no coverage at all. Many states have a variety of coverage options available that can help you fill the void if you are locked out of enrollment into an Affordable Care Act (ACA) compliant plan.

Saying to yourself that you are “healthy” and don’t need healthcare insurance can leave you thousands of dollars in debt so what choices do you have? Since options available in one state may be completely different than another, it's highly advisable to consult an independent healthcare insurance agent to help you get an objective opinion on your options. Here are a few possibilities:

Dear Politician: Just What Is “Medicare For All”?

By Marc Manor

As we prepare ourselves for the onslaught of political rhetoric associated with the 2020 presidential and Congressional campaigns, we have all heard the term “Medicare for All” as a means to fix our healthcare system.  I must admit, the more I hear the talk about Medicare for All, the more questions I have.  As an insurance agent who works to place Medicare beneficiaries into appropriate coverage, I can tell you that most people I talk to do not really understand our current Medicare system when they become eligible.  Based on much of what I have heard from politicians, it seems to me they also don’t understand Medicare.

Courtesy of pexels.com

I should disclose, I do have some personal interest in how Medicare for All would come to be.  Obviously, if commercial insurance companies were cut out your proposed system, me and thousands (if not millions) of people would have to find a new livelihood.  Having said that, I would support any functional system of healthcare over what we have now for people not eligible for Medicare.

Recovering From a Medicare “Wrong Turn”

By Marc Manor

Much of what I do is problem solving.  Frequently, the problems relate to “wrong turns” through the streets of the Medicare “Metropolis”.  By wrong turns, I mean when someone that has been enrolled in Medicare Part A and Part B beyond their initial enrollment period finds themselves outside the traditional open or annual enrollment periods and wants to transition to or from Original Medicare.  Sometimes the constraints of the Medicare “system” prevent immediate relief. However, there are solutions in many cases depending on when and how the “wrong turns” occurred.

Courtesy of pexels.com

Under the Medicare system, there are two basic paths: 1) Original Medicare and 2) Medicare Advantage (or Medicare Part C).  You can only be on one path or the other.  Typically, the path you choose occurs at the time you initially enroll fully into Medicare Parts A and B.  The choice initially of which path you take is very important so is necessary to give some basic information about these choices:

Employee Group Plans vs. Medicare; When to Cut the Cord.

by Marc Manor

If you are coming up on age 65 and you are still working and are using an employee group health insurance plan you may be asking yourself if you should dump the employer plan to take advantage of your Medicare benefits.  If you thought that, you are not alone.  This situation comes up frequently and as an agent, I can only really answer by making a recommendation that you seek assistance from your company benefits advisor.

Seeking assistance from your benefits advisor is really the only answer because they should be the most knowledgeable about the group plan benefits.  Human Resource professionals earn their living managing employee benefit plans.  So, as you ask yourself the question of whether to part ways with your employee group plan to join Medicare, you need to go to HR.  You may be fortunate and get the HR professional that provides you with all the information you need to make an informed decision; or you may just be handed a form and be left on your own to make the decision.

Courtesy of pexels.com

Either way, you need to know the questions to ask just in case you aren’t presented with enough information to make a determination best suited for your situation.  Here are some tips:

Changing your Medicare Plan - Should I Stay or Should I Go?

by Marc Manor

For a number of reasons you may be asking yourself if you should make a change to your Medicare Insurance or Prescription Drug Plan.  I am often asked, “what do you think about this company” or “which company is best”?  Because of Centers for Medicare and Medicaid Services (CMS) regulations, I am not allowed to impart my personal opinion in answering these types of questions.  Agents are only allowed to state the facts when it comes these questions and besides, the question should be which plan is best for you in your situation based on your doctors, ongoing medical concerns, and the prescription drugs you are currently taking.  When it comes to Medicare Insurance Plan performance, it’s all in the stars!

Courtesy of pexels.com

Each Medicare Advantage (Part C) and Prescription Drug Plan (Part D) are assigned a star rating by CMS each year.  That is the objective criteria we as agents can use to let you know how that company performs.  The star ratings are assigned using a system of surveys that are compiled using information that is obtained from providers and members, among others.  But star ratings alone are not the only indicator of whether you should make a change or not.  Here are some things to think about before making a change:

What does $9.95 buy in 2019?

By Marc Manor

I was thinking of what I subject I should tackle on this blog and just like a gift from

heaven above, it fell right into my lap.  The TV was on and I heard a familiar celebrity

making a pitch for Life Insurance. His contention was that “price” was the most

important aspect of this guaranteed issue Life Insurance product for which you

“could not be turned down.”  Every example he gave came with a monthly premium

of only $9.95.

Courtesy of pexels.com

I thought this would be a good subject

because, I have had many people trying

to get Life Insurance to cover final

expenses and they are shocked when

I tell them what their monthly premium

would be for $10,000 to $20,000 of

insurance.  Some will say, “I think I’ll

look elsewhere. Mr. Celebrity said

I could get insured for only $9.95”. So, I

decided to run a quote on their website

to see what $9.95 would buy me (using

my age and zip code) to protect my

family in the event of my demise:

$1,214.00 of insurance!  Yes, I would

only have to pay $9.95 but how far would

that $1,214 go?

Let’s take a look at average funeral expenses

according to the National Funeral Directors Association (NFDA) for 2017:

Be Prepared for Long-Term Care with Clear Communication

By Marc Manor

Most of us are horrified as the prospect of being in a position of no longer being able to care for ourselves.  We are horrified for two reasons:  First, we don’t like the idea of not being able to carry out our own “Activities of Daily Living” (commonly known as ADLs) which are those activities required for one to adequately take care of themselves (bathing, bathroom, mobility, dressing, self-feeding etc.); and secondly, we really don’t like the idea of our spouse or children changing our diaper!  

Courtesy of pexels.com

It is hard to imagine ourselves getting to the point where we cannot function on our own, but assisted living and nursing homes are full of people who probably felt the same way just a few short years ago.  The reality is we are all just one accident or illness away from that horrible reality.  Some of us think about how we will handle the possibility of requiring long-term care, yet others don’t seem to think of this as a priority.  As someone who has dealt with this situation for both of my parents, I highly recommend discussing the possibility with those you love and trust and have a plan in case long-term care becomes a reality.  Some of the most well thought out financial and estate plans have been derailed because of long-term care requirements.  Here are some things to consider:

Save $ with the right “Pharm” Team

By Marc Manor

Please forgive me, but as a lifelong sports fan, I always try to squeeze in a sports analogy or pun when I can. If you have seen the movie “Money Ball” and/or you are a baseball fan, you know the importance of a good “Farm” Team System. Major League Baseball teams find young talent and sign them to Minor League Farm Teams to develop them as opposed to signing high priced free agents to help their team win. This is good business for professional baseball and the same holds true for Medicare beneficiaries. In this blog I will explain how Medicare beneficiaries can save money by using the right “pharm” (pharmacy) system to put together a winning team in the medicine cabinet!

Courtesy of pexels.com

Beneficiaries using Medicare Part D benefits have a vast landscape of plans they can choose from. Many Medicare Advantage Plans have Part D Prescription Drug coverage included. So how does one go about choosing the right plan? There are a number of factors, not least of which has to do with what pharmacy they use.

Medicare Prescription Drug Plans frequently contract with certain pharmacies for discounted prices for their prescription drugs. This can make a big difference with how much a beneficiary pays for their drugs on a recurring basis. Usually there are three categories to consider:

Juvenile Life Insurance: The Gift That Keeps Giving!

By Marc Manor

Very few people I talk to insure their children and it can be an uncomfortable subject to bring up. The very thought of losing a child is almost unthinkable. We all know children have lives that can end tragically, but fortunately they rarely do. Because the death of a child is so rare, it makes for the perfect opportunity to insure them. No child I know can pay the premiums, but if their parents or grandparents, take the initiative, they can open a door to financial security for a lifetime.

Courtesy of pexels.com

Now I'm sure little Johnny or Janet would rather see a toy or a puppy under the tree at Christmas. But a life insurance policy stuffed in the stocking can bring an immeasurable amount of happiness throughout their lives. And it is so inexpensive, they can probably still enjoy those toys under the tree from Santa! So, let me tell you why I think Juvenile life insurance is the perfect gift!

Why You Can Rest Easy After Being F'd

By Marc Manor

Usually if you find yourself thinking you've been “F'd” it has a negative connotation; however in the Medicare Supplement world, being “F'd” can leaving you with the ultimate feeling of safety and security when it comes to your healthcare. This is because being “F'd” for the purpose of this article, means you have a Medicare Supplement Plan F. Medicare Supplement or “Medigap” Plan F provides comprehensive coverage and provides maximum flexibility when it comes to your use of medical facilities and providers under Medicare.

Courtesy of pexels.com

Medicare Supplement Insurance is used in conjunction with Original Medicare. This means if you are using Original Medicare and a Medicare Supplement, you have access to any provider or facility that accepts Medicare. Original Medicare pays about 80% of most covered services and Medicare Supplements help pay for those costs not covered. Plan F is comprehensive and will fill the many of the gaps where Medicare leaves you with that 20%. This can be a significant benefit, especially with the high cost of healthcare these days. Let's break down the standard benefits of Plan F: