Health insurance and medical bills

Health insurance is there to cover your medical bills and services you receive while visiting a hospital, doctor or having an x-ray, lab test, surgery, etc. Before the services are reimbursed to those providers of care, they all start out as medical bills. Some of us see the medical bills (due to lack of insurance coverage) all the time while others of us don’t really see the medical bill from the doctor visit because the doctor’s office staff submitted the (medical bill) services to the insurance company directly and the service is paid.


What happens when the bill doesn’t get paid by the insurance company or just gets submitted to you directly? Are you aware of what you are reading on the hospital bill?

Would you believe me if I told you that over 80% of the people in the United States do not know what they are looking at when it comes to reviewing their medical bill? Such an unbalanced statistic has given hospitals, facilities and doctor billing offices an enormous edge to get paid now (by you) and deal with the insurance company later or not at all.

Learn to read your medical bill so you or your family members don’t get taken advantage of by hospital and doctor billing offices paying something too soon or at all.

Club helps people who don’t have health insurance

NBC
Published: March 24, 2009

If you lose your job, there are two alternatives when it comes to your health insurance.

One option is to pay for the COBRA plan offered by many companies.

Some companies can charged you as much as $400 a month.

The second option: Go without it, and hope that you do not get sick because it could end up costing you thousands upon thousands of dollars.

Now a new program is helping people without health insurance get some coverage.

It is called the No Insurance Club and for some, it is just what the doctor ordered.

Take Ralph Demicco for example.

He suffers from Type 2 diabetes, and by going without a doctor or getting the medications he needs, it could become a life or death situation.

“These are conscious patients they know they can’t buy insurance outside on their own but a program like this covers their maintenance side,“ said James Stanley, a doctor at the Briarcliff Medical Associates.

For one person to join the No Insurance Club, it cost $480 for the year.

After you sign the contract, you get 12 doctor visits a year that include services like physicals, blood work and flu shots.

For a family, no matter the size, it will cost you $680 for the year.

It includes everything that an individual plan does, but ups the number of doctor visits to 16.

“We’re trying to fill that gap where they can still come to us for that amount it’s a pretty good deal,“ said Stanley.

Once thing about the club unlike other insurance companies, you must see the same doctor for each and every visit and you can only see him no matter what.

Secondly, you can get your prescription drugs for $4.

The only thing is they have to be the generic version.

If you need to get a name brand, you will have to pay out of pocket.

If you use up all of your visits for the year before the end of the year, then you can renew your contract at the original price.

The No Insurance Club does not cover visits to the emergency room or hospital stays.

It also does not cover specialists.

To see if there are participating club physicians in your area, go to to their

Swelling ranks of US jobless yearn for health insurance

FORT WAYNE, Indiana (AFP) — For many among the growing ranks of unemployed workers in the United States, the scariest part of losing their job is losing their health insurance.

Even before the current economic crisis, 45 million Americans were uninsured. That number is expected to rise to 54 million by 2019 if changes aren't made to the system, according to the director of the non-partisan Congressional Budget Office.

One of the swelling ranks, Amy Newlin, has been getting by on her savings and unemployment benefits after she and her husband lost their jobs last fall.

But while they can cut back on dinners out, new clothes or other inessentials, the costs of treating her diabetes, high blood pressure and thyroid difficulties have risen dramatically.

"I need insulin strips to test my blood, and medicine for my high blood pressure," Newlin told AFP.

"My insulin is 80 dollars a bottle without insurance and the strips are expensive, too. It's not easy to keep up."

The Indiana woman was one of dozens who attended a meeting Thursday for uninsured people to register for government-funded health care.

Health officials held the clinic in the basement of an elementary school to deal with a surging number of applicants as a flood of layoffs forced scores of area residents off their employer-provided plans and into the peril of being uninsured in America.

Newlin arrived prepared with a folder jammed with old pay stubs, her birth certificate and all the other necessary documents to ensure she would be signed up.

But even if she qualifies, it will be some time before she's insured and any serious illness or accident could still bankrupt her family.

Health care has long been a contentious issue in American social and political life.

High costs, the exclusion of patients with pre-existing conditions and bureaucratic snafus plague the private system, which is unattainable for a growing number of Americans.

The federal government manages two health care systems: Medicaid -- for the poor -- and Medicare -- for the elderly. They currently amount to 5 percent of America's gross domestic product.

But the costs will more than double to 12 percent by 2050, under the Congressional Budget Office's current estimates.

Indiana launched a plan at the start of 2008 to cover some -- the working poor, single parents, the moderately disabled -- who are not protected by Medicaid.

Residents aren't eligible until they've gone six months uninsured, and there's a small pay-in for participants, helping to hold down costs.

President Barack Obama made health care reform a central plank in his populist platform when he ran for the White House.

And the massive stimulus package he signed Tuesday included plans to help cover the cost of temporary coverage for scores of displaced workers and possibly extend Medicaid coverage to other uninsured Americans who would not normally be eligible.

Yet comprehensive reform has been hampered by the distraction and cost of the current economic crisis, along with the loss of Obama's first pick for health secretary, Tom Daschle, who withdrew from consideration amid questions about his tax history.

Washington's political wrangling is a far way from those gathered in the colorful basement cafeteria of Indiana's Fairfield Elementary School.

Newlin, for one, doesn't hold out much hope for the government to solve anything soon.

"I don't even know if they know where half that money is going," she said of the stimulus.

Jerome and Brenda Lewis, a couple in their mid-50s, have been without insurance since October when she lost her job -- and their coverage.

They are hopeful Obama will bring change and are thankful for the work of people who organized the clinic, but turn to a greater power for balance in these unsteady times.

"Right now, by the grace of God, everything is all right for us. We keep praying that everything will be all right," Jerome Lewis said.

Hundreds turn out for job fair

By Brandon Fincher
02-14-2009

LINCOLN – Companies who were looking to hire certainly had no shortage of candidates who arrived at the old Lincoln gymnasium on Friday to participate in the Lincoln Job Fair.
Deborah Thornton, research analyst for the Talladega County Economic Development Authority, said, as expected, the turnout by job seekers and employers was large.

“So far it’s been great. We have 30 plus employers registered. I would say we probably have 200 to 300 employees who have already signed in who are now looking for jobs at the various employers’ tables,” Thornton said around 30 minutes after the doors opened.

People from all walks of life were in attendance including Reginald and Tonia Kelley, both of Oxford, who were job seeking as husband and wife.

Reginald Kelley said, “I’m getting ready to retire from the military, and I’ve been to job fairs before. In fact, I’ve participated in some job fairs, and the setup here is nice.”

Tonia Kelley added, “It’s pretty informative. We just recently relocated here, and it’s given us an idea of what’s in the area job wise.”

The Kelleys were far from the only job seekers in attendance, though. Danny Mitchell, of Cropwell, was also on the job hunt.

“I’ve just got my mind open. I’ve never been to one of these before,” Mitchell said. “So far it’s so good.”

Employers either passed out information or accepted job applications.

One of those was the Alabama Department of Corrections which was looking for correctional officers. Cynthia Nelson, with the ADOC, said she was looking for applicants that could pass the physical testing, background check and who were ready to come in and work in the state’s prison system.

Nelson said, “There are a lot of opportunities for advancement once they come in as a correctional officer trainee and after they’ve gone through the academy and established permanent status.

“Whenever we give our promotional exam or sergeant’s exam, they can take that and advance up. Once they’ve been in that classification, and if they desire to move up, they can take the next promotion.”

Nelson said the turnout was great, and there were many people who stopped by the ADOC booth who were interested in the job and picked up information to research.

“We have great benefits, and it is a career,” Nelson said.

The job fair was sponsored by the Talladega County Improvement Foundation, the Greater Talladega/Lincoln Area Chamber of Commerce, the Childersburg Area Chamber of Commerce, the Sylacauga Chamber of Commerce and the Talladega County Economic Development Authority.

Thornton said she had received calls from job seekers as far away as Cleburne, Randolph and Chambers counties who inquired about the job fair.

“We started in January with a job fair in Sylacauga. We were trying to do them every 90 days, but the needs were so critical we decided to bump it up and do it sooner,” Thornton said. “We have another job fair scheduled for April 10 in Childersburg.”

Thornton said the sponsors had devised a list and contacted companies from Talladega, Calhoun and St. Clair counties to see if they would like to participate.

She said the job fair benefited from volunteers who manned the sign-in table and restaurants and grocery stores such as Domino’s Pizza, Carter’s Barbecue, R and B Barbecue, Jack’s, Wal-Mart in Talladega and Pell City, and Super Foods in Lincoln who provided food to feed the employers.

Thornton said she also was thankful for service group who provided information and assistance at the job fair. They were Alabama Department of Public Health’s ALL Kids Insurance, Cheaha Regional Head Start, the Coosa River Baptist Association, and FIRST Family Service Center.

Job seekers were just thankful for the opportunity to have a chance for a job.

“When you have an opportunity to participate in a job fair, you’re always looking for something, a new job or a better job. It gives you a good feel for what’s out there,” Reginald Kelley said.

Doctor and Patient Building a Healthy Community, One Child at a Time

By PAULINE W. CHEN, M.D.
Published: January 22, 2009

Like many other Americans this past Tuesday, I was moved by President Obama’s inspiring call to duty.

"Now, there are some who question the scale of our ambitions, who suggest that our system cannot tolerate too many big plans,” he said during his inaugural address. “Their memories are short, for they have forgotten what this country has already done, what free men and women can achieve when imagination is joined to common purpose and necessity to courage.”

One of the "big plans" of the Obama administration will be to revamp the nation’s health care system. But are these ambitions big enough to help the country’s smallest patients?

It has been hard over the last year not to feel that health care coverage for our neediest young people could have benefited from a “big plan.”

In May, the Commonwealth Fund, a nonprofit health policy research group, published a report that detailed striking health care disparities between states. The report found, for example, that three-quarters of children have regular medical and dental preventive care in Massachusetts, but less than half of the children in Idaho do. Whereas only 55 per 100,000 children are hospitalized for asthma in Vermont, South Carolina has a staggering hospitalization rate of 314 per 100,000.

More recently, the Kaiser Family Foundation summarized the role of Medicaid, the federal program that aids the poor, and the State Children’s Health Insurance Program. Roughly 30 percent of the nation’s children depend on these programs, but another 11 percent remain uninsured.

That’s 8.9 million American children who have no health insurance.

Last year, there was a big plan to try to change those numbers. But two bipartisan attempts in Congress to expand children’s health coverage withered after presidential vetoes.

This year, it appears that a revised and more comprehensive version of the State Children’s Health Insurance Program will likely pass, supported by the new president. After the House passed the bill last week, Mr. Obama said in a statement, “This coverage is critical, it is fully paid for and I hope that the Senate acts with the same sense of urgency so that it can be one of the first measures I sign into law when I am President.”

I am thrilled by the prospect of better health care coverage for children. At the same time, however, I understand the concerns of critics who ask if we are just throwing more money at the larger problem: our broken health care system.

As the President said on Tuesday:

“The question we ask today is not whether our government is too big or too small, but whether it works.... Where the answer is yes, we intend to move forward. Where the answer is no, programs will end.”

In at least one part of the country, North Carolina, the answer has been yes.

Since 1991, primary care physicians, administrators and state legislators there have worked to create and support a state Medicaid program called Community Care of North Carolina. The program has not only offered high-quality, patient-centered care for the state’s neediest children and adults, but has also saved millions of dollars in health care costs.

Based in part on the idea that each patient should have a “medical home,” the Community Care program assigns each Medicaid patient to one of 14 community health networks. Each network in turn is organized and operated by physicians, nurses, hospitals, health departments and departments of social services.

Patients receive primary care and preventive health measures coordinated by the various professionals in their network, and physicians and others receive fees for their services. In addition, each network receives $3 per patient per month to help implement additional programs like after-hours office care, nurses on call and community-based care coordinators for patients with complex issues, including children with cerebral palsy or cystic fibrosis.

North Carolina, in conjunction with independent consulting groups, has documented the savings for state taxpayers with this innovative program. In asthma management alone, Community Care of North Carolina saved an estimated $3.5 million dollars over three years. With diabetes care, the program saved an additional $2.1 million dollars over the same time period.

The most striking difference, however, between Community Care of North Carolina and other state Medicaid programs is the complete absence of insurance companies. Most states partner with an insurance company to deliver care to Medicaid patients; any residual profits go to the insurance company. But in North Carolina, state Medicaid administrators and health care providers manage the program exclusively and then funnel profits directly back into patient care.

I recently spoke to Dr. David Tayloe, the president of the American Academy of Pediatrics and a practicing pediatrician in North Carolina. Dr. Tayloe has been actively involved with Community Care of North Carolina since its inception.

“We have been able to have an effective collaboration between state government and physicians,” Dr. Tayloe said to me over the phone in a deep baritone voice that accentuated his rich Southern accent. “We basically have a not-for-profit administrative program for Medicaid, and the real winners are the children and the families.”

I asked if there might be something different about North Carolina compared to other states, something that made it possible to run a program like Community Care.

“If you look at the fundamentals of the program,” Dr. Tayloe replied, “they could be adopted by other states. There’s nothing holding a state back from saying ‘We want community-based care.’ Any state Medicaid program that commits the dollars to it can do it.”

“We’ve done it for 17 years,” he added, “and we’ve saved a lot of money for the state. No one in our general assembly even thinks about going to another system of care anymore.”

I asked Dr. Tayloe what had inspired him to become so actively involved with his state’s Medicaid program. He paused to think, then talked about his father, who had practiced pediatrics in North Carolina for over 40 years, and about his own lifelong desire to care for any child that walked into his practice.

“With the shortage of primary care physicians in the U.S., we are at risk of allowing our system of health care to deteriorate such that our most needy and deserving children do not have access to good pediatricians,” he added via e-mail the next morning. “This is what Community Care of North Carolina is all about — paying for a system that assures patients access to the best in primary care — a real medical home.”

He continued, “I envision a medical system in which the poorest at-risk children have access to the best and the brightest we have in medicine — on the front lines in our communities.”

Dr. Tayloe’s work and his words, even via e-mail, reminded me of the President’s message I had heard on Tuesday:

“We have duties to ourselves, our nation and the world, duties that we do not grudgingly accept but rather seize gladly.”

Click here to join the discussion on the Well blog, “In Health, Still Leaving Children Behind.”