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NHIA Blog2018-10-03T17:48:50+00:00

Check Out the Latest From National Health Insurance Agencies!

2603, 2021

Weight Loss Surgery and Insurance

By |March 26th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

According to the CDC, the estimated population of American adults with morbid obesity is roughly 40%. The crisis of obesity is quickly becoming an epidemic in the U.S., many  people are seeking to lose weight. As a result, they are curious if insurance providers might assist their road to weight loss through weight loss surgery. Procedures like gastric sleeves, bypasses, and duodenal switches are all potentially covered beneath your insurance plan. In this article, we include the basic premises and what to look for when deciding to undergo an operation with your physician’s assistance.

Diet and Exercise

Providers usually have steps before seriously considering the push for surgery. They will first require you to put some serious effort into your weight loss with diet and exercise. Begin by first, speaking with your physician and finding a routine fit for you and following it. Without effort and proof of attempts, the insurance companies will not cover your operation.

Common Prerequisites of Various Providers

With each provider, there are ‘underlying checks’ that you must pass before they consider you for coverage for surgeries. Some of the most basic are things like minimum age, which is usually eighteen but can be lower with some specific plans. Others are things like your body mass index being at least forty or lower with risk factors that will jeopardize your health further.

Before treatment, you must also have no evidence upon checkup of substance abuse. You’ll also undergo psychological testing and be required to quit smoking beforehand, so prepare for the surgery by preparing to give up nicotine. An unfortunate reality for many, but necessary for your health.

Some of the worst symptoms of obesity include:

  • High blood pressure
  • Sleep apnea
  • Asthma
  • Cholesterol Issues
  • Fatty liver disease
  • Urinary stress incontinence

With surgery, It’s been heavily documented that conditions such as these will begin drastically improving as the stress on your body lowers from your weight loss.

Common Providers

Some of the most common providers that Americans are using are insurance companies such as Medicare, Medicaid, CIGNA, and Aetna. Though, if you aren’t within these major companies, be sure to request a copy of your provider’s insurance policies to review them yourself. Additionally, a few calls to discuss the terms and requests for the surgery to your provider might be a good idea.

Medicare covers some surgeries, but you need to meet their BMI requirements above 35, serious health issues arising, and years of attempts to lose weight with diet and exercise. CIGNA has similar rulings regarding BMI requirements and health issues and differentiates by requiring a weight-loss program directed by a physician. They’ll also require several recommendations, evaluations, and more before paying for the procedure. Aetna’s program is roughly the same as CIGNA’s.

If They Decline You

If your provided information isn’t enough for them to warrant the surgery, you still have options to appeal. Every health insurance provider has documented materials to assist you in the appeals process; find them, study them, and follow them to the letter. Keep in mind, some providers give you a limited amount of time to appeal the process. So if you get denied, work fast to reach the next steps necessary to attempt fighting their rejection.

Average Cost of Weight Loss Surgery

The surgery’s average cost appears to be roughly anywhere between a low of $17,000 to a staggering high of $26,000. Of course, each pricing is a variable factor depending on your age, size, the operation you choose, and other factors.

Even the highest price of the surgery is still a far cheaper option than treating the various long-lasting consequences of staying within the morbid obesity bracket, as the stress of large amounts of weight upon your body will quickly cause it to break down.

1903, 2021

Stem Cell Therapy and Health Insurance

By |March 19th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

Stem cell therapy is a rising star in the treatment methods for various debilitating diseases and illnesses. It can help treat everything from leukemia to diabetes. However, such treatments’ costs vary from a modest $2,500 to a staggering $100,000 and up.

It is also not suitable for everyone and is not a magical ‘instant cure’ for every condition. If you have active cancers, infections, or a history of bone marrow cancers, stem cell therapy might not work. As an addition, those with blood-related conditions might also end up on the ‘no treatment’ list for stem cells. This is due to the risks attributed to their illnesses.

What Are Stem Cells?

Stem cells are the basic building block of most of our bodily tissue. This includes blood, bone, organs, and everything else within our creation. Researchers can harvest cells from one of the body. Then, they redistribute the cells to another part in order to assist in repairing your body.

Alternatively, this may also refer to the far more controversial cells that are harvested from human embryos. Thankfully, this has been battled on various legal platforms and, with some amount of research, is now considered ‘unviable’ by a majority of the healthcare field.

Insurance and Stem Cell Therapy

Medical debt being one of the leading causes of bankruptcy in the US. So, some potential patrons of stem cell treatment look to health insurance to help pad the blow to their finances.

Unfortunately, despite the positive research showing their usage effectiveness, the FDA has not yet approved their use. Most insurance providers won’t cover in-clinic stem cell injections on principle, but they will cover SCT for various cancers. Exceptions can only be made if the physician presiding over your case assures the insurance company that the treatment is absolutely necessary. Though, even then, they’ll still be hesitant to pay for the procedures.

Before you begin researching, a few notable companies that do not consider stem cell treatment necessary:

  • Anthem
  • Aetna
  • Medicaid
  • Medicare

These are some of the most notable and widely covering providers for Americans. If your illness calls for stem cell treatment, the general recommendation would be to contact your provider and discuss the topic at hand with them. Collect as much information as possible, be a well-informed dependent.

Suppose you wish to explore all treatment options. In that case, you could possibly be covered to discuss treatment consultations by your provider, even if the topic is to discuss a treatment option they don’t necessarily recommend or desire.

Preapproval

Before moving forward with anything, even if you do not believe your insurance will provide coverage, still put forth the effort to contact your insurance company and attempt to reach an agreement and expand on the situation at hand.

Paying For Stem Cells Without Insurance

A majority of stem cell therapy providers are more than happy to assist those interested in the treatment with personal payment plans that, when insurance is unavailable, may make their recovery far more affordable. A variety of financing options exist, be sure to discuss the terms by contacting the treatment provider you’re interested in and discussing the terms of payment at hand with them.

Medical Tourism

Suppose you cannot find assistance from your insurance provider, and all other alternatives are at an end. In that case, another potential and sometimes popular option for Americans is to take trips to other countries for alternative treatment. It is recommended to speak with your presiding doctor and specialists before moving forward and only use this option as an absolute ‘last resort’ as the treatments can be made at less-than-adequate unlicensed facilities that may do more harm than good.

Your doctors can at least point you in other potentially usable directions or, at least, give the facility you’re thinking of a once-over for the accuracy and likelihood of success.

1203, 2021

Eating Disorders and Healthcare

By |March 12th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

If you or a loved one have eating disorders, the process of gaining treatment can be a struggle. It would be best if you asked yourself the tough questions on treatment options. They can be anything from in-patient care to simple therapy sessions. However, all will likely need some documentation and healthcare providers’ assistance.

It can be challenging to get insurance providers to pay for these disorders. This is due to these disorders’ conditions and treatment requirements, but it is not impossible. Written below are a few things to consider.

What Are Eating Disorders?

An eating disorder’s medical definition is a “Serious and sometimes fatal illness that causes severe disturbance to a person’s eating behaviors”. These disorders do not discriminate but are more prevalent in women than men. Medical professionals do not fully understand the cause of these conditions. However, they assume that the conditions come from a mixture of biological, psychological, and sociocultural attributes.

Professionals estimate that at least 9% of the worldwide population suffers from one of the various eating disorders. The most common are binge eating, bulimia nervosa, and anorexia nervosa. Some are the lack of eating, overeating, or simply eating in brief, excessive bursts. Many varieties are a response to stress, which then lead to the onset of said disorder.

The average age for most varieties of these disorders is between eighteen and twenty-one.

Consequences of Eating Disorders

The damage done through ‘purging’ through the usage of laxatives or vomiting can cause loss of electrolytes. This, alongside fewer absorbed calories, can damage your cardiovascular system. The vomiting can also cause dental damage due to your stomach acids’ acidity, which can be a tad costly.

Alongside this, anything from dry skin, brittle hair, kidney failure, anemia, infection-chance raise, and more may be consequences.

Treatment

Less severe cases of eating disorders can be treated with therapy, medication, management, and dental repair from the issues stemming from the illness. The treatment team you pick can help you find resources to help you recover and also prevent relapses.

More severe cases may require hospitalization based on the extent of physical illness from dietary habits or mental disturbance from the state you’re in. These stays can cost anywhere from $500 to $2,000 a day for your visit.

Medicare and Medicaid often do not like to cover eating disorders. This is largely due to the high rate of relapse for the illness.

Relapse

The unfortunate reality for sufferers of eating disorders is that this disease has a very high rate of failure in treatment. Some have stated that roughly 86% of sufferers relapse around eighteen months out.

Thus, there’s a general consensus among the insurance providers not to cover these issues usually, but they will usually treat the problems that arise from it. You can still expect them to cover the dental and physical illnesses that might arise.

Health Insurance and Eating Disorders

Unfortunately, some insurance providers are hesitant to provide coverage for eating disorders, considering the cost of treatment facilities for this debilitating condition. It is advised that you seek out your insurance company yourself and discuss your case’s severity and how necessary it is.

It is also recommended to request a copy of your insurance policy to understand the topic at hand better. Your provider is legally required to give a copy, so this is a wise step to navigating their resources. You can refer to the Mental Health Parity Act in your state as additional research material.

If denied, take the time to put together a well-written letter to your provider. You have the opportunity to appeal the case, and hopefully, succeed in getting the funding you need. After that, your journey to a better, healthier life can begin.

503, 2021

Depression Treatment and Insurance

By |March 5th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

There is nothing to be ashamed of to seek out assistance in treating your depression. As shown by various studies, depression is one of the most common mental illnesses in the modern age. One in ten of every group has a high risk of depression, putting you in the bracket with millions of others just like you. Everyone seeking effective treatment to improve their quality of life. The key to managing mental illness is often getting depression treatment early and quickly, otherwise your health will worsen with the passage of time as you put off treatment. Fortunately, the government heavily subsidizes depression treatment through legislation in order to make mental health care affordable for all. In fact, the act itself is called the “Affordable Care Act” or ACA for short, and this bill makes finding assistance simple and nearly effortless.

Symptoms of Major Depressive Disorder

Some of the most easily recognized symptoms of depression can be broken down into a short list of potential changes to watch for. If you have any of these, begin considering that your simple case of sadness might, indeed, be Major Depressive Disorder.

If you have:

  • A constant sad or depressed mood with little change
  • Uncharacteristic gain or loss of weight
  • Fatigue regardless of amount of sleep
  • Difficulty concentrating
  • An unending feeling of hopelessness and despairing
  • Lack of interest in hobbies or things once enjoyed
  • Feelings of guilt or shame
  • Slower thinking
  • Thoughts of death, suicide, or other ‘ends’

Any of these are warning signs. If you or someone you love has these symptoms persist for more than few weeks, it might be time to seek out professional help. First, go to your family doctor, they might be able to find another underlying cause of the issue. If they cannot, that’s when they’ll recommend you to a specialist.

Lifestyle Changes to Consider Beforehand

Before you go into a physician for a diagnosis and treatment of depression, consider these few lifestyle changes that could, potentially, be the cure for mild depressive cases.

One of the most heavily recommended lifestyle changes is to include physical exercise in your routines. Even as little as twenty to thirty minutes of movement a day can be considerable assists in raising mood. Activity is stated to be as “potent as antidepressants,” a quote from Dr. Jerrold Rosenbaum.

Other notable treatments for your depression are treatments such as lightboxes in the winter, filling your life with enjoyable hobbies, mindfulness exercises, and adjustments to your diets. All of these things can lead to some changes in your mood.

If none of these changes help you, or if your mental state is so horrid you cannot wait to change things, then the next step is to seek medical intervention in the case of such a dire emergency.

Screening for Depression

One of the first steps in treating depression is to be screened for the symptoms by a professional to begin assessing a proper treatment plan. Because of the ACA, this is almost always free for clients – only plans that predate the ACA could be exceptions to this clause.

This process is usually a questionnaire or a sit-down with a therapist to reach a conclusion on your status. If proven to be necessary, then the process of seeking treatment or alternative issues could be considered as root causes. After that, It’s onto the process of, usually accepted, insurance qualification.

Getting Proper Treatment

The ACA now requires almost every health plan on state Marketplaces to include mental health in their essential health benefits. These plans include things like psychotherapy, medication, inpatient treatment, crisis prevention, and more.

As requested by the ACA, there’s also precedent for your family doctor taking an active part in helping you with your treatment. Often, they’ll screen you for depression themselves on routine visits. These are all attempts to promote better care, lower risk for relapses, and help improve overall quality of life.

2602, 2021

Pandemic Exercise

By |February 26th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

During this pandemic, we are all at home most of the time. There has been a huge influx in people turning to exercise as a means of keeping themselves busy and sane. Now we’ll discuss the benefits of pandemic exercise – not only for your health, but to buy time until you leave the house again.

Why Exercise Is Important

Although it might be tempting to skip your workout during these challenging times, public health officials say that exercise — while undoubtedly crucial under normal circumstances — is essential to your physical health and mental well-being during the COVID-19 pandemic. Here’s why you should stay active and how you can exercise safely during the pandemic.

How To Get Pandemic Exercise

Consider engaging in physical activity once or twice daily that includes brief periods (30-90 seconds) of greater intensity. For some, this might be accomplished through exercise in their homes including jumping jacks, mountain climbers, and sequencing strength training exercises (i.e. standing squats, push-ups, sit-ups). For others, the use of home exercise equipment such as treadmills, elliptical machines, and stationary bikes may be helpful. Regular exercise is essential for everyone under normal circumstances. However, here are a few reasons why exercise is especially crucial during the COVID-19 pandemic:

  • Boosts the immune system. Research shows that regular, moderate-intensity exercise has immune-boosting benefits that may help your body fight off infections, including COVID-19.
  • Prevent weight gain. Exercise can help you burn extra calories caused by dietary changes and offset the effects of sedentary activities.
  • Reduces stress and anxiety. Exercise is a proven mood-booster and can help adults reduce stress levels and build emotional resilience.
  • Improves sleep. There is evidence that suggests regular exercise helps you fall asleep faster and improves sleep quality. Getting a good night’s sleep has also been found to boost your immune system.

Where You Can Get It

Many companies are offering free use of their on-line platforms that may help to identify a variety of in-home activities (indoor cycling, treadmill running, dance cardio, yoga, strength training, and more) to help make exercise more enjoyable during this critical period. We strongly support the idea of ongoing vigilance regarding physical-distancing and limitations on in-person contacts as guided by the CDC.

It is important for family members to take a supportive role in the promotion of physical activity and exercise. Allowing individuals to maintain their autonomy and choice in their activities will be important for ongoing engagement.

Here are a few suggestions to help you get moving:

Exercise with family

Exercise is an excellent opportunity for family fun. Walks, bike rides, dance parties, living-room yoga sessions, or backyard soccer games are just a few examples of how you and your household members can exercise together.

Get outdoors

Walking, cycling, jogging, and hiking can help you get some much-needed fresh air while staying safely away from others. Don’t have time for a full-length outdoor exercise session? Consider breaking your workout up into several 10-minute sessions. You’ll be surprised at how quickly a few brisk walks around the block can add up to a full workout.

Follow along with online exercise videos

Whether you enjoy yoga, cardio kickboxing, Pilates, strength training, barre, dance, or another type of workout, chances are you can find a service that offers online videos. Additionally, many exercise studios and other community organizations are now providing on-demand virtual fitness content.

Take a virtual class

If you have the financial resources, consider supporting your local fitness studio or personal trainer by signing up for online fitness classes or training sessions. Some personal trainers are even offering private virtual sessions for your needs, schedule, and preferences. Plus, having a class or training session on your calendar allows you to interact with other people in a fun way, which may be just the motivation you need to keep up with your fitness regime.

Although it may take some effort to create and adjust to new fitness routines, regular physical activity can help you optimize your health and well-being during the coronavirus pandemic. We may even look back on this difficult time as the turning point when we learned new ways to build our emotional resilience and our physical health.

1902, 2021

Insurance Incentives

By |February 19th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

Among states, there is growing interest in offering insurance incentives to those enrolled in public health plans. The insurance incentives should promote healthy behaviors. Many states are developing programs to motivate enrollees to curtail smoking, lose weight, and access vaccines and prenatal care. By providing rewards for healthy behaviors, these states are giving members a greater stake in improving their health status. The goal is for the incentives to help enhance prevention and health outcomes, and reduce program costs.

The Concept

To reduce payer claim costs, would you pay members to go see their doctor once a year?  That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies. For healthcare insurance payers, it’s just good business to have a healthy member base.  This starts with annual preventive care visits.

Minuteman Health

Minuteman Health is a non-profit HMO which serves the Massachusetts and New Hampshire individual and small business marketplace. Cook, as CMO, has been a strong proponent of the MinuteMember Wellness Rewards program.

Members who establish PCP relationships have overall lower healthcare costs. Preventive care allows physicians to monitor and manage chronic diseases and proactively identify emerging health issues. The subsequent decrease in ER visits and specialty referrals also reduces payer expenses.

According to Cook, three main objectives of a wellness incentive program are to get members to establish a close relationship with their in-network PCP, to receive recommended screenings and immunizations, and to offer providers the opportunity to intervene with any health issues before they advance to chronic or life threatening levels. “Having members establish a relationship with an in-plan PCP is a good first step in identifying chronic medical issues,” said Cook.

States are using a variety of incentives to encourage healthy behaviors, primarily among Medicaid populations but also in the State Children’s Health Insurance Program (SCHIP) and state-funded programs. Incentives can take the form of reduced cost-sharing, or vouchers or coupons for health-related products such as over-the-counter medications, as in Florida.

Wisconsin

In addition to the individual incentive programs, Wisconsin has developed a voluntary member pledge. By signing the pledge, families will promise to practice healthy behaviors; in turn, health plans will promise to support members in these efforts, in part through the incentive programs. The state is currently conducting focus groups with approximately 100 current BadgerCare members to learn what types of incentives might be effective, how they should be structured, and, perhaps even more important, what it would take to get people to participate in voluntary programs.

Michigan

While Wisconsin is on track to embark on its incentive program next April, other states are in the planning stages. Some states are considering incentive programs as part of larger Medicaid reform efforts.

For example, in Michigan, both the executive and legislative branches are planning to incorporate incentives into the state’s Medicaid program. Governor Granholm has introduced the Michigan First Health Care Plan, which would require Medicaid health plans to offer education, support, and financial incentives for lifestyle changes. Features of this plan include:

  • Asking enrollees to complete a health risk appraisal within 90 days of enrollment and having them follow up with a primary care physician;
  • Waiving copayments on important maintenance drugs for chronic diseases;
  • Offering incentives to members to use behavior change/wellness programs; and
  • Setting performance measures for participating health plans.

Do Insurance Incentives Work?

It remains to be seen whether incentives for promoting healthy behaviors among Medicaid and other public program populations will have a significant effect on health outcomes and costs. A review of the literature by the Center on Budget and Policy Priorities (CBPP) found that no rigorous studies have been conducted to determine whether incentive programs achieved their goals, and the few existing studies did not look specifically at the Medicaid population.

What’s more, environmental factors play a role in unhealthy behaviors—an issue that incentives or other efforts cannot address. Low-income individuals face considerable barriers to obtaining healthy foods and getting sufficient exercise and activity. Creating programs targeted not just at individuals’ behavior but also at the unhealthy environments in which they reside will require enormous creativity and energy from states hoping to promote healthy lifestyles.

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