By Angela Wilson Pennisi, PT, MS
Fall has arrived and with it, open enrollment for most insurance plans. Patient out of pocket health care costs increased by 11% last year, and from our experience in 2018, this trend shows no signs of slowing. Avoid unpleasant financial surprises by reading the fine print on the plans you are considering and asking targeted questions before you make your decisions for 2019.
Deductible: The amount you have to pay before your insurance company pays any benefits. May be waived for services that have a copayment, such as annual check ups. Many policies have separate deductibles for in and out of network providers and may also share a larger deductible across a family policy.
Coinsurance: The percentage of each bill that you must pay. For in-network providers, you are responsible only for the percentage of the negotiated amount that in-network providers have agreed to accept. For out-of-network providers, the coinsurance will typically be a higher percentage and is a percentage of what the provider bills.
Copayment: A set fee per service that the patient is responsible for and must be paid at the time of service.
Out of Pocket Maximum: After your health care costs reach this level, the plan will pay 100% of health care costs for the remainder of the policy year.
A plan might sound great — no deductible, $10 copayment, reasonable premium. What could be better? Make sure you read the policy details and understand exactly what types of requirements these plans have to access your benefits. Many plans will limit you to providers on a short list or limit you to accessing care only at specific hospital systems. Before you sign up, make sure you not only look up all your providers, but also ask your regular providers whether they intend to participate in 2019. If your preferred providers don’t participate, any savings might evaporate with increased out of pocket costs.
If your provider doesn’t participate, consider that they may have opted out because these plans deliver these savings by paying providers very low rates, which then require the provider to see many more patients to make the same amount of money. Ask yourself whether you need more personalized attention that may not be able to be found through an extremely low cost plan or whether the savings will allow you to pay more to see an out of network provider in certain situations.
Calculate Your True Costs
Health care costs can have a huge impact on your household budget, so take the same time you commit for retirement planning or deciding whether you can afford a certain house payment before making a decision. Look back over the past year or two — how often did you go to the doctor, how many medications do you take, and what were your out of pocket costs? If you are healthy and go only for annual checkups, a higher deductible plan might be a great fit. However, make sure you budget some money for that deductible in case of unforeseen expenses. A health savings account is a great place to set aside pre-tax dollars and for that money to grow tax-free year to year if you don’t use the funds. Consider the cost of the premium, the deductible, coinsurance and copayments, whether annual checkups are covered without application of the deductible, and whether you might use out-of-network providers under certain circumstances when calculating your true health care costs. Finally, consider the time-cost of a plan that might come with a lot of administrative burden, such as ones that require preauthorization for many procedures or plans with insurance companies that have a reputation for putting up barriers to paying the bills. If you have to spend hours on the phone resolving claim issues, you must consider the cost of that time, as well.
Medicare Advantage Plans
There has been prolific growth in Medicare Advantage plans in recent years as patients are lured by lower premiums and out of pocket costs. However, be aware that a name brand Medicare Advantage plan is not the same as having a name brand commercial policy. Plans are frequently more restrictive and create more administrative burden for both the patient and provider. Regular Medicare Part B coverage generally offers reasonable payment and hassle-free claims processing for most procedures. While any federal program comes with its own set of regulations and requirements for your providers, providers are familiar with them and used to complying. Medicare Advantage plans all have different rules and guidelines that may be difficult for you and your providers to stay on top of. For more information, read on to learn about preauthorization and utilization review.
Preauthorization Requirements and Utilization Review
When you select a health care plan and review the coverage information, many patients consider whether they are covered for a certain number of visits in a year’s time. However, in an effort to control health care costs, many insurers have contracted with outside companies to manage the preauthorization process or to retrospectively review charges for medical necessity (and request a refund!). Unfortunately, the plan you chose that allows up to 80 physical therapy visits, may end up only approving 6 or 8 visits as medically necessary, whether you and your provider agree or not.
Additional problems arise when providers and patients are given different information from the insurer than they are given from the outside preauthorization contractor. For example, the insurer may advise you that preauthorization is required, but when the provider submits for preauthorization from the outside contractor, he or she is advised that it is not required. How the claim ultimately ends up processing is anyone’s guess, but many he said/she said phone calls may be required to get around the insurance company’s efforts to pass the buck! As you review materials for open enrollment, talk directly with your human resources staff, as well as call the insurance company you are considering directly for more information about what types of procedures will require pre-authorization.
If you select a plan that requires additional authorization beyond your physician’s or physical therapist’s recommendation, be prepared to take names and reference numbers for every interaction to ensure your documentation is in place in case you ever need to demonstrate that you attempted to obtain preauthorization but were advised it was not required in this case.
As you navigate open enrollment, remember that the insurance company is trying to sell you a policy and that you may need to read between the lines to really understand the potential limitations and how they might affect you. I’ve often advised patients that insurance companies have perfected behaving like the “children of divorced parents,” telling one parent (the patient) exactly what they want to hear and blaming everything on the other parent (the provider or the utilization management contractor for example). When your insurance company tells you that your provider doesn’t know how to file a claim properly or that you don’t owe your provider for a service that was provided in good faith for your benefit, take it with a grain of salt and be empowered to advocate for yourself to access the benefits for which you have paid.
Angela Wilson Pennisi is president of PhysioPartners, with locations in Lakeview and the Loop in Chicago.
Numbness? Burning? Tingling in your fingers and toes? If you have been treated for cancer, it could be chemotherapy induced peripheral neuropathy (CIPN). Neurotoxic chemotherapy, secondary side effects of treatment and disease process itself can all cause damage to the nerves in your body. The peripheral nerves are all the nerves outside your brain and spinal cord. They are responsible for letting us experience touch, deep pressure, temperature, pain and awareness of our body in space (also known as proprioception). CIPN describes the damage caused by chemotherapy agents that are known to be neurotoxic. When damaged, they can result in pain and decreased ability to complete meaningful life activities.
Symptoms of CIPN:
Tingling/ Pins and needles
Pressure or feeling of compression on hands or feet
Sensitivity to textures or temperatures
So what causes CIPN?
Researchers are still working on better understating the CIPN process. Neurotoxic drugs first attack sensory nerves due to their size and location. They attack the axons first, then cause degeneration and dying back of axons and myelin sheaths. As symptoms progress through continued exposure to a neurotoxic drug, motor neurons are then involved. CIPN is typically symmetrical and follows a stocking (starts in the toes, then feet, ankles, etc) pattern and glove (fingertips, then hands, then wrists) pattern. But some people do report numbness in hands first. It may occur soon after chemotherapy administration is started, during administration, or worsen after drugs are stopped.
Type of chemotherapy (vincristine, taxanes, and platinum analogs), dosage, use of more than one neurotoxic drug, and rapid infusion.
Previous neuropathy from another condition
Age – being over 65 years old may increase likelihood of CIPN, but research is inconclusive
Occupational or Physical Therapy – Occupational therapy (upper body, fine motor tasks) can help evaluate your overall muscle range of motion, your fine motor control, and your independence and involvement with meaningful daily activities and design a holistic and personalized intervention to address any issues. Physical therapy can evaluate your lower extremity and gait, and design a program to increase muscle strength, balance and prevent falls.
Preventing CIPN During Cancer Treatment – Depending on how your CIPN progresses, certain chemotherapy drugs may be suspended to dispensed in a lower or less intensive course. Be vocal and honest with your physician about how your symptoms are impacting you.
Braces or splints – Orthotic devices, such as wrist or feet braces may be recommended by your doctor, occupational or physical therapist. They can support muscle weakness and prevent impingement.
Topical Agents – Typically consisting of lidocaine which may help with mild to moderate neuropathic pain.
TENS (Transcutaneous electrical nerve stimulation) – A non-invasive intervention that involves attaching electrodes to skin and administering a gentle electrical current.
Mindfulness and Pain Management Strategies.
Sensory Retraining Exercise – Staying fit and strong (but not over doing it) can help prevent muscle weakness, improve balance and increase overall sense of well-being. Regular exercise can help reduce stress, anxiety and depression which may be making pain worse. Get your doctor’s approval prior to starting a new exercise regime.
Caitlin Smith, OTD, is an occupational therapist at PhysioPartners and can be reached at (773) 665-9950.
By Joseph Ascher, PT, DPT
Days are getting shorter, temperatures are dropping, and leaves are starting to fall. Don’t let shorter days shorten your fitness activities and slow you down. A recent study published in the Journal of Medicine and Science in Sports and Exercise found that sedentary time increased in autumn despite multiple strategies to curb it (Meyer et al, 2018). That’s the bad news, but the good news is that groups that participated in an aerobic exercise class and a mindfulness-based stress reduction program were able to increase their activity minutes and curb the increase of sedentary time found across all groups. How can you get your physical activity minutes and stay motivated as the seasons change?
Join a Class
Joining a class makes you accountable to yourself, the instructor, and your fellow classmates. It also requires you to put those activity minutes on your calendar, making it much more likely they will actually occur. PhysioPartners offers multiple options for both group and private personal training and Pilates sessions several days per week, as well as new specialized sessions in January 2019 for improving mobility or optimizing bone health for clients with osteoporosis or low bone density. Exercising in a private or small group setting magnifies the accountability significantly and allows personalized attention so that you make the most of the minutes you are spending.
Check out our Move Free group session that emphasizes mindful movement and relaxation while improving your mobility, coming soon in January 2019. In the meantime, try the “Stop Breath & Think” application on your phone for some guided meditation and mindfulness training.
Do Something Fun
Go apple picking, get lost in a corn maze, attend a fall festival, or walk around the mall so start your holiday shopping early. Just find something and go do it!
Change up your Routine
Instead of lounging on the couch during your favorite TV series or sporting event, do a home workout or dust off that recumbent bike or treadmill and drop it in front of the television.
If aches and pains are making it difficult for you to get moving or you overdid it on your summer activities, call to schedule a consultation with one of our physical therapists at (773)665-9950.
1) Meyer, Jacob D., et al. “Benefits of 8-Wk Mindfulness-Based Stress Reduction or Aerobic Training on Seasonal Declines in Physical Activity.” Medicine & Science in Sports & Exercise, vol. 50, no. 9, 2018, pp. 1850–1858., doi:10.1249/mss.0000000000001636.
By Mandie Martuzzo, PT
Did you know that most neck pain and headaches can be attributed to poor posture? Low and mid back pain can also be rooted in postural origins. Wikipedia defines poor posture as “the posture that results from certain muscles tightening up or shortening while others lengthen and become weak which often occurs as a result of one’s daily activities.”
The positions where you spend most of your time can lead to postural changes that then promote dysfunction and pain. For most of us, the positions we are in most frequently are those we are in at work.
How you sit in your chair, your desk height, and computer set up all can affect your posture and sustained positions. How far you have to reach for things, the direction your head or body is turned, and how you talk on the phone all can make a difference.
Some of the symptoms of bad posture include:
- Rounded shoulders
- Head that leans forward or backward
- Muscle fatigue
- Back pain
Rounded shoulders encourage the head to come into a forward position, and the forward head position forces the muscles of your neck and upper back to attempt to counterbalance the force of holding up your head against gravity in an abnormal position. The potbelly can also cause increased pressure at your low back as those muscles try to counterbalance the weight.
Some things you can do to avoid postural pain are to change your positions frequently, make repetitive tasks as symmetrical as possible, and avoid persistent movements to one side or constant rotation of the neck and back to the same side. An example of this would be looking back and forth at multiple computer monitors throughout the day which can often aggravate joints and soft tissues causing neck and back pain.
Good desk/computer ergonomics include:
- Sitting all the way back in your chair, with the chair adjusted for height so that your feet reach the floor. Generally, your knees should be bent at about 90 degrees and hips at about 100 degrees
- The computer keyboard or desk should be at the level of your hands when your shoulders are relaxed down and elbows are bent to 90 degrees.
- Your computer monitor shoulder be at eye level and right in front of you.
Some health habits are instilled in us at a young age. For as long as you can remember, for example, you made annual treks in the family minivan to both the pediatrician and the dentist. As you entered adulthood, you probably transitioned to a primary care physician, and maybe even a different dentist better equipped to address adult needs. Anytime you’ve moved or switched insurance carriers, one of your first priorities has been to track down new providers. You probably figure that between these two health care professionals, all of your health needs are covered, right?
As it turns out, neither of these health care professionals are specifically trained to assess your musculoskeletal system, which is comprised of your muscles, bones, cartilage, tendons, ligaments, joints and other connective tissues. Who is the right health care professional to ensure that these essential internal structures are working properly and helping to support, stabilize and move your body? That’s right — a physical therapist.
At a yearly physical therapy “checkup,” your physical therapist will gather your medical history and observe as you participate in screening tests and other assessments to establish a baseline of your physical abilities, fitness level and personal health. Physical therapists are educated on how your musculoskeletal system functions properly and are trained to identify dysfunctions before they grow into bigger problems.
To maximize the encounter with your physical therapist, prepare before your appointment. To ensure that you cover everything and address any issues you may be
having, make a list that includes:
• Health issues like diabetes or high blood pressure
• Current medications, including supplements
• Physical fitness activities
• New activities you’re considering
• Fitness goals
The information exchange between you and your physical therapist is critical to forming an ongoing relationship, and to ensuring that you’re functioning and moving at top form. By understanding what sports and recreational activities you’re currently participating in and the fitness goals you’re aiming to achieve, your physical therapist will be better prepared to make recommendations and tailor a home exercise program designed to help you achieve your goals.
Making wellness a part of your everyday life and taking steps to ensure that your
musculoskeletal system is functioning at top notch can be very empowering and rewarding. Why not begin—or continue—that journey with a physical therapist? Now that you know how to prepare for a physical therapy checkup and understand what you can expect during the appointment, the next step is to call and schedule your annual visit!
By Susan Hardin Rocchini, PT, DPT
Arthritis affects about one in four adults or more than 54 million men and women. Arthritis is defined as inflammation of joints, and osteoarthritis is the most prevalent type of arthritis. This type of arthritis is characterized by deterioration of a joint, with the hip and knee being the most common joints affected. Osteoarthritis can be further defined by inflammation and degradation of the cartilage on bones, which can be quite painful. The good news is that you can manage the pain and dysfunction associated with arthritis, and research has shown that the actions you take can help minimize disability related to the condition. Arthritis is typically diagnosed through medical imaging and discussion of one’s symptoms. Typical symptoms can be the following:
- Sharp, shooting pain or dull, achy pain in the region, both during or following an activity
- Stiffness of the joint, which is worse after sleeping or sitting for an extended period
- Swelling of the joint
- Crunchiness and/or popping of a joint with movement
- Difficulty with everyday activities such as walking and stair climbing
Osteoarthritis of a joint can cause surrounding muscle weakness, loss of motion and balance problems if a lower extremity joint is affected, such as the knee or hip joint. At first thought, one might thing that exercise could worsen the condition, but in reality, exercise can reduce arthritis-related pain and improve function, when done appropriately. In fact, research has shown that activities such as walking, biking and swimming are very beneficial to your joints. Additionally, walking 6,000 steps a day or about 1 hour of walking has been shown to potentially help knee arthritis. More research is needed regarding this specific number, but an observational study published in Arthritis Care & Research in 2014 demonstrated that functional limitations were reduced by 16 to 18% among those who walked 6,000 steps per day. Also, it is important to note that exercise and activity must be gradually implemented and incrementally increased, especially in someone who has arthritis and/or who has been sedentary.
Community-based physical activity programs can be beneficial in helping one manage exercise and symptoms related to arthritis. According to the American College of Sports Medicine, all adults, including those with arthritis, should aim for at least 150 minutes per week of moderate intensity aerobic exercise and weight or resistance training two to three times per week. For example, to meet the aerobic guidelines, you could set a goal of walking briskly for 30 minutes, 5 times per week or breaking up the 30 minutes into several 10 minute sessions within the day. Arthritis may be prevented or limited by maintaining strong muscles around a joint and flexibility of muscles around a joint, maintaining a healthy lifestyle and weight, and moving with good body mechanics.
You physical therapist can help you manage the symptoms of arthritis by providing tips to reduce the pain, improve muscle strength and mobility around the affected joint, and improve performance of functional activities such as walking, stair climbing and sitting and standing from a chair. In severe cases, surgery might be recommended.
Need help getting started? Join us each Monday at 9:30 a.m. at our Lakeview clinic at 2869 N. Lincoln Avenue for Walk with Ease, PhysioPartners’ community-based and free walking program developed by the Arthritis Foundation to help you get moving and feel better. Sign up for this free program by calling (773) 665-9950 or emailing email@example.com.
Physiopartners will be hosting team walks beginning Monday July 9th at 9:30 am. Sign up today!