Dr. Michael Lee graduated from Stanford University with honors and received his medical degree from the University of Chicago in 1996. Dr. Lee completed his internal medicine residency at Mount Auburn Hospital, a Harvard Medical School teaching hospital.

How do I choose health insurance for 2014? Tip #1 Look at The Out of Network Annual Out of Pocket Maximum

If you are traveling out of state and need to be treated by a doctor that is not in your network or you need to be treated at a national medicial center that is not in you network, there is one number which will become all important to you.

    The Out of Network Annual Out of Pocket Maximum.

I live in Washington and was surprised to find that every health plan on our health insurance exchange wahealthplanfinder.org that offers Out of Network coverage has an Annual Out of Pocket Maximum that is unlimited.

Let’s take an extreme case where you rack up a $200,000 bill out of network. If your deductible is $10,000 and your coinsurance is 50% (percentage you pay after you meet your deductible), you’ll also be on the hook for half of the remaining $190,000. Total expense is $10,000 + 50% of $190,000 = $105,000.

So far, I know of one insurance company, Regence Individual Direct Plans, that has an Out of Network Annual Out of Pocket Maximum of $12,500. Surprisingly, you won’t find it on the exchange. You have to go directly to the Regence website.

Bonus tip: Not all insurance plans are on the health insurance exchange websites.

So with a $10,000 deductible, your total expense is $10,000 + 50% of $190,000 (up to a max of $12,500) = $22,500. For me, the Bronze level of this plan is $280/month.

The cheapest exchange plan that offers Out of Network Annual Out of Pocket Maximum that is unlimited costs $253/month.

Most healthy people will not need to be seen out of network, but it’s at least worth knowing that there are options to limit your potential liability.

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Suboxone Film – Help for Opiate Dependence

If you or someone you know is struggling with dependence on opiate pain medications (Vicodin, Percocet, Oxycontin, etc) or heroin, there is treatment that does not require admission into an inpatient detox program.

Suboxone Film is a prescription medication that blocks the effect of opiates and eases the symptoms of withdrawal. Learn more about opiate dependence at turntohelp.com.

If you are interested in starting Suboxone treatment at our office, we’ve put together a Suboxone New Patient Packet.

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Healthcare Reform Explained by YouToons

via Stacy

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Congratulations to my patient PK! 100 lbs lost in 8 months! [Weight Loss]

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How do I choose a Medicare Part D Prescription Plan for 2012?

It’s a pain, but every year (between October 15, 2011 to December 07, 2011 for Plan Year 2012) you should enter your medicines and see which plan is the least expensive for you.

Here are a few tip to make the process a little less frustrating.

1. Click on Medicare Prescription Drug Plan Finder.

2. Scroll down to the Personalized Search and enter your information.

3. As you enter your medications, copy down the Drug List ID and Password when the window pops up. This will come in handy should that list suddenly disappear which happened to me.

4. If you’re only interested in Medicare Part D Prescription Plans, check the first option Prescription Drug Plans (with Original Medicare).

5. If you take medications consistently and don’t mind mail order, scroll down to Prescription Drug Plans, Sort Results By and choose “Lowest Estimated Annual Mail Order Drug Costs”

6. From there, I’d compare the least expensive plans, comparing the plan ratings and making sure they cover your particular drugs and in the quantity that you take monthly.

7. If money isn’t a limitation, choose a plan with no Drug Restrictions.

If you take mostly generic drugs, I found Humana Walmart-Preferred Rx Plan to be the cheapest.

If you take a few brand name drugs, Blue Shield Medicare Basic Plan might be a good option.

Update: For some reason, when I checked again on Dec 5 Medco was coming up the best plan for generics and brand name drug. Perhaps there was a plan update.

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Costco Pharmacy – You don’t need to be a member/Drug Pricing Link

If you’re not a Costco member, you can still use the pharmacy. I was told that you just need to tell the person who check membership cards that you’re going to the pharmacy.

You can find drug prices here.

While inexpensive generics are $4 for 30 tablets at most pharmacies, prices for the more expensive ones are still better at Costco. Here’s an example from my last post.

Famvir 500mg tablets 30 tablets
Costco $66.57
Target $152.47
Sam’s Club $202.88
Wal-mart $246.78

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Cold Sore Therapy Tips [Cold Sores]

About a third of adults suffer from recurrent outbreaks of cold sores which usually occur on the border of the lip, begin crusting in 3-4 days, and completely heal in 10 days.

Topical antivirals (penciclovir) or OTC (over-the-counter) Abreva decrease the duration of cold sores by a day.

Oral antivirals like acyclovir, famciclovir (Famvir), and valacyclovir (Valtrex) decrease the duration of cold sores by 2 days. Famciclovir seems like a good deal if you have insurance or are paying cash. It’s 500mg, 3 tablets taken together at one time ($7 at Costco). Remember, these medicines need to be started ASAP within 48 hours of symptoms (lip tingling, itching, burning), hours count so it’s good to get a supply to keep on hand.

Patients with frequent outbreaks may consider taking famcyclovir 500mg twice daily. The same regiment can also be used before periods of sun exposure or dental work.

If it’s your first time with an outbreak, the recommended dosage is 500mg twice daily for a week ($31 at Costco).

You can improve this by half a day by using OTC 1% hydrocortisone cream five times daily.

Cold Sore Relief (a lemon balm) should be applied as well two to four times daily at the first symptom until healed. This may shorten healing time, prevent spread, and reduce symptoms of recurring cold sores.

Try to reduce triggers such has prolonged sun exposure and stress. If you notice that you get outbreaks after eating sweets and nuts, you might try avoiding these foods.

Cold sores sure aren’t fun but hopefully this will help.

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Expensive Prescriptions with Medicare Part D Prescription Plans [Tier Reduction]

I’ve been learning that if you are on a high tier medication like Amitiza or Aricept (both Tier 3), and you have tried all the medications on the lower tier (or none exist), you can ask your Prescription Insurance for a tier reduction which changes the tier from Tier 3 to Tier 2. This substantially reduces your out of pocket cost.

Incidentally, Aricept is suppose to be generic by the end of 2010, but it’ll be around June 2011 before the price drops.

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A Great New Product for Dry Skin

My sister has just launched a new product called Hanbi Hydration Moisturizing Serum. What I’ve noticed about it is that it keeps skin hydrated and soft all day (or night) compared to other products that last only a few hours leaving skin still feeling tight and dry. If you have dry skin or eczema, you should definitely give it a try.

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My Choice for 2011 Medicare Part D Prescription Drug Plan

Every year, you should see if your Medicare Part D plan is the best value. You can change your plan between November 15 to December 31 during the open enrollment.

I found the new Medicare Prescription Drug Plan Finder a bit confusing and inconsistent, so here’s a few tips to guide you.

1. Enter your ZIP Code and other information, but when you get to Do you have Medicare Supplement Health Insurance (Medigap)? select I don’t know. I’ve found that sometimes, the website will automatically pull this information for you, other times it doesn’t.
2. After entering your drugs, copy down the Drug List ID and Password. The site times out after a few minutes of inactivity and it’s no fun re-typing in that list.
3. If you’re only interested in Medicare Part D Prescription Plan, uncheck Medicare Health Plans without drug coverage and Medicare Health Plans with drug coverage.

In 2011, I’m recommending both of my parents to go with CVS Caremark Plus (PDP) which is administered by SilverScript since it is the lowest overall cost for their medications.

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