I recently had the opportunity to experience the pitfalls of my own commercial health
insurance. I tell patients all the time “the proof is in the pudding.” Well it was my turn to see how this pudding really was in the health insurance world.
This past fall my daughter was hit with yet another bout of strep throat. She has fought it throughout her young life. At the age of seven I made the call to consult with one of my favorite ENT docs. It was an easy decision that she would do better if we proceeded with tonsillectomy and adenoidectomy.
I, like so many of my patients, have a high deductible plan that I have married with an HSA(Health Savings Account). I knew the bulk if not all of the cost of the procedure would be my responsibility. I did not hesitate to ask for cash pricing.
Insurance Negotiated Pricing vs Cash Pricing
Pricing for any surgical procedure needs to include the following fees:
Surgical Facility’s Fee
INSURANCE NEGOTIATED PRICING:
Anesthesiologist + Facility
FINAL PRICING AND SAVINGS:
I was actually able to pay the insurance negotiated pricing for the surgeon and the cash pricing for the anesthesiologist and the facility. My final pricing was $1830.34 for the entire procedure. And there lies the proof in the pudding:
Almost $1200 in Savings
Happy Healthy Kid at Great Cost Savings by Paying Cash
Beckie Moore, APRN was born in Wichita, Kansas and raised in Platte County, Missouri. After 12 years in Platte City, Missouri, she and her family settled just north of Dearborn, Missouri, where she enjoys her time away from patient care on her farm. Beckie graduated valedictorian from North Platte High School in 1983. She has been an RN since 1987. Beckie went on to earn her Master’s degree in nursing from the University of Missouri, Kansas City in 1999. As a Family Nurse Practitioner in the Northland for over a decade, Beckie noticed patients interested in and seeking alternative options that were not taught in her traditional western medicine education. Seeking answers and education for herself, she discovered that the University of Arizona offered a two year medical fellowship in Integrative Medicine. Beckie completed her fellowship in 2016. She hopes to compliment patient care with her new knowledge base. Her passion is treating root causes of illnesses and promoting wellness at every turn.
Calories Consumed < Calories Expended= Weight Loss
It can be one misstep in your day that will sabotage all your good efforts. Stealing the term introduced to me by an inspiring patient, I would like to bring “the calorie creep” to life in the pictures below:
Keep in mind it does not have to be junk food that can be your calorie creep–avoid the creep in whatever form!
One of the most common allergens is grasses and specifically timothy grass. We are seeing these right now. While preventive treatment is ideal, treatment is currently focused on relieving the symptoms. There is a new option for allergy sufferers of common grasses for future seasons. The middle of freezing temperatures is when the grasses are dormant. It is that time that preventive treatment needs to start.
The newest option to treat for the timothy grass allergen is Grastek. This is immunotherapy in a pill. For those that have endured the weekly shots this is a novel, relatively painless approach to immunotherapy that can be done in the comfort of your own home.
Grastek covers Timothy grasses but also has cross coverage to other grasses.
It should be started for seasonal care 12 weeks ahead of pollen and throughout the season or taken consecutively for 3 years.
Click on the following link for more information on administration of Grastek.
Another common allergen that is on the horizon is ragweed. Fortunately, our timing of discussing this form of treatment is ideal. The same manufacturer of Grastek has developed a similar treatment for ragweed with the prescription drug Ragwitek.
Ragwitek like Grastek should be taken 12 weeks before the allergen season. In this geographic area the typical ragweed season begins about August 15. That gives an estimated start date of the medication in mid-May.
Ragwitek is taken similarly to Grastek with pre-seasonal and seasonal administration or continuous administration for 3 years.
TRADITIONAL ALLERGY CARE
Many other treatments remain the mainstay for allergy treatment:
While avoidance can be difficult here are some pointers that may help:
Stay indoors when the pollen count is high especially between 5AM to 10 AM when pollen counts are highest
Wear a mask when mowing or avoid mowing altogether
Choose grasses for your lawn that produce less pollen–dichondra and irish moss are some examples
Mow frequently to keep grass short
Keep windows closed
Avoid attic fans
Bathe pets frequently
Do not dry clothes outdoors
Minimize alcohol intake as it leads to dehydration and increased sensitivity to allergens
Another topic to come…How do I know what I am allergic to?
No better time to discuss smoking cessation than when we are at the new year and resolutions are starting to fade while the freezing temperatures outside continue. I tell my patients that are contemplating smoking cessation that if successful they will be richer in more ways than one. The health benefits of smoking cessation are clear. The often overlooked benefits of smoking cessation are the return of significant time and money.
decrease in bronchitis, COPD
decrease in blood pressure
decrease in heart rate
decrease in ALL cancers
decrease in diabetes
decrease in osteoporosis
decrease in rheumatoid arthritis
decrease in erectile dysfunction for men
decrease in ectopic pregnancies, miscarriages, small birth weight in pregnancy
decrease in second hand smoke decreases sudden infant death syndrome, ear infections, respiratory illnesses, and asthma
We never seem to have enough of either time or money and smoking cessation recaptures both.
The actual cost savings can be calculated here. The following depicts the savings realized when smoking 1 pack per day with a cost of $5.70 per pack:The amount of time spent smoking is estimated at 6 minutes and 20 seconds per cigarette. Calculations for smoking 1 pack per day equates to over 2 hours per day.
If you extrapolate the value of your time then your costs rise exponentially.
Smoking Cessation Aids
So you are ready but want some help. There are over-the-counter, prescription, and alternative options to help you be more successful.
Nicotine nasal sprays
Bupropion is a common anti-depressant medication that was once marketed as Zyban. This medication can diminish the cravings and withdrawal symptoms from the nicotine.
Chantix is for smoking cessation only and can diminish the cravings and withdrawal while also blocking nicotine effects from smoking.
E-cigarettes–long term safety has been unclear but recent studies identify significant concerns on safety and effectiveness
No better time than the present to kick the habit as you will be richer in more ways than one!
My patients often prove to be my best resource in providing patient-driven affordable healthcare. A viable health coverage plan eludes many of us and often those with a plan quickly discover its shortcomings. One of our earliest members at Direct Medical Care introduced me to a great alternative to healthcare “insurance”–health cost sharing plans that are truly affordable. These plans have been around for over 20 years and I anticipate they will become more and more favorable with the current direction of healthcare.
Health Cost Sharing Plans
Health Cost Sharing Plans(HCSP) do qualify as approved health insurance coverage by the Affordable Care Act.
The general philosophy is in line with Direct Medical Care’s as HCSPs “seek to return health care to a private, patient-centered model” and “(are) designed to restore and protect the doctor-patient relationship.”
Our patients using these plans attest that their experiences have exceeded their expectations.
Samaritan Ministries was established in 1994. Their focus is Christians helping Christians. Not only are they focused on the financial burdens taken on by the community of Christians but the physical, emotional, and spiritual burdens as well.
Liberty Direct was also established over 20 years ago and interestingly has the same share amounts today that they did when they began. They focus on helping like-minded individuals who are committed to their individual health and well being of their community.
Influenza strikes every year and leaves much to be discussed. The flu statistics reveal that the highest risk groups are those 65+ years of age followed by those 0-4 years of age. The other high risk groups include pregnant women and those with chronic respiratory illness or those with weakened immune systems.
Seasonal influenza is typically the following with rapid onset:
Seasonal influenza is not typically:
The only absolute is a positive influenza swab. Unfortunately the test can be inaccurate. Some studies suggest the influenza swab is only 30% accurate while others suggest 70% accuracy. The best case scenario it misses 3 out of 10 individuals with influenza. This makes clinical suspicion and evaluation by your physician key in diagnosis.
Tamiflu or other antivirals are the only prescription form of treatment but have their limitations. They need to be started within 48-72 hours of onset of symptoms. Antivirals when started early in the course of the illness can decrease the severity of symptoms and length of course but are not a cure. Large families or those with high risk individuals may opt to take antivirals as preventive or prophylactic care when a known influenza carrier has been diagnosed.
Supportive care is the true mainstay of care for anyone with influenza:
There are always lots of opinions regarding vaccination. While it is not a perfect vaccine as far as guaranteed coverage for influenza, it is safe.
The CDC recommends annual vaccination for everyone 6 months of age and older.
Vaccination is one way to protect yourself from influenza and can reduce the severity of illness if contracted and prevent hospitalizations in addition to doctor visits and time off work.
Does the flu shot cause the flu?
No but can cause a flu-like response with mild headache, joint pains, and fever
How long until I am covered after receiving the vaccination?
Vitamin B12 deficiency May be Making you tired, foggy, and numb…
Fatigue is one of the most common complaints I hear from my patients that unfortunately can be caused by many things. Vitamin B12 is one of those causes and it is quite common. Vitamin B12 plays a crucial role in energy as it aides the conversion of our foods to energy for the body.
Patients often complain of difficulties focusing, forgetfulness, and just a general fuzziness. Vitamin B12 helps in cognition with overall brain health. Deficiencies can also lead to general mood disorders, depression, and insomnia due to its role in production of certain natural brain chemicals.
The classic presentation of B12 deficiency is a “stocking-glove distribution” of numbness. The hands and feet are described as numb or tingling. Vitamin B12 is utilized by the body in the maintenance and repair of the nervous system.
tongue changes–smooth, burning, or red
shortness of breath
diarrhea or constipation
Am I deficient?
If you have any of the above mentioned symptoms it is worth getting a simple blood test to evaluate your levels.
medications that decrease absorption–classically antacid medications
disease processes that affect absorption such as pancreatitis and inflammatory bowel diseases like Crohn’s Disease or Ulcerative Colitis
gastric surgery for weight loss
Vitamin B12 Dietary Sources
The human body doesn’t make vitamin B12 so dietary sources are essential. Common dietary sources:
Vitamin B12 Supplement Options
Vitamin B12 supplements come in pill form, sublingual tablets, nasal sprays, and injectables. Many people can’t absorb vitamin B12 through the gut so nasal absorption, oral absorption, or injections are often preferred.
Vitamin B12 deficiency is easily detected and easily treated if you look for it…
Cold laser therapy is a novel, non-invasive approach to treating inflammation and promoting healing.
It is FDA approved and has been utilized in America for over 16 years.
Contrary to its name it is not cold at all–it is a pulsatile, low-level laser that will not burn.
Cold laser therapy has also been referred to as:
We introduced cold laser therapy in our office over 6 months ago. We have been impressed with its results for back pain, shoulder pain, elbow pain, heel pain AKA plantar fasciitis, and much more.
The cold laser is thought to work by decreasing inflammation and thus pain by decreasing the following:
prostaglandin-endoperoxide synthase 2
tumor necrosis factor-alpha
The greatest advantage is that there are NO serious side effects. It is a great option to try to avoid medications and surgery.
While insurance is variable on recognizing cold laser therapy as a reimbursable treatment, we are pleased to announce we have had patients receive reimbursement for this service at Direct Medical Care.
In as little as 2-4 treatments per week, we have seen 80-90% improvement in symptoms.
If no improvement by the 4th treatment alternate treatments can be utilized. Combining therapies can maximize healing and return to health.