Emergent vs. Urgent - Planning Ahead for the Minor Stuff

If your health plan is like most, it offers a persuasive disincentive to visit the emergency room when an urgent care center will do. This disincentive often takes the form of a higher 
co-payment for emergency care. (The 
co-payment is your share of the cost.) Moreover, if you go to an emergency room for an ailment that seems questionable as an “emergency”, the insurance company may deny the claim, leaving you on the hook for the entire bill.

PPACA (i.e., “Obamacare”) defines a medical emergency as symptoms which would cause a reasonable layperson to fear that an absence of immediate care could mean a loss of life, limb, or organ; or the loss of function in a limb or organ.

Generally speaking, emergency rooms are connected to hospitals. They are heavily staffed, expensively equipped, and never closed. Patients typically wait for hours to see a doctor. Emergency rooms treat major traumas, broken bones, heart attacks, uncontrollable bleeding, unconsciousness, and the like.

Urgent care centers, by contrast, are free-standing facilities, lightly staffed, less equipped, and open later than normal business hours (but not open all night). Patients typically wait a matter of minutes, not hours, to be see a physician’s assistant or nurse practitioner. Urgent care centers treat flu symptoms, fevers, chills, sprains, headaches, and the like.

One of the most common reasons policyholders go to the emergency room for symptoms that do not meet the PPACA criteria above is a lack of planning. Nevada Benefits recommends that you take a moment now, while you are well, to locate the urgent care centers nearest your home and place of employment; then make a note for future reference. Waiting until you are sick or injured before mapping your way to the nearest urgent care center will prove more difficult than doing so in advance of your actual need.

Of course, if you experience a medical emergency, then you should call 911 or go to the nearest emergency room. Otherwise, an urgent care center, if appropriate to the ailment, can save you money, time, and aggravation.   

Do not hesitate to contact us with any questions about the emergent and urgent care benefits under your plan.

Telehealth- what is it?

Virtual House Call

Telehealth is a word coined to describe a doctor-patient encounter mediated entirely by technology. In its simplest form, telehealth is your primary care doctor hearing your complaint, forming a diagnosis, and recommending an over-the-counter remedy, all in the course of a single phone call. You receive care without darkening your doctor’s door.

In its more evolved form, telehealth is a video link-up through a corporate vendor specializing in just such electronic encounters. Or instead of taking a half-day off work to drive across town and haunt your doctor’s waiting room, you simply use your smartphone to transmit to her office a photo of that mysterious rash.

With carriers like Anthem, Cigna, and UnitedHealth Group expanding their telehealth networks, and pharmacies like CVS, Rite Aid, and Walgreens investing in telehealth platforms, it’s safe to say that multimedia medicine is more than a trend; it’s an important solution to the problem of healthcare scarcity.

Dallas-based Teladoc is at the forefront of this technological movement. Teladoc’s physicians are available for consultation 24/7. Place a call to Teledoc and an experienced, state-licensed, board-certified physician will get back to you in minutes (16 minutes on average). This service is ideal for cold and flu symptoms, allergies, respiratory infections, urinary tract infections, ear infections, sinus disorders, and the like. Teledoc physicians can prescribe certain short-term prescriptions, such as antibiotics.

(Remember, however, that in the event of a medical or psychiatric emergency, you should always call 911. Telehealth is not for emergency treatment. Nor is it for chronic ailments or specialty care; although Teladoc can provide guidance as to whether you require a specialist.)

Perhaps best of all, expenses incurred through Teladoc qualify for reimbursement under your FSA, HSA, and HRA.

The expansion of consumer access to limited healthcare resources is among the great economic and social challenges of our time. Nevada Benefits supports and encourages the spirit of innovation embodied in the telehealth approach.  

Professionals are worse as predictions than the crowd

NPR put out a great podcast that describes a small sampling o how the crowd generally is good at averaging the right guess of what things really are. http://www.npr.org/sections/money/2015/08/07/430372183/episode-644-how-much-does-this-cow-weigh

This goes well with timing of the overall market. It is becoming widely accepted that most fund managers under perform the market almost 95%+ of the time. We all just assume this is the case because they have to charge fees for their services on top of matching the market, but it seems it might be a little more than that. So why do we need fund managers or professionals?

We can always just invest ourselves and try to take a jab at it. We would maybe fall short or maybe we will get lucky and pull ahead. We can also try and become experts, but then if we do we will probably be doomed to under perform just like other experts. I have quite a few clients who do their own investing and actually live off of their income from trading. I kind of put these clients in the same realm of my professional gambler clients. I notice their actual incomes to be quite dismal in the grand scheme of losses and gains, but they sure have some really big roller coaster rides along the way. Living in a gambling town we always hear about the extraordinary big wins, but we never hear about how much was lost to make that money.

Working in insurance I see some these same big mistakes made. People look at insurance as a way to win the jackpot in having someone else pay for your losses. The way insurance is sold is through telling you about one incident where someone had a huge tragic loss and then the insurance came and saved the day. What they didn't tell you was about how much that family spent and the many other families that never used that coverage.

Life never works out the way we plan. We learn good principles and adhere to making good decisions and we create good outcomes. When insuring yourself against anything, take a look at what resources you have and think about what your real risks are. If you are making random decisions in your investments, maybe it would be a good idea to use an advisor who can minimize the downsides. If you are young and have a family, maybe get some term life insurance to protect them if you were to die prematurely. If you have a job that relies heavily on your good health, consider a good disability policy. If you are concerned about staying in good health, make sure and get a good health insurance policy, but don't be afraid of deductibles.

To sum up my question of why do we need fund managers and professionals, it is because we sometimes need some perspective on what we are missing. Maybe we have too much insurance or maybe we are under performing the market and just making less ideal choices. It is always helpful to take a look at what the crowd is doing on average and make sure we are't missing the boat.