Preventative Services Information

Use your health insurance to stay healthy, not only when you are sick or have an emergency. All health plans purchased through Connect for Health Colorado include many preventive screenings and tests for adults and kids—at no additional cost to you. These services are free only when delivered by a doctor or other provider in your plan’s network.

Urgent Care or the ER?

Urgent Care or the ER? Know the difference BEFORE you need help!

All too often an illness or injury appear out of the blue: You wake up in the middle of the night with intense abdominal pain. You stumble while carrying groceries up a flight of stairs, and can no longer put weight on your swollen ankle. Or your baby spikes a high fever on the weekend. Whenever an illness or injury occurs, you need to decide how serious it is and how soon to get medical care. Can you wait to see your regular doctor? If not, you may need to visit an urgent care or emergency room. But which one?  While the answer is not always simple, knowing the difference between urgent care and the emergency room can save your life in a medical emergency. It can also save you a lot of time and money.

Trust your gut. If it feels serious, do not hesitate and call 9-1-1 or go to your nearest hospital emergency room. However, if your condition isn’t serious and you aren’t sure if you should wait to see your provider, call his/her office.  Even if the office isn’t open, most providers have an after-hours service that can connect you with a professional who can make a recommendation on where to go based on your symptoms.  

Urgent care clinics help fill a vital gap when you become sick or injured, your regular provider is not available, and you can’t wait for an appointment. Urgent care centers are same-day clinics that can handle a variety of medical problems that need to be treated right away but are not considered true emergencies. However, while urgent care clinics are not a substitute for your primary care physician, they are a great resource when you need care but can’t get in to see your healthcare provider. 

Hospital emergency rooms provide medical care at any time, day or night. However, unlike urgent care centers, they are equipped and staffed for even the most complex or critical needs, including life- and limb-threatening situations ranging from a heart attack and stroke to traumatic injuries following a car accident. They are equipped to provide rapid or advanced treatments (such as surgery) that are only available in a hospital setting. If your injury or illness isn’t a true emergency, (like a sore throat or sprained ankle) you may have to wait while the ER staff address more critical cases.

If you are not sure where to go, call your healthcare provider. Even if the office isn’t open, most providers have an after-hours service that can connect you with a professional who will make a recommendation on where to go based on your symptoms. Your healthcare provider or health insurance company may also offer a nurse telephone advice hotline that can make a recommendation. 

Prepare BEFORE you have a medical problem. Check with your health insurance company to find out which urgent care centers and hospital emergency rooms in your area are covered under your plan. Have their contact information, along with your provider’s in an easily accessible place, like your cell phone and by your home phone.  For a deeper dive into this topic, Scripps has a great website.
 

Health Care Fraud

WASHINGTON (AP) — More than 400 people have been charged with taking part in health care fraud and opioid scams that totaled $1.3 billion in false billing, Attorney General Jeff Sessions announced Thursday.

Sessions called the collective action the "largest health care fraud takedown operation in American history" and said it indicates that some doctors, nurses and pharmacists "have chosen to violate their oaths and put greed ahead of their patients."

Among those charged are six Michigan doctors accused of a scheme to prescribe unnecessary opioids. A Florida rehab facility is alleged to have recruited addicts with gift cards and visits to strip clubs, leading to $58 million in false treatments and tests.

Officials said those charged in the schemes include more than 120 people involved in illegally prescribing and distributing narcotic painkillers. Such prescription opioids are behind the deadliest drug overdose epidemic in U.S. history. More than 52,000 Americans died of overdoses in 2015 — a record — and experts believe the numbers have continued to rise.

"In some cases, we had addicts packed into standing-room-only waiting rooms waiting for these prescriptions," acting FBI director Andrew McCabe said. "They are a death sentence, plain and simple."

Nearly 300 health care providers are being suspended or banned from participating in federal health care programs, Sessions said.

"They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves, often at the expense of taxpayers, but also feed addictions and cause addictions to start," Sessions said.

Health care fraud sweeps like Thursday's happen each year across the country, but law enforcement officials continue to grapple over the best way to fight the problem.

The people charged were illegally billing Medicare, Medicaid and the health insurance program that serves members of the armed forces, retired service members and their families, the Justice Department said. The allegations include claims that those charged billed the programs for unnecessary drugs that were never purchased or given to the patients.

Colorado Health Insures Propose 21% Rate Higher

By Jakob Rodgers The Gazette, Colorado Springs July 15, 2017

Rates could rise about 27 percent next year for Coloradans buying their own health insurance amid turmoil surrounding Republicans' health care reform efforts and rising medical costs, Colorado's insurance commissioner said Friday.

Each insurer offering plans next year requested double-digit rate hikes on Colorado's individual market, and some have said they still might decide against participating in Colorado's health insurance exchange next year because of Capitol Hill's legislative wrangling.

"They know that at any given time, things could turn upside down," said state Insurance Commissioner Marguerite Salazar. "So I take this instability factor as a real big deal in why we're seeing the increases that we're seeing."

The filings offer the first glimpse of rates that consumers without employer- or government-based health insurance could pay in 2018. And unlike past years, many insurers appeared to be factoring in the political risk of congressional Republicans' health care reform struggle, as opposed to merely the medical risk of insuring their policyholders, health care analysts and industry members said.

A recent report by the American Academy of Actuaries echoed that observation, saying uncertainty over the Affordable Care Act's fate has contributed to rate hikes for 2018 and rising medical costs.

Anthem - the only carrier to offer plans on Colorado's exchange in every county - pegged it on rising medical and pharmacy prices and a "shrinking and deteriorating" individual market. But it also named special tax subsidies for low-income policyholders - a political bargaining chip of late - as cause for concern.

The filings were "pretty disheartening," because health analysts had expected this to be a year insurers found their footing under the Affordable Care Act, said Joe Hanel, a Colorado Health Institute spokesman.

During Obamacare's first couple of years, insurers undercut one another's prices seeking market share and resorted to a fair degree of guesswork in setting rates. Then prices rose dramatically for 2017 to compensate for sicker-than-anticipated customers.

But that turmoil was supposed to subside in 2018, Hanel said.

"It's just tough to set prices in an environment where you don't know much about who you're going to be selling to and what the regulations are going to be," he said.

Rates specific to the Pikes Peak region were not available Friday, and statewide averages varied.

Cigna proposed the largest average increase, 41 percent, and two Anthem-owned companies each requested increases topping 30 percent. Cigna blamed those hikes on the cost of care and the "evolving" nature of the marketplace.

Almost every small-group insurer - those catering to small businesses - requested rate increases averaging 7 percent statewide.

The requested rates could change, though. Colorado insurance regulators will review each filing to ensure each increase is justified and isn't too high or too low.

An announcement on approved rates is expected in late summer or early fall.

The filings mirror similar rate hikes across the nation, with many states reporting double-digit increases. And it signaled the second straight year of double-digit rate increases in Colorado.

Individual market rates rose an average of 20.4 percent for 2017 - the largest such increase since the Affordable Care Act took effect in 2014. Plan prices climbed an average of 7 percent in 2016 and 1.1 percent the previous year.

Congressional Republicans and President Donald Trump routinely point to rising monthly premiums as reason for scrapping former President Barack Obama's health law, the Affordable Care Act.

U.S. Sen. Cory Gardner, R-Colo., continued that refrain Friday.

"We need to find a legislative solution to address the growing negative impact of the Affordable Care Act," he said in a statement.

Salazar said the health law needs to be improved, but current House and Senate measures do nothing to address the underlying issue of ever-skyrocketing medical costs.

Insurance markets had actually shown signs of stability this year.

A Kaiser Family Foundation study released this week showed insurers were regaining profitability in the first quarter of 2017, meaning "no sign of a market collapse." It suggested rate hikes for 2017 were a "one-time market correction."

WASHINGTON (AP) — The Latest on the health care bill in the Senate (all times local):

8:05 p.m.

Democrats are pointing to changes in the latest Senate GOP health care bill that appear to help three states represented mostly by Republicans.

The new legislation changes how much money states that expanded their Medicaid programs for the poor last year would get. Democrats say Louisiana, Alaska and Montana would gain from the changes.

Those states are home to five Republican senators and one Democrat.

Senate Majority Leader Mitch McConnell is trying to secure Republican backing for the measure. He needs to nail down 50 of the 52 GOP senators' votes so he can push the measure through his chamber next week

Louisiana GOP Sen. John Kennedy says the "unfair treatment" under McConnell's original bill would have cost the state $2 billion. His GOP colleague, Sen. Bill Cassidy, says the change resolves a "Louisiana specific issue."

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4:15 p.m.

Senate Majority Leader Mitch McConnell's latest health care bill has something for Louisiana and its two Republican senators — money.

The Kentucky Republican's new legislation changes how much money states that expanded their Medicaid programs for the poor last year would get. McConnell is trying to nail down 50 of the 52 GOP senators' votes so he can push the measure through his chamber next week.

Louisiana GOP Sen. John Kennedy said the "unfair treatment" under McConnell's original bill would have cost the state $2 billion. His GOP colleague, Sen. Bill Cassidy, said the change resolves a "Louisiana specific issue."

Democrats said the changes seemed aimed at helping Louisiana. They said the revisions would also help Alaska and Montana — home to three GOP senators and one Democrat.

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6 a.m.

The nation's largest doctors' group says the new Republican health care bill falls short on coverage and access, particularly for low-income people on Medicaid.

The American Medical Association says in a statement that the Senate bill "does not address the key concerns of physicians and patients."

The group says Medicaid cuts and what it calls "inadequate subsidies" will lead to "millions of Americans losing health insurance coverage."

The AMA says GOP leaders took a "positive step" by adding $45 billion for treatment to help victims of the opioid epidemic. But the AMA says people dealing with addiction also need regular health insurance, and many would lose it if Republicans succeed in rolling back Medicaid financing.

The group is calling for bipartisan cooperation, starting with action to shore up shaky insurance markets

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4:20 a.m.

President Donald Trump is urging fellow Republicans to approve a health care plan in the Senate.

It "must happen," he says in a tweet while in Paris.

He says Republican senators are working hard to "get their failed ObamaCare replacement approved" and says he'll "be at my desk, pen in hand!"

The president says it's important for Republicans under Senate Majority Leader Mitch McConnell to pass the legislation and "come through as they have promised." He's crediting Vice President Mike Pence for working to get GOP senators "to do what is right for the people."

Trump's pressure comes as McConnell's revised plan faces opposition from some in his own party.