Medicare Card Fraud: Protect your Identity!

There are so many stories about identity theft in the news lately.  Join Dr. Hulon Crayton, as he shares with you a quick and simple step to protect your identity.

Pictured below is a Medicare card card and a social security card.  We all know that protecting our social security numbers is important.  However, your Medicare card typically has your social security number on it.  In the unfortunate event that your wallet or purse is stolen, the thief not only has your money but now has your personal information that can lead to financial disaster.  An identify thief can take your driver’s license and social security number off your Medicare card and have all the information they need to assume your identity and open lines of credit in your name.

A simple solution to carrying your original Medicare card with your social security number is this.  Make a copy of your Medicare card.  With a black marker, mark through the first 5 numbers leaving only the last 4 numbers visible.  Carry the altered version of your Medicare card with you and place your original Medicare card in a secure location such as a safety deposit box or safe.  When you are required to present your Medicare card to physician’s offices or pharmacies, simply fill in your full Medicare card on the required paperwork. 

This is a quick and simple action for you to take to help protect your identity. 

For more information from Dr. Hulon Crayton with The Arthritis & Infusion Center on arthritis, helpful tips, or on my practice, follow me on Twitter, Facebook or visit my website.

PPO vs. HMO: What’s the difference?

Are you responsible for obtaining your own private insurance policy?  Do you have questions, concerns, and anxiety when it comes to choosing a plan?  Don’t worry, because you are not alone.  Thousands of working and retired Americans are now finding themselves in the market for an individual insurance policy.  The Arthritis and Infusion Center understands that the world of insurance is confusing.  We have set up a few tips to help you navigate you through the process.

What is an HMO?  An HMO (Health Maintenance Organization) is the most common form of managed healthcare.  In this managed care plan, the patient is required to utilize a primary-care physician (PCP) who will oversee all aspects of the patients care.  This physician will be a member of the HMO network.  As necessary, the PCP will refer the patient to a specialist or an outpatient facility for services or treatment.

What are the advantages/disadvantages of an HMO?  The advantage of an HMO is the patient has one physician overseeing the general health and wellness of the patient.  This plan can be very beneficial in ensuring preventative medical care such as yearly wellness exams.  The disadvantage of an HMO is that the patient is required to see in network-physician, therefore removing some of the freedom of traditional plans.  Additionally, in many instances, venturing outside of the “network” for an HMO will result in nonpayment by the carrier. 

A PPO is known as a Preferred Provider Organization and is much different from an HMO.  In the PPO setting, the patient has the freedom to choose any physician and there is no need for primary care physician referrals.  Usually, this type of policy has an annual deductible and coinsurance that the patient is responsible to pay to the treating physician.  Physicians often sign up to become PPO network providers, which is a benefit to the patient.  An in-network physician will accept the negotiated contract payment schedule for the particular insurance company and then the patient is only responsible for the deductible, or coinsurance, of reasonable and customary billed services.  The disadvantage of the PPO plan is that if a patient chooses to see an out-of-network provider, then the patient may be billed for the difference between what the insurance company pays the physician and what the physician actually charges, plus the deductible and coinsurance.  In some cases, there is a separate deductible for out-of-network providers.  Be sure to read the term of your insurance policy for specific information.

Medicare Advantage Plans: What You Need To Know

Medicare Advantage plans are very popular and are a wonderful way to combine three traditional Medicare policies and even add an extra coverage without purchasing a separate policy.  However, be extremely careful when choosing this type of policy.   As with any insurance plan, there are advantages and disadvantages to these particular combined plans.

By definition, Medicare Advantage Plans are a combined Medicare policy that will take the place of traditional Medicare Part A and B and often Medicare Part D.  These plans are offered by a private insurance company that is approved by Medicare, and have a set monthly premium.  Medicare Advantage plans are not supplemental coverage to traditional Medicare.

Medicare Advantage Plans would cover the traditional healthcare cost that are usually covered by traditional Medicare to your doctors, hospitals, and pharmacy.  In many cases you may also purchase additional coverage to include vision, dental, and hearing.  However, keep in mind that additional coverage equals additional premiums. 

There are a few disadvantages to this type of plan.  Here are a few questions you should consider before choosing a policy: 

·    Are you required to choose a physician that accepts, and participates, in Medicare Advantage Plans?

·    Are you required to have referrals to specialists, outpatient or radiology services?

·    Does the policy have a flat copay for physician services, or is there a deductible and coinsurance?
·    What does the prescription policy cover?  Is there a mail-order supply company offered?

·    Am I locked into the policy for a specific amount of time before I can change back to traditional Medicare or switch to a different policy?

·    Am I purchasing this policy from a reputable company with actual patient reviews of their product?

·    Is there a limit on how much this policy will pay out in one year?

There are many more questions that need to be considered before you make such an important decision for your healthcare needs.  The point of this blog is to get you thinking about your current healthcare situation, policy, as well as your future needs.  Take time, ask questions, and get multiple quotes for coverage. 

DEDUCTIBLES: What to Expect January 1st

There are many concerns regarding the cost of healthcare these days. Now it is more important than ever to know the details of your policy and formulate a budget for your healthcare needs. The Arthritis and Infusion Center understands that healthcare language can often be confusing. We have compiled a few of the most commonly used terms that refer to healthcare insurance policies.

Healthcare definitions according to the Medicare website: 

• Assignment - An agreement by your doctor, other health care provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
•  Coinsurance - An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
• Deductible - The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
• Medically Necessary - Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.
• Medicare Approved Amount - In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. 

Typically deductibles renew on January 1st each year. In other words, the slate is wiped clean from the previous year and you are required to pay your annual deductible again. Keep in mind, when making your healthcare budget, often deductibles and coinsurance will be collected at the same time from your provider until the annual deductible is satisfied. Be prepared, before your office visit, with the necessary monetary means to satisfy your obligations at the time of the service.

The Arthritis and Infusion Center is ready to help. If you are unsure of your policy’s deductibles or coinsurance, give us a call and we will be more than happy to help you determine this information. An informed patient is a happy patient.