Month: January 2017

When Your Doctor Doesn’t Accept Your Health Insurance Plan

By Nathan Blake | 1/17/17
Updated | 9/14/18

When I relocated from Massachusetts to Virginia, I was lucky to find a doctor I really liked. She was smart, sympathetic, had a sense of humor, and treated me like a person instead of a checklist.

But a few weeks following one of my routine checkups, I was shocked to find that the clinic had charged me nearly 3 times more than what they usually did for such a visit.

I called my insurer thinking there must have been some kind of billing error. Come to find out, that surprise bill was the result of a recent restructuring of my insurance plan. My doctor no longer worked with my employer-based health insurance and was now considered “out-of-network.” If I wanted to continue being her patient, I would have to pay the full cost for every visit out of my own pocket.

Health insurance is about as easy to grasp as quantum physics. Deductibles, out-of-pocket maximums, copayments, in-network coverage, co-insurance, accumulation periods — few people know how their health plan works, especially since plans change over time. But not knowing what your health insurance policy does — and doesn’t — cover can leave you exposed to unexpected medical costs down the road.

What do you do when your doctor doesn’t accept your health insurance? Keep reading for a few tips that might just keep you under your preferred doctor’s care no matter what your health insurance situation is.

What to Do When Your Doctor Doesn’t Accept Your Insurance

So your preferred doctor doesn’t accept your new health insurance, and you don’t want to find another provider. The first step you should take is an easy one: Ask your doctor what insurance carriers they DO accept.

Rather than finding a new doctor, you can switch to a different health insurance policy that you know your doctor will work with.

Unfortunately, Marketplace plans can only be changed during certain times of the year or for specific “special enrollment” scenarios like having a baby, getting married, losing a job, etc.

Check online to see if you qualify for special enrollment before you make any big decisions. If you’re eligible for special enrollment, this is by far the most painless solution.

But there are other options if you can’t afford the cost or hassle involved with switching policies. If you desperately want to keep your doctor, you can:

Ask your insurer to add an out-of-network doctor to their network. If your doctor isn’t in your insurer’s network, call the insurer directly to see if they’ll consider adding your doctor to their network of providers. If they refuse, ask for specific reasons why. You can also try convincing your doctor to join a particular insurer’s network. Sometimes just being determined is enough to do the trick. It may not work, but it can’t hurt to try!

•  Negotiate a discounted “cash price” with your doctor. It’s common for medical providers to limit the number of insurers they work with. The result is that patients insured through incompatible plans are forced to pay the price for medical services up-front. Thankfully some doctors will negotiate prices with patients on an individual basis, especially if there’s already a long-standing relationship. The key to these negotiations is knowing the fair price for a given health expense and working from there. Again, it costs nothing to ask, and the potential payoff is worth it.

•  Visit an urgent care center or walk-in facility. Urgent care centers and walk-in clinics are set up to treat patients with non-life-threatening illnesses and injuries like fevers or the flu, bleeding/cuts, sprains/strains, etc. They’re also good for immunizations and some diagnostic services such as X-rays and routine lab work. What’s great about these centers is that they are relatively inexpensive, don’t require appointments, and are often open seven days a week. If you can save money on “small” issues, then you may be able to afford seeing your doctor for the more serious issues that crop up from time to time.

•  Pay the difference out-of-pocket and seek reimbursement later. This one hurts. But if you have the financial resources to do so — and your doctor is too good to let go of — then you can pay for their services out of pocket and then submit insurance forms for reimbursement. It’s important to note that insurers will often apply reimbursements to your policy deductible (how much you’re expected to pay before the insurer picks up the bill) rather than give you the money outright. There’s also a good chance you will be reimbursed for only a portion of the original cost. Stay in touch with your insurer during the reimbursement process and make sure your voice is heard.

When It’s Time to Move On

Sometimes the cards just don’t play out the way you want them to. If you can’t afford to see your doctor without health insurance, and none of the above options works for you, then it might be easier to simply move on and find another doctor in your new network. Most health plans these days provide a list of physicians in their network. Call your plan directly for more information.

There are a lot of great websites out there to help you find the doctor of your dreams. Check out of collection of websites for finding a doctor in the Doctors & Hospitals category.

Being prepared for change and knowing what options are available is your best bet for making a smooth transition between providers. Comment below and let us know how your situation worked out!

What Are the Health Risks of Exercising Outside in Winter?

By Nathan Blake |1/4/17
Updated | 10/27/17

Who doesn’t love this time of year? Leaves are changing color, the breeze smells like campfire, and pretty much everything comes in “pumpkin spice” (chicken sausage, anyone?). In just a few months, you’ll be making yet another list of New Year’s resolutions.

Last year, 41% of Americans said they wanted to “live a healthier lifestyle,” while an additional 39% wanted to “lose weight.” And let’s be honest—most of us can sympathize. 40% of U.S. adults are considered obese, a record high.

But gym memberships aren’t getting any cheaper. Rising costs have inspired health buffs to develop fitness routines requiring little or no cost such as bodyweight exercises, yoga, and dancing, or incorporate old standbys like running and cycling.

What most people don’t realize is that the physical cost of cold-weather exercise can mean devastating heart and lung damage. In fact, numerous studies show that heart attack rates tend to spike in colder months, especially December and January.

Those of you who choose to brave the cold this fall and winter should be aware of the potential benefits—and dangers—that lie ahead.

Benefits of Cold Weather Exercise

It’s a myth (more like a half-truth) that chilly weather means greater weight loss. Unless you’re noticeably shivering and expending more energy than usual, your winter workout won’t burn more calories than usual.

That’s not to say athletes should hibernate until spring.

Want to improve your mood? Exercise helps combat the symptoms of seasonal affective disorder, a form of depression affecting 20% of Americans. Additionally, more sunlight exposure increases endorphin levels, putting the “sunny” in “sunny disposition.”

Some research even suggests that 45 minutes of running in cold weather can reduce flu-risk during the winter months by as much as 20-30%.

You may be able to up the intensity of your workouts in the cold, too, since hot weather has been shown to negatively impact physical performance. Factor in the lack of humidity and the invigorating wind chill, and all of a sudden colder climes don’t seem so bad for training.

But as with life in general, moderation is key.

Now for the Dangers (and How to Prevent Them)

Don’t fall into the trap of thinking you’re capable of doing the same activities in winter as you could in summer without a hitch. If you’re in excellent health, you probably won’t experience any major issues exercising outside this winter—barring accidents, of course.

However, if you have a history of heart, lung, or circulation issues, you’re putting yourself at risk for increased discomfort, injury, and even death.

Here’s what you need to be on the lookout for if you want to stay well and fit this winter.

Muscle TearsWhen temperatures drop, our bodies overcompensate to perform tasks that would be easier in milder weather. Our muscles and tendons lose more heat, which causes them to tighten up and become less flexible. This leads to muscle soreness or damage like strains and tears.

What You Can DoTake time to warm-up properly before exercising, but save the stretches for your post-routine cool-down. Ease into your workout with some light cardio instead. Brisk walking, for instance, is great for raising your core temperature and increasing blood and oxygen circulation. Common problem areas include your hamstrings, chest, shoulders, and quadriceps. Show them some extra love!

Asthma: Ever hear of exercise-induced asthma? Coughing, wheezing, chest-tightness, shortness of breath, excessive fatigue. Winter athletes frequently report these symptoms even though they may never experience them in other seasons. Cold, dry air and exercise both aggravate asthma individually. Combined, they’re downright dangerous.

What You Can Do: Cover your mouth with a mask or scarf to warm the air you breathe. If you use an inhaler, use it 15-30 minutes before exercise to open your airways, and carry it on your person at all times. You can also drink extra water, which thins the mucus in your lungs and helps your body move more efficiently.

Heart Attack: Cold temperatures can cause vasoconstriction, or narrowing of your blood vessels. As these passageways constrict, blood pressure rises, which reduces oxygen supply and blood flow to your heart. The result is your heart works harder than it would under normal circumstances. People with heart conditions are inviting additional cardiovascular strain that may result in angina or, potentially, a full blown heart attack.

What You Can DoPeople with a history of high blood pressure and/or heart disease should consult a doctor before starting a new exercise routine. Begin physical activity slowly, and give your body a break every 15-20 minutes. If you begin to feel chest pain, or pain that radiates down your left arm, call 911 immediately or visit the nearest emergency room.

Frostbite: Frostbite occurs when the body’s skin and underlying tissues begin to freeze. As blood flow slows, ice crystals form inside your cells, killing them in the process. People with frostbite will immediately notice numbness and skin discoloration in localized area(s). Left untreated, the resulting skin tissue death can result in gangrene and amputation.

What You Can Do: Limit your exposure to cold, windy, wet weather. Keep an eye out for signs of frostbite like red or pale prickling skin, and stay dry (wet clothes increase heat loss). Dress in layers; aim for clothing that is comfortable, loose, and light; and make sure your outer layer is both windproof and waterproof. If you do notice signs of frostbite, don’t rub or aggravate the frostbitten area. Instead, find shelter as soon as possible, and treat the affected area using either warm—not hot—water or body heat.

Hypothermia: Prolonged exposure to cold weather causes the body to lose heat through the skin and lungs faster than it can be produced. A dramatic drop in body temperature (generally recognized when core temperature falls below 95 degrees Fahrenheit) slows brain function, heart rate, and breathing. Soon, confusion, fatigue, and organ failure set in.

What You Can Do: Layer up, and wear a hat, scarf, and mittens to conserve body heat. Stay dry, being especially mindful of your feet and hands. Avoid alcohol and caffeine, both of which stimulate heat loss. Seek medical attention immediately if you notice any symptoms of hypothermia. In the meantime, remove any wet clothing and wrap yourself warmly in a blanket or other covering. However, do not immerse yourself in hot water. This can lead to shock.

Even though the above scenarios may sound dire, it never hurts to be prepared when it comes to your health. Stay warm this winter, but enjoy the chill. Your body will thank you come spring.

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