How Does Health Insurance Work?

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What are the costs associated with health insurance?

Most health insurance costs can be divided into three categories:

  • Premiums: Most health insurance companies offer several types of plans with varying degrees of coverage. These differences in coverage affect monthly costs, known as premiums. The higher the premium, the less you will pay when you get sick.
  • Deductibles: The dollar amount you pay out-of-pocket before your insurance begins to pay is called your deductible. Insurance plans that have higher monthly premiums tend to have lower deductibles, while plans with lower monthly premiums tend to have higher deductibles.
  • Copays or Coinsurance: When you visit the doctor, you may be asked to pay either a copay which is a standard flat rate, or coinsurance, which is a percentage of the total charge for the visit.

What are the different types of health insurance plans?

There are four types of traditional healthcare plans:

  • Exclusive Provider Organization (EPO): A managed care plan in which services are covered only if you use doctors, specialists or hospitals in the plan’s network (except in an emergency).
  • Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally does not cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage, and you must select a primary care physician (PCP) to manage your care.
  • Preferred Provider Organization (PPO): A type of health plan in which you pay less if you use providers in the plan’s network. You can use doctors, hospitals or providers outside of the network without a referral for an additional cost.
  • Point of Service (POS): A type of plan in which you pay less if you use doctors, hospitals or other health care providers that belong to the plan’s network. POS plans require a referral from your PCP in order to see a specialist.

Colonoscopy Myth #2: Colonoscopy Prep is Not Easy

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A colonoscopy can prevent colon cancer, but only if your doctor can view the entire colon during the procedure. Your responsibility is to clear all debris from the colon so your gastroenterologist can detect and remove precancerous polyps and prevent colon cancer.

Inadequate bowel preparation is responsible for one out of three incomplete colonoscopies, so commit to your colon prep with determination and precision.

For Easy Colonoscopy Prep, Ask for “Low Volume Colonoscopy Prep”

It’s normal to dread or even fear the colonoscopy prep. The first step to calming your fears and having an easy colonoscopy prep is to talk with your doctor. You will not be the first patient to express concerns about colonoscopy preparation. Know that you can request a low volume prep and even ask about “split-dose prepping.” Most modern prep formulations are designed to enhance patient comfort, but talking with your doctor will confirm you get the prep best suited to your preferences and medical needs.

Ask your gastroenterologist about:

  • SUPREP
  • Moviprep
  • Plenvu
  • Halflytely

How to Easily Prep for a Colonoscopy

Colonoscopy prep doesn’t have to be painful or complex. Make your colonoscopy prep simple and more comfortable. Use this guide on what to eat and what to avoid before a colonoscopy.

A week before the exam

Begin eating a “low-residue diet.” A low-residue diet is low in fiber and will reduce the volume and frequency of bowel movements.

What to eat:

  • Pasta
  • White bread
  • White rice
  • Eggs
  • Lean chicken
  • Cooked or canned fruits and vegetables without seeds

What to avoid:

  • Whole grain bread
  • Seeds
  • Nuts
  • Raw fruits and vegetables
  • Leafy greens
  • Legumes
  • Fatty meats

A few days before the colonoscopy

Consume clear liquids like beef broth, chicken broth, clear fruit juices, Gatorade, sports drinks, sodas, Jell-O and Italian ice. You can even buy Gummy Bears because they dissolve into clear liquids. Avoid any product that is red, blue or purple because the dye can interfere with your colonoscopy results.

Thoroughly read the instructions in your prep kit. If you have questions, call your doctor’s office.

How to Survive Prep Day

On your prep day (the day before your colonoscopy), you’ll begin drinking the clear liquids you have purchased. Dissolve your “prescription cocktail” of laxatives and salts in your desired liquid, and chill it in the refrigerator. The instructions in the prep kit will tell you when to begin drinking the solution.

Many prep solutions can be divided into two equal doses, known as the “split-dose regimen.” This new method advises you to drink half of the prep solution the evening before the colonoscopy and the remainder of the liquid on the morning of the procedure.

Easy Colonoscopy Prep Drink Tips

To make your colonoscopy prep solution more palatable, here are five tips and tricks:

  1. Use Gatorade or Crystal Lite in your prep solution (avoid red, blue or purple colors/flavors)
  2. Chill the solution for several hours and drink it cold
  3. Use a straw
  4. Chase the prep with cold water
  5. Treat yourself with a piece of hard candy after consumption (no red, blue or purple colors/flavors)

Remember, your goal is colon cancer prevention. Failing to cleanse your colon properly will delay testing and force you to dedicate more time to the screening process. If you do not adequately cleanse your bowel, you will have to reschedule and go through the process again.

Schedule Your Colonoscopy Today

The American Cancer Society recommends adults at average risk for colon cancer begin screening at age 45, but certain risk factors may require earlier screening. Most cases of colon cancer are preventable with routine colonoscopies, but one-third of American adults aren’t up-to-date on their screenings. Are you one of them? Call your gastroenterologist to see if you are due for a colonoscopy. And don’t let the prep scare you — modern prep formulas are easier to swallow than ever before.

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Relieve Joint Pain with Exercise

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It’s normal to want pain relief right away. Although ice and anti-inflammatory medication can help, they can only offer temporary relief.

You may be tempted to avoid certain motions that seem to aggravate your joints. However, limiting your mobility can actually increase your joint pain since you are allowing your muscles to weaken. Weak muscles can further stress the joint, which may increase the chance that you will eventually need surgery.

Joint Pain Exercises Reduce Stiffness and Promote Weight Loss

Exercise can strengthen joints and reduce stiffness. That alone is reason enough to begin an exercise routine. But there’s another reason your painful joints will feel better when you exercise: it can help you lose weight, which will take pressure off your aching joints.

In fact, for every pound you lose, you’ll release 4 pounds of pressure from your knees and hips.

Lose just 10 pounds, and it will lift an equivalent 40 pounds of pressure off these weight-bearing joints.

Relieve Joint Pain by Walking

According to the U.S. Centers for Disease Control and Prevention (CDC), a person with arthritis should be moderately active for at least 150 minutes each week. The CDC suggests walking 30 minutes a day, five days a week, dividing those walks into smaller 10-minute sessions throughout the day.

An easy way to get started — and to get support and encouragement — is to join Walk with Ease, a six-week walking program developed by the Arthritis Foundation. It can be done alone or with a group, and they even offer a free app for iPhone or Android to help you track your steps.

Joint Pain Exercises to Try at Home

In addition to walking and aerobic exercise, you should include range of motion and strengthening exercises in your routine. Here are examples of joint pain exercises you can try at home:

  • SI Joint Pain Exercise: Lie on the floor. Then bend your knees, keeping your feet on the floor. Next, grasp a knee and slowly bring it towards your chest, going only as far as you can without feeling pain. Hold the position briefly, then return your foot to the floor.
  • Knee Pain Exercise: Stand behind a chair, holding it. Lift your heel up as close to your rear as possible. Do several lifts, then switch to the other side.
  • Hip Joint Pain Exercise: Stand holding a sturdy chair next to you. Lift one knee up to form a 90-degree angle at your hip; hold briefly, then lower your knee to its original position. Do several lifts, then switch to the other knee.

Visit the Arthritis Foundation for tips on how to start an exercise program that addresses your unique type of joint pain.

Relieve Joint Pain While Exercising with Others

If you prefer to exercise with others who have arthritis versus exercising by yourself at home, check out these programs:

Orthopaedic Surgery Center of Ocala Performs 100th Total Joint Replacement Procedure

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Joseph Locker, M.D., one of the center’s two physicians who perform TJRs, led the milestone procedure. The patient did not require pain medication and was able to leave the surgery center on crutches that day after spending two hours in recovery. In his post-operation follow-up, the patient rated the overall experience and the facility as a 10 out of 10.

Shorter Total Joint Replacement Recovery Time Compared to Hospitals

The physicians and staff at Orthopaedic Surgery Center of Ocala are committed to providing safe, high-quality, evidence-based care. As part of the center’s patient-centered approach, the team does not administer a spinal nerve block prior to surgery. Instead, they apply local anesthesia to the joint, which results in shorter recovery time and can have patients out the door within two hours after surgery.

Patients’ discharge is contingent upon ambulating to a reclining chair after the anesthesia wears off and demonstrating they can walk to their car. Following the surgery, patients are provided at-home physical therapy until the first post-operative appointment one week later. They are then transitioned to outpatient physical therapy.

These unique offerings have established Dr. Locker and his colleague, Zakariah Mahmood, M.D., as pre-eminent total joint orthopedic surgeons in the region. The center also relies on the expertise of surgeon Mark Rogers, M.D.

Surgery Center Patient Experience Surpasses Competitors

The staff at the center prides itself on going above and beyond the typical standard of care. The stellar patient experience is one of the many reasons the Orthopaedic Surgery Center of Ocala had a 97 percent patient satisfaction rate from April 2017-April 2018, as determined by Press Ganey’s annual patient survey. Little touches such as post-operative food and beverages and a tumbler emblazoned with Orthopaedic Surgery Center of Ocala Total Joint Program set the facility apart.

The Orthopaedic Surgery Center of Ocala opened its doors July 29, 2016. The 10,000-foot facility is certified by Medicare and the Accreditation Association for Ambulatory Health Care and has three operating rooms. It also offers completely private post-operative rooms to ensure patient comfort. While the most common TJR is a hip procedure, the team frequently performs total knee and total shoulder replacements. As more patients seek care in the outpatient setting, the team expects its TJR program to continue growing.

How to Lower Eye Pressure Through Glaucoma Medication and Meditation

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Meditation Can Help Lower Eye Pressure in Open-Angle Glaucoma

A recent study published in the Journal of Glaucoma suggests holistic glaucoma treatment such as meditation and mindfulness can reduce intraocular pressure (IOP) in primary open-angle glaucoma, the most common form of the disease.

The study included 90 patients with primary open-angle glaucoma who were divided into two groups. One group participated in one-hour guided daily meditation sessions for 21 days, and the other group served as the control. All participants continued their prescribed glaucoma medication to lower IOP. Individuals who practiced meditation showed lower IOP, reduced stress and improved quality of life. The control group did not experience these benefits.

Researchers concluded holistic glaucoma treatment, in conjunction with prescribed glaucoma medication, can benefit glaucoma patients.

Ophthalmologists Can Detect Glaucoma Early Through Comprehensive Eye Exams

According to the Glaucoma Research Foundation, more than 3 million Americans have glaucoma, but half are unaware they are affected. Ten percent of all cases of blindness in the United States are caused by glaucoma, and 75 percent of those affected are senior adults.

Because primary open-angle glaucoma symptoms are rare, patients cannot depend on warning signs to alert them of a vision problem. In fact, glaucoma can diminish the visual field by 40 percent without notice. Lowering IOP in open-angle glaucoma is the only method to prevent optic nerve damage and vision loss. This is why it is essential to have annual eye exams with an ophthalmologist.

Through annual comprehensive eye exams, ophthalmologists can detect glaucoma at an early stage before vision damage takes place. Eye doctors can check eye pressure with a test called tonometry and can detect early indications of disease long before a patient would notice signs and symptoms of glaucoma. Additionally, ophthalmologists can identify other forms of degenerative eye disease like cataracts and macular degeneration.

Make an Appointment with Your Ophthalmologist

Call your ophthalmologist to ask whether you are due for a comprehensive eye exam. If you have glaucoma, your doctor can suggest other natural ways to lower eye pressure like exercise, diet, biofeedback and relaxation. Although holistic glaucoma treatment can never replace prescribed glaucoma eye drops or glaucoma medication, these therapies may delay the progression of the disease and help preserve vision.

Medicare Website Compares Costs at Surgery Center vs Hospital

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This is part of a Congress-mandated initiative called the 21st Century Cures Act.

“Can you imagine going to the grocery store, getting the groceries you need for the week, but never knowing the price of your items until a week later when the store sends you a bill? Sadly, that’s how healthcare works every day” – Seema Verma, Centers for Medicare and Medicaid Services Administrator (CMS Blog).

Medicare Pricing Tool

The Procedure Price Lookup Tool allows a qualified Medicare beneficiary to compare average payments and copayments for medical procedures performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). The website also provides the national average copayment a beneficiary with no Medicare supplemental insurance policy (Medigap) would pay the provider.

Here are the average costs Medicare patients would pay for common procedures at a surgery center vs hospital.

Medicare Website Compares Procedure Costs at Hospitals/ASCs

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This is part of a Congress-mandated initiative called the 21st Century Cures Act.

“Can you imagine going to the grocery store, getting the groceries you need for the week, but never knowing the price of your items until a week later when the store sends you a bill? Sadly, that’s how healthcare works every day” – Seema Verma, Centers for Medicare and Medicaid Services Administrator (CMS Blog).

Medicare Pricing Tool

The Procedure Price Lookup Tool allows a qualified Medicare beneficiary to compare average payments and copayments for medical procedures performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). The website also provides the national average copayment a beneficiary with no Medicare supplemental insurance policy (Medigap) would pay the provider.

Cataract surgery, cataract removal with YAG laser and blepharoplasty (removal of excess skin above or below the eye) are three of the most common outpatient eye procedures for Medicare patients. Here are the average costs Medicare patients would pay for these procedures at a hospital outpatient department (HOPD) compared to an ambulatory surgery center (ASC).

Medicare Website Compares Procedure Costs at Hospitals and ASCs

by

This is part of a Congress-mandated initiative called the 21st Century Cures Act.

“Can you imagine going to the grocery store, getting the groceries you need for the week, but never knowing the price of your items until a week later when the store sends you a bill? Sadly, that’s how healthcare works every day” – Seema Verma, Centers for Medicare and Medicaid Services Administrator (CMS Blog).

Medicare Pricing Tool

The Procedure Price Lookup Tool allows a qualified Medicare beneficiary to compare average payments and copayments for medical procedures performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). The website also provides the national average copayment a beneficiary with no Medicare supplemental insurance policy (Medigap) would pay the provider.

Colonoscopy, upper endoscopy and esophageal dilation are three of the most common GI outpatient procedures. Here are the average costs Medicare patients would pay for these procedures at a hospital outpatient department (HOPD) compared to an ambulatory surgery center (ASC). 

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5 Glaucoma Risk Factors to Be Aware Of

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Glaucoma can cause irreversible vision loss and blindness. This sight-robbing disease has no cure or method of prevention, yet it affects more than 3 million Americans. According to the National Eye Health Education Program, glaucoma’s prevalence will increase by 58 percent by 2030 and affect 4.2 million men, women and children.

January is National Glaucoma Awareness Month, so it’s wise to take some time to learn more about this eye disease and assess your risk. Although anyone can develop glaucoma, you may have an increased chance of developing the disease depending on the following glaucoma risk factors:

Family History of Glaucoma

Heredity is responsible for over half of glaucoma cases, and you are up to ten times more likely to develop glaucoma if you have a sibling with the disease (Glaucoma Research Foundation). If glaucoma runs in your family, encourage family members to make yearly appointments for comprehensive eye exams to detect glaucoma early.

Age

Another glaucoma risk factor is your age. Your chances of developing eye diseases like glaucoma, cataracts and macular degeneration increases with age. If you are over 60 years old, you are six times more likely to develop glaucoma.

Ethnicity and Glaucoma

After cataracts, glaucoma is the most common cause of blindness among African Americans and people of African ethnicity. A study published in JAMA Ophthalmology suggests Mexican Americans may also be at elevated risk for developing primary open-angle glaucoma, the most common form of the disease.

Elevated Eye Pressure

Glaucoma is often associated with elevated intraocular pressure (IOP), or inner eye pressure. You may wonder what normal eye pressure is: the Glaucoma Research Foundation considers normal eye pressure to be 12-22 mm Hg. An ophthalmologist can perform a simple pressure test, known as tonometry, during an eye exam and can advise you as to whether you have elevated IOP. Higher-than-normal eye pressure does not indicate glaucoma, but it is a primary glaucoma risk factor.

Glaucoma Eye Exams Preserve Vision

Because glaucoma symptoms and warning signs are rare, it is essential to see your eye doctor regularly. If you have a family history of glaucoma, you will need to schedule your appointments more frequently. Knowing your risk for glaucoma and scheduling comprehensive eye exams are integral to preserving your vision for years to come. Because glaucoma-related vision loss is irreversible, glaucoma treatments like eye drops, laser procedures and surgery are more effective in the early stages of the disease.

During your eye exam, ask your doctor to review your complete medical history with you so you can make updates or changes. Be sure to include family medical history, and mention any chronic diseases like hypertension, diabetes or heart disease, as well as any eye diseases that run in your family.

Schedule an appointment for yourself and your entire family during National Glaucoma Awareness Month and enjoy the gift of clear vision.