Tag Archives: emergency care

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.

Medicare Advantage Mythbusting

Long View: Medicare Advantage Truths Might Just Change Your Mind

As I travel around the Illinois countryside, I hear the same misinformation about Medicare Advantage over and over. To tackle some of that, here’s a Q and A.

Question: When I join a Medicare Advantage plan do I lose my Medicare coverage?

Answer: No. If you have a Medicare Advantage HMO or PPO plan, a private health insurance company that has a contract with Medicare, like Health Alliance Medicare, provides the services instead of Original Medicare. People who disenroll from Medicare Advantage plans revert to Original Medicare. In either case, no one loses Medicare coverage.

 

Question: Will I be able to stay with my current doctors?

Answer: Probably, especially with Health Alliance Medicare. That’s why it’s important to check any plan’s provider directory to confirm your doctors work with the plan. People who select a Preferred Provider Organization (PPO) plan can use out-of-network providers, but they typically pay more when they receive services.

 

Question: We travel and might need to use the emergency room. Will Medicare Advantage plans only cover me for emergency care when I’m close to home?

Answer: No. Medicare Advantage plans cover out-of-area emergency and urgently needed care.

 

Question: If something serious happens and we need lots of services, could we predict how much we would pay for care?

Answer: Yes. Medicare Advantage plans have an annual Out-of-Pocket Maximum (OOPM), also called a Yearly Limit. When a Medicare Advantage member reaches that limit, the health plan pays 100 percent for Medicare-approved services. This amount doesn’t include the premium and other limited expenses. You can estimate what your expenses would have been last year on the Medicare Advantage plan you are considering.

 

Question: Medicare Advantage sounds good for me, but wouldn’t the premium be too costly for my 88-year-old mom?

Answer: Not at all. One of the best things about Medicare Advantage plans is the premium is the same no matter the member’s age. You and your mom would pay the same monthly premium if you had the same plan, unless either of you could get extra help paying for coverage based on your income.

 

Question: Would I have to deal with all the paperwork I get when I receive services from Original Medicare plus a Medicare Supplement plan?

Answer: No. You would have much less paperwork with a Medicare Advantage plan. In fact, that’s one reason Medicare Advantage plans exist, and I’m all for less paperwork.

 

Remember, the Medicare Annual Enrollment Period, or AEP, runs from October 15 to December 7. That’s the only time most people can change their coverage for the following year.

If you are thinking about a change for yourself or a loved one, you will have to do a bit of research. Trusted resources like Area Agencies on Aging and your local senior center can help.

Please consider Health Alliance Medicare a resource, too.

We all want to make well-informed choices that don’t depend on myths and misinformation.

Asthma Treatment

Know Your Asthma

What Is Asthma?

Asthma is a long-term disease where your airways become inflamed and narrow, making it harder to breathe. This can cause chest tightness, shortness of breath, and coughing.

It’s affects all ages, but is usually diagnosed in kids. More than 25 million people have it.

Your airways are tubes that carry air in and out of your lungs. When the airways react to an allergen, the muscles around them tighten, which limits the air getting into the lungs.

Cells in the airways can also make more mucus in this situation, which further makes it hard to breathe.

And once this has all happened, it’s easy for things like stress or activity to make it even worse. Asthma’s symptoms are in many ways, a chain reaction.

There is no cure for asthma, but there are great forms of treatment, including meds, nebulizers, and inhalers. These let you prevent and treat attacks right away to prevent a more serious attack, which can require emergency care.

Your Asthma

Everyone’s is a little different. Many things create the recipe, or chain reaction, for your asthma. Your age, triggers, allergens in your environment, weight, overall health, where you live, and which meds you’re taking can all matter.

Common Triggers

  • Acid Reflux
  • Allergies
  • Bad Weather
  • Certain Foods
  • Certain Medicines
  • Cold or Dry Air
  • Exercise
  • Food Additives
  • Fragrances
  • High Humidity
  • Infections from Flu, Cold, or Virus
  • Pets
  • Strong Emotions or Stress

Common Allergens

  • Chemicals
  • Cockroach Allergens
  • Dust Mites
  • Mold
  • Outdoor Air Pollution
  • Smoke from Burning Outdoors
  • Tobacco Smoke

Your allergies especially affect your asthma. Your runny nose, sniffling, and sneezing can actually start that chain reaction. And by treating them, you can actually improve your asthma.

Treatment

Everyone with asthma should have an Asthma Action Plan that they make with their doctor. It’s a personalized plan that has:

  • The kinds of medicine you’ll take
  • When you’ll take it
  • How you’ll manage it long-term
  • How you should handle attacks
  • How you’ll manage your allergies
  • When you should go to your doctor or the ER

Even though each person will have a different set of things that cause their symptoms, asthma medicine categories are the same for everyone.

Combinations and doses vary, but most people with asthma have 2 kinds of meds, a quick-relief one in case of a flare-up and a long-term controller they take daily.

Types of Meds

Medicine Category

What It Does

Examples

Long-Term Control

This is your most important med. When taken daily, these help control symptoms and prevent attacks. Skipping doses raises your risk of attack.
  • Inhaled Corticosteroids
  • Leukotriene Modifiers
  • Long-Acting Beta-Agonists (LABAs)
  • A Combination Inhaler with a Corticosteroid and an LABA

Quick-Relief or Rescue Meds

Take these as needed to quickly treat an attack and to prevent attacks from exercise. If you’re using these more than 2x a week, tell your doctor. Short-Acting Beta-Agonists:
  • Albuterol (Proventil, Ventolin)
  • Metaproterenol (Alupent, Metaprel)
  • Pirbuterol (Maxair)
  • Bitolterol (Tornalate)
  • Levalbuterol (Xopenex)

Oral Steroids:

  • Prednisone
  • Prednisolone
  • Methylprednisolone

Allergy-Induced Asthma

Take these daily or as needed to control allergies, like pollen, mold, grass, etc.
  • Allergy Shots (Immunotherapy)
  • Omalizumab (Xolair)

Info via National Institutes of Health (NIH)

Your Action Plan

Make sure you have the answers to these important questions in your action plan:

  • What are the names of my medicines?
  • What does each one do?
  • What are their side effects?
  • What can I do to decrease their side effects?
  • Will they work with other drugs, vitamins, food, and drinks?
  • How much is a dose of each?
  • When is the best time to take each? With breakfast, before bed, or with symptoms?
  • How long do I have to take them?

Things You Can Do

You should also work with your doctor or our disease management program to make sure you know how to use your inhaler and flow meter.

Keeping track of your triggers and taking care of yourself can also help: