2015 Medicare- Know the Benefits You’re Entitled to at the Best Price!

This is a guest post written by Amy Bigelow.

Medicare’s Open-Enrollment Period Runs from Oct. 15 through Dec. 7, 2014

MedicareDuring this time, beneficiaries can make changes to their Medicare and Medicare Advantage plans. It’s time to enroll in Part A (hospital), Part B (medical) insurance and additional coverage including Part C or Part D. In the Medicare Advantage plans (Part C), seniors receive Medicare benefits through private health plans they have opted for. At the same time, beneficiaries can also select or change their Medicare Part D drug plans. According to The Kaiser Family Foundation, a nonprofit that specializes in health-policy analysis, many Medicare enrollees just reinstate their current plans without looking at the new premiums or added benefits of newly available plans.

Seniors:  Are You Selecting Your 2015 Medicare Benefits?

There are a few significant changes that may benefit you—if you know about them first! I just helped my 71-year-old mother enroll and I am saving her $1,000 in 2015 (between her deductible, premium and prescription co-pays). AND- we figured out that all of her specialists are in-network, so she will be getting the same quality healthcare she has now.  Even more, we had a Humana representative come to her home for a brief overview- who told her about the OTC (over-the-counter) medication program she’s had access to for years and never utilized. Crazy! It’s so important to stay in the know—otherwise you are probably losing money!

Beneficial Changes in Medicare Advantage Plans and Part D (Rx) Plans

In a recent article about Medicare improvements for 2015, a spokesperson stated, “Medicare wants everyone to know that quality continues to improve in both the Medicare Advantage and the Part D prescription drug programs.” This year, people with Medicare who choose to enroll in a Medicare Advantage or prescription drug plan have access to more high-rated, four- and five-star plans than ever before. Approximately 60% of Medicare Advantage enrollees are in a Medicare Advantage plan that earned four or five stars in 2015, compared to an estimated 17% back in 2009. This is good news. Plans that are rated higher deliver a high level of care, such as improving the coordination of care, managing diabetes or other chronic conditions, screening for and preventing illnesses, and getting much-needed access to prescription drugs.

A Little Knowledge Can Save a Lot of Money

As far as my mother’s consultation, she discovered that the Humana Gold Plus HMO plan is going to save her a bundle: $0 prescription drug deductible instead of $320; $78 monthly premium instead of $117; $5 co-pay for doctor visits instead of $20; and $15 co-pay for a specialist visit instead of $30. The thing is- this Medicare Advantage Plan is new for 2015. If she would’ve just ignored the 2015 Medicare handbook and re-enrolled with the same plan as last year, she would’ve overspent by over $1,000 this year! The OTC medication plan offered to every Humana beneficiary? Up to $50 in brand name medications per month delivered to your door. This includes pain relievers, allergy relief, indigestion relief, sleep aids, first aid creams and ointments, bandages, the list goes on and on. She never even knew about this benefit! Now, she has her OTC medication catalog and can stop shelling out money at the drug store. I’m jealous! I guess aging has its benefits, right? I’m actually looking forward to Medicare at this point.

Conclusion? Take the time to investigate the plans available to you. You know best which benefits you will utilize and how much coverage you really need. The goal should be select coverage that will maximize necessary benefits while keeping out of pocket costs down.

If you are enrolling in Medicare 2015 and have questions, be sure to visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227).

Reference: http://www.nj.com/opinion/index.ssf/2014/11/opinion_medicare_open_enrollment_brings_improved_plans_steady_rates.html

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Monitoring your Medication Prescriptions – My Ongoing RANT

Donna_smiling_officeWell, periodically I get on my prescription medication rant and your role in making sure your prescriptions are correct. So,  here I go again… I recently went to a client’s home and reviewed their medications.  I noted there was a new doctor and a new pharmacy. I noted that one of the medications was changed from a PRN or “as needed medication” to being scheduled around the clock.  The client did not notice the change, but was following instructions on the newly labeled prescription.

I called the pharmacist and he confirmed that the prescription they had on file was in fact now scheduled around the clock.  The client had denied any symptoms that would have required this.  I called the new doctor’s office who wrote the prescription– and in fact, the prescription had been written wrong.  They called the pharmacy and corrected it.  The client brought the prescription to the pharmacist to have it filled and labeled correctly.

Doctors are human and very busy.  No matter how tedious it seems, check your prescription labels carefully when they are picked up at the pharmacy.  If they have changed from your last prescription (even the color of the pill) or do not indicate instructions given by your doctor, please follow up.  Check with the pharmacist to see what order they have on file. If it is not what you are expecting, ask if they can call the doctor to clarify. Or better yet– call the doctor yourself to get it clarified. That is my rant…until next time!

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Word to the Wise: Be Aware of Tick- and Mosquito-borne Diseases

avoid vector-borne diseaseMid-summer is upon us and it’s time to enjoy the great outdoors! However, trekking through woods and trail does come with a caveat. This is also the time of year we have to worry about vector-borne diseases. A “vector-borne disease” is an illness transmitted to people by very unpopular blood-sucking insects. Disease carriers are the “vectors:” usually mosquitoes and ticks. Mosquitoes carry the infectious material that causes malaria and West Nile virus. And ticks are the culprits that transmit Lyme disease. Both summer and Fall are high tick season. And while the most famous tick-borne disease is Lyme disease, Rocky Mountain spotted fever and Anaplasmosis are other diseases carried and transmitted by ticks.

Professor of medicine and infectious disease, David Calfee explains, “Lyme disease is a summertime problem, with its peak in July and August. So when people spend the most time outside, ticks are the most active.” Ticks are mostly found in wooded and grassy areas, so you need to be watchful about your exposure. Ticks are very small arachnids that look similar to mites and can attach themselves to a mammal’s skin. Not only should people be cautious when it comes to tick exposure, it is important to protect dogs from tick bites, too!

Symptoms of Lyme Disease

When a person contracts an illness from a tick bite, the initial symptoms are nonspecific—making it somewhat difficult to diagnose. Calfee says, “The most common symptoms are fever, headache, fatigue, and muscle or joint pain.” However, the early stage of Lyme disease has a characteristic skin rash that can help people identify it. People often develop a ‘bull’s-eye’ mark where the bite occurred. It may enlarge over time, and the perimeter of the bull’s-eye stays red while the center tends to turn back to normal flesh color. Rocky Mountain spotted fever also has a characteristic rash of small spots. Awareness of these symptoms is helpful for identifying the ailment and seeking treatment.

How to Avoid Lyme Disease

The key to fighting a tick-borne disease, such as Lyme disease is avoidance and awareness. For Lyme disease, the tick has to be attached for more than 24 hours in order to transmit the disease. It is essential to use insect repellent! Repellents containing DEET are the most successful for preventing tick bites. People need to perform a full-body tick check any time they have been exposed to the elements. If you do find a tick, carefully remove it with tweezers, and be sure to remove the entire insect. Then clean the area with either rubbing alcohol or soap and water. Antibiotics are used to treat patients who contract Lyme disease; if left untreated, the infection can cause arthritis or other problems.

Protect Your Dogs from Ticks

For those of you who know me well, you know that I am a dog lover! I have 4 dogs of my own who love to be outdoors. Since there are wooded areas near our home and on trails we take the dogs, we always check the dogs for ticks when we come home. Ticks attach themselves to dogs—typically in the head, neck, feet and ear area. If you see a tick, try to remove it immediately—but there is a correct way to do it! You don’t want the tick’s blood to come in contact with your dog. First, prep the area with rubbing alcohol. Then, pluck the parasite with tweezers, making sure you get the entire tick out. Since you want to make sure no disease was transmitted, it is best for your dog to be evaluated by a veterinarian.

Safe Insect Repellents for Dogs

Do not use insect repellent designed for humans on dogs. DEET is toxic when ingested by animals—and dogs tend to lick things off. It’s important to get a repellent specially formulated for dogs. Products like K9 Advantix II will repel mosquitoes, fleas, ticks, and flies for up to 30 days. Ask your veterinarian which repellent they recommend for your dog. That way, both you and your pets can be protected!

Reference: http://www.nydailynews.com/life-style/health/vigilance-best-summertime-defense-lyme-disease-carrying-ticks-article-1.425900#ixzz37reWTjLs

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Be Careful when Taking Acetaminophen!

tylenol-boxesFor years, acetaminophen has been widely used and considered safe for lowering fever and relieving aches and pains. Advertised as the pain reliever most recommended by doctors, Tylenol is typically found in every medicine cabinet. However, people need to be aware of the serious risks associated with taking too much acetaminophen (which is the active ingredient in Tylenol). Recent FDA warnings have been published in an attempt to cut down on incidences of potentially fatal liver damage associated with acetaminophen. In January of this year, the Food and Drug Administration (FDA) urged healthcare providers to stop prescribing combination drugs products that contain more than 325 mg of acetaminophen, due to the potential for serious liver damage.

What is a Combination Drug Product?

Examples of a combination drugs include prescription medications that contain acetaminophen. Incidentally, acetaminophen is used in several pain medications with opioids. This includes oxycodone (Percocet), hydrocodone (Vicodin) and acetometophin and hydrocodone (Norco). Several of my clients were totally unaware that Percocet and Vicodin  and Norco contain acetaminophen. When these same people take over-the-counter (OTC) cold medicine or Tylenol PM, they are very likely taking an overdose of acetaminophen. Because of drugs like Percocet, the Food and Drug Administration is asking doctors to stop prescribing those that have more than 325 mg of acetaminophen per dose. FDA spokesman Eric Pahon points out, “By limiting the maximum amount of acetaminophen in prescription products to 325 mg per tablet, capsule, or other dosage unit, consumers will be less likely to overdose on acetaminophen if they mistakenly take too many doses of acetaminophen-containing products.”

So, the overall problem is that numerous OTC medicines and prescription painkillers contain acetaminophen in varying strengths. According to statistics, 7 in 10 Americans use OTC medicines to treat cold, cough and flu symptoms—not to mention using them as sleep aids. DayQuil, Tylenol Cold and Flu, Tylenol PM and other multi-purpose cold remedies are on every store shelf. People who are looking for relief from a cold or the flu may not know that acetaminophen comes in combination with these other medications. The FDA got involved because there are more than 600 medicines on the market that contain this popular and powerful painkiller, and it is the leading cause of acute liver failure in the U.S.

Acute Liver Failure, Skin Rashes Caused by Acetaminophen Overdose

According to the FDA, “your risk of liver damage goes up if you take a medicine that contains acetaminophen to treat a headache—and while that medicine is still active, you take another medicine that contains acetaminophen to treat a cold.” Currently, the safe 24-hour dose limit of acetaminophen is set at 4,000 mg (for adults), but some experts say that it should only be 3,250 per day. Doctors may prescribe extra strength doses of painkillers containing acetaminophen, yet some consumers still reach for over-the-counter remedies. Doses of acetaminophen can contain as much as 1,000 mg, so it can be easy to over-shoot the 4,000 mg mark.

Bottom line: If you’re taking more than one medicine at a time, you may be inadvertently putting yourself at risk for liver damage due to overusing acetaminophen. Tylenol and other acetaminophen-containing combination drugs kill hundreds of people and send about 56,000 more to the hospital.

Skin Rashes Also Associated with too much Acetaminophen

As it turns out, liver damage isn’t the only side effect from taking too much acetaminophen. The FDA warns that acetaminophen may also be linked to rare but serious skin reactions.The FDA says anyone taking acetaminophen that develops a rash or other skin reaction should stop taking the product immediately and seek medical attention right away.

Dr. Sharon Hertz, a spokesperson for the FDA says: “This new information is not intended to worry consumers or health care professionals, nor is it meant to encourage them to choose other medications.” Because this warning is new, labels on some products bought over the counter will presently make no mention of the serious potential adverse skin effects of acetaminophen. The FDA is now working with pharmaceutical firms to update the labeling. Meanwhile, the regulator is already requiring that all prescriptions for the drug mention the new safety information.

Contact MVLNC for Help with Medication Safety

 As a Patient Healthcare Advocate, I review all of my client’s prescriptions and daily medication routines. I can answer questions about drug interactions, dosage information and safety when using prescription or over-the-counter medication. If you or a loved one has questions or needs help with medication, feel free to contact me via email or telephone!




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Important Advice for Anyone who Takes 2 or More Medications

Medicine**This article is part of my special series about prescription safety. If you or a loved one is currently taking doctor-prescribed medications, it is important that you understand the risks and precautions associated with them.

Prescription medications can substantially improve a patient’s medical condition and improve quality of life. However, taking multiple prescriptions is nothing to take lightly and should be regularly examined. In the past two articles, I talked about medication dispensing errors (which can occur at the doctor’s office or pharmacy) and inadvertent duplication of medication (are you taking too many?) Now, I would like to consult you about how to avoid drug interactions.

Adverse drug interactions can occur when medications are being taken simultaneously or when a patient is also taking herbal supplements or over-the-counter medications. The risk of adverse drug interactions increases with each medication prescribed. According to statistics, the risk of adverse events increased 13 percent with two medications, 58 percent with five medications, and 82 percent with seven medications. 2.8 billion out-patient prescriptions are filled each year.  That’s 10 prescriptions for every person in the U.S. Drug interactions are also more common when a person sees different doctors or uses more than one pharmacy.

Polypharmacy is the technical name for the problems that can occur when a patient is taking more medications than are needed. More specifically, it is often defined as the use of five or more regular medications.  Polypharmacy is often a problem in older adults (those aged over 65 years). What types of negative interactions can occur?

Drug-Drug Interactions: Now a Major Public Health Problem

When speaking about drug-drug interactions, we’re referring to any prescription or over-the-counter (OTC) medication, vitamin or herbal supplement.  Sometimes the effect of one or both of the medications will be increased; other times their effectiveness can decrease.  Examples of an adverse reaction include:  a dangerous drop or rise in blood pressure, irregular heartbeat, a buildup of toxins that are potentially damaging to the heart, liver or kidney.  More common symptoms of a drug-drug interaction include nausea, headache, heartburn or dizziness.  If you or a loved one experience any unusual reaction after taking a drug (prescription or otherwise), contact your physician immediately. Your pharmacist can also check possible interactions.

Statistics are Not Meant to Scare, But to Create Awareness…

This problem is more common in older patients because they are often dealing with multiple ailments. However, adverse drug interactions can occur at any age. Studies are beginning to show that your chances of experiencing an adverse drug reaction begin to increase even before the age of 50. Food and Drug Administration (FDA) reports of deaths or hospitalizations from adverse drug reactions reveal that at least half of the patients were younger than 60. The assumption is that by the age of 50, the amount of medication prescribed starts to increase; therefore the odds of having an adverse drug interaction also increases. The risk of an adverse drug reaction is about 33% higher in people aged 50 to 59 than it is in people aged 40 to 49. A recent analysis of patient hospitalizations determined that approximately 1.5 million hospitalizations a year were caused by adverse drug reactions. So, we’ve identified a problem—now, what’s the solution?

How to Prevent Adverse Drug Interactions:

  • Discuss your medication list with your doctor and every other healthcare provider you see. Be sure to include herbal supplements, vitamins and other over-the-counter medications you take regularly.
  • Consider using just one pharmacy! (We’ve discussed this in other blog posts) They can serve as the gatekeeper in ensuring that it is safe to use all of your medications together.
  • Make sure your pharmacist includes the drug information sheet with each prescription and read it carefully.  Look for possible interactions with prescriptions you’re already taking.
  • If you are taking multiple medications, always carry a list of your Rx’s on your person! If you experience any strange symptoms, you can inform a doctor or seek immediate help.

Please contact MVLNC if you have questions or comments about this topic. We would love to hear from you!

References:  Worst Pills, Best Pills “Adverse Drug Reactions: How Serious is the Problem and Why does it Occur?”

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Are You Taking too Much of the Same Medication? Top 10 Tips to Avoid Duplication

Medicine bottlesIn a previous post, I talked about making sure you get the correct prescriptions filled. Medication errors can range from a doctor prescribing the wrong medicine to a pharmacy filling the wrong prescription.  Now, I would like to spend a few minutes explaining the importance of not taking (or being prescribed) duplicate medications.  At first, this doesn’t seem like it would be a widespread problem—but in actuality, duplicate medication consumption is fairly common.

Here is a common scenario:  when a patient sees two or more doctors, both doctors may prescribe medication that treats the same condition.  If each of these doctors thinks they are the only provider treating the condition, this can result in the patient double dosing.  The brand name of these medications may be different, but they both contain the same active ingredients.  Anybody who is seeing multiple doctors or using more than one pharmacy is at risk for medication duplication. Recently, I identified a duplication situation in one of my patients who lives in a group home. This patient was getting duplicate medications filled because they were being prescribed by more than one physician.

There can be negative side effects from taking duplicate medications.  For example, if you are regularly taking 2 medications that contain acetaminophen (Tylenol), it can be harmful to your liver.  On a positive note, it is easy to make sure you or a loved one is not double dosing.

Here are 10 tips for everyone to follow when it comes to medication safety:

  1. Keep an up-to-date a list of your medications; include dose and frequency:
  2. Keep a copy of your medication list with you at all times. If you use a smart phone or tablet – email it to yourself and put the email in an easy-to-find folder, so you can access it at any time.
  3. By all means, always use the same pharmacy! This allows the pharmacist to check for duplications or drug interactions.
  4. Make sure your physician sees your medication list with every visit. It is best to have one main doctor that coordinates your care. This doctor can keep track of the medications prescribed by other doctors or specialists.
  5. Make sure to share this list with every physician you see.  You should bring it with every visit – do not assume that your most recent copy is in the chart.
  6. When your physician prescribes a medication, ask him/her what it is for. Write it down next to the Rx on your list.
  7. If you see a duplicate medication or one that is supposed to treat the same thing – ASK your physician if he meant to order it.  Your pharmacist can also help with this.
  8. Review all medications with your primary physician at least once a year.
  9. Ask the pharmacist to run your medication list through a drug interactions database to identify potential problems, especially if you’re taking five or more drugs.
  10. Learn about your medications from your physician or pharmacist or nurse. The internet is not always 100% accurate.

We will be expanding pharmaceutical topics in upcoming blog posts, as well as polypharmacy. Please contact MVLNC if you have concerns or comments about this topic. We would love to hear from you!


“Navigating Your Way Through Our Healthcare System.”

Posted in Clinical Corner, General, Patient Advocacy, Private Healthcare Advocate, Public Health Concerns, Senior Care Management, Uncategorized | Leave a comment

Your Health Insurance Claim – DENIED!!!

Have you ever received a denial letter regarding your health insurance coverage?  Do you know of someone who has?  Unfortunately this happens more than I would like to see. 


 A couple of reasons for denial of your healthcare insurance claim are:

  • Documentation did not support the diagnosis or the treatment billing
  • Diagnosis is not covered under your insurance policy – The Exclusions

I should note this is not an exhaustive list. This second one is interesting.  Most of us do not read the exclusions in our insurance policies.  When we sign up we make sure that what is important to us at the time is included in the policy.

One of the most common problems I notice in my Patient Healthcare Advocate work is that a diagnosis  written down on the medical record  without the supporting diagnostic tests or assessments.  The insurance company reads the diagnosis and determines your coverage for that claim is  “DENIED based on Exclusion # ….. of your policy.”

Sometimes these situations have relatively easy solutions such as a letter to the insurance provider accurately pointing out the disconnect in the medical record for the diagnosis.

For the sake of simplicity I will use one of the more common denials.  Some insurance companies deny claims if they believe someone is alcohol or drug intoxicated. The Physician, Physician Assistant, or Nurse Practitioner, might write a diagnosis that says: “ETOH intoxication.” If this were the case you would expect an alcohol blood screen order and result on your medical record.  However often I see the diagnosis without the blood test.  Here is your disconnect. The insurance company reviewer simply saw the diagnosis but did not review for supporting data. The reviewer write “DENIED based on Exclusion …. “.

“Connecting the dots”, as I call it, to show the insurance company that there was no testing done to support the diagnosis is a key step to getting insurance to cover the bill.

I am sure you know what your health insurance policy covers. Do you know what the exclusions are in your healthcare insurance policy?

More on this topic another day.

Have an awesome day!


“Navigating Your Way Through Our Healthcare System.”

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