Wednesday, September 10, 2014

Understanding Cost Sharing: Deductibles, Copayments & Coinsurance

All health insurance requires consumers to pay some of the cost of covered health care services. This is called "cost sharing" or "out-of-pocket" costs. Cost sharing varies with different types of health plans, but most will have a copaymentcoinsurance or deductible amount. 
Cost Sharing Requirements
·         Your plan may require you to pay before the plan begins to pay. This is called a deductible (e.g. if your deductible is $500 per year you would pay the first $500 of incurred medical expenses). Plans also may charge a deductible for certain services (e.g., you pay $100 for a hospital stay).
·         You also may need to pay a portion of each visit called a copayment (e.g., you pay $10 for each prescription medication). You may have a copayment for emergency room services. Also check your plan for details emergency services for non-emergency problems.
·         Some plans require you to pay part of each service as a coinsurance (e.g., 20% of the cost of a service).
Children's Preventive Services
Children's preventive services, such as well-child checkups and immunizations, may or may not be covered without cost sharing. You should carefully review your plan's benefit description for details. The best time to review a plan is before you sign up with it.
Methods of Payment
Before visiting your child's doctor, check the accepted methods of payment for your out-of-pocket expenses. Options for payment may include cash, check, or credit card. Remember to bring your insurance card with you to each visit.
Medicaid and CHIP plans have very little cost sharing and subsidies will be available in health insurance marketplaces to reduce cost sharing for some families beginning January 1, 2014.
Affordable Care Act
Health care plans may have a specified annual dollar amount that can be used for specific types of health care. However, after passage of the Affordable Care Act (ACA), health plans are no longer able to set annual or lifetime limits on ‘essential’ services.
·         Under the ACA individual and small-group non-grandfathered health plans are required to provide coverage for all recommended services for children, with no cost sharing. 
·         Note: A health plan is considered ‘grandfathered” if the plan was in place when the ACA signed in March 2010.  Plans that are granted “grandfathered” status are exempt from some of the ACA provisions. 
·         Check whether their plan is considered a non-grandfathered plan.  

Last Updated 7/29/2014
Source American Academy of Pediatrics (Copyright © 2013)

Wednesday, August 13, 2014

Parents, put down the cell phones

Children and Healthy Weight

VANCOUVER, B.C. – Very few overweight and obese children outgrow their at-risk weight, and the window to address the problem is fairly narrow.
Dr. Raquel G. Hernandez, assistant professor of pediatrics at Johns Hopkins University, and her colleagues looked at obesity resilience, seeking to identify the prevalence of favorable growth patterns, such as healthy weight maintenance and return to healthy weight in school-aged children.
"There are pervasive expectations among parents that their children will magically outgrow their weight risk, and unfortunately, I think this applies to some providers as well," Dr. Hernandez said at the annual meeting of the Pediatric Academic Societies.

Dr. Hernandez recommends early interventions for childhood obesity.

The researchers analyzed data on more than 9,000 children in the Early Childhood Longitudinal Study database, looking at their growth during the elementary school years. Measurements included body mass index (BMI), race/ethnicity, gender, and socioeconomic status and were compared for kindergarten, first, third, and fifth grade.
At baseline, nearly 26% of children were overweight or obese, while most (70%) were classified as healthy weight (BMI from the fifth through the 85th percentile). The rest were underweight. The majority of the cohort maintained healthy weight, but less than one in five (17%) of the overweight or obese children were able to return to healthy weight (BMI between the 5th and 85th percentile) over the study period.
In this unpublished study, Hispanic boys and girls were less likely to return to healthy weight, compared with children of other races/ethnicities. Boys of all races/ethnicities and socioeconomic statuses were more likely to be persistently overweight or obese. For girls, middle and low socioeconomic status was associated with lower likelihood of returning to healthy body weight.
"Most surprisingly, in contrast to pervasive expectations, greatest incidence of outgrowth occurred in overweight kids during kindergarten to first grade," said Dr. Hernandez, who is also associate director of medical education at All Children’s Hospital Johns Hopkins Medicine in St. Petersburg, Fla.
Less than 5% of children returned to healthy weight after third grade, she said.
"It’s time to open [the conversation about weight], and also parents should be open about having that conversation, knowing that outgrowth doesn’t really happen as frequently as we thought it would," Dr. Hernandez said in an interview.
The study had several limitations, she said. A portion of children weren’t included in the analysis because of missing relevant data, leading to potential for selection bias. Also, the criteria for return to healthy weight and healthy weight maintenance might have led to exclusion of children who made favorable transitions, the authors said.
"Curbing the pediatric obesity epidemic will depend on exploring all growth trends in children, including the potential for obesity-resilient growth patterns," said Dr. Hernandez. Future work should seek ways to help "clinicians to more deliberately message healthy weight maintenance and explore how these patterns can be more robustly discussed among children who are at risk, especially Hispanic children and children who have low socioeconomic status," she added.
Dr. Hernandez reported no financial disclosures. The research was funded by an institutional grant from the All Children’s Hospital Johns Hopkins Foundation.
On Twitter @naseemmiller

Tuesday, June 24, 2014

Well Check-ups vs Sports Physicals…

How do you know which one and when to schedule?

Well check-ups are preventative physicals and also cover requirements for school sports physicals.. Your insurance usually covers well check-ups with zero out of pocket to you.  IHSAA/school guidelines need a well check-up or sports physical on or after April 1st.  If you schedule your child’s well check-up after April 1st, this will be good for the entire school year and through summer conditioning.  Our doctors recommend a well check-up every year. 
If your child had a well check-up before April 1st, you can schedule a sports physical which is an abbreviated physical and only covering the sports portion.  We advise you to check with your insurance for coverage on these.

Northpoint Pediatrics 

Accepting New Patients | Call 317-621-9000 today for more information or  REQUEST AN APPOINTMENT ON LINE

George Wright, CPC
Director Business Operations

Director of the Business Operations at Northpoint Pediatrics and a certified coder himself, George leads a team of professional coders, patient account professionals and scheduling team members. 

Married and dad of three active boys, you can often find his family either at the soccer fields or watching soccer matches. 

Teens: Ban the Tan!

Using tanning beds can harm your skin, eyes

    Are you feeling a bit pale after a long winter? Thinking about using a tanning bed before going somewhere warm for spring break? You might want to think again. Indoor tanning beds can be dangerous — or even deadly.
People who use tanning beds before they are 35 years old are 75% more likely to get melanoma (skin cancer). Melanoma affects 68,000 people in the United States and kills one out of eight of those people every year. Those who start tanning when they are young also have a higher risk of other types of skin cancer. That’s why the American Academy of Pediatrics (AAP) and pediatricians tell anyone under age 18 that they should never use a tanning bed.
Tanning salons sometimes give out wrong information about safety. For example, tanning salon workers in Missouri allowed children as young as 10 years old to use tanning beds, according to a new study in the medical journal Pediatrics. Some customers were told that they should use a tanning bed before going on vacation somewhere warm to avoid sunburns (they shouldn't or that doctors recommend tanning beds (they don’t). Actually, the “healthy” glow on your skin after tanning is not healthy at all. It is a sign of skin damage.
Tanning beds do more than just hurt skin and cause cancer. The bright light can cause eye problems, itchy skin and make you more likely to get sick. Even teenage boys are at risk. In one study, boys who use indoor tanning often said they feel bad about how they look. They also were more likely to do other unhealthy things, like try weight loss tricks, alcohol, drugs, cigarettes and steroids.
In many states, it is illegal for anyone younger than age 18 to use a tanning salon. Even if you are allowed to go with a note from your parents, think before you ask. It is healthier to be happy in your own skin.

Northpoint Pediatrics WWW.NORTHPOINTPEDS.COM 

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© 2013 American Academy of Pediatrics - Trisha Korioth, Staff Writer
Baby girl with pony tail in white