Tag Archives: members

Making a Difference on Every Call

Vantage Point: Making a Difference

As our Annual Enrollment Period (AEP) came to an end, I sat back and thought of all of the work our team had done. Each year, prospective members call in to get information to determine if Health Alliance is the right fit for their needs.

Of course we go over the basics, like monthly premiums, copays, and out-of-pocket maximums, but that is all very black and white, and not every situation is the same or so simple.

At Health Alliance, the expectation is to go the extra mile for our members and prospects. Our potential members rely on our expertise to guide them in the right direction.

This past AEP, I had someone call in asking if our plan covers a certain medication that’s given at the doctor’s office. My immediate response to the caller was, “I don’t know, but let me research that for you.”

I wanted to make sure they were making the right choice by switching to our plan. After doing some research and calling our pharmacy department, I called them back and shared the details I’d gathered.

Later, I got the chance to meet the potential member to go over our plans in person. They could not thank me enough for gathering the information and told me my phone call back was a nice surprise. We gained credibility and their trust by taking the extra step to respond to their particular situation.

I was actually surprised because I didn’t feel like I had done that much, but after thinking about it for a while, I realized it really is the little things that count the most to our members. This is a perfect example of why our role as liaisons is so important for our community and what sets Health Alliance apart.

As liaisons, we go out of our way to give our members the most accurate information we can and to take away the pressure of those difficult and complex questions. Our job is to simplify and educate. We’re making a difference every day, no matter how big or small.

Jessica Arroyo, born and raised in Wenatchee Valley, is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant, and Okanogan counties in Washington. During her time off, she enjoys spending time with her husband and infant son.

Reliving Summers Past

Long View: Summer Memories

It’s been quite a summer hasn’t it? We’ve faced state budget issues, unreliable weather, and rising prices every time we turn around. By the way, when will we be done with the ragweed pollen? There seems to be a never-ending parade of things to worry about, and I’m worn out.

This summer does not fit with my memories of my favorite season. My main worries used to be how to get the frisbee off the roof and finding the next bag of Fritos. It seems I didn’t have much to worry about. But wait a minute, I was a kid, so it was my parents’ job to worry.

My mom and dad would leave my younger brother and me at my grandparents’ farm for a couple of weeks in the summer, and we had a great time. We were a little spoiled, to say the least, and at the time, I felt like we had no rules.

We could eat anything we wanted, as long as we cleaned up our plates at mealtime. We could stay up as late as we wanted, but we usually turned in early because we were exhausted from playing all day. We could go wherever we wanted on their property, as long as there was a grown-up or older cousin within shouting distance. Best of all, we could watch as much TV as we wanted, but there always seemed to be too many distractions on a working farm.

The day before my parents would come to pick us up, our grandfather would take us into town for haircuts at the same barbershop he had used since the Great Depression. The morning of my parent’s arrival, we were scrubbed and polished, from our fingernails and neck to our ears, and dressed in our traveling clothes. It was hard to leave, but I think we were ready to get back to our routines, our friends, and the start of the school year.

One of the nicest parts about talking to our Medicare members is hearing their memories. I think the stories and experiences they share enrich us and give us a better perspective on the present. Try asking an older family member or friend about their favorite summer. I bet you get a smile and hear a wonderful story from their past.

Looking back, maybe this wasn’t such a bad summer after all. There might even be kids today who will look back on the summer of 2016 as the best one they can remember.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.

In Case of Medical Emergency

Long View: What Is a Medical Emergency?

According to Medicare.gov, a medical emergency is a situation where “[Y]ou believe you have an injury or illness that requires immediate medical attention to prevent a disability or death.”

It seems pretty straightforward, so why are there so many questions around the decision to get treatment at your local emergency room?

An emergency room (ER) provides some of the most sophisticated diagnostic options in a hospital and the most immediate care to patients in crisis.

The list of possible emergencies is endless, so it’s important for you to recognize how serious your injury or illness is and to know the best way to get treatment for it.

Many of us have heard about folks with medical emergencies driving themselves to get treatment or catching a ride with a family member. Please don’t. Driving yourself puts you and others in jeopardy and delays the start of your treatment. Dialing 911 brings you the treatment quickly and gets you to an emergency room faster than a white-knuckle trip across town, dodging traffic lights.

Dr. Frank Friedman, one of our medical directors who specializes in emergency care, said, “A true emergency is one that can’t wait. It is something causing such severe pain or such a risk to life or limb, for oneself or a loved one, that it can’t wait hours, or a day or two, to be seen by one’s own doctor or healthcare provider.”

If it’s not an emergency but you need medical care to keep an illness or injury from getting worse, call your doctor. If your doctor can’t see you right away or the office is closed, urgent care (or convenient care) can help you get treatment quickly.

Over the years, I have heard some interesting and alarming questions from our members. This FAQ can help answer those questions.

Q. I just got one of your policies, and I’m having severe chest pain. Will you cover me for an ER visit?

A. This is one of the most unsettling questions we receive. If you’re experiencing severe chest pain, don’t call your plan, call 911. It’s as simple as that.

Q. Do I have to pay a copay when I get there?

A. No, they should be able to bill you, so there’s no reason to wave your credit card around as they wheel you through the front door. In fact, under federal law, an ER has to evaluate and stabilize you in an emergency medical situation, without regard for your ability to pay.

Q. What if I have special conditions they need to know about?

A. Keep a list of your medications with you. MedicAlert’s medical IDs or the Yellow Dot program can also help you share this information. And many smart phones have features that let you add emergency contacts and medical information. Plan ahead.

Q. What are some examples of when I should go to the ER and when I should go to my doctor or urgent care?

A. Visit the ER for emergencies like chest pain, broken bones, poisoning, shortness of breath, fainting, and seizures. For things like a constant fever, strep throat, sprains, the cold or flu, earaches, or minor infections like pink eye, call your doctor or visit urgent care.

Will you recognize a medical emergency? Probably yes, so trust your judgment, act quickly, and please be careful out there.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.

A Happy Ending from Your Decisions

Vantage Point: Life Is Not Like The Brady Bunch

Growing up watching The Brady Bunch, I loved how when there was a problem, like Jan getting a bad perm, Greg having his first fender bender, or Marcia getting braces, it was always resolved in a happy ending by the end of the episode.

I didn’t think to question how Mr. and Mrs. Brady could afford to raise 6 kids and pay for a maid and the mortgage on a tri-level house. I know now, from raising my own kids, that braces are really expensive, and so is adding teenagers to your car insurance. Real-life decisions don’t always end as positively as a Brandy Bunch episode.

In my work, I counsel people who made a choice that costs them later. For example, if you don’t pick up prescription drug coverage when you first become Medicare eligible and then realize you need to add it later, you’ll get charged a late enrollment penalty. Many times in these cases, members have sadly told me that they didn’t know or that no one had told them. They’ve truly taught me the importance of staying informed.

Recently, I had the chance to meet with Callie Klein from COUNTRY Financial, and we found that we share a mutual desire to learn about each other’s professional services.

We know Medicare can be confusing, so we do our best to help people make sense of their options. Retirement planning can also be confusing, but Callie helped me to understand how choices like life insurance and long-term care can affect your financial future. Callie pointed out that people are living longer, and some people can spend just as many years in retirement as they did on their career. That’s what makes it so important to plan ahead, so your resources match your longevity.

As we enter a new year, I am reminded how fast time goes and how important it is to give some thought to your future now. Set some long-term goals rather than just short-term resolutions.

If you haven’t already and need help, I encourage you to seek out a professional like Callie. She showed a genuine concern for her clients and a desire to guide them toward the decisions that will help them attain their future retirement goals. Professionals like her can help you at least become educated and stay informed.

Most importantly, though, I wish you happiness in 2016, and I hope that, like an episode of The Brady Bunch, your biggest problems are resolved quickly and with a happy ending.

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant and Okanogan counties in Washington. She has four sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.

National Influenza Vaccination Week

National Influenza Vaccination Week

This week was National Influenza Vaccination Week. The flu shot is the best tool to protect you and your family.

Struggling Through the Flu

 

The flu causes millions of illnesses, hundreds of thousands of hospitalizations, and thousands of deaths every season. Get your shot today!

Avoid Getting Sick with the Shot

 

More than 132.7 million people have already gotten their flu shots. If your kids are over 6 months, protect them now!

Protect Your Kids From the Flu

 

Flu shots are the best way to avoid seasonal doctors’ visits, missed work and school, and to prevent hospitalizations.

Avoid Flu Season Woes

 

The flu can be a serious danger to your health, especially to those under 6 months old, pregnant women, and the elderly. Protect yourself now!

Our blogger overcame her fear of the flu shot. Let her story remind you why you need yours.

As a Health Alliance member, your flu shot is covered, so there’s no reason not to get yours today!

You're Covered, So Feel Better!

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Team Up for Greatness

Vantage Point: To Be A Star

There is a patch of I-5 South, just as you turn the bend, where The Tacoma Dome comes into view, and the sight always makes my heart jump into my throat. Opened in 1983, The Dome has hosted major concerts, professional sports competitions, and events. Most importantly for me, it’s also the place where Washington state high school athletes compete at the championship level.

My boys got to experience the honor of standing up among their peers as a part of a team of excellence on December 7, 2008, when Cashmere won the 1A High School Football State Championship. It’s a memory that I, and most of the town, which filled one whole side of the dome, will never forget.

This accomplishment started with the players, who had been honing their skills since grade school. It also took a school backing them with quality equipment and coaching, a town believing in them, and parents dedicated to supporting their goals. The second-string players, who only got a few seconds on the field that day, were just as important as the starters. In practice, they were the ones who helped the starters sharpen their skills. To say the least, they were all stars that day.

I am fortunate in my professional work to also be part of an amazing team. A team, which I say with great pride, whose Washington Medicare plans just earned 4.5 out of 5 stars from the Centers for Medicare & Medicaid Services.*

These Star Ratings measure more than just customer service. They also measure help managing chronic conditions, member complaints, working with providers to help members stay healthy, and members’ overall experience with the plan.

This achievement means a lot. It validates our efforts at Health Alliance and lets us know we are taking good care of our members. But just like a championship football team, we respect this is not an individual endeavor, and we appreciate all of you for sharing access to your resources and welcoming us into your communities. There is no way we could have accomplished this without your support and collaboration. As we share this esteemed recognition with you, please know, we sincerely count you as a member of our team, and we couldn’t have done it without you.

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant, and Okanogan counties in Washington. She has four sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.

 

*Medicare evaluates plans based on a 5-Star Rating System. Star Ratings are calculated each year and may change from one year to the next.

Legal Advice: The Right Time for a Professional

Long View: Leaving Some Things to the Professionals

I have to admit the health insurance business is complicated and often difficult to understand. So many regulations are involved, and then there are the exceptions, annual plan changes, and the wide variety of policies that are available.

We help our Health Alliance members navigate the wonderful world of health insurance every day. Another arena that seems especially complicated to me is the law.

In central Illinois, there are resources for people who need legal advice for civil cases (not criminal), which are provided at no cost to those who qualify. One of these is called Prairie State Legal Services. Its mission is “to ensure equal access to justice and fair treatment under the law by providing legal advice and representation, advocacy, education, and outreach that serve to protect basic human needs and enforce or uphold rights.”

Adrian Barr is the Managing Attorney for Prairie State. He told me, “The legal system is a very difficult place to navigate for people who do not have attorneys. It is almost as if we in the legal community speak and write in a different language.”

“Having the opportunity to consult with an attorney about one’s legal situation can be an invaluable resource,” he said. “Prairie State will discuss a person’s legal situation with them and provide legal advice. Prairie State will also provide representation for important legal issues, including those that affect a person’s finances, safety, housing, or their health.”

Lora Felger is my co-worker in Iowa. She is very sharp, but knows legal questions are best left to the professionals. Lora suggests Iowans start with their local Area Agency on Aging. Iowa’s 6 regional Area Agencies on Aging partner with Iowa Legal Aid to offer free legal services to eligible seniors with the Legal Assistance Program. This program “serves persons 60 years of age and older by providing legal advice and representation, information and education, and referrals in civil legal matters throughout the state.”

I think I will have to be satisfied with my expertise in the field of health insurance. I feel justified in my decision to let the professionals handle any legal question that might come up. My personal experience also tells me it would be prudent to use a professional electrician whenever the need arises. I accidentally created an arc welder one time, but that’s a subject for another column.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.