Insurance Help

Insurance Expertise for Free

It’s that time of the year again… Open Enrollment, when you can change your health insurance policy or plan. But you can’t change unless you know what your needs are, and can calculate what your budget is and what expenses will be. Insurance is frustrating, it’s daunting, and with a bleeding disorder, it’s expensive.

But I just saw this on Facebook, which made me happy for two reasons: 1) a licensed insurance broker can help you get started for free, and 2) he’s a wonderful person I’ve known for a long time.

Meet Alexander Ell!

For over 10 years, Alex has helped over one thousand clients with their insurance across multiple states and numerous insurance companies. Alex’s goal is to walk you through the process, providing non-biased advice about the best plan for your needs and goals. His website helps you learn the basics of insurance, defines the many acronyms that insurance loves to use, and has a Frequently Asked Questions section.

On Facebook, he wrote: “Hey everyone! If you hear of any friends or family that need help with their Medicare or Health Insurance, please send them my way. I’ve been a licensed insurance broker for over 10 years. My services are free and I provide non-biased advice about the best plan for their needs and goals. I’m licensed in ID, NV, OR, WA, TX, GA, and FL. If you have any questions, please reach out to me. https://capitalrealm.com

Alex has navigated the complex healthcare system for himself as he has hemophilia. Now he’s here to do the same for you! Contact him to get started with a free consultation today.

Welcome to the Jungle, I mean Marketplace! Part 2

At NHF’s Social Worker Insurance Workshop in Baltimore on January 16, there were some great questions asked from the audience concerning the Marketplace. Social workers know they will most likely be the first line of defense for patients with bleeding disorders facing the many challenges of the ACA. Here are some questions asked and other snippets of information from the workshop.
Q. What if you don’t like the insurance plan options in the Marketplace. How do you file a
special appeal [concerning coverage]?

Go to Healthcare.gov; there is a link for an appeal. Appeals are
worthwhile because sometimes codes are entered in wrong, and sometimes people
get approved for procedures and benefits that were originally denied.
Is there a limit to the number of appeals?
No.
Q: But after you pick a plan and don’t like it, what if you just don’t pay the next month’s
premium? Won’t you just get canceled and then you can choose another plan? Isn’t
that easier than an appeal?
There is an open enrollment time, so you can’t choose to switch outside that time period. After March 31 you can’t get into a “QHP” (an insurance plan that is certified by the Health
Insurance Marketplace, provides essential health benefits, follows established
limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum
amounts), and meets other requirements.)

Mike Bradley (Baxter), Laurie Kelly, and Derek Robertson (Apogenics, Inc.)

Joanna Gray, of CRD Associates told us that the ACA says HTCs must be included in-network. But… plans don’t have to include any specific medical procedure. They only need to cover “sufficient” providers, and they don’t say who those providers are. The ACA hasn’t come through in its promise. NHF says be careful! Don’t pick a plan that doesn’t include your HTC or product, because now it’s legal for providers to avoid HTCs. We can’t change the policy for this year. Maybe next? We need to complain to get changes made.
NICOLE of NHF said that every state has its own definition of EHB (essential health benefits). So picking a plan is harder, because there are more plans, and picking one that covers what you need is hard.
Q: To use the Marketplace, you must be a legal resident.  What happens to legal immigrants,
who are not citizens?
   In Nevada, they are currently covered under high-risk pools but will lose this soon (the pools are closing). Are there alternatives?
No. You can still get emergency medical through Medicaid; and of course, anyone can buy insurance in the commercial marketplace.

Nancy Hatcher and Ed Kuebler

JoAnn Volk of The Center on Health Insurance Reform, Georgetown University Health Policy Institute, said that six states will not enforce the ACA: Alabama, Missouri, Oklahoma, Texas, and Wyoming. The ACA gives primary responsibility to states to enforce the rules, but there are 10 state benchmarks (Essential Health Benefits) that must be followed, and will be reviewed by the feds.
If you find a QHB but it doesn’t include factor, JoAnn thinks that the appeals process will work, recommending that people get their drugs for 20 days, during the appeals process, even if they are not on formulary.
Q: How do I find the benchmark plan for my state?
All benchmarks are listed in the state insurance department website. www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/Vermont  (for example)
Q: What’s the advantage of going into the Marketplace?
The advantage of going into the Marketplace is subsidies; you can be eligible for discounts within limits. To buy into a Marketplace, you have to be physically in the state, not incarcerated and be legally present. There are no other limits.
Q: When we couldn’t find what we were looking for (was our hematologist covered), and we called the website, we couldn’t get any help.
Don’t call the health.gov website. Call the plan provider. Sometimes it’s best to work with your HTC contracting department!  They will know who is in network.
And there is so much more information! Be sure to keep reading your HemAware (from NHF), Pulse (from us), and tap into your chapter’s or your local hemophilia organization’s efforts to educate their families about insurance changes. Lots happening; don’t miss deadlines and opportunities by not staying on top!
Great Book I Just Read (Again)
Ada Blackjack: A True Story of Survival in the Arctic  by
Jennifer Niven [Kindle]
A secret exploration to Wrangle Island, in
the Behring Sea, in September 1921 goes terribly wrong when food runs low and
sea ice keeps a relief ship from rescuing the stranded four young men and one 25-year-old
Eskimo woman trapped there. The trip sets off an international crisis when
Russia, Great Britain and the US learn that the trips leader, the opportunist and
greedy explorer Vilhalmur Stefansson, who never even went, was trying to claim
the island for Canada. Only Ada survives the horrible conditions, and her
return sets off a media firestorm. Did she kill her companions? How did she survive?
Diaries are stolen, Ada is hounded and used by the press and her own sponsors.
She becomes at once a hero and a villain. Fantastic read and Ada will amaze you
with her spirit and ingenuity. Her real survival started when she returned home.
Four/five stars

A NEW Co-Pay/Co-Insurance Assistance Program

It’s Superbowl Sunday, but take time to read this important press release: while it’s meant only for Kogenate® FS users, remember that almost all manufacturers of blood-clotting products have some kind of assistance program. I’ll post them as I hear of them, but don’t hesitate to call your manufacturer to find out what they are doing to help you with insurance!
PSI AND BAYER HEALTHCARE INTRODUCE A CO-PAY/CO-INSURANCE  ASSISTANCE PROGRAM
Patient Services, Inc. (PSI) and Bayer HealthCare are pleased to announce the Kogenate® FS
Co-pay/Co-Insurance Assistance Pilot Program. The pilot program is funded by Bayer to help qualified Kogenate® FS patients with their out-of-pocket payments.
What is offered through the
pilot program?
PSI will administer and determine eligibility for the Program to help Kogenate® FS patients afford
their copay/coinsurance expenses.
Patients are qualified to
apply for the pilot program* if they:
· have Hemophilia A.
· meet specific financial criteria for enrollment.
· currently have private health insurance.
. Who is not eligible for
assistance?
·Patients on public health insurance, including (but is not limited to) patients insured through Medicare, Medicaid, TriCare, DOD plans, PCIP programs, and High Risk Plans associated with a PCIP.
· Patients enrolled in Bayer Assistance Programs.
Once approved…
·
Financial assistance may be provided for up to 12 months or as long as funding is available. Funds administered by PSI can only be used towards a patient’s co-pay/co-insurance expenses for Bayer’s Kogenate® FS.
·
Financial assistance will be based on each patient’s specific health plan design and annual income, subject to yearly and per payment maximums.
· As a condition of payment, patients and pharmacies must comply with all contractual obligations made with Third-Party Payers and insurance companies, and must provide notice of any benefits received and the value of this program to all payers as required by law, contract, or otherwise.
For inquiries regarding the Kogenate® FS Co-pay/Co-Insurance Assistance Pilot Program, please contact Bayer’s Factor Solutions at 1-800-288-8374. Please remember that applications will be processed and patients will be enrolled on a first-come, first-served basis. Program may be cancelled or changed at any time without notice.
Interesting Book I Just Read
Ice Balloon: S. A. Andree and the Heroic Age of Arctic Exploration by Alec Wilkinson [Kindle]
The story of S. A. Andrée, the visionary Swedish aeronaut who, in 1897, during the age of Arctic exploration, convinced donors to fund an attempt to be the first to discover the North Pole by flying to it in a hydrogen balloon. The book is an easy read, and covers the history of Arctic exploration, failed attempts to reach the pole, a glimpse into Andrée’s past and makeup, his reasons for being obsessed with attempting this, despite many misgivings by experts. If you are new to readings about polar exploration you will love this adventure book. Learning about balloons, how they are handled and how they stocked it for a long haul trip was fascinating! But… the book is a mixed bag. I have been studying polar exploration for over a decade and have an extensive collection of biographies and books. So for me, this book was a bit fluffy: the writing was good, but there was a lot of filler. Six chapters alone were spent on an unrelated story about the Greeley expedition, I guess just to show how tough it can be in the Arctic? But it was disconnected to the rest of the story, and you’d be better off reading Ghosts of Cape Sabine, which is superb reading about the Greeley expedition (which is now legendary). I am glad Andrée’s story was told, but honestly, there isn’t much to his story. He went up, he came down, and his diaries, terse and factual, left little information on what happened. A lot of the book consists on just quoting directly from the diaries. This books gets mixed reviews on Amazon.com. It’s definitely worth reading, but it could have been better. Two/five stars.

POTR is Hot in San Antonio!

Insurance is still the hottest subject in bleeding disorders, and this past weekend in San Antonio really proved it. We had a great turn out for “Pulse on the Road,” our unique symposium, sponsored by Baxter Healthcare Corporation, that is completely devoted to educating patients about insurance reform. As guests of the Texas Central Hemophilia Association and Lone Star Chapter of NHF, we presented a three-hour symposium on Sunday, June 26, from 7 am to 10 am, to an audience of over 200 patients and their families.

The chapters did an excellent job of attracting patients and families to attend. With hundreds of family members and a fair amount of industry representatives, this was a stellar meeting. I loved seeing the children with hemophilia scampering about, or holding relay races in the hallways as part of the supervised kids’ programs. No joint problems anywhere!

While a nutritious, hot breakfast was served, I started the session Sunday morning with an overview of hemophilia’s history and how our unique history has been placed high on the radar screen of insurance companies and state governments. My talk was followed by Elizabeth Stoltz of Baxter Healthcare, who gave an Insurance 101 session; her talk covered common terms that all families will need to know to navigate healthcare reform. Then, Michelle Rice of NHF presented the results of a patient-focused survey from last fall, which tested to see how much bleeding disorder patients knew about their insurance and insurance reform. Results were encouraging, as high numbers knew that lifetime maximums were being eliminated and that dependents would be able to stay on their parents’ insurance until age 26.

Finally Jim Romano of Patient Services, Incorporated (PSI) gave the keynote about healthcare reform. Breaking down the many changes into digestible amounts, Jim covered how the new healthcare reform will help us, and what we need to monitor to ensure we continue to have access to the care we need.

To spice things up and keep our audience sharp at such an early hour, I asked the audience after each presenter a question, and whoever got the right answer won cash! The message: we are trying to educate to keep the cash in your wallets. If you don’t know much about your own insurance policy, you may overpay. If you don’t know how insurance reform will impact you, you may lose money. In these economic times, we want every family to preserve their hard-earned dollars. The “competition” added some fun to the topic of insurance and we had some sharp people in the audience!

Following the speakers we had three breakout sessions on Medicaid, Out of Pocket Costs and Advocacy. Everyone agreed that 45 minutes for break out was not enough. These interactive and informal gatherings proved the highlight of the meeting. Patients were able to ask questions about their personal situation with experts in their field. Jim Passamano, of Sufian & Passamano LLP, a lawyer specializing in chronic disorder and insurance, helped explain Medicaid changes to many families. Shannon Brown, a social worker from Texas, spelled out certain out of pocket costs that patients will need to monitor closely. And Michelle Rice of NHF presented a new personal tool to help families get a handle on comparing insurance plans.

Simultaneous translation into Spanish helped the many Spanish-speaking families understand how healthcare reform may impact them.
Patients truly appreciated the three-hour program and the chance to speak to insurance experts in bleeding disorders. “I would like to have attended all the [break out] sessions and not just one!” commented one attendee. “I’m very pleased at how much I learned and all the wonderful people I met!” exclaimed another. When asked if they learned something new, every hand in the room was raised!

Thanks to Luis and Shannon, executive directors of their chapters, and coordinators of the event, for inviting us, and to Baxter Healthcare Corporation for their sponsorship.

Visit our website (“Events”) to see where we take Pulse on the Road next!

Visit our website to download your complimentary copy of Pulse, our newsletter devoted to insurance reform for the bleeding disorder community.

Interesting Book I Just Read
Altitude Illness: Prevention & Treatment
Stephen-Bezruchka, MD
This is a small book, written to be taken while trekking on mid- to high-altitude mountains. I read most of it on one plane ride. It’s chock full of good information, and goes into great (and scary) detail of what can happen to you if you are not careful on the mountains. It’s very dry, terse, to the point, and may make you think twice about attempting the big ones. Too late for me! I am going to tackle Mt. Kilimanjaro in August. The strange thing about altitude sickness is you just never know who it will strike. Marathoners and top athletes, like Martina Navratilova, can get it, and 12 year olds with limited climbing experience may avoid it. You never know till you are there. Two stars.

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