All posts by Debbie Sears

What Is Fair?

Health Care Reform, , , , , ,

As we all have our feelings on this matter (and my position is to respect all views) our elected Governor is operating on an “elected by the people” position and what we may not realize is that if he would have gone the other way, we would have a federal subsidy that would be entitlement (starting with 150,000 people and going rapidly) lasting for four years. Then the federal subsidy would end and we would have all of the financial burden to pay…raising our taxes…where does this end??? Other states share his sentiment.

Also, he is asking for volunteers on the State payroll to pay for 20% of their premium. Presently the State employees’ premium is provided 100%. Polk County Board of Supervisors recently approved a contribution to their cost of an approximate $25 per month. The true cost is around $1100 per month for family plans. The employer is mandated to pay 50% of the employee premium for any business. How could the employer pay 50% of the premium, increased taxes for the uninsured to have more entitlement and still stay in business?

Governor Branstad is trying to bring our jobs back. He is trying to make us healthier (Blue Zones and Healthiest State Initiative). Somewhere in this struggle we all have to come to the table and be fair. There must certainly be a balance between free and 100%.

 

Health Insurance Open Enrollment For Children up to Age 19

Group Health Insurance, Health Insurance, Healthcare updates,

From July 1 through August 14, 2012, children under the age of 19 can apply for child-only policies or be added as dependents to existing family policies as long as they are not enrolled in or eligible for other coverage. Other coverage does not include HIPIOWA, HIPIOWA-FED, Medicaid, or hawk-i.

When applying during this open enrollment period, qualifying children cannot be turned down or have coverage for certain conditions limited or excluded because of any pre-existing medical conditions.

Learn More…

Information for Teens and Tanning Beds

Cancer

As summer quickly approaches we all have a desire to be in the sun – it feels good – our tans always look good – we think that appearance makes us look youthful, attractive and full of energy but the real truth is not as pretty.

Research has proven many times over that the damage we get as a child comes back to haunt us in our later years. Skin cancer sounds so innocent. Go in, have a spot burnt off and forget it. It just simply is not that easy.

There are different kinds of skin cancer. The least invasive is referred to as basal cell. This is usually treated with a “burning off” of the site and it is considered done. Another treatment is called a “Mohs” procedure that entails a surgical removal. This can be very invasive and can involve stitches and plastic surgery. The most threatening cancer is melanoma. This can end one’s life. Until the lab results are complete it is not necessarily easy to determine “if you got it all”.

My experience with my husband, extremely blonde and blue eyed, has been a 35 year journey so far. I am attaching some links here that further explain this ongoing medical nightmare. Please do not take this lightly. Once the problem starts, seldom does it end. Most of our health issues we have some degree of control over and some are genetic. In this case we could be dealing with both. My intent is to create awareness so that we can best protect ourselves and our children. Education is our best defense.

National Men’s Health Week – Men’s Health IS A Family Issue

Healthcare updates,

The purpose of Men’s Health Month is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. This month gives health care providers, public policy makers, the media, and individuals an opportunity to encourage men and boys to seek regular medical advice and early treatment for disease and injury. The response has been overwhelming with thousands of awareness activities in the USA and around the globe.

To quote Congressman Bill Richardson (Congressional Record, H3905-H3906, May 24, 1994): “Recognizing and preventing men’s health problems is not just a man’s issue. Because of its impact on wives, mothers, daughters, and sisters, men’s health is truly a family issue.”

We encourage all men and women to be aware of the screenings that are available and please schedule them regularly. What a great gift for Father’s Day…schedule the necessary routine screenings…prevention can save lives. Here’s a screening schedule for men of all ages from Wellmark.

Want to be Skinny and Happy all at the same time?

Health Insurance

Dan Buettner has discovered a beautiful place that I would like to share with you. San Luis Obispo is beautiful and the people are happy. Some of the simplest things can reduce the stress of daily life. Check out the green spaces and the no drive-up fast foods, etc. I think this could be interpreted as “slow down and smell the flowers”. Our mind, body and spirit should be in sync to ensure happy and long lives.

I have noticed in taking applications for all types of insurance, health, life, disability, dental, etc. that the folks with appropriate height/weight (or BMI) were the happiest people. I think that without a doubt some of that can be attributed to the fact that they usually have less health problems. So my goal is not only to be skinny but to be HAPPY!

Is there anything cuter than a baby’s smile…want to keep it that way???

Dental health, SMILES

Pediatric Dentistry is a very important part of a child’s overall health. News from a government survey wasn’t as good for the nation’s littlest mouths. The number of cavities in the baby teeth of children ages 2 to 5 increased by nearly 5 percent between 1988 and 2010.

Healthy teeth are important to your child’s growth and development. They help your child eat right, talk properly, and feel good about his/her smile. Baby teeth hold space for permanent teeth and assist in the development of the bones in the face and jaws. Keeping baby teeth healthy can also save children from the pain of a cavity—and from stress caused by the dental visit it may require. 

Ask me to add dental insurance to your health plan. It is low premium and offered by Delta Dental of Iowa. Please check out the Sun, Sand and Smiles Contest offered by Delta Dental of Iowa.

What is the Big Deal About Centers of Excellence? Part II

Health Insurance

Read Part I of this post here.

Dan is the typical “blue eyed blonde”. He has had a 30 year history of basal cell skin cancer. His mother had the same situation and four of his five children are now diagnosed and have received treatment! What started as a very small “bump” under his left jaw was a squamous cell skin cancer. This did not hurt, did not have any color and could have very easily been ignored. Don’t ignore your body if it is telling you something is different than a norm for you! His dermatologist that he has used for over 30 years sent him to an ENT for a biopsy and was then referred to a local oncologist/hematologist. After many tests and about three weeks came the answer… A Death Wish.

Dan was diagnosed as Stage 4, bi-lateral cancer of the lungs – inoperable/terminal with 4 to 6 months left. This was July 2008. In the upcoming months ahead, the youngest daughter was to be married at St. John’s Church, Creighton campus; we had to develop a strategy to tell five children, twelve grandchildren and five great-grandchildren and the legal work needed an immediate review. Dan was scheduled to receive chemotherapy starting the following week.

We took the next day to analyze our situation along with a very dear family friend (our doctor since I was a teenager – just yesterday!) and our loyal attorney. There was just something about this that was not right. Our doctor asked us to please do not take treatment, go to University of Texas, MD Anderson Cancer Center, Houston, TX. I immediately made a self-referral, confirmed insurance and off we went. We had 12 round trips to Houston in 2 yrs – travel expenses compare to the cost of a new car…vs. life – no big deal. Out of pocket medical expenses were $124 –near $1,000,000 costs incurred!

End result – NO lung cancer at all – no lung biopsy had been done here! Dan had extensive head/neck surgery, walked the daughter down the aisle, and went back to Houston for six weeks of chemotherapy and radiation. He has no facial nerve damage and has resumed life as he knew his “norm” to be. All checkups are good. Amazing!!!

Moral of the Story – Don’t sell yourself short by carrying “bargain” insurance – always get a second opinion outside of the state that you reside – go to a center of excellence for your “specific” diagnosis rather than a “general” hospital.

Your health and your dollars are precious – call me for a free consultation! The right “fit” for you and your health insurance makes a difference!

What is the Big Deal About Centers of Excellence? Part I

extended illness or injury, Health Insurance

A government-defined Center of Excellence, beginning in the mid-1960s, is a facility or organization that creates healthcare value above the average found in a specific location. In the late 1990s, the US Health Care Financing Administration (HCFA) began to examine and compare treatment outcomes among hospitals paid by Medicare. Other divisions of government as well as the private sector have developed their own systems for rating and/or developing Healthcare Centers of Excellence.

As an example, The United States Federal Government established national centers of excellence in health care in the 1990s through their Department of Health and Human Services. Since that time, other new systems of Centers of Excellence have emerged, including a system of medical centers under the supervision of the US Veterans Administration and a system developed by insurance companies. Other systems exist as well and the healthcare consumer is wise to investigate the history, development, and certification rationale for any medical or healthcare “center of excellence.” They are not all the same.

By exploring this option, my husband, Dan is alive. I have a duty to share our story with each and every one of you. The lessons that we learned through his journey in 2008 have already made a difference not only to our family but several friends and clients. We learned the genetic patterns for family health history and the cutting edge of what may be in the future for our children and grandchildren. They also now have valuable resources that they may not have discovered on their own.

Stay tuned for Part II where I share our story.

It’s All About Prevention – Part 2

Health Insurance, Healthcare updates, ,

Click here to read Part 1.

What is the difference between a health maintenance exam and a well-female exam?

A health maintenance exam is a complete physical, including:

  • Health history
  • A review of all health and lifestyle risk factors
  • An exam of all systems including cardiovascular, respiratory, neurological, musculoskeletal, reproductive and behavioral
  • Laboratory studies appropriate for age, risk and sex
  • Discussion of recommended lifestyle changes.

These exams are recommended every five years from ages 18-39, every 2-3 years from ages 40-49, and every 1-2 years for ages 50 and over.

Well-female exams are far less extensive, limited essentially to pelvic and Pap tests, as well as your clinical breast exam. Well-female exams can be performed by your primary care provider or selected Plan OB/GYN provider.

How often should I have a well-female exam?

Well-female exams are recommended for women 18 and over. Sexually active women should have well female exams every 1-3 years. Discuss the interval that’s appropriate for you with your physician.

What if my child has already had his or her health maintenance exam this year, but is now required to have a sports physical for school?

Since your child already had a health maintenance exam, it is usually not necessary to also have a separate sports physical. In this case, have your provider complete the school’s physical form, and use the date of the previous physical examination. This should be acceptable documentation for the school’s purposes.

If there is a range recommended for an exam, how often should I schedule the exam?

Where there is a range, such as 1-2 years, talk to your physician about how often you need to have the exam.

What if my provider recommends that I have these exams more frequently?

In most cases, your benefits provide coverage for an exam to be performed once per benefit period.

If the reason for a more frequent exam schedule is due to an underlying chronic disease, benefits would apply. However, if your physician just wants you to have health maintenance exams at a more frequent rate than once per benefit period, the additional exams are not a covered benefit.

Click here to read Part 1.

It’s All About Prevention – Part 1

Dental health, Health Insurance, Healthcare updates, , ,

What are the Preventative care guidelines?

The guidelines list the types of care screenings and exams needed for your particular age and gender.

  • For infants and young children, the guidelines focus on physical and mental development, immunizations, nutrition, and safety.
  • For children and young adults, the focus is on maintaining or developing healthy lifestyle habits and eliminating high-risk behaviors.
  • For adults, the focus continues to be on eliminating high-risk behaviors, however, screening for chronic and/or life-threatening disease becomes more important.

Does my health insurance cover these preventive care exams?

The health care reform Affordable Care Act (ACA) requires that plans begin providing benefits for preventive services with no member cost share, such as co-payments, deductibles, and coinsurance, when services are performed by in-network providers. However, some plans are not required to comply with this mandate.

If your contract is affected by this change, Wellmark will provide first-dollar coverage for covered preventive services performed by in network providers. Claims for preventive services from out-of-network providers will process using the benefits specified in your benefits policy or coverage manual, and will continue to apply member cost-sharing amounts.

The change will become effective in stages over the next several months, depending on your health plan. For more details about your preventive benefits, contact Customer Service at the number on your identification card.

What is a health maintenance exam (HME)?

A health maintenance exam is what was commonly known as a “routine” or “annual” physical. You might have heard of an “annual physical.” Your health benefits, however, do not necessarily cover “annual” physicals. Instead, your benefits cover periodic health maintenance exams.

How is the frequency of health maintenance exams determined?

Our guidelines are based on recommendations from the American Academy of Pediatrics, The American Academy of Family Practice, the American College of Obstetrics and Gynecology, and the Center for Disease Control, among others. Wellmark’s guidelines are reviewed annually. We provide benefits for health maintenance exams at time frames that are considered most appropriate given your age and gender.

Read Part 2 about female exams.

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