Posts Tagged - ‘preventative care’

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Healthcare Reform Provisions and Obesity Treatment

Wednesday, September 22nd, 2010

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Tomorrow, several of the earliest provisions of the healthcare reform law will go into effect. Many of these involve preventative care.

The paradox with a lot of health insurance plans is that they typically do not pay for medically supervised diets or nutritional counseling for the overweight and obese. (They may cover gastric bypass or other weight loss surgery, but some patients are not considered morbidly obese enough to be eligible for reimbursement.) However, they will cover the more expensive cost of treating related conditions like type 2 diabetes or sleep apnea when they are later developed.

The legislation looks to change that. Here is how it will change:

  • Recommended preventative care treatments are covered without co-payments or co-insurance percentages for policyholders, including behavioral counseling and obesity screening.
  • Public health initiatives will make calorie counts more visible, making it easier for people to eat healthily and lose/maintain their weight.
  • Comparative effectiveness research will be undertaken to determine if insurers will be required to cover gym memberships, therapy, or special meal programs.
  • An advisory group will look into the effectiveness and risks of weight loss drugs and surgery, possibly requiring coverage of those deemed more effective than harmful.
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Should Health Insurance Plans Cover Gastric Bypass Surgery?

Thursday, September 16th, 2010

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Obesity is a condition that impacts the health of millions of Americans. There are several options in dealing with it: diet and exercise is the most obvious. An increasing number of health insurers are encouraging the former through wellness programs.

However, success rates are relatively low. Some are proposing gastric bypass surgery as a solution. Some health insurance plans cover the $30,000 surgical procedure for the morbidly obese, but others believe that the investment in preventative care. Obese teenagers, especially, are increasingly taking advantage of it.

By no means is surgery a panacea: some people manage to regain all their weight (though fewer than the 95% who do so with diet and exercise), and up to a third of patients have medical complications. Still, in most cases gastric bypass seems to cure type 2 diabetes (which is expensive to treat for many years). The Atlantic‘s Marc Ambinder, himself a gastric bypass patient, speculates that paying for the procedure for all obese Americans would end up costing less than the medical complications associated with obesity. However, it is an extreme option of last-resort, and is an over $30 billion-worth pipe dream.

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ER Visits To Jump With More Health Coverage

Monday, July 5th, 2010

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Most people would assume that an increase in the percentage of those with health coverage would result in fewer people going to the emergency room. After all, they would have primary care doctors and the means to get preventative treatment early. That was actually one of the arguments for health insurance reform.

Unfortunately, it may not turn out that way. ERs are actually likely to become even more crowded! There is a shortage of family physicians that won’t be remedied for years. Medicaid patients–not the uninsured–are the most likely to utilize emergency services.

A preview of what may be coming: emergency room visits increased by 4-7% in Massachusetts after that state passed universal healthcare reform.

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Should Health Insurance Plans Fully Cover Contraception?

Wednesday, June 9th, 2010

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For the most part, health insurance plans do cover contraception, such as birth control pills. However, they are usually subject to co-payments like other medications. In some cases, they are put on a higher, less-essential tier: meaning that the insurer picks up a higher percentage of the cost–for example, a woman may have to pay $25 or $30 to fill the prescription instead of $5 or $10 that she’d be charged for other medications. For people with health savings accounts or other high-deductible plans, the full cost often rests on their shoulders.

Now, doctors and activists are calling for birth control to be fully covered as part of health care plans. After all, paying for those prescriptions is far less expensive than providing prenatal care (which is often sought later when unplanned), and less controversial than abortion. Some believe that the health insurance reform legislation can be interpreted as mandating such coverage by the Department of Health and Human Services, due to an added amendment to the healthcare reform bill.

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Is Iran An Inspiration for Rural Health Care?

Thursday, June 3rd, 2010

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As strange as it may sound, rural areas in the United States are taking cues from the Iranian health care system. Its outcomes (including infant mortality) have improved over the last several decades, as a result of the advent of health houses.

Health houses are run by citizens, and provide preventative care in an informal yet effective manner. They can provide care faster and cheaper than far-away emergency rooms, possibly serving to promote the advent of more affordable health insurance. If more extensive care is needed, the houses have contracts with local hospitals and clinics.

The poor and mostly uninsured population of the Mississippi Delta are looking towards any solution to improve their health outcomes. This particular method can be especially helpful in preventing hospital readmissions, a key goal of healthcare reform. Unfortunately, a health care system that originated in Iran is a hard sell, and supporters have struggled to receive funding.

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Do State or Federal Health Insurance Requirements Apply?

Friday, May 21st, 2010

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The healthcare reform legislation creates a list of mandatory minimum coverage level, which require all health insurance options to cover certain treatments and tests.

However, 27 states and Washington, D.C. have their own coverage mandates, which extend from colon cancer and preventative care to autism therapy. In the case where they conflict, which one holds sway?

Not to worry: the broader standard will apply to health insurance companies in each state, regardless of whether it is state or federal.

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New Health Insurance Plans Must Cover Colonoscopies

Friday, May 21st, 2010

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In many cases, health insurance providers have refused to cover colonoscopies–regardless of their ability to to help diagnose colon cancer.

With the new healthcare reform bill, that will change; at least for newly created health insurance plans. They will be required to fully cover all preventative care procedures classified by the U.S. Preventative Care Task Force as A or B.

However, existing plans are exempt from the requirement. If a colonoscopy exam are important to you, you may be interested in new coverage with plan years that begin after October 1st of this year. Those will not require any cost sharing on your part.

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Health Insurance Reform Brings Free Screening

Monday, April 12th, 2010

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One of the main tenets of affordable health insurance reform is the promotion of preventative care services. To that end, you will no longer be responsible for a co-payment on annual physicals, immunizations, or mammograms. Some people avoid them, either because they are uninsured or cannot afford steadily increasing co-pays.

If you buy a new health insurance plan after this September, the expanded wellness benefits will be included. However, existing plans won’t be upgraded until they make significant changes to their cost structure or other major elements.

This increase in services is expected to result in an eventual decrease in health insurance costs, because preventative care is cheaper than treating an expensive, chronic disease. With more people insured, they will be better able to afford regular checkups.

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Don’t Try This At Home! DIY Operations

Monday, February 8th, 2010

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In these tough economic times, many people are struggling to pay for basic needs. Health care is one of those essentials. For pet owners, Fido or Fluffy is a part of the family, and their health is also a priority. Due to their smaller size and simpler physiology, health care for pets is far less expensive than human health insurance. However, some owners will go to desperate measures when their pets are very sick and uninsured–even if they are not in the pet’s best interest.

A man in Rhode Island was recently arrested for taking matters into his own hands and operating to remove a cyst from his 14-year-old dog’s leg. He was unable to afford a visit to the veterinarian, so he used local anesthetic. Unfortunately, he chose the wrong way to go about treating the Labrador mix. As it turns out, the surgery was completely unnecessary: the cyst was benign, and vets believe that the dog had been feeling no pain from it. What the man did was inexcusable, but it holds some lessons for people.

The dog required a second surgery by medical professionals to reverse the first surgery, which was even more expensive. Do-it-yourself surgery on another person is similarly dangerous. On a more realistic note, skimping on quality and visiting a quack physician–or skipping regular check-ups–to save money will also cost you more in the long run. It is better to save your money for individual health insurance, even if it’s only a catastrophic health plan for emergencies.

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