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.
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.
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.
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)
At the start of this holiday season, we’d like to give thanks for Balance(d). I named my practice Balanced because I believe in a measured approached to things – to the body, to patient care, and to life. It serves as a reminder to me as much as I hope it does for my patients. Last year I wrote about the importance of balance during the holidays, and you can read about it here. This year, I thought I’d share how I keep my balance during the holidays. Keeping your holidays stress free is great advice, but I want to talk a bit about how you actually do it.
For me, as an introvert, I’ve learned it is really important not to over schedule myself. If I do, it can really wear me out. So I keep track of my schedule in a calendar, and when I consider any invitation I look at the time slot and see what’s around it. If attending the event doesn’t leave me any recharge time, or there’s too much travel time, or if it means I’ll miss too much of my exercise plans, it’s likely a pass for me. Of course for those with children, schedules can be more complicated. You just have to keep your mind on the balance.
Another consideration around the holidays is food. I love food. You can often hear me talking about cooking, restaurants, and value-driven ingredients. To balance food around this time of year, I try to keep lunch light and very healthy – especially if I have plans for dinner or a party later. Then there are the oh-so-tempting sweets that pop up everywhere during the season. So, I eat a healthy snack before I head out since counting calories doesn’t work for me. When I am trying to relax and enjoy a party the last thing I want to think about is how healthy the food is I am eating. Filling up a little on healthier foods before I go can also help ease the guilt along with the managing how much I eat. I gain weight easily if I’m not careful, so I tend to stick with my plans.
I’m a big proponent of exercise, as many of my colleagues in the healthcare field are. If you’re trying to keep from gaining weight, or if you’re trying to lose weight during the holiday season, you’ve got to pay attention to your diet the most. However, exercising during the holidays will also help keep your weight in check as well as help to alleviate stress and keep you in a better mood overall. Of course, if you’re on a set plan for a competition, stick with your plan. If you’re like most people, you exercise more because you should and less because you love it – or perhaps you don’t exercise at all. Time is a big factor for those who don’t, but it doesn’t need to be all or nothing. The key thing is to keep your body moving. If during the holidays, you drop from four days a week to three, that’s a good trade-off. Another way to make the most of your time is to consider high-intensity interval training to make your exercise shorter but more intense. You’ll still build muscle, improve your cardiovascular function, and get all those wonderful stress relieving chemicals – going hard for 10-15 minutes can be as useful as an hour of moderate exercise on the bike or a long walk.
So, take these tips and find your balance this holiday season:
- Look at your calendar frequently and make sure you aren’t overloading yourself and the family
- Stick to a healthy breakfast and lunch and have a healthy snack so you don’t have to watch too much at a party
- Keep up with some amount of exercise, even if it’s less than you normally do
Sam Spillman, DC
The balance system is one of the most important systems the body uses. Throughout the day it helps us to drive a car without getting dizzy; slip on a slick surface without tearing ligaments; go up and down stairs without looking at every step; and walk down the sidewalk without tripping on uneven cracks. Balance is a complex masterpiece that can be honed to help every person function at their highest level. Have you ever wondered how gymnasts balance on the balance beam, or hockey players skate on ice while handling the puck, or how skiers tear manage to slalom downhill without falling? It all has to do with practice and creating a balance set to fit their unique sporting needs. There are three different balance systems that work together to create a wholly balanced world.
This is the feeling that we have in our feet, and is sometimes intertwined with proprioception. Somatosensation and proprioception are defined as how the sensors within the skin on our feet, joints, muscles and tendons sense where we are in space. These sensors constantly give feedback to different parts of the brain and brain-stem to correct movement, and ensure that the proper muscles are contracting to stabilize and move our body. This system can be disrupted by nerve damage (often called peripheral neuropathy), which often occurs with diabetes and some artery diseases. It can also be disrupted by pain, which is why anyone who has had an ankle sprain will tell you that they sprain the ankle over and over after the first injury. This is because the system is disrupted in the presence of pain so the ability of the ankle muscles to contract and prevent further sprains is impaired. When this system is disrupted due to lack of sensation or pain, the body relies on the other two systems below.
Simply put, vision gives us our picture of the world and integrates with the other systems to adjust muscle activity and movement to match what we see. We rely most of our vision during balance.
The vestibular system is an integral part to the balance system. It activates postural muscles throughout the day and also helps us move our eyes independent of head movement. This allows us to focus on one thing while there may be a lot of other things going on around us – think about reading a street sign while driving on the highway, for example. If both of your vestibular systems were non-functioning (you have two, one in each ear), the horizon would bounce up and down instead of being still when walking. Mismatches in information within this system is usually what causes motion sickness. The reason people get nauseous with motion sickness is that the brain has trouble with deciding which input to use – vestibular, somatosensory, or vision. Nausea is your brain’s way of saying: we need to sit down and take a break so I can figure this out. When this system is not functioning correctly, patients generally experience dizziness – defined as feeling off, light-headed, or spacey – and vertigo, which gives the sensation that the world is spinning around you. This system is most important for balance at night when vision can be eliminated.
Balance may not be as straightforward as it seems. It requires a lot of input and processing within our nervous system to work well. The good news is that our balance system can adapt to use one part of the system more than the other through training and practice. The bad news is that as we age, we generally lose sensation in our feet and vision leading to increased risks for falls.
We can help you find your balance before issues develop. Give us a call for your balance screening today!
Bryan Esherick, DPT
Inflammation can strike at any time. Anti-inflammatory drugs can be helpful, especially for new injuries and certain inflammatory-based pathologies. However, our bodies experience new episodes of inflammation (both beneficial and detrimental) all the time. So, using natural remedies is a safer way to decrease those frequent bouts of non-beneficial inflammation.
Here are a few natural remedies to try before you reach for a pill.
- Exercise: Even just 20 minutes of exercise can have anti-inflammatory effects on the body’s systems.
- Add powerful anti-inflammatory spices to meals: Give turmeric, cinnamon, and ginger a try. Turmeric can be sprinkled on variety of foods, cinnamon can be a great addition to your oatmeal or tea in the morning, and ginger brings a nice twist to a smoothie.
- Reduce red meat consumption: Recent studies show red meat can actually bring on inflammatory effects on the body. Chicken, salmon, and other foods high in Omega 3’s can be great options to prevent inflammation and get the protein you need.
- Eat more foods with anti-inflammatory properties: Fruits, vegetables, nuts, and legumes are your friends. Be sure to include multiple servings of these throughout the day to allow your body to be at its best.
Remember, your body is your greatest asset. Take good care of it, and it will take care of you for years to come!
Bryan Esherick PT, DPT
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.
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 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 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
Try these quick lunch tips to help you AND the kids!
- Buy fresh produce. Sunday night prep can be 30 minutes: wash, peel and cut all carrots, celery, broccoli, cucumbers, etc. and store in large ziplock bags for the week for a quick grab-and-pack.
- Create your own lunchables. Sliced cheese/ham and crackers in a reusable container, grapes and carrots in another, hummus and pretzels for non meat eaters, and you’re set!
- Avoid sweet drinks. My kids would finish a juice pouch and eat nothing else. Keep juice and sweet treats at home as an after-school-treat. They’ll look forward to that!
- Provide ample food storage. Having sandwich and snack size reusable containers on hand make packing a lunch so much easier for little ones.
- Pack a note. Wouldn’t you want a note from Mom/Dad? (I would!) A silly joke or a ‘have a crazy day!’ can help your child (or spouse!) get through the rest of the day.
Enjoy healthy and happy lunching!
Concussions. They can have lasting effects later in adulthood, so prompt treatment is essential to mitigate long-term effects. While the end of summer draws near, and fall sports get underway at the start of a new school year, it’s important for parents, trainers, and coaches to remain vigilant in watching for signs and symptoms of concussion in young athletes.
Here some tips to help you recognize concussions:
- Your child isn’t acting quite like themselves: Look for changes in your child’s usual mood, cognition, ability to pay attention, and energy level. When your child isn’t acting like he/she normally does following a game, it’s a safe bet they may have suffered a concussion.
- They sustained a jarring hit: Any hit, whether it is to the head or body, has the possibility of causing a concussion. Hits to the head are obviously related to concussions, but hits to the body can also cause concussions through whiplash-like mechanisms.
- Nausea or sensitivity to light or sound: These are some very common signs seen following a concussion.
- Dizziness while using their phone or watching TV: This can be caused by a sensory issue within the vestibular system. Also watch out for dizziness or imbalance while driving and walking in busy areas.
- IF YOU SUSPECT A CONCUSSION SEEK MEDICAL ADVICE: Waiting to seek medical advice can have an impact on the overall time it takes for your child to recover. Seeking medical advise as soon as you suspect your child may have a concussion is key.
One of the best things that you can do for your athlete as a parent or coach is to be sure that they have baseline testing consisting of physical, cognitive, and equilibrium tests prior to participation in practice and games. Should an injury occur, baseline testing allows the coach and trainer to know when it is safe to allow the athlete to return to sport after an injury has occurred. Also be sure that the testing for your athlete is comprehensive, and not performed only using the IMPACT computer-based test that doesn’t take into account the other functions of the body that may be impacted through concussion.
When seeking medical advice, remember that advice can come from a variety of medical practitioners including medical doctors, physical therapists, athletic trainers, etc. Medical examination usually consists of some tests and measures to determine the severity of the injury. Examination is necessary to rule out other serious pathologies, including a brain hemorrhage. Usual care for a concussion is a brief period of rest (1-3 days), followed by a graded return to sport and school, and then rest. Rest is essential for the brain to heal itself in the early stages, although activity should be resumed as quickly as possible while maintaining little to no symptoms. Physical therapists can help by determining a safe level of activity for the athlete and developing a sport specific training plan. Before your child returns to sport, ensure all testing compares to baseline, that physical activity has been progressed, and that your child is symptom-free with sport specific training.
By following these key steps after sustaining a concussion, your athlete can return to sport as quickly and safely as possible.
Note: This blog is not considered medical advice that should be used if you suspect a concussion in your child. If you believe your child may have suffered a concussion or would like to receive baseline testing, contact our clinic at 434-293-3800.
Want to do better in school? Get more, restful sleep! We all know sleep is important but we might think of it more as an “eat your vegetables” important kind of way. In reality, we should be thinking about it more in a “this could impact my life, hopes and dreams” kind of way. That’s exactly what researchers are finding as we learn more and more about sleep and the value it brings.
Sleep is vital for so many functions and processes in the body: memory, cognitive function, blood pressure, hormone regulation (cortisol, insulin, leptin, grehlin, testosterone), healing, muscle recovery, immune system, etc., etc.,. And, it is especially important for children. Sleep deprivation can significantly impact a child’s performance in school.
So, how do you know if your child is getting enough rest? Here’s a good rule of thumb:
- Children aged 6-13 should be getting 9-11 hours of sleep each night
- Teens should be getting 8-10 hours
While these are good gauges to check patters in your household, that’s just a starting place. Behavior can be a great clue.
Signs of sleep deprivation are similar to symptoms of ADHD. They include:
- easily distracted
- difficulty focusing
- difficulty learning new concepts
- feeling “fuzzy”
- increased appetite
Most likely, we could all make a few adjustments to get a better night’s sleep.
The best rules work for both children and adults:
- keep a consistent, daily bedtime
- avoid eating within three hours of bedtime
- discontinue screen time at least an hour before bed
- can the caffeine after noon
- maintain a set bedtime routine for children
With these simple tips, you and your little ones will be sleeping sounding and reaping the benefits in no time!
Sam Spillman, DC
Here are some backpack tips to lighten the load:
- Choose a backpack that has two wide straps with good padding to distribute the load evenly.
- Adjust the height. Tighten straps so the bag is centered on the back, ideally above the lower curve of the spine.
- Use both straps. The one-shoulder method may be cool, but it adds serious pressure and throws body alignment out of whack.
- 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.
- 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.
My grandfather was a farmer in the heart of Cornell chicken country. He raised dairy cows, chickens, and corn in upstate New York and when he retired, he continued farming the most delicious corn – and even became adept at growing brussels sprouts – on the few acres behind his house.
Back in the day, Cornell chicken was widely popularized by Cornell University’s poultry science and agricultural program as an inexpensive protein alternative to beef. And Cornell’s very own Robert C. Baker actually invented the barbecue recipe now famous in Cornell chicken recipes – like the one my grandfather perfected. However, Baker’s real claim to fame was his invention of the chicken nugget, which he actually invented while at Penn State but only gained appreciation after he joined the faculty at Cornell. He would travel all over the country sharing his love of poultry and demonstrations of his recipes.
At one point, Cornell had approached my grandfather inviting him to be one of their instructors at the agricultural school but his love of farming kept his focus. I must say I’m glad it did because my grandfather’s Cornell chicken recipe is a summer classic, and brings back some of my fondest childhood memories.
This Fourth of July I’ll be grilling up a batch of my grandfather’s signature summer fare, complete with corn-on-the-cob for the side – though I’ll be getting my corn from the local farmer’s market. Give it try!
What you’ll need:
- 1 egg
- 2 cups of apple cider vinegar
- 1 cup of vegetable oil
- 3 tbsps salt
- 1 tablespoon of black pepper
- 1 tablespoon of poultry seasoning
What to do:
- In a bowl, beat the egg and whisk in oil followed by the vinegar and then the seasonings.
- Marinate whole chicken, or chicken pieces, for 24 hours.
- Throw it on grill and cook to an internal temperature of 165 F.