How might you know it if your thyroid organ hindered creation of thyroid hormone? Then again the a different way, accelerated? What’s more, what are the outcomes, assuming any? For a layman and even specialists, the manifestations are difficult to recognize.
Do you know what to do if things go astray?
A dysfunctioning thyroid organ causes an assortment of bewildering side effects and numerous individuals and specialists botch them for indications of another infection or typical maturing. It is appraisals that more than 12 million Americans have some sort of thyroid infection, huge numbers of whom don’t understand that that is the situation.
Figure out how to comprehend hypothyroidism and hyperthyroidism and how to know whether your thyroid organ is not working as it ought to. So what treatment required catching up if your levels are too high or too low? All through a man’ life, this bustling little organ situated at the base of your neck, just beneath your Adam’s apple and is partitioned into two flaps associated by tissue of a tight scaffold. This
Anyone who watches the news has seen the abundant health care debates – making medical coverage affordable, making it compelling, and making it possible for everyone to be covered. Understanding medical coverage and how health insurance can be of use to you will prompt you to analyze your current health plan or seek information for obtaining medical insurance.
Individuals who admit routine health care know how considerable health insurance is. Routine visits to your family doctor will be of use to identify any underlying medical dilemmas and allow you to seek proper treatment for any medical conditions that arise.
Those who have medical coverage are able to take prescriptions at a discounted rate, often paying only a co-pay which is a critical reduction from the retail cost. Overall, individuals with medical benefits are healthier than those missing coverage because they are able to seek medical attention at the first sign of a problem. Routine health management is considerable for everyone.
If you flip the coin to individuals deprived of health care benefits you see abundant people who live with everyday aches and pains; those who self-medicate and misdiagnose generally serious medical conditions resulting in hefty out of pocket expenses because they hold off going to the doctor. Individuals deprived of coverage are hesitant to seek medical care as they cannot afford a trip to the doctor or emergency room.
The health insurance crisis has acerbated quite a bit of controversy. Many companies have contracted the amount that they contribute to health care benefits making primary care costs a major expense for families and even single individuals. Some say health is a fundamental while others have considered it as a luxury.
Knowing how health insurance can be of use to you in a time of need is certainly worth considering getting coverage, especially if you have children. If you don’t currently have medical coverage acquire some time to examine your options. It is far greater to have coverage and not demand it than to need it and not have it.
The truly viable hostile to maturing nourishment or eating regimens are new natural products, vegetables particularly red vegetables, Red vegetables contain an assortment of helpful vitamins and supplements. Lycopene and anthocyanidins, two intense cancer prevention agents, are available in numerous red vegetables. Red vegetables, for example, tomatoes, peppers and beets, entire grain and nourishment containing high measure of fiber. Sleek fish is exceedingly prescribed hostile to maturing specialists with taking after advantages.
How many of us crave for that early morning cup of tea or coffee as soon as possible after the eyelids open? Whats the attraction?…Its probably that the early morning mouth is so dry it desperately needs a liquid. The first thought is to put the kettle on and have a quick brew, and that caffeine appears to help the mind get into gear and it gives you a kick start for the day.
Now, Im not suggesting that you give up your cuppa, but maybe just delay it a little. Why?- Because if theres an alternative that potentially gives you heaps more health benefits and you will still have that feeling of mind and body burst that caffeine can seem to give you Then why not give it a try?…
I have actually applied the following to my own lifestyle and its my find of 2014! Certainly pushes back my first tea by a couple of hours. So Im continuing into 2015 with this light start to the day.
1. OK, so first thing, grab that glass, go up to the watercooler (more and more homes now have one), and pour a glass of room temperature water and down it in one. It may seem odd at first when you are used to that caffeine hit but it shouldnt give you the Yuk feeling that, say me asking you to drink a double whisky, or diet coke would, and of course a glass of plain water is the perfect solution for the dry mouth syndrome!
Once youve had that first watercooler drink, the mouth wont be dry and you may not be quite as desperate for that cuppa.
2. So, to try delaying that caffeine kick even longer and push those health boundaries a little further. Refill the glass from the watercooler, grab a lemon from the fruit bowl, cut it in half and squeeze half of the lemon juice (if you weigh over 150lbs, squeeze the whole lemon) into the water and plonk the remaining lemon in too. Put it in the microwave and just heat it gently on the Max setting for 45 seconds (make sure you dont overheat as it will ruin the vitamin C). (A slice of fresh root ginger with a squeeze of lime is great too).
3. Drink this slowly and let that lemon cleanse the innards!
4. After you have finished, rinse the mouth with a little water to dilute the citric acid, as this is the only area that you want the lemon lingering, as its not great for teeth.
For this reason, make this a once-a-day drink… certainly not something to sip throughout the day.
There are loads of benefits of Lemon Water;-
1. It contains good things, including Vitamin C, B-Complex Vitamins, Iron, Magnesium and Potassium which all adds to the trace minerals that are already present in the water if youre using a Natural Mineral Water or Spring Water. I find it aids digestion and makes one feel cleansed!
2. It can help freshen the breath.
3. The antioxidants in a lemon as part of a healthy diet can contribute to decreasing blemishes and maintain your skins radiance.
4. Lemons contain Vitamin C which can help ward off colds.
And lastly, it gives a fantastic energy boost, for me at least! You may just find that by following the above health tip, you will be surprised how great you will feel, and how the urge for a cup of tea or coffee subsides. By the time a couple of hours go by you will be then ready for your first cuppa of the day, and it will taste even better knowing youve had a lemon detox beforehand!
It?s hard to fathom anyone who would be willing to risk injury, his or her health or even life just for a job. Management and employers have a big influence on managing risks and it doesn?t mean just because a job is dangerous, it?s no longer needed to address the workplace health risks involve. We?re talking about human beings here and being safer only leads to good things such as increased savings later on and better workplace moral.
One of the most basic and fundamental of any workplace health practice is having it free from common workplace hazard. Workplace hazards vary from one working environment to another. Mechanical, chemical and even biological hazards are present in most workplaces.
Working environments like inside a manufacturing plant can be damp, wet and slips can be a common thing. The severity of the injury depends on mostly how the accident happens. Mechanical hazards are fairly easy to spot so company should not have a hard time preventing these from tarnishing workplace health record.
There should always be signs on places where it is slippery or dangerous. Another example is restricting dangerous areas to only the people that are meant to be there. Each and every single one of these workplace health measures to reduce risk and eventually eliminate it altogether.
Everywhere around us we see chemicals and mixtures of chemicals. Some chemicals can be inert and non-reactive while other chemicals are extremely volatile. Thus, the risks of chemical hazards on workplace health are different for each one.
Each and every single chemical in any workplace, whether the office, manufacturing plant or any other place should be identified and catalogue as well as made available the material safety data sheet for each one, as this is the single most important step in reducing workplace health risks. MSDS are a great resource to keep in reach and near the chemicals. Moreover, companies should educate their employees first and foremost on the proper handling and storage procedure of each chemical.
Moving on, we have the most complicated types of hazards in the form of viruses, bacteria, molds and fungus, pathogens, diseases like tuberculosis and so forth. No matter where you work, biological workplace health hazards are present everywhere. One more reason why biological hazards are hard to manage is their ability to travel from place to place.
Education is the first step to prevention, therefore educating employees in the proper sanitary conditions in the workplace is one of the easiest ways in preventing diseases to affect people. Some examples of basic practices are covering one?s mouth when sneezing, cleaning up after one?s self, all these impact workplace health. Companies should sponsor or at the least require employees to get regular or yearly checkups to mitigate diseases from infecting and taking a toll on the workforce.
Making the staff more aware of the risks involved in the workplace is more helpful for the company instead of constantly trying to eradicate the risks. The workplace is safer once staff and employees know and can identify the risks at the workplace. Lastly, prevention is the best medicine and all workplace health issues lie ultimately on the individual.
What makes you interested to a person in the very first sight? Is that the looks? The hair? Or directly the personality that you count on the most? Well for most of the people, it is neither the looks nor the way on talks but the way he or she smiles. Smile has been one of the most important parts of the first impression from one person to another, we can say it gives first judgment whether the person is friendly or not. Knowing that smile is one of the most important features in ones personality and appearance, surely we will not take the least treatment for our dental health.
Anywhere you live, there must be one or two best dentists that you can trust for your mouth and dental health, but if you are living around Orange Park Florida you don’t need to look far for the great dentist and prosthodontist. that we will be talking about is dr. Matthew Nawrocki. Not only having the professional work as dentist, dr. Nawrocki is also dealing with the aesthetic caring for your teeth. As a prosthodontist, he cares about the aesthetic replacement and restoration of teeth.
dr. Nawrocki and his staffs understand how important a smile for many people, so if you have problem with your teeth, maybe chipped teeth, or broken teeth, you will be offered a full caring with series of treatment you can choose, for example the porcelain veneers or crowns. Other treatments that may be also works for you and your family member’s teeth problem are dental implant, dentures and bridges. All kind of treatment will be suited according to your need. Feel free to come to their clinic in Orange Park, Florida, or you can reserve place via online for scheduling an appointment.
The lifestyle of the working professionals in today’s era is different than what it used to be earlier and is more hectic. They work for extended hours. These extended working hours and sitting longer at their work stations are taking a physical toll on their body. The common problems encountered by the work force due to this kind of lifestyle are back aches, computer vision syndrome CVS, wrist pains, neck and shoulder pains or many other long term ill effects. The lack of time in everyone’s life is leading to reliance on fast food which is conveniently available instead of home-cooked food, similarly vegging out on the couch despite of going out for a walk. However, contrary to what most people think, eating well and staying physically active can be incorporated into the daily routine of working section of the country.
Now that you have realized the importance of staying fit and keeping your body in perfect shape, it is important for you to know the right way of doing it. Below are some health and fitness tips that will help working people discover ways to maintain a better and healthy lifestyle, and that will keep them away from common physical ailments;
As exercising offers so many benefits, make it a part of your routine even if you are at work. If your office is located nearby your home, you can take a walk to reach to your office. If you are inside the office, use stairs instead of using lift.
During work, take several 5-10 minutes of break at regular interval for just a walk or for quick run up and down the stairs. This helps keep the body fit, and mind rejuvenated.
Sitting at stretch in front of computers can be hard on the body. So standing up and stretching your body after every short interval will remove the occurrence of common problems like back ache and shoulder pain.
You can carry workout clothes with you while going to office so that after you leave office you can straight away go to the gym without the need of going home to carry your stuff. This will save your time and this saved time can be utilized in the exercise.
You should keep an option with you to be healthy and fit. Keep healthy snacks with you so that when you feel like eating anything you have an energy booster in front of you. Also sipping water throughout the day is a good way to keep yourself refreshed.
Just do not forget the need of stretching your body for two minutes after every hour of work. You can also set an alarm to go off every hour to remind yourself to stand up and move around.
As you know exercising helps in keeping you fit, you should not avoid it in any case even if you work for extended working hours or if you don’t get time. It’s time to work for staying fit, not for making excuses.
Get ready for Your Child’s First Dental Appointment
Is it accurate to say that you are pondering when it would be the ideal time to take your youngster to the dentist’s? Is it when their first tooth develops, or when they praise their first birthday? The following are a few tips that you can use to make your tyke’s first dental experience a win.
At the point when the First Tooth Emerges
The best time to visit the dental practitioner is the point at which your youngster’s tooth first rises, and this is on account of a child’s tooth is exceptionally defenseless to rot at that age. Dental visits from a youthful age will help the teeth stay sound up until the point they are prepared to turn out and be supplanted with perpetual teeth.
Most guardians don’t know about the way that your child’s teeth ought to be brushed when they rise. This is a practice that ought to be empowered. There are different delicate swarmed toothbrushes that are alright for use on infants.
Lessons on Teeth
Thankfully, youngsters at a youthful age affection to investigate and find out about new things. This would be an extraordinary time to acquaint them with their teeth and show them of their significance. Amid this time, you can likewise educate your minimal one about how to clean and watch over their teeth. Once your tyke is OK with his/her mouth then their first visit will be simple.
All together for your kid to need to take in more about their teeth, you have to make brushing their teeth a gathering action. They will have a ton of fun on the off chance that they get the chance to do it with “mother” and “father” and their more seasoned kin. It is imperative for you to comprehend that in as much as little children may emulate the movements you make, at last, you will even now need to brush their teeth for them, to guarantee that it is done well. In any case, what makes a difference, is that they feel included. On the off chance that you find that your youngster is not open to brushing their teeth then, you can attempt to make it a positive part of their day by catching up the action with an amusement. They can then partner brushing their teeth with a fun and positive thing.
Manufacture a Positive Attitude
You would be amazed to know exactly how discerning youngsters are. On the off chance that you make a scowl at whatever point you specify the dentist’s, then your youngster will figure out how to relate setting off to the dental specialists with something negative and offensive. Discover approaches to educate your tyke about what goes ahead at the dental specialist, why it is vital to timetable customary registration and even go for dental visits. These visits will help your kid get usual to finding out about the different sounds that he/she will hear at the dentist’s. Odds are, the point at which your tyke comes in for his/her arrangement, he/she won’t be threatened by the different machine sounds.
Pick a Dental Practice You Trust
Pick a practice that is near your home that takes into consideration adaptable planning, and has an empathetic and kid agreeable staff.
Hearing that you have cancer is a physical and emotional burden. There are many different concerns about prostate cancer, treatment, eradication of the disease, and any aftereffects such as erectile dysfunction or incontinence. Although prostate cancer is not generally a fast-progressing disease, it still needs to be taken care of quickly. If you want to learn more about prostate cancer laser treatment, visit this website.
What Is Laser Treatment for Prostate Cancer?
Using high intensity focused ultrasound, the cancer is destroyed without damaging the surrounding tissue. The sound waves heat the cancerous tissue to about 90 degrees Celsius, (194 degrees Fahrenheit). It’s much like the sun’s rays through a magnifying glass to start a fire. The patient is given an epidural during the treatment. Using today’s imaging technology, the doctor can pinpoint the area that will be targeted. Depending on the size of your prostate, the treatment takes about one to four hours.
Do You Have Questions?
As with any treatment option for your cancer, you probably have many questions. This procedure is generally a one-time thing. It’s most effective when the cancer is localized to the prostate gland and is still in its early stages, but the treatment is non-ionizing, which means it can be redone should the cancer return. Unlike radiation, other treatment options can be performed after laser treatment. You really have to discuss this option with a doctor who specializes in prostate cancer laser treatment to know if you fit all the requirements.
Prostate laser cancer treatment was envisioned back in the 1940s, but the technology to target the prostate gland was not available yet. It wasn’t until the 1990s when ultrasound technology advanced enough to allow doctors to determine if the modality would work. Since that time, it’s been used on about 6,000 men around the world with success.
One other concern with the laser treatment is how the urethra is affected, because it does run through the center of the prostate. The urethra is a different type of tissue than the gland itself. Imaging technology lets the technician avoid the sphincter and bladder neck during the treatment which are vital to urinary continence.
Benefits of Prostate Cancer Laser Treatment
The advantage to prostate cancer laser treatment over traditional treatment therapies is that it only takes about one afternoon. The recovery time is minimal compared to surgery, chemotherapy, or radiation, because it is non-invasive. You are given a spinal anesthesia, an epidural, to manage your comfort during the procedure. Typically, you will be up and walking around just a few hours after the treatment. You should probably rest a couple of days before resuming your normal lifestyle.
Learn More When You Talk to Your Healthcare Provider
Of course, you have to discuss your treatment options with your doctor. Ask about prostate cancer laser treatment to see if it can treat your body. Making a decision with all the information you need makes it easier to know if you’re doing the right thing for your own health. Feel better about your wellbeing when you’ve gotten enough information to choose what’s best for you.
With each passing year we are getting older and no one can stop this process. As we age, we all can clearly see that our physical features change a lot compared to what we used to have a few years ago. Sometimes, the ageing process doesn’t slow down, no matter how much we eat healthy and exercise.
To deal with the problem of ageing process, one of the best ways is to consider cosmetic surgery. You can visit a renowned cosmetic surgery clinic in Mumbai and consult the best cosmetic surgeon in Mumbai to know more about various surgical options available.
Here are 5 things which play a pivotal role in slowing down the ageing process. Have a look.
Fresh Fruits & Veggies: There’s simply no doubt that huge amount of benefits are provided by fruits and vegetables. Antioxidants in leafy greens, blueberries, carrots, tomatoes, etc. stop molecules from harming healthy skin cells.
Most of the expert doctors suggest that we should intake around 5 to 10 servings of fruits and vegetables every day. Ageing process can be slowed down with help of antioxidants such as zinc, beta-carotene and vitamin C. So make sure you’re getting the required amount every day.
Sleep: We often fail to realize the fact that sleep is really crucial for your health physical and mental health. You might become sleep deprived if you’re working all day & night without getting proper sleep. At least eight hours sleep is highly recommended by expert healthcare officials. Without proper sleeping time, one might develop many diseases also.
Physical Exercise: Studies have suggested that exercising regularly helps to acquire stamina, strength in muscles, density and balance in the bones. After exercising you’ll feel a great level of fitness and revitalization in your body. With each workout your health will become better!
Dairy Products: Calcium and vitamins in dairy products are the main source to get stronger bones and play a significant role to prevent osteoporosis. Many people don’t like to consume dairy products dairy products, so in that case you can go for other foods that have calcium and vitamins (especially Vitamin D). Some of these alternatives are cereals, soy milk or almond milk.
Sun: With this tip, you need to stay careful as it might prove to be a bit risky. Sun exposure is necessary as it has benefits like Vitamin D, but Overexposure to the harmful ultra-violet rays from the sun can be quite dangerous. If you’re planning to stay outside for long then use a good sunscreen lotion or cream to protect your skin. Sun provides the much needed Vitamin D to our body.
You know how important it is to have health coverage when you you have been sick or injured. But if you’re confused about what kind is best for you, you’re not alone.
If your employer offers you a choice of health plans, what should you know before making a decision? What types of health coverage are available? In addition to coverage for medical expenses, do you need some other kind of insurance? What if you are too ill to work? Or, if you are over 65,will Medicare pay for all your medical expenses?
These are questions that today’s consumers are asking; and these questions aren’t necessarily easy to answer.
This booklet should help. It discusses the basic forms of health coverage and includes a checklist to help you compare plans. It answers some commonly asked questions and also includes thumbnail descriptions of other forms of health insurance, including hospital-surgical policies, specified disease policies, catastrophic coverage, hospital indemnity insurance, and disability, long-term care, and Medicare supplement insurance.
While we know that our guide can’t answer all your questions, we think it will help you make the right decisions for yourself, your family, and even your business.
Making Sense of Health Insurance
The term health insurance refers to a wide variety of insurance policies. These range from policies that cover the costs of doctors and hospitals to those that meet a specific need, such as paying for long-term care. Even disability insurance – which replaces lost income if you can’t work because of illness or accident – is considered health insurance, even though it’s not specifically for medical expenses
But when people talk about health insurance, they usually mean the kind of insurance offered by employers to employees, the kind that covers medical bills, surgery, and hospital expenses. You may have heard this kind of health insurance referred to as comprehensive or major medical policies, alluding to the broad protection they offer. But the fact is, neither of these terms is particularly helpful to the consumer.
Today, when people talk about broad health care coverage, instead of using the term “major medical,” they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans. Moreover, you’ll also hear about specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans.
While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences that will make one or the other form of coverage the right one for you.
The section below is designed to acquaint you with the basics of fee-for-service and managed care plans. But remember: The detailed differences between one plan and another can only be understood by careful reading of the materials provided by insurers, your employee benefits specialist, or your agent or broker.
This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service rendered to the patient – you or a family member covered under your policy. With fee-for-service insurance, you go to the doctor of your choice and you or your doctor or hospital submits a claim to your insurance company for reimbursement. You will only receive reimbursement for “covered” medical expenses, the ones listed in your benefits summary.
When a service is covered under your policy, you can expect to be reimbursed for some, but generally not all, of the cost. How much you will receive depends on the provisions of the policy on coinsurance and deductibles. Here’s how it works:
The portion of the covered medical expenses you pay is called “coinsurance.” Although there are variations, fee-for-service policies often reimburse doctor bills at 80 percent of the “reasonable and customary charge.” (This is the prevailing cost of a medical service in a given geographic area.) You pay the other 20 percent – your coinsurance. However, if a medical provider charges more than the reasonable and customary fee, you will have to pay the difference. For example, if the reasonable and customary fee for a medical service is $100, the insurer will pay $80. If your doctor charged $100, you will pay $20. But if the doctor charged $105, you will pay $25. Note that many fee-for-service plans pay hospital expenses in full; some reimburse at the 80/20 level as described above.
Deductibles are the amount of the covered expenses you must pay each year before the insurer starts to reimburse you. These might range from$100 to $300 per year per individual, or $500 or more per family. Generally, the higher the deductible, the lower the premiums, which are the monthly, quarterly, or annual payments for the insurance. Policies typically have an out-of-pocket maximum. This means that once your expenses reach a certain amount in a given calendar year, the reasonable and customary fee for covered benefits will be paid in full by the insurer. (If your doctor bills you more than the reasonable and customary charge, you may still have to pay a portion of the bill.) Note that Medicare limits how much a physician may charge you above the usual amount. There also may be lifetime limits on benefits paid under the policy. Most experts recommend that you look for a policy whose lifetime limit is at least $1 million. Anything less may prove to be inadequate.
The major types of managed care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.
Managed care plans generally provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan. In managed care plans, instead of paying separately for each service that you receive, your coverage is paid in advance. This is called prepaid care.
For example, you may decide to join a local HMO where you pay a monthly or quarterly premium. That premium is the same whether you use the plan’s services or not. The plan may charge a copayment for certain services – for example, $10 for an office visit, or $5 for every prescription. So, if you join this HMO, you may find that you have few out-of-pocket expenses for medical care – as long as you use doctors or hospitals that participate in or are part of the HMO. Your share may be only the small copayments; generally, you will not have deductibles or coinsurance.
The interesting things about HMOs is that they deliver care directly to patients. Patients sometimes go to a medical facility to see the nurses and doctors or to a specific doctor’s office. Another common model is a network of individual practitioners. In these individual practice associations (IPAs), you will get your care in a physician’s office.
If you belong to an HMO, typically you must receive your medical care through the plan. Generally, you will select a primary care physician who coordinates your care. Primary care physicians may be family practice doctors, internists, pediatricians, or other types of doctors. The primary care physician is responsible for referring you to specialists when needed. While most of these specialists will be “participating providers” in the HMO, there are circumstances in which patients enrolled in an HMO may be referred to providers outside the HMO network and still receive coverage.
PPOs and POS plans are categorized as managed care plans. (Indeed, many people call POS plans “an HMO with a point-of-service option.”) From the consumer’s point of view, these plans combine features of fee-for-service and HMOs. They offer more flexibility than HMOs, but premiums are likely to be somewhat higher.
With a PPO or a POS plan, unlike most HMOs, you will get some reimbursement if you receive a covered service from a provider who is not in the plan. Of course, choosing a provider outside the plan’s network will cost you more than choosing a provider in the network. These plans will act like fee-for-service plans and charge you coinsurance when you go outside the network.
What is the difference between a PPO and a POS plan? A POS plan has primary care physicians who coordinate patient care; and in most cases, PPO plans do not. But there are exceptions!
HMOs and PPOs have contracts with doctors, hospitals, and other providers. They have negotiated certain fees with these providers – and, as long as you get your care from these providers, they should not ask you for additional payment. (Of course, if your plan requires a copayment at the time you receive care, you will have to pay that.)
Always look carefully at the description of the plans you are considering for the conditions of payment. Check with your employer, your benefits manager, or your state department of insurance to find out about laws that may regulate who is responsible for payment.
Your employer may have set up a financial arrangement that helps cover employees’ health care expenses. Sometimes employers do this and have the “health plan” administered by an insurance company; but sometimes there is no outside administrator. With self-insured health plans, certain federal laws may apply. Thus, if you have problems with a plan that isn’t state regulated, it’s probably a good idea to talk to an attorney who specializes in health law.
HMOs, PPOs, and fee-for-service plans often share certain features, including pre authorization, utilization review, and discharge planning.
For example, you may be asked to get authorization from your plan or insurer before admission to a hospital for certain types of surgery. Utilization review is the process by which a plan determines whether a specific medical or surgical service is appropriate and/or medically necessary. Discharge planning is an approach that facilitates the transfer of a patient to amore cost-effective facility if the patient no longer needs to stay in the hospital. For example, if, following surgery, you no longer need hospitalization but cannot be cared for at home, you may be transferred to a skilled nursing facility.
Almost all fee-for-service plans apply managed care techniques to contain costs and guarantee appropriate care; and an increasing number of managed care plans contain fee-for-service elements. While the distinctions among plans are growing increasingly blurred, the number of options available to consumers increases every day.
How Do I Get Health Coverage?
Health insurance is generally available through groups and to individuals. Premiums – the regular fees that you pay for health insurance coverage – are generally lower for group coverage. When you receive group insurance at work, the premium usually is paid through your employer.
Group insurance is typically offered through employers, although unions, professional associations, and other organizations also offer it. As an employee benefit, group health insurance has many advantages. Much – although not all – of the cost may be borne by the employer. Premium costs are frequently lower because economies of scale in large groups make administration less expensive. With group insurance, if you enroll when you first become eligible for coverage, you generally will not be asked for evidence that you are insurable. (Enrollment usually occurs when you first take a job, and/or during a specified period each year, which is called open enrollment.) Some employers offer employees a choice of fee-for-service and managed care plans. In addition, some group plans offer dental insurance as well as medical.
Individual insurance is a good option if you work for a small company that does not offer health insurance or if you are self-employed. Buying individual insurance allows you to tailor a plan to fit your needs from the insurance company of your choice. It requires careful shopping, because coverage and costs vary from company to company. In evaluating policies, consider what medical services are covered, what benefits are paid, and how much you must pay in deductibles and coinsurance. You may keep premiums down by accepting a higher deductible.
Many people worry about coverage for preexisting conditions, especially when they change jobs. The Health Insurance Portability and Accountability Act (HIPAA) helps assure continued health insurance coverage for employees and their dependents. Starting July 1, 1997, insurers could impose only one 12-month waiting period for any preexisting condition treated or diagnosed in the previous six months. Your prior health insurance coverage will be credited toward the preexisting condition exclusion period as long as you have maintained continuous coverage without a break of more than 62 days. Pregnancy is not considered a preexisting condition, and newborns and adopted children who are covered within 30 days are not subject to the 12-monthwaiting period.
If you have had group health coverage for two years, and you switch jobs and go to another plan, that new health plan cannot impose another preexisting condition exclusion period. If, for example, you have had prior coverage of only eight months, you may be subject to a four-month, preexisting condition exclusion period when you switch jobs. If you’ve never been covered by an employer’s group plan, and you get a job that offers such coverage, you may be subject to a 12-month, preexisting condition waiting period.
Federal law also makes it easier for you to get individual insurance under certain situations, including if you have left a job where you had group health insurance, or had another plan for more than 18 months without a break of more than 62 days.
If you have not been covered under a group plan and have found it difficult to get insurance on your own, check with your state insurance department to see if your state has a risk pool. Similar to risk pools for automobile insurance, these can provide health insurance for people who cannot get it elsewhere.
What Is Not Covered?
While HMO benefits are generally more comprehensive than those of traditional fee-for-service plans, no health plan will cover every medical expense.
Very few plans cover eyeglasses and hearing aids because these are considered budgetable expenses. Very few cover elective cosmetic surgery, except to correct damage caused by a covered accidental injury. Some fee-for-service plans do not cover checkups. Procedures that are considered experimental may not be covered either. And some plans cover complications arising from pregnancy, but do not cover normal pregnancy or childbirth.
Health insurance policies frequently exclude coverage for preexisting conditions, but, as explained, federal law now limits exclusions based on such conditions.
You should also remember that insurers will not pay duplicate benefits. You and your spouse may each be covered under a health insurance plan at work but, under what is called a “coordination of benefits” provision, the total you can receive under both plans for a covered medical expense cannot exceed 100 percent of the allowable cost. Also note that if neither of your plans covers 100 percent of your expenses, you will only be covered for the percentage of coverage (for example, 80 percent) that your primary plan covers. This provision benefits everyone in the long run because it helps to keep costs down.
A Final Word
If you get health care coverage at work, or through a trade or professional association or a union, you are almost certainly enrolled under a group contract. Generally, the contract is between the group and the insurer, and your employer has done comparison shopping before offering the plan to the employees. Nevertheless, while some employers only offer one plan, some offer more than one. Compare plans carefully!
If you are buying individual insurance, or any form of insurance that you purchase directly, read and compare the policies you are considering before you buy one, and make sure you understand all of the provisions. Marketing or sales literature is no substitute for the actual policy. Read the policy itself before you buy.
Ask for a summary of each policy’s benefits or an outline of coverage. Good agents and good insurance companies want you to know what you are buying. Don’t be afraid to ask your benefits manager or insurance agent to explain anything that is unclear.
It is also a good idea to ask for the insurance company’s rating. The A.M. Best Company, Standard & Poor’s Corporation, and Moody’s all rate insurance companies after analyzing their financial records. These publications that list ratings usually can be found in the business section of libraries.
And bear in mind: In some cases, even after you buy a policy, if you find that it doesn’t meet your needs, you may have 30 days to return the policy and get your money back. This is called the “free look.”