365 Days of -----------

I’m a recent fan of Pinterest. I swore up and down I wasn’t going to get started on this as I figured it would be just another tool to suck my time mindlessly on the internet. Did this ever prove me wrong! Sure, I admit I roam around looking at my home page and viewing other people’ pins, and I’ve even repined several myself. What I didn’t realize was how many clever and creative people are out there. And there are so many times that I say to myself, “Why didn’t I think of that”? I’ve even made recipes that other people post and made a few crafty items. Now this brings me to today’s post.

365 Days

Someone posted that in the year 2013, they are going to take a photo a day for365 days. This got me to thinking. Sure, I would like to take a picture on my SLR camera every day, but maybe there is something else that’s more important to me that I should do. I’ve come up with a short list of things that I may pursue.

*Eat healthy (that means no processed sugar)

*Exercise in some shape or form

*Learn a new language

*Track my spending

*Recycle

*Say I Love You to someone

*No t.v.

*Sew or work on a craft project

*No shopping (other than for groceries and household items)

*Do something that involves music

*Do something “green” everyday

*Blogging (Not going to happen here)

*Journaling
*Do something nice for someone (without them asking)

*Take a picture

*Meditate
*Be Greatful
*Smile at a Stranger

*No personal driving (I can ride with my someone else, but otherwise must  bike, walk or take public transportation)

These are just a few ideas. I think I’ll probably try one or two on a daily basis, and practice the others year round (but not daily). How about you? Are you up for the 365 day challenge? Why wait until 2013? I challenge you to start today!

*I've also found a website with other great ideas.  Maybe I'll try a few of them as well. You can find it at http://the365daychallenge.com/the-list/

MORE REASONS TO REVIEW YOUR COVERAGE

My neighbor sold a truck today to pay off his deceased wife’s medical bills. He said he just got a bill from the ambulance company and his portion was $800.00. I asked him if he had his Explanation of Benefits from the insurance company and if it agreed with the bill. He replied he didn’t know where it was, but he was sure he owed this. He went over the bill with me over the phone. From the best I could tell, he read off the billed charges, and the amounts paid by his insurance company. The exact balance was what he thought he owed. He didn’t indicate to me if there were any adjustments on the bill. Hmmm. I of course asked him what his deductible and out-of-pocket was. His reply was, “Don’t really know – couldn’t really tell ya”. Wow, so he’s just going to pay his bill! He didn’t really want any “help” because the ambulance gave them good service. REALLY!!!!  I told him if he wants me to go over his bills and make sure they’re correct I would. I could do this even after he paid them, just in case he’s due a refund. I also mentioned that lots of places will set up monthly payment plans with you, and some will even discount the bill if you agree to pay a lump sum right away. Again, he didn’t really care. This seems pretty scary to me, especially since he wife was in the hospital for 3 ½ weeks and had two more trips via the ambulance that he hasn’t received bills for yet. Enough said……

Skilled Nursing Facilities: Medicare Qualifications

My little aunt passed away on Halloween. Everyone pretty much expected this, she had been in failing health for several years and her body just could not hold on anymore. She would have been 89 years old on Nov 14. 

She had been living at home for the last few years with the assistance of her daughter and son. A few days before she passed she became unresponsive and more lethargic than usual. She was taken to the hospital and was admitted. It was determined that she had suffered a stroke and had a bladder infection. She was in the hospital for two days, then discharged back home under the guidance of home health and hospice. Even though she was in very poor condition, the hospital would not keep her. They sent her live out her final days at home.

I do not live in the same town as her, but asked my mother why she wasn’t transferred to a Skilled Nursing Facility (SNF). Apparently, one has to meet certain criteria to be admitted to an SNF. She did not qualify because she had to be an inpatient in the hospital for three consecutive (and not just for observation), days before Medicare will approve SNF care.

 

For those of you who are not familiar with SNF’s, they are where patients go for medically needed long-term care or rehabilitation and they have the required staff (Registered Nurses, Licensed Practical and Vocational Nurses, Physical and Occupational Therapists, Speech-language pathologists and Audiologists.), to manage, observe and evaluate such care. They are able to give medications, IV’s, injections and physical and occupational therapy. Sometimes theses are referred to as “nursing homes”.

Medicare will cover certain skilled services that are needed daily on a short-term basis (up to 100 days) and will only cover it if you carry Medicare Part A (hospital insurance). In addition, there are several other requirements that you must meet in order to qualify for SNF care. Some (but not all), of these are ~

   ■     You must have days left in your benefit period.

■     You must have a qualifying hospital stay, (three consecutive days or more, starting with the day the hospital admits you as an inpatient, but not including the day you are discharged). If you were “under observation” in the hospital for any of this time, it will NOT count toward your 3-day qualifying hospital stay.

■     You must enter the SNF within a short period of time, (generally 30 days), of leaving the hospital

■     You require skilled care on a daily basis and can only be provided in an SNF as an inpatient.  

Obviously, there are many other guidelines to be admitted to an SNF, but these are just a few. Each patient’s case is unique and will have to meet the criteria for his individual circumstance.

How long can you stay in an SNF? Medicare uses a benefit period-of-time to keep track of the number of days you use in an SNF and how many are still available. This starts on the day you start using the SNF coverage in a benefit period. You can get up to 100 days in a period. Once you use those 100 days, your current benefit period must end before you can renew your SNF benefits. There is no limit to the number of benefit periods you can have, however once a benefit period ends, you must meet Medicare requirements before you can get up to another 100  days of SNF benefits. If at some point you no longer qualify for Medicare coverage, you (or if someone is acting on your behalf), must be given a written “Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage”. This notice informs you that the SNF believes you no longer qualify for SNF services paid my Medicare. It has to state:

    ■     When your Medicare coverage will end and when you must start to pay.

    ■     The reason why your stay is no longer covered.

 ■     Your right to request that the SNF submit a claim to Medicare so you can receive an  official payment decision from Medicare.

 ■     That if you request to have a claim submitted to Medicare, you are not required to pay for your current SNF stay until you are informed of Medicare’s decision, (but you will still be required to pay any coinsurances and for services not covered by Medicare).

 ■     Where you should sign to show you got the Notice.

If you do not agree with the decision, you can file an appeal. You will be responsible for SNF charges if Medicare denies the appeal and determines you do not meet the requirements for additional SNF care. One such option is a fast (expedited), review or an immediate appeal. During this process, an independent reviewer called a Quality Improvement Organization will look at your case and decide if your health care needs to be continued. The SNF should give you information on how to contact them within the allotted timeframe. Be prepared to supply information (evidence), why you think you need the additional stay.

Lastly, you can also choose to pay for SNF costs yourself when your Medicare coverage ends. Long-term care is quite costly and many patients use other resources to help cover these costs. Always check with your state or county to see if you qualify for additional benefits (such as Medi-Cal in the state of California). You would be surprised to find out that there may be other options to help you pay with these costs.

RIP Aunt Alvera. Give Grandma and Grandad a big hug and kiss for me and tell them that I miss them and think of them often.

October is Breast Cancer Awareness Month

As many of you know, October is Breast Cancer Awareness Month.  This is an annual campaign to increase awareness of the early detection, cause, effects and treatment of breast cancer.   Not only will one in eight women will be diagnosed with breast cancer; approximately 70 thousand men (yes men can get breast cancer too), as well as women ages 15 -39 will be also be diagnosed with the disease in the US.

One of the ways to detect breast cancer is by doing a monthly BSE (Breast Self Examination). Forty percent of diagnosed breast cancers are detected by women who found a lump, so it is of the utmost importance that an individual becomes familiar with their own breasts and notify their medical provider immediately if they find any unusual changes or lumps. This in conjunction with an annual clinical breast exam is an essential tool for early detection.

Another tool for detecting breast cancer is a mammogram.  Most people are familiar with mammograms, but are uncertain as to what is involved.  When you call to make your mammogram appointment, the scheduler will ask you if you are having a “screening mammogram” or a “diagnostic mammogram”.  Screening mammograms are used to check for breast cancer for patients who have no symptoms or signs of disease.  These are usually referred to as your annual or yearly mammogram.  Diagnostic mammograms are for patients who have found changes in their breast such as a lump, pain, disfiguration or discharge.

Mammograms are essentially an x-ray picture of the breast.  There are different types of mammograms: analog mammograms, digital mammograms and 3-D mammograms.  Analog mammograms are when the breast is pressed between two plates and a fixed x-ray is taken on film and then developed.  The  process is similar during a digital mammogram, though a digital mammogram takes about half the time, there is less radiation exposure,  and the images are viewed and stored on a computer, which can be printed out on film.  3-D (three dimensional ),  breast imaging, also known as breast tomosynthesis, is a type of digital mammogram where the x-ray tube and imaging plate move from different angles during the exposure.  It creates a series of thin slices through the breast and computer software can reconstruct the image.  Mammograms can also use a CAD (Computer Aided Detection), software that searches for abnormal areas of density, masses or calcifications that may indicates the presence of cancer.  The CAD program highlights areas of concern on the images, further alerting the radiologist for additional examinations or testing. 

If your radiologist, (the physician who reads the mammogram), suspects there may be an area of concern, he or she may suggest that you have further studies.  One may be an ultrasound of the breast.  An ultrasound uses sound waves to make a picture of the tissues inside the breast.  It uses an instrument called a transducer which is passed back and forth over the breast and images are captured.  It does not use radiation like the mammogram.  Your radiologist may also suggest an ultrasound-guided breast biopsy.  This is performed by taking samples of some of the cells (usually through a hollow needle) from a suspicious area of the breast, then sending them to the pathologist to be studied under the microscope.  The ultrasound helps guide the physician to the site of the area of concern.

Another test is an MRI (magnetic resonance imaging) scan. This uses powerful magnets and radio waves to create detailed pictures of the breast and surrounding tissues that are difficult to see clearly on a mammogram or ultrasound.  These pictures can show the difference between normal and diseased tissue and provide the radiologist with information that is not found on a mammogram.  An MRI may be done in conjunction with a mammogram and an ultrasound, but is not a replacement for a mammogram.  MRI’s do not use radiation (x-rays).  Breast MRI’s are not routinely done and must warrant a diagnosis to perform this test.  They are much more expensive than traditional mammograms and most insurance companies will need justification (such as checking for more cancer after cancer has been diagnosed) to authorize this test.

There is also a type of x-ray called a CT scan, (computerized tomography) of the breast.  This uses 2-dimentional slices or cross-sections from many different angles.  The images are sent to a computer where they are put together to create detailed pictures.  CT’s of the breast are not routinely used to evaluate the breast. This is another exam where your insurance will need justification to authorize it be done.

An additional test is a PET scan (positron emission tomography. During the PET scan, you are injected with a substance made up of sugar and a small amount of radioactive material.  Cancer cells seem to be more active than healthy cells and as a result absorb more of the radioactive sugar.  A special camera scans the body to pick up any highlighted (sugary) areas on a computer screen.  The highlighted areas help the radiologist determine areas that may indicate cancer. Although, this test has only a limited ability to detect small tumors, it can be useful for evaluating people after breast cancer has been diagnosed.   It gives the physician information to determine where the cancer has spread to lymph nodes and other parts of the body and to see if the cancer may be responding to treatment.  Sometimes this is done in conjunction with a CT scan; PET/CT.  Again, this is a very expensive test and insurance companies will need justification to authorize it.

Lastly, there is a blood test called the BRCA that analyzes two genes (BRCA1 and BRCA2) to see if you have inherited any abnormal changes that might increase your risk for certain types of cancer.  This blood test is usually done on women that have a strong family history (parent, sibling or child) of breast and/or ovarian cancer or who have had breast or ovarian cancer themselves at a young age.

Mammograms charges can vary from place to place in price.  Most private insurances cover the cost of a “screening” mammogram with no co-pay or deductible.  Always verify this with your insurance company, as not all plans are the same.  Also keep in mind, if you call for an appointment and have a lump or problem, this will change from a “screening” mammogram to a “diagnostic” mammogram and you will most likely owe towards your deductible and out-of-pocket expenses.  During the month of October, a lot of radiology offices offer a reduced price screening mammogram.  This is usually for women who don’t have insurance and couldn’t otherwise afford a mammogram.  Lastly some state and local health programs provide mammograms free or at low cost.  Information about free or low-cost mammography screening programs is available for the NCI’s Cancer Information Service@ 1-800-4-CANCER (1-800422-6237) and from local hospitals, health departments, women’s center, and the American Cancer Society.  Don’t discard your physician as well.  They may know of community groups that have programs to assist with mammogram fees.

For more information, please go to:

http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

It's time for your annual flu shot

It’s that time again.  No, not when Christmas decorations are popping up at the department stores, or little goblins come ringing your doorbell.  It’s actually time for your annual flu (influenza) shot.  Though, not everyone needs a flu shot, some people are at higher risk of having medical complications if they do contact the flu. 

Who should get a flu shot?

• People 50 years of age and older
• Residents of nursing homes and other long-term care facilities housing anyone of any age with chronic medical conditions
• People with chronic disorders of the lungs or heart, such as asthma, emphysema, chronic bronchitis, or cystic fibrosis
• People who are less able to fight infections because of a disease they are born with; infection with the Human Immunodeficiency Virus (HIV); treatment with drugs such as long-term steroids; and/or treatment for cancer with x-rays or drugs
• People who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), kidney diseases and blood cell diseases such as sickle cell anemia
• Children and teenagers 6 months to 18 years of age on long-term aspirin treatment, who, if they catch influenza, could develop Reye's syndrome which causes coma, liver damage, and death
• Women who will be 6 or more months pregnant or who will have just delivered during the influenza season

~ To help protect high-risk people from exposure to influenza, these two groups should receive influenza vaccinations as well: ~

• Health care workers (doctors, nurses, hospital and medical office staff, personnel of nursing homes or chronic care facilities) in contact with people in high-risk groups
• People--including children--who live with persons in high-risk groups for flu (household contacts)

                 Will your insurance cover the cost of your flu shot?

Many insurance plans cover the full cost of the flu vaccine (along with other vaccinations).  It’s always best to read your policy to verify this.  If you’re still uncertain, call your insurance company and ask to speak to a customer representative.  If you have private insurance, you will need to go to a provider that accepts and bills your insurance.  For instance, if you have a managed care plan, such as a HMO, you can’t just drop in at a clinic that doesn’t have a contract or accept your insurance.  When in doubt, ASK!

Medicare Part B covers both the flu and pneumococcal vaccines.  You will NOT have to pay a coinsurance or a deductible, providing you go to a Medicare provider. 

Lastly, your local county health department also offers vaccinations, at no or little cost. 

*Parts of this article were excerpted from http://www.medicare.gov/health/fludetails.asp



It's Open Enrollment Time

We got hit hard last year with medical costs when I had to have an emergency surgery at the end-of-the-year (Dec. 21to be exact), and ended up with a four day hospital stay.  Prior to last year, we had a local HMO insurance plan.  Had we still had our HMO plan, I would have owed very little (if anything) for this, but since we changed insurances to a PPO plan for 2011, I paid more than $3,500.00 (for myself) and at least another $1,000.00 + for my husband and daughter's bills in 2011.  Again, if we would have stayed with the HMO, we would have owed very little, if anything! 

Here's the back story.  In 2011 we decided to go with the PPO to save money on our premium expenses.  The HMO was much cheaper, but we had fewer choices and always had to play the game to get referrals, authorizations, etc for our medical care.  Seeing how we never used the HMO for much, and didn't have much in the way of medical expenses, we decided to save the "Premium Money" and go to a PPO. We would have much more flexibility with the PPO and just take our chance that we stayed healthy and didn't have any major problems.  To make a long story short, WRONG ANSWER.  As you can probably guess, we didn't save any money switching plans, and ended up paying more in the long run. If only I had that magic crystal ball, not only would I have stayed with the HMO, but I also would have chosen the winning lottery numbers

This brings me to my topic of Open Enrollment. Now is the time where most companies offer you the chance to change your insurance plan.  If you work for a big organization (such as a state entity), you probably have more than one plan to choose from. If you work for a small company, you may not be able to choose and have to go with the plan they offer.  I can't advise you on what to choose.  That is a personal decision you must make after weighing all the factors. I can give you a list of questions to ask yourself to help you make an informed decision.


      *Do you need insurance for just yourself or your family?

    * Do you need to make adjustments to your current plan?

    *Do you want to be able to have access to a large number of providers     that you can see without getting permission from your insurance company?

     *How much will it cost me?

      * How affordable are the different plans?

     *Do you want to have a high deductible so that you’re monthly premiums will be lower?

     *How do I pick a health plan?

     *Do I need to pick a primary care physician?

      *Am I able to see my current doctor on the plan?

      *What do the plans cover?

      *Are there any limits on how much I will have to pay in case of a major illness?

      *Does it cover hospitalizations for elective services?

     *Does is cover pre-existing conditions, chronic illnesses and preventative care?

      *Do I need referrals to see specialists?

     *What will my insurance company cover if I need attention for an emergency of when I’m out of town?

      *Are there any wellness incentives?

      *Will it coordinate benefits with my spouses insurance?

You may have noticed I have blogged about this in the past, but I felt it was an important topic to revisit at this time.

The Big Move

I 'haven't posted for some time again.  I seem to have been distracted with a lot going on.  At the end of June, my siblings and I hosted a 60th wedding anniversary party for my parents up north.  It turned out really nice and went off without a hitch.  Then, we had company for the Paso Robles Mid-State Fair.  For those of you who have never ventured to our little fair, it's a must have to do on your bucket list.  It runs for 12 days, usually starts the last Wednesday in July.  They usually have amazing concerts every night.  We were fortunate enough to see Brad Paisley.  His openers were Easton Corbin and The Band Perry.  Did we ever have a great time.  All the performers were AMAZING.  Brad Paisley sang forever.  The started at 7:30 and finished at 11:15.  I've also managed 3 trips to San Diego.  Our youngest daughters starts at San Diego State next Monday.  She's transferring as a 3rd year student.  We just moved her down.  Oh, the Traffic!  I'm sure not going to miss that.  Now we have our oldest and youngest daughter, our son-in-law and our grandbaby in San Diego.  Now that everyone has moved, I think I'll take the easy way and fly when I go visit.  Lastly, our big move.  We're moving north (San Leandro/East Bay Area) at the beginning of October.  Originally it was going to be September, but there is still way to much to get done on our house here.  Luckily our youngest daughter took a lot of our big furniture, so we won't have to put it in storage.  The house here is looking quite bare these days.  I have no couches, table or chairs or bar stools.  I can sit outside (weather permitting) and eat at the picnic table.  Now we're just in a big dilemma.  Do we rent out our house or sell it?  We've had it appraised, and met with a realtor today.  Now were just waiting to hear back from him to see what he thinks we could get for it.  Which brings me to where I should be with my life after all is said and done.  I've been working on a book and haven't picked it up for awhile.  Once things get settled, I plan on finishing it up and marketing/selling it.  Whether it be an e-book, physical book, or both,will have to be soon determined.  To learn more about my book, I've linked the website for you.  This book idea is what got my interested in blogging in the first place.  Until next time (blog)........


http://www.understandingyourmedicalclaims.com/

This is an article I ran across on the internet.  I haven't written any part of it, but thought it was of great interest. 

High court health care ruling could force California to 'rethink everything'

By Emily Bazar, CHF Center for Health Reportingdailynews.com

Posted:   06/16/2012 06:23:37 PM PDT

June 17, 2012 1:41 AM GMTUpdated:   06/16/2012 06:39:35 PM PDT

When President Obama's health care overhaul became law two years ago, California lawmakers jumped into action. Within months, they adopted several state laws that implement or build on the federal measure, including one to create a state health insurance exchange and another to allow young adults up to age 26 to remain covered by their parents' health insurance policies. Lawmakers passed even more bills related to the overhaul last year and continue to debate sweeping proposals now. The difference this year is that the fate of those state laws, and the impact they will have on Californians, hang under what state Sen. Ed Hernandez calls a "cloud of uncertainty." Before the end of the month, the U.S. Supreme Court is expected to rule on the constitutionality of the Affordable Care Act. Among the most likely scenarios, the court may leave the federal health law intact, overturn it completely or strike down a key provision that requires most people to purchase health insurance. Each possibility carries different implications for California, a state that took an early and aggressive approach to implementing the federal law. "We will have to rethink everything" if the federal law is overturned in part or whole, said Hernandez, D-West Covina, chairman of the Senate Health Committee. "We have to reassess all of these measures. Some of them are actually contingent upon the implementation of the Affordable Care Act."

Experts predict up to 3 million uninsured Californians will become eligible for health coverage starting in 2014, when the major provisions of the law, such as an expansion of Medicaid eligibility, kick in.
And the Golden State, which already has received more than $1 billion in federal funding, is counting on billions more. Should the Supreme Court undo the law's provisions or funding, some state lawmakers and consumer advocates say Californians still will benefit from better health coverage, thanks to the new state laws. Others fear that those new requirements will raise the cost of insurance. "It will be important for everyone in California to step back and think through how we respond in a way that will work for affordable coverage," said Patrick Johnston, CEO of the California Association of Health Plans. The list of state bills that implement or expand on the Affordable Care Act is long, including a law that created a state health insurance exchange where Californians will be able to buy health coverage and find out whether they qualify for subsidies; a law that prohibits insurance companies from denying health coverage to children with pre-existing medical conditions; and a law that prohibits insurers from setting lifetime caps on benefits. "There are things that millions of Californians already are benefiting from," said Richard Figueroa, director of Health and Human Services for the California Endowment health foundation.
 
Additional measures are being debated by the Legislature now, such as a proposal that would prohibit insurance companies from denying coverage to anyone - not just children - regardless of pre-existing conditions. Hernandez, the author of that measure and a fervent supporter of the Affordable Care Act, says he will move forward with that bill as long as the federal law stands. At the same time, his office is scouring existing laws to determine which are tied to the fate of the federal law, and which will remain state law regardless. Hypothetically, he said, "let's say most of those laws are invalid - we have to start all over and turn those into statutes that are not dependent on the federal government."
 
But could those measures come at a price to Californians? "They cost money. There's no doubt about it when you mandate things like expanding coverage to kids or banning lifetime maximums," said Geoffrey Joyce, director of health policy at the Schaeffer Center for Health Policy and Economics at USC.
Just who will bear that cost is up for debate. Figueroa and Kim Belshe believe that insurers already have built into premiums the costs of the new mandates. Belshe, former secretary of the state Health and Human Services Agency, is a California Health Benefit Exchange board member. "The insurance products being sold last year, this year and next year reflect the changes that have already occurred," she said. But Johnston, of the health plan association, said the true effect of the state's laws on Californians' pocketbooks will hinge on the Supreme Court's decision. He describes the critical pieces of the Affordable Care Act as a "three-legged stool" that work together to keep costs down. One leg of the stool is the billions in federal funding for expanding coverage, he said. The second is the requirement - known as the "individual mandate" - that most people purchase health insurance. The third is called "guaranteed issue," which restricts health insurance companies from denying coverage to people for any reason, including pre-existing conditions. If the Supreme Court strikes down any one or more of them, he said, California "can't just ignore the leg of the stool that was removed." Take the individual mandate, for example. If everyone must purchase insurance, the theory goes, insurance companies will have a large and balanced pool of customers where risk is spread among the sick and healthy - and so is the cost. Without the mandate, some healthy people wouldn't buy insurance, which would reduce the size of the pool and boost the price of insurance for others, he said. Plus, the state has passed laws requiring additional coverage from insurance companies, such as bans on lifetime coverage limits. "The premise of the mandate is that you're spreading the cost of these kinds of improved coverage across the population. The impact on rates is not as great," said David Lansky, CEO of the Pacific Business Group on Health, a nonprofit coalition of 50 large companies that focuses on health care issues. "But if you don't have that mandate in place, the cost of the required improvement in the benefits is only being shared by those who have coverage." Hernandez already is considering a statewide individual mandate or other measure should the Supreme Court strike down the federal one. But he and others caution that a state individual mandate and insurance exchange can't be successful without federal money. "If those federal funds disappeared or were enjoined by the court, California would be back to the drawing board," Belshe said.

 http://www.dailynews.com/news/ci_20875047/high-court-health-care-ruling-could-force-california?source=rss

HICAP

HICAP

Did you know there is a non-profit organization dedicated to Medicare advocacy and education for Californians?  It’s called HICAP, which stands for the Health Insurance Counseling & Advocacy Program.  It offers free, one-on-one Medicare counseling. Trained volunteer counselors can answer your questions and help you understand your Medicare rights and benefits, including how to appeal denials of coverage; Medicare supplemental insurance (Medigap policies); Medicare Advantage plans; employee and retiree coverage; and long-term care insurance. HICAP counselors do not sell, recommend, or endorse any insurance product, agent, insurance company, or health plan.  Many senior centers offer this service in their community.  For more information on HICAP, visit the California Health Advocates website @http://www.cahealthadvocates.org//

Immunizations and Vaccines for Children

Immunizations and Vaccines for Children

Immunizations protect us from serious diseases and also prevent the spread of those diseases to others. Over the years immunizations have thwarted epidemics of once common infectious diseases such as measles, mumps, and tetanus. And because of immunizations we've seen the near eradication of others, such as polio and smallpox.  Immunizations, also called vaccines, safely and effectively use a small amount of a weakened virus or bacteria to prevent infection by that very virus or bacteria.  When you get an immunization, you're injected with a weakened form of (or a fragment of) a disease. This triggers your body's immune response, causing it to produce antibodies to that particular ailment.

Why Should Your Child Get Immunized?

The goal of public health is to prevent disease. It's much easier and more cost-effective to prevent a disease rather than treat it. That's exactly what immunizations aim to do.  Some vaccines need to be given only once; others require updates or "boosters" to maintain successful immunization and continued protection against disease.

How Effective Are Immunizations?

Vaccines are very effective at preventing disease, but they don't work all the time. According to the CDC, most of the recommended childhood immunizations are 90%-100% effective.  However, sometimes a child will not become fully immunized against a disease after receiving a vaccine. In cases where a vaccine has not given your child 100% immunity and then are exposed to an infectious disease, their symptoms may be milder than if they had not been immunized at all.

Which Immunizations Do My Children Need?

Because proof of immunization is often a prerequisite for enrollment in school or day care, it's important to keep your children up to date on their vaccines. The recommended immunizations for children 0-6 years of age include:

·         Hepatitis B

·         Rotavirus

·         Diphtheria, tetanus, pertussis

·         Haemophilus influenzae type B

·         Pneumococcal

·         Inactivated poliovirus

·         Influenza

·         Measles, mumps, rubella

·         Varicella

·         Hepatitis A

·         Meningococcal (for certain high-risk groups)

It's important to keep your child's immunizations on schedule and up to date, but if your child misses a scheduled dose he or she can "catch up" later, but should be done in a timely manner.  The complete updated schedule of immunizations for children ages 0-18 can be downloaded from the CDC web site.

Can Immunizations Cause Side Effects?

Today, vaccines are considered quite safe. As with any medication, they can have side effects, which are in most cases usually quite mild. Most common minor reactions to an immunization are:

·         Soreness or redness around the injection site

·         Low-grade fever

Side effects like these usually disappear in a few days. In extremely rare instances a high fever, in excess of 104 degrees, can occur with a vaccine.  Children have also been known to have serious allergic reactions to a vaccine. These usually happen very soon after getting the vaccine, and doctors' offices are well equipped to handle such reactions. If you think your child has or may have an allergy to any component in a vaccine, be sure to share that information with your doctor.  Medical providers generally agree that the proven preventive benefits of vaccines far outweigh the risks of the minimal side effects associated with them. More information about vaccine side effects and precautions can be found in the CDC's brochure Parents Guide to Childhood Immunizations.

Vaccine Myths and Misinformation

We don't need to vaccinate against rare diseases

Few parents today have even heard of all of the diseases we vaccinate against, let alone seen a case of the measles, polio or diptheria.  It is these very vaccines that are keeping these illnesses so rare. Avoiding having your child immunized because of myths and misinformation about vaccine safety puts your child -- and public health -- at risk.

The preservative thimerosal makes vaccines risky

Another concern about vaccines involves the use of a mercury-based preservative called thimerosal.  Thimerosal has been used as a preserving agent in some vaccines and other products since the 1930s. According to the CDC, no harmful effects have been reported from the amount of thimerosal used in vaccines, other than expected minor reactions like redness and swelling at the injection site.  In July 1999, the Public Health Service (PHS) agencies, the American Academy of Pediatrics (AAP), and vaccine manufacturers agreed to reduce or eliminate thimerosal in vaccines as a precautionary measure.  With the exception of some flu vaccines, no U.S. vaccines used to protect preschool children against infectious disease contain thimerosal as a preservative. A preservative-free version of the inactivated flu vaccine (containing trace amounts of thimerosal) is available.

Vaccines cause autism

Because symptoms of autism usually occur around the same time as the first measles, mumps, rubella (MMR) and other immunizations, some have assumed that there is a link between thimerosal and autism.  However, the MMR vaccines have never contained thimerosal, and neither have the vaccines for chickenpox or inactivated polio. In 2004, an Institutes of Medicine report concluded that there is no association between autism and vaccines that contained thimerosal as a preservative.  Diseases such as measles, mumps, and rubella can cause serious health problems, disabilities, and even death. Your children face a much greater risk from an infectious disease than they do from its vaccine.

** Information for this blog was taken from Web MD, http://children.webmd.com/vaccines/immunizations-vaccines-power-of-preparation

INSURANCE CLAIM FORMS, aka the HCFA-1500

You may someday need to file your own insurance claim form. Whether it be that your provider doesn't accept your insurance, so won't do the necessary billing, or you may have a provider that doesn't do "secondary" or "supplemental" claim billing.  Whatever the case may be, you need to file it on a
HCFA-1500 claim form.  You can download one from the internet @  http://www.dm.usda.gov/shmd/owcp-1500.pdf     In order to do this, you will need your own personal insurance information, a copy of your providers bill, which should include the charges, codes (diagnosis and billing), identification numbers, and name,address, phone number, etc.  If there are any blanks you do not know how to fill out, or don't understand, call your insurance company and ask for their assistance.  They will be able to help you with this, or direct you to the questions and answers you need to get from your provider of services.