I have suffered with eczema and asthma since childhood. As a child I would regularly get shots for my asthma either on an emergency basis at the Doctor's office or regular shots to keep my asthma under control. At one point in time my Mother learned to give me the shots, although not a pleasant experience for a child to go through.
Over the years I have had to make only a few emergency visits to a Doctor for my skin condition. One time when making meatloaf I rubbed my face without washing my hands, which left my face in an itchy rash. Ever since that disasterous experience I use a wooden fork to mix ingredients without physically touching the ground chuck.
Usually my hands are the worse in the winter months, but the past few months my face was suffering from flareups constantly. When shopping at Walgreen's last Saturday for some redness relief moisturizer lotion the cashier told me she had a similar experience that got better after she went to the Emergency Room for a shot of Cortisone.
I had not considered going to the Emergency Room for my facial swelling, even though most mornings my eyelids were swollen. I read through my Health Maintenance Organization (HMO) Handbook trying to decipher what constitutes an Emergency Room visit.
It is clearly spelled out in the Handbook not to use Emergency Room for routine health care services. The steps to use Urgent Care are also discussed, starting with a call to your Primary Care Physician (PCP), identify yourself as a plan member. Ask to speak to the Doctor on-call about what has happened. If you cannot get in contact with your PCP contact the Health Plan.
Urgent Care is what you need when a condition, illness or injury is not life-threatening, but needs medical care right away. Emergency Medical Condition is a medical condition manifested by acute symptoms of sufficient severity (including severe pain), such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health or unborn child in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any body organ or part. This includes psychiatric disturbances and symptomos of substance abuse.
I still was not certain my visit to an Emergency Room would be covered by my Insurance plan, since I would be going to one near my residence that is not part of the network. I started by calling an Emergency Room at a Hospital not too far from my house. I inquired to the length of wait since my kids both are on the Autism Spectrum and not familiar with the place. I was told by the Emergency Room Personnel that we should probably try another location.
I wanted to go to the Hospital my youngest son has been a patient of three times, as well as a few trips to the Emergency Room. I figured this would be less stressful for my kids and I would feel better going someplace we all were familiar with. I started by calling the PCP, which had no answering service or machine. I let it ring for several minutes before realizing I would not get anyone on this line.
I used the phone number on the back of my Insurance Identification Card that says for 24-hour authorization. I figured this was the number the Hospital would call to get approval. I gave my ID# and explained my situation with my skin and my two kids. The person told me this would be covered to go to the Emergency Room at the Hospital of my choosing and they would call to get autorization once I got there. She also stated it was not unusual for the PCP to not have a message service.
I packed a backpack of reading material for us, diapers for my younger son and water and snacks. I brought along the medications I had been taking, as well as some cosmetics and lotions I had recently purchased. We got to the Emergency Room at 2 pm on Sunday afternoon. Within forty-five minutes I was assessed by a Nurse, had my blood pressure checked and temperature taken. I was given a wristband with identifying information and told to go to another waiting room at the end of another hall.
This was the waiting room for another section of the Emergency Room for minor conditions. I was not happy to learn that my inflamed face with swollen eyelids was considered a minor issue. There were families coming in with several children running around. Several people were ahead of us in this room, that seemed to take each one in the order they appeared. We were given paperwork on our situation and placed these documents in a box for a Nurse to remove.
I was called into the Emergency Room section by 5pm and quickly seen by an Intern. She mentioned some courses of treatment for me and needed to see her Attending Physician to determine which method would work best for me. She told me one shot would work quickly where another one would take longer to work. Luckily I did not have to make the decision since I wanted fast results.
The Attending Physician came awhile later to look at my swollen face and they went off to consult. The Doctor returned to tell me which method would be used and that the Nurse would give me an antibiotic and then get the shot from the Pharmacy. They would then have to keep me longer to make sure there was no allergic reaction to the shot and then I would get prescriptions.
This whole process took longer than the actual wait in the waiting room. It was more than an hour to get the shot and then like another one for them to check me out for reactions. Initially I was told the shot would be in the arm, but the Nurse learned from the Pharmacist that a shot would have to be in the muscle of my torso.
This freaked my kids out since he wanted to pull the curtain. My son did not want the door closed and once the gloves went on the Nurse he paced about thinking they were coming for him. There turned out to be some problem with the computer and my financial information, so I was not released until 8:30 pm. My face was burning and it seemed worse to me from what I could see in my little mirror.
The Nurse told me they were short staffed and very busy. Each person that came into the Emergency Room after us was seen by the same Doctor within five minutes. It looked like the Nurse was the busiest person in the Emergency Room with the Doctor handling the caseload in rapid succession.
My paperwork said to see a Dermatologist in 1-2 days for follow up care. The Nurse had told me the shot was slow released giving me twelve hours of medication. He said my face would look better the next morning. My face was worse with both eyelids swollen. The Doctor told me to stop taking the Prednisone I had been taking that did not seem to work for four days and to take the Antibiotics for ten days. They did not give me any creams or ointments to put on my face and said they were working from the inside.
Turns out the Hospital office building only has a Dermatologist on Tuesdays and the Nurse at their office would not give me an Emergency appointment. I called my PCP to get a referral and was told I had to go in to see the PCP to get one and this would take too long.
In the end I went through the yellow pages and found a Dermatologist that charged $135 and could see me at 3:30 that afternoon. Driving to Rite Aid for the Rx was hard to do with my swollen eyes tearing up, so we headed to the Dermatologist in a taxi during a rainstorm to get some care - this the day after being at the Emergency Room for over six hours.
This Dermatologist told me to start back on the Prednisone and stop the Antibiotics and to put ointment on my face twice a day. I am happy to report that by Thursday my face was clear and has continued to be that way. I did not have to pay $95 for a follow-up visit with the Dermatologist on Friday, but will be making an appointment soon to keep the eczema under control before an emergency arises.
On Tuesday morning we had a power outage at 4 AM from the overnight rainstorm. With my skin starting to mend I did not want to suffer without ventilation in my house. I have air conditioning in the bedroom plus a ceiling fan and fans throughout the house. We ended up staying at a Super 8 Motel overnight that had ample Air conditioning, as well as cable Television for the kids, microwave and refrigerator. I had such a pleasant sleeping experience in that cold room I am sure it helped in the healing process.
My Insurance plan does not have a nurse hotline. As a home health care worker for the State my plan includes only County Hospitals. I was tempted to call the Blue Cross Hotline from my previous Insurance plan, or to contact the hotline for my kids insurance. Instead I perused over the Insurance Handbook and went directly to the plan for assistance in determining whether my situation was an Emergency.
I encourage people to read over your plan and familiarize yourself with Urgent and Emergency Care steps so you will be able to obtain the proper care for when a situation mounts. I had not contemplated an Emergency Room visit until the cashier at Walgreen's mentioned she had done the same thing. It helps to get feedback from others and take advice where you least expect it.
Sunday, July 20, 2008
Take Advantage of Open Enrollment
It is that time of year again where companies offer the choice to change your Employee Benefit Plans. An open enrollment period can be once or twice a year with the time frame being about one month to make the changes to your existing plan. If you have not turned in your signed applications within the allotted time frame you will have to stay with the previous plan you chose when first hired.
A Company will send out literature explaining the dates and perhaps a time to learn about all the offerings to choose from. It is well worth an Employee’s time to become informed on each benefit and research Hospitals in their area. Each Insurance Company prints an Explanation of Benefits that will outline each option available. Depending on the Broker the Human Resources Department works with a comparison of the plans will be given to help in decision making.
If your Employer allows flex time for doctor appointments you might want to consider a Hospital closer to your work than residence. During lunch hours you can observe the facilities for their hours of operation. For a single person this could be a better option with less time away from work.
For those who are in the child bearing years it is a good idea to contact various Hospitals in the Plan to see what options they offer before you choose. If it is a teaching Hospital the Doctor listed in the Directory will most likely not be the attending Physician. I chose a Primary Care Facility for my first pregnancy with the only option for each prenatal visit being either a mid wife or registered nurse. I inquired about the delivery and insisted on a Doctor, which was my right.
In some States it is now mandatory to have a two-day stay after delivering a baby while others you leave within a twenty-four hour period. You can pre-arrange a birthing plan with the options for medication early on. Another consideration prior to signing an application is the policy for visitors and where the baby sleeps. One other point is to call the local number for your emergency and ask what is the nearest Hospital you would be transported to.
The following is a brief description of the choices having to face when picking Health Insurance:
PPO – Preferred Provider Organization – These plans have the option of 80/20 coverage where you get to choose from a number of Physicians. The decision also on which deductible makes the price fluctuate. For the employees who maintain overall good health with the only visit being a yearly physical this is the best choice. You pay the out of pocket expenses on the few visits you make while choosing a high deductible. Check the rating for the Insurance Company to see if rated A+ by Best or Moody’s.
HMO – Health Maintenance Organization – This is where the plan you pick is the place you see the same group of doctors and the Hospital is affiliated within. There is a co-payment for each visit that can be from two dollars to ten and up. These are typically cheaper in monthly cost but can get expensive if you have monthly visits with children also. They will most likely want you on a regular basis to maintain your health. I get letters informing me I have to schedule an appointment.
EPO – Exclusive Provider Organization – If you are employed within the Medical Field this would be the option to pick the Hospital you are affiliated with. The Hospital might be one of a few within a system so there will be some options to choose which facility to become a member.
Prescription Plans – There are many options available depending on your local Pharmacy and whether they are located nation wide. The comparison will be in the Generic and Brand prices. Many plans offer the discounted generic prescriptions only while others have a mail order option. You might end up paying a few dollars for each prescription and worth comparing all companies. Many Medical offices now have pharmacies in their buildings, this would be part of a HMO plan.
AD&D – Accidental Death & Dismemberment – This costs a few dollars each deduction period and well worth signing up for. It will usually include air travel, car travel and inside the home. For example, a Los Angeles Newswoman had an accident while reporting a story suffering severe burns and loss of limbs.
LTD – Long Term Disability – This is another option that has a smaller cost that has options to decide. This is also a benefit on many credit cards and might be already one the employer pays but for an added cost you can ask for more coverage.
Cancer Services – Prevention and Early Treatment
Home Care – Hospice, Medical Equipment, Health Aides
Behavioral Medicine – Psychiatric, Alcohol and Drug Abuse – Mental Health
Alternative Therapies – many are now offering acupuncture and chiropractic services
Urgent Care – is there a separate facility and entrance – available 24 hours
Transportation – this is an option we have, they pick up senior citizens free of charge
Pre-existing Condition – Mention what all members of your family may suffer from, being an asthmatic I have never been turned down or charged more. Another example would be if you use a hearing aid.
Vision Care – There is a limit to how many visits, choose from directory
Smoking Cessation – this might be covered and worth considering in a plan
At this time you can make changes to your Charitable donations through United Way, change your plans for Profit sharing, join a credit union and switch to direct deposit. It is advised to read over the literature, make phone calls, discuss with family members and choose the best Benefit Plan for your future health needs.
A Company will send out literature explaining the dates and perhaps a time to learn about all the offerings to choose from. It is well worth an Employee’s time to become informed on each benefit and research Hospitals in their area. Each Insurance Company prints an Explanation of Benefits that will outline each option available. Depending on the Broker the Human Resources Department works with a comparison of the plans will be given to help in decision making.
If your Employer allows flex time for doctor appointments you might want to consider a Hospital closer to your work than residence. During lunch hours you can observe the facilities for their hours of operation. For a single person this could be a better option with less time away from work.
For those who are in the child bearing years it is a good idea to contact various Hospitals in the Plan to see what options they offer before you choose. If it is a teaching Hospital the Doctor listed in the Directory will most likely not be the attending Physician. I chose a Primary Care Facility for my first pregnancy with the only option for each prenatal visit being either a mid wife or registered nurse. I inquired about the delivery and insisted on a Doctor, which was my right.
In some States it is now mandatory to have a two-day stay after delivering a baby while others you leave within a twenty-four hour period. You can pre-arrange a birthing plan with the options for medication early on. Another consideration prior to signing an application is the policy for visitors and where the baby sleeps. One other point is to call the local number for your emergency and ask what is the nearest Hospital you would be transported to.
The following is a brief description of the choices having to face when picking Health Insurance:
PPO – Preferred Provider Organization – These plans have the option of 80/20 coverage where you get to choose from a number of Physicians. The decision also on which deductible makes the price fluctuate. For the employees who maintain overall good health with the only visit being a yearly physical this is the best choice. You pay the out of pocket expenses on the few visits you make while choosing a high deductible. Check the rating for the Insurance Company to see if rated A+ by Best or Moody’s.
HMO – Health Maintenance Organization – This is where the plan you pick is the place you see the same group of doctors and the Hospital is affiliated within. There is a co-payment for each visit that can be from two dollars to ten and up. These are typically cheaper in monthly cost but can get expensive if you have monthly visits with children also. They will most likely want you on a regular basis to maintain your health. I get letters informing me I have to schedule an appointment.
EPO – Exclusive Provider Organization – If you are employed within the Medical Field this would be the option to pick the Hospital you are affiliated with. The Hospital might be one of a few within a system so there will be some options to choose which facility to become a member.
Prescription Plans – There are many options available depending on your local Pharmacy and whether they are located nation wide. The comparison will be in the Generic and Brand prices. Many plans offer the discounted generic prescriptions only while others have a mail order option. You might end up paying a few dollars for each prescription and worth comparing all companies. Many Medical offices now have pharmacies in their buildings, this would be part of a HMO plan.
AD&D – Accidental Death & Dismemberment – This costs a few dollars each deduction period and well worth signing up for. It will usually include air travel, car travel and inside the home. For example, a Los Angeles Newswoman had an accident while reporting a story suffering severe burns and loss of limbs.
LTD – Long Term Disability – This is another option that has a smaller cost that has options to decide. This is also a benefit on many credit cards and might be already one the employer pays but for an added cost you can ask for more coverage.
Cancer Services – Prevention and Early Treatment
Home Care – Hospice, Medical Equipment, Health Aides
Behavioral Medicine – Psychiatric, Alcohol and Drug Abuse – Mental Health
Alternative Therapies – many are now offering acupuncture and chiropractic services
Urgent Care – is there a separate facility and entrance – available 24 hours
Transportation – this is an option we have, they pick up senior citizens free of charge
Pre-existing Condition – Mention what all members of your family may suffer from, being an asthmatic I have never been turned down or charged more. Another example would be if you use a hearing aid.
Vision Care – There is a limit to how many visits, choose from directory
Smoking Cessation – this might be covered and worth considering in a plan
At this time you can make changes to your Charitable donations through United Way, change your plans for Profit sharing, join a credit union and switch to direct deposit. It is advised to read over the literature, make phone calls, discuss with family members and choose the best Benefit Plan for your future health needs.
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