22.) Will I be able to go to the same doctors I?ve been using?
If you return to the Original Medicare Plan, it is very likely you will be able to continue seeing the same doctors and other providers you have seen through your current managed care plan. Most physicians participate in the Original Medicare Plan.

If you choose to enroll in a new managed care plan you may need to select a new primary care physician and begin using a new network of providers. Before making a decision, you should check with your doctor to see if he/she will be able to see you in whatever new arrangement you have chosen.

23.) What if I am receiving other services at home which need to continue after December 31, 2011, when my managed care plan leaves Medicare?

How can I receive assistance to make sure that I still get the care I need?
If you are currently receiving home health care, or are using medical equipment such as oxygen or wheelchairs, you need to call the phone number shown on your Medicare managed care plan identification card and ask for Utilization Management (UM). They will help you receive care under the

Original Medicare Plan or under a new Medicare managed care option.

If you select a new managed care plan, you should contact the new managed care plan as soon as possible and ask for the UM department. If you return to the Original Medicare Plan, you should tell your provider to bill Medicare directly after January 1, 2012.

24.) Will the Original Medicare Plan offer to pay for my prescription drugs?
Under current law, the Original Medicare Plan does not cover outpatient prescription drugs except in a few cases, like certain cancer drugs.

However, many Medicare managed care plans cover outpatient prescription drugs, up to certain limits. Check with the health plans you are considering to see if they cover prescription drugs. After September 15, 2011 you can find this information on the Medicare website.

25.) What if I have employer or union coverage?
If you join a Medicare managed care plan or private fee-for-service plan and also have employer or union coverage, you may, in some cases, still be able to use this coverage along with your Medicare health plan coverage. Talk to your benefits administrator about the rules that apply.

You enrolled in a Medicare managed care plan upon first becoming eligible for Medicare at age 65;
You disenroll from your Medicare managed care plan within 12 months of your original enrollment date in the managed care plan; and
You apply for the Medigap policy of your choice within 63 days of the date your managed care plan coverage ends.
17.) Are all managed care plans leaving the Medicare program?

No, but some areas of the country will lose all managed care options on January 1, 2012.

18.) Why are some managed care plans leaving the Medicare program?
Medicare managed care plans are private companies that make business decisions to contract or not contract with Medicare. Managed care plans voluntarily enter into 12-month contracts (January ? December) with HCFA to serve Medicare enrollees. Each year, managed care plans have the opportunity to choose whether or not to renew their contracts, and generally must notify HCFA by July 1 if they are not going to renew.

19) Can HCFA make Medicare managed care plans continue their contracts to provide services to Medicare beneficiaries?
No. While HCFA is responsible for ensuring that managed care plans meet their contractual obligations, we cannot require them to stay in the

Medicare program.

20) Some plans have increased their premiums and/or reduced their benefits. Why does HCFA allow plans to do this?
All Medicare managed care plans must offer the basic Medicare benefits. However, the law gives plans broad authority to offer supplemental benefits and to set premium and copayment levels.

HCFA reviews the costs of all plan benefits to ensure that additional benefits are included, if necessary, and that beneficiary premium and cost sharing amounts fall within upper limits permitted by law. As long as the premiums and cost sharing amounts remain under these limits, we have no authority to disapprove increases.

21.) Will members of managed care plans leaving Medicare be able to keep prescription drug coverage, or is new coverage being made available?
If a member currently has prescription drug coverage through a managed care plan that is leaving Medicare, this coverage will end December 31, 2011. Members have the option to enroll in other managed care plans available in their area which may cover prescription drugs. However, the Medigap policies that must be made available to most members of a withdrawing managed care plan (policies “A”, “B”, “C” and “F”) do not include prescription drug coverage.

Medigap policies that contain prescription drug coverage are available, but insurers may refuse to sell a policy based on health status, may impose waiting periods for pre-existing conditions, and may charge you more based on these conditions.

Remember, if you had previous Medigap drug coverage (plans “H”, “I”, or “J”), and this was your first time in a Medicare managed care plan, and you leave the Medicare managed care plan within 12 months, you can go back to this policy if your old insurer still sells it.

For instance, beneficiaries whose enrollment in the managed care plan began on August 1, 1999 would need to disenroll from their plan by July 31, 2011 in order to get these extra choices.

If you think you may be entitled to one of these 12-month periods, talk to your State Health Insurance Assistance Program. It is important that you not act on the assumption that you are entitled to these extra protections without getting expert help.

BUT if you are in this 12-month period, you must actively disenroll before your 12 month period ends and before you are automatically disenrolled on December 31, 2000 in order to exercise the broader choices that are available to you.

Remember, however, if you are in one of these two groups and you stay in your plan until December 31, 2000, you will still have the same rights as others who will be disenrolled at that time.

14.) What if I dropped a Medigap policy before I joined this Medicare managed care plan? Can I return to my old Medigap policy?
Maybe. If you are age 65 and over and you dropped your Medigap policy to join a Medicare managed care plan, you may be able to buy the same type of Medigap policy you had before IF:

A. The Medigap policy you dropped is still being sold by the same insurance company;
B. This is the first time you have ever been enrolled in any kind of Medicare managed care plan;
C. You leave (disenroll from) this managed care plan within 12 months of joining the plan; and
D. You apply for your previous policy no later than 63 days after coverage from your managed care plan terminates.
Before you disenroll from your managed care plan you should make sure the policy is still available from the original insurer. If the previous policy is no longer available, you are still guaranteed the right to buy a Medigap policy designated “A”, “B”, “C”, or “F” that is offered by insurers in your State. You can use your right to return to your old Medigap policy any time during the first 12 months that you are enrolled in the managed care plan.

NOTE: This right also applies if you are under age 65 to the extent policies are made available in your State to beneficiaries under 65.

15.) What if I joined this managed care plan when I first turned 65 and I have been in it less than 6 months? Do I still have a Medigap open enrollment period?

During the first 6-months an individual is both 65 years of age or older and enrolled in Medicare Part B, the individual has what is called a

Medigap open enrollment period.

During this period, an insurer cannot:
(1) refuse to sell you any of the 10 standardized Medigap policies that the insurer sells in the State, including the three called, “H,” “I,” and “J,” which contain outpatient prescription drug coverage;
(2) delay the issuance or effectiveness of the policy; or
(3) discriminate in the pricing of such policy because of your health status, claims experience, receipt of health care, or medical condition.
If you became entitled to Medicare Part A at age 65 within the last 6 months, you may still have some time left in your Medigap open enrollment period which you could use.

You did not lose it because you decided to enroll in a Medicare managed care plan when you first became entitled to Medicare Part B at age 65 or older.

16.) Do I get any special protections because I never got to use my 6-month Medigap open enrollment period because I chose this HMO instead?
Even if your Medigap open enrollment period has passed or will expire very soon, you may be guaranteed the right to buy any Medigap policy (Plans “A” through “J”). These include the three plans that cover outpatient prescription drugs.

In addition to the questions and answers below, for a copy of the Guide to Health Insurance for People with Medicare. This guide gives information on buying a Medigap policy, using Medigap insurance and other kinds of health insurance, and your rights and protections.

11.) If I choose to return to the Original Medicare Plan, can I purchase a Medigap policy?

In most cases, yes. When a managed care plan leaves Medicare, you have certain rights but must apply for a Medigap policy within certain time frames. These rights apply to all beneficiaries over age 65. If you are under age 65, these rights apply to you to the extent that Medigap policies are made available in your State to beneficiaries under age 65.

These rights are sometimes referred to as “guaranteed issue” rights. This is a good name because it means that you are guaranteed the right to buy (or “be issued”) a policy.

To get these rights, you must apply for a Medigap policy within:

63 calendar days from the date on your Final Notification Letter (which should be dated October 2, 2011); OR
63 calendar days after your managed care plan coverage ends on December 31, 2011.
If you voluntarily disenroll from your managed care plan before December 31, 2011, your 63-day guaranteed issue period will end 63 days after the date on your final notification letter, or December 4, 2011. If you remain in your plan until you are automatically disenrolled on December 31, 2011, your 63-day guaranteed issue period will end on March 4, 2012.

CAUTION: If you disenroll any time before December 4, 2011, you will still only have until December 4 to apply for a Medigap policy. If you disenroll any time after December 4, but before coverage automatically ends on December 31, you will have no Medigap protections. You should consider your options carefully if you are considering disenrolling before December 31, 2011.

If you apply for a Medigap policy within one of these two guaranteed issue periods, the seller or insurer of that policy:

Cannot deny you Medigap coverage or place conditions on the policy;
Cannot charge you more for a policy because of past or present health problems; and
Must cover you for all pre-existing conditions.
You must keep your copy of the Final Notification from your Medicare managed care plan (October 2, 2000 letter) and show it to the Medigap

Insurer as proof of your guaranteed issue rights.

Further information is available from each State?s Insurance Department or State Health Insurance Assistance Program (SHIP). The telephone number for the SHIP in your state is available.

12.) How soon will I need to make a decision about Medigap coverage?
The answer depends on your individual circumstances. Most beneficiaries should wait to make a decision until after they receive the Final Notification Letter from their managed care plan (which should be dated October 2, 2011). These beneficiaries then have 2 guaranteed issue periods to choose from, as described in Question # 11.

However, if you are getting your Medicare benefits in a managed care plan for the first time, and you enrolled within the last year, you may want to act sooner.

While you are still in the first 12 months of your first enrollment in managed care, you are entitled to broader choices of Medigap policies than are generally available to other beneficiaries who are being affected by their Medicare managed care plan withdrawals or service area reductions. (See Question #13)

CAUTION: If anyone who is NOT in their first 12-month period in managed care disenrolls and returns to the Original Medicare Plan before October 2, 2011, he/she will not have any guaranteed issue rights to purchase a Medigap policy.

13.) What are the special circumstances under which I might want to apply for a Medigap policy sooner than waiting until October, November or December?

Two groups of beneficiaries in their first 12 months of managed care enrollment are entitled to broader Medigap protections than are generally available to other beneficiaries who are being disenrolled by their managed care plan:

People who were formerly in the Original Medicare Plan with a Medigap policy that they dropped when they joined a Medicare managed care plan for the first time and are within their first 12 months of enrollment in the plan.

People who joined a managed care plan as their first choice when they first became entitled to Medicare at age 65 and are within their first 12 months of enrollment in the plan.

I keep getting severe monthly cramps, what is the cause and what can I do to prevent this?
This is known as dysmenorrhea and is a common gynecologic disorder that affects approximately 50% of menstruating women. One must keep in mind that dysmenorrhea may be caused by many different things. Cramping that appears within 1-2 years of beginning you menses is usually due to anovulatory cycles, but this cause may also be seen years after starting you period. Dysmenorrhea may also be caused by things your MD could diagnose. Such as uterine fibroids, endometriosis, ovarian cysts. These things you need to consult you doctor about diagnosis and treatment. The pain of dysmenorrhea usually begins within a few hours prior to or just after the onset of a period and may last as along as 48-72 hours. The first line treatment for this type of pain is medicines known as prosaglandin synthase inhibitors such as Motrin, Ibuprofen, Naprosyn. The medication should by taken for the first few days of menses. After seeing your doctor the patient who has no contraindications to birth control pills may also be used with very good success.”

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Is it true that the fetal heart rate is an indicator of the baby’s sex?
No. That is only one of many wive’s tales which surrounds human reproduction. The myth that a fast heart rate (140bpm) is a girl and a slow heart rate (

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No one really knows when your baby is due, but we do know that human gestation is on average 266 days from conception or 280 days from your last menstrual period. If your periods have been regular and roughly 27-30 days from first day of bleeding one month to first day of bleeding the next month, then you may take the date of your LMP or last menstrual period, add seven days, and substract 3 months to arrive at your due date or EDC (estimated date of confinement). For example, if your last period was January 14, then you add 7 to get 21; and subtract 3 months to get October; so your due date is October 21st! If your periods were irregular before you conceived or you conceived while on the birth control pill, your doctor can determine your due date by an ultrasound as early as 7-8 weeks gestation.

I’m in my first trimester and I’ve started spotting; am I having a miscarriage?
A miscarriage is another word for a spontaneous abortion (SAB) and is defined as the loss of a pregnancy anytime from conception until 20 weeks of gestation. About 15 to 20% of all pregnancies after a positive pregnancy test end in miscarriage. There are no common activities which lead to miscarriage including exercise, sex, heavy lifting, flying, or work related stress. There are also generally no ways to avoid a miscarriage in the first trimester if one is destined to happen. (The exception would be in the rare case of repeated aborters who are known to have immune system problems which can be treated early on with anticoagulants such as aspirin and heparin.)

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Researchers evaluated the distance from storm drains to swimming areas, and then they measured bacteria levels.

If the drain was 400 yards or closer, it doubled the risk of a swimmer’s exposure to bacteria.

In the study, 60 percent of the people who swam close to storm drains had intestinal problems.

What’s your best bet?

The farther you are from a drainpipe, the better — especially after a storm.

From George Bush and Dick Cheney to Al Gore and Joe Lieberman, it is God who is being acknowledged, praised, invoked and thanked for everything from the “miracle” of Senator Lieberman’s nomination to the strength for moving forward and creating change.

This is as it should be, I think, and long overdue in public life. A combination of forces — from the trend to an increasingly secular society to the “politically correct” interpretation of separation of church and state that has banned prayer at the beginning of school — has led many Americans away from the path of God. The “cool people” make fun of traditional religious values and virtues such as faith, devotion, piety, even obedience and loyalty, kindness, compassion and its outward manifestation, charity. But the rest of the American people are more than ready to rediscover those values and virtues and to talk about them openly. And it seems that the political candidates were chosen appropriately for this moment.

George W. Bush is a born-again Christian who takes his faith very seriously. Dick Cheney is a pious, serious man who invokes God as naturally as he invokes his conservative beliefs. Al Gore often sounds like a Tennessee preacher when he thanks God for his blessings and Joe Lieberman, an orthodox Jew, lives his faith daily, even keeping his Sabbath holy.

Leaders lead by example. There could be no better example for a nation filled with material things but low on emotional and spiritual fuel than very powerful men taking time to acknowledge that there is a higher power that guides our lives. This was the message of the Founding Fathers, who invoked God even on something as totally “of this world” as money. In God We Trust, they proclaimed. In the 1960s, as part of a cultural revolution that tossed out the old and traditional and embraced the new and the forbidden, God was declared dead. For a couple of decades, that almost seemed to be true, as music and movies and much of the popular culture led the way in telling us to take what was ours, by force if necessary, to indulge our every whim, to sacrifice our families for our needs of the moment. The result?

A more violent culture, one with a drug and alcohol problem, a distressingly high divorce rate and an equally high abortion rate all these years after birth control has become a relative snap, and a curious emptiness where the happiness so many were searching for ought to be.

God needs to be center stage now. Not as a club with which to beat others, but as the sure and steady force that guided Washington and Jefferson and Lincoln, Florence Nightingale and Jane Adams and Susan B. Anthony, George Washington Carver and Dr. Martin Luther King. We need to rediscover the God in all of us and to spread the word that he is alive and well and living in our hearts and minds, our words and deeds.

Long live the G-force. It will bring real power to the people.

Constantine Hering used the following visual scheme to illustrate these four dimensions of a complete symptom, and he gives it to us in his introduction to ‘The Guiding Symptoms’:
- -
- Sensations -
- -
- -
Localities – - Modalities
- Causation
Tissues – - Conditions
- -
- -
- Concomitants -
- -

It was Boenninghausen’s observation, however, that in the provings recorded in Hahnemann’s Materia Medica Pura (the original source record of provings of the remedies of his day), the recorded symptoms were often “incomplete”, that is, the recorded symptoms of any one prover may be lacking modalities, or well-described sensations, etc.

Now each of these provers presents an incomplete symptom, but taken together, we have location (hypogastrium), sensation (sore, cutting, grasping, severely clawed, colic-like), modalities (bent-forward, >tobacco), and concomitants (distention, flatus, restlessness).

Boenninghausen also observed that, in provers, these “parts” of a complete symptom were sometimes assorted differently. For example in one prover, the mental/emotional concomitant of restlessness would be seen during headache; in another, the amelioration by tobacco would be seen with the irritability; in another, the grasping, colic-like sensation would be felt in the bladder in what looked like a cystitis.

Similarly to these provers, in patients presenting with illness, symptoms are often stated incompletely, or modalities may not be clearly expressed.

Based on his extensive experience with clinical work and with provings, Boenninghausen concluded that this problem of “incompleteness” of individual symptoms in both provings and clinical cases could be solved by “analogy.” That is, that symptoms in one part of the case or proving which existed in an incomplete state could be reliably completed by analogy, by applying the strong & reliable conditions of other parts of the case. For example, when we look at the pains (whatever kinds of pains) of a Colocynthis state, we see some consistency in their being almost always cramping, grasping and colicky, better from pressure, and most often ameliorated by bending double and by heat, and we usually see restlessness as a mental/emotional concomitant symptom with the pain. So perhaps we see someone with a headache that is grasping in character, better by squeezing the head with the hands and accompanied with restlessness. Even though we might not find this exact symptom in a Colocynthis prover, we can consider Colocynthis as a possible remedy, by analogy of the sensation, modality and concomitant of their headache with those seen in pain in other locations of Colocynthis provers.

So (in this example) the strong, reliable & characteristic “parts” of the abdominal pain symptom – the sensations, modalities, and concomitants – can be considered as general symptoms of the whole person, rather than just as peculiarities of that specific symptom, and can be applied in their various combinations to other localities and tissues as well.

To deal in the Repertory with this issue of “incompleteness” of symptoms, and to be able to apply his notion of symptom completion by analogy, both in the provings on which we are basing our identifying of a simillimum, and in the clinical case we have before us, Boenninghausen divided up symptoms into their “parts” in his repertory. Rather than looking up “abdominal pain better bending double,” you will have to look up “abdominal pain” and “better bending double” to assemble your symptom.

Boenninghausen has been sadly misinterpreted as de-emphasizing the importance of mental/emotional symptoms, largely because of the difference in the way he and Kent recommended working with them in repertorization. The mental/emotional symptoms did not take to being “broken up” as elegantly as the physical symptoms did. So in his repertory he emphasized only more general states, to be used in the later stages of repertorial analysis when they were marked as strongly in the case as in the repertory listing, and suggested confirming mental/emotional symptoms of the patient directly with the words of provers as a late step in case analysis after repertorization provided a list of remedies to consider. This is not because Boenninghausen assigned a lower value to mental/emotional symptoms in the totality, but rather because he felt that the mind was a complex entity not as easily understood as the physical symptoms in this manner of breaking down symptoms into their “parts.”

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