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According to a recent report from the Commonwealth Fund the number of uninsured young adults (age 19-29) has risen to 13.7 million people in 2006. While this group makes up approximately 17% of the population not eligible for Medicare they account for 30% of the uninsured.
Question: How can I make better use of a Flexible Spending Account?
From: Virginia G. of Santa Cruz, CA
Answer: A Flexible Spending Account (FSA) is essentially a cafeteria plan offered through an employer. It provides a tax advantage by allowing the employee to designate a non-taxable amount to be set aside from earnings to pay for qualified expenses within the cafeteria plan. The employee then submits for reimbursement from the FSA. It is more often used for medical expenses but may allow for dependent care. Medical expenses not paid by the health insurance plan, such as deductibles, co-insurance, dental, vision, over-the-counter medicine and mileage reimbursement for medical visits, are eligible for reimbursement. Items reimbursed must be to treat or prevent a specific medical condition. Ineligible items include health insurance premiums, cosmetic items, and cosmetic surgery (non-elective cosmetic surgery is eligible). Money not reimbursed to the employee is forfeited.
There are several steps to take to make sure you are reimbursed appropriately. Keep all medical receipts/statement from the provider for which you want to be reimbursed. Make sure they show the provider’s name, reason for treatment or visit, date of service, charge for the service, and amount paid by patient. The plan will define the time frame during which services rendered may be reimbursed and will also define the time frame by which application for reimbursement must be made so be sure to submit within the allowable time frame. In 2005, the IRS authorized employers to allow a 2 ½ month grace period after the plan date to seek reimbursement. You may seek reimbursement at one time or periodically throughout the time period. You may also seek full reimbursement from the plan if you have spent the complete amount of your projected deductions but you will continue to have the money withheld from your pay. Deciding how much to have deducted from your earnings should be done carefully. Make a list of out-of-pocket expenses for yourself and your dependents. Remember that unused money is forfeited. Lastly, effective 1/1/08, approved merchants (grocery stores and discount stores) are required to have inventory systems which can identify healthcare purchases and over-the-counter items each time you use a health care debit card.
The first thing I learned as a student in medical terminology is that the suffix otomy means “incision.” With that one piece of information, I felt empowered. Knowing that any term with the suffix otomy meant that the body part would have an incision made into it gave me instant understanding of a plethora of medical terms. For example, a gastrotomy means “incision into the stomach (or gastric region).”
The more I learned, the more empowered I felt. That same day, I also learned two other suffixes: algia, which means “pain,” and itis, which means “inflammation of.” I now knew that the term neuralgia means “pain from the nerves or caused by a nerve.” And I now knew that arthritis means “inflammation of the joint” (arth being a prefix meaning “joint”). Once you learn the basic rules of the language, root words, prefixes, and suffixes, the process of learning a language is much easier.
Question: Is there some sort of easily available rating system that can help one choose a good hospital?
From: Steve W. of Rahway, NJ
Answer: This question comes up fairly often and I am always happy to respond. It pleases me that consumers are actively looking into the best resources available for their needs, including the best healthcare. It is important, however, to do a self survey. What qualities are important to you? Is it the nurse to patient ratio and the hospitals current staffing? Is it cleanliness, friendliness of the staff, explanations of treatment and medications, written instructions, specialty physicians on staff, technology? There are many resources available to research hospital ratings so I will recommend what I consider to be the top sites. Check whether the hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) which sets the gold standard for care. Other sites are U.S.News & World Reports annual list of the best hospitals by specialties, the Leapfrog Group (www.leapfroggroup.org), HealthGrades (www.healthgrades.com), VIMO (www.vimo.com), the Commonwealth Fund (wwwcmwf.org). Study what quality indicators these sites use (e.g., mortality, reputation, patient volume, advanced technology, professional credentialing, cost) and then compare to your expectations.
In my book, 7 Steps to Your Best Possible Healthcare, I address these issues in great detail. I also provide some practical tips to look for and questions to ask.
The Happy Times in Healthcare Podcast is here to help healthcare consumers become better educated in order to receive the best possible healthcare available to them. This podcast series covers a wide variety of topics including paying for healthcare - when you are insured and when you are not insured, selecting a new physician, using healthcare quality rating tools, and understanding your medical record. In this episode:
Podcast: KDKA Interview Part 1 - Dr. Ruthann Russo joins John Steigerwald on KDKA News Radio 1020 to discuss the
state of the US Healthcare system.
A theory is a system of ideas or statements explaining something. Raw and living
food theory claims that uncooked food produces greater health benefits than
cooked food. Based on its history, leaders, and the current documented
practices, the following six concepts appear to be the principles of the raw
food or living nutrition theory.
While we wait for studies to be conducted at some point in the future, we can read, analyze, and possibly even try out some of the principles of the raw food theory in our own lives. I overheard a conversation recently about raw food. A man was describing the raw food diet to his companion. His explanation contained many of the six principles listed below. His friend responded, “it sounds like just another diet fad to me.” The man (who was not a raw foodist), responded, “Maybe, but when you think about it, how can something that is fresh, organic and good for you be a fad?”
Details of each concept are addressed in my upcoming
book The Raw Food Diet Myth.
The purpose of this book is to introduce you to the revolutionary philosophy of raw and living foods by pulling together all of the components, including, but not limited to, diet, into one place. The book provides you with information to make a conscious decision about whether you will, or perhaps already have, incorporated any of the raw and living food philosophy into your own philosophy of living.
Question: Why does one have to wait months for a mammogram?
From: Diane W. of Oreland, PA
Answer: I’m not sure that there is one answer for every mammography center. I would hope that the main reason is that more and more women are scheduling their mammograms and heeding the recommendations for early detection. Please note that there are regular screening mammograms as well as diagnostic mammograms being done. The regular screening is usually done annually to ensure that there are no irregularities. A diagnostic mammogram is performed to evaluate a new abnormality or in follow-up for a past abnormality. I have had a few friends and relatives who had diagnostic mammograms and the radiologist was able to interpret the study immediately. Since 10/94, mammography centers must be certified by the U.S. FDA in order to perform, interpret, and develop the studies. They may be located in hospitals, outpatient clinics, or physicians’ offices. Many facilities accept self-referral (but not all). If your facility does, you do not need a physician’s referral. Remember to check with your insurance company, however, as some insurance plans do require a physician’s prescription to cover the mammogram. Medicare covers an annual screening for all women age 40 and over who have Medicare. Medicare pays for one baseline study for women between 35 and 39 who have Medicare. Medicare also covers digital technologies for screening mammograms. There is no Part B deductible but the 20% coinsurance or co-pay applies.
The Happy Times in Healthcare Podcast is here to help healthcare consumers become better educated in order to receive the best possible healthcare available to them. This podcast series covers a wide variety of topics including paying for healthcare - when you are insured and when you are not insured, selecting a new physician, using healthcare quality rating tools, and understanding your medical record. In this episode:
Podcast: KDKA Interview Part 2 - Dr. Ruthann Russo joins John Steigerwald on KDKA News Radio 1020 to discuss the dealing with insurance companies, what to do when a claim is denied, the benefits of high deductibles, plus how medical records impact your healthcare and why you should have a copy.
Question: What happens if you fall sick outside the USA?
From: See L. of Forest Hills, New York
Answer: What a practical question! I must admit, it made me stop and think and consider my actions when I next travel outside of the U.S. For those with private health insurance plans, it is important to check with your health insurance plan to learn if benefits are available when traveling to other countries. Even if your plan does, the problem remains whether that health plan is accepted by the country you are traveling to. Medicare and Medicaid do not provide coverage in other countries. You may want to consider purchasing a short-term supplemental health insurance plan that is specifically designed to cover international travel. For options, check the Bureau of Consular Affairs. Make sure the plan covers care as well as medical evacuation back to the U.S. as evacuation may exceed $50,000. Most of these policies can begin right away.
There are some other practical tips provided by the State Department when traveling. Register your plans with the State Department (free online at https://travelregistration.state.gov) so the State Department can better assist in case of emergency, whether the crisis is with family in the U.S. or where you are. Make sure to complete emergency information when applying for travel permits. Leave copies of the itinerary with family or friends. Familiarize yourself with services and environment where you plan to be-medical facilities, immunization needs, pollution, etc. If you are being treated for a medical condition, take along a letter from your physician describing the condition and the medications you are taking. You may want to check with that country’s foreign embassy (again through the State Department site at www.state.gov) to make sure the medications are not considered illegal narcotics. If you are injured or become ill abroad, the U.S. consular officer can assist in locating medical services, inform family members, and assist in the transfer of funds from the U.S. Remember that payment of hospitals and expenses are the responsibility of the traveler.
As healthcare costs continues to rise, a recent NY Times article describes the growing trend of underinsured Americans. This group now numbering 25 million people includes those who have health insurance coverage that may not adequately cover them in a healthcare crisis or have high out of pocket expenses and deductibles.
“The rates of underinsurance among families earning more than $40,000 a year nearly tripled from 2003 to 2007. Most worked for small businesses with poor coverage or had to buy costly, bare-bones individual policies on the private market. A typical family might have to cope with rising premiums, high deductibles, benefit limits that exclude or cap treatments and substantial co-payments for each service.”
As costs continue to rise it becomes more important than ever for healthcare consumers to become better educated about not only their health but also what insurance plans are available and how they work. Websites are available to assist you. MostChoice (www.mostchoice.com) serves as an insurance broker. You can also check the quality of a healthplan at Consumer Assessment of Healthcare Providers and Systems (www.cahps.ahrq.gov) and National Committee on Quality Assurance (www.ncqa.org).
Ruthann Russo, PhD, JD, MPH, RHIT, is a healthcare expert with more than 20 years of experience working in and advising healthcare organizations.
