Insurance can be confusing and knowing what your responsibility is, and what your out of pocket costs are can be a challenge.
I had my own insurance nightmare with a chiropractor, and that's one of the reasons why I became one. A chiropractor I was seeing didn't submit my claims in a timely manner. I started seeing them in January, and didn't get any EOB's (explanation of benefits) until March! By that point, the insurance was saying she was out of network (whereas I was previously told they were in-network), and had racked up a $500 balance.
It took me a while to pay down my balance as I was buying my first house that spring, and eventually ended up being dismissed from care for not paying my balance. I felt they had lied to me about their "in-network" status, and I apparently didn't understand how insurance worked.
Insurance is an agreement between the patient and the company and ultimately the patient is responsible for knowing their benefits, and for paying for services insurance doesn't pay for. There are many different insurance plans, and many different terms to know.
What to know about your insurance
Many insurance companies have online sites where you can check your benefits. There is also a phone number on the back of your card that is useful to talk to a customer service representative with additional questions.
Where do you start? If you have a doctor you are seeing or wanting to see, look on your insurance carrier's website or call to make sure that doctor is in-network. Being in net-work may mean lower fees for you, but not always. Some doctors that are out of network may have lower fees, membership plans, concierge services, etc because they don't have to "deal" with insurance filing and paperwork.
Do you have a deductible that has to be met BEFORE your insurance will pay for care? Many insurance companies will have a deductible amount anywhere from $150 all the way to $11,000! That's a pretty wide gap to cover. You also want to know how much of your deductible has been met for the term of your policy. For many policies, the deductible "renews" every calendar year, but you might want to ask just to make sure.
1. What is my deductible?
2. How much of my deductible has been met?
3. When does my deductible renew?
Co-pays - some insurance companies will require you to pay a co-pay for appointments. Each time you see a doctor, you may be required to pay a co-pay. Some policies will "waive the deductible" for doctor's visits, meaning each time you see a doctor, you only pay your co-pay, and your deductible does not need to be met. Some policies will require you to meet your deductible first, before you only have to pay your co-pay. Some co-pays only apply to what we call E/M services (Evaluation and Management) where a person is getting examined and diagnosed, but not treated. Some co-pays will cover visits for treatment too, like chiropractic, physical therapy, etc. It's important to ask if the the co-pay only applies to certain services.
1. Do I have a co-pay? What is my co-pay amount?
2. Does my co-pay apply to office visits only, treatment, or both?
3. Is my deductible waived or do I have to meet my deductible first?
Co-insurance - some insurance companies won't have a co-pay, but a co-insurance percentage. This is where the patient is responsible for a percentage of the "contracted rate" for services. When a doctor is in-network, they have agreed to give a discount on services or to cap the cost of services, as determined by the insurance company. This is why many doctors offices don't like insurance - some of the discounts are very high. Every insurance company, will have different "contracted rates," and they may vary by region, state, or even policy. A co-insurance means a person pays a percentage of the contracted rate, like 10% or 20% and that may be before or after the deductible is met.
1. Do I have a co-insurance percent and what is it?
2. Is my deductible waived or do I have to meet my deductible first before my co-insurance applies?
Some insurance policies may have a combination of co-pay, and co-insurance. They may have a co-pay for office visits that entail an evaluation and management service, and a co-insurance for treatment, labs, diagnostic imaging, etc.
If you need help determining your coverage benefits, we are happy to do this prior to your appointment, which is also why when scheduling online, we ask for a picture of your insurance card. This way we can know what you benefits mostly likely will be when you come for your appointment. While all insurance companies state that determination of benefits and payment are made at the time a claim is submitted, we can sometimes find out information for patients before they accumulate high balances they were not expecting. You can always e-mail a picture of your insurance card, front and back, along with your date of birth, to firstname.lastname@example.org, and we can determine your benefits before your appointment.
Our goal is to not only provide meaningful and effective care for our patients, but to also care they can afford and trust. We offer care plans for individuals who may have financial difficulties, or high deductibles. Please let us know if you need assistance determining out of pocket costs, or a payment plan that works with your budget.
No, your bed and the way you slept is not the reason your back hurts in the morning.
Many people like to blame their mattress or "sleeping wrong" for their back pain, but the fact is, the reason you have back pain is due to normal changes that you can't and can control.
What happens to your spine as you sleep?
As you sleep, laying down, your discs are no longer under the force of gravity. During this time, fluid (nutrients) seep from the vertebrae through the vertebral end plate, into the nucleus of the discs. The fluid nourishes the nucleus, and causes it to swell.
When you wake up in the morning, and stand up, the gravity and pressure slowly forces this fluid out of the nucleus of the disc. You are actually taller in the morning than in the evening.
The nucleus of the disc swelling isn't exactly the reason for the pain or discomfort either, but does contribute to it. You can't control it, nor would you want to stop it from happening because it's the only way your discs can get nutrients, and flush out waste.
So how does this normal occurrence contribute to pain? It causes tension on other ligaments surround the nucleus of the disc, and of the spine that slowly over time because less elastic or stretchy.
The reason you have pain is because your ligaments are becoming less elastic, and aren't able to accommodate change in position, even these minor changes in position.
As kids, we can practically sleep in any position we want. As we age, we find that we are less able to do so. We start to require certain pillows to sleep, mattresses that form to our body, etc. It's not your mattress that's the problem. And it's not your pillow. It's your body.
Many times we think of the spine as being composed of bones and discs, and we forget that there are multitudes of ligamentous attachments. Cells in these tissues sense tension, pressure, vibration, movement, and pain - they have neurosensory function! When stretched, these cells send signals. When injured, they send pain signals. When ligaments start to loose elasticity, they can't stretch as much. Think of it as a dried out rubber band - you stretch it and it breaks! These ligaments do too.
We can't stop our ligaments from losing elasticity over time, but we can slow down that process by adopting certain habits and avoiding behaviors that increase their decline
1. Avoid smoking.
2. Avoid alcohol.
3. Stay hydrated by drinking water, avoiding caffeine, and consuming moisture rich foods.
4. Eat foods high in antioxidants such as vegetables and fruits, like berries.
5. Move your body! Ligaments and joints need movement to stay healthy.
6. Improve circulation and movement through your spine by breathing with your diaphragm.
7. Get chiropractic care to make sure all the segments in your spine have healthy movement.
8. Do yoga and pilates to move, stabilize, and stretch your body.
9. Apply good, evenly applied stress to joints with weight lifting.
10. Avoid sitting and inactivity for long periods of time.
11. Reduce use of chemicals that can negatively impact ligaments such as corticosteroids and some antibiotics
12. Get a sufficient amounts of restful sleep at night.
13. Be intentional in reducing stress and stressful situations in your life.
14. When a ligamentous injury occurs, avoid using ice, seek treatment involving passive, active, and loaded movement.
15. Learn mindfulness and self awareness, and listen to your body when something doesn't seems right, don't ignore what your body is trying to tell you - address it.
Last week I had the opportunity to join the Functional Health Team Academy Educational and Networking Event on "The Complexities of Drug - Drug Interactions," presented by Kurt Grady, PharmD, MBA. Kurt is a successful healthcare and business leader currently working in the health economics and in the outcomes research arena of the biopharmaceutical industry. Rooted in advanced degrees from the St. Louis College of Pharmacy (Pharm.D.) and Southern Illinois University (MBA), he has forged a broad and varied clinical and business career. Knowing that balance is imperative to personal and professional growth, Kurt also holds a Doctorate in Biblical Studies (Biblical Counseling) and serves several colleges and organizations teaching medical issues in counseling both domestically and internationally.
Kurt discussed how pharmaceuticals and everything else breakdown into one category -- chemicals. It's all chemicals, regardless of whether we are talking about drugs, supplements, herbs, vitamins, foods, essential oils, cleaning products, and even what we breath. Water is a chemical.
In talking about chemicals we discussed 4 basic concepts - Absorption, Distribution, Metabolism, and Elimination (ADME). Absorption is how a drugs gets into the body and there are different ways this can happen. Having been in the biomedical and veterinary fields, we utilized many different methods of absorption: oral, intravenous, subcutaneous, intramuscular, inhaled, topical, etc. When I broke my arm in 2013, riding in a bouncy ambulance, I opted for intranasal administration of pain medication knowing an alternative method of administration for the drug they were going to give me.
Absorption methods determine how "bioavailable" a chemical is to the body. If something is taken orally, it has to be absorbed from the gut, and often ends up in the liver first. Here in the liver the drug may be changed, or unchanged. Some drugs rely on the liver changing them into a metabolite, cutting part of the original chemical off, attaching parts to it, etc to make it "active," whereas others may be rendered less active.
After absorption via a certain route, the chemical must be distributed to its target tissue. A chemical has to be carried via the bloodstream, and cross into its specific tissue. Many times chemicals in blood are transported bound by proteins in the blood. When chemical changes occur, the chemical is let go from the protein and is able to diffuse or be actively transported into its target tissue.
Metabolism is how chemicals are unfolded, changed, hacked up and repackaged to get it out of the body. The liver OWNS metabolism! The goal of metabolism is to unmask and create handles that enzymes can grab onto to make everything either hydrophilic (water-loving) to be able to eliminate the chemical via urine, or lipophilic (fat loving) to eliminate the chemical via bile through feces. Some other elimination pathways are via our respiratory system in the form of aromatic compounds like ketones, ammomia, etc, and there are more locally specific routes such as sweat, oils, earwax, tears, etc.
Elimination is where the chemical exits the body - either by way of renal excretion via urine, or via fecal matter. Some may be reabsorbed, like theobromide a chemical found in chocolate can be reabsorbed in the bladder, or B vitamins from fecal matter in the large intestinal tract.
When it comes to chemicals nothing is inconsequential! Even simple compounds have interactions. Those "inert" or "inactive" ingredients do count and do have effects. There are intended interactions, but there are also unintended interactions. Many variables determine how a chemical from any source may affect a person, and its effects can be different in each individual.
When it comes to drugs, and everything else we put into and on our bodies, it's essentially like having one bucket, and many holes that are always changing. There is not much education in drug induced nutritional deficiencies, drugs interactions with foods, supplements, herbs, etc. In fact, there isn't much study in drug interactions involving the use of more than 2 drugs, or specific compounds as many of these interactions are studied on a one to one bases. When we get into the use of multiple drugs - it's really anyone's guess, especially when assessing more than 5 interactions. There exist unintended interactions and a combination that may be okay in one person, may not be okay in another. Inert ingredients really aren't and even changes from one brand to another brand may causes unknown problems. One thing to always remember - You are not a P-value. While research may suggest that a drug does one thing or has certain unintended effects, there may be more to be seen when used in indifferent individuals along with different compounds. We can't ignore the consequences unique individuality - it's not one size, fits all.
As a doctor that chooses to treat without the use of pharmaceuticals, I do use supplements, herbs, oils, and foods to treat patients. I recommend the use of cleaning products that don't use a lot of chemicals. I must be educated in their applications, affects, utilization, and interactions. A supplement I recommend may change how other medications works. Some people may seek out my assistance for that very reason. A medication may cause a nutritional deficiency, such as the popular metformin, and many birth control drugs. A supplement I use may elucidate an unintended interaction causing side effects of another. Supplements are not an inexpensive method to escape pharmaceutical intervention, nor are they all safe. They too come with unintended interactions depending on the same variables stated above. This is why I do want to see the bottle, know the brand, see the dose, and know what form of a vitamin is being used. This is why I caution the use of supplements and herbs without knowing their possible interactions and unintended effects. This is why I may also write letters to a physician asking them to "please consider" a lower dose, a different brand, or even a trial of elimination due to unintended interactions, or diminished benefit.
"Have a problem, take a pill," was a mindset that even I ascribed to in my younger years. Pills only work, until they don't, and there's no telling the interactions, depletions, and loss of function that can occur. One area that I love to explore is how our genetics affects how medications work in individuals. We are all genetically unique, and there are endless possibilities of combinations of functions and mutations that occur. One pill, does not fit all and many can be made more effective by lifestyle interventions like nutritional changes, increased activity, probiotics, and even supplements given certain genetic mutations or depletion.
So, please consider that not all problems are solved by pills alone, and enjoy this clip from Fridays - The Pharmacist.
Here are the recipes for our yummy treats from our JUST FOR U NIGHT! We hope you enjoy!
GF/DF Coconut Macaroons Made with Sugar
1. Preheat the oven to 350 F.
2. Line 2 large baking sheets with parchment paper.
3. In a large mixing bowl, place eggs whites and vanilla and beat until fluffy
4. Add in the sugar and salt and mix well.
5. Add the shredded coconut last and coat thoroughly.
6. Using your hands, form the mixture into small 1 1/2- 2 tablespoon mounds and transfer each to the prepared baking sheets (you won't need to space these out much, as they will maintain their form)
7. Bake until just the peaks of the cookies are light golden brown, about 12-15 minutes. Turn the pan halfway through to ensure even baking.
8. After baking, leave on them on a parchment paper so they can set up. You can remove the parchment paper from the cookie sheet and replace with another sheet if you have more to make.
Allow the cookies to cool completely on a wire cooling rack on the parchment paper. Serve at room temperature.
These can be refrigerated and stored for a few weeks!
GF/DF Coconut Macaroons Made With Honey
GF/DF Chocolate Chip Cookies!
GF/DF Peanut Butter Chocolate Chip Cookies
Lemon Complete Bars
1. Combine all together in a bowl
2. Shape in bars or balls.
3. Refrigerate a couple hrs to make shaping easier
Sinus Problems? Pressure Headaches? Hearing Loss? Mouth Breathing? Bad Breath? Constant Drainage? Chronic Ear Infections?
Endonasal Technique addresses many of these common ailments!
I first learned of endonasal techniques through my own humbling experience. In November 2016 after experiencing the flu, I lost hearing in my right ear. I thought it would go away on it's own, but it didn't even despite conventional (and by conventional I mean convenient) treatments with antihistamines, decongestants, anti-inflammatories, and even antibiotics. I gave it a month, but lost hope that my body would be able to heal itself. What I learned from that experience, was that my body needed a little help.
I sought the care of Dr. Michael Fiscella, a chiropractor who's been treating individuals with ENT for decades, and who coincidently teaches the technique through Logan University School of Chiropractic.
ENT or EndoNasal Technique uses a few different applications to open the airways, remove inflamed and exuberant tissue, and decrease pockets of trapped mucous and bacteria.
The purpose of the sinus passages is to decrease the weight of the head, and to add turbulence to air flow as it enters the airways. This turbulence aids in our sense of smell. The airways and sinuses are lined with mucous to catch particulate that we don't want getting into our lungs, and to warm and humidify the air before it goes into our lungs.
When we are infected with a virus, these membrane linings will become inflamed. They will have increase in mucous production, increased blood flow, become sensitive, and swell, which increases pressure on delicate nerve endings. This is why many times when we are sick, we have sinus pain, pressure, runny noses, discharge, watery eyes, and even bloody discharge when blowing our nose.
The body is perfect in its function, but sometimes it needs help. If we aren't doing anything to maintain this open airway, stuff gets stuck. When the virus goes away, the swelling and mucous decreases, but the new tissue and new blood vessels formed doesn't always go away. That mucous? It dries out and thins, but it can also become glue and causes these membranes to stick together. So we are left with more tissue than before, that is stuck together.
We have living on us in a symbiotic relationship of certain microbial populations. These populations inhabit our skin, mucous membrane and digestive tracts. When we get sick and have increased blood supply and mucous, this gives this bacteria a perfect space for growth. Not only does it grow with abundance, but as mucous glues membranes together and forms pockets, these bacteria get trapped and their populations can change to a more problematic form that maintains an inflammatory state, or is prone to worsening at the slightest provocation.
Endonasal techniques used include a handful of different procedure performed here in the office, and some you can do at home! We are happy to be able to provide our patients with the home care essentials to help them progress more efficiently with the care provided in our office. Some of the procedure we use in the office include:
In the picture above, we can see the intricate detail of the nose, and the nasopharynx. There are three canals (called meatus), through which air passes. In the first (inferior meatus), the nasolacrimal duct opening can be visualized. In the second or middle meatus, the opening of the maxillary sinus can be seen in the diagram. In the third, superior meatus, we have openings to the sphenoid sinus, and the frontal sinus. This superior meatus has the smallest opening, and also houses the cribiform plate of the ethmoid bone, which contains olfactory nerve endings, responsible for olfaction - your sense of smell. The back of these canals leads to the nasopharynx, which then leads to the oropharynx, the back of the throat.
On our way from the nasopharynx to the oropharynx, we pass another very important structure - the opening of the Eustachian tube. The Eustachian tube communicates with the inner ear to maintain pressure equilibrium and to drain fluid. If this structure becomes blocked with mucous or inflammatory tissue, its dysfunction can lead to hearing loss, ear pain, fluid discharge from around the ear drum, and what many call "ear infections."
A closer look at the nose, and its surroundings leads us to the nervous tissue. These very delicate structures are highly susceptible to tension and pressure changes caused by inflammation and excess mucous. In the far left, we can see these nerves in relation to the meatus, and directly to the left we see them with the choncha removed. Note the olfactory nerve endings in the superior meatus. It's no wonder we hurt when we are sick!
Many individuals will reach for convenient and conventional intervention first when illness strikes.. Products to decrease swelling in nasal and sinus cavities, like decongestants, actually cause vasoconstriction of small capillaries and may be taken systemically in pill form, or in the form of a nasal spray, delivering the medication directly to the area of concern. The vasoconstriction can help with the runny and stuffy nose feeling. Some may resort to products that break up mucous like the ever popular Mucinex, which contains an expectorant Guaifenesin, and its cohort Dextromethorphan, a cough suppressant. Some may use Flonase type products that dispenses a steroid into the nasal cavity. You can see from the picture below that these local sprays, while they do a good job reaching one opening of the nasal cavity, the do a poor job reaching areas of importance like the back of the nasal cavity communicating with the nasopharynx, and the superior meatus, that receives the frontal and sphenoid sinuses.
While many of the products can certainly help in the beginning phases of illness, that is where their efficacy is limited. They may work great in the short term, but vary in chronic conditions. Even the label on many of these products tell the consumer to consult a physician if symptoms persist beyond X number of days. But what happens when we do consult a physician? Often times we are told to keep taking them. Interestingly enough, the 2008 Cochrane Collaboration meta-analysis of over-the-counter medicines concluded that there was not enough high-quality clinical data to prove whether it is effective or not.
Many physicians will resort to prescribing antibiotics for "sinus infections," but one thing many researchers and doctors know is that the majority of these "infections" are caused by viruses, not bacteria. One thing many individuals don't know is that many antibiotics actually have anti-inflammatory properties, and may even change the way the body responds to inflammation. I know this from experience in veterinary medicine, where we prescribed long term use of doxycycline for inflammatory conditions like lupoid onychodystrophy.
While these treatments help with symptoms, they certainly don't get to the root of the problem, and they certainly don't have the same effects over time. ENT does get to the root of the problem, opens the nasal passages to allow for aeration and drainage of sinuses, removes excessive inflammatory tissue, removes mucous, and opens tissues that are stuck together by mucus getting rid of pockets. It allows the body to be more effective at repairing itself. Treatment in the office, and home care at home can aid in the recovery of the body, and help maintain a healthier state.