Author Archives: Dianne Savastano

My List of Essential Health Care Resources

First, a bit of background…

When I launched Healthassist in November 2004, there were very few private practices dedicated to the delivery of private “Health Care Advocacy / Advisory” services (my terminology for the work we do).

I had the great fortune of some national press, some of which led me to a fellow advisor in California. She founded her practice a bit after ours and was starting a national association. Her goal was simple: To bring advocates together and to educate the public regarding our new profession.

I became a founding member of the National Association of Healthcare Advocacy and things took off quickly. I presented at the first conference (and all subsequent conferences) and served for five years as Treasurer on the Board of Directors. Along the way, we developed Standards & Best Practices as well as a Code of Ethics to benefit and protect consumers.

Fifteen years later, I remain a member of NAHAC’s advisory board. It’s been a wonderful experience and I value the relationships I’ve developed with fellow advisors.

Here then, are some of the best health care resources I find myself recommending again and again to clients, friends and loved ones.

Resources for Health Care Advocacy

National Association of Healthcare Advocacy

“My dad lives in Chicago, and I live in LA. He was recently hospitalized and has now been in and out of the hospital and rehab three times. My brother is there but is not familiar with the healthcare system and it seems no one is communicating. What can I do? Can you help?”

Sadly, this is a common scenario. When we receive a call like this about someone in New England, our team goes into overdrive, acting quickly to assess the situation, introduce ourselves to the relevant healthcare partners and begin to put an action plan in place. With complicated situations, in particular, “boots on the ground” matter. An advocate who can go to the hospital, rehab centers and physician appointments is required.

When we aren’t able to help, I recommend visiting the NAHAC web site and conducting a zip code search for local professionals. When possible, and because I know so many of my fellow advocates across the country, I make a direct, virtual introduction to a local resource.

Massachusetts Resources for Health Care Advocacy

Sometimes, fellow advocates are better positioned to serve a client’s needs. In those cases, I refer callers to the web site of the first regional group of NAHAC, one that I helped to found, known as Massachusetts Healthcare Advocates (MAHCA). We now have 18 members.

AdvoConnection

AdvoConnection is another national directory web site. In addition, it provides a wealth of information and tools for consumers, to help them make smart, informed decisions in choosing a professional advocate.

Patient Advocate Certification Board

A recent milestone within the profession of Health Care Advocacy was the development of certification to “credential” those who work in the field (I’m proud to have been awarded PACB certification this year).

The certification process is rigorous and knowing that your advocate has received this distinction gives you confidence in their level of competence and professionalism.

Resources for Transition to a New Living Environment

“My mom has been considering moving to a retirement community in her area and we’ve heard about many different models and levels of care. Can you help us find the best place for her?”

When I receive these calls, I first explore what is contributing to the decision to make a change. If it is an unstable health-related issue, I suggest first achieving medical stability before a move occurs. Otherwise, I refer these callers to one of my Aging Life Care Professional colleagues.

These professionals, previously known as Geriatric Care Mangers, are regionally based, know their local communities and resources, and are best suited to conduct an assessment on the environmental, safety and psychosocial needs of an older adult. They are fabulous at matching the older adult’s needs to the most appropriate living environment, taking into consideration financial constraints.

The Aging Life Care Association includes a zip code search capability for finding local professionals. Many are trained as Social Workers, while others are trained nurses or other Allied Health Professionals.

Resources for Legal Issues

“My parents don’t have their affairs in order, and I’m concerned. What can I suggest?”

In these circumstances, I ask if the caller is familiar with attorneys certified as Elder Law Attorneys. It’s a specialty that most people are not aware of, so I describe The National Elder Law Foundation (NELF), the national organization certifying practitioners of elder and special needs law.

The National Academy of Elder Law Attorneys is another, similar resource.

Both resources allow national searches on their sites.

Summary

As much as I would like to assist everyone who calls, it’s not always possible.

I have great confidence in the resources noted above and I’m thrilled to be able to share them with you to help keep you and your loved ones safe and well cared for.


Medication List Template — Follow-up from May newsletter

In last month’s newsletter , we recommended a “project management” approach to managing the healthcare of yourself or a loved one. We also shared a template titled Medical Conditions, Surgeries, Hospitalizations.

We recommend using a similar template for tracking medications. You can see and use it here.

The Medication List has multiple tabs to include the following:

  • Daily Medications
  • Herbal Medications and Nutritional Supplements
  • PRN/Occasional or As Needed Medications
  • Previously Taken Medications

Recommended Reading: Healthcare Costs

In hospital settings, the classification of “Observation Status” is something we frequently encounter. The ramifications for care and cost can be catastrophic.

Learn more, here.


One topic that I am asked about frequently is the lack of transparency regarding healthcare costs, a reality that makes it difficult for consumers to make informed decisions.

This article addresses the topic and provides a few examples of organizations working on the issue.

Take Control of Your Healthcare Experiences

Twice during the past two months, I delivered a presentation titled, “Navigating the changing healthcare system.” Once in the form of a webinar and once in front of a live audience.

Within it, I share several strategies, one of which is to prepare and use a Personal Healthcare File that includes a document titled, “Medical Conditions, Surgeries, Hospitalizations.” This recommendation sparked so many great questions during the presentations that I decided to share more about it with you, today.

Medical Conditions, Surgeries, Hospitalizations

When working with clients, we take a “project management” approach. Simply put, that means collecting, tracking and communicating information about yourself and your medical history to your team members and physicians. This allows all involved to work jointly in the creation of an action/treatment plan.

We tend to use Excel, but truthfully, any tool that allows for easy input and changes is fine. Don’t let technology get in your way — even pen and paper works!

Our tool, “Medical Conditions, Surgeries, Hospitalizations,” contains a few more items than the title implies.

It includes the following:

  • Name and date of birth
  • A list of medical conditions and when they were diagnosed
  • A list of surgeries and when they were performed
  • A list of hospitalizations, for what condition and when they happened
  • A list of procedures that were done along with diagnostic testing, for what condition and when they happened
  • A list of immunizations and when they happened
  • Preferred hospital, including the address
  • Preferred pharmacy, including address and phone number
  • Emergency contact(s) along with associated phone numbers

This tool, along with another one for medications (see below), helps physician appointments flow efficiently. (Click here to download a sample tool that you can modify for your own use.)

The medication spreadsheet includes:

  • Name and date of birth
  • Medication(s) currently prescribed and/or prescribed in the past, as well as any supplements
  • Dosage
  • Frequency
  • What the medication is prescribed for
  • Who prescribed it
  • Allergies to medications and other things, including foods, latex, environmental items, etc.
  • Preferred pharmacy, including address and phone number

I know, it may seem like a lot! But remember, even with physicians with whom we have existing relationships (and certainly with new physicians), their medical records may not be up-to-date. It’s up to us to keep the information current. Having this tool in hand will make that so much more efficient.

Where to Begin

Prior to the advancement of electronic medical records and Patient Portals, this type of compilation was hard to create. When working with clients, we were forced to rely on memory and/or the tedious process of formally requesting medical records from all the healthcare systems from which our clients received care in the past.

Today, it’s much easier, provided you enroll in whatever Patient Portals are available to you. Keep in mind, however, that while these may feel comprehensive, they are not easy to access while sitting down with a provider. In addition, if you seek care from a provider that is not in the same healthcare system as your electronic medical record, you are again forced to rely on memory.

A Real World Example

Recently, I accompanied a client who was seeking specialist care for a particular diagnosis — one that could require treatment that has benefits, but that also has potential side effects. I was so pleased to see my client use the “Medical Conditions, Surgeries, Hospitalizations” tool to relay her incredibly complex medical history, previous procedures/testing, treatments, etc.

At one point, while discussing potential treatments, the client’s knowledge of a condition that developed 10 years ago following a medication that was taken 13 years ago impacted the recommendations of this physician. A suggestion to obtain additional diagnostic testing, based on the readily accessible previous testing, was also recommended.

In the end, not only was my client able to quickly and accurately answer the questions posed by her physician, she even asked her if she wanted a copy (the physician enthusiastically said yes)!

The discussion was comprehensive, detailed and satisfying, all as a direct result of the time my client spent taking responsibility for her own experience.

Summary

In the spirit of Sua Sponte,” I highly recommend getting organized and creating whatever tools work best for you. Do this not only for yourself, but also for those in your life for whom you may be a Care Partner.

Before each physician appointment, get in the habit of reviewing your tools to see if any updates are required. This will get you thinking about your medical history and, hopefully, prompt you to prepare an agenda with an objective and specific questions.

I guarantee that if you take the time and the responsibility, you will have a positive experience!

What Young People Need to Know About Insurance Coverage

Within just a few days of each other, the following things happened…

First, and as discussed in a previous newsletter, my dad was successful in resubmitting an improperly coded surgery bill. Once his claim was reviewed, he paid just $300 instead of the $6,500 bill he had rightfully questioned. I’m so grateful he brought it to my attention.

Second, I resolved my own $1,200 claim for a bill I received from an anesthesiologist following wrist surgery last summer. The entire amount was covered by the insurance company despite numerous claims that it was not.

Third, I read a moving article about a woman who did everything right to prepare for her son’s surgery, only to be faced with a $12,000 bill that caused her incredible anxiety.

Lastly, I was interviewed by representatives of CIBC Private Wealth Management for their Podcast targeted to younger clients, a program that strives to improve their audience’s financial literacy. Because health care costs must be considered as part of any financial planning, they asked me to elaborate on the advice I would give to young adults on the topic.

Taken together, all of these things got me thinking about the importance of teaching “insurance literacy” early to our young adult friends and loved ones.

What follows are my recommendations, broken out by phase of life!

At the Age of Twenty-Six…

In my experience, young adults insured on their parents’ health insurance plans rarely pay much attention to their coverage levels. They rely heavily on their parents to manage both their healthcare and their insurance. As a result of The Affordable Care Act, that arrangement can continue until the age of 26.

After that, and whether because they now have to purchase health insurance on the open market or because they have the good fortune of being employed and able to avail themselves of an employer-sponsored plan, they begin to take interest and the questions arise:

  • I’m young, why do I need insurance?
  • I’m healthy, why should I spend the money?
  • What if I don’t have the money?

At this point, I focus on the idea of mitigating risk against a huge unanticipated healthcare cost. We talk about the potential costs associated with an unexpected illness, accident and/or the necessity of a costly hospitalization.

We also talk about the concept of an out-of-pocket (OOP) maximum — the maximum amount an individual would pay for healthcare services, beyond the cost of monthly premium, after which a plan pays healthcare expenses at 100%.

For example, a plan may have an OOP Max of $7,500. If an accident results in $100,000 worth of bills, the most you would have to pay is $7,500. This coverage not only protects the young adult, it also offers comfort and relief to anxious parents.

In terms of the cost itself, it’s worth exploring plans available through a state healthcare exchange in which income data is considered to identify eligibility for financial assistance, to defray the cost of the premium and OOP expenses. Depending on income, excellent options may be available at minimal cost. What a relief for everyone involved!

Getting that First “Real” Job…

Having a portion of the premium subsidized by an employer can be a fabulous benefit and one that should not be ignored. At this stage, I recommend understanding and paying attention to the following:

  • Employee contribution. The monthly amount an individual pays toward the premium.
  • Employer contribution. It’s good to know how much the employer is contributing. It gives an employee a true sense of the value of the benefit and should be considered, especially if a job change may happen.
  • Deductible. This refers to the initial amount the employee must pay for health care-related expenses — out-of-pocket and in addition to any premiums — before the plan begins to pay any benefits. Many young individuals, especially if healthy, are surprised to learn that they must budget additional money for this. And while many never meet the deductible thanks to their youth and good health, one sports-related injury can change all that!

Starting a Family…

When individuals marry and/or begin to have children, health insurance concerns once again take center stage. The decision to keep individual plans vs. having both members of the couple on one plan should be made following a thorough analysis. It should begin by assessing the health status of those involved, concentrating on the specific benefit coverage levels of services likely to be used and their anticipated costs.

Adding a child to the mix creates an interest in maternity and hospitalization benefits, as well as the coverage details for the baby once he/she arrives.

At All Stages of Life…

Overall (and at any age), when making decisions about health insurance there are two important considerations:

What’s the status of my health and/or anyone else that might be covered on my plan?

This gets to how much or little you will expect to use your insurance and, if needed, what benefits you are likely to use.

For example, if you have an old sports injury that is now limiting your normal workout routine, you may want to investigate coverage for surgery and rehab with significant physical therapy. Focusing on outpatient surgical benefits, coverage for the physician and anesthesiologist, and co-pays for physical therapy, will help manage expectations.

What are the requirements for using my insurance to ensure I receive the maximum benefit?

When you enroll in a plan you are agreeing to a set of “contractual rules” — rules which you must follow in order to receive coverage.

For example, you may need a referral before accessing specialist care. You may need to ensure that your physician, hospital and any specialist care such as anesthesiology are considered in-network. Or you may need to gain prior-authorization for care. Each of these and more can have a significant impact on your coverage, so make sure you are clear regarding what your policy requires.

Summary

I am certain the topic of health insurance is not as exciting to young adults as it is to me! But, it remains one of life’s necessary evils.

In the United States, in particular, it is incumbent upon each of us to manage the health insurance market available to us and to become an educated healthcare consumer.

Make informed choices and limit any surprises. The earlier in life you begin, the more smoothly things will go in the future!