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January 31, 2008

Health Insurance Billing Explained

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So there are many patients who do not quite understand how billing through their insurance companies work. Words like deductible, copay, coinsurance, and premium all seem to blur together resulting in confusion in terms of what they may anticipate paying for a given medical service. This blog is to help demystify and clear up the confusion so that hopefully, there will be no surprises when you get a bill from either your physician or the hospital.

SO, perhaps the best way to explain the differences is through an example. Keep in mind that every single health insurance plan have different charges (even within the SAME plan with the same name), so look at the contract you signed to see exactly what your obligations are.

EXAMPLE: Mr. John Smith has Anthem PPO which has the following criteria:
Premium: $10,000 per year
This means he must pay $10,000 per year just to have Anthem PPO health insurance.
Deductible: $500
This means he must pay $500 in a given year BEFORE his health insurance coverage even kicks in.
Copay: $30 PCP/$50 Specialist/$75 ER
This means that if he sees a primary care doctor, he will have to pay $30 every time. $50 and $75 for a specialist or ER visit respectively.
Coinsurance: 20%
He will be responsible to pay 20% of allowable charges of his healthcare bill set by his insurance company, Anthem PPO.

In case you lost or misplaced your contract, call the number on your insurance card to get all this information. For those individuals where their health insurance is covered by their employer (ie, you are not paying premiums), you STILL are paying premiums reflected in lower wages OR hidden costs that may not be readily apparent. However, the expense of health insurance in a company is spread out through all its workers and the company gets a "group rate" that is cheaper than if an individual gets health insurance on his/her own.

HINT: Before you make an appointment with a doctor, make sure that the physician participates with your health insurance plan. Otherwise, you may find yourself paying the entire bill out of your own pocket! Click here to read more about this situation.

A final point to consider is that the copays, deductibles, co-insurances, etc discussed above apply if a physician is IN-NETWORK. OUT-OF-NETWORK coverage means a given doctor participates with your insurance, but you will be paying much more than if you remained with a physician who is an IN-NETWORK participating provider. How do you find out whether a given physician is in-network or out-of-network? Call your health insurance plan and ask. Click here for more info regarding in-network vs out-of-network.

To see what health insurance plans Fauquier ENT participates with, click here.

January 28, 2008

New Video on Pediatric Nasal Saline Flushes

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A new video has been created showing a young child performing saline flushes to his nose without assistance. Indeed, kids older than 5 years are able to tolerate flushes without difficulty. A nasal saline flush kit using the Neilmed Sinus Rinse bottle is shown here. This video can also be found on YouTube.



There are also devices that perform the same thing:

January 16, 2008

Allergy Medications Explained

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A new webpage has been posted going over the different types of allergy medications in the market today. Given that there is plenty of information on the internet on the science behind how these medications work, the webpage does not go into the pharmacodynamics and pharmacokinetics, but rather uses terms hopefully a layperson can understand.

Furthermore, small useful tidbits of info are given including differences between allegra and allegra-D not only in terms of medical benefit but also cost as well as why it's OK to take several different types of allergy medications at the same time.

Click here to check it out!

January 15, 2008

Dr. Christopher Chang Recently Featured in Regional Serial Publication

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Dr. Chang was recently featured in Healthy Happenings, a regional quarterly publication. The article mainly focused on one of Dr. Chang's patient whom he had diagnosed and successfully treated for laryngeal sensory neuropathy as a cause of her chronic cough for over 10 years.

To read the article, click here.

January 14, 2008

New Video Example of Tracheomalacia Causing Noisy Breathing

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A new video has been posted of an examination revealing upper airway collapse (aka, tracheomalacia) causing a sound similar to the bark of a seal. Patient had this peculiar breathing sound only on exhalation (especially with coughing) even though he did not feel sick or have trouble breathing. Notably, the patient did not get correctly diagnosed for over 5 years during which he was unsuccessfully treated for asthma, allergy, and vocal cord dysfunction.

Click here for more information.

January 08, 2008

Prescriptions Now Routinely Sent to Your Pharmacy Instantly!

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Our office has successfully transitioned to prescribing all medications over the internet directly to your preferred pharmacy. Except for narcotics which require a hardcopy paper prescription, most prescriptions will be ready for you to pick up within 30 minutes!

What does that mean? It means that for many patients, by the time you leave our office and arrive at your pharmacy, your prescription will be ready to pick-up!
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