Inside This Issue
Healing Takes Time
Change in Season
Spring-FINALLY! What a winter we had! But that’s part of the Pennsylvania experience, right? Well, after being cooped up all winter, most of us are up and running with the faster pace of spring. There is a lot going on with Easter approaching and warm weather beginning. Please be cautious as you jump into gardening, yard work and other outdoor activities. Many injuries occur when we do too much before giving our bodies’ time to condition to a more active lifestyle. Start in gradually with outdoor exercising. Be deliberate and guarded with posture and movements as you start cutting grass, planting flowers and digging up gardens. Think of how the PIRATES went to spring training to allow their bodies to condition before beginning the new season. Be patient and careful and you should reduce your risk of experiencing unexpected injuries which could put a damper on you enjoying springtime.
Change in Insurance
In addition to the scurry of the new season, there are some changes happening in healthcare and the office that you may want to know about. Open enrollment for Obamacare has ended. Now, we will all be learning together how this $2 trillion government expansion will affect us, for good and bad. Many of you have asked me how it will affect your chiropractic coverage. Honestly, it’s too soon to tell. Nancy Pelosi said we will find out what it’s about once we have it. Apparently, that is the case and we will be learning together. Frankly, it doesn’t look like the government has a clear idea yet, either.
However, there are some things we are noticing that do seem related to the implementation of Obamacare. Medicare plans appear to be making it harder to have care covered. For many years, Medicare has covered 12 chiropractic visits per year before challenging the necessity of care. Now, we are finding that they are questioning even the first few visits, for what appear pretty straightforward problems. Alternative Medicare plans such as Freedom Blue and Security Blue are denying care for chronic conditions, such as low back pain. Because degenerated discs and osteoarthritic joints are permanent by nature, they are denying painful flare-ups due to the fact that they will likely recur. We obviously disagree with the logic offered here. If we applied that rationale to other chronic conditions such as diabetes, high blood pressure or high cholesterol, people would be given episodes of treatment and then denied because these also are chronic, recurrent conditions.
Even non-Medicare plans appear to be reacting to Obamacare regulations, apparently trying to offset cost increases by reducing the amount of care they will cover. Managed care is demanding more paperwork from you and us to justify coverage. We apologize for this and hope you understand the necessity of your cooperation.
We are studying the changes and will keep you up-to-date as we learn more. We hope you agree that, regardless of the government and insurance companies, you receive excellent care in the office at a very reasonable cost. Chiropractic care remains one of the best values in an otherwise overpriced American healthcare system. We will continue to do our very best to earn your confidence and trust.
Change of Staff
The other big news in the office is that our veteran front desk/billing assistant, Colleen, will be phasing out over the next 2 months. She will be leaving to spend more time with her little ones, Elyse and William. We will be sad to see her go and will miss her but, definitely agree with her priorities. As all of us with older children know, how soon those little ones grow up! She will cut back to working on Mondays only, beginning in May, and then leaving after Memorial Day.
Changes, changes, that’s how life goes. It’s one reason why we cherish the people and good things in our life each day. Well, those are probably the biggest changes to report on this month. As always, feel free to contact the office by phone or email if you have any [email protected] or [email protected]
Wishing you good health and happiness,
Dr. Steve, Colleen, Lindsey and Maria
Colleen is Beginning a New Adventure!
“I have met so many great people and their families over the past 3 ½ years. Everyone has welcomed me into their lives with open arms and I appreciate all of your kind words, thoughts and advice. It was a hard decision to leave, but I am excited to see what the future holds for us!” ~Colleen
Pre-visit Denial Waivers
If Highmark denies your care and you still choose to continue receiving chiropractic care in our office, you will need to sign a form in advance showing that you understand that they will not pay for your care but want to receive it anyway. Highmark requires this as a condition of our being in-network. We can help you estimate what additional amount you will owe for your care.
Here is a common example for a straightforward chiropractic adjustment for those of you with Freedom Blue or Security Blue:
Your visit cost: $40
Your copay: $20.00
98940 (1 or 2 region adjustment) $26.86 -$13.14 (insurance adjusts off allowed amount)
98941 (3 or more region adjustment) $39.61 -$0.39 (insurance adjusts off allowed amount)
If Highmark denies your care, you would owe an additional $6.86 (code 98940) or $19.61 (code 98941) or Highmark’s portion of payment. This is the amount Highmark pays when your visits are approved. The total cost of your visit would be either $26.86 or $39.61, which would include your copay and the difference between Highmark’s allowance and the insurance adjustments off of our charge.
“The Insurance Company Denied My Care!”
Apparently in response to Obamacare, insurance plans are tending to deny care far more often than we have seen in past years. If they deny your visit or treatment plan, you will typically get a computerized letter stating that they require more information in order to reconsider their decision. Please understand that by the time they send you a denial, they have already received our COMPLETE notes and documentation. There is, most likely, nothing else for us to send.
If your care has been denied but you disagree with their ruling, you have the option to appeal their decision directly to your insurer. The benefit is that you are now able to speak directly to a claims rep and state why you believe your care is medically necessary and justified. Calmly and respectfully describe the problem you are dealing with and how you are benefitting from your care. Many people have had their insurance company reconsider and cover their care, taking this approach.
If you would rather not bother with an appeal, you certainly may choose to continue receiving care in the office. You would be responsible for the portion of your charges the insurance denied and may have to sign a waiver stating that you understand your insurance will not pay and are choosing to receive the care anyway. We can help you see the additional amount you would owe. It is usually less than people imagine because of the limited amount insurance plans often pay.
Have you ever been caught in a weight loss plateau during or after completion of a fad diet? This may be because a diet, any diet, is not a permanent solution. The only sure way to maintain a healthy weight is to live a healthy and moderation based lifestyle.
A good way to lose stubborn weight is to follow the Volumetric Diet. It is not a diet, per se, but a theory that people tend to eat the same volume of food each day, regardless of how many calories they are actually taking in. Not all foods are created equal; low density foods have fewer calories per gram and high volume to help you feel full and satisfied while shedding pounds. Whereas high density foods have more calories and lower volume leaving you unsatisfied. The biggest negative concerning fad diets are that you tend to always be hungry! The Volumetric diet is about getting more mileage out of what you eat so that you don’t have that issue, thus making it a more sustainable, healthy weight management regime.
In general, diets full of low density foods have been shown to promote fullness on fewer calories and deliver weight loss according to the Center of Disease Control and Prevention (CDC).
So quit dieting and focus more on a volumetric approach. Eat more low density foods (which have a higher nutrient content), greater volume and fewer calories. This will inevitably help you on your way to weight loss and living a more nutrient dense, healthy lifestyle.
Reference: American Journal of Clinical Nutrition
RECOMMENDED READING FOR WEIGHT LOSS:
“Dr. Shapiro’s Picture Perfect Weight Loss 30 Day Plan”
“Same calories, more food-the choice is yours!” says Dr. Shapiro in his book. This is a pretty neat book which presents some basic concepts about eating for weight loss. However, it is mostly a picture book with side-by-side comparisons between 2 food choices with the same amount of calories. Only, 1 of the choices lets you eat a much greater quantity of food. This makes for an eating plan that will be easier to follow for the long haul. Give it a look!
Healing Takes Time
One of the most common questions people have in the office regards how long it will take to feel better. There is no simple, one-size-fits-all answer to that question. Every person and every episode of pain may respond differently. The common factors that determine the speed of recovery are:
- How severe the injury
- How long has it been hurting
- What underlying permanent changes exist (degenerated/bulging disks, osteoarthritis, scar tissue/muscle fibrosis, etc.)
- Lifestyle factors (you must continue doing the same things that caused the condition such as a repetitive motion at work, long hours on a computer, etc.)
- Your overall state of health and fitness (conditions such as hypothyroidism or diabetes tend to result in slower than normal responses)
- Your muscle strength and flexibility
By the time some people first notice painful symptoms, they are seeing just the tip of the iceberg, so to speak. Conditions such as STENOSIS, OSTEOARTHRITIS, DISC BULGES are a few examples of this. Your spine may have been degenerating quietly for years before you experienced your first really painful episode.
Due to the above, most people are recommended to give their condition a trial period of 2-4 weeks of care. Most people report at least 30-50% relief within that time period, often more. While maximum healing may take months or sometimes even longer than a year, the improvement noticed provides hope and encouragement to follow through with treatment.
It may help to think of it like you would imagine climbing up a mountain. Progress may be faster on the early slopes but slower as you near the top. But if you look back, you may see how far you have come.
WHEN WILL CARE END?
The first answer to that is, simply, whenever you decide. YOU decide how much care you receive and for how long. Some conditions make full recoveries and Dr. Wohar will discharge you on either a “Call” basis or recommend periodic maintenance care. Many problems involve permanent damage to muscles, discs, and/or joints. These conditions typically require long-term management. Without it, you may notice more painful and frequent relapses. Dr. Wohar will explain your condition and, based on his experience and judgment, make his best recommendation to you. From that point on, the choice is always up to you. We will do our best for you with whatever amount of care you decide on.
“WHAT IF I’M NOT GETTING BETTER?”
A very good question. If a course of care is recommended and followed, it is expected that improvement will result. It is very rare that someone shows less than 30-50% improvement within 4 weeks of care. When that happens, Dr. Wohar will typically recommend you see your family medical doctor for a second opinion or to rule out other concurrent health problems that may be causing/contributing to your symptoms.
Sometimes, a person does not respond as well as anticipated due to under-treatment or not following recommendations. For example, someone wanting to lose weight who only exercises once per week is obviously going to see much slower, lesser results than another person who exercises 5 days per week. In the same way, most conditions require more frequent care initially to see faster, better results.