The Cost of Health Care

Posted on by Diane in index | Leave a comment

I am not sure if the general public understands the administrative nightmare involved in getting paid for services rendered by health care professionals.
I just spent over an hour on the phone with a health insurance company, attempting to get paid for services rendered to a client. After being transferred five times, and sitting on hold for over an hour, I hung up in frustration.
Part of the reason why health care costs are so high in this country is because of the incompetence and arrogance of health insurance companies, who put roadblocks in place so that clinicians are not paid. Clinicians must then pass the administrative cost of phone calls, paperwork, and follow up onto the consumer.
This problem is not because of Obama Care, as health insurance companies want the consumer to believe. This is pure and simple greed.
I would encourage all consumers to write to their state legislators regarding quick, easy, and streamlined payment of health care claims by insurance companies. The current system was put into place to ensure checks and balances; the result has been increased costs to the point where many clinicians are simply giving up and changing careers or not accepting insurance at all.

New Parents Support Group Starting

Posted on by Diane in index | 1 Comment

Therapy at Work LLC is resurrecting its Parents of Teens Support Group, which will meet the second Monday of each month from 7 to 8 p.m. at 496 US Highway 22 West, Lebanon NJ 08833. To register, call 908-809-3721.
The group will meet on the following dates: November 10, 2014, December 8, 2014, and January 12, 2015 from 7 to 8 p.m. The group will be limited to 15 people, and will be facilitated by Diane Kolodzinski, LPC, a licensed mental health professional, who has worked with adolescents, parents, and families for more than eight years.
This will be an open group; members can bring topics for discussion. Suggested topics include: communication, rebellion, adolescent brain development, addiction issues, academic struggles, sexuality, pregnancy prevention, conflict resolution. Special consideration will be made for parents of teens with mental health issues, adopted children, and developmental delays.
Cost for the group is $30 per session; $45 for a couple who attends together on the same night. All major credit cards accepted.
Please register in advance, and pass the word!

A Tribute to Robin Williams

Posted on by Diane in Adult Therapy, Counseling, index, Mental Health | Leave a comment

Countless touching comments, stories, and memories of Robin Williams have been shared this week, and I feel compelled to write as well on a topic many struggle to discuss: suicide. I have personally been touched by three individuals I knew well who committed suicide, and in my practice treat individuals with suicidal thoughts; and family members who have been impacted by a loved one’s taking his or her own life, or attempting to. The aftermath is devastating and long-lasting.

Clinicians actively assess suicide from three distinct viewpoints: 1 — thoughts, which are more common than one would expect. 2 — a plan; does the person have a specific plan, and the means to carry out that plan? and finally 3 — intent. Does this person really intend to hurt themselves? A trained mental health professional knows the difference between suicidal thoughts (also called suicidal ideation); a thought with a plan, and a thought with intent, and a plan. Any thought to harm one’s self should be taken VERY seriously, with discussion about in-patient treatment.

Good, effective treatment for depression is available! Consult your primary care physician, your insurance company, mental health professionals in your area, on-line and community resources. Loved ones: you may have to help facilitate treatment for your family member or friend if he or she is deeply depressed; typically that person may not have the motivation or energy to navigate the often complicated mental health system.

The old adage that if a person mentions suicide, it is unlikely that they will actually commit the act is ABSOLUTELY WRONG! Any mention of suicide should be taken seriously, and dealt with immediately. Suicidal thoughts are an indication that depression may be moving from moderate to severe in intensity. Seek help right away.

Finally, for those of you who have lost a loved one, my heart weeps for you. Not only is there the loss of your loved one, but the thought that perhaps something more could have been done; perhaps a sign was missed, and opportunity not seen. My only thought is that perhaps the pain of this life is too much for some people; especially those who care and feel deeply. And that the soul is finally at peace.

And for Robin Williams: Nanu Nanu.

The Latest Statistics — Who is Normal?

Posted on by Diane in Counseling, index, Mental Health | Comments Off

According to the National Institute of Mental Health, 18 percent of the US population suffers from some kind of anxiety disorder, and additionally:

6 percent have Major Depression

2.6 percent have been diagnosed with Bipolar Disorder

1 percent Schizophrenia

On top of that, 4 percent of adults have ADHD; and 9 percent have some diagnosable personality disorder, such as Borderline Personality Disorder (often linked to trauma), Narcissistic Personality Disorder or Anti-Social Personality Disorder.

All that adds up to 40.6 percent of the US population.

There’s more. The Center for Disease Control estimates that 5 percent of the US population drinks heavily (that’s 15+ drinks per week for men, and 8+ drinks per week for women). 17 percent of the population binge drinks, 9.2 percent of the population uses some type of illicit drug, and 2.6 percent abuse psychotropic medications. If we add that to the 40.6 percent, it totals 74.4 percent.

These statistics do not include all the other categories of mental health diagnoses, including learning disabilities, pervasive developmental disorders (such as Autism), tic disorders, dissociative disorder, sleep disorders, sexual functioning disorders, neurocognitive disorders (such as dementia), paraphilic disorders, gambling, and eating disorders.

Now, it is common for individuals who suffer from mental illness to have what is called a “co-occurring disorder,” such as depression and anxiety, or anxiety with substance abuse. So, there is certainly some overlap in these statistics. However, these statistics are still staggering!

Let’s say that 25 percent of people with a mental health diagnosis also use substances to self medicate. That still leaves 66 percent of the US population with some kind of mental health or major substance abuse issue. That’s two out of three people. Could this be true?

MORE ON MENTAL  HEALTH STATISTICS TO FOLLOW!

 

 

 

DEALING WITH ADOLESCENTS

Posted on by Diane in Adolescent Therapy, index, Mental Health | 1 Comment

The teen years can be turbulent for both the teen and his or her parents. You will survive! Remember: we all went through this stressful and often confusing period, but we all came out the other side.

The transition from childhood to adulthood starts for many at age 12 and can continue on through 19, 20, even up to age 25, when research shows the brain’s executive functioning is mostly fully developed. Until then, teens are struggling with separating from their parents or caretakers, developing their own individual identity, finding their place among peers, and exploring long-term goals and career paths. To add to the stress are hormones, opportunities and pressure to use alcohol and drugs, sexual identity issues, struggles to control impulses, and a media that promotes sex, violence, drugs, and angry outbursts as “normal.”

What’s a parent to do? How can we navigate this period with ease and grace? Here are some tips:

– Remember — it is not about you! Try not to take what your teens says or does personally. It is about them — their stress, their development; not you or your parenting skills. Often teens act respectfully to teachers and their friends’ parents, then decompensate at home and act out. This is normal.

– Take care of yourself. While you are working, running your teen to soccer practice, and band, and dance, and looking at colleges, and worrying about them driving, remember to take good care of yourself and, if you are in a relationship — your spouse or significant other. After the teen years are over and your children are grown and launched successfully, there will only be you — and perhaps you and your mate. Nurture your soul, and your relationship.

– Stay firm yet calm. Yelling, threatening, punishing, and losing control will only escalate a situation and promote the same behavior in your teen. In all situations, stay calm. Where you once gave your child a “time out,” now, take one yourself. Breath, go for a walk, call a friend, then return to a situation when you are calm and can think more rationally.

– Know this period is a phase and will end!

STAY TUNED FOR MORE TIPS ON PARENTING WITH GRACE!

ODE TO THE SNOW SHOVEL

Posted on by Diane in index | Comments Off

The Northeast US was plummeted with 10+ inches of the white fluffy stuff yesterday, shutting down roads, businesses and schools. Rather than take on all 10 includes at once, I decided to shovel 3 to 4 inches at a time, getting several bouts of fresh air, exercise, and winter at its finest!

A snow shovel is a unique and special tool. Mine is old and flat and bent and metal, making a raw, scraping sound as it hits the pavement. Several people have recommended I purchase a new one, but I am holding onto that shovel with a vengeance, as it holds many years of memories. The air is fresh and crisp; a light snow is still falling. My neighbor is out, too, hidden under layers of bulky gear, and we comment on how Mother Nature has hit us hard this year, trying to recall whether this was our third or fourth snowfall. Getting back to normal meant brushing off cars with brooms, arming ourselves with our personal shovel, and battling the elements.

But wait! Our light conversation and the sweet sounds and smells of winter are interrupted! A neighbor down the way has started his muscle machine: THE DREADED SNOW BLOWER! It is loud and imposing, and we are now greeted with the putrid smell of exhaust fumes, six houses down wind.

Am I the only soul who longs for a simpler time, when all the neighbors were out with shovels, scraping the pavement, and lamenting about the power of nature. I recall the fruits of our labor being rewarded when someone would invite the rest of us in for a  cup of hot cocoa or tea, and we would chat about current events or work or children or school or life?

Thinking of this, I finished the last bit of my driveway, the part where the professional plows skate by and heap the snow from the road onto the base of everyone’s driveway, creating the most daunting final task. Just about ready to retire inside, my neighbor popped her head around a mound of snow: “Am I the only person who hates snow blowers? They give me a headache!”

I smiled, and chuckled and nodded. “I agree,” I said, then invited my neighbor inside for a cup of hot cocoa!

 

 

What to Ask your Doctor

Posted on by Diane in Health, index | 1 Comment

Traditionally, a person would not walk into a doctor’s office and ask how much this service or that service costs. Health care is unique, in that there are no price tags on services, no prices posted when you walk through the door. How much is that immunization shot? How much will that blood test cost me? How much is that MRI?

As transperancy becomes more of an issue in health care, it is important for consumers of health care services to ask about price. Afterall, a physician states that it is your responsibility to know what your insurance plan does and does not cover. Do you not have the right to know how much a procedure will cost prior to agreeing to accept that procedure?

I’m not suggesting that if you are in the hostpial, you would ask what every procedure or pill costs before you accept it. But, perhaps that is the wave of the future.

I went to the gynocologist recently and was handed a cup by the receptionist, who pointed me to the restroom. “Why do you need a urine sample?” I asked. The receptionist said it was “standard procedure;” every patient is asked to provide a sample. I had just had a urine test at another doctor recently; why did I need another, and how much would it cost? When I asked if the sample was absolutely necessary, and if I did choose to participate, how much would it cost, the receptionist called in the office manager to speak with me.

A good policy is to ask when you set up the appointment what will happen at the visit. Will a urine sample be required? Are you or your child due for any immunizations; if so, which? What blood work might be taken? You may need to speak with a nurse on staff, as the person setting the appointment may not have this information. You may also need to return to the doctor, if he or she recommends a procedure or test, and you do not know if it is covered  by your insurance company. I have called insurance companies while in a doctor’s office to see what is and is not covered.

It may be helpful to follow up with your insurance company prior to the visit. You might say, “My physician is telling me that an annual blood test is standard procedure. Is that covered under my plan?” Or, “My physician is recommending a specific immunization for my child, what would my cost be for that?”

Check every time, as plans and coverages change frequently. Some insurance companies, for example, are only covering pap swears every two years now. Your physician may recommend it annually; he or she may just go ahead and do the procedure. If it is not covered and your physician recommends it annually, you might wish to have a conversation with your doctor: “I called and my insurance will not pay for that procedure. How much do you charge for that?”

Asking initiative questions up front, checking with your insurance company in advance, and questioning your health care provider about costs may turn some heads, but it will make you a more informed consumer in the long run. It may even become standard one day soon!

 

Understanding Your Health Insurance

Posted on by admin in Blog, Health, Health Insurance, Mental Health, Uncategorized | Leave a comment

Understanding Your Health Insurance

Undoubtedly, you have entered a physician’s office and read a sign stating: “Knowing your health insurance policy is your responsibility. Any unpaid balance or non-covered charges will be billed to you!”

But, who’s to know what is covered and what is not? How much does insurance pay, and how much will you be expected to pay? What is the bottom line bill going to be?

Here are some keys terms you should know related to health insurance:

– Deductible. The deductible is the amount you are required to pay before your benefits kick in. If your deductible is $1,000, that means you have to pay $1,000 out of pocket before your benefits apply. This amount need to be paid regardless of whether you are using an in-network or out-of-network medical professional. Co-pays are not included in the deductible.

– Allowable rate. This is the amount your physician is allowed to charge for services, based on his or her contract with the insurance company. For instance, a health care professional might typically bill $300 per hour for a particular service. However, when he or she contracted to be “in network” with a particular insurance company, he or she might have agreed to accept only $150 for the same service. This is called the “allowable rate;” it is the amount the health care provider is allowed to charge you because you are using an in-network health professional.

This is also the amount the health care professional should be charging you if you have a deductible to meet before your benefits kick in. You might want to ask your health care professional the “allowable rate” for services you receive. This rate is going to differ substantially depending on the physician’s contract with insurance companies. With one insurance company, the service may cost $100, and with another $120. This is a private contract between the physician and the insurance company, which is why allowable rates vary.

– Co-pay. This is the amount you will pay per visit to your primary care physician, gynocologist, mental health professional, specialist, etc. There is typically a different co-pay for primary care physicians and for specialists. If you go to a specialist, the co-pay may be higher. Co-pays can vary from $10 to $50 or more per visit.

– Co-insurance. This is the amount you are responsible for when you finally get a bill and once your deductible is satisfied, in addition to your co-pay. Sometimes the co-insurance is 10% of the ALLOWABLE rate, sometimes 30%, sometimes 40%. The Affordable Care Act has termed plans “Platinum, Gold, Silver, and Bronze” as a way to determine the co-insurance amounts easily. Platinum plans pay 90%; your contribution is 10%. Gold plans pay 80%, Silver plans 70% and Bronze plans 60%.

Next: Tips on what to ask your health care professional regarding insurance.