Wednesday, November 28, 2007

Insurance jargin you need to know

Ok - so after a stressful day at work I am putting this out there because the bottom line is - you should NOT have health insurance if you don't know this stuff! So stop calling my office and asking me why you have a balance if it went towards your deductible - here is your explanation.

In-network: This means the place you are going (hospital, doctor, etc) is contracted with your insurance company. They MUST accept the contracted rate in which your insurance pays them. This DOES NOT mean you will not have a balance.

Out of network: Providers are nonparticipating with your insurance and can balance bill you for whatever your insurance does not pay. Example: Your X-ray cost you $200. Your insurance only paid $50. That provider can bill you the balance of $150.

Contracted: This means the place you went (doctor, hospital) has a written agreement with your insurance to accept payment directly from them and accept a negotiated amount on your claim (they don't pay it in full and there is a discount).

Claim: The bill for your services

Deductible: This could be an IN or OUT of NETWORK deductible. You may have 2 - you may also have an individual and a family one to meet each year. This is an amount you have to pay each year before your insurance starts to pay claims for you.

Co Insurance: This is usually an amount left after insurance. Such as your insurance pays 90% and you are responsible for 10% of each claim.

CoPay: This is what you pay for a doctor visit, specialist, hospital. Also what you pay at the pharmacy for your prescriptions.

Invisible provider: This is providers that work within a facility that you may not know about but bill separate from the actually place you went. Example: you go for an X-Ray at the hospital. The hospital charges to do the exam (use of the room and equipment). Then there will be a professional fee for the reading of the exam from the radiologist. Sometimes this provider is a separate group from the hospital itself and will bill separate. This also happens with ER docs, lab work, etc.

Reprocessing: Your insurance is looking at a claim they already processed and looking at it again to see if it was processed correctly.

Duplicate: the claim was received more than one time by the insurance OR more then one of the same exam was done on the same day and more documentation is needed.

Coordination of benefits: Every year, some insurance companies waste time wanting you to fill out a form saying that you have other insurance or if things are the exact same as they were - I look at it as a waste of time and an excuse for them to hold up claims.

Explanation of benefits (EOB): What your insurance sends you and the provider of service telling you how they have processed your claim.

Pre-existing condition: UGH I don't like this one! This means that before you had said insurance, you had a condition that they feel they now will not cover your services. Sometimes there is a limitation on this, where after a time period they will start to cover it.

Medical Records: This comes from your doctor, or whomever treated you - NOT the billing office, we do not have this info, sorry.

Ok kids, that's your lesson for today! There will be a quiz on this later in the week.

Monday, November 26, 2007

Ugh - Monday!

So, It's Monday - after a nice long weekend and I'm tired! I can already feel my head throbbing. It's up the left side of my neck and into my left eye. I was in to work about an hour and a half before anyone else. I thought if no one else showed up I would leave, but alas, they did.

My aunt is doing ok. The doctors found nothing after her turkey day fiasco. She stayed in the hospital till Friday evening. It's just so strange.

I think it is going to be a Frova day today. That and positive thinking. It's a gross, rainy NJ day out there. My migraine is probably weather triggered. That's all I can come up with at the moment. I'd much rather be here:

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But for now - I'll sit here in dark glasses, try to go unnoticed and down a Frova.

Friday, November 23, 2007

Oh what an exciting Thanksgiving - how are we going to top this one next year?

So I didn't end up making it to my full "6 days no migraine" like I really thought I would. I don't know who I was kidding - I was prodrome for like 2 days....I guess I just didn't want to believe it. Oh well. It wasn't bad, I got that baby the second it started so it wouldn't ruin my turkey! - gone in about 20 mins but the postdrome stayed with me all day like a narcotic hangover or a night you were out too late partying (man, have not done that in YEARS!)

So I knock out my little migraine monster and head off with my husband to my aunts house. We had a very lovely time there. Everything was wonderful. We were sitting around the table having dessert after dinner, ya know "girl talk" when all the men go lay on the couch for "turkey naps". And we're talking - and all of a sudden we notice my one aunt is unresponsive. We start calling her name, nothing. She looked as if she was looking under the table a bit, looking at the cat. Then we thought she dozed off for a second. We kept calling her name, nothing.
We started to gently shake her. - by this time - the cell phone is in my hand and I'm dialing 911. My aunt has had a history of seizures and other problems....she's 80 for crying out loud! So I call 911 - I tell the dispatch that she is 80 and unresponsive but breathing. They are sending someone.

My cousin is holding her up to not fall out of her chair - she is still not responding. Then she starts to breathe a little heavy - rub her forehead and look like she is going to cry. I can only describe this by saying if you've ever watched someone having a nightmare? Or a baby sleeping (like a 3 month old) That is how she looked, like she had the mannerisms of a baby.
She rubbed her head, we kept calling her name. She started to look around and say something, but we couldn't figure out what she was saying. My other aunt kept saying "who am I" to see if she knew who anyone was....she didn't know. Then she opened her mouth really wide and took this big gasp and was kinda "back". She was still a little out of it. But once she realised I called 911 she was ticked!!!!! I almost started yelling at her like "you have to be checked out you were not responding and something happened!"

So the paramedics, rescue, police, you know, the whole darn town show up. They checked her out and said everything seemed ok. She knew we would all be mad is she did not go to the ER so she went. They did more tests, still nothing but they kept her over night to be sure.
See the problem is my aunt has had 3 seizures that we know of. We don't think she is being completely honest to the family about her condition. And seeing as she is as stubborn as a mule, she won't let anyone go to the doctor with her.

I know she is on a lot of blood pressure medication, but what I don't know. I also know she is taking Keppra twice a day.....but I couldn't read what all was on her info and was distracted by what was going on.

We really want to get her somewhere that she has help but she is just stubborn. I'm sure they won't find anything wrong and she will be like "see I told ya" but there is something going on. Maybe it's just age? They told her before it's not TIA - she's never had a heart attack - I mean for 80 the lady is still very healthy!

So I'm sure I'll get more details of what happened today from my mother, but it was scary. I don't think she can be alone anymore, not if this is happening. I mean she didn't remember being out of it (I mean who does?) And she lives alone - what if this happens and no one is around? She needs to have some sort of an assisted living program, not saying they need to cook for her, but someone to check on her.

Thursday, November 22, 2007

Here we go!

So I decided to start a blog....

Here's a little about me. I am a migraine sufferer. For those of you who don't know, Migraine is a neurological disease that strikes 36 million Americans. I have had the honor of hosting at a wonderful site - My Migraine Connection which is run by the lovely Miss Teri Robert!

After reading her book, Living Well with Migraine Disease and Headaches I can honestly say it changed my life. I went from being just a sufferer to being an advocate. I am now so much more involved with my health care then I ever was before. Her book gave me my life back.
And, the forum setting she has created on that site is so comfortable - it's like talking with family - only they actually "get it"!

Since this is my first "blog" and I'm just learning my way around this thing - I'll just start with this.

If you are suffering from migraine - know there is help out there. You do not have to suffer alone. Migraine is a silent disease. It can also be very depressing. I know for me, there are many times when I feel alone and sad, depressed and like no one understands. Trust me - people do.

There are so many medications out there now to help control migraine - it's amazing. There are over 100 different preventives, in almost every drug family, Anticonvulsants, Beta Blockers, Anti-depressants, SSRI's, Muscle Relaxers, ACE inhibitors, Calcium Channel Blockers, just to name a few!

My current regimen consists of 75mgs of Topamax (anti seizure) which I take in a split dose, 25mgs in the morning and 50mgs in the evening. I also take a multi vitamin, 250mgs of Magnesium, Frova 2.5mgs to abort, Skelaxin 800mgs as needed, and Meletonin every night at bed.

That's just a bit about me - I figure that's good for a first post right? But because of my obsessive nature, I'm sure I'll be back on here later to post again!