Do You Make These Mistakes in Choosing Your Health Care Plans

There are a lot of details to consider when you are choosing a health care plan, whether it’s one offered through your employer or one you buy on your own. No matter what age you are, your health should be a primary concern, although young people often act as if they will live forever and sometimes postpone making health care decisions.

Here is a list of common mistakes that people make all the time when choosing a health care plan. They are in no particular order, and all are important to consider, carefully and completely. If you are not conversant with all the terminology or are finding it difficult to make the decisions, you should ask for help from a neutral third-party such as family member or friend. Don’t ask a health insurance company unless you want to hear a sales pitch!

Common mistakes
– You don’t check out your doctor, or any others – Although some healthcare plans require you to use a physician in their own network, other plans are more inviting. If you already have a physician, and are buying your own insurance, check with the doctor to see what plans he is a member of. If you do have to choose a new doctor, you should look into the health plan doctors’ credentials by contacting the AMA.

– You forget “location, location, location” – The location of your doctor or clinic, and the travel time required, are other factors you should consider when considering health care plans. Find out where the doctor is located and also look into the regular and emergency hours of the facility.

– You don’t consider specialists – If you already need specialist care, or think you may need to in the future, you need to know the health care plan’s procedures on using them. Some plans require you to contact a primary care physician, while others allow you to make specialist appointments directly.

– You don’t consider your own specialist – You should definitely find out if your current specialist is in the health care plan you are considering. If not, perhaps your specialist can refer you to one who is.

– You forget to check the policy on “pre-existing conditions” – Even though this should be a “no-brainer,” people forget to ask about the policies on pre-existing conditions. Coverage for pre-existing conditions varies widely among health plans. Some exclude them entirely, and will not even consider coverage, while others cover them fully. Many health care plans fall somewhere in the middle, offering coverage after a certain amount of time, or for a certain amount of time or expense. Rules promulgated by the Health Insurance Portability and Accountability Act guarantees you coverage for your pre-existing conditions if you join a new group plan offered by your employer after being insured the previous year. Do your research to make sure you know what your policy covers.

Less common oversights
– You don’t ask about physicals and health screenings – Again, it seems an obvious thing to ask, but if you appreciate getting regular physicals and health screenings you should ensure that they are covered. Most “managed care” plans do cover these types of procedures, usually on an annual basis, but there are some plans that do not cover them. If you have children, make sure to ask if “well baby” check-ups, physicals and immunizations are covered.

– You forget about additional services – Everything, from prescription drug coverage to mental health care, is an important consideration. You need to consider which of the various additional services that you may need are, in fact, covered when you are comparing health care plans. Other examples of these additional services that may be important to you are drug and alcohol counseling and treatment, home health care, nursing home or extended care, hospices, experimental treatments, alternative and complementary medicine, chiropractic care and physical therapy.

Bottom line considerations
– You don’t price things out correctly – Once you know what you want in your health care plan you need to compare costs, and you need to do it right, which means covering all the bases. You will need to know exactly what deductibles must be paid first before the health care plan coverage starts paying, and don’t forget to ask if the deductible needs to be met before certain services can be utilized. Find out about “out of network” charges if you anticipate having to go beyond your plan facilities or physicians. Finally, there are co-payment, cap amounts and total-care limits you need to know about. Some plans have lifetime limits, some have lifetime and annual limits, and others have mixed formulas for making this determination. Get all the facts.

– You don’t check the exclusions – If you don’t read the exclusions list, you will not know what is not covered. You need to see if any condition you currently have, or that you expect to contract in the future, is included. This is an important bottom-line consideration since, if you don’t get this settled and dealt with up front, you will likely spend a great deal of money down the line to treat excluded conditions.

It is a difficult thing to look at your health in a dispassionate, dollar-oriented way, but that’s life. As we age, more of our energy goes into thinking and planning against death and disability, but the subject need not be morbid or depressing. Do your best to get a health care plan that covers what your particular needs are, and remind yourself that you are worth the trouble – and the expense.

Health Care Planning

One of the foremost challenges faced by health care professionals is to formulate a well-devised, well-thought out plan for assisting both the patients as well as the health care givers. Care planning is an essential part of health care, but is often misunderstood or regarded as a waste of time. Without a specific document delineating the plan of care, important issues are likely to be neglected. Care planning provides a sort of ‘road map’, to guide all who are involved with the patient’s/resident’s care. The health care plan has long been associated with nursing; however, all health care professionals need to be assisted in the care giving process. In today’s world, highly expensive Health Insurance policies are not viable for most individuals. Therefore, the government needs to play a crucial part in ensuring that ‘health care’ is impartially and effectively provided to all citizens.

At the beginning of the 20th century, a new concept, the concept of ‘health promotion’ began to take shape. It was realized that public health had neglected the citizen as an individual and that the state had a direct responsibility for the health of the individual. Consequently, in addition to.disease control activities, one more goal was added to health-care planning- health promotion of individuals. It was initiated as personal health services such as mother and child health services, mental health and rehabilitation services. C.E.A.Winslow, one of the leading figures in the history of public health in 1920, defined public health care planning as: ‘the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort.’

The first step in the health care planning program is accurate and comprehensive assessment. Once the initial assessment is completed, a problem list should be generated. This may be as simple as a list of medical diagnosis. The problem list may include family/relationship problems,which are affecting the parent’s overall well-being.

Following the problem list, the health-care professional must ask,’ will I be able to solve this problem?If yes, then the goal of the health-care professional must be to solve that particular problem. Moreover, this goal should be specific, measurable and attainable. The approaches towards achieving that goal should also be measurable and realistic. An example of a problem that could improve, would be health-care deficit related to hip fracture. With rehab, this problem is likely to resolve.

In case a medical problem is irreversible- such as diabetes- the next step would be to eliminate further complications or possible health deterioration. In the case of such health problems, the goal should be to retain the level of health at an optimum level.

In case of an illness, where further health complications are inevitable, the goal should be to improve the quality of life. It is note-worthy that for all medical problems, approaches must be ordered by the physician. The health care planning process is never completed until the patient is discharged from the current care setting. Periodic schedule re-evaluation is also necessary once the patient is discharged.

In the final analysis, the ultimate purpose of the health care plan is to guide all who are involved in the care of the patient and to provide appropriate treatment.