A Case of the Flu.

2015 started with a bang…actually with a cough.  Like many in my circle of friends and acquaintances, I got the flu.  After a few days of suffering, I found myself on a Saturday morning in mid-January with a choice to make. Do I continue with my Nyquil binge and wait till Monday to see my doctor or head out now to visit an Urgent Care center?  

Urgent care services have found a nice niche in our healthcare system. You can avoid the higher cost of a hospital emergency room for a non-emergency, which was my case, and they fit nicely in our “need to know now” mentality. I knew this could cost me hundreds, but perhaps I could rule out strep or bronchitis or, if I wasn’t so lucky, get a jump on it with an antibiotic. Note: For those of us with HSA-compatible health insurance with no copays for office visits, urgent care, or prescriptions, we ponder these decisions more carefully weighing our pain and suffering against our anticipated out-of-pocket costs. It was a tough choice but made easier by my family who handed me a jacket and scarf and sent me on my way. 

I envisioned a full waiting room with fellow flu sufferers so I brought reading material. To my surprise, I was alone. After 15 minutes with the front desk clerk disclosing my personal information (that I pray ends up on a secure database somewhere), I was assigned a sterile room complete with a fresh paper liner. Over the next 45 minutes, I was visited by not two, but three healthcare professionals. First, an intake nurse took my vitals and swabbed my throat for the quickie strep test. Then, after testing negative, I was visited by a doctor who gave some valuable insights but no solution. It could be viral and heal itself; I could start an antibiotic on Monday if I didn’t improve on my own, etc. After all this, I decided to wait till Monday to see my personal doctor.

As I prepared to leave the center, and to my surprise, I was told to wait for the exit nurse for instructions. Come again? I’m all for procedures, but this was a bit over the top. I knew my instructions; stay miserable for two more days and then see my doctor Monday for some drugs. The actual instructions given by the exit nurse amounted to common sense home remedies which of course included, drum roll…”drink lots of fluids”.  So for an hour visit to urgent care for the flu, which included encounters with four staff (one clerical, two nurses and one doctor), I received information that could have been obtained from a good Google search. Half my time was spent waiting for an inconclusive result and no remedy.

So what is the point here, choose Nyquil next time?  Perhaps. It would have saved me hundreds of dollars. Or is it that there is waste and abuse in our healthcare system. Duh.  But as I consider this, I think the bigger point is accessing information. Information is everywhere and, like many of you, I love how easy it is to access. The information I received from urgent care is exactly what my Google search returned (resource: the Mayo Clinic), which included of course…“drink lots of fluids”.  Technology is making the accessibility of more and more information easier so we can make more informed decisions about how to spend our time and money. 

Urgent care was not a complete waste. I ruled out complications and appeased family members. But in addition to this example, I find the more I embrace and use technology to solve simple tasks (dare I say it, and avoid human contact), I’m often delighted with the result. For example, in my need for a recent lab test I Googled “Quest Labs” for directions and discovered I could make an appointment online. I did so and, after entering a full waiting room at my scheduled time, was whisked by many restless, envious, and sick patients straight to the lab room for my tests. No waiting on hold to schedule an appointment or suffering in a crowded waiting room. That doesn’t excuse companies for poor service, but good service now comes in different forms.

The power of the internet is not a revelation, but the healthcare industry is embracing it full throttle.  Insurance companies, healthcare providers, pharmacies, heck, even your local plumber are investing in technology and avoiding adding extra staff to solve simple requests. While holding on the phone for a company representative, healthcare or otherwise, we are often reminded that most of the answers are available on their website. That should tell us where companies are investing and where they want us to go. Whether it’s information that saves me a trip to a provider (and being stuck in traffic) or scheduling an appointment, embracing technology can save us time, money and frustration.

More next time of what the future holds.

Phil Dougherty


Blue Shield and Sutter Health, a love story.

It was touch and go there for a bit, but Blue Shield of California and Sutter Health resolved their differences and signed a new two-year agreement that will keep Sutter hospitals and medical centers in Blue Shield’s provider network.  The public jousting was palpable and thankfully short-lived.  Coming to an agreement before the end of the open enrollment (February 15) means many can check insurance off their to-do list, for a while anyway. Continue reading

Deadline approaching…

There are just five days left to renew your health insurance for 2015 if you want it effective on January 1, 2015. 

In both Covered CA and the private marketplace, you have through December 15, 2014 to explore your options and make any changes to your health insurance for a January 1, 2015 effective date. Please read the specifics below to understand your options based on the market in which you obtained your current health insurance. Continue reading

Open Enrollment is here!

The first annual open enrollment period since the implementation of health care reform has started and it’s time to evaluate plan options for 2015.  For those who have existing individual or family coverage and want to consider a change, are enrolled in group or COBRA insurance and want to compare their current plan with 2015 marketplace plans, or are without health insurance and entering the market for the first time, now is the time to consider a change. Continue reading

Commissioner Jones: Superhero or Opportunist?

BAM! POW! WHAM! Insurance Companies take cover. CA Insurance Commissioner Dave Jones has changed into his spandex and cape! (Play superhero theme music.)  And, with the help of his sidekick (Proposition 45), he’s ready to challenge his arch nemesis (aka insurance companies) and protect the good people of Gotham (California) from their tentacles and stinging rate increases. (Aside: Isn’t anyone concerned that there are no more phone booths for Superman to change in?) Continue reading

It’s not just what’s on the ballot that matters; it’s when the vote is held.

There is no better example of this than the upcoming November election.

Originally set for October 15 – December 7, this year’s annual open enrollment period, when consumers can enroll in ACA compliant coverage for the first time or change plans for the next plan year, was pushed out to November 15 – February 15.  CoveredCA, California’s version of ObamaCare, has followed suit and will match the new open enrollment schedule.

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How to Choose a Carrier.

Health Care Reform has leveled the playing field as far as coverage benefits and eligibility goes. Plans are standardized and fall into four distinct benefit levels (Bronze, Silver, Gold, and Platinum) and must be actuarially equivalent. Pre- existing conditions no longer restrict your access to coverage or result in higher premiums. By removing these two critical elements, what’s left to compare? Plenty!

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Next Open Enrollment Period Uncorked…

In addition to sizing up a turkey or sniffing a yam, you might add squeezing a health plan or two into your Thanksgiving shopping list. This year’s open enrollment period was moved from October 15 – December 7 to November 15 – February 15, 2015, and if you want to ring in the New Year with a “fresh” plan, you’ll have a shorter amount of time to act this year.  Let’s look a little closer to see what this enrollment period date change really means. Continue reading

Employers & Employees Beware.

Popular among small employers was an arrangement by which they would pay the employee’s individual insurance plan premiums on a pre-tax basis. Market reforms within our new healthcare law now prohibit this.

Starting January 1, 2014, employers who reimburse or pay premiums directly to a carrier for any employee’s individual or family health insurance policy will no longer be able to do so tax-free. This may adversely affect both employer and employee. Continue reading

Short Term Insurance still has a place.

Our new health care reform law has made it possible now for virtually anyone to obtain health insurance. Those with a pre-existing condition(s) cannot be denied insurance, charged a higher premium or have coverage restricted in any way. This is a huge step forward in our health care system and the ramifications of this step are being played out as I write this message.

But there has been another significant change that was less publicized. There are only certain times of the year when you can enroll in or change coverage, called Open Enrollment. What! Did we fix one problem in our system just to create another?

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