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Ninety percent of Americans have never emailed or texted with their doctor. Should they?

The average American writes a novel’s worth of email every year. They also read a novel’s worth of trend stories about how all we do is text — how 15 million texts sent every minute are destroying the art of conversation, rotting our souls.

Still, only about one in ten Americans has ever emailed or texted with their doctor. The formal in-office face-to-face patient-doctor dynamic is largely sacred.

In a survey conducted for a well-known newspaper in conjunction with GlaxoSmithKline, 1000 Americans talked about their tech habits.

Seventy-three percent said they had “doctors and dentists whom they can access regularly.”

So, why isn’t access to doctors more electronic? Confidentiality is one concern, and not every patient wants to text — but a lot more than ten percent do.

Many doctors just don’t have a system to accommodate texting and emailing with patients.

How often is too often?

During what hours?

When is it a billable service?

Of course a patient should still come into the office for any substantial concern. No one’s recommending attaching an image to an email, subject line “this is a broken arm?”

But checking in with quick questions can allow doctors to triage what really warrants an in-person office visit — which costs, on average $130-$180; $580-$700 if it’s an emergency room — and what can be accommodated remotely.

All by the means of communication that has defined the rest of modern society for a decade.

Tech-savvy practices and hospitals are increasingly using remote access systems for patients, where they can log in to a website and get test results or leave messages for physicians, within a secure system, in a limited capacity.

That’s a good place to start. It keeps all interactions in one HIPAA-compliant place and keeps doctors’ personal phones and emails from being overrun by concerned patients.

If a busy primary care physician has 1,500 patients, even if each one only emailed him every six months, that would be eight emails 365 days a year.

But some doctors, expecially specialists with a smaller patient base who manage fewer chronic conditions, have been able to integrate texting into their practice.

There are HIPAA-compliant text and email platforms, and most major insurers are figuring out ways to cover “digital visits.”

For people who don’t have that sort of access to a doctor yet, the increasingly immediate option is Internet self-service.

This survey found that people are generally reasonable about taking medical information from the Internet for what it’s worth, not acting on it until they have talked it over with a doctor.

Surprisingly though, a third of people said they have never looked up their symptoms or conditions online.

Then what do people use the Internet for, if not to figure things out about the nature of their bodies?

Of those who do, here’s where they go:

Yahoo! Health

NIH (National Institute of Health)


Medicine Net

Mayo Clinic

Weight Watchers



Here’s how people generally use these sites:

– doctor reviews

– exercise information

– second opinion

– nutrition information

– determine the need for a doctor

– self diagnosis

– learn and educate about a health issue

And even though a third of people haven’t gone online to read about medical things at all, a significant number are on board with paying to consult their doctor via text or email. Especially wealthy and rural people.

Some go so far as to be willing to communicate with their doctors primarily online. That includes about a third of people under age 30.

Not asked in the survey, but presumably few people would be willing to communicate with their doctor via telegraph. Times are changing. What’s next? Doctors stop carrying giant one-way pagers?





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Under the Patient Protection and Affordable Care Act, applying for benefits could be as daunting as doing income taxes.

The government’s draft application runs 15 pages for a three-person family. An outline version has 21 steps, some with additional questions.

Just six months before the October 1, 2013 start of enrollment season for millions of uninsured Americans, the idea that getting health insurance could be as easy as shopping online at Amazon or Travelocity is starting to look like wishful thinking.

At least three major federal agencies, including the IRS, will scrutinize applications. Checking identity, income and citizenship is supposed to happen in real time, if applying online.

That’s just the first part of the process, which lets a person know if they qualify for for financial help. The government asks income questions because PPACA is means-tested, with lower-income people getting the most generous help to pay premiums.

Once finished with the money part, actually choosing a health plan will require additional steps, plus a basic understanding of insurance jargon by an independent insurance agent.

HINT: Even better than waiting until October 1, 2013, get coverage now. With insurance underwriting, it could save premium dollars.

The government process is a mandate, not a suggestion. The law says virtually all Americans must carry health insurance starting next year, although most will just keep the coverage they now have through employment, including Medicare and Medicaid recipients.

It is a concern that a lot of uninsured people will be overwhelmed and simply give up.

The lengthy draft application will take a considerable amount of time to fill out and will be difficult for many people to complete.

The online application will take 30 minutes, on average, and the paper application is estimated to take an average of 45 minutes.

Uninsured people will apply through new state-based markets, also called exchanges. And the new coverage starts January 1, 2014.

Middle-class people will be eligible for tax credits to help pay for private insurance plans, while low-income people will be advised to safety-net programs like Medicaid.

Health and Human Services estimates receiving more than 4.3 million applications for financial assistance in 2014, with online applications accounting for about 80 percent. Because families can apply together, the government estimates 16 million people will be served.

Here are some pros and cons on how the system is shaping up:

PRO: If applying online, near-instantaneous verification is available. An online government clearinghouse called the Data Services Hub will ping Social Security for birth records, IRS income data and Homeland Security for immigration status.

CON: If household income has changed in the past year and help is needed to pay premiums, some extra work will be involved. Help is based on expected income in 2014, but the latest tax returns are for 2012. More documentation must be provided.

PRO: Even with all the complexity, the new system could end up more simplified thanks to public input. There is no medical questionnaire, although a disability needs to be disclosed. And even if disabled, coverage is still available for the same premium as someone not disabled.

CON:If anyone in a household is offered health insurance on the job but does not take it, there will be some particularly head-scratching questions. For example: “What’s the name of the lowest cost self-only health plan the employee listed above could enroll in at this job?”

The process should help people make apples-to-apples comparisons of costs and coverage between health insurance plans and learn if there is any break in costs.

What if a person just wants to buy health insurance in their state’s exchange, and they are not interested in getting any help from the government?

An application still must be completed, but it’s shorter.








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When we hear something once, we might pay attention but when we hear the same thing from totally unrelated people, don’t we begin to suspect there’s a trend? 

Some of the conversations a person can have with long-term care insurance claim departments are most enlightening and interesting.

Two different claim departments from two different leading LTC carriers regularly get LTC claims submitted 12 or even 24 months after the claim event. Surprised?

Why on earth would someone wait that long to receive the money for which they are entitled?

It’s because the family “just found” the LTC policy!

The insured needed daily living assistance, was not communicative, and the family just “happened” to find the policy in a shoebox or file cabinet in the basement.

Have you ever been into the basement of the house that someone has lived in for 30 years and tried to find a specific file?

It is wonderful that a policy gets found and even more wonderful that the carrier is paying “late” claims, even though some of which they are no longer contractually obligated to pay.

What about the LTC policies on other insureds that never get found?

If some do get found, others surely do “not” get found.

Caregivers and families can tell many stories about luckily finding policies or, on the other hand, “knowing” mom or dad bought a policy, but they could never find it once it was needed.

These are not isolated incidences, according to LTC carriers. And it goes without really saying that certainly if someone lapses their policy, it’s a whole different story. It’s a person’s right and decision.

But what about the person who is paying the premiums for the duration and the carrier gets a bye on the contractural agreement because the policy was not found?

The claimant made a smart choice when buying the policy, but in the end the family loses a lifetime of assets and now the family home has a lien and the insured is on Medicaid in a Medicaid facility.

This just cannot be right! Sure, the policies that eventually get found get paid as agreed, but then the assets might be gone, mom or dad is in a Medicaid facility, and now the family gets a $200,000 check.

At this point it’s better than nothing for the family, but not for mom or dad.

We can hear the family discussions now…

“I sure wish mom had bought long-term care insurance because she really wants to remain at home in her house of 30 years.”


“Dad did buy a policy, but never told anyone, which is exactly like not buying a policy at all.”

The insurance carriers and regulators require a designated third-party in case the premiums aren’t paid. What about a third-party to make sure a claim is filed?

Perhaps a third-party notification memo should be created at the time of purchase. The new policyholder is then able to designate several people who get notified about the policy purchase.

Yes, these people may or may not be around 25 years later at claim time, but most certainly the odds of that effort outweigh the strategy of hope.