Presentation is loading. Please wait.

Presentation is loading. Please wait.

Outreach and Enrollment Distance Learning Series Patient Education and Health Insurance Literacy Welcome to the Outreach and Enrollment Webcast Series.

Similar presentations


Presentation on theme: "Outreach and Enrollment Distance Learning Series Patient Education and Health Insurance Literacy Welcome to the Outreach and Enrollment Webcast Series."— Presentation transcript:

1 Outreach and Enrollment Distance Learning Series Patient Education and Health Insurance Literacy 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 1 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

2 O&E Distance Learning Series Visit CHAMPS Distance Learning Page for more informationPage 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 2 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

3 Community Health Association of Mountain/Plains States (CHAMPS) 3 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

4 Colorado Community Health Network 4 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

5 Presented by: Liz Tansey Colorado Community Health Network Covering Kids and Families Community Health Center Outreach and Enrollment Training Coordinator 5 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

6 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 6 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

7 Health Insurance Literacy CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 7 Low health insurance literacy causes Problems obtaining, processing, and understanding basic health information and services Causes Low language literacy Low health literacy

8 The Value of Health Coverage 8 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

9 Resources CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 9

10 Terminology 10 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

11 Terminology Co-payCo-insurance 11 Set amount of money Paid to the provider at the time of service If the co-pay is$35 And the health care visit costs$100 The patient pays$35 The insurance company pays$65 If the co-insurance is20% And the health care visit costs$100 The patient pays$20 The insurance company pays$80 Set percentage of health care costs after deductible has been met Generally billed later CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

12 12 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

13 In-Network vs. Out-of-Network 13 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

14 Medication Tiers 14 TierCo-paymentPrescription Drugs Covered 1$Most generics 2$$Preferred, brand name 3$$$Non-preferred, brand name Specialty$$$$ or high co-insuranceUnique, very high cost Prior authorization Step therapy Quantity limits CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

15 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 15 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

16 Educating Patients 16 Handouts Workshops Group appointments One-on-one appointments Community events CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

17 Utilizing Coverage 17 When to visit the ER When to visit the CHC How to prepare for an appointment CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

18 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 18 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

19 Primary Care Through the CHC CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 19 Illness Minor injuries Lifestyle changes and support Health screening Wellness visits Care coordination Disease management

20 Preparing for an Appointment CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 20

21 Appealing CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 21 1.Check the details of the insurer’s appeals process 2.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 3.Enlist the help of the provider 4.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 5.Write down the argument 6.Follow up

22 Timeline of Appeals Process CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 22 Urgent Care – 72 hours Non-urgent care not yet received – 30 days Non-urgent care already received – 60 days

23 Staying Enrolled Private insurance Pay premiums Report life changes Medicaid/CHIP Future open enrollment periods 23 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

24 Paying Premiums James John Grace Period $100 due Grace Period $100 due Grace Period $100 due Grace Period $300 Unpaid Grace Period $100 due Grace Period $300 Paid Covered Uninsured 24 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

25 Reporting Changes Qualifying Life EventsReporting 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 25 Online Log in Select application Select “Report a life change” By phone Reporting to Connect for Health Colorado CHAMPS/CCHN Outreach and Enrollment Distance Learning Series Call 855-PLANS-4-YOU ( )

26 Staying Enrolled in Public Insurance Administrative RenewalsNon-Administrative Renewals CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 26 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

27 Future Open Enrollment Periods CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 27 November 15, 2014 – February 15, 2015 January 1, 2015 coverage No insurance? Sliding fee scale Referrals Planning for the future s Text messages Post cards

28 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 28 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

29 Additional Terminology Resources Department of Labor Glossary of Health Coverage and Medical TermsGlossary How Health Insurance Works Infographic by Adelante con la Salud Latino Health Care Engagement Project in ColoradoInfographic Families USA Glossary of Insurance Terms (English or Spanish)English Spanish Enroll America’s Get Covered Guide (English or Spanish)English Spanish 29 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

30 Additional Resources From Coverage to Care Roadmap by CMS (English or Spanish)English Spanish Partnership for Prescription Assistance websitewebsite Kaiser Health News/National Public Radio Appeals StoryAppeals Story CHAMPS/CCHN Outreach and Enrollment Distance Learning Series 30

31 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 Thank you for Participating 31 CHAMPS/CCHN Outreach and Enrollment Distance Learning Series


Download ppt "Outreach and Enrollment Distance Learning Series Patient Education and Health Insurance Literacy Welcome to the Outreach and Enrollment Webcast Series."

Similar presentations


Ads by Google