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!

Snow...Ice... My Appointment...?

It's that time of year when the weather is unpredictable - 55 degrees one day and then bitter cold with snow and ice just a few days later.  As of today, January 26th there are only 53 days until the official first day of spring but that hardly seems real as we are facing some snow and ice over the next few days here in Cincinnati.

So what does that mean if you have an appointment or need an appointment when the weather is like this?

We will make every attempt to be open as long as it is safe to travel on the roads but please call first (513-271-2862) just in case we have decided it is not safe and we are closed.  We will have current information available for you, including a later opening time if this is the case.  If there is a statement issued by Hamilton County indicating that essential travel only is permitted, we will be closed.

If you decide you would like to reschedule your appointment please give us as much advance notice as you can.   We do understand that this is not always possible, of course and are just happy to hear from you - that you're okay.  We will be happy to reschedule your appointment at your convenience.

If you have an emergency and the office is closed, please use the emergency room at the hospital closest to you.  If you need an appointment you may leave a message with our answering service and we will contact you as soon as we are open again.

So, stay warm... be safe... and stay off the snowy icy roads as much as you can.

Something common... something FIXABLE

Urinary incontinence affects millions of men and women in the United States yet it is one of the least talked about problems.  Too many people "suffer in silence" because it is embarrassing to admit to this problem and often difficult to bring the subject up to a doctor.

It doesn't have to be this way.  There are many very effective treatments for incontinence. There are different reasons people lose urine when they don't want to, so the type of incontinence must be determined in order to choose the right solution.  

Stress incontinence is one of the most common types.  It can occur in both men and women but is more common in women and can happen at any age.  Typically a person with stress incontinence loses urine with coughing, laughing, sneezing or activities such as dancing and exercising. 

Urge incontinence is the "Gotta go, gotta go RIGHT NOW" type of incontinence.  Many people with this type of incontinence are extremely inconvenienced by having to plan their activities around knowing where the closest restroom is.  It is difficult to enjoy going to movies or sports events if you have to get up frequently to urinate!  And often people with this kind of incontinence make it to the bathroom only to lose urine before actually getting to the toilet.

Of course, there are other reasons for incontinence as well.  Dr. Roesel has a special interest in treating incontinence because she feels it is such an important quality of life issue.  No one should have to go through life wet.  

There are a variety of effective treatments available for different kinds of incontinence.  Dr. Roesel can diagnose the specific type of problem you have using a combination of history, physical exam and specialized testing if needed.  Our office is set up to provide a full diagnostic work up including urodynamics which is a study of how well the bladder is able to store urine to prevent leakage.

Once a diagnosis has been made, your treatment options may include medication, physical therapy or surgery.  Treatment is individualized and Dr. Roesel works with each patient to make sure they understand the plan and feel comfortable with her recommendations.

If you are having trouble staying dry, don't suffer in silence.  Give us a call at 271-2862.

In-network with United Healthcare

We are happy to announce that we are now in-network with United Healthcare.  Many thanks to all of you who waited patiently for Dr.  Roesel to become a participating provider!  We'll be calling everyone who left his/her name to be notified as soon as we had the "go ahead" to start seeing UHC patients.