CalPERS AND BLUE SHIELD EPO-THE FINAL DEAL

By this time (8/16/07) you have received written notification from CalPERS that the Blue Shield EPO is not an option and reviews your options for the upcoming open enrollment period for 2008.

We are now at the point CalPERS has been moving towards for the past half a decade- you have two HMO choices, and two PPO choices and you are in the unfortunate position of assigning a dollar value to being able to get any medical care outside of the Sacramento- Folsom area.

For those who are not insurance/medical industry professionals,

• HMO (Health Maintenance Organization)
• Usually, but not always, lower monthly cost.
• You have to pick a primary care doctor, whose name has to appear on your card.
• You cannot see a specialist unless your primary care doctor makes a referral to one.
• Medications largely covered, but formulary (list of covered drugs) can be very limited.
• Doctors are salaried (as with Kaiser), or paid a certain amount per patient per month (as with other HMO’s) whether they see you or not. This creates an incentive to avoid seeing you whenever possible, and as quickly as possible otherwise. This pressure in some ways relates to the method of doctor payment, and also because doctors have to take on a lot of patients to offset the costs of sick patients

• PPO (Preferred Provider Organization)
• Usually, but not always, higher monthly cost.
• You may see any doctor that accepts your insurance.
• Formulary of medicines usually less restrictive than HMO’s.

So, this is the deal: you can either choose an HMO (Kaiser or Blue Shield HMO) and go down the hill, or pick a PPO (Blue Cross PERS Choice or PERS Care) and keep your medical care here.

• Your HMO Choices:
• Kaiser
• Well, it’s Kaiser. ‘Nuf said.
• Blue Shield HMO
• I think there are two offices up here that take this HMO, but Lots of Luck.
• You still have to go down the hill for any X-Rays or specialists.
• If you have to go to Marshall ER, your doc will have to work very hard to get you sent down the hill as soon as you are stable.
• You still cannot use Sutter hospitals, which I suppose is fine as long as you never need spine or brain surgery, or never get cancer.
• Your PPO Choices:
• Blue Cross
• PERS offers two flavors called PERS Choice and PERS Care.
• They are pretty much the usual PPO type coverage, but vary between the two of them in premiums, deductibles and co-payments.
• We already have patients with these two insurances, and have had no problems with either.

The bottom line:

If you want to continue to be able to have a doctor where you and your family live, to have a choice about getting blood tests and x-rays (also CT scans, MRI and heart tests) done here and see specialists or use your local hospital it is going to cost more than Kaiser or another HMO. It may not be much more than your current Blue Shield.

We think it’s important to base your family’s medical care where you live, and we hope you will continue to do so since we enjoy having you as our patients. If you were ever unhappy with our care we would want to know about it, but we think it stinks if you have to change doctors because of insurance.

For retirees:

MediCare already covers doctor visits, ER visits, hospitalization labs and tests.

Look very carefully at what you want any secondary insurance to cover such as medicines, long-term care and so forth. It may be that PERS Choice or PERS Care may do this perfectly well, or you may want to investigate the various MediCare supplements such as Part D which covers drugs/medicines or other ones which cover long-term care and other aspects of medical care.

Travel Questions

Travel is an all year 'round opportunity for pleasure or business. Either way, it's a great way to see what the rest of the world is like and meet new people!

People often have questions from a medical standpoint about whether they need shots before leaving the country.

Really, the medical and health concerns about travel not only include shots to prevent certain types of infection, but also the treatment or prevention of foreseeable problems that may arise.

Specific travel recommendations can be found at the Traveler's Health site at the US Centers for Disease Control (CDC).

Also, you can check with the US Department of State for advise regarding political concerns involving your destinations.

Immunizations
These are also known as "shots", or "jabs" if you're from the U.K., and are administered to prevent you from getting certain bacterial or viral diseases such as tetanus or hepatitis.Shots for unusual infections (such as cholera or yellow fever) can be obtained at county public health departments and specific travel clinics.

Make sure you check for immunizations as entry requirements for other countries. If you have an immunization card or record, check it to see what immunizations you may need and which ones you may have already gotten.

Tetanus is a deadly bacterial infection that can occur from wounds. A tetanus booster within the 5-10 years before travel may be a good idea, especially if you are doing any hiking or trekking or other less usual travel. We can give this at the office.

Hepatitis A is a viral infection of the liver that can be gotten from eating contaminated food or drink. If you have had Hep A before, or had the shots for it you do not need to get shots for travel. Otherwise, getting a shot four weeks before you leave will protect you from getting Hep A for the following 6-12 months. A second shot 6-12 months after the first one is good for life. We can arrange to give you both shots. You probably want to get these shots for travel to any destination where you are instructed to avoid drinking the local water.

Hepatitis B is a viral liver infection that can be a permanent chronic infection. Most people under 30 got shots to prevent it before kindergarten as part of their routine baby shots, and would not need to worry about getting more shots. Hep B is gotten from blood transfusion, drug abuse and as a sexually transmitted disease. Getting immunization before travel would probably only be necessary if you feel you would be at risk to get exposed to it during travel, or you will be abroad for an unusually long time.

Preventive Medications
Prescription medications can be prescribe prior to departure to prevent you from getting malaria or altitude sickness. You can check with the link for CDC to find out whether you need to be concerned about malaria at your destination. Medicine to prevent altitude sickness may be helpful at destinations above 8,000 feet (2,500 meters) elevation.

Bring DEET based insect repellent!

Treatment Medications
Antibiotics (such as Bactrim or Cipro) to take in case you get diarrhea while travelling can be prescribed.
Sleeping pills (such as Ambien) for "jet-lag" can be helpful, and can be prescribed before you leave.

Prevention Overall
Staying out of trouble is better than dealing with trouble, so a few pointers:

• Take a supply of any regular medications with you.
• Bring commonly used items as well, such as band-aids, Motrin (for pain), eye drops (for eye irritation), Neosporin (topical antibiotic), Imodium/AD (for diarrhea), Lamasil/AT (topical for fungus), Benadryl (for allergy and also nausea or vomiting), meclizine (for sea-sickness) and so forth.
  
• Bring medicines in original containers or pill bottles, to avoid problems at customs.
• Don't forget spare glasses, sun glasses, micronized zinc-containing sunscreen, and mosquito repellent.
• Avoid tattoos, piercing, acupuncture, sharing razors, and casual relations while abroad.
• A flashlight is very handy.

Bottom Line

See me about 4 weeks before you are leaving the States to discuss any concerns or questions you may have, and to get any presciptions that will help you, and to receive shots that you need.

On a personal note:

Here are links to some helpful travel-related websites that I have found useful in my own travels.

TripAdvisor is a great website for general information, reviews and pictures. Igo Ugo is good, too.

This is a foreign exchange currency calculator. Also, here is a handy conversion calculator since only the US and UK don't use the metric system.

The National Weather Service website can link you to current weather conditions at any airport in the world.

The Transportation Security Administration regulates what you can bring on a plane. On the other hand, major airlines may also have their own regulations.

Bon Voyage!