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Patient Education and Health Insurance Literacy. Outreach and Enrollment Distance Learning Series. Welcome to the Outreach and Enrollment Webcast Series You can use the Join.Me Control Buttons (green) to navigate to: Connect to the call via the internet Connect to the call via the phone

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patient education and health insurance literacy

Patient Education and Health Insurance Literacy

Outreach and Enrollment Distance Learning Series

Welcome to the Outreach and Enrollment Webcast Series

You can use the Join.Me Control Buttons (green) to navigate to:

Connect to the call via the internet

Connect to the call via the phone

Use chat to ask a question to the host

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

o e distance learning series
O&E Distance Learning Series

Visit CHAMPS Distance Learning Page for more information

  • Making the Business Case for O&E
    • Monday, May 5, 2014, 1:00PM – 2:30PM Mountain Time
  • Best Practices for Young Adult Outreach
    • Tuesday, May 20, 2014, 2:00PM – 3:00PM Mountain Time
  • Maximizing O&E Staff and Continued Enrollment
    • Tuesday, June 3, 2014, 1:00PM – 2:30PM Mountain Time
  • Rural Outreach Strategies
    • Tuesday, June 24, 2014, 10:00AM – 11:00AM Mountain Time
  • Outreach to Special Populations
    • Tuesday, July 22, 2014,10:00AM – 11:00AM Mountain Time
  • Planning for Successful Outreach
    • Tuesday, August 19, 2014,2:00PM – 3:00PM Mountain Time
  • Diving Deep on Premium Tax Credits
    • Tuesday, September 23, 2014,10:00AM – 11:30AM Mountain Time

www.champsonline.org/events/distancelearning

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

community health association of mountain plains states champs
Community Health Association of Mountain/Plains States (CHAMPS)

www.champsonline.org

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

colorado community health network
Colorado Community Health Network

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

presented by
Presented by:

Liz Tansey

Colorado Community Health Network

Covering Kids and Families

Community Health Center Outreach and Enrollment Training Coordinator

[email protected]

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

learning objectives
Learning Objectives
  • Educate consumers on how health insurance works
  • Educate consumers on when to seek what type of medical care
  • Educate consumers on how to retain their health insurance

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

health insurance literacy
Health Insurance Literacy

Low health insurance literacy causes

  • Problems obtaining, processing, and understanding basic health information and services

Causes

  • Low language literacy
  • Low health literacy

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

the value of health coverage
The Value of Health Coverage

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

resources
Resources

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

terminology
Terminology

Premium

  • Set amount of money
  • Paid to the health insurance company
  • Typically paid monthly
  • Keeps coverage active

Deductible

  • Set amount of money
  • Paid to the provider
  • Must be met before insurance company pays
  • Shares costs among patient and insurance company

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

terminology1
Terminology

Co-pay

Co-insurance

Set amount of money

Paid to the provider at the time of service

  • Set percentage of health care costs after deductible has been met
  • Generally billed later

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

in network vs out of network
In-Network vs. Out-of-Network

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

medication tiers
Medication Tiers
  • Prior authorization
  • Step therapy
  • Quantity limits

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

samantha s coverage
Samantha’s Coverage

Premium: $117/month

Deductible: $600

Co-pay for office visits: $30

Co-insurance: 20%

Out-of-pocket maximum: $1,500

Skiing Accident

Co-pay: $30

Tests and X-rays: $600

Wellness Visit

20% of lab test costs

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

educating patients
Educating Patients
  • Handouts
  • Workshops
  • Group appointments
  • One-on-one appointments
  • Community events

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

utilizing coverage
Utilizing Coverage
  • When to visit the ER
  • When to visit the CHC
  • How to prepare for an appointment

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

emergency care
Emergency Care
  • An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm
  • Emergency room care should only to be used in the case of an emergency

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

primary care t hrough the chc
Primary Care Through the CHC
  • Illness
  • Minor injuries
  • Lifestyle changes and support
  • Health screening
  • Wellness visits
  • Care coordination
  • Disease management

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

preparing for an appointment
Preparing for an Appointment

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

appealing
Appealing
  • Check the details of the insurer’s appeals process
  • Have all the paperwork in order
    • the bills from the provider
    • the patient’s explanation of benefits
    • copies of denial letters
    • medical records
    • letters from the provider
  • Enlist the help of the provider
    • Take detailed notes when speaking with the insurance company
    • time and date
    • length of the call
    • the name and title of the person you speak with
    • all the details of the conversation
    • follow-up activities and next steps by all parties
    • Write down the argument
    • Follow up 

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

timeline of appeals process
Timeline of Appeals Process
  • Urgent Care – 72 hours
  • Non-urgent care not yet received – 30 days
  • Non-urgent care already received – 60 days

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

staying enrolled
Staying Enrolled
  • Private insurance
    • Pay premiums
    • Report life changes
  • Medicaid/CHIP
  • Future open enrollment periods

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

paying premiums
Paying Premiums

James

Covered

Grace Period

$100 due

Grace Period

$100 due

Grace Period

$300 Paid

John

Grace Period

$100 due

Grace Period

$100 due

Grace Period

$300 Unpaid

Uninsured

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

reporting changes
Reporting Changes

Qualifying Life Events

Reporting to HealthCare.gov

Moving to a new state or service area

Losing another type of health coverage

Changes in citizenship or immigration status

A change in income

A change in household status

A change in family size

Online

Log in

Select application

Select “Report a life change”

By phone

1-800-318-2596

Reporting to Connect for Health Colorado

Call 855-PLANS-4-YOU (855-752-6749)

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

staying enrolled in public insurance
Staying Enrolled in Public Insurance

Administrative Renewals

Non-Administrative Renewals

If eligible, enrollment continues with no action needed

If no longer eligible, a denial is available so patient can shop for insurance through the marketplace

The patient can appeal coverage decisions

Patient sent pre-populated form

30 days to confirm, sign, and return

If eligible, enrollment continues

If no longer eligible, a denial is available so patient can shop for insurance through the marketplace

The patient can appeal coverage decisions

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

future open enrollment periods
Future Open Enrollment Periods
  • November 15, 2014 – February 15, 2015
    • January 1, 2015 coverage
  • No insurance?
    • Sliding fee scale
    • Referrals
  • Planning for the future
    • Emails
    • Text messages
    • Post cards

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

advocacy resources
Advocacy Resources

The Coverage Gap

Medicaid expansion advocacy

Work with your state PCA

Work with CHAMPS

Work with NACHC

Work with other community organizations

The Family Glitch

Federal rules change

Federal advocacy

Work with your state PCA

Work with CHAMPS

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

additional terminology resources
Additional Terminology Resources

Department of Labor Glossary of Health Coverage and Medical Terms

How Health Insurance Works Infographic by Adelante con la Salud Latino Health Care Engagement Project in Colorado

Families USA Glossary of Insurance Terms (English or Spanish)

Enroll America’s Get Covered Guide (English or Spanish)

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

additional resources
Additional Resources

From Coverage to Care Roadmap by CMS (English or Spanish)

Partnership for Prescription Assistance website

Kaiser Health News/National Public Radio Appeals Story

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

thank you for participating

Thank you for Participating

Please join us Monday, May 5 from 1:00-2:30 p.m. MT

Making the Business Case for Outreach and Enrollment

With Northwest Regional Primary Care Association

Please join us Tuesday, May 20 from 2:00-3:00 p.m. MT

Best Practices for Young Adult Outreach

With Enroll America

Link to survey

CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

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