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Insurance Coverage Explained

Insurance coverage can be a tricky thing to navigate. Do you know what your individual deductible is? If so, do you know about your family deductible and coinsurance for a specialist visit? For most of us, myself included, the insurance specifications have become seriously complex.  Many times I’ve intervened on behalf of patients that have met their wits-end while attempting to understand their chiropractic or physical therapy benefit coverage. In an attempt to simplify some of the frequently used insurance terminology, I put together this little cheat sheet to help in minimizing the frustration factor.

Co-insurance

A coinsurance occurs when there is cost-sharing between the insurance company and the covered member/family.  The insurance company may tell you that your responsibility is a 20% co-insurance and that they will cover the rest of the charges (remaining 80%).  Quite often a coinsurance comes in to play after an individual or family deductible has been reached.

Example: Your opthamologist visit is $400 and Optima informs you that you have a 20% coinsurance after meeting your $200 deductible.  Currently, you have met $0 of your deductible. Your responsibility would be: $200 of the deductible and then 20% of the remaining $200 specialist visit charge = $40.00. The total you can expect to pay for the visit is around $240.

Co-pay

A copay is a set fee that you are responsible for each time you visit a doctor.  There are usually tiers or copays where a primary care doctor is typically less than the copay you may have for a specialist. Some plans have a copay due in addition to a co-insurance.

Deductible

The set amount an individual or family must reach before transfering over to coinsurance coverage for medical services.  Some plans have relatively low individual and family deductibles of $200 – $500 while other plans have larger $5000 – $9500 deductibles.  Once you have met your deductible you may only be responsible for a fraction of the percentage of your medical care, referred to as a co-insurance.

Out of pocket maximum or stop loss

This is the absolute maximum a covered member or family will pay out of pocket for medical care including copays, deductibles and co-insurance for a defined period of coverage (usually a calendar or a contract year)

 

Treating Pain without a Pill

Treatments come in a variety of options. Opioids (oxycodone, hydrocodone, etc.) are often prescribed as treatment for an episode of pain patients are experiencing. If you haven’t been the recipient of these directly, there’s a good chance you know someone who has. They’ve been widely prescribed as they had always been considered both safe and effective. However, in the wake of an opioid epidemic, we want to remind our patients that there are safe and effective treatments that let you avoid the drugs – and without the side effects, That said, there are instances where these types of drugs are appropriate – post surgery or serious injury – and with proper management may be used safely. However, we want to use this platform to highlight our approach to more conservative treatments that can effectively alleviate pain.  

As physical therapists, chiropractors, and massage therapists, we look to provide that first-line treatment for acute and chronic injuries alike – including: manual therapy; joint mobilizations; massage and soft tissue release; targeted therapeutic exercise; and health education. Let’s take a closer look at these distinct areas. 

Joint Manipulation and Mobilization

Manipulation and mobilization are used throughout musculoskeletal health by chiropractors, physical therapists, and some osteopathic doctors. Despite popular belief, the aim of these treatments is not to put a bone back in place. Treatments like this work with the nervous system to affect pain (through release of endorphins), muscle tension (through reduction in pain and thus reduction in spasm), and proprioception (your brain’s sense of your joint position). In my opinion, 95% of cases require exercise to reinforce the effects of the manipulation. In other words, mobilization and manipulation gives your body a window to exercise with less pain so that you can correct the issue at fault and increase muscle tone. However, it does not correct the underlying cause of the pain independently. These are  powerful pain relieving tools that can be employed to aid in your recovery from pain, especially in the spine.

Massage

Generally massage is thought of as a relaxation and stress reducing technique, but it can also be used as a powerful pain relieving and recovery tool. Therapeutic and sports massage are given in order to improve recovery through reduction in muscle tone and improvement in blood flow. Relaxation in muscle tone allows the muscle to receive the adequate nutrition is desperately needs to heal. Think of a muscle as a sponge; when it is squeezed out (overactive) it is not able to receive the water (blood) it needs to function. We see this happen often in cases of back pain associated with sustained postures, and receiving occasional massages would help alleviate this chronic paid in a more effective and cost-effective treatment. Massage also releases endorphins through a healing touch and targeted techniques, which helps to ease pain and creates a relaxing therapeutic environment for the body to heal. Your chiropractor or physical therapist may also use targeted soft tissue techniques to promote healing and pain reduction. 

Therapeutic Exercise

Therapeutic exercise is used widely by physical therapists and chiropractors as well. Movement encourages the body to release endorphins, reduce tissue tension through increased blood flow, promote healing through cellular processes, and prevent chronic pain from fear of movement. Exercise can be used as a means for tissue to adapt and heal to specific stresses it will encounter through daily activities. We use therapeutic exercise not only as a pain relieving mechanism, but also as a way to introduce stress to healing tissues in a controlled manner. If the tissue is not properly loaded over time, it can be substantially weaker than it was prior to the injury causing recurrent injuries. The best example of this phenomenon is chronic ankle sprains. Without proper rehabilitation, ankle sprains are likely to keep occurring as the body is unable to fully heal the tissue prior to sustaining a second, third, or fourth injury. Another common misconception is with arthritis. Many people stop moving because the arthritis is causing too much pain. On the contrary, our joints need to be loaded in order to provide nourishment to the joint surfaces. Without movement, joints can continue to degrade and become more painful. Remember, movement is your friend and is ultimately what will keep you feeling happy and healthy for years to come.  

Education

Education about a particular condition should not be taken for granted. It is the responsibility of your healthcare provider to educate you on your conditions, the treatment options, and expected recovery prognosis. Please don’t hesitate to ask your provider questions – fully understanding your condition is a key element to complete recovery. Education about pain can also be invaluable for the patient, which is why our office strives to provide pain education to help contextualize thoughts and beliefs about pain. Sometimes education is the stepping stone to preventing a patient from progressing to a chronic state of pain. For this reason, our office doesn’t just treat your condition, we help you understand it.

As you can see, there are many alternative treatment options for pain relief – and with far fewer side effects – than prescription drugs. It is important when seeking care for pain, that you explore all options landing on an course of treatment. Second opinions can often be helpful when you are unsure if a certain treatment is right for you. Trying a more conservative option first may save you time and dangerous side-effects from other riskier alternatives. 

Our office uses all of the above techniques, and when necessary, uses other techniques including modalities and dry needling. Our goal is to provide our patients with the most comprehensive, evidence-based treatments to ensure the fastest and most complete recovery path from injury. We ensure that each patient is treated individually, as every patient has different needs from the healthcare system. Still have questions? Give us a call to learn more. We’d love to help you become the strongest version of  your best self!

Bryan Esherick PT, DPT

 

Backpack Safety Tips

Backpacks. They’re necessary, but they also need to be safe. A child may lug to school more than 10 percent of his or her body weight which can be a serious pain in the back!

Here are some backpack tips to lighten the load:

  1. Choose a backpack that has two wide straps with good padding to distribute the load evenly.
  2. Adjust the height. Tighten straps so the bag is centered on the back, ideally above the lower curve of the spine.
  3. Use both straps. The one-shoulder method may be cool, but it adds serious pressure and throws body alignment out of whack.
  4. Weigh the bag. It should weigh no more than 10% of the child’s weight. If your child regularly has to carry more than that then you should get them one of those rolling backpacks that they can pull.
  5. Have your child checked. If your kid complains of back pain-even if it seems minor-talk to your doc. No amount of achiness is normal, and a physician can recommend strengthening exercises to help ease it.

Happy backpacking!

Why Chiropractic or Physical Therapy before Opioids?

Opioid prescriptions have skyrocketed over the last 25 years. Originally they were intended for post surgical patients and those in the end stages of cancer. In 1991 there were around 76 million prescriptions but by 2013 that number had risen to almost 207 million prescriptions.

There are strong ties in rises of opioid use and heroin use.

As prescriptions have risen, so have abuses. According to the CDC more than 1000 people a day are treated in emergency rooms for inappropriate opioid use.  As many as 1 in 4 people using opioids long term struggle with addiction. In 2015 there were nearly 60,000 drug overdose deaths, nearly half of those were from opioid drugs and opioid prescriptions frequently lead to other narcotic abuse. The economic costs of opioid abuse is estimated to be$75 billion a year. On top of all of that, there is no research to suggest that the amount of opioids has had any impact on people suffering from chronic pain. Patients who take opioids for even 1 day have a 6% chance of using them a year later, a 13% chance if they are used more than 8 days and a 30% chance if they are used for a month.

This year the American College of Physicians updated its guidelines for the treatment of acute and chronic back pain to recommend first using non-invasive, non-drug treatments before resorting to drug therapies.

The Joint Commission (the organization that accredits hospitals) has also added chiropractic treatment to its pain management recommendations. The guidelines were published in the Annals of Internal Medicine and based on reviews of randomized controlled trials and observational studies, and recommend spinal manipulation, massage and therapeutic exercise as first treatments for low back pain. Multiple studies support manual therapies and exercise to both resolve acute and chronic pain, but also for conditions you might not expect to see a chiropractor or physical therapist for: Parkinson’s, balance disorders, arthritis, and many others.

Chiropractors and physical therapists have excellent patient satisfaction scores.

A typical treatment plan for a chiropractor or a physical therapist costs less than an MRI.  Chiropractors and physical therapists are neuromusculoskeletal experts, and do far more than just pain relief, they create treatment plans that correct problems. You’ll be stronger, have better range of motion, and in general be more functional and be better able to do the things you love and your chance of recurrence will be lower. Do you have pain? Give us a call and see how we can help!

Posture Perfect

With the increase in technological devices of late, posture has been a recurring theme in physical health news more and more. You may have even heard the term “text neck”. If you’ve ever been to a physical therapist or a chiropractor you may have even heard more sophisticated terms like “Upper Cross Syndrome” and “Lower Cross Syndrome.” If you’ve been to Pilates, yoga or barre classes you’ve also probably heard about pelvic tilts and “tucking.”

We know that a good posture is healthy for us. But, you may be asking yourself – what exactly is good posture, and how can I maintain it?

Good posture looks like this. 

Your ears should be in the middle of your shoulders – and your shoulders directly over your hips – and all of that in-line directly over your ankles. Be sure and keep your shoulders down and back, too – not rounded forward. When you’re in a good posture position, you should notice:

  • Your spine should make a gentle ‘S’ curve.
  • Your pelvis should be level and your weight should be evenly distributed through your feet.
  • You experience no pinching in your lower back.
  • You feel no discomfort or excess weight in your heels or the balls of your feet.

 

The affects of not maintaining correct posture can be significant. Bad posture can lead to pain, injury and even degeneration of the spine. So, take heed and be mindful of your posture in during everyday activities – including how you are holding your head and neck while texting.

Stay tuned for more in our series on posture – the positive, and negative, affects it can have on your health.

Healthy Sleep Habits, Happy Back

Sleep is important. Yet, despite our awareness of sleep benefits, we often don’t make getting enough of it a priority. Sleep loss costs the U.S. $4.2 billion dollars a year – an equivalent of 1.2 million work days a year. But there is more to sleep than getting enough. How you sleep can be just as important to your health.

Stomach sleeping.

Many people sleep on their stomachs. And while stomach sleeping can help with snoring, it can also exacerbate and prolong neck and shoulder pain from a recent or recurring injury.

Side sleeping.

Side sleeping – with your arms below chest  level – is better. But, also brings risk of waking with numbness and tingling in your arms from having them in the wrong spot. I recommend sleeping on your side with your arms down, and your legs almost straight, with a pillow between your knees. Many people have a tendency to bring their chin toward their chest in this position. Try to keep your neck straight, and be sure your pillow is thick enough to keep your spine straight. Side sleeping requires a thicker pillow than sleeping on your back.

So, what’s the best sleep position to cover by best?

Back sleeping.

As a chiropractor, I like back sleeping with your arms down best. It keeps your spine straight and level. This is the ideal position for back health and injury recovery. Tucking a pillow below underneath your knees can be a good extra measure as well. However, if you snore or have sleep apnea, this may not be the best position for you.

So, be sure to get your sleep – and be mindful about how your body is feeling when you wake up – you might need to make some adjustments. If you have pain or stiffness when you wake that’s a good sign that you’ve some adjusting to do. When we wake we should feel our best.

Healthy Life, Healthy Back

Patients often ask: “What caused my problem and how do I keep it from returning?” The origin of a condition may be easily identified as an accident or injury. However, more than half the time, the exact cause is more difficult to pinpoint – because the problem was generated by a series of seemingly harmless events and circumstances (e.g. your posture; increased activity; mild repetitive strains; etc). In fact, most conditions are started by a “recipe” of irritants rather than any single “ingredient”. From a slight increase in your daily exercise routine coupled with less than ideal posture in an old office chair, to a few extra trips up and down the stairs and layering on the Spring chores, all add up to: “Ouch, my back…!”

When life’s physical demands exceed your body’s tolerance for those challenges, muscle, bone, joint and nerve problems begin. So, how do you prevent recurring injury?

Here are five tips to help keep the back strain away.

  1. Lift with your legs. The strongest among us are still at risk of back injury when we lift heavy objects incorrectly. Be sure to squat down, grab the item and use your leg muscles to lift up.
  2. Exercise your core. Your core muscles are key to supporting your lower back. Low-impact activities, like walking, will get your heart-rate up, deliver increased oxygen to your spine, and help keep your middle fit.
  3. Practice your good posture. Much like poor posture can lead to painful back problems, good posture can help prevent injury and strain. Set reminders for yourself throughout the day to check your posture – get up and walk around from time to time – and avoid slouching.
  4. Reduce your stress. We hold tension in our back muscles, and this type of constant stress can cause back pain. Try introducing stress-relieving activities into your daily routine – meditation, yoga, tai chi – the list of options is long. The trick is finding something that works for you.
  5. Be the healthiest You that you can be. Think of your spine as an indicator of your body’s overall health and well-being. So, practicing activities that have a positive affect on your health will also have a positive impact on your back. Drink lots of water; minimize alcohol; avoid nicotine; and limit inflammatory foods (sugar, flour, dairy, processed meats, fried and saturated fats).

Of course, prevention is always the best measure to keep your body pain-free. But, if you do encounter a mishap, partnering with your physical therapist and employing these measures to help increase strength and flexibility can also help increase your threshold for future injury.

 

Fitness Apps and Trackers: Is Technology Right For You?

Technology is everywhere. We consume tons of media on our phones. We adorn wearable tech that improves our posture. Sleep apps (Rested, Sleep++, Sleepbot) that use motion sensing, sound, and a smart alarm help us measure our sleep quality. All are agreed – there are some great innovations that have entered the marketplace in recent years. But there’s so much to choose from. How can we determine which technology is best to support our health and fitness goals. The trick is in finding what’s right for you.

Let’s start with apps. They are varied in scope and features. You can get some for free, while some cost extra for upgraded features.   They all work best when you’re faithful about putting in your data every day. If you’re the type of person who doesn’t like to mess with data and numbers, these apps may not work for you.  Here’s a closer look at three technology options:

 

  • Myfitnesspal – Like most apps, it requires you to manually input data each day, but lets you track your exercise, food and weight, and helps to create a calorie budget based on your goals. It also syncs with several other popular media and fitness devices, and even plays music while you’re working out.
  • Strava – This one is geared for the competitive runners and cyclists, allowing you to compare your achievements to everyone else using the app. This can be a great boost if a little competition is what you’re going for.
  • Spotify – A new player in the fitness app game, Spotify is allowing premium members to search for songs based on your running pace so you can use music strategically to help you train.
If you find that using an app is causing you stress and anxiety, or affecting your self-esteem, it’s a warning strategy is not good for you.

Fitness trackers are another tool for supporting your fitness goals. The philosophical idea behind them is “that which is measured, improves.” However, a new study revealed that people who used fitness trackers actually lost less weight than a control group that didn’t. The trackers and apps rely on an algorithm to determine your ideal caloric intake – but, in many cases, this one-size-fits-all approach doesn’t get it right. So, while you may be moving more, you also may be eating more.

It takes years of research and dozens, if not hundreds, of research papers before the scientific community is able to achieve consensus on what truly works and what doesn’t. These devices are only a few years old, so those studies are far from over – until then, research should be used merely as a guide to help shape personal opinions. If you want to try a fitness tracker, go for it. If it helps you, that’s great. But, if you find yourself using an app or following a tracker without the results you wanted, try making modifications. These tools should help to take the guess work out.

This technology is new and all devices currently on the market have quite a way to go before they will fulfill their promises.

While the technology gets a little better each year, it will likely still be a while before we can rely on them completely. They are a good starting point. But, if you think fitness technology might work for you, be sure to read reviews first – the good, the bad, and the ugly. If you are using one but not getting the results you want, talk to your healthcare provider about help in finding a support solution that’s right for you.

Patient Centered Care: Putting the Patient First

Lots of medical Practices and hospitals promote a patient-centered approach. It’s a hot buzzword in healthcare right now. But, what does that really mean? The IOM (Institute of Medicine) defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”

Patient-centered care is a custom tailored approach. It takes the individual patient into account when making care recommendations. While the practice of medicine uses a great deal of science, not all approaches will work well for every patient. That’s where this approach comes into play.  It’s more than just following intuition and the available science. It takes unique patient preferences into account – from individual challenges to lifestyle factors. As care providers, we need to listen to our patients and prescribe programs that adapt to their needs and align with what is realistic for them.

So, how do you know if your healthcare provider is truly taking a patient-centered approach? Check these three cues:
  1. Are they asking questions and engaging in a discussion around your holistic health situation?
  2. Does the program prescribed fit with your lifestyle, and feel realistic and attainable for you?
  3. Have they listened to you? Do you feel heard?

Your health and well-being requires action on both your part and that of your healthcare provider. You will achieve better results when you follow the requirements within a customized recovery and wellness plan. So, look for a partner when seeking medical assistance – and,  remember, when choosing a healthcare provider or a hospital, look for a patient-centered approach.

10 Tips to Keep Your New Year’s Resolutions

Keeping your New Year’s resolutions. It’s tough – we’ve all been there. You gain so much clarity at the end of another year and you find your focus – determined to (finally) achieve those targeted goals. January is welcomed in with a surge of excited anticipation at how amazing everything will be once you hit those goals. Then, February comes. Sticking to those resolutions may be tough but, with a little help, we can do it.

2017 New Year's ResolutionsHere are 10 tips to help you stay the course and rise to the resolutions.
  1. Keep it attainable. Set specific, measurable, attainable, realistic (SMART) goals. This will make the process manageable. Trying to lose 100 pounds is steep goal – but trying to lose 5 pounds per month, is a realistic goal that you can measure your progress by. Celebrating the smaller victories will only fuel your motivation to continue.
  2. Skip the fancy fitness trackers. A large study just published in the Journal of the American Medical Association reveals that people tend to actually gain more weight while using these trackers, because they overeat when they feel they are burning more calories.
  3. Exercise moderately, but stay away from the super intense workout routines. Advertising for some of these intense programs focuses on the incredible results you could enjoy. However, the reality is that most people are more likely to get injured in one of these programs than reap the rewards. Start an exercise program gradually and give your body time to adapt. When you are ready for the high intense activities, try working under the supervision of a trained professional.
  4. Get more sleep. Sleep helps you to be happier; to think better; to heal faster; and to get more out of your workouts. Maybe you’re already getting the great-8 – and you wake up feeling energized for the day without the aid caffeine – but if that doesn’t sound like you, take note and plan for more sleep.
  5. Make informed buying decisions.  Getting to the gym can be a hassle, and you’re convinced that if only you had the exercise equipment at home, you’d be on it every day. But, did you know that there are lots of resources on body weight exercises that you can do without spending any money? If you are in the market to outfit your home gym, be sure to do your research and buy from a reputable brand dealer.
  6. Pass up the sports drinks and diet sodas. Sugar is not your friend, and we’ve all heard about losing electrolytes while working out – but unless you’re in the middle of an endurance competition or training session, your average run or exercise class isn’t going to deplete you. You’re just sabotaging your hard work with unnecessary sugar and calories.
  7. Practice willpower. Willpower is like a muscle – the more you use it, the stronger it gets. The toughest choices are easiest to make earlier in the day when you’re fresh and your resolve is strong. Set yourself up for success. Make the tough choices early in the morning and take it easy on yourself at the end of the day.
  8. Walk more. Walking is great- it helps lubricate your joints; relieves pressure on the spine from sitting; burns calories; and helps clear the mind. So take that empty parking spot at the end of the row and take a few laps around the office – it will help keep you moving towards those goals, plus your joints will thank you.
  9. Receive regular adjustments. Once you’re injured, the risk of re-injury increases. Seeing your chiropractor for proper adjustments regularly can result in a lower incidence of re-injury. Keep your body tuned in good alignment, and don’t forget about the physical therapy.
  10. Smile. Smiling can lower your heart rate, and reduce blood pressure and stress. It causes endorphins to be released and elevates your mood. Smiling also lowers pain and can improve relationships with people around you. Plus, it’s a lot easier to smile than frown, and your face will thank you for it!
With these tips, we hope you keep all of those resolutions – and wish you all the best for a happy, healthy and fit 2017.