Here’s the oxymoron of the day.

If hospitals start telling obstetricians stop doing C-sections (or try to reduce them), that’s problematic for hospitals because they make money off them.  So they are less likely to engage in C-sections because many hospitals are struggling to stay afloat.   But get this, if you’re a woman who has had a C-section the insurance company sees you as an even bigger risk for complications.

This can lead to you seeing higher insurance premiums or being denied for coverage altogether.

Why?

Mainly because having the operation once can often lead to more c-sections in future births. The problem for insurance companies is that a c-section is usually over $2,500 more expensive than a regular birth. Rather than take the risk of having to pay for another c-section, insurance companies label the women as having a health condition and charge them higher rates. This practice is actually illegal in some states, in which case the insurance companies simply reject applicants completely. Like other so-called conditions, insurance companies are simply looking for a way to protect themselves from possible expenses.

Recommended action:  Talk to your insurance company around their practices in denying/approving women for coverage who have had C-sections.  Check with your state to make sure that you understand the law: is it illegal?

Now You’re Asking How Can I Avoid A Rate Hike?

Obviously, if your doctor wants you to have a c-section, there isn’t a lot you can do to avoid it. In some cases, the procedure may be optional, in which case you’re probably better off doing things naturally. Some companies are willing to overlook a c-section if the woman is sterilized after the operation, as then there’s no risk that they could have another pregnancy and c-section. A premium increase may also be avoided if the woman applies for coverage at least two years after giving birth and is a certain age. Another thing to keep in mind, insurance purchased through employers isn’t likely to increase due to a c-section as group policies generally require that the insurer cover everyone in the group at approximately the same rate.

Have you had a C-section?  Did your rates go up?  Tell us about it!

Source

With Obama’s recent visit to the Cleveland clinic, who will cease hiring smokers as of September 1, the Today Show is speculating that this may become a corporate health care trend.

Here’s the message from Dr Delos Cosgrove, CEO and President at the Cleveland Clinic:

While we are on the topic of smoking, I understand that there are differences of opinion about our recently announced policy to stop hiring smokers as of September 1st. Many people have told me that they totally agree with the idea. I have also seen and heard comments that what we are doing is discriminatory….Some have questioned the wisdom of our new hiring policy….

But we are not the first organization to implement such a policy.The World Health Organization, American Cancer Society and more than 6,000 companies across the country have adopted similar policies in an effort to promote a healthy workplace. It’s a growing trend; one that will likely keep gaining momentum. … Some also have claimed that our new policy is not really about health, but about saving money….

First, with our new policy, any applicant who fails the nicotine screening will be referred to a free tobacco cessation program that we pay for. Those who are successful in quitting will be encouraged to reapply after 90 days.…We also are committed to taking a lead role in shifting the national focus from “sick” care to “health” care. As a true “health care” provider, we must create a culture of wellness that permeates the entire institution, from the care we provide, to our physical environment, to the food we offer, and yes, even to our employees…..Secondly, no one can deny the staggering cost smoking places on society.

The U.S. Centers for Disease Control and Prevention estimates that smoking costs more than $75 billion annually in direct and indirect medical costs, and that businesses lose approximately $3,400 each year for every employee who uses tobacco because of increases in health costs and decreases in productivity related to smoking breaks….

While current employees will not be tested, I encourage any employee who smokes to please consider enrolling in a tobacco-cessation class.

I think it is fair to also note that obesity and smoking do drive up healthcare costs, thereby burdening the employer who usually subsidizes the group health insurance at yourplace of employment.

From CNN:

A government-sponsored study recently estimated that medical spending for obesity reached $147 billion in 2008, almost doubling in the past decade. It’s not surprising. About 32 percent of American adults are obese, a condition linked to diabetes, heart disease, even cancer. As the story above illustrates, obesity can also do a number on your bones and joints.

If you want an idea of how big $147 billion is, it’s roughly 6 percent of all health care spending in the United States.

How about smoking? Almost 21 percent of American adults are addicted to cigarettes, according to the Centers for Disease Control and Prevention. That’s more than 45 million people. The estimated health care costs pegged to smoking: $96 billion.

It’s virtually impossible to live in the United States and not be aware of the health risks associated with smoking, yet the addictive habit continues – with tragic consequences for smokers and an immense burden on the health care system.

If this trend continues, then the conversation between employer and employee could look like this:

Employer to potential employee: “If you smoke or are overweight, then you cost me money and I cannot hire you.   If I hire you then you will go into a smoking cessation program (or weight loss program) I invest in your health-you invest in my bottom line.”

Do you think this is fair?  Why or Why not?

My position?  I think it can easily become discriminatory without certain laws in place as this could become a slippery slope to discriminate against every condition under the sun that costs the employer more money.  And, according to the Kaiser family Foundation:

Women… have more complex health needs than men. In addition to pregnancy and related reproductive health needs, women also have a higher incidence of chronic illness for which they need ongoing medical treatment (38 percent of women versus 30 percent of men). Women are also at a much greater risk for maladies such as osteoporosis and autoimmune diseases like lupus, multiple sclerosis and rheumatoid arthritis—all of which require ongoing treatment.

In addition, women tend to live longer and therefore use more health care services throughout their lives. Women have also been shown to be the major decision-makers on health issues for their family, thus making their access to all facets of the health care system essential.

Tell me what you think in the comments area.

Resources:

• Women and Health Insurance:  Falling Through The Cracks?
• Obesity, smoking add immense burdens to health care costs
• Kaiser Family Foundation:  Women And Health Insurance Survey

Guest Post By: Single Edition, Divine Caroline.com

photo credit: Hamed Saber

It never occurred to me that the health care system for seniors in this country was so dire until my FIL became ill. To have every door closed to us because of a pre-existing condition, age and lack of continuing insurance blew my mind. So what options do seniors have when it comes to health care? Here’s what we found:

Group Insurance

Wikipedia:

Group insurance is an insurance that covers a group of people, usually who are the members of societies, employees of a common employer, or professionals in a common group.

Group insurance may or may not be converted to individual coverage. As group insurance gets big business for an insurance company with minimum operational expenses (under one master policy issued to an employer, union or any recognised group), it is usually less expensive than individual policies.

Now if you’re retired and battling a major illness which prevents you from working and obtaining group health insurance, what are your options?

Exactly, same questions we were faced with. Again, this is something we never thought about until now because we always assumed that Medicare or Medicaid took care of this sort of thing. He isn’t yet 65 and while his income qualifies him for Medicaid, he would still be living with us and they would count our income as I understand it which would make him ineligible. It’s like one frustrating merry go around that just seems so unfair to this section of our population. Don’t get me started on the cost of prescription drugs out of pocket.

Individual Insurance

After a comprehensive internet search we found a few plans that might be worth considering with the only issue being cost. Given his pre-existing conditions (diabetes and high blood pressure) we want a plan whereby he can see a specialist in a network, no deductible, no more than $50 per office visit to the PCP or specialist and emergency room coverage all for less than $300 month. What turned me off was the eagerness and shady behavior of the insurance agents who started calling 10 minutes after submitting the application. I don’t like being rushed into anything and so I had to tell one agent to back off while we get together and make a decision. After all, it isn’t final as to whether or not his stay here will be permanent OR if he will be returning to NJ and if so what level of independence will that mean for him?

It goes without saying that individual plans are more expensive than group plans because group plans get a larger discount for bigger business. This is our primary barrier to getting the best insurance as our preferred plan will run around $515 per month.

Medical Discount Plans

Medical Discount Plans are not insurance. This is a type of plan sometimes underwritten by insurance companies where you pay a set fee as which entitles you to plan benefits similar to that of regular health insurance. I am a bit wary of these plans as Ive never used them and not sure how binding the plan benefits are given that the company we interviewed could not guarantee for us how much they would cover after seeing a specialist. She kept on saying up to 70%, even with telling her he would be seeing a renal specialist and/or endocrinologist. Granted, they do have an advocate but what good does that do if the insurance company’s decision is final?

So, this isn’t a full health insurance policy and does not give one the same benefits and I am not sold in this plan. It merely gives a discount and boasts a large provider listing but what if they aren’t near? Well, we found out none of the 250,000 providers were near us and we live in the DC metro area, come on now. So this plan is a no go and that is final. And about the discount? This can get expensive if you need surgery or need to see a specialist, the latter of which is a reality for us at this time.

I am still waiting for the administrators of the Maryland Senior Health Insurance Assistance Program program and Maryland Health Insurance Plan (MHIP) to call me back to discuss health insurance options. Hopefully, they may be able to provide some information and insight into our options moving forward.

Have you been faced with a similar situation? If so, what were your options and how did you obtain insurance for a senior or edlerly person in your care?

photo credit: tempophage

Over the last few days I’ve been forced to think about possible continuing care options given my father in law’s recent stroke and seizure over the weekend. We were not prepared to deal with a major illness in that it required care after leaving the hospital. As adult children the thought of long term care is a daunting one at least it was for me.

Retiring Early and Losing Independence Due to Major Illness or Disability
My father in law (FIL) was forced out of his job due to his illness so he had no choice but to take the severance and wait for Social Security to kick in which it did this year. This no doubt led to his subsequent depression and isolation from friends and family as having a job at his age contributed to his sense of livelihood and independence.

I have often wondered why would any one want to work after the legal age of retirement but I fully understand the reasoning now. While visiting with him yesterday I had a chance to see and understand how deeply committed he is to remaining independent in certain aspects of his life. I think we could/should have paid more attention to his health once he retired but he always assured us that he was fine and life would go on. He continued to look for work and of course let his health slip by not following the appropriate diet recommendation for his diabetes and hypertension.

Senior Adult Individual Health Insurance
Is there even such a thing? After several talks with my spouse’s group plan administrator we figured that adding my FIL would not be an option. I will go through his Employee Assistance Program to see what options they may have to assist us in this transition. We also came across these programs while researching our options to supplement his Medicaid coverage from About.com:

Maryland Health Insurance Plan (MHIP)
MHIP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers “HIPAA-eligible” individuals as described above. The MHIP website has information on their eligibility requirements, current premium rates, and a fact sheet which details the benefits available under their program here.

Maryland Health Insurance Plan
10455 Mill Run Circle
Mail Stop RR-291
Owings Mills, MD 21117-9185
Phone: 443-738-0667 OR 1-888-444-9016

Maryland Senior Health Insurance Assistance Program(SHIP)
SHIP provides free one-on-one counseling for Medicare beneficiaries with questions about any aspect of Medicare, including the new Part D prescription drug benefit, or Medigap coverage.

Medicaid
Medicaid is a government program designed to help the poor and indigent obtain health care services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage, along with aged, blind, and disabled individuals. For more information about Maryland’s Medicaid program, including eligibility requirements, contact Maryland Medicaid at the number listed below.

Maryland Medicaid
Phone:1.800.492.5231 or (410) 767-5800

Ive already been in contact with the SHIP program and awaiting word from the administrator on how we may move forward.

Finding Important Documents In An Emergency

Get a lockbox. If your parents don’t have one, buy one for them. The time will come when you’ll need all important documents and this keeps everything in one place. This is especially important as we scrambled to find their important documents as neither kept them in a lock box. This included insurance, medical (allergies, current medications, medical histories), final wishes documents etc. You’d be surprised how much you don’t know when in a quasi-emergency situation when one or all of these documents are needed and you don’t know where to find them.

We don’t live in the same state as our parents so we had no idea where to find anything outside of talking to family members who pieced together information as we passed it on to the doctors and dealt with the insurance company. For the love and sanity of your children please put all important documents in an accessible lockbox, preferably fireproof.

This is an ongoing process so I will be writing about what we finally decide to do with regards to his care depending on the results of a few tests and what happens after he is released from the hospital today.