Question: Why large corporations are given a better insurance discount, while small employers struggle to provide coverage at all.
From: Kim W. of Colorado Springs, CO

Answer: This is a very interesting question and before answering, I would like to provide some statistics from the National Coalition on Health. In 2007, $2.3 trillion (or $7600 per person) was spent on healthcare in the U.S. Total healthcare spending equaled 16% of the Gross Domestic Product (GDP). During the same year, employer health insurance premiums increased by 6.1%, or 2 times the rate of inflation. The average annual premium for an employer health plan for a family of four was $12,100 and $4,400 for a single person. For employers with less than 24 employees, the increase was 6.8%. As we all know, employee contribution has continued to climb in an effort to offset the costs to the employer. But the higher the employee contribution, the fewer employees enroll. Various agencies define small employers differently. According to the Agency for Healthcare Research & Quality (AHRQ), ¾ of businesses in the U.S. are considered small employers and they employ nearly 1/3 of the private workforce. AHRQ’s reports indicate that medium to large employers have 50+ employees and small employers have less than 50 employees.

And now as to why smaller employers face higher rates. While larger firms hire Human Resource or Benefits Specialists to manage healthcare issues, the smaller employer relies on the insurance company or a broker to manage and administer. This means more work and cost per enrollee for the insurance company. Smaller firms tend to have higher employee turnover, again more time and cost to the insurance company. The smaller company has an increase likelihood of dropping and then adding coverage and has a higher risk of actually failing. When a company has only a few employees, it is harder to predict the health risks of that employee group and to spread the risk out among employees. To this end, some states even allow insurers to review the medical history of each individual in the group and charge higher premiums for groups that have individuals in poor health.

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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.

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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.

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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.

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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.

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Question: Why do we have to wait so long in the emergency room before we receive treatment? The wait often seems so long and many of the patients don't look well. Why is there such a wait for treatment?
From: Jack M. of Pittsburgh, PA

Answer: I have heard this complaint from many people so it seems to be a rather common problem. According to the National Academy of Sciences’ Institute of Medicine, the U.S. population grew by 12% from 1993 to 2003. ER visits grew by 27% in the same time period. Furthermore, a 2004 study of university-based hospitals showed that ER beds were occupied 35% of time. Many hospitals have tried to decrease the wait and have critiqued their own ER procedures to find ways to more ways to efficiently serve their patients. Emergency room care is costly and overcrowding causes services to be slow. Seriously ill patients may wait hours to days in the ER before being admitted to an inpatient bed or ICU because of bed shortages. For those without health insurance coverage, the ER becomes their first option. Too often, people use the ER for non-emergency health concerns rather than call their physician or go to a health clinic or an urgent care center. Not every situation is an emergency but the dilemma is in knowing the difference. Emergent conditions include loss of consciousness, fractures, chest pain, head injury, seizures and should be addressed immediately. Conditions such as cold, flu, prenatal care, sore throat, and headache may be treated by a primary care physician or health clinic or urgent care. Federal law requires that ERs must evaluate anyone who requests help. Additionally, ER staff must treat the most serious injuries and illnesses first. Many ERs lose money and some have closed, further contributing to overcrowding.

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Question: How to find good health care in rural areas without having to drive hours to a big city?
From: Julie T. of Warner, OK

Answer: Access to healthcare for people living in rural areas is a major concern. I would like to share a few statistics with my readers. According to the American Hospital Association, 54 million Americans (including 9 million Medicare recipients) live in rural areas. For many, travel to community or urban hospitals is limiting. Additionally, rural hospitals face the pressure of decreased government payment and limited assets. Rural areas tend to have higher poverty rates and a higher percentage of elderly, that segment of the population which is in poorer health. Although approximately 20% of the U.S. population lives in rural areas, only 9% of the country’s physicians practice there (from U.S. Department of Health & Human Services Agency for Healthcare Research and Quality). The federal government is aware of this imbalance and has made efforts to improve the situation. Government designated Critical Access Hospitals (CAH) are often found in rural areas and are paid by the government on a cost basis rather than the prospective payment system (paid on cost rather than diagnosis basis). Some medical schools are trying to do more to rotate medical students into rural areas. Currently, the federal government reimburses Nurse Practitioners in Federally designated rural areas but legislation is pending for all areas. Nurse Practitioners are registered nurses with advanced degrees and can treat common ailments, do physical exams, prescribe medicine, manage chronic health problems, and do medical screenings.

Question: I'd like to be able to learn more about the different doctors that are practicing in my area. I'd like their background information and it'd be nice if there was a way for former patients to rate them. That way I can get a doctor that is right for me.
From: Amy G. of Allendale, MI

Answer: This is an issue that I have addressed in recent presentations as well as in my book, 7 Steps to Your Best Possible Healthcare. When purchasing a new car, we will go to several auto dealers and check safety and price reports on the car we are interested in buying. We take the care for a test drive to make sure we like the way it runs and that we feel comfortable in it. And, yet, we often rely on family or friends to suggest a new physician. Good health is precious good healthcare is essential. A family or friend’s recommendation should be one part of our study. Your local medical association provides names and information of physicians in your area and local hospitals often list physician providers affiliated with the hospital. A rating agency, http://www.healthgrades.com, provides ratings based on outcomes. New legislation also requires that providers survey Medicare and Medicaid beneficiaries. Most health insurers are doing the same. Patients with health insurance may soon see surveys asking how they feel about their healthcare and their providers. Medicare will publish results to help improve the healthcare system, give patients information so they can choose their provider, and to measure the quality of care the patients received. Medicare will begin to reimburse providers, in part, based on the quality of care they provide. And just as you would test drive a car, try to meet with the doctor and talk with the office staff and observe office operations. But you will need to prepare ahead for this. Find out what is important to you and what you expect from the physician and staff and then organize your questions. I provide many helpful examples of questions and observations in my book.

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Question: I would like to know more about alternative health
From: Alla R. of Cordova, MD

Answer: Conventional medicine (allopathic medicine) is medicine as practiced by MDs or Dos and their allied health professionals. Complementary and Alternative Medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not currently considered part of conventional medicine. Complementary medicine blends conventional and alternative treatments. For example, aromatherapy may be used to alleviate a patient’s discomfort following surgery. Alternative medicine is used in place of conventional medicine. An example of alternative medicine is using a special diet to treat cancer instead of surgery, chemotherapy, or radiation. Some examples of current mainstream practices that began as CAM are acupuncture for headache pain, glucosamine to assist in treating arthritis, and fish oil to help treat heart disease. The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government’s lead agency for scientific research on CAM and has been moved within the National Institutes of Health. You can explore CAM further by going to the NCCAM’s website, www.nccam.nih.gov. In my book 7 Steps to Your Best Possible Healthcare, I describe the approaches, publications, and teachings of several physicians.

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Question: What are the training requirements of mid level providers?
From: Andrew S. of Rochester, NY

Answer: Besides physicians, there are other members of the health care team who provide a certain level of care to patients. They are mid-level practitioners and include Nurse Practitioners and Physician Assistants. They are licensed and often provide more than a registered nurse can provide, but less than a physician provides. Mid-level practitioners also include certified registered nurse practitioners (CRNPs), nurse midwives, and nurse anesthetists. These professionals are all registered nurses, most with bachelor’s degrees or the equivalent, and additional training for certification. Physician assistants graduate from a 5 to 6 year program. All mid-level practitioners are licensed within the state where they practice. If permitted by the state, nurse midwives may treat patients independently. Most other mid-level practitioners work under the direct supervision of a physician. Federal law allows mid-level practitioners to treat patients for certain conditions without physician oversight if they work in a rural area that has a shortage of PCPs (primary care physicians).

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Question: Why are so many doctors becoming plastic surgeons? Isn't this stupid, frivolous health care?
From: Valerie W. of Hesperia, CA

Answer: Plastic surgeons are often thought of as solely devoted to cosmetic alterations of the face and body. In fact, they deal with the repair, reconstruction, or replacement of physical defects or cosmetic enhancement of the skin, musculoskeletal system, face, hands, extremities, and breasts. In addition to residency, plastic surgeons undergo an additional 2 to 3 years of training. They are certified by the American Board of Plastic Surgery which also offers subspecialty certifications in plastic surgery of the head, neck, and hand. Some of the essential surgery they perform include breast reconstruction following mastectomy, post burn and trauma repair and reconstruction, and cleft palate repair. Their goal is to restore impaired function and physical appearance. Elective cosmetic surgery is a component of plastic surgery. Cosmetic surgery includes tummy tucks, facelifts, liposuction, dermabrasion, and rhinoplasty (reshaping of the nose).

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Question: I would like to know beforehand what I would have to pay for any procedure.
From: Esther S. of Saginaw, MI

Answer: This seems like a logical and reasonable request. You should also speak with the physician (s) providing the service and the facility where the procedure is to be performed. Remember that the facility, physician, and anesthesiologist will probably bill separately so you may have to make a few contacts. If you have insurance, contact the plan’s Customer Service Department and ask if this is a covered procedure and, if so, at what percentage. Also ask how each physician participating will be reimbursed. This should give you an estimate pending unforeseen issues.

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Question: Is Medicare really all it's hyped up to be?
From: Andrew L. of Cranbury, NJ

Answer: Your question is a broad one. Most people know that Medicare is federally funded and is available at age 65 or younger if disabled and on Social Security Disability for 2 years. What may not be as well known are the types of services covered by Medicare. The following is not an exclusive list of services covered by Medicare but will at least give you an idea of the benefits-inpatient hospitalization, inpatient skilled nursing services, physician coverage, outpatient surgery and therapy coverage, inpatient Hospice benefits, home health services at a skilled level, home Hospice services. Screening tests are also covered. As with any other insurance coverage, there are conditions to be met and limits on the amount of coverage (benefits are renewed if the patient is not an inpatient for at least 60 days). Many patients purchase Medigap insurance to supplement Medicare. Managed Care Medicare plans must provide the basic coverage available in traditional Medicare. More recently, Medicare prescription plans have arisen. Is it all it’s hyped up to be? It appears that the government intended to provide comprehensive coverage for its older and disabled population but also recognizes that ongoing improvements and changes will be necessary.

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Question: Why are we so rushed in doctors’ offices?
From: D.M. of Winchester, IN

Answer: In my book, 7 Steps to Your Best Possible Healthcare, I cite a study by The American Academy of Ophthalmology which indicates that patients find quality of their physician appointments to be more important than quantity. The study goes on to say that patients who were satisfied with their doctor visit tended to overestimate the time spent and those who were dissatisfied complained that the physician hurried, even if the visits were actually long. Patients have an average of 16 minutes with their physicians so it is important to be prepared when going into the visit. As I explain in the book, the preparation will reap benefits in the dialog you have. Important points are to organize your questions (write them down so you don’t forget), research the problem so you know what to ask, answer all the physician’s questions fully, listen carefully, repeat what you are told or instructed, ask for clarification if you don’t understand, ask for written instructions. You may want to take someone along if you are comfortable with that arrangement.

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Question: Why patients aren't informed as to what their test results, etc. are leading their doctors to believe as a possible diagnosis?
From: Leanne S. of Vineland, NJ

Answer: The federal government guarantees that patients have healthcare rights and providers have responsibilities they must meet in caring for their patients. You have probably seen these Rights and Responsibilities posted in hospitals and clinics that you have visited and have received a copy upon admission to a hospital. One of your rights is to receive information in a clear and understandable fashion and to accept or decline treatment. As a patient, you also have the responsibility to ask questions and share information pertinent to your healthcare issues. These rights and responsibilities apply to tests that have been performed so please ask your physician for an explanation and make sure you understand the results.

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Question: Is cosmetic surgery covered under normal health insurance?
From: Sherri W. of Milpitas, CA

Answer: Most likely, no. Most medical insurance plans specifically exclude cosmetic surgery. Even dental coverage is limited or reduced for what may be considered cosmetic procedures. I can think of certain situations for which exceptions will probably be made-e.g., a burn patient or mastectomy patient in need of reconstructive surgery or prosthetics. If there is an issue in question, you may need a letter from your physician explaining the necessity of the surgery and that it is not merely for cosmetic reasons. But general cosmetic work such as liposuction, face lifts, tummy tucks, etc. are usually not covered by health insurance

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Question: What are dental care options on insurance?
From: Jane M. of Junction City, KS

Answer: Like healthcare benefits, dental benefits are often provided by an employer. Private coverage is also available but you want to research the premium cost, out of pocket responsibility, and the types of services covered and at what percent. There are truly many options out there (check the web) but be careful that you choose one that meets your needs. Your dentist’s office may or may not work with that plan so you want to check that point. Many dental providers know how plans work so ask your dentist’s office staff for their thoughts.

Question: Can I find out actions taken against doctors; complaints about doctors?
From: Mandy S. of Strasburg, PA

Answer: There are several websites available to check physician training. Some may offer information about disciplinary action taken against a physician but ease of access to the information may vary. Some state licensing boards may offer the information but getting it may be difficult. At a cost to the consumer, HealthGrades.com will indicate whether a physician has been disciplined but may not give specifics. The U.S. Office of the Inspector General administers two databanks that include disciplinary action against physicians but they are not available to the general public. They can be accessed by government agencies, credentialing organizations, and certain other parties. They are National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB). An on-line search will yield some sites such as Docinfo.org, a Web site operated by the Federation of State Medical Boards (FSMB). The public can access disciplinary, education, licensure and location information on U.S. licensed physicians and physician assistants. The consumer will pay a fee but can then receive credentialing and disciplinary information.

Question: Why is there not mental health parity across the board with physical health nationally and state-wide?
From: April C-W. of Bradenton, FL

Answer: You are bringing up a point that has no doubt been a point of contention for some time. You are correct in that some health plans cover mental health conditions differently than medical and surgical conditions. I doubt I could satisfactorily explain why that is but action to amend this has started and continues. In 1996, the Mental Health Parity law was passed to provide parity but only for annual and lifetime limits between mental health coverage and medical and surgical coverage. There are hopes to expand parity under this law to include deductibles, co-payments, out-of-pocket expenses, coinsurance, covered hospital days, and covered outpatient visits. Legislatures will most likely continue to amend and clarify this law for many years and the joint committee of the Senate and House of Representatives are also working to eliminate this disparity.

Question: How to get inexpensive good insurance for elderly parents?
From: Steve of Ames, IA

Answer: You did not provide details about your parents” ages, whether or not they have Medicare and/or a supplement to Medicare. Since you use the term “elderly,” I will assume they are in the Medicare age group. Medicare is health insurance offered by the federal government for people 65 and older and to some younger people who have disabilities. Part A of Medicare is automatically available to people who paid social security taxes and it helps pay for hospital bills, nursing home care, hospice and home care. Medicare Part B is a supplemental insurance option for people who qualify for Medicare and covers outpatient doctor services and other medical services. Its purpose is to provide coverage for health care not covered under Part A. Part B provides coverage for doctors services, lab tests, physical, medical equipment, and some other medical services. There is a monthly premium and a co-pay. A fairly new part of Medicare is referred to as Plan C or Medicare Advantage Plans (like HMOs and PPOs). These private health plans have their own networks but do provide all Part A and Part B coverage and some offer drug coverage. The individual may have to see providers within their network. Out-of-pocket costs in these plans may be lower because of this. An excellent website www.medicare.com lists the options: Medicare Preferred Provider Organization (PPO) Plans, Medicare Health Maintenance Organization (HMO), Medicare Private Fee-For-Service (PFFS), Medicare Special Needs Plans (SNP), Medicare Medical Savings Account (MSA) Plans. People are generally eligible if they live in the service area of the plan, they have Medicare Part A and Part B coverage, and they don't have End-Stage Renal Disease. The newest part of Medicare is Part D prescription drug coverage. You must be enrolled in Medicare before you can apply for Part D coverage. It is offered by private companies and there is a monthly premium.

Question: Why insurance companies have the right to deny what the doctor deems necessary treatment?
From: Sylvia G.

Answer: It sounds like you have had encountered a denial or at least questions from your insurance company about a recommended treatment. An insurer may refuse to approve a test or treatment or it may refuse coverage of the test because you did not follow one or more of its rules. The important points are to know your insurance benefits and the rules, respond to requests within the specified timeframe, document information you are given by phone, give correct insurance information to the provider, and check whether the provider is within your health plan. If there is still an issue, your physician may need to write a justification and/or further explanation to the insurance company. An insurance company may approve payment of a generic, less expensive medication unless otherwise specified by the doctor. It may consider a treatment experimental. Know the reason for the denial and follow the insurance company’s appeal procedure.

Question: How to check your bill for errors at hospitals?
From: Bonnie B.

Answer: It is always wise to review your hospital bill. Although hospitals may do a “self audit” to check that services ordered were rendered and charged to the appropriate billing codes, errors do happen. If you or a family member feel you or your insurance company are being charged incorrectly, contact the hospital’s Patient Accounts Department. Insurance companies will also scrutinize the bill and may request a copy of the medical record to review for medical necessity and appropriate charges. Hospitals are wary of fraudulent behavior but you are also responsible. In some instances, incorrect information may have been given at registration so you should also make sure that insurance information is correct.

Question: How much money is spent on healthcare related expenses in the US each year?
From: Locke D. of Seattle, WA

Answer: Healthcare in the U.S. comprises about 16% of the gross domestic product (GDP) according to the National Coalition on Health Care. In 2005, healthcare spending reached $2 trillion. Unfortunately, despite these expenditures, about 15% of the U.S. population lacks or has inadequate healthcare insurance. It is no wonder that this is one of the major platforms in the presidential race.

Question: Why I have to ask what some medical words mean?They should be written so you can understand them.
From: Lori R. of New Hudson, MI

Answer: Sometimes hearing healthcare providers speak is like being in a foreign country and not understanding the language. If you or a family member is a patient, you have a lot at stake and should ask for verbal and written explanations. But don’t wait until you are in the midst of a crisis. Healthcare providers use medical terms for efficiency and clarity while treating a patient. A basic explanation is that there are three parts to medical terms-a root word which is generally a body part, a prefix before the root word, and a suffix after the root word. Sound complicated? Not really. For example, the root word “card” refers to the heart. Add the prefix “peri” (means around) and the suffix “itis” (means inflammation) and you have pericarditis or inflammation around the heart. I have compiled a list of common root words, prefixes, and suffixes along with their definitions in my book. Also, I have listed common medical abbreviations and common medical terms for several body systems.

Question: Very often, doctors don’t give instructions on taking medicines-time, with other medicines, side effects. It gets very confusing when taking several medications, what can I do?
From: M.K of Bethlehem, PA

Answer: I have found myself in this situation also. I have called the pharmacist for instructions and/or read the leaflet that comes with the medicine. But even that does not always completely help if taking multiple medications. As I stress in my book, it is important to get clear and preferably written instructions from the physician. Make sure the doctor is aware of all medications you are currently taking. Take a list with you. Ask about side effects, best time of the day to take the medicine, with or without food, impact on or from other medicines you are currently taking..

Question: How can I decide what specialist I need for what without having to call my personal doctor for everything.
From: Jennifer B. of Hopkinsville, KY

Answer: The American Board of Medical Specialties (ABMS) lists 95 specialties and subspecialties. Additionally, some specialties overlap as they seem to care for the same types of problems. You need to check on the training of the specialist and on what types of medical or surgical problems they deal with. Chapter 13 of my book, 7 Steps to Your Best Possible Healthcare discusses how to choose a specialist and gives a description of the more common medical specialties and subspecialties, their training and the conditions they treat.

Question: How long do they have to keep your medical records in the doctor’s
office?
From: Heidi E.

Answer: Most states require that providers, hospitals and physicians, keep medical records for 7 to 10 years, depending on the state. My own primary care physician retired several years ago and he had my records for the entire time I had gone to him-almost 30 years. Upon my request, he forwarded records to my new physician. I would suggest that you ask your physician how long he keeps records. As you can imagine, the record from a hospital visit will be much longer than a physician’s office visit and so storage has been a problem. As hospitals and even some physicians make the transition to electronic medical records, some of this will be alleviated. In January 2005, the Bush Administration called for the establishment of a national network of electronic health records within 10 years. There are certainly advantages in accessing records quickly in cases of disaster but confidentiality and security must also be protected.

Question: Can I find out more about medicaid?
From: Brittany T. of Burleson, Texas

Answer: There are 2 types of government sponsored health insurance-Medicare and Medicaid. Medicare is funded by the federal government and provides coverage for patients 65 and older and for disabled individuals who meet certain criteria. Medicaid is funded by both the federal and state governments and it is available to those at or below the state-determined maximum income levels. Each state administers its own Medicaid program and so each state’s details vary. Medicaid insures individuals who are economically needy, medically needy, and/or have a certain diagnosis. To find the eligibility requirements for your state, go to www.govbenefits.gov. Under “Benefits Quick Search,” select Medicare/Medicaid, then select your state. Since 1997, Medicaid covers children through the State Children’s Health Insurance Plan (SCHIP).

Question: Why do you have to wait to go see the doctor for 1 year if you have a preexisting condition, especially when you are currently paying $200 a month for insurance that you can’t even use?
From: Leslie BB of Rantoul, Il

Answer: A pre-existing condition is any medical condition diagnosed or treated before you join a new health plan. The Health Insurance Portability and Accountability Act (HIPAA) limits a health plan from denying payment for care for a pre-existing condition. Previously, a health plan required a waiting period for pre-existing conditions for new members (e.g., 1 year). Obviously, this could have a detrimental impact on the member’s health and lead to high financial burden for the member. Under HIPAA, if you have been insured for 12 uninterrupted months before joining the new plan, no waiting period is required for the pre-existing condition.

Question:  Where can I find information about Medicare for my grandma?

From:  Garrett B. of Ontario, NY

Answer:  You do not specify what specific Medicare information your grandmother needs.  Medicare is the government sponsored health insurance available to people 65 and older, people who are disabled and have been on Social Security Disability for 2 years, and people with End Stage Renal Disease and have had a kidney transplant or require dialysis.  Part A of Medicare provides coverage for inpatient hospitalization, skilled nursing facility, home care and hospice.  Part B provides coverage for physician services and outpatient care.  To learn more about the specific number of days covered, criteria that must be met to receive the coverage, annual deductibles, etc., you may access several websites and government agencies.  Your local social security office should have information available.  You may want to check into the Department of Health and Human Services website on Medicare by typing www.medicare.gov or www.cms.gov (Centers for Medicare and Medicaid).  Each site provides information on eligibility, covered services (and not covered services) and has many of the Frequently Asked Questions.

Question: Where can I find a directory of doctors?
From: Jessica S. of Tulsa, Oklahoma

Answer: So often, we look to family or friends to give us the name of a physician. You can certainly gain insight into that person’s experience and feelings about the physician. Other options are to check into your health insurance plan’s list of providers, contact your local medical association, check into the American Medical Association website, or check the local hospital physician directories. Most hospitals will list physicians by specialty as well. You may want to check whether the physician is board certified, years in practice, where the physician trained and you may consider visiting the doctor’s office to observe the environment and office operations. In my book, 7 Steps to Your Best Possible Healthcare, I provide some practical questions to ask of the staff and the physician and things to observe.