Kidney Stones

If you've recently had a kidney stone you might want to skip this post to avoid painful memories...

Cincinnati is considered to be in the "Stone Belt" of the United States.  For some unknown reason,  kidney stones are common in this area.  Men get stones approximately 3 times more frequently than women do, and once you have one stone, your chance of having another one rises.

Kidney stones that do not cause complete blockage may cause dull or intermittent pain, usually in the flank area or high up in your back.  If a stone is blocking farther down the ureter (tube between the kidney and bladder that carries urine made by the kidney) it can cause a complete obstruction.  This means PAIN and SUFFERING.  This pain may be sharp and excruciating.  It can be bad enough to cause vomiting and it may seem you can't find a comfortable position to lie in.  The pain can radiate down into your groin or into the scrotum or genitals.

If you are having pain like this, the best thing to do is go to the nearest emergency room.   If the doctors suspect a kidney stone, you will get a CAT scan.   The upper left picture shows a CAT scan with an arrows pointing to stones in the kidney.  Of course, pain can be caused by other things so the doctors will certainly check you out for other possibilities.

If you have a stone, your treatment will likely involve control of pain,  IV fluids and anti-inflammatory medicines as well as medicines that may help you pass the stone.  Being admitted or sent home depends on a number of factors such as whether or not the pain can be controlled with oral medicines, if you can drink enough fluids to stay hydrated and whether or not you have a urinary tract infection.

If you are discharged from the ER, follow up as soon as possible with a urologist.  We hold open appointment times every day for urgent visits such as these.  The correct treatment for your particular stone will be discussed with you at the time of your visit.

If you know you have a stone here are the warning signs to call your urologist and then go immediately to the closest ER:

1. Pain that cannot be controlled with oral medicines at home

2. Nausea or vomiting that prevents you from drinking and eating

3. Fever over 101 degrees

4. If you have a single kidney or have a transplanted kidney.

The best source of general information on the web for more information about stones is from the NIH.  Here is the link:

http://kidney.niddk.nih.gov/Kudiseases/pubs/stonesadults/

 Just 21 more days until spring!

Our terrarium and its inhabitants

You may have noticed the terrarium in our waiting room. It has a small fountain, live plants and is home to five little tree frogs. These tree frogs are not poisonous.

There are three marbled tree frogs who look like this:

Their scientific name is Hyla marmorata. They are found in Central and South America.Marbled tree frogs are often called"bird dropping tree frogs" due to their color and shape. This camouflage protects them from predators.

They have very bright orange colors and spots on their undersides so if you catch them while they are sticking to the side of the terrarium glass you might see something like this:



There are two little green tree frogs that look like this:

The green tree frogs can change color. Sometimes they are green, sometimes they are brown and sometimes they are almost white. Their scientific name is Hyla cinerea. They are native to the United States and can be found in Cincinnati in the summer time. The females are typically larger than the males.

Both these species of frogs are nocturnal so when you see them in the office they are likely to be sleeping. They are very good at hiding. Children have the best eyes for spotting them it seems. The marbled tree frogs like to sit around the fountain or stick to the back of the cage. The green tree frogs hide under or on leaves or high up near the top of the terrarium.

We hope you enjoy looking at our little tree frogs as much as we do!

Patient Suggestions

We LOVE them!

Good or bad, we want to hear your suggestions. Your satisfaction with your care in our practice is extremely important to us. If you have had an unsatisfactory experience, we want to know about it right away so we can make it right for you and also never have it happen again.

As a patient, you have lots of rights. You have a right to prompt, courteous service. You have a right to have your questions answered. You have a right to understand the plan of care or treatment Dr. Roesel has reccomended for you. You have a right to being treated in a clean and modern facility.

If you ever feel something is not right, please feel free to talk to Dr. Roesel or one of our staff. We will do everything to "make it right".

We have had several recent suggestions from patients which we have immediately implemented. Here are two:

1. Give lollipops after a procedure



2. Use wiper warmers for the baby wipes we provide for patient use after exams



Many thanks to those patients who gave us ideas to make things more pleasant for everyone!

Just 28 days until spring!

Deductibles - Sorting out the confusion

Deductibles can be confusing. Most insurance holders know they have one... but what does it mean? In the simplest terms, it means the amount of money the policy holder must pay out of pocket prior to the health benefits being used to pay for medical bills.

Early in a new calendar year or a new insurance plan year most people have not yet met their deductibles. At our office, when we verify your insurance we also verify the amount of your deductible you have met to date. If you have not met your deductible, our office bill will be used in full or part to satisfy it. This means we will collect your deductible (or portion of it) along with any copay you may be responsible for at the time of your office visit.

Then as a courtesy to you, we bill your insurance company. Your benefits are then calculated by the insurance company and an explanation of benefits is sent to you. Once the insurance company has calculated your portion of the responsibility for our bill if there is additional money you owe, we will send you a bill. If you have overpaid, we will immediately and cheerfully refund the amount we owe you.

With Health Savings Accounts (HSA) this can be a new and shocking experience to pay for your care to meet a deductible which can be very, very high. HSAs have money in a special savings type account which is used to meet your deductible. Most people with HSAs have a special debit-type card which is used to pay the bills from that savings account.

The reason we collect your unmet deductible at the time of your visit is twofold. One, it reduces the amount of paperwork involved in sending out bills and two, it reduces time spent trying to collect from patients who choose not to pay the part of the bill they are responsible for.

Trying to keep the lid on burgeoning health care costs is a goal we are committed to. Please feel free at any time to ask to speak to Dr. Roesel about concerns you have about your bill or if you have questions about your insurance coverage. We will do everything we can to help answer your questions to the best of our ability, and if we don't have an immediate answer, we will contact your insurance company and get an answer.

Only 28 days left until spring!

Happy Valentine's Day

A valentine for you from Dr. Gwen Roesel and her staff.  

Very important HUMANA UPDATE

We won!

After the recent awful discovery that we were not in-network with Humana as we had been told, we decided that we were not going to accept "too bad" as an explanation for our practice or any of our patients.  To make a long story short, Humana has agreed to back date all claims filed from January 1, 2009.

What this means to you is that our billing company will resubmit all claims that have been denied.  Many of you have been surprised to get copies of the explanation of benefits from Humana - especially if it says that you are responsible for the entire bill.  The cost of health care is indeed shocking.  

The amount billed is rarely the amount that is paid by the insurance company.  Insurance companies have predetermined amounts they pay for each service or procedure.  Each insurance company also determines how much responsibility the patient has for that amount. In some cases the patient has no further responsibility after the copay has been made.

More commonly, the patient is responsible for a percentage of the cost after a certain deductible has been met.  Usually this percentage is around 20% but it can be more or less.

Check your insurance card or look online at your insurance company's website if it has one to learn more about your coverage.

This was good, good news for us and we could not wait to share it with our Humana patients!

Only 36 more days until spring...

Important information for Humana insurance holders

We had been told that we were fully credentialled with Humana as of January 1, 2009 and have been seeing patients.  On Friday January 6  we found out that we are actually not yet an in-network provider for Humana.

Needless to say, this was not good news.  Here is how it will impact those patients we have already seen and what we will do until we are truly in-network.

1.  For patients with out-of-network benefits, we will accept Humana's out-of-network reimbursement for care that has already been provided.  

2.  For patients without out-of-network benefits (meaning Humana will reimburse our practice nothing at all for your care) we will reduce your bill to a portion that you will be responsible for.

We are truly sorry that this miscommunication has occurred.  We try hard to be able to provide our patients with as much information as possible regarding their insurance coverage and responsibility for the cost of their health care.

Having insurance is not a guarantee that your health care will be fully covered. We file claims with your insurance company as a courtesy but ultimately the patient is responsible for the charges incurred.  In this case, because we incorrectly told our Humana patients that we were in-network we will accept reduced rates of reimbursement.

We are not able to provide care free of charge, however.   When you get a statement from Humana, please feel to contact us to find out the amount you should pay.  We will advise our billing company of the change as well.

Health insurance has changed so much over time.  Many of us remember small office visit copays, free prescriptions and low premiums to pay.  Now everything is more expensive and more of the cost is being passed on to the patient.  Doctors are being reimbursed less, sometimes even less than the actual cost of providing care.  This is one reason why some doctors do not accept particular insurance plans.

When you call for an appointment, our receptionist will ask you what insurance coverage you have.  This is not meant to sound "greedy" but rather to help make sure you know what your responsibility will be for your care. Another way to check if a particular doctor is participating in your plan is to call your insurance company and ask.  Many insurance companies have websites you can access from home to find participating providers as well.

We'll let everyone know when we are TRULY in-network with Humana just as soon as it happens.

Stay warm and safe, only 42 days left until Spring!