Omaha Insurance Solutions - August 2022

CHANGING THE SCOPE OF EXERCISE LIVE LONGER AND STRONGER

Cycling Whether it be in a class or outdoors, cycling can be very beneficial for stiff or sore joints. You’re able to get your blood flowing and build muscles in the front and back of your legs as well as your hips. Your arms are also strengthened due to the resistance of balancing your arms and shoulders to steer. Yoga Holding a series of poses can stretch and strengthen your muscles, tendons, and ligaments. It also helps lower heart rate and blood pressure and can even relieve symptoms of anxiety and depression. For older adults, a well-rounded workout that consists of endurance, strength, balance and flexibility can help in many ways. Some can even be fun!

Your body undergoes a variety of changes over the years, many of which are degenerative and can be debilitating to your health. But exercise can help slow these age-related issues, like heart disease or high blood pressure, and even prevent them in the long run. Here are four ways you can get moving without overexerting yourself.

diseases like osteoporosis. If you want to sweat it out some more, jogging might be a great alternative. But remember to be kind to your joints: Walk at a pace you’re comfortable with, wear supportive shoes, take breaks as needed, and walk on soft surfaces, like tracks or grass. Gardening While gardening doesn’t seem as vigorous as other exercises, it is a hearty physical activity. Digging around in the dirt is actually great for your immune

Walking or Jogging Taking a stroll around the

neighborhood or a few laps around the

system, and it strengthens your arms, legs/knees, and balance. Mycobacterium vaccae, which

park can help build stamina, strengthen lower body muscles, and help fight against bone

is a bacteria commonly found in gardening soil, can alleviate symptoms of allergies, asthma, and even psoriasis.

3 SURPRISING ASPECTS OF CLAIM DENIAL AND A SOLUTION

Denial of claims is an important concern for clients. Many people have had the experience of an insurance company denying a claim or not approving a procedure. Some situations are highly charged because the health issue may be life-threatening and the treatment very expensive. When people come to Medicare, they intuitively ask if this could be a problem: Will Medicare or the insurance company deny coverage? There is always the possibility. A Harvard and University of Pennsylvania study identified $416 million worth of denied spending, or $60 of denied spending per beneficiary annually. Traditional Medicare coverage rules comprised 85% of denied services and 64% of denied spending, while Aetna’s Medicare Advantage plans made up the rest of the denials. The sample was nearly 3 million beneficiaries.

Advantage. The Medicare billing system is not remotely as complex as the billing system CMS (Center for Medicare & Medicaid Services) imposes on the insurance companies that offer Medicare Advantage plans. My second surprise from the study was the average cost of the claim denial: $60. When you hear about Medicare or Medicare Advantage denying a claim, your mind runs to big bills and life- critical treatments. An average denial of $60 puts the issue more into context. The third surprise was that the most significant denial was for low-value lab services and, after that, experimental or investigational services. Many times, clients will call when an issue arises with their coverage. When an issuing company and/or Medicare is saying no to a

procedure, I find the denial is usually rooted in a lack of supporting documentation.

Doctors’ offices and hospitals are busy. The billing codes are voluminous and complex. The miracle is that there are not more problems with medical procedures. Usually, the

issue comes from a lack of communication. Medicare

and/or the insurance company is not receiving the necessary reasons for the treatment.

When people call with a denial problem, I send them back to the doctor’s office with some suggestions on how to present the subject matter. Usually, we find out the case was not well presented. On the second try, the request is approved. Medicine, insurance, and administration are all very human. Mistakes need to be forgiven, and guidance and encouragement offered.

I was surprised that Medicare had a higher percentage of denial than Medicare

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