Keep lifting the fork to your mouth and you'll have to fork over some cash. This is essentially the message the state of Alabama is sending out to its 37,000+ employees.

The state has already had a policy in place where smokers can either quit their habits or they must contribute to the costs of their health insurance. Recently state employees were told that they have a year to get their BMI under 35 or else they'll be charged $25 per month toward their insurance costs.

The state also has an upcoming plan in place for 2010 where, if state employees don't take free health screenings the state offers for them, they'll also be charged. If employees take the screening and conditions such as high blood pressure or high cholesterol are found, the employees will be offered free doctor visits and wellness programs to help improve the problem. A year later, they'll be screened again and if there's no improvement, they will be charged, too.

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About four years ago I took a position with a small company. It was a great place to work and I was so excited to get the position. The only problem was that the employer didn't offer medical insurance. He couldn't. It was a small company, and it just wasn't cost effective. So I've footed my own insurance bills for years and it's a bit of a wrench, frankly. But I guess I should consider myself blessed that I'm able to afford insurance at all.

The rates of uninsured workers are growing. In fact, one-third of low-paid workers don't have any insurance (up nine percent from 1996). Uninsured workers often have to turn to government programs for help. After all, that's what the programs are there for. But these programs don't come cheap; Medicaid, the State Children's Health Insurance Program, and uncompensated care expenses add up to a 45 billion dollars per year.

While it's mostly small companies that can't afford insurance for employees, an ever-growing number of mid- to large-sized companies don't cover insurance costs either. From 1999 to 2004 there was a 33 percent increase in uninsured workers in companies with 100 or more employees.

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Nearly four in 10 Americans cite health care costs as one of their biggest financial woes. As more and more employers cut medical insurance coverages (or eliminate them all together), health care costs are falling squarely on the shoulders of the individual. A Kaiser Family Foundation poll found that health care costs are one of the top financial concerns for American families. In fact, health care struggles have affected many families financial well-being and have influenced their health care decisions.

28% of Americans report that they have had a serious problem paying for health care/insurance. And the difficulties don't only exist for lower income families; almost three in 10 middle income families report financial problems due to health care as well. More than four in 10 Americans state that they have cut corners (such as postponing treatment or not getting prescriptions filled) because of the related costs.

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What if your insurance premiums reflected the things you wrote on social networking sites like Facebook, MySpace, or LiveJournal? Or worse: what if an insurer denied coverage altogether because of your blog? That is the situation a New Jersey court will be deciding on in regards to a pair of girls with eating disorders.

The concept being debated is whether or not these online expressions should be available for review by insurance companies. A class action lawsuit was brought against one insurer for not picking up the claim to treat anorexia and bulimia for two teenagers. The companies say that things posted online, diaries and even emails should be fair game.

How do these things relate to health insurance anyway? Well, these two cases are references a mental illness. For coverage to be extended, the illnesses have to be biologically based -- not peer pressured or externally influenced. A girl's MySpace, for example, may be able to give them an idea on how "biological" their daughter's bulimia is. However the parents don't think that is fair. People have been saying to be careful about what you put online. It is a situation like this which makes you understand what they were referring to.

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When you're a young child going to the dentist, it can be scary. Not everyone feels comfortable sitting in that big chair with a huge light hovering over his or her head. But when someone is an adult and still gets chills when thinking about a supposedly trustworthy dentist working on their mouth, something is wrong.

That describes the feeling of one person who fell victim to a crook who just so happened to work on teeth too. Dentists are fantastic, but like in any job, some are out for money (and not your well-being). Take this guy who was profiled by ABC News as an example. He put a lot of people in unnecessary pain and now serves time in jail for it -- not to mention a slew of lawsuits from ex-patients.

Phantom billing is another way to subtly charge someone's insurance for services never actually performed. It can drive huge amounts of money and max out your benefits if left unchecked. While this is certainly not an epidemic, it goes without saying that you should stay keen. Some people may not have to worry about this issue, as they see the same professional year in and year out. But be wary of sudden surgeries or get a second opinion if insurance won't cover certain expenses. However, if you have a family doctor that you already entrust your dental care with, no need to worry!

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California and a few other states may be onto something with their push for universal health care coverage. Frankly, in a country as wealthy as our own, it's almost embarrassing that some citizens must sometimes forgo medical procedures and routine physical exams solely because they cannot afford to pay for it. I'm not just venting here, either.

Research into this very topic has revealed an increased risk of cardiovascular disease. In the April issue of the Journal of General Internal Medicine, researchers from the Beth Israel Deaconess Medical Center published information related to the "insurance deterrent" (as I like to call it), a pervasive problem facing the U.S. The fear of mounting medical bills oftentimes causes some uninsured people to opt against going in for something as standard as a routine physical. T

he result: Blood pressure could be high, diabetes could be an issue, cholesterol levels may also be through the roof -- but, that person doesn't have a clue that these risk factors are in play. The study in the Journal of General Internal Medicine highlights the statistically significant relationship between a lack of health insurance and increased risk of cardiovascular disease. You can read it, and get even more stressed about it, here: http://www.blackwellpublishing.com/journal.asp?ref=0884-8734

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Fitzness Fiends is a section devoted to you, the reader! We all have learned so much on our path to becoming more fit, and now it's time to learn from and inspire each other! Fitzness Fiends are constantly working to better themselves. Some are perfect, some are not. All have health on the mind. Please send Fitz your answers to these questions with a photo of yourself. Time for you to be the motivator!

Name: Chris Wilmont

Age: 34

Occupation: Claims Manager

How often do you exercise? Try to keep it between 4 to 6 times a week.

What type of exercise do you do? Mostly weights, but I incorporate cardio to ward off bad doctor visits.

What gets you to workout, even when you're feeling lazy? The inspiration to feel good after accomplishing something for a better me.

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A study that seemed to expose the differences in insured and uninsured health care concluded this week that uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage.

Surprised? In the U.S. health care system, you shouldn't be. Uninsured patients may not have certain tests and treatments suggested to them as a result of not having the safety net of insurance backing them up. Nice.

This is significant because by the time any needed tests roll around for uninsured patients, their cancer has spread and the likelihood of long-term survival is quite diminished.

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Sometime today, Democratic presidential candidate Sen. Hillary Clinton will suggest a required amount of insurance for all U.S. citizens -- and cost the federal government about $110 billion.

The health care plan is expected to be announced while Clinton tours Iowa today as she gives a speech centered on health care policy in the U.S.

As expected from the Democratic Senator, those unable to afford health care and/or insurance would receive subsidies from the government. Additionally, large businesses would be require to help pay for their employee's coverage -- or even provide it completely.

What do you think?

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Did you know that illness and medical bills are the cause of nearly half of US bankruptcy cases? It's not a great shock, is it? For example, my niece has a serious chronic condition; just within the past year her medical costs (above and beyond what her relatively decent insurance plan covered) totaled more than $5,000. I can only imagine what the costs would have been had she been uninsured.

This article offers 6 tips for choosing the best health insurance:

1. Location. Certain states have higher or lower insurance costs. Research if there are any lower-cost insurance options sponsored or partially subsidized by your state (income restrictions may apply).
   
2. Write out your priorities. Determine the criteria that are important to you -- keeping your same doctors, not requiring referrals from a general practitioner, low co-pays, etc. These criteria will help you narrow down your options.
   
3. Use a broker. An insurance broker can weed through the confusing paperwork and help you find the best option. Just make sure the broker is reputable and that they have a "large book" (a large network of insurance agencies that they work with -- otherwise you'll only be given a small range of options).
   
4. Ask for a "free look." It's not advertised, but many insurance plans will give you a trial period. If you're unhappy with the insurance plan within a set period of time, the companies may refund the money you've paid so far.
   
5. Consider a Health Savings Account. HSAs work together with low-cost, high-deductible plans. The money you save on premiums is deposited into a pre-tax savings account and can be used for any health-related purpose.
   
6. Negotiate. Be a savvy consumer and negotiate costs with your doctor (for example, get pre-approval from your insurance agency for any surgical procedures; if the doctors costs are above the "reasonable and customary" costs defined by your insurance plan, ask your doctor to consider lowering his rate).

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Did you know that your insurance company may reimburse you for staying healthy? Sadly, most people aren't aware of this, and that means you could be missing out on some well deserved cash.

Yes, companies like Oxford Health Insurance will give you $100 per six month period ($20 per month) back if you stay active and belong to a gym that encourages cardiovascular health. If you belong to a club like Bally's ($19 per month), you basically receive a free membership. If you have a personal trainer ... think of it as getting 3 to 4 free sessions per year.

If you are 55 or older there may be no need for a reimbursement because many providers (not just Oxford) offer the SilverSneakers program at no additional cost to individuals who belong to participating Medicare health plans or Medicare Supplement carriers.

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I thank my lucky stars that I'm not on any medications. But my father takes meds every day to help manage several chronic conditions. The co-pays are an expense my parents have to work in to their budget. Medications and medical coverage in general are becoming a concern even for those who are still lucky enough have employer-sponsored insurance. (In this respect, I'm not so lucky.) The University of Michigan conducted a study to see if the practice of "pill-splitting" can help reduce costs for insurance companies, employers, and ultimately patients.

Pill-splitting isn't a new concept. Basically, patients just cut larger doses in half to increase the amounts of their medications. (As instructed by their physician. Lowering your dosage just to extend medications is never recommended.) Since drug companies don't typically double the cost of medication for higher dosages, this can translate to cost savings.

Certain medications are more conducive to splitting that other. For example, pills that are coated in a time release coating are not good choices for splitting. 89% of patients in the study stated that they'd be willing to continue with the slight inconvenience of splitting pills if it meant a cost savings for them. The practice doesn't come without some concerns, however. The elderly and people with arthritis or other dexterity issues would likely have trouble splitting pills. Also it could result in people accidentally doubling their dosage or halving the dosage of medications that should not be split.

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Okay, so here's a thought from the health care industry: flat rate surgery, with a warranty? A hospital group in Pennsylvania is doing just that, charging a flat fee for services that includes 90 days of follow-up care. This approach to health care encourages medical professionals to give better care as opposed to more care, since the less follow-up a patient requires the better for everybody. The way the health system currently works in this country hospitals are almost rewarded for errors and sub-par care by needing to see the patient again, and billing for even more services.

I think this is a great idea, although do you think hospitals would start to get choosy about who they performed certain procedures on? It might make things difficult for high-risk patients and people with complicated mixes of health conditions.

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For those of you who have ever provided health insurance for yourself -- as opposed to having it provided by (in part, at least) an employer, I am anxious to hear from you.

Have the prices you paid, the coverage you receive, the benefits you get and the dependent benefits you receive been worth it over comparable coverage from a present or former employer?

I've heard from many people -- those who have done extensive research and who have willfully searched for their own health insurance -- that individual health coverage is indeed very competitive with company-sponsored plans, in general.

What is your take?

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Most people, when told they need a major medical procedure or surgery, simply go to whatever hospital their doctor has it scheduled in -- without a second thought. But in the face of a new trend that may no longer be the case in many situations. Washington, in response to state lawmaker's requests, has created a website that makes hospital pricing for medical procedures, surgery, and other information like customer service more easily accessible to the public. The idea being that if you're told you need knee surgery, for example, you can look it up online and see at a glance which hospitals charge more or less, and which have better patient teaching and end-result track records.

Not to say that your doctor isn't referring you to the best hospital in his opinion, but it's just that -- his opinion. I think it's awesome that patient's can now take a more active part in how and when they are treated, and this has to be having a positive impact on how the hospitals manage things. Plus I can honestly say, from experience, that the last thing on most doctor's minds is making sure you get the best deal financially. That's entirely up to you.

Can't wait until this catches on in my area.

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