Tag Archives: ER visit

Insurance Awareness

Insurance Awareness

Wednesday was National Insurance Awareness Day, so we helped raise insurance awareness this week with education and info about your plan.

Insurance may seem like a luxury, but without it, the cost of a broken arm is typically more than $2,500 dollars. If you have to stay in the hospital, it’s around another $7,400.

Broken Arm Costs

 

Under the ACA, you have certain benefits that are always covered, like yearly checkups and more.

Essential Health Benefits

 

If you’re on an HMO, you have to see doctors in your plan’s network, and if you’re on a PPO, you’ll save when staying in-network.

Choosing a primary care provider (PCP) gives you personal care, and your yearly visit keeps your preventive care up to date.

Your Yearly Preventive Care and Physical

 

The average ER visit costs more than the average American’s monthly rent. Know where to go when you’re sick and save.

Know Where To Go

 

Not sure what your insurance does after you get care? See a claim’s journey and make sense of what you get in the mail later, the EOB.

A Claim's Journey

 

Are you getting ready for Medicare? Learn about the parts, your eligibility, and enrolling.

Prepare for Medicare

SaveSave
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.

Your Personal Health Coach

Vantage Point: A Helping Health Hand

Not every coach is as well known as Pete Carrol of the Seattle Seahawks, but Susan DeLong, our nurse case manager and health coach in our Wenatchee office, is key to our team.

She’s smart, caring, a good listener, and a compassionate advocate. You will probably never see her on TV, but in our members’ eyes, her work is just as important and meaningful as any superstar’s.

Managing a health condition can be hard, and a health coach is someone with extensive experience who can be a consistent source of support. There’s so much information that it can be hard to know what’s key. One of the benefits of a Medicare Advantage plan like ours is the free education and support a health coach can provide.

At Health Alliance, a health coach like Susan can give our members:

  • Answers to questions about their conditions
  • Tools and lifestyle skills to minimize the risk of problems
  • Information about self-care skills
  • Free educational materials and resources about managing conditions
  • Support on the phone at their convenience
  • Help keeping them, their provider, and their caregivers connected
  • Help making the most of their healthcare benefits

Health coaches do not replace medical care from a doctor, but instead work with their primary care physician as part of a team to make sure their management plan is working.

Compassionate nurses like Susan also help identify warning signs for possible health problems, and they make sure members have a plan, day or night, to handle those issues if they become serious.

Susan also works hard to troubleshoot these issues before they become serious health problems. For example, she helps members understand the importance of refilling prescriptions and outlines what they should do if their drugs run out too soon.

Susan even partners with community resource agencies, like Meals on Wheels and the Confluence Health Patient Service Department, to help our members overcome barriers to their care. She knows when a member has a hospital stay or ER visit, and she tracks follow-up appointments and makes sure any meds they’re sent home with will work well with their current prescriptions.

But just like famous coaches, a big part of the job is to motivate. Susan empowers our members to take an active part in their health by setting attainable goals, and we value the important role she plays in our team and in lending a helping hand to our members.

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.