HMO - Health Maintenance Organization
An HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. You will usually need a referral from your Primary Care Physician to see a Specialist, resulting in multiple co-pays. All healthcare services are managed in-network through your Primary Care Physician.
In California, the popular HMOs are Kaiser Permanente, Sutter Health Plus, Western Health Advantage, Health Net of California, Sharp Health Plan, LA Care, Molina Healthcare, and Valley Health Plan.
PPO - Preferred Provider Organization
A PPO is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. PPOs do not require you to select a Primary Care Physician. One of the benefits of a PPO is you usually can self-refer to a Specialist.
In California, the popular PPOs are Blue Shield of California, Health Net Life Insurance Company, and Oscar.
EPO - Exclusive Provider Organization
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). Under an EPO plan you do not choose a Primary Care Physician. You can receive care from any of the in-network doctors and self-refer to in-network specialists.
In California, the popular EPOs are Anthem Blue Cross, Health Net Life Insurance Company, and Oscar.
If you want to discuss options about your health insurance, we recommend speaking with an independent insurance agent like George Beach Insurance Services. We work for you the client, and not a particular big company.
Since the 2019 Open Enrollment Period is over, you can now enroll in or change a Health Insurance Marketplace plan only if you have a life event that qualifies you for a Special Enrollment Period.
A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.
There are 4 basic types of qualifying life events. (The following are examples, not a full list.)
Loss of health coverage
Changes in household
Changes in residence
Other qualifying events
Opioid use, whether for a short or long period of time, can make you susceptible to addiction and possible overdose. There are many factors that can play a role in prescription drug addiction, including your personal background and length of use, but there really is no sure way of knowing who will fall victim to opioid abuse. Whether a person acquires them legally or illegally, these drugs are to blame for the vast majority of overdose deaths in the United States. Over 115 people in the United States die daily from opioid abuse. This has turned into a national crisis affecting public health as well as social and economic welfare. The United States loses over $78.5 billion a year fighting this crisis. Unfortunately, this negative trend is showing no signs of slowing down.
How it Started
Drug companies originally assured the medical community and government that opioids would not be addictive. This contributed to physicians prescribing these drugs more often. Eventually, this led to widespread abuse of these medications before medical professionals realized they were very addictive. In the meantime, opioid misuse and overdose rates continued to steadily climb. By 2015, over 33,000 Americans died of opioid-related overdoses. In that same year, nearly 2 million Americans suffered from opioid pain reliever substance abuse, and nearly 600,000 suffered from heroin addiction. It is important to be considerate toward addicts because it is a difficult situation to deal with, and many factors are beyond the user’s control.
Medical Coverage for Addiction
You may be wondering if medical insurance covers opioid addiction treatment. Generally speaking, yes. The Mental Health Parity and Addiction Equity Act, which was passed in 2008, mandates that insurance companies provide coverage for opioid addiction that is comparable to regular medical and surgical care. The types of drugs that are covered and other specifics will vary based on your insurer and plan type. Prior to the Affordable Care Act, many people did not have health care insurance, and their addiction problems went untreated. Today, nearly 85 percent of adults have medical insurance coverage.
The United States has over 14,500 facilities that specialize in drug addiction. It is important to remember that your insurance plan may not cover every facility. Most insurance plans also cover maintenance programs for people who are recovering from addiction. These programs are designed for individuals who had severe addictions and are unable to survive without drugs even after rehabilitation. Typically, maintenance programs will prescribe medications to help these people live a drug-free life. In most cases, these drugs are very expensive, so medical coverage is essential.
Opioid addiction is a very serious problem in the United States that costs billions of dollars each year to confront. The problem started with a misunderstanding of the addictive potential of the drugs. On the bright side, the majority of people in the United States do have medical insurance to treat addiction and improve their lifestyle.
At your first appointment, you’re required to have:
The following lists will help the doctor get to know you and learn about your health care needs. While sharing personal health issues can be embarrassing, the more information you give, the better equipped the doctor will be to keep you healthy.
Before the day of your appointment, write down this information to bring with you:
With your written permission, your doctor can get a copy of your medical records from your previous doctor. The physician’s office will provide the forms for you to sign.
It’s often hard to remember what you want to ask the doctor. Here’s a list of questions to get you started:
Want to know what your health plan covers before your appointment? Send me an email (email@example.com) and I will review your policy with you. You can even text me at 209-353-2330.
If you are dealing with addiction problems, then you know how difficult an addiction can be to beat. When a person does not find the correct resources to help with his addiction, he can find himself in a constant cycle of addiction and pain. Unfortunately, there is a stigma attached to addiction and addiction recovery, so some people may want to try to quit on their own without telling anyone about their struggle. Although there have been individuals who have been able to get clean on their own, most people do need to go to some type of treatment center. Many leading doctors agree, “coupling medication with psychotherapy and support creates a solid foundation and results in a longer lasting recovery." Treatment centers can offer a person relief from the lifestyle that is keeping them in the prison of addiction.
Do Insurance Companies Cover Treatment Centers?
Since the majority of people who suffer from addiction will need some type of help from a treatment center, you may wonder how it is possible to cover the cost. These recovery experts explain, “there are many approaches to successful treatment such as: behavioral therapy, 12 step programs, motivational interviewing, contingency management, medication treatments, and even alternative methods.” Treatment centers can keep a person for weeks or even months. These centers have to be able to fund the professional staff that works at the center and the facility itself. For that reason, the cost of staying at a treatment center can be high. Instead of worrying about payment, you'd do well to get in contact with your insurance company.
The good news is that most insurance companies will cover treatment centers; there may be some stipulations on the coverage. It is possible that the insurance company will want you to only go to a treatment center that is in their network, or they won't cover the expenses. On the other hand, the insurance company may only cover you for a certain amount of days, or for a percentage of the total cost. There are still some insurances that will ask you to pay a certain amount towards the deductible and copay before they offer coverage.
Don’t Hesitate To Get Help
Regardless of the issues that may come up with insurance, the most important thing is that you get the help that you need in order to stop the addiction rollercoaster. This government agency reinforces, “You suffering is real, and it is possible to overcome it. Don’t give up on hope. It may not be simple or easy, but it will be worth it.”
It is worth the time and effort that you may have to spend when working with your insurance company to find the right treatment center. There is no price on your happiness and your livelihood, so do the initial work so that you can live a better life. Various treatment centers can give you the tools that you need to break the cycle of addiction.
If you find yourself in need of insurance, whether it be health insurance or some other kind, keep George Beach Insurance in mind! We want our clients to be happy, healthy, and safe. Get in contact with us for a free quote!
Just like adults, children often face numerous oral problems. Once you realize that your children are suffering from oral pain and other oral-related issues, you should be able to take them to an experienced dentist for examinations. The best way to ensure that you and your children are taken care of is to have the right dental insurance plan that suits you. Below are three common dental procedures done on children that just might break the bank if you don’t have insurance.
This procedure is used for children who have weak, worn out and broken teeth. Adding a crown strengthens the tooth and improves its shape. If the teeth are severely decayed, the doctor is likely to use stainless steel crowns to restore their shape and hold fillings. You can also find crowns made of porcelain. Some people prefer them because they are stronger than the rest and they look more like natural teeth. Depending on the type of crown, the cost without insurance can be between $1,000-$1,500. Also keep in mind that this procedure usually takes more than one appointment, so the bills may start to add up if you’re paying full price for each visit.
Fillings are common dental procedures performed on children who have cavities. Traditionally, dentists used fillings or dental restoratives made of porcelain and gold. However, there are modern dental fillings that can mimic and match the appearance of natural teeth. The natural colored fillings however, are typically between $90 and $300 for one to two teeth without insurance. Also, this is one procedure that putting off could do more harm than good. If you don’t have insurance and are trying to wait until you have more money, a simple cavity or two could turn into a much more serious and expensive problem.
If a particular tooth is affected by decay or your kid’s mouth if overcrowded, your dentist can recommend extraction, which is the removal of a tooth. The process depends on the severity of the child’s situation. For instance, the dentists may recommend extraction due to long and painful roots. Depending on severity, you may need an experienced dental surgeon to perform this practice, which can add $75 to $300 more to your price tag without proper coverage.
Having dental insurance could make any of the above mentioned procedures much less draining on your wallet. Additionally, if you recognize these orthodontic problems in your children early, then your likelihood is even higher that you won't have to pay for the more extensive procedures. It is advisable to take your child for teeth examination at least once per month. This will help to keep your child happy and healthy, and your wallet just a little more taken care of.
There are many insurance products out there that you can benefit from. Some of the most common that people are aware of are health insurance, car insurance, and life insurance. But there are other valuable insurance policies that you may not think about or be aware of. Here are five insurance products that you didn't know you needed.
Every year, everyone has to update their health insurance. It is inevitable and many people dread having to decide which plan they should go with for the following year. There are so many variables, and cost is one of those variables. The cost of the health insurance plan can vary depending on the size of the deductible.
Because the insured will be responsible for a larger amount of their initial care at the beginning, a high deductible plan will have a lower premium each month. The deductible can range from $1,000 or more depending on the size of the insured’s family. The money paid out for the deductible will end as soon as the limit is reached for the plan.
If the insured decides on a high deductible plan, they maybe be eligible for a Health Savings Account. This account allows the insured to set aside a certain amount of pre-tax dollars for medical expenses. Sometimes an employer will also contribute to an employee’s Health Savings Account.
A low deductible plan means that the insured will pay less for medical care when they visit a doctor, but their premiums will be much higher every month. Most of the time with a low deductible plan, the insured is paying a co-pay for each visit to the doctor and these co-pays will need to be paid throughout the year.
It is usually best to estimate the medical costs for the following year before signing up for a plan. A person should make a list of all of the routine and necessary appointments plus prescriptions and then add on a few extras just in case. Next, add up all of the expenses including the premium for a high deductible plan and then for the low deductible plan and compare them. A low deductible plan has the potential to cost twice as much per month than a high deductible plan, depending on how often the medical insurance is used.
A high deductible plan is usually best for people who are healthy and do not have children. Low deductible plans are always best for people with chronic medical issues and children.
Health insurance is necessary and it is not something that can be ignored. Every person needs to look at the information carefully and make the best decision for themselves and their family.
Well, what can you do about health care promises made by politicians? However you cut it, you might need to find your own way to finance high-cost medical procedures. Take control of your health care bills by finding a creative funding source.
Expensive Medical Bills
Many costs are rising; but, healthcare costs are rising faster than the average. Cosmetic surgery, dental work or LASIK might be necessary high-cost medical procedures. If you have no health insurance, you are not alone. In 2017, CNBC reported that 11.3% of American adults lacked health insurance coverage.
Aren't there any groups or businesses that can help you out? There are many charitable organization and government programs that can help you put a dent in high-cost medical procedures so that you can cover the rest. Here are some other ways to pay those bills.
Health Savings Accounts (HSA)
The primary goal of HSAs is to provide tax deductions for funds that will be used to pay for medical procedures. Now, might be the time to tap into your healthcare account. Obviously this isn’t the option for those who need immediate help, but as with many things in life, preparation goes a long way. No one expects to get sick or need medical care, but everyone does at one time or another. That’s why it’s important to set up a HSA or something like it well in advance.
If the reason why you're getting this expensive procedure is because you suffered a disabling injury, then disability insurance can help cover your procedure by compensating you for lost income, which is a big part of recovery costs. Other types of insurance, like auto insurance and workers compensation can also help, depending on the nature of the injury. Also depending on the type of insurance and degree of coverage, insurance may be able to cover the entire expense.
You could tap into your 401(k) plan. The government allows you to withdraw a certain amount of money without a penalty. Read the fine print of your 401(k) plan to see the terms and conditions. It’s critical that if you’re thinking of tapping your 401(k) you understand what goes into that process. You need to talk to a financial adviser if you’re wanting to do this since it’s very easy to do it wrong and you could cause problems for your financial future. There are also ways you can tap into your 401(k) without causing any problems, and speaking with a financial adviser will help you navigate those tricky waters.
You could also go to a peer-to-peer lending organization. Unlike crowdfunding services, these peer-to-peer funds are personal loans. These sites offer unsecured personal loans which are great for people who have issues with banks or other lending services. But just like any other lending or loan service, you will be required to repay the amount you borrowed plus interest. This isn’t a long term solution, but can help you overcome bills that are due immediately which you will pay back later.
Another intriguing possibility is to take out a HELOC of a Home Equity Line of Credit. You might have built up a significant amount of home equity and wouldn't high-cost medical procedures be one of the best ways to spend this money? A nice feature of the home equity loan is that the interest you pay is tax-deductible.
Other Financial Options
There are other special options to help you pay your medical bills. Most hospitals will have social workers who have access to special government programs. You can talk to the hospital social worker to create a payment plan. Since their job is to help patients and those in need receive the financial help they require they know a lot of information on how to make the system work for your benefit.
If you’re a military veteran, you might have some additional options not available to other citizens. Because of your service and determination you might have the option to look into VA refinance options for your home loan that can allow you gain a substantial amount of money to help cover costs.
You can try to set up a project on crowdfunding, peer-to-peer lending, use HSA accounts, take out a loan, or see if the hospital can help. High-cost medical procedures might save your life. Hopefully, you find ways to finance high-cost medical procedures, so you can enjoy a long, healthy, productive life.
If you’re wanting some financial or insurance help make sure to get in contact with us!