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Healthcare and Insurance: Everything You Need To Know

by Nitin Chhoda PT, DPT | Feb 12, 2018 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Whether you are healthy or not, having the right insurance for you is a must. Nitin Chhoda elaborates the importance of having the right insurance, and how it can help you prepare for future healthcare needs.

The terms healthcare and insurance have gotten a bit muddled in the minds of most Americans. So much of the public debate around healthcare is focused on health insurance.

But the reason that we need a better system of healthcare and insurance is because people aren’t getting the kind of healthcare they need to stay healthy.

It can be difficult to understand the healthcare practice management system if you never need to know how it works. But then one day you do need to understand, and maybe that’s because you’ve ended up in the hospital and are uninsured or underinsured.

The Truth About Healthcare and Insurance

The truth is that patients these days need better healthcare, and healthcare and insurance is the way that healthcare becomes affordable. If you had millions of dollars in the bank, you might not care about health insurance.

If something happened, if you were in a car accident or got sick with a serious disease like cancer, you could pay for your healthcare, even if that meant spending tens or hundreds of thousands of dollars for the best care. However, if you don’t have unlimited funds to spend on unforeseen expenses, healthcare and insurance is there to cover the big costs.

What is Healthcare?

For a moment, let’s forget about healthcare and insurance altogether. Imagine that every time you got sick and needed to go to the doctor, you would just go and the doctor would charge you a fee for the visit, and you could afford to pay that fee.

You have a bad sore throat that won’t go away, you go to the doctor, suspecting strep throat, and the doctor charges $30 for the visit and gives you a prescription for antibiotics. Then you visit the pharmacy and pay $10 for your medication and you’re all better in a week. You don’t feel like you need a healthcare and insurance.

That is healthcare at it’s most simple approach. Of course, the situation gets more complicated if something serious happens.

You have pain in your back all the time and you visit the doctor. You have to go back a number of times for a number of different tests.

Each time it costs $30, plus the costs of the tests. Then your doctor orders an MRI. In the United States, an MRI costs hundreds of dollars. Healthcare and insurance seemed to be important at this time.

Or if someone has back pain that is making their life difficult and full of pain, they do not have a choice about seeking out healthcare and insurance.

The alternative is to live with awful pain all the time, limiting what they do in fear of making it worse, and possibly taking pain medication which will do further damage in the long term, to the liver, kidneys, and other important organs.

Getting Healthcare and Insurance is Part of Life

So rather than risk that this patient will have to pay for all these medical tests and potentially ending up in surgery, which will cost $50,000 to $100,000, the alternative is to buy healthcare and insurance.

You may choose a high deductible and pay for all those inexpensive visits, but if something truly bad happens, you are financially protected from medical bankruptcy.

Health Care Insurance : The Patient’s Perspective

by Nitin Chhoda PT, DPT | Jan 28, 2018 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Although patients know the importance of healthcare and insurance, most do not understand their coverage and benefits. Nitin Chhoda explains how patients misunderstand insurance, and why it is important to openly communicate with them in order to avoid financial struggle.

The nature of health care insurance of a healthcare practice management in the United States leaves most patients pretty confused about what they need and what they are entitled to.

For example, even patients who have health care insurance may not benefit from their insurance most of the time.

If a deductible is built into the insurance plan, the patient will end up paying for most of their doctor visits every year. The only time they benefit from having insurance is when a serious accident occurs or they are diagnosed with a serious illness.

A Patient’s Perspective

From the patient’s perspective, the health care insurance system is confusing and always more expensive than they expect. A co-pay that is required, perhaps $20 for a visit or 20% of the bill, might come as a surprise to a patient that doesn’t understand their policy.

Even worse is when the patient does not understand the deductible of his/her health care insurance. They may look at their policy, find out that a certain treatment is covered, and not realize that they must pay the entire cost because they haven’t met their deductible limit.

For Clinicians and Medical Practices, Misunderstandings Can Mean Lost Revenue

Let’s consider a patient who does not understand the deductible, but they want to go to a dermatologist to test an unusual mark on their skin. They wonder if it’s skin cancer or just a mole, so they figure out that this kind of test is covered by their health care insurance, as long as they get a referral.

First they go to a general practitioner who is covered by the particular health care insurance company. They pay for that visit, or perhaps just a co-pay, and get their referral.

But then they have an appointment with a dermatologist and tests are done to determine what the skin growth is. This is all pretty expensive and the bill comes to $1000.

At first both the dermatologist’s office and the patient believe that the patient must only pay the co-pay of 20%, which is $200 because of his/her health care insurance.

If the patient has a $3000 deductible that they have not reached, a chain of events ensues, which causes expense, wasted time, and stress for the patient and the medical staff.

First, the medical billing staff will bill the health care insurance company for the amount they typically pay, in this case $800. But the claim will be rejected because the deductible has not been met. Then the medical office has to bill the patient that $800 – an amount the patient is not expecting to pay.

A Realization

From the patient’s perspective of health care insurance, this is a terrible realization. From the practice’s perspective, this has been a waste of time and now they do not know if they will be paid for services already rendered. It is quite possible that the patient cannot afford to pay that $800. Even the $200 was probably a bit of a bummer at least.

The truth is that the patient made the right choices in making a health care insurance.

If that skin growth was skin cancer, it should be tested and removed. If they leave it alone, they may get seriously ill and have to undergo much more expensive and intensive treatments. But they are discouraged from taking those first steps because it is so costly.

Insurance and Benefits: What the Average Citizen Should Know

by Nitin Chhoda PT, DPT | Jan 22, 2018 | Physical Therapy Documentation, Physical Therapy Management

It’s not enough that a person should have insurance, it is equally as important they know what type of coverage they are buying. Nitin Chhoda explains the difference of premium, deductible, and co-payments types of insurances.

If you want to save money on health insurance in the United States, first you have to understand just what it is you are responsible for paying when you need healthcare.

Insurance and benefits and physical therapy documentation can be incredibly confusing, partially because insurance companies use certain terms to describe what you will be paying.

If the average citizen was better educated about insurance and benefits, they can make better decisions about healthcare and insurance. Healthcare providers are also better off when patients understand their responsibilities and what is covered by their insurance benefits package.

Below are the commonly misunderstood terms that related to payments that patients must make as part of their healthcare insurance and benefits responsibility.

Premium

The premium for health insurance is the monthly, quarterly, or annual payment that the patient makes to the health insurance company. By continuously paying the premium, a patient remains insured. If the patient stops paying the premium, or pays the premium late, insurance and benefits can be withdrawn.

For employer insurance plans, often the employer pays the premiums for employees. This is not always the case, but even when the employer does pay, they tend to reduce the salary for the position based on the cost of adding another employee to their insurance plan.

Deductable

The deductable is usually referred to as a cash amount, and it is the cash amount that the patient is responsible for paying. Most plans for insurance and benefits will include a deductable, and as the deductable rises for a different plan, the monthly premiums go down.

For employer plans, you may not have a choice unless you are choosing between an HMO and a PPO. The word deductable is used in insurance and benefits as the amount of money you have to pay before you can start benefiting from your policy.

For example, if your deductable amount is $500, no matter what you go to the doctor for, the first $500 in bills are yours to pay. If you want to have a higher deductable, you can get a cheaper insurance and benefits plan. But you’ll be paying the amount before you can collect benefits.

If you rarely go to the doctor, a high deductable can save you money. If you need medical care suddenly and it will cost thousands of dollars, you only pay the deductable and the rest is covered by your insurance company.

Co-Payment

A co-payment, or co-pay, is also a cash amount. Some insurance and benefits plans are zero deductable plans and instead they require that you pay a percentage or flat fee for each visit to the doctor.

Even some plans with deductibles include co-pays for standard visits to the doctor for general check-ups.

Knowing the details of your insurance and benefits is different from understanding the insurance and benefits you are entitled to.

Most people who are healthy never even think about their co-pay or deductible until they need to go to the doctor and they find out that the amount is not yet billable to the insurance company. Often, this realization comes at great cost to the patient and the healthcare facility.

Insurance and Benefits and How They Relate To Good Health

by Nitin Chhoda PT, DPT | Jan 16, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

The future of healthcare and insurance is still uncertain. Nitin Chhoda imparts how major changes are needed to be made in order to help policy holders maximize the use of their insurance policies.

Without a good understanding of health insurance and benefits and physical therapy billing process, many patients make big mistakes that end up costing them money.

These are mistakes that also cost their healthcare providers time and money in the form of billing, rejected claims management, and late payment of fees.

Because so many people don’t understand that even with insurance and benefits they will still have to pay for some healthcare, the system can be very inefficient.

Some People Do Not Understand Their Insurance

But what about the cost to the health of people who have insurance and benefits but do not understand how the system works? Some people who do not understand will have certain healthcare procedures done without realizing that they will have to pay.

When they find out that they actually have a deductible of insurance and benefits which they are responsible for, they are shocked and disappointed to be suddenly in medical debt.

And even for patients who do understand the system, making these decisions is dangerous to health.

For a patient who has a problem with their skin and is wondering if they might have a melanoma, the correct and safe thing to do is go to the doctor right away. When skin cancer is caught early it is much easier and cheaper to treat and treatment is more likely to be effective without having to use paid insurance and benefits.

If a patient knows that they will have to pay up to a $3000 deductible, they may be nervous about going to the doctor for financial reasons. What good is an insurance and benefits plan if you still have to pay for medical care that you can’t afford?

What Patients Should Know Before Selecting Insurance and Benefits

The best way to avoid a bad situation is to educate patients before they choose their insurance and benefits plan.

That way, patients can choose a plan with a deductible that they can afford and that makes sense for their health history.

Of course, for people working in the healthcare industry, it is usually too late by the time they see patients.

In many practices today, the induction process for new patients includes a somewhat sobering educational experience.

Rather than waiting until the billing process starts and services have already been provided, the reception staff or nurses will actually find out exactly what is covered by a patient’s insurance and benefits plan, and they will find out if the deductible has been reached yet.

Financial Future

This may take more time at the beginning, but in the long run it saves time and money for the practice. As a patient, if a practice wants to figure out how much financial responsibility you have, it is best to indulge them so you also know what you will be responsible for paying.

By working together, patients and medical practices can determine what the best course of medical treatment will be based on both the financial resources and insurance and benefits that the patient has.

Healthcare and Insurance and Its Future

by Nitin Chhoda PT, DPT | Jan 8, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

The future of healthcare and insurance is still uncertain. Nitin Chhoda imparts how major changes are needed to be made in order to help policy holders maximize the use of their insurance policies.

For a long time, the healthcare and insurance industry has been entirely unregulated.

Insurance companies have been allowed to drop paying customers who suddenly become ill or injured, based on technicalities.

People who are diagnosed with cancer are often suddenly reviewed by their healthcare and insurance providers and if anything is outside the policy, even if it is unrelated to the diagnosis of cancer and has an effective physical therapy documentation, the insurance company will drop the patient, leaving them with the responsibility of paying hundreds of thousands of dollars for treatment.

Medical Care Is Unaffordable

Most people in the United States cannot afford the high cost healthcare and insurance of medical care. The option for most patients in this situation is very bleak.

On the one hand they can forego treatment and die from the disease, but nobody expects a patient to make that choice. On the other hand, if they go forward with treatment they will be committing to financial debt that will most likely cause them to declare medical bankruptcy.

Not only does diagnosis with a serious disease like cancer put you in a bad financial position, it can also cause you to miss work and even lose your job. Treatment is often very uncomfortable and has side effects that make patients unable to do their work.

Just because someone is diagnosed with cancer, they should be condemned to medical debt, job loss, and potential financial ruin. Cancer is bad enough on its own.

Even if a healthcare and insurance company does not drop a patient, the policy may only cover up to a certain amount. Most insurance plans have a cap, and most caps are too low to actually cover the costs of treatment for a disease like cancer.

How Will This Situation Improve?

There are many potential improvements that can be made to the current system. In the government’s role to protect the people, laws are being introduced that restrict the way healthcare and insurance companies can drop patients without cause.

There are also provisions which restrict insurance companies from putting unfair caps on their insurance pay-outs for healthcare and insurance plans. We have seen that without legal protections for consumers, healthcare and insurance companies will go to great lengths to save money, at the cost of their policy holders.

The Reality of Healthcare and Insurance

Even if someone pays their healthcare and insurance premiums for ten years, a health insurance company will not hesitate to find a loophole when the times comes to actually pay for some healthcare of their policy holder.

Some healthcare and insurance providers have simply changed the way they bill to adjust for people who need healthcare but don’t have insurance.

Or they do not assume they will collect any money from patients and increase prices so that the insurance company’s share of each bill is higher than it would have been otherwise.

These are desperate and unethical, if not completely illegal, ways to deal with the current situation. But the reality is that major changes will have to take place before healthcare and insurance become affordable for the average American.

Healthcare and Insurance Solutions in the United States

by Nitin Chhoda PT, DPT | Jan 2, 2018 | Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

Healthcare and insurance issues in the United States remain unsolved. However, Nitin Chhoda shares how the Affordable Care Act is planning to revise the provisions of insurance by changing the age limit of dependents, and amending the law when it comes to pre-existing conditions of a potential policy holder.

There is no single, simple solution to the problems with physical therapy documentation of healthcare and insurance in the United States. In fact, the problems have become circular in a way that feels like a loop; nobody knows if there is a way out.

We have been traveling in a direction that is destructive and unhealthy for a long time, and turning around is not going to be easy.

However, there are plenty of healthcare and insurance systems in many other countries that do work. With some research and open-mindedness, the U.S. could start to invest in new strategies and at the same time the American people could get better healthcare and insurance, leading to better health overall.

There will not be a perfect solution anywhere else, because every country is different. But for the price that the U.S. government pays in tax breaks to the health care industry, a better solution could probably be designed.

The Near Future

In the near future, we may see some improvements if the Affordable Care Act is implemented well. Some provisions which have already become effective have ensured that 3.1 million young Americans have healthcare and insurance.

Previously, as soon as a child reached the age of 18, they were no longer eligible to remain on their parents’ healthcare and insurance policy. The Affordable Care Act changes that age to 26, so that students and young people looking for work can still be included in their parents’ plans.

Additionally, the Affordable Care Act has made it illegal for healthcare and insurance companies to institute lifetime limits on healthcare benefits. For parents with children who become ill with life threatening diseases, the lifetime limit was like a death sentence.

Insurance Limit

If at the age of 7 a child is no longer insurable because they have reached a lifetime limit, the parents must somehow pay for healthcare and insurance on their own, which is impossible for the majority of Americans.

And finally, one more perk about the Affordable Care Act is that insurance companies can no longer reject a potential policy holder because they have a pre-existing condition.

In the past, if someone lost their job and subsequently their healthcare and insurance, any pre-existing condition could be reason enough to reject an application for insurance.

If you have diabetes, a mental illness, or any other disease that will cost money to treat, no insurance company will provide insurance for you. But because of the new healthcare and insurance law, insurance companies can no longer deny people with pre-existing conditions.

The Bigger Picture

While these changes are exciting and potentially life-saving for the people who benefit from more protective laws, they are really only patches for a system that has not really been working.

The bigger picture shows that the price of healthcare and insurance in this country is unaffordable to the majority of Americans. The question that will need to be answered eventually is whether or not it is worth it for the people of the United States to be given high quality healthcare and insurance.