Health Insurance Explained In Plain English

Understanding health insurance and the health industry is much easier if you recognize some of the basic terminology and how it applies to you and your health insurance policy. If you have a health insurance plan and aren’t sure how it works or what the terminology means, take a few minutes to read the explanations below. Knowing these terms and what they mean to you can greatly aid you in dealing with your health care providers, insurance company, insurance agent, or during the health benefits shopping process.

Benefit Year
This is the 12-month period in which your benefits are calculated. Most insurance companies use a CALENDAR year, which is January 1 to December 31, but a few will use a 12 month period from when your policy goes into effect. For example, if your insurance goes into effect on June 1, the END of your benefit year is May 31. Make sure that you understand how your benefit year will be calculated.

Deductible
Deductible means the amount of money you must pay out of your pocket for medical expenses EACH YEAR before your health insurance begins paying out. Deductibles are usually reset to 0 at the beginning of each calendar or benefit year. Many insurance companies offer health plans that have benefits that are not subject to having to meet your deductible each year such as doctors office visits, immunizations, wellness or routine exams, etc. An easy way to remember what this term means and how it works is this:

When you have incurred medical expenses, all bills must be sent to the insurance company. When the insurance company looks at your bills, they then look at your policy and see how things are covered. They will then add up what the combined medical expenses have been for the year to date: determine what your deductible is and how much you have already paid towards meeting your deductible for the year, and pay out according to how your insurance policy says it will.

So in a nutshell, the insurance company is “deducting” your financial responsibility for medical expenses each year from the total combined medical expenses before they have any responsibility to pay out…hence the term “deductible”.

Co-Pay
A co-pay is an amount that is paid by the patient to a provider at the time of service. It will either be a flat fee (like $15 or $20) or it can be a percentage of the service provided. The percentages or fee may vary depending on the type of service provided. A co-pay is different than “coinsurance” – see next.

Coinsurance
Coinsurance is the percentage paid by the insurance company after you pay the deductible. Example: Your health insurance pays 70%, you pay 30%. The insurance company pays 70% coinsurance, you pay 30% coinsurance. Most health insurance policies will have a limit on the amount of coinsurance you have to pay out each year this is known as your “Annual Coinsurance Maximum” or “Stop-loss”.

Annual Coinsurance Maximum
After paying your deductible and after paying your coinsurance (classically 20% or 30% of medical expenses) to a certain dollar amount, your health insurance will pay 100% for the remaining costs in the calendar year. Example: After you pay your deductible, your health insurance pays 70% of medical expenses and you pay 30%. Once you reach the coinsurance maximum, you no longer pay 30% of the medical expenses because the insurance pays 100%.

Out of Pocket Maximum or Stop Loss
Stop Loss is the maximum amount of money you will have to pay out of your pocket in the benefit year.

Lifetime Maximum
This is the limit of the money the health insurance will pay out over your lifetime. Most major medical health insurance policies will be a $2 million lifetime maximum, while others will go as high as a $12 million lifetime maximum. In general, it is not recommended to have a policy with less than a $2 million lifetime maximum.

Office Visits
When you visit a doctor in their office they normally bill the health insurance company for an “office visit.” Most health insurance plans pay office visit expenses at the coinsurance (generally 70% or 80%) after the deductible. Some health insurance plans pay office visit expenses at the coinsurance rate but waive the deductible, which means you don’t have to reach the deductible amount before they will cover their portion of the expense. Still other health insurance plans pay office visit expenses in full after a co-pay (usually $25 or $30). It should also be noted that office visits can be classified in two different categories. One category is usually called “Routine Care,” “Wellness visits” or “Preventative care” (see definition below). The other type of office visit is deemed as “Medically Necessary” (see definition below). Certain health insurance policies cover each of these types of visits differently and other plans do not cover them at all. If having these types of office visits covered by your health insurance policy is important to you, make sure you let your agent know so that they can help find the right plan for you.

Preventive Care
Preventive Care is classically defined as routine exams, immunizations, well child care, and cancer screenings. These include your yearly exams and checkups for things such as physicals, pap smears, mammograms, etc. Not all plans cover preventive care. It may not be a wise use of your money to have preventative care included in your plan if you never go to the doctor. A good health insurance agent can help you determine if this is necessary coverage for you.

Medically Necessary
These are the visits utilized for your smaller ailments such as colds, flu, ear infections or minor accidents. Not all plans cover ‘medically necessary’ visits, so make sure you know if your policy includes these exams if you need them covered. You may consider purchasing accident insurance or adding a rider (explained below) to your policy to cover these types of issues.

Diagnostic Lab and X-Ray
These are tests involving laboratory or imaging services (such as x-ray, CAT scan, etc.) to diagnose a health problem. These services are usually paid at the coinsurance (typically 70% or 80%) after the deductible.

Chiropractic Care
When you visit a chiropractor for spinal manipulation or other services, these expenses are customarily paid at the coinsurance rate (70% or 80%) either after the deductible is met, or by waiving the deductible. Most health insurance plans limit the number of chiropractic visits/services to 10 or 12 per year – especially if the deductible is waived. After this, additional visits are not paid by the health insurance plan, and you will be responsible for the full amount of the bill.

Inpatient or Outpatient Care
When you receive care from a hospital (inpatient or outpatient services), these expenses are customarily paid at the coinsurance rate (70% or 80%) after the deductible has been met.

Emergency Room
When you receive care from a hospital emergency room, these expenses are customarily paid at the coinsurance level (70% or 80%) after the deductible. Most health insurance plans also require you to pay an additional co-pay (commonly $75-$100) for each emergency room visit. A number of plans waive this additional co-pay if you are actually admitted to the hospital through the emergency room and the plan will pay as an inpatient service. A plan can sometimes be structured to have separate coverage for accidents as an additional rider (see definition below) to your policy.

Prescription Medications
Prescription medications can be classified as generic, brand name, or non-preferred brand name (see below for definitions). Please Note: Not all health insurance plans pay for prescription drugs, so if you already take prescription drugs or think you will need help in the future with prescription drugs, you will want to make sure that you are purchasing a plan that includes this coverage. Prescription drugs may be covered at the coinsurance rate (70-80%) after a deductible specifically for prescription drugs is met, other plans may include Prescription drugs in the total deductible for the plan.

Generic Medications
Drug manufacturers are permitted to sell a generic version of a medication after the patent expires for the brand name medication (generally 20 years after the brand name medication was registered). Generic medications are equivalent to the corresponding brand name medication, but are much less expensive than the brand name medication. Health insurance plans frequently provide better payment for generic medications as an incentive for you to ask for the generic version. About half of all prescription medications filled in the United States are filled with generic medications.

Brand Name Medications
Brand name medications are more expensive than generic medications. Most health insurance plans create a limited list of brand name medications that they will pay for and many health insurance plans also provide less coverage for brand name medications than for their generic counterparts.

Non-Preferred Brand Name Medications
Most health insurance plans create a limited list of brand name medications they will pay for. If your brand name medication is not on this list, it might be paid at a lower level under “Non-Preferred Brand Name Medications.”

Maternity
Some health insurance plans cover the cost of maternity, which includes doctor and hospital charges for prenatal care as well as labor and delivery. Maternity is expensive to add into a health insurance policy because it is considered a “guaranteed expense” for the insurance company. If a woman becomes pregnant, it is a safe bet that there is going to be medical expenses incurred! If there are no complications and the birth goes well, the insurance company will be out a large monetary portion of the cost of delivery and even more if there are problems with the delivery or the newborn. Insurance companies price maternity so that they can still maintain profits. In some cases it may be best to save your money and pay for the prenatal care and the delivery out of your own pocket (or on a credit card) and let the insurance cover the catastrophic events. The difference you save in the monthly cost of having maternity coverage may be well worth it to you. Remember, once you have a policy that covers maternity, you can’t just remove the maternity coverage after the pregnancy is done! You will continue to pay for that maternity coverage for as long as you have that policy.

Mammography
Mammography is a specific type of imaging that uses a low-dose x-ray system for the examination of breasts to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms. Current guidelines from the American Cancer Society (ACS), and the American Medical Association (AMA) recommend a screening mammography every year for women, beginning at age 40. Various plans will have automatic coverage for mammograms but some will not. Several states (like Washington State, for example) have specific guidelines that require companies to have coverage for mammograms in their policies as an automatic benefit.

Mental Health
Outpatient mental health services include visits to a licensed counselor, therapist, or psychiatrist. Inpatient mental health services include admission to a psychiatric hospital. Many plans do not cover mental health services.

Rehabilitation Therapy
Rehabilitation therapy may include physical therapy, occupational therapy, speech therapy, message therapy, cardiac rehabilitation, and chronic pain therapy. Most health insurance plans limit rehabilitation therapy to a certain number of visits per calendar year or to a certain dollar amount that they will pay for rehabilitation for either the year or for a lifetime.

Rider
Anything that changes the way your policy acts by default is called a “Rider”. A rider can be anything from an exclusion of coverage for a medical condition, or additional coverage for potential conditions. (As in an “accident rider” mentioned earlier in this report)

Occupational Coverage/On the job coverage
The largest portion of health insurance plans do not cover occupational related medical expenses. This can be a HUGE pitfall for self employed people. Always make sure that if you need to be covered while you are working that your plan will give you “on the job coverage”. If you get injured or sick while you are on the job and you do not have Workman’s Compensation or Labor and Industries accident coverage, you may have to pay for ALL medical expenses out of your own pocket.

Vision Coverage
Vision coverage is usually broken into two parts: vision exam, and vision hardware. Vision exam benefits include the cost of a refractive exam used to test vision acuity (20/20, 20/40, etc.). Vision hardware represents the cost of eye glasses or contact lenses. A number of health insurance plans do not cover vision exams or hardware. However, medical issues relating to the health of the eye (like Glaucoma) are almost always covered under the regular medical portion of the health insurance plan.

Doctor Directory
Each insurance company will have a list of doctors that the company has negotiated terms for payment of services with. You can go to the insurance company’s website to find a listing of contracted “preferred providers”.

This information may help you understand a policy that you already have, or aid you in understanding a policy that you may be thinking about purchasing. The more knowledge you have about what the industry “jargon” means, the more you will be able to make informed decisions about the insurance you choose to use.

By: Shad Woodman

5 Incredible Facts About Medicine Of The Ancient Romes

In the ancient world, the Greeks and Romans were brothers. There was the obvious close proximity of the two countries. However, their relationship was deeper than that. In fact, their cultures were so closely linked that the Greeks and Romans shared gods with different names, but similar backgrounds! However, both groups maintained a unique history and culture. For instances, here are some of the highlights about ancient Roman medicine:

1. Doctors were vital to the Roman Empire

The Roman’s Empire’s public health system was actually quite broad. While doctors in ancient Rome could receive formal training, here are some other interesting facts about them:

• Anyone in ancient Rome could refer to himself or herself as a “doctor.”
• Doctors would often serve as surgeons in the Roman Empire’s army.
• Several female doctors existed.
• Women typically served the healthcare needs of other women.
• Doctors provided free healthcare services, to those living in impoverished towns.

2. Much of Roman medicine was Greek medicine

The Roman defeated the Greeks, in the former’s formation of the Roman Empire. Afterwards, Roman doctors then accepted many of the ideas that the Greeks had, concerning medicine. In fact, most of the doctors who were practicing in the Roman Empire–were Greek! Furthermore, the works of Hippocrates, the Greek “Father of Medicine,” served as the basis for numerous Roman doctors’ training.

3. The Romans focused on public health

Obviously, the Romans were unaware of bacteria, and the use of cheap urbane scrubs to reduce their transmission. However, the Romans placed an emphasis on public health. Improvement in personal hygiene would ultimately improve public health and reduce diseases’ occurrence.

4. Rome further developed the Greek’s theories about medicines

The Romans adhered to many of the beliefs of the Greeks, about maintaining the health of humans. For instance, they focused on the importance of cleanliness and exercise. This was due to the Romans’ borrowing theories from the Greek, Hippocrates. A second century AD Greek doctor, Galen, was instrumental in developing these theories. Galen further developed Hippocrates’ notion that human bodies contained four “humours.”

5. Galen influenced both Roman and European medicine

In addition to affecting Roman medicine, Galen also influenced European medicine for more than 15 centuries! His theories and practices focused on obtaining a balance of the four humours, which he believed were inside human bodies.

The Romans would obtain advice from their doctors, while also presenting offers to various Roman gods, such as the Roman goddess of safety–Salus. Interestingly, during the 3rd century BC, this god became linked to Hygieia–the Greek goddess related to healing. Furthermore, the Romans also used Temples of Asclepius, which had originated from the Greeks.

While the Romans were not as innovative as the Greeks were, in the study of medicine, the former certainly contributed to the development of Greek concepts related to medicine. Ultimately, the Romans improved humans’ overall understanding of hygiene and health, which is noteworthy. After conquering the Greeks, the Romans would contribute to humans’ epic war on bacteria!

Vitamins For Depression – It’s Time To Feel Better!

Few things adversely affect the quality of life like a struggle with depression. This I know all too well. I’ve been prescribed Paxil, Zoloft, Prozac, and Effexor. They helped a little, but left me more apathetic than anything.

I wasn’t a fan of the side effects, either. I experienced odd tingling sensations and unquenchable thirst. I believed that going the pharmaceutical route to relieve my anxiety and depression symptoms was merely trading one evil for another.

As I dove head-first into the world of nutrition and supplementation, the truth emerged before my eyes like a phoenix rising from the ashes. Depression, along with anxiety, is primarily caused by our brain’s inability to manufacture certain hormones and neurotransmitters like dopamine, serotonin, and melatonin.

Depression is also perpetuated by an inability of the brain to transform glucose (blood sugar) into fuel.

Your brain wants to do these things for you, but (if you’re suffering from depression) it can’t.

Why not?

One simple answer: Vitamin Deficiency

The biggest deficiency is that of the B-Complex vitamins. Deficiencies of vitamins B1 (thiamine), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), and B12 are the biggest offenders. Vitamins C and D will also contribute to depression, if not in ample supply.

A mineral deficiency also contributes in a big way. The biggest of these are:
Magnesium
Calcium
Zinc
Potassium
Maganese
Iron

So is it really that simple? All we have to do is provide our bodies with an abundance of these vitamins & minerals and our depression will suddenly vanish? We just eat the right foods, take the right supplements, and we’re cured, just like that?

To some degree, yes.

There are obviously psychological factors you will need to address. By no means am I qualified to give any psychological or psychiatric advice. I would encourage you to seek out some type of therapy or counseling from a mental health professional.

However, if you make a few dietary shifts and implement a consistent, effective supplementation regimen, you will, at the very least, notice some tremendous improvements in your overall outlook on life. You will feel more alive and vibrant than perhaps you ever have.

For starters, if you smoke or drink, try your very best to quit. At the very least, minimize your intake, if you feel you are able to do so. Nicotine, alcohol, refined sugar, and caffeine destroy B vitamins faster than anything. So the higher the degree to which you avoid ingesting these things, the better your results will be.

Next, supplement. Take an all natural, whole-food multivitamin. Make sure it’s plentiful in vitamins B, C, and D, as well as chelated versions of the minerals listed above. If it contains probiotics and nutritional enzymes, even better. This should fulfill your vitamin requirements for depression, but if you’d like additional B vitamin support, feel free to seek that out, as well.

I also very strongly encourage you to pick up a powerful, natural antioxidant formula. If one of its ingredients is the acai berry, it is a definite winner! This will do away with any free radicals that may be hanging around trying to compromise the effectiveness of your vitamin intake.

In addition, St. John’s Wort is an herbal supplement that is widely known to help with mood issues. I recommend taking it daily as an extra measure.

Make sure your supplements are, in fact, of the natural, whole-food variety. Synthetics suck! Avoid them. Get your vitamins at either your local health food store or online, from a company that deals exclusively with natural products.

Also, be sure to hydrate (4 to 6 liters of purified water daily), move your body in fun ways (dance, jump, skip, etc.), and SMILE! Think about all the great things in your life. If nothing seems great, imagine things being exactly the way you want them to be. How would that feel?

Again, I’m a nutrition consultant, not a mental health professional, so I won’t delve to deep into the mental aspects of depression. I can testify, however, with great confidence and enthusiasm, that the two worlds (mental and physical) do go hand in hand, and they have a significant effect on one another.

Bottom line, be good to yourself. Eat right, think sweet, play nice, love whole-heartedly, and for the sake of your health and sanity, take your vitamins! I assure you, if they’re the right kind, they will change your life!

My very best wishes for you. Thanks for reading.