Addendum to yesterday's rant

Of course I had to google and see if my blog made it to the search engines yet. It didn't, but I found this. It kind of made my day!

My day to vent

This blog is for you, patients and fans, but sometimes I just need to vent, ok? One of my jobs is making sure that Hahn and Nelson Family Medicine gets paid. Usually things go pretty well but today was my day to go through unpaid claims and figure out why we didn't get paid. I have to tell you, Carefirst and Blue Cross Blue Shield patients: your insurance is a big headache for many reasons. But today was a killer.

Maryland just passed a law last year as part of healthcare reform that allows providers to bill insurance companies a small extra charge whenever they see a patient outside of "regular" business hours. Regular business hours are after 6 on weekdays. We see patients until 7 on Tuesdays and Thursdays, and as you know, our doctors will occasionally see patients on the weekends (and even make a house call now and then!). The law was passed partly to encourage providers to see patients in the office rather than have them go to the more expensive emergency room. If you've ever had to go to an ER, you know it's way more expensive than your friendly physician's office, and well, not nearly as friendly.

So we saw a young patient in our office one recent Saturday. We billed the extra $10. Whoopee! Ten dollars doesn't seem like a lot does it, when you consider the provider interrupted his busy Saturday, drove 6 miles to and from the office....? Anyway. Carefirst didn't pay it because this patient is "self-insured" and apparently the law exempts self-insured policies. This made me angry. They didn't *have* to pay it so they didn't. Well, guess what Carefirst? We didn't *have* to see that patient in our office. We could've sent her to the ER, or told her she'd have to wait until Monday to see a doctor. So I wrote a letter to the Senior Vice President. Here's what I said:

M. Bruce Edwards
Senior Vice President, Network Management
Carefirst

We recently filed a claim containing the CPT 99050. It was returned with that part of the claim unpaid. After filing an appeal, we received a letter stating that those patients who had self-paid policies would not be getting that CPT reimbursed, and that it is not required to be reimbursed by law.

Just because you aren't required by law to reimburse this doesn't mean you shouldn't. We are saving your company significant money by not directing our patients to emergency rooms and urgent care facilities after hours. In this case, a young patient was very ill on a Saturday, Instead of the office visit we billed Carefirst, she could've gone to an ER and been billed much more. Furthermore, she would've had to deal with a strange doctor, which is not ideal especially when dealing with a small child. Or, she could've stayed home until Monday and gotten worse.

We are not required by law to provide after-hours services but we choose to do it, in part because it's a symbol of how much we care for our patients. We do this regardless of what kind of insurance our patients have, or even if they have no insurance. It isn't always economically advantageous to do so, especially given that we practice in a rural area. We think it makes us a better practice. We're disappointed in you as an insurer that you don't strive to do the same for us and our patients. 

So there. I got to blow off steam. And by the way, don't worry. This is not a charge we're planning on passing on to our patients if your insurance company decides you're not important enough to pay it. Because you are important enough to us.

Take an Art Drive this weekend

Take the Berkeley Springs Studio Tour  this weekend to indulge in our area's unique beauty, both natural and man-made. As you meander through Morgan County, admiring the wildflowers, lush green foliage, and the rushing of Sleepy Creek, you can stop by a multitude of art studios and see what our local artists are up to. There's nothing like gazing at a beautiful work of art, trying to imagine what inspired the artist, and understanding the hard work that went into a masterpiece; many of the artists offer demos of their work and intensive tours of their studios. For example, walking into the Hsu Studio is like walking into fairyland; there are sparkles of light everywhere as the sun dances over the amazing anodized aluminum works. Best of all, Jean Paul and Carol Hsu offer a guided tour of how their jewelry is made. Or check out Frog Valley Artisans, an artists' collective where you can see high-end metal sculpture, stained glass, pottery, photography, and more all in one place. Warning: after you fully appreciate the work and thought that goes into artwork like this, you may not ever be able to buy mass-produced items again!

"Archaeologists have not yet discovered any stage of human existence without art. Even in the half-light before the dawn of humanity we received this gift from Hands we did not manage to discern." Aleksandr Solzhenitsyn from his Beauty Will Save the World: The Nobel Lecture on Literature

Art is good for the soul. Looking at any kind of beauty is relaxing, inspiring, and revitalizing; it's especially so when you get to meet the artists responsible for the work. So take some time out this weekend for this special opportunity. 

Healthy eating when dining out

More and more meals are being eaten outside of the home these days. In fact, the typical American consumer now is almost as likely to spend just as many dollars on food away from home as on food prepared at home. The fact that the obesity rate is climbing just as fast as the rate of dining out may or may not be linked; regardless, it's even more important that you scrutinize your choices when dining out. When you're eating at a restaurant, you are much more likely to make impulsive, unhealthy choices than when you're carefully planning your family's menu at home. You're not always sure about what undesirable ingredients, or method of preparation, has gone into an entree when you order from a restaurant. So here are some simple rules of thumb to keep you on track while dining out:

• First and foremost, order small! I love Five Guys  but their regular burger is just way too big. So I order a Little Burger, which still packs 480 calories (vs the regular, which clocks 700). 
• One of my favorite ideas comes from my mother and her beau, Dan. Instead of ordering two big entrees, they order one to split, sometimes with appetizers or a salad to round out the meal. My family also really enjoys sharing a dessert. 
• If you're dining by yourself, or your dining partner doesn't want to share an entree, have the waiter box half your entree right away. You can have it for lunch the next day.
• A little advanced planning can go a long way. If you're eagerly anticipating a date night, but you're concerned about overeating, try going to the restaurant's website and check out the fare beforehand. You can plan a few healthy choices instead of being overwhelmed when you get there.
• Start with a salad and send the bread basket away. The vegetables will tell your belly it's getting full, but it'll be full of vitamins instead of relatively empty simple carbs. Always order dressing on the side.
• If you're choosing alcoholic beverages for your celebration, remember that 1 gram of alcohol has 7 calories! Mixers usually have a lot of sugar so be careful when considering a mixed drink. A glass of wine or a light beer are better choices because you know exactly what's in them. Also remember that alcohol in general lowers your inhibitions, and those inhibitions could include a bad decision about bingeing on something you wouldn't normally consider. Check out this article on WebMd for more. 
• And always, always, always, allow yourself to indulge now and then! Indulging in a favorite delicious meal with good friends or family is a wonderful way to celebrate a special event. Restricting yourself too much is just going to make you feel deprived and could lead to bingeing later.  And sometimes it really does make sense to eat dessert first!

Salad days are here!

The approaching warmer weather (it's really coming, believe me!) means you're going to want to spend less time cooking over a hot stove. It also means a plethora of wonderful sun-ripened produce, either at the Farmers Market (every Sunday in Berkeley Springs!), from a roadside stand, or even from the good old grocery store. Why not try some main dish salads for dinner over the next few months? You already know how to toss a salad, using whatever looks good. But ramp it up a notch, and make your own dressing. A simple vinaigrette can be nothing more than 3 parts oil to one part vinegar, or you can get fancy and experiment with different flavored vinegars such as balsamic, fruit-flavored (raspberry is really nice), or one of the wine-flavored vinegars (try to match it to whatever meat or other main ingredient that you're using). Add some herbs, fresh if you have them, some salt and pepper, taste and correct the seasoning, and you're done. 

Besides tossed salads, you might try a composed salad. One of our family's favorite composed salads is the Salad Nicoise. You don't have to use fresh tuna like this recipe does; just use a good quality canned tuna if that's what you have. But the vegetables should definitely  be fresh....Serve with a nice homey bread and maybe a glass of wine, and it's suitable for company.

Or try a chopped salad. You'll literally load your chopping board with whatever you have on hand and chop it all into uniform, small pieces. Here's some ideas to get you started:

Lettuce, avocado, red onion, bacon, red pepper, spinach, chives, cheddar cheese, tomatoes, cucumbers. If you want to see a demo of how it's done, check out this video. I find that when the ingredients are chopped, you often don't even need dressing, since the ingredients meld together so nicely on their own. 

Salads are fresh excuses to get creative with your ingredients, creating a healthy meal in the bargain. Have fun!

Zumbathon for the Bikers/Skaters

Happy Friday the 13th!
The blogger is back. She's been out of town, and then, as soon as she got home, she got sick! But that's all behind us now, and it's time to start writing again!
I wrote awhile back lauding the benefits of having a bike/skate park in the area. Bikers and skaters need a safe and legal place to practice their sport just as much as kids who play soccer and football. Giving them a safe place to practice makes the sidewalks and streets safe for everyone. Entrepreneurs will have a chance to profit by opening businesses that cater to the sport and existing shops can stock items for the bikers and skaters that are sure to flock in droves to check out the new park. Enthusiasm for the park is building, evidenced by the number of people who have shown up on workdays to help plant a rain garden and install ramps. And now that enthusiasm is growing in new ways: watch for a plethora of fun fundraisers coming up this summer.

One of those events is a Zumbathon that I plan on participating in on June 26th. Zumba mamis will be asking for people to sponsor them to do Zumba for 2 hours! If you're interested in sponsoring me or anyone else, shoot me an email and I'll get you set up. Also coming up is a Blender at the skatepark on June 18, featuring bands and skater demonstrations for just a $5 donation. If you're thinking of joining Rankins Fitness Center, they recently posted that they will donate 15% of any new memberships to the Park.

OK we'll be back to our regularly scheduled blogging next week. Tune in and watch for new recipes, fitness ideas, and health tips.