Tag Archives: hospital

Making Sense of Medicare Advantage and Medicare Supplement

Vantage Point: Medicare Supplement or Medicare Advantage? What’s the Difference?

Have you ever had a conversation with a friend or family member where you were both thinking that you’re talking about the same thing, but then you realize (usually after much confusion and the conversation has drifted a bit), that you’re in fact not talking about the same thing?

The conversation comes to the point where you find that you’re talking about two different things, an “apples and oranges” conversation.

I think that there are a lot of “apples and oranges” conversations when it comes to what Medicare Supplement and  Medicare Advantage plans are. We’re talking about insurance with both, but they are different things.

Medicare Supplement plans, also known as Medigap plans, work with Original Medicare, which is Part A (hospital) and Part B (medical) coverage. They help pay for all or part of the 20% that Original Medicare doesn’t pay for, depending on what plan you choose. Medicare Supplement plans do not include prescription drug coverage, so if you want that, you’ll have to pick up a prescription drug plan separately.

Medicare Advantage, also known as Part C, are plans where a private insurance company replaces Original Medicare. Medicare Advantage plans have the same Part A hospital coverage and Part B medical coverage that you’d get with Original Medicare. (Remember, you’d still pay your Part B premium if you get a Medicare Advantage plan.) Plus, Part D prescription drug coverage is included in many Medicare Advantage plans. That means you’d have hospital, medical, and drug coverage together in one plan. Medicare Advantage plans may come with extras as well.

Now that the Annual Enrollment Period is here, you’ll be better equipped to have the “apples and oranges” conversations if they come up. If you still want more direction when it comes to your options, there’s a great local service available called SHIBA (Statewide Health Insurance Benefits Advisors). SHIBA is a free service of the Washington State Office of the Insurance Commissioner, Consumer Protection Division and can be reached at 509-902-1114 or 1-800-562-6900  It has great volunteers who can help you.

You can also come into our local office in Creekside Business Park, and we can go over anything you’re confused about in person, bit by bit.

We at Health Alliance Northwest in Yakima are here to help our community learn what the various parts of Medicare are to help each person make informed decisions that are the best for them. (The best choice might not be us, and we’re okay with that!)    

Breck Obermeyer is a community liaison with Health Alliance Northwest, serving Yakima County. She is a small-town girl from Naches and has a great husband who can fix anything and 2 kids who are her world.

Essential Summer Safety Tips

Essential Summer Safety Tips

The summer season is finally here! But as we start to enjoy the outdoors and more adventurous activities, hospitals and urgent care facilities are bracing themselves for “trauma season” as they call it in the healthcare industry. 

Emergency rooms usually see injuries and traumas double in the summer compared to the winter months. The most common causes of injuries during the summer include car accidents, severe sunburns, water-sports injuries, dehydration, heat exhaustion, and falls.

But many of these can easily be avoided by following these essential summer safety tips that will keep you and your family safe and healthy during the summer months.

WaterTo avoid dehydration, drink plenty of water or beverages high in electrolytes. Avoid drinking too much alcohol or caffeine, both of which actually make your system lose water. Eat fruits and vegetables which contain a lot of water like grapefruits, peaches, eggplants, and spinach.

Sun ProtectionTo avoid sunburns, apply sunscreen with an at least SPF 30 and make sure you’re using a waterproof formula if you’re swimming. Stay in the shade from 11 a.m. to 4 p.m., cover your skin, and wear a hat if you’re exposed. Keep children in the shade as much as possible.

Heat ProtectionTo avoid heat exhaustion and heatstroke, don’t engage in physical activities during the hottest hours of the day. Get acclimated to the hot weather by slowly increasing the amount of time you spend outside.

Water SafetyTo avoid water-related injuries, always bring a buddy along while participating in water sports and follow the lifeguards’ instructions. Take time to get used to the difference in temperature between in and out of the water. Don’t drink alcohol before water activities.

Car SafetyTo reduce the risk of car accidents, make sure all your car maintenance is done before you leave on a trip. Allow plenty of time to arrive and try to drive during off-peak hours. Stop and take breaks every 100 miles or 2 hours, and if possible, take turns with a passenger.

 

Sometimes accidents, illnesses, and injuries cannot be avoided, even for the most careful traveler. If you find yourself injured or sick, remember that our travel emergency partner, Assist America is here to help. 

You can download the free Assist America Mobile App to access your membership details, membership ID card, list of services, or to call the 24/7 Operations Center with the tap of a button.

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Types of Providers

Types of Providers

If you have complicated health issues or your doctor has called another doctor an industry term you’ve never heard before, you may be left wondering what all these health care names really mean. We can help you make sense of the different types of providers.

Your Doctors

Primary Care Provider (PCP)

A primary care provider, or PCP, is your main doctor. It’s who you visit for routine checkups, preventive care, and general health problems. Each person in your family can have a PCP, or you can all see the same one.

If you’re on an HMO or POS plan, you have to choose an in-network PCP who will oversee your care and refer you to specialists. If you’re on a PPO plan, you don’t have to choose a PCP to get referrals, but you can to get personalized care and savings.

And if you’re a woman, you can set a doctor as your PCP or choose another in-network doctor, like an OB-GYN, to oversee free preventive care, your yearly well-woman visit, or a pregnancy.

Setting and changing your PCP is easy. Just log in to Your Health Alliance to update your PCP.

Specialist

A specialist is a doctor who provides health care services for a specific disease or part of the body, like dermatologists, who focus on skin care.

Usually, you’ll be referred to a specialist when your personal doctor wants you to check on specific issues or problems. You’ll also be sent to a specialist when you’re diagnosed with something serious, like a heart condition or cancer, or if you find out you’re pregnant. 

Surgeon 

A surgeon is a doctor who is qualified to perform surgery, and they have their own specialties. If you have a heart attack and need surgery, your surgeon will be an expert in heart surgery.

If you’re sent to the ER because of an emergency or diagnosed with a condition or disease, you might be sent into surgery. But if you need a minor procedure, like having your wisdom teeth out, you’re seeing a surgeon too. 

Hospitalist

A hospitalist is a dedicated, in-patient doctor who works only in a hospital or network of hospitals. If you’re taken to the hospital in an emergency or accident, you might be treated by a hospitalist.

Help with Your Care

Care Coordinator

Care coordinators help you figure out your health care in lots of ways, especially after a hospital stay, diagnosis, or if you have a chronic or complex condition.

They can help provide you with resources, educational materials, and self-care techniques, help you understand your doctor’s instructions, connect you to resources in your community, and help you plan for the future.

Health Coach

Health coaches can help you or your family plan for better health. Our health coaches can help you get the best care possible from your healthcare team and get the most from your coverage.

They’ll partner with you to help in areas like nutrition, weight and stress management, and preventive screenings and immunizations.

Nurse Navigators

You might get help handling your care from a nurse navigator when you’re discharged from the hospital if you get a serious diagnosis. For example, a cardiac nurse navigator will help patients with a primary diagnosis of heart failure or myocardial infarction.

They will usually start the process by visiting you before you leave the hospital, then they’ll stay in-touch to walk you through the first 30 days after discharge. 

Nurse navigators can help you organize your appointments, connect you to education on your diagnosis, medications, exercise, diet, therapies, and when to call the doctor. And they might host support groups that can help people like you.

Other Kinds of Care

Home Health Care

Home health care is medical care, treatment, or skilled care you can get in your home. You doctor might recommend this in situations where care in your own home will be easier for your case and condition.

Skilled Nursing Facility

You doctor might order medical care that must be given or supervised by a licensed health care professional in a skilled nursing facility. This type of care could include:

  • X-rays and other radiology services
  • Physical, occupational, and speech therapy
  • Storage and administration of blood
  • Use of appliances, like wheelchairs
  • Meals, including special diets
  • A semiprivate room or private room if medically necessary

Hospice Care

Hospice care is special care for people who are terminally ill, including medical and physical care and help with social, emotional, and spiritual needs. It also provides support for family and caregivers.

Other Help

Pharmacist

Pharmacists are healthcare professionals who practice pharmacy, which focuses on safe and effective medication use. You might not think about your pharmacist’s skillset when you pick up your drugs at the pharmacy, but they’re trained to know how drugs work.

They know which drugs can interact to protect you from dangerous drug combinations, they can explain the side effects of your drug to you, and they make sure you’re getting the right dosage of your drugs on the right schedule.

Social Worker

Social workers are there to help you with social problems that can affect your quality of life and health care. They can help you and connect you to resources for domestic violence, sexual assault, abuse and neglect, housing and food insecurity, home-delivered meals, substance abuse, mental health issues, advance directives, and more.

Other Providers

Medical Director

A medical director is a leader who recruits and manages doctors, nurses, and other personnel. They also examine and coordinate processes within their organizations to improve and guarantee the medical quality of the facility. 

 

If you need to find covered providers, use our Find a Doctor or Hospital tool to search for covered doctors, hospitals, and more.

Recognizing Early Labor

Recognizing Early Labor

Early labor begins before you’ve finished 37 weeks of pregnancy, and babies born this early can have lifelong or life-threatening health problems.

What Happens

If you go into early labor, you will likely be given meds to delay or stop it. In some cases, it can be delayed long enough to transport you to a hospital that has a . You may also be given medications that can improve the baby’s health if they come early.

Warning Signs

  • Contractions – Your abdomen will tighten like a fist every 10 minutes or more.
  • Change in Vaginal Discharge – You might leak fluid or bleed from your vagina.
  • Pelvic Pressure – This might feel like your baby is pushing down.
  • Cramps – These might feel like your period or like abdominal cramps with or without diarrhea.
  • Backache – You might feel a low, full backache.

What to Do

Call your doctor or go to the hospital right away if you’re going into labor or have any of the warning signs. They may tell you to:

  • Come into the office or go to the hospital for a checkup
  • Stop what you’re doing and rest on your side for an hour
  • Drink 2 to 3 glasses of water or juice

If your symptoms get worse or do not go away after an hour, call your doctor back or go to the hospital. If the symptoms improve, relax for the rest of the day.

Play for National Parks and Rec Month

National Parks and Rec Month

July is National Parks and Rec Month, and you should take advantage of your community’s parks and activities to get active!

Visit your local pool to cool off and get moving with classes like water aerobics and swim lessons, or at some, you can even join night swims or walk against a lazy river.

Water Workout

 

Stay fit as you get older with walks, exercise classes, and activities from your local park district.

Active as You Age

 

Camps and day camps from your park district can be the perfect summer activity for your kids.

Camp Fun

 

However you want to move, from kickboxing and  yoga to line dancing, your park district has the class for you.

Work Out Your Way

 

Be prepared to save a life with CPR classes from your local park district or hospital.

Save Lives with CPR

 

Find fun, safe events and classes for your teens on things like babysitting.

Safe Teens

 

If you or your kids love to compete, join a team to get active.

Compete Your Way to Fitness

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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.

Finding Doctors & Personalized Care

Finding Doctors Made Easy

Finding doctors and care that’s covered on your plan, like from a Primary Care Physician (PCP) or a clinic in your service area, is key to helping us pay for the care you get.

For some plans, like HMOs, you must go to a doctor in your provider network. And for some plans, like PPOs, although you can go to out-of-network doctors, going to doctors in your plan’s network can help you save.

Log In

The best way to find doctors in your network is to log in to Your Health Alliance, our one-stop member website. If you’ve never used Your Health Alliance before, you’ll have to register for an account first.

On Your Health Alliance, when you choose Find a Doctor or Hospital from the very top menu on your dashboard, you’ll see a list of all the providers you can use on your plan. From there, you can filter these or search by doctor or hospital name to find what you’re looking for.

Plan Details Search

If you can’t log in to Your Health Alliance, you can also find a doctor by looking at your plan’s network through our Plan Details Search.

You can find this feature by choosing learn how to use your benefits on HealthAlliance.org’s home page. This takes you to our Member Benefits & Forms page. The first bullet under Using Your Benefits, What Your Plan Covers, will take you to the search.

On the search, you just need to enter your member number from your ID card to see a list of all your plan’s documents, which will include your network of doctors. You can find your member number here:

Finding Your Member Number

Finding Doctors

You can also search for doctors on HealthAlliance.org. Choose Find a Doctor from the top menu to start your search.

Once you’re here, you can search for your network or by a doctor’s name, or you can look at a list of all our directories.

The best way to find your network is to search with your member number from your ID card. (The above image can help you find your member number.)

Or you can find your network by choosing your state and plan type and directory. If you have our insurance through your employer, you’ll choose employer groups. If you’re on a Medicare plan, you’ll choose that. If you shopped for and bought our insurance for yourself (and it’s not a Medicare plan), you’ll choose individual and families from the list.

Then you’ll choose your directory. Your directory is based on what type of plan you have. If you or your employer bought your plan from a public exchange, like Healthcare.gov or a state exchange, it will say public in your directory name. If you bought it directly from us, it will say direct.

It will also say your plan type, like HMO, PPO, or POS. If you bought a plan in a specific market, like Riverside or Methodist, it might say that, too. Your plan policy or plan documents can tell you what the name of your plan is to help you know which plan type you have.

Once you’ve chosen one of these, you can also add filters, like doctor or location info, to find certain providers.

Now that you’ve searched and found your network, you’ll see details for each of the doctors in your plan’s network, like address, if they’re taking new patients, and more. You can also add filters at this point to narrow your search.

And if you’re shopping for a new plan, we’ve made it easy to find doctors on those plans by connecting you to their networks while you’re shopping.

Still need help finding doctors or have questions about our providers? It’s no problem! Our Customer Service is here to help! Just contact us.

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