What to Look for When Choosing a Health Plan

Have you looked at your health insurance policy lately? Maybe it’s worth checking over the details of your plan to see if it suits your needs. A recent article in Insureme.com discussed tips on how to dust off your insurance policies this spring.

Health Advocate provides the following advice on what to look for when selecting a health insurance policy. Keep in mind that with an employer-sponsored plan, once you are enrolled, you will not be able to make changes until the next annual open enrollment period. However, you can make changes if you have a life-changing event such as a divorce, job change, marriage, birth of a baby or adoption of a child.

Choosing a plan.  To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any medical procedures you might need.

Do you really need all the bells and whistles? Some people have a tendency to think, “It’s a health insurance policy--I want the best.” That often translates into the most expensive plan. You may be paying too much if you choose a policy with a low deductible. Low deductibles are good if you frequently need medical care. However, if you’re young and healthy, it may be wiser to choose a high deductible plan. That way you’re covered for catastrophic illnesses without paying high insurance premiums.

Picking a robust plan. If you have a serious medical condition, you may want a health insurance plan that gives you several options for care, even if it costs more. You may not want to keep a plan that restricts you to doctors within a single healthcare system or requires referrals to see specialists.

Double-check the plan. Does the plan have prior authorization requirements? A prior authorization is an extra step that some insurance companies require before they decide if they want to pay for a medical service or a prescription medication.

Check into whether your doctor is in the plan’s network. You will pay more to visit healthcare providers outside the plan’s network, so it’s best to make sure your doctor is covered under your plan.

Understand who is covered. Check to see if your spouse or dependents are covered. If you recently got married or had a baby, you may want to add the new members of your family onto your plan. Some plans cover dependents, while other plans do not. Be sure to find out about whether stepchildren are covered. Some plans have a time limit for adding a spouse or newborn. For example, some plans require you to add your baby within the first 30 days following birth. Other plans will waive the additional premium for the first 31 days if you enroll within 31 days following birth. If you recently got married, some plans allow you to add your significant other within 30 days of the event.

 Find out if your medications are covered. If you take prescription medications, check them against the insurance plan’s formulary. Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost.

Budgeting your expenses.  If your employer offers you the option of a healthcare spending account, whether it is a flexible spending account (FSA) or a health savings account (HSA), take a good look at it. These tax-free accounts can help you save money on qualified medical expenses that aren’t covered by your healthcare plan, such as deductibles and co-insurance. Each account has a different set of rules about how and when you can spend the money, but each is worth considering because the savings you’ll see can add up quickly.  

Prepare for the unexpected.  Everyone needs to be prepared for the unexpected, including job loss, divorce, or other life-changing events. Be sure you know what the benefit plan costs might be if you need to pay for it under COBRA. COBRA requires that most employers with group health plans must offer employees the opportunity to temporarily continue their group health care coverage under their employer’s plan.

How Health Advocate can help

If you are a Health Advocate member and have questions about your health insurance policy, call us to speak to a Personal Health Advocate.  Your Personal Health Advocate can help you with many insurance-related concerns, including but not limited to:

·         Explaining the difference between a high-deductible and a traditional health insurance plan

·         Finding out whether your current doctor is in-network in your new insurance plan

·         If your current doctor is not in-network, finding you a new, in-network doctor—plus transferring your medical records and help schedule an appointment for you

·         Evaluating your health insurance plan to see if it has prior authorization guidelines

·         Looking into whether your spouse and/or dependents are covered under your health insurance plan

·         Researching which prescription medications are on your health insurance plan’s formulary

·         Explaining the benefits of a flexible spending account or a health savings account, and tell you what is a “qualified medical expense” that you can pay for from these accounts

·         Helping you understand any insurance-related terminology that you find confusing

·         Helping explain COBRA and go over your options with you

Health benefits can impact your overall financial well-being, so making well-informed decisions about the type of coverage you currently require will help you reduce costs. If you are a Health Advocate member, we can help you be better informed about your health insurance policy, which can help you—and your bank account—stay healthier!

Confused by your Explanation of Benefits (EOB)? Health Advocate can help!

When you or your family member goes to the doctor for a checkup, lab work, or other medical tests or procedures, you should receive an Explanation of Benefits (EOB) in the mail. An EOB is not a medical bill. It is an itemized statement that includes the healthcare service you received, how much was charged for the service, what was paid by your insurance carrier, and what you are expected to pay out-of-pocket.

When you first look at an Explanation of Benefits, you may feel a little intimidated by all the information listed there.  Even if the document confuses you, don’t ignore or discard it.  It’s important to take steps to understand your EOB.  Here is a list of the most common information you will find on your EOB statement and how to read it.

Member: This will include your contact information or the contact information for a member of your family who received care. The group number on your insurance card will also appear here. 

Summary of services. This lists the medical services that you or your family member received. This will also list any charges that you may owe and that were not paid for by your insurance company. If you do receive a medical bill, it’s important to compare the bill to the EOB. You’ll want to make sure that you are being billed for the correct services that you or your family member received.

Summary of deductibles and copayments. This column shows you how much of your copays and deductibles you’ve paid to date.

Details of services. This explains what type of care was received, the date of the appointment and the provider’s name. This is very important information to keep on hand. If you receive a medical bill, make sure the healthcare provider on the bill, as well as the date and the type of service received, match the same information on the EOB. Errors are not uncommon, and it’s possible that the bill and the EOB may not match. In order to notice and handle billing errors quickly and efficiently, you should always keep your EOB on file so that you can compare it to your bill.

Allowed amount: This is the contracted amount of payment a provider has agreed to accept for a service, treatment or product from an insurer.  In network providers can collect up to this amount, but out of network providers may balance bill up to their charges.

Balance.  This is the amount that you owe the provider for any deductible, co-insurance, co-pay and non-covered services. You may have paid some of this (for example, your co-pay) at the time the services were provided.

Still feeling a little confused about your EOB? If you are a Health Advocate member, call us—a Personal Health Advocate can help you better understand your EOB.  If necessary, your Personal Health Advocate can also help you resolve any errors you may find on your EOB or medical bill.

Get Up from Your Desk and Keep Moving

Did you know that sitting less could be good for your health?  An article on CNN.com cited a recent study in the journal Diabetologia that suggests reducing your sitting time could be more important than exercise when it comes to lowering your risk of diabetes.  The new results, however, should not replace standard recommendations for exercise, and more research is required, according to the authors. But still, this information could be a good reason to get up and get moving!

For many people who have desk jobs, your ability to move around during the day can be limited. But the good news is that even if you spend most of your time behind a desk, there are many ways you can take brief breaks to incorporate some mild activity into your daily office routine.  Health Advocate offers the following tips on ways you can be more mobile during the workday.

Don’t sit during your whole lunch break. Instead of sitting for your allotted lunch hour, take some time to eat for the first half and then squeeze in a short walk during the second half. Walk outside if the weather is pleasant, or take a walk inside the building. Consider taking a few trips up and down the stairs, too.

Don’t use the elevator. If you’re headed to a meeting on another floor, use the stairs.

Split up office errands. If you have to give a file to someone in accounting or you need to drop off a package to be shipped, make several trips throughout your day instead of doing all of these errands at once. This gives you more reasons to get up and move around.

Tag along with a colleague. Take a stroll to the break room with a buddy. This is a quick and easy way to incorporate more physical activity in your day. 

Substitute walks for email. Instead of emailing colleagues, walk over to colleagues and talk to them.

Stretch it out. Get up from your desk and take a stretch break. Try shrugging your shoulders to release neck and shoulder tension, or stretch muscles in the upper body by doing a torso twist.

Fit in more steps.  Do you drive to work?  If so, park farther away from your office door so that you have to do a little more walking from your car to your building.

You don’t need long periods of time to fit in more mobility during your workday.  Short bursts of activity are better than the alternative—no activity at all.  If you are a Health Advocate member with access to the Wellness Coaching service, give us a call!  A Wellness Coach can give you more advice about how to stay active during your workday, plus answer other questions you might have about getting started with exercise, eating healthier, reducing stress, and much more.

Helpful Tips for Handling Medical Bills

A recent study conducted by the American Journal of Public Health said that of the 83 percent of participants who had health insurance, nearly 27 percent of them had difficulty paying their medical bills.  Common reasons for people not paying medical bills include confusion about what exactly they’re responsible for owing  ), and/or they can’t afford the larger than expected price tag.

Fortunately, there are several ways you can avoid incurring large medical bills. Health Advocate Inc., an advocacy and assistance company that helps people navigate the healthcare system, offers the following tips:

Be informed.  Know the details of what your health insurance plan covers.  Being insured does not always mean that all of your medical costs are covered. Ask your insurer what kind of out-of-pocket expenses you can expect.

How Health Advocate can help: A Personal Health Advocate will research your insurance policy and determine your out-of-pocket costs for doctor visits, medical procedures, lab work, etc.  

Verify that the provider you choose is “in-network.”  Make sure that any labs your provider may use for various tests are also considered in-network.  If the provider and/or the lab and facility the provider is using are in-network, your medical bills will be less costly than out-of-network labs/facilities.

How Health Advocate can help: If you’re looking for an “in-network” provider, your Personal Health Advocate can locate one in your area. Your Personal Health Advocate can even schedule an appointment for you and transfer your medical records.

Do your homework. Costs for medical procedures can vary dramatically, depending on the doctor and facility where they are performed. For example, an MRI at a large teaching hospital is likely to be more costly than having the very same procedure done at a stand-alone facility. Start by researching different hospitals and facilities to comparison-shop.

How Health Advocate can help: Using Health Advocate’s pricing tool, Health Cost Estimator (HCE), your Personal Health Advocate can provide you with a list of providers in your zip code and the estimated cost of the procedure. You can also access Health Cost Estimator yourself. Simply go to your member website (HealthAdvocate.com/members) or download our FREE mobile app (from Apple or Google Play) and access HCE right on your tablet or smartphone! Plus, one touch connects you to a Personal Health Advocate for one-on-one help.

Read your bill carefully. Ask for an itemized bill. This could help you spot major errors on your bills.  For example, does the bill indicate that you received a treatment or procedure that you didn’t actually receive?  Are you being charged twice? A Consumer Reports Health survey said that 80 percent of medical bills have errors.

How Health Advocate can help: A Personal Health Advocate can check for errors on your bill and if found, can help resolve the problem.    

Talk to your doctor. Providers consider your financial status when recommending care. Let them know that costs are important to you. Discuss a payment plan with your physician.

How Health Advocate can help: If you are having a difficult time paying a doctor bill, your Personal Health Advocate can work out an agreement with your provider, such as an setting up a payment plan on your behalf.

Remember, if you are a Health Advocate member, you can reach out to us for help.  Our Personal Health Advocates can estimate costs of common treatments and procedures, locate in-network doctors, resolve insurance claims, assist with correcting medical billing errors, and much more. 

You’re Not Alone: Tips on Caring for an Elderly Loved One

Caring for an elderly loved one often requires an abundance of time and energy. Being a caregiver can include tasks such as administering medications, transporting someone to doctor appointments, and trying to make sense of medical coverage and bills. For the caregiver, trying to meet these needs could lead to taking extra days off of work or even quitting a job.

If you are a caregiver for an elderly loved one, Health Advocate provides the following tips that can help you avoid handling caregiving duties alone.

If you are a Health Advocate member…

• We can help. Our Personal Health Advocates can help you with caregiving needs, including:
• Locating alternative care facilities
• Obtaining coverage for medical supplies
• Providing information on local adult day care programs
• Coordinating coverage for home care services with insurance provider or Medicare
• Locating private duty nursing and home health aides
• Finding physicians who make house calls

Health Advocate members and non-members alike can benefit from these tips:

• Get the family together. If possible, hold a family meeting to discuss the needs of your aging loved one. A social worker or other facilitator can help with difficult issues, such as placement in an assisted living center or a skilled nursing facility.
• Discuss advance directives. Living wills detail medical care preferences. A power of attorney for healthcare document allows your loved one to designate another person to make financial or medical decisions, should they themselves become unable to do so.
• Investigate eldercare products. Work with a case manager and/or insurance company to locate emergency call buttons, stair chair lifts, electric scooters and other helpful items.
• Expect "live-in" adjustments. Be prepared for readjustments in mealtimes and sleep schedules, and to experience a "role reversal" in your relationship, placing you in a parenting type of role.
• Find support for yourself. Local organizations may offer adult day care, emergency respite and support groups. Health Advocate’s "Helping You Help a Loved One" brochure lists some resources you can turn to for support.

As you are caring for your loved one, don’t underestimate the ability of others to help alleviate some of the day-to-day challenges associated with caregiving. Remember, if you have Health Advocate as a service, we can help address your eldercare questions and needs—give us a call today!

Taking Control of Stress at Work

Whether you’re stressed out at work due to looming deadlines, too much on your plate, or any other reason, you could likely benefit from a little TLC. At work, it’s important to take a little time to care for yourself in order to prevent stress from getting the best of you. If you are an employee looking to better manage your own stress in the workplace, consider using coping strategies. Try the following ideas to help ward off tension that could arise throughout the day.

Spend time alone.

Take a 10-minute coffee break in the morning before the day starts, or try a brief, brisk walk in the middle of the work day. This may help you feel calmer and more focused when you come back to your desk.

Take a deep breath.

Try some deep breathing techniques at your desk. Inhale deeply, feeling your stomach expand. Hold your breath for a few seconds and then slowly exhale, visualizing tension leaving your body.

Train your brain.

Mindfulness training is an emerging stress management technique that involves training the mind to focus attention on the moment. This approach can train you to find the ability to rest and find qualities of peace and relaxation into your everyday life.

Stretch it out.

Stretching can easily be done at your desk. Sit in a chair with your upper body resting forward on your lap. Slowly roll up, starting at the base of your spine, until your back is straight. Stretch the neck muscles by titling your head the right and slowly rolling your head down and to the left. Repeat a few times in both directions.

Self- massage.

Sit with your shoulder relaxed. Use your right hand to massage your left shoulder and neck, working your way up to the scalp. Repeat using the left hand for the right shoulder.

Positive self-talk.

Replace negative mental thoughts that are in response to stress, such as "I’ll never get this done" with positive ones like "I know I can do this."

Reach out for help.

If you have access to Health Advocate, we have several resources that can help you:

If you have access to Health Advocate’s EAP+Work/Life service, you can call and speak to a professional about stress, work/life balance, and more.


If you are a Health Advocate member, you can call your Personal Health Advocate to help you locate a nearby in-network counselor or other mental health professional that can help you address stress.

While you often can’t control many of the stressors in your everyday life, you can learn to deal with them using coping techniques. When things start feeling too stressful, coping strategies like the ones listed above may be able to help you feel calmer and better able to tackle the tasks at hand.

Resources for employers

If your employer has Health Advocate’s EAP+Work/Life service, our Management Assistance Program (MAP) may be able to help you reduce stress in the workplace. MAP can give you the guidance you need to become an even more effective leader. Plus, check out Frontline, our quarterly newsletter full of helpful information for managers and supervisors.

Health Advocate’s free

white paper "Stress in the Workplace: Meeting the challenge" identifies ways that employers can help mitigate stress in the workplace. Read it today at HealthAdvocate.com.

National MS Education and Awareness Month: Support your Loved Ones

March is National Multiple Sclerosis Education and Awareness Month. Multiple sclerosis is a progressive disease of the central nervous system (CNS), which is comprised of the brain and spinal cord. MS is an autoimmune disorder that evolves slowly, causing the destruction of myelin, the insulating material that surrounds nerve fibers (neurons). Myelin helps electrical signals pass quickly and smoothly between the brain and the rest of the body. When the myelin layer is destroyed, nerve messages are sent more slowly and less efficiently. The symptoms of MS occur when the brain and spinal cord nerves no longer communicate properly with other parts of the body. MS causes a wide variety of symptoms and can affect vision, balance, strength, sensation, coordination, and bodily functions[i].

According to the Multiple Sclerosis Foundation, more than 400,000 people in the United States have MS.  An estimated 2.5 million around the world also suffer from the disease.

As part of Multiple Sclerosis Education and Awareness Month, Health Advocate, Inc. offers the following tips on how to support a friend or loved one who has MS.

-       Educate yourself. Familiarizing yourself with the physiological, emotional and cognitive symptoms of the disease will help you support friends and family facing the illness. The National Multiple Sclerosis Society and the Multiple Sclerosis Foundation offer educational materials, online caregiver communities and updates on treatment research.

-       Be emotionally supportive. It may be difficult for a friend or loved one who has MS to ask for help. If you are able, and with their permission, quietly take on a few of their daily tasks like laundry, cleaning or errands.

-       Support your loved one as they adapt. Although many people living with MS can remain independent for a long time, some people may lose physical and cognitive abilities. Establish new ways of “doing life.” Adaptation could mean family members taking over some daily responsibilities or the patient utilizing assistive devices to simplify tasks. Support your loved ones who are struggling with a loss of independence. Encourage them to accept and embrace life in every way they are able.

-       When possible, break out of the daily routine. Set aside some time to do fun activities together, like eating at a favorite restaurant, walking in the park, and going on fun outings, such as visiting a museum or going out to see a play or sports game.  Make sure to tailor these activities to your loved one’s abilities and interests.

If you have access to an advocacy service like Health Advocate and you need to find more information about MS, call your Personal Health Advocate, who can direct you to the appropriate resources, such as support groups, local chapters of the National Multiple Sclerosis Society or Multiple Sclerosis Foundation, and more.

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[i] "Multiple sclerosis." Genevieve T. Slomski, Ph.D. and Tish Davidson, A.M. The Gale Encyclopedia of Medicine. Ed. Jacqueline L. Longe. 3rd ed. Detroit: Gale, Online update, 2007. 5 vols. Updated October 2009. Health & Wellness Resource Center. Gale. March 22, 2011.