Latest Technology Gadgets of 2008 – Arghh! I Know ’em

Curtains for 2008 are coming down in few days from now and if you see the developments the years witnessed, for instance the latest technology gadgets of 2008, it had been all complex devices that could perform intensive and incredible tasks. These latest gadgets 2008 are indeed with simple designs and several of them even user friendly, iPhone is one for sure. Most of the so-called latest technology gadgets are uni device multiple task performers. In fact the advent of nanotechnology enabled to device smaller gadgets that perform several functions while being nano in size. So said, it should be admitted that most of the latest electronic gadgets are designed for comfort, safety and weekend entertainment area. Iphone has revolutionized the communication and in fact changed its face and the latest technology gadgets of 2008 has given us the Apple 3G which is the world’s first multi-touch screen gizmondo. Other high-end gadgets include the tablet PCs, electronic medical equipment, Bluetooth calls, mobile entertainment devices, voice commands and visual/audible traffic rerouting as well as complex car systems with GPRSs.

And did I mention about the accelerometer sensor used in the iPhone technology and other high-end handsets? The technology enables a phone to rotate its image automatically when it is turned sideways. Another technological advancement is the ambient light sensor that detects changes in the light conditions and adjusts the display brightness automatically and the proximity sensor senses things that are larger than fingers when they come close and turns off the display in order to save power and accidental key presses.

In the healthcare industry, one of the major developers of latest gadgets in technology in 2008 had been Philips. Cliniscape is used to keep updates of each patient’s health condition by providing uses information of blood containers, medication and others. It is from the Philips and is used as a mobile point of care device in order to access medical applications such as iSite PACS medical image, clinical information Portfolio and information management system. And the latest computer gadgets in the field of education is the XO laptop which can be used at anytime and any place. Another innovation is the TI graphing calculators that can be used to solve complex math-related calculations. These calculators have large 3.5-inch display and more familiar mouse-like controls and spreadsheet capabilities, etc. The MacBook Air is the world’s thinnest laptop is another innovative product and a run away hit during 2008. The laptop is again by the iPhone manufacturers, Apple. The latest auto gadgets include car GPS, Bluetooth car starter, ozone air purifier, Driv-e-mocion and LED rims, etc.

Best Small Business Tips and Ideas

Deciding to start a business can be one of the most exhilarating decisions you make in your life. We are living in a world wherever everyone wants to make extra money and add to his income. Most people have achieved this by acquiring great business ideas. When one starts up a company, he must be ready to meet competition. It is important to note that you would not need to become rich or popular to succeed in business but have to think smartly. But there are a lot of moving parts and many different elements to consider.

10 basic tips essential to start a business successfully.

Tip 1: Get inspired and Love your idea

Every business begins with an idea you may have imagined of opening your own business for years, or motivation may have hit you suddenly. Nevertheless of the source, the first step of starting your own business is coming up with a business idea. And as important as your idea, you must in love with the idea.

Tip 2: Do Your Research / learn everything about the business

You’ve recognized your big idea, now it’s time to balance it with the reality. Are you truly ready to start a business? Answer the questions below and see what you need to prepare yourself for business. For a small business succeed it must fulfill a need, solve a problem or offer something the market wants.

You can identify this need in many ways by doing research, focus groups, and even trial and error.

As you search the market, some of the questions can be:

• Is there a need for your anticipated services or products?
• Who needs it? (Target Costumers)
• Are there other companies offering similar services or products right now?
• How is the competition?
• Can or how will your business fit into the market?

Tip 3: Make a Business Plan

You need a business plan in order to make your business idea a reality. If you expect to seek monetary support from an investor or financial organization, a formal written business plan is a must.

Even if you don’t need monetary support, a simple business plan can give you precision about what you hope to accomplish and how you plan to do it.

In overall, your business plan should summary your business goals and the inspiration behind them, as well as your plan for realization of your goals in terms of marketing and funding.

Tip 4: Planning Finances

Opening a small business doesn’t have to involve a lot of money, but it will involve some investment.

There are a number of methods you can fund your small business:

• With Small business grants
• By Financing
• With Small business loans
• Or Angel investors

You can also attempt to get your business off the ground by bootstrapping, using as little capital as necessary to start your business.

Tip 5: Business Structure

Your small business can be an individual ownership, a partnership, a limited liability company (LLC) or a corporation. The business structure you might choose will impact in many factors from your business name, to liability, and how you file your taxes.

You can choose an initial business structure, and with time re-evaluate and change your structure as your business grows and needs to be changed.Tip 6: The Business Name

The name you choose plays a role in almost every aspect of your business, so you want it to be a good one. Make sure you think through all of the possible consequences as you explore your options and select your business name.

Once you have selected a name, there is the need to check if it’s trademarked, currently in use and if stills free you will need to register it. A individual proprietor must register their business name with either their state or county clerk. Corporations, LLC, or limited corporations usually register their business name when the creation paperwork is filed.

These days you need to have a website, so please don’t forget to register your domain name once you have selected your business name. The best domains and more valuable online are the ones ending with .com.

Tip 7: Licenses and Permits

There are a range of small business licenses and permits that may apply to your situation, depending on the type of business you are starting and where you are placed. You will need to inquiry what licenses and permits apply to your business during the initial process.

Tip 8: The Business Location

Setting up your place to work is essential for the operation of your business, whether you will have a home office, a shared or private office space, or a retail location. You will need to reflect about your place, equipment, and overall setup, and make sure your business place works for the kind of business you will be doing.

Tip 9: Accounting System

One of the most essential systems for a small business is an accounting system. Your accounting system is essential in order to build and manage your budget, set your charges, conduct business with others, and file your taxes. You can set up your accounting system by your own, or hire an accountant to take away some of the work.

Tip 10: Promote Your Small Business

As soon your business is up and running, you need to start attracting customers. You’ll want to initiate with the essentials by writing a single selling offer and building a marketing plan. Explore as many small business marketing ideas as you can so you to choose how to promote your business most successfully. Completed these business start-up actions, you will have all of the most important small business bases protected, and be prepared for small business success.

15 Business Ideas to Generate Extra Income

If you want or need to start a side job because you still need to wait a little bit longer to start your own business, here are 15 suggestions for you.

1. Make money Blogging

If you enjoy writing, find a theme you’re passionate about and start a blog dedicated to covering that theme and anything else interesting you enjoy to talk about. All you need is a laptop, some time, and inspiration to consistently write. It can start as a hobby and turn into a business over time. Creating a blog is free, but if you want to look professional it can cost less than $ 12 per month.

2. Buying or selling on eBay

Thanks to internet there are more opportunities to make money than ever to buy and resell products for extra money. There are lots of people buy at a discount and resell them on eBay for profit.

3. Freelance writing

If you’re great with words, you might be capable to find some work as an online freelancer. A variety of publications need online content in the form of product, stories, service descriptions, and reports, and if you have the talent and ability, you could easily be the one to create them. Luckily, all you need is a computer and Internet connection to get started. You can start here freelancer.com

4. Social media expert

Now a day almost everyone uses Facebook, Twitter, and Pinterest, but did you know that many companies are willing to compensate people to support them managing their social media accounts and sometimes you can do it part-time from home. If this appeals you, to find social media jobs you can start by writing companies with a social media presence and visiting sites like Elance.com for opportunities.

5. Proofreading and editing

Do you have strong English skills and outstanding grammar? You may have chances to work as a proof-reader from home. Marketing for this can be hard; seek out those who might actually be able to use your services and advertise directly to them.

6. Virtual assistant

Many companies and individual professionals like having someone who can check and answer their email, organize task lists for them, someone who can update their calendars, and perform other administrative tasks, with minimal communication. The best of being a virtual assistant is that you can offer this service from home with a good Internet connection.

7. Website design

If you know a little bit about web design you can approach small businesses in your community, as they could use a very basic web presence to tell others about their business. These businesses usually don’t have a large budget for websites and create a great yet simple website is for you, get a bunch of clients from your local community, create sites for them, and maintains them for a small fee. You can easily get enough businesses to have a nice side business of your own with a low investment.

8. Affiliate marketing

Certain types of online businesses will pay you to promote their products and encourage sales. If you’re interested in learning more, check out affiliate marketing programs such as Click-bank, Commission Junction, and these websites are trustworthy and you can earn money by posting their products in your blog, website or Facebook. The secret of online business is all knowing targeting the right public and marketing efficiently. It can be overwhelming with all the information available online as more than 50% of the information is just a waste of time.

9. Become a business or life coach

If you are a good speaker and passionate about the business world and able to inspire and encourage others in a unique way, you could marketing your services as a business or even a life coach. Take your passion and expertise to the next level giving advice and suggest actionable steps people can take to progress their professional and private lives. 10. Start a resume writing service

If you’re excellent at writing remarkable resumes that in the end result in people getting the job, contemplate advertising those services. Most of your work will spin around writing, editing, designing, and proofreading, so you will only need few supplies outside of your computer and basic software to get started.

11. App Developer

Web app development is the creation of application programs that reside on remote servers and are delivered to the user’s device over the Internet. Now a day you can do apps with software’s you don’t really need to be a weirdo to do it, you can be an app developer for Facebook for instance and of course you can do it part-time and home based.

12. Business Consultant

If you are high organized and skilled being a good problem solver this job is for you. Companies bring Business Consultant to identify their problems, provide solutions and optimize companies. The only investments are your skills.

13. Data Entry Service

Many companies and online businesses require some type of manual information tracking, creating a vast amount of data entry work. Although there are many work-at-home scams related with data entry work, there are a lot of genuine chances available for genuine data entry businesses. If you are an excellent typist with an eye for detail, a data entry business is a great idea for you.

14. Freelance Writer

If you have the skill to write and inform people in a certain area, you can write small books or guides and sell them online, the biggest books platform is Amazon.com, where you can display your books for free and when they are sold, you will receive a percentage from the selling. Payments are made every month depending on your sales. Investment is only your time to write and imagination.

15. Internet Researcher

The Internet provides a vast amount of information. If you can quickly and efficiently navigate through that wealth of information, and essentially find a needle in a haystack, you can create a very successful business as an Internet researcher. Search for this kind of job online or about a company which is looking for this of service.

I give you only a glimpse what you could do, and these are just a few ideas, but many ideas were left behind.

First of all I advise you to think what you like to do as a hobby or in your free time, why don’t you make profit from what you are doing already?

You have the world as your disposal, but for a business to work out the first thing from all things is, it doesn’t matter what you intent to do, but you have to love it. If you love what you do it doesn’t feel like a job, you will be doing it with joy and this way you will be successful.

There are some side business opportunities that have grown more common in the past few years. And thanks to internet you have much more opportunities, ideas and help to develop your business.

Real Estate Agents and the Internet – How to Buy and Sell Real Estate Today

Then and Now

Ten years ago, a search for real estate would have started in the office of a local real estate agent or by just driving around town. At the agent’s office, you would spend an afternoon flipping through pages of active property listings from the local Multiple Listing Service (MLS). After choosing properties of interest, you would spend many weeks touring each property until you found the right one. Finding market data to enable you to assess the asking price would take more time and a lot more driving, and you still might not be able to find all of the information you needed to get really comfortable with a fair market value.

Today, most property searches start on the Internet. A quick keyword search on Google by location will likely get you thousands of results. If you spot a property of interest on a real estate web site, you can typically view photos online and maybe even take a virtual tour. You can then check other Web sites, such as the local county assessor, to get an idea of the property’s value, see what the current owner paid for the property, check the real estate taxes, get census data, school information, and even check out what shops are within walking distance-all without leaving your house!

While the resources on the Internet are convenient and helpful, using them properly can be a challenge because of the volume of information and the difficulty in verifying its accuracy. At the time of writing, a search of “Denver real estate” returned 2,670,000 Web sites. Even a neighborhood specific search for real estate can easily return thousands of Web sites. With so many resources online how does an investor effectively use them without getting bogged down or winding up with incomplete or bad information? Believe it or not, understanding how the business of real estate works offline makes it easier to understand online real estate information and strategies.

The Business of Real Estate

Real estate is typically bought and sold either through a licensed real estate agent or directly by the owner. The vast majority is bought and sold through real estate brokers. (We use “agent” and “broker” to refer to the same professional.) This is due to their real estate knowledge and experience and, at least historically, their exclusive access to a database of active properties for sale. Access to this database of property listings provided the most efficient way to search for properties.

The MLS (and CIE)

The database of residential, land, and smaller income producing properties (including some commercial properties) is commonly referred to as a multiple listing service (MLS). In most cases, only properties listed by member real estate agents can be added to an MLS. The primary purpose of an MLS is to enable the member real estate agents to make offers of compensation to other member agents if they find a buyer for a property.

This purposes did not include enabling the direct publishing of the MLS information to the public; times change. Today, most MLS information is directly accessible to the public over the Internet in many different forms.

Commercial property listings are also displayed online but aggregated commercial property information is more elusive. Larger MLSs often operate a commercial information exchange (CIE). A CIE is similar to an MLS but the agents adding the listings to the database are not required to offer any specific type of compensation to the other members. Compensation is negotiated outside the CIE.

In most cases, for-sale-by-owner properties cannot be directly added to an MLS and CIE, which are typically maintained by REALTOR associations. The lack of a managed centralized database can make these properties more difficult to locate. Traditionally, these properties are found by driving around or looking for ads in the local newspaper’s real estate listings. A more efficient way to locate for-sale-by-owner properties is to search for a for-sale-by-owner Web site in the geographic area.

What is a REALTOR? Sometimes the terms real estate agent and REALTOR are used interchangeably; however, they are not the same. A REALTOR is a licensed real estate agent who is also a member of the NATIONAL ASSOCIATION OF REALTORS. REALTORS are required to comply with a strict code of ethics and conduct.

MLS and CIE property listing information was historically only available in hard copy, and as we mentioned, only directly available to real estate agents members of an MLS or CIE. About ten years ago, this valuable property information started to trickle out to the Internet. This trickle is now a flood!

One reason is that most of the 1 million or so REALTORS have Web sites, and most of those Web sites have varying amounts of the local MLS or CIE property information displayed on them. Another reason is that there are many non-real estate agent Web sites that also offer real estate information, including, for-sale-by-owner sites, foreclosure sites, regional and international listing sites, County assessor sites, and valuation and market information sites. The flood of real estate information to the Internet definitely makes the information more accessible but also more confusing and subject to misunderstanding and misuse. Despite the flood of real estate information on the Internet, most properties are still sold directly through real estate agents listing properties in the local MLS or CIE. However, those property listings do not stay local anymore. By its nature, the Internet is a global marketplace and local MLS and CIE listings are normally disseminated for display on many different Web sites. For example, many go to the NATIONAL ASSOCIATION OF REALTORS Web site, http://www.realtor.com, and to the local real estate agent’s Web site. In addition, the listing may be displayed on the Web site of a local newspaper. In essence, the Internet is just another form of marketing offered by today’s real estate agent, but it has a much broader reach than the old print advertising.

In addition to Internet marketing, listing agents may also help the seller establish a price, hold open houses, keep the seller informed of interested buyers and offers, negotiate the contract and help with closing. When an agent provides all of these services it is referred to as being a full service listing arrangement. While full service listing arrangements are the most common type of listing arrangement, they are not the only option anymore.

Changes in the technology behind the real estate business have caused many agents to change the way they do business. In large part, this is due to the instant access most consumers now have to property listings and other real estate information. In addition, the Internet and other technologies have automated much of the marketing and initial searching process for real estate. For example, consumers can view properties online and make inquires via email. Brokers can use automated programs to send listings to consumers that match their property criteria. So, some agents now limit the services they offer and change their fees accordingly. An agent may offer to advertise the property in the MLS but only provide limited additional services. In the future, some real estate agents may offer services in more of an ala carte fashion.

Because of the volume of real estate information on the Internet, when people hire a real estate agent today they should look at the particular services offered by the agent and the depth of their experience and knowledge in the relevant property sector. It is no longer just about access to property listing information. Buyers and sellers historically found agents by referrals from friends and family. The Internet now provides ways to directly find qualified agents or to research the biography of an agent referred to you offline. One such site, AgentWorld.com, is quickly becoming the LinkedIn or Facebook for real estate agents. On this site an agent can personalize their profile, start a blog, post photos and videos and even create a link to their web site for free. Once unique content is added to their profile page the search engines notice!

Some have argued that the Internet makes REALTORS and the MLS less relevant. We believe this will be false in the long run. It may change the role of the agent but will make knowledgeable, qualified, and professional REALTORS more relevant than ever. In fact, the number of real estate agents has risen significantly in recent years. No wonder, the Internet has made local real estate a global business. Besides, Internet or not, the simple fact remains that the purchase of real property is the largest single purchase most people make in their life (or, for many investors, the largest multiple purchases over a lifetime) and they want expert help. As for the MLS, it remains the most reliable source of real estate listing and sold information available and continues to enable efficient marketing of properties. So, what is the function of all the online real estate information?

Online real estate information is a great research tool for buyers and sellers and a marketing tool for sellers. When used properly, buyers can save time by quickly researching properties and, ultimately, make better investment decisions. Sellers can efficiently research the market and make informed decisions about hiring an agent and marketing their properties online. The next step is to know where to look online for some of the best resources.
Internet Strategies

In the sections that follow, we provide strategies and tips on how to use the Internet to locate properties for sale and research information relevant to your decision to purchase the property. There are many real estate Web sites from which to choose and although we do not mean to endorse any particular Web site, we have found the ones listed here to be good resources in most cases or to be so popular that they need mention. One way to test a Web site’s accuracy is to search for information about a property you already own.

Finding Real Estate for Sale

Despite the widely available access to real estate listings, many believe that MLS databases continue to offer the most complete and accurate source of real estate information. Most MLSs now distribute content to other Web sites (primarily operated by real estate agents). An excellent starting point for MLS originated content is the national NAR Web site, realtor.com, which is also the most popular web site for searching real estate listings. Virtually all local and regional MLSs have an agreement with realtor.com to display much of their active listing inventory.

Some local and regional MLS systems also have a publicly accessible Web site. However, to get complete information you will most likely still need to find a qualified local REALTOR. Many local real estate agents will also provide their customers (via email) new listings that are input into the MLS that match their predefined criteria. This can be very helpful to a busy buyer.

There are also many Web sites that display both real estate agent listed and for-sale-by-owner properties. Some of the more popular Web sites include zillow.com and trulia.com. These sites offer other services too. For example, zillow.com is best known for its instantaneous property valuation function and trulia.com for providing historical information. Another source of properties for sale is the state, regional, and local Web sites associated with brokerage companies; for example, remax.com or prudential.com. Search engines like yahoo.com and classified advertising sites like craigslist.com also have a large number of active real estate listings.

One key difference between these sites is how much information you can access anonymously. For example, at trulia.com you can shop anonymously up to a point but then you will need to click through to the agent’s Web site for more information. Many new real estate search engines allow you to sift through listings without having to fill out a form. The best strategy is to browse a few of the sites listed above to find geographic areas or price ranges that are interesting. Once you get serious about a property, then that is the time to find a qualified REALTOR of your choice to conduct a complete search in the local MLS.

It also never hurts to search the old-fashioned way by driving through the neighborhoods that interest you. There is no substitute for physically, not virtually, walking the block when you are making a serious investment decision. In this sense, real estate is still a very local business and standing in front of the property can lead to a much different decision than viewing a Web page printout.

Valuing Real Estate

As we mentioned, one of the most popular real estate tools is zillow.com’s instant property valuation. Just type in an address and in and you get a property value. It even charts the price ups and downs, and shows the last date sold (including price) and the property taxes. There are other sites that provide similar tools such as housevalues.com and homegain.com. Unfortunately, many people use these estimated values alone to justify sales prices, offers and counteroffers. However, these are only rough estimates based on a formula that incorporates the local county sales information. These estimates can swing wildly over a short period of time and do not appear to always track actual market changes, which are normally more gradual. In addition, these estimates do not automatically take into account property remodels or renovations or other property specific or local changes. This is not to say these sites are not useful. In fact, they are great starting points and can provide a good ball-park value in many cases.

When it comes to getting a more accurate value for a particular property, there are other strategies that are more trustworthy. One is to go directly to your county’s Web site. More often than not the county assessor’s area of the Web site provides sales and tax information for all properties in the county. If you want to research a particular property or compare sales prices of comparable properties, the local assessor’s sites are really helpful. When you visit a county’s Web site you are getting information straight from the source. Most counties today publish property information on their Web sites. Many times you cannot only see the price a previous owner paid, but the assessed value, property taxes, and maps. Some county assessors are now adding a market and property valuation tools too.

Given the importance of valuation to investing, we are also going to remind you of the two most important (non-Internet) valuation methods: real estate agents and appraisers. Working with a local REALTOR is an accurate and efficient way to get value information for a property. While one of the primary purposes of the MLS is to market the active property listings of its members, the system also collects sales information for those listings. REALTOR members can pull this sales information and produce comparable market analyses (sometimes called CMAs) that provide an excellent snapshot of a particular property’s value for the market in a particular area. Finally, the most accurate way to value a property is by having a certified appraiser produce an appraisal. An appraiser will typically review both the sold information in the MLS system as well as county information and then analyze the information to produce a valuation for the property based on one or more approved methods of valuation. These methods of valuation can include a comparison of similar properties adjusted for differences between the properties, determine the cost to replace the property, or, with an income producing property, determine a value based on the income generated from the property.

The Neighborhood

There are many ways the Internet can help you get the scoop on a particular neighborhood. For example, census data can be found at census.gov. You can also check out the neighborhood scoop at sites like outside.in or review local blogs. A blog is a Web site where people discuss topics by posting and responding to messages. Start by looking at placeblogger.com and kcnn.org/citymediasites.com for a directory of blogs. Trulia.com has a “Heat Map” that shows how hot or cold each neighborhood is based on prices, sales, or popularity among the sites users.

Schools

When it comes to selling residential property or rental properties that cater to families, the quality of the area school district makes a huge difference. There are many Web sites devoted to school information. Check out greatschools.net or schoolmatters.com. Most local school districts also have their own Web site. These sites contain a variety of information about the public schools and the school district, including its district demographics, test scores, and parent reviews.

Finding the Right Real Estate Agent

A recent addition to the Internet boom in real estate information is Web sites that let real estate agents market their expertise and local knowledge by displaying their professional profiles and socially networking with blogs. You can search to find an agent with a particular expertise, geographic area of specialization, or an agent offering specific services. The web site AgentWorld.com lets users quickly and easily find an agent with the right expertise using keyword searches and clean and simple agent profiles. AgentWorld.com also enables agents to post personalized blogs, photos and videos to help consumers find the best agent for their needs. Plus, many agent profiles include a direct link to the agent’s web site where you will likely find the local MLS listings.

Maps and Other Tools

The Internet has made mapping and locating properties much easier. To get an aerial view or satellite image of a property or neighborhood, go to maps.live.com or maps.google.com or visit walkscore.com to see how walk-able a particular property is. These sites can give you an idea of the neighborhood characteristics and the types of entertainment, restaurants, and other facilities that are within walking distance of the property. Maps.Live.com provides a view at an angle so you can see the sides of houses and Maps.Google even gives you a 360 degree street-level view for certain neighborhoods. If you have not tried one of these satellite map Web sites, you really should if only for amusement.

Final Thoughts on Internet Strategies

The Internet is a very effective research and marketing tool for real estate investors but is not a replacement for a knowledgeable experienced real estate professional. The Internet can save you time and money by enabling quick and easy property research and marketing options. Sites like AgentWorld.com also help you efficiently find a REALTOR who fits your buying or selling needs.

Always remember, when it comes to Internet strategies for real estate: More knowledge is better. You need to use the Internet to build your knowledge base on a target property or to find a real estate agent with expertise you need. However, the big caution here is that the Internet should not replace human judgment and perspective, expert advice or physical due diligence-keys to successful investing.

Getting Insurance To Pay For Preventive Health Under The ACA

The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the “wellness visit” into a “sick visit.” The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the “free preventive health” visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.

Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than “routine preventive health screening,” the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.

This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone – those at risk as well as those facing no known risk – to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 – $2,500 cost, it will give people a strong financial disincentive to getting tested.

As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form “yes or no” in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.

To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forums

There is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.

The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don’t have that in health care.

I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the “preventive health visits” to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.

Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don’t think a letter writing campaign is the correct way to reform payment for the “preventive health visits.” If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor’s office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.

COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn’t there one?

There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.

The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.

But we are using the much less common colonoscopy example. Instead, let’s return to preventive care with a primary care doctor. Should a patient have the right to check a box and say “I want this visit to cover routine preventive care and nothing more”? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.

When I expect to receive a “zero cost to me” preventive screening, I do not imply that I am willing to accept a “bait and switch” change of procedure and payment due to the doctor from me. The “zero cost to me” induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a “zero price” for a visit, the doctor’s office better honor that price, or it amounts to fraud.

It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.

It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor’s billing practices match the patient’s expectations for a free preventive health office visit. I investigated the web site and discovered some inconsistencies. For example, the site purports to list the services covered under the “preventive health” coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer’s own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.

Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.

If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor’s office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.

It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.