Author: medicalcodingmama

A young widow came into the doctor’s office, with a stack of papers in her hand.

“Can you help me read what the heck this says?” she asked, holding out the stack of paper.

“What ya got there?” asked the medical biller quickly scanning the top page

“Ahhhh. You have an EOB!”

“A what?” asked the young widow

“An EOB,” the medical biller chuckled, “To you it’s called an eligibity of benefits, a shortened version of your health plan to make it easier to read without all the legal jargon….”

“Oh”. The young widow’s shoulders slumped. “It’s still not making sense, it’s like I’m reading greek or something!”

The medical biller chuckled. “Yeah, to the average person it does look like an entirely different language. Sure, I can help you learn how to read this.

Almost 2 decades later, I’m now the one teaching people how to read EOB’s like the kind medical biller did for me over a decade ago. I am eternally grateful she taught me what to look for and how to spot errors.

So on to the basics:

An EOB is not a medical bill, but “it’s the first step you have towards checking to see that they’re billing you for the right things”

What to look for in an EOB
Compare the EOB and your doctor’s bill to make sure the dates, providers, types of service and billing codes match. a word of caution, sometimes not everything is on the statement you receive from the doctor. Depending on when it was paid, it can make it on the month end report, or not when then makes it on the statement you get from the doctor, so don’t go chewing out the billing office if you’re angry, they won’t help you one bit if your cussing bad words at them!
Check that you’re not being charged for services you didn’t receive or billed multiple times for a service you received once. each procedure will have it’s own separate line in most cases. If there is more than that listed , call the office to have them explain what all was done. Most are happy to help you read your EOB so you can understand exactly what happened at the visit.
Take note of the amount you are expected to pay. If everything was done correctly, you should receive a bill in this amount from your provider. If the insurance company rejected some or all of a claim, look for a note or “reason code” explaining why. For example, the doctor might need to submit more information to demonstrate a procedure was medically necessary, or your plan doesn’t cover that type of service.

The EOB has different parts:

A Summary of Benefits and Coverage (also called an SBC) is a tool that was created in 2010 as part of the Affordable Care Act. A basic Summary of Benefits and Coverage is designed to help you understand what’s covered by your health plan. Since SBCs present information in a uniform way, you can also use them to directly compare insurance plans. SBCs effectively provide a quick snapshot of your plan’s coverage, without requiring you to dive into complex legal documents from your insurance company.

Descriptive Information
On the top of each Summary of Benefits and Coverage, you can find the name of the insurance company and the name of the plan. The header will also list the plan’s coverage period, which is the maximum length of time the plan will last for.

Confirm the Plan Type
Your plan will probably be a PPO, HMO, EPO, or POS. This will determine what medical providers are in your plan’s network, and how you can get in touch with them. Make sure you check this section carefully. I’ve seen some where it was a PPO and it was an HMO, or the other way around, so please check this section carefully so there isn’t an error.

“Coverage for” Tells You What You’ll Need to Pay
This “Coverage for” line in this section will confirm who the plan covers — whether it’s just an individual (you), individual + spouse, individual + child, or an entire family. This will be important as you read your Summary of Benefits, because deductibles and out-of-pocket maximums often vary by the number of people covered per plan.

What Is the Overall Deductible?
The deductible is how much you’ll pay on your own each year before the plan begins paying for your covered services. Usually an SBC will include an individual and a family deductible. This corresponds to the “Coverage for” listed in the top header of the SBC. There may also be separate deductibles for in-network and out-of-network services. This doesn’t apply to preventative care.
Are There Other Specific Deductibles?
Some plans have separate deductibles for specific items, like pharmaceutical costs. In this case, you would have to meet the separate deductible for pharmaceutical costs before the plan begins to pay for this specific category of medical costs.

What Is the Out-of-Pocket Maximum?
Health insurance plans will let you off the hook for medical costs once you’ve spent a high amount of money on your own. This amount, known as an out-of-pocket maximum, is the most this plan will have you pay each year. The out-of-pocket maximum does not include the portion of bills paid by the health insurance plan. Similar to a deductible, the out-of-pocket amount may differ for in-network and out-of-network services.
Is There an Overall Annual Limit on What the Plan Will Pay?
All plans that were created after 2014 have no annual limits on what they pay each year. Your SBC for health insurance will have a line about overall annual limits to emphasize that there is no annual limit on what your plan will pay.
However, plans may put annual limits on certain services. Many plans will institute a maximum number of chiropractor or mental health visits per year.

Do I Need a Referral to See a Specialist?
Your plan’s referral procedure will depend on your plan type. Specific plan types, like HMOs, require you to have a referral before seeing a specialist. Other plan types allow you to visit anyone without a referral. You could be subject to out-of-pocket charges if you see a specialist without following your plan’s referral rules.

Are There Services This Plan Doesn’t Cover?
All Affordable Care Act-compliant plans (the most common type of coverage) will cover 10 essential health benefits that most Americans would expect to be a part of their insurance policy.
There will almost always be incidental services, like medical care in foreign countries, that a plan doesn’t cover. Plan exclusions can be found further down on your Summary of Benefits.

Common Medical Events
This section will help you prepare for the unexpected. The Common Medical Events section walks you through the costs of likely ways your plan will be used. Charges for office visits, diagnostic tests, pregnancy, and more are broken down in detail.
This section will also note the difference in cost if you use a provider that’s outside of your plan’s network.
This is also where you can see if you have a limitation or exemption to a service, such as chiropractic visits or children’s eye exams.

Excluded Services & Other Covered Services-There is usually a box with a colored band on the top, and they will NOT list all the exclusions. it’s important to look at that box. It is important to note that a Summary of Benefits doesn’t include every exclusion in your plan.

While the SBC will list the most asked-about exclusions, you will need to read more detailed plan documents to get a comprehensive list.

Common exclusions include:
Long-term care,
Cosmetic surgery,
Dental and vision services for adults,
Weight loss programs.
Acupuncture and Infertility Treatment.
Similarly, the Other Covered Services section is not a full list, but it offers a quick snapshot of some other services covered by your plan that are not laid out in the Common Medical Events section.

So that’s how to read your EOB in a nutshell.

Call to action for the week……When is the last time you looked at what your insurance plan covered? Better got check it to see if anything has changed. There is nothing worse than finding out after the fact that something on the plan is no longer covered when you thought it was!

It is one of the hardest decisions a person can ever have to make….the decision to put a loved one into hospice care. It completely shatters the dreams of the family member or loved one ever recovering from the illness the family had hoped would be beaten and they could live a normal life again.

A few years ago, the phone on the desk buzzed as the intercom came to life. The head doctor’s voice came over the intercom
“Are you busy right now?” The head doctor asked “Can you come into my office for a moment?”
“I can be there in a minute,” I replied. “Let me finish putting in these last codes into the patient’s chart first and then I can be right there.”
“Roger that.” the head doctor replied
After finishing putting in the last of the medical codes on the chart I had been working on, I headed to the front of the office, completely puzzled as to why I was being summoned right as lunch was about to begin.
“Ah, there you are!” the doctor replied when he heard me enter the private office he used for working on reports. It was then I noticed my new co-worker, who had just started in the office a week and a half before, whose eyes were red rimmed and swollen from crying.
“What can I do for you?” I asked the doctor
Motioning to the co-worker, the doctor explained that she had a huge decision and asked if I could take some time, take her for a walk and see what I could do to be of help. I nodded. I needed a break from looking at all the charts on my desk anyway. Soon my co-worker and I were in our warm coats and headed outside to a little walking path that ran alongside the building we worked in.
“How can I help?” I asked my co-worker gently. She softly started crying again. “ They said my dad was terminal with cancer, there was nothing more they could do for him, and they said I needed to get him hospice care. My dad wants to be at home, I don’t want to ship him off to a cold building with no family around!” and then she softly sobbed into my shoulder.
In spite of myself, I chuckled. I asked her how much she knew about hospice care. When she confirmed my suspicions that what all she knew about hospice were merely myths, not facts, she asked me to write down all the facts so she could tell her family what I had told her on our walk.
Here’s the list I gave her…..
The facts about Hospice care are:
1. Hospice is more of a philosophy of care, than a mortar and brick building.
2. Having hospice care doesn’t mean you have to give up all your medical care.
3. You have to qualify to be accepted into hospice care. Most people don’t realize you have to qualify to receive hospice care, and it’s quite a shock to the family when they find that out, however, you can opt out of you wish to do so.
4. You can still see your regular doctor while on hospice.
5. Hospice goals are to enable you to live well, the goal is not to sedate you until you die, like most people fear.
6. Hospice is for the entire family, not just the person receiving hospice care. Most people honestly don’t realize hospice care takes care of the entire family, no matter what the need is. The common myth is that hospice is only for the loved one who is dying, which isn’t true at all. Hospice takes care of the entire family, from counseling, to educating, to something as simple as a listening ear.
7. Hospice care goes well beyond the death of the loved one. Most hospice care places give 12 months of grief counseling to the rest of the family after the loved one has passed away.
8. Hospice is covered by major insurances, Medicare and Medicaid.
9. Hospice is offered to people regardless of age or what the life limiting illness is. (I’ve seen children as young as a year in hospice care while doing medical coding for charts. Those always bring a small tear running down my face when I got those kind of charts to code).
10. Research has shown that the majority of people want to die in the comfort of their own home, not in a hospital.

Once I was done explaining the facts of Hospice care and debunked the myths she had thought were completely true, she looked at me straight in the eye and then motioned that she wanted to start walking again.
“How is it you know so much about hospice care?” my co-worker finally asked as we walked along the path after a while.
“Personal experience.” I softly replied
“Father? Mom? Sibling?”
I shook my head. “My first husband.” I replied
She stopped short. “WHAT??” She blinked in shock. “But you’re so young!”
“I’m actually older than I look.” I chuckled,
My co-worker started walking again “How old were you when your first husband died?”
“34. Three days shy of turning 35 as a matter of fact.”
“He had the gall to die right before your birthday????” I actually laughed out loud right after she said that. “ I wouldn’t quite put it that way…..” I continued chuckling
“Ok, so what am I in for once dad is in hospice?” My co-worker asked
“How much time you got?” I asked as we reached the benches so we could sit down
“Things that happen after a loved one goes into hospice……ok, go!” We talked for a half hour more then headed back to the office we worked at.
I learned shortly after our walk that my co-worker had taken to heart what I had told her, and her entire family was at her father’s bedside when he passed away three weeks after our little walk.
Here’s the things I shared with her that day:
1. Tempers are going to flare. You may love your siblings and other family to death, however, having a loved one in hospice care is going to leave you tired, stressed, emotionally and physically drained. I have lived this reality. I slept for a full 24 hours after my first husband died. I was that worn out from the stress and being emotionally and physically drained.
2. If there is a living will, the majority of the time the wishes of the person in hospice aren’t going to be followed very well if it’s necessary that the care must come first. It’s just a reality. People can put what they want in a living will, however, family do what they think is best, leaving the wishes of the person dying not being followed. This happens more often than not. And if the wishes are followed, be prepared for some anger of the other family members blistering you from family who just aren’t on the same page.
3. If you have power of attorney, use it but don’t abuse it. I have sadly seen people think they have the right to undo everything. it brings a lot of heartache if the power of attorney is put in the wrong hands.
4. If it brings closure to other family members, give them space as they say goodbye. I personally lived this scenario. My first husband had wanted to die at home, however, his siblings had him taken to the hospital. When the hospital got wind that there was a power of attorney and it was none of them, the siblings could not forbid me from saying goodbye to my first husband, even though that was exactly their wish ( he was a few years older than me, yes). However, I understood that his siblings were also grieving, and wrestling with the reality their brother was going to die by that evening. After I had said my goodbye, I asked the nurse to let his siblings back into the room. All heck broke loose when the request got back to the head nurse, who had seen how poorly I’d been treated by the rest of his family. I held up my hand to stop her and quickly explained that when their mom had died, they had not been allowed to see her before she died. I was not putting his siblings through that second time. They needed to be there in the room, without me being there. When the doctors and nurses saw I was completely serious about my request, and that I wasn’t backing down, they relented. In the years since that night, I have had no regrets for making that decision to let his siblings be there in the room when he passed away. No regrets whatsoever. It helped give them closure.
5. The person will rally one last time have one last hurrah before fading away completely. They will gather all their strength and it will be like everything is going to be ok. It’s the loved one’s swan song before they pass away.

Many people are shocked when they find out none of my first husband’s siblings came to the funeral. I wasn’t offended in the least. That was their decision and I honored and respected that decision. By giving up my place in the room as my husband passed away, they had closure, and as such, they didn’t feel they needed to come to the funeral. And yes, people have told me over the years they think I was completely nuts to do that. Honestly? It just felt like the right thing to do and I’ve had no regrets for doing it the way I did.
I have pointed out and have continued to point out over the years that I was not the only person to lose him. His father lost his son, his siblings lost their brother, his nieces and nephews lost an uncle. I honestly thought that was the best gift I could give them, after what had happened with their mom and they weren’t allowed in the room as she passed away. Giving up my place in the room was a no brainer at that point. I cared enough about his siblings that I refused to put them though not being able at saying goodbye to a loved one a second time. I just simply couldn’t do that to them, even though I had every right to kick them to the curb if I had wished. I took the high road and let them say their goodbyes in their own way and on their own terms. Sometimes making the right decision is not always the easiest decision ya know? I took the high road and I’ve had no regrets whatsoever in the years since then for doing so.
Have I hear from my first husband’s family since my first husband passed away? No.
Would I love to hear from them? You betcha! I’d be over the moon to have any of them reach out and let me know how all of them are doing. I have missed them terribly.
Death changes many things. Having a loved one in hospice makes that change burst out into the open a lot faster than it would have otherwise. It’s not fun, it’s not pretty, and sometimes, life is super messy at times, it’s just that way.
Having a loved one in hospice is not easy, for anybody. Having them in hospice gives all of you a chance to say goodbye and a better quality of life even if it’s just a short time. Treasure the time you have left. You never know when death will come knocking.

“How do you do it?” A co-worker asked me once one day as we were closing up the office for the day.
“Excuse me?” I blinked in surprise at their question.
“How do you do it?” She repeated. “And you’re a single parent to boot! I don’t think I will ever get the hang of doctor’s offices!”
“It’s actually not that hard, once you know the tips and guidelines from fellow parents.” I chuckled

It’s a question I do get a lot. And I realized a few days ago, I really need to share this with all of you. Feel free to pass along to loved ones, co-workers, whomever. This information deserves to be shared far and wide.
For the new parents out there, Congratulations on the new bundle of joy. You may have noticed the baby doesn’t comes with instructions. Relax, you got this! This Medical Coding Mama is so delighted at your new little one has joined your family. A warm congratulations to all the new parents out there in the world!
Here’s some tips I have learned as a parent and some tips I gleaned from friends
You are not going to jive with every doctor you come in contact with. It’s perfectly normal.
Don’t get too worried if your child is not always on the chart. It happens. You will not be the first parent to not have your child on the chart percentages, nor will you be the last set of parents.
When you’re a first-time parent, poop blowouts happen. It’s stinky and messy and your kids clothes will be stained. It’s inevitable that you will have a poop blowout at the doctor’s office, especially if your child is sick. They’ve just about seen it all. Just ask for wipes in case you forgot to pack some or ran out of diaper wipes in the diaper bag.
If the doctor asks for the child’s social security number, RUN! In the United States where I live, it’s against the law to give out the child’s social security number before 18. It’s to prevent medical identity theft, and identity theft and prevent problems for them later in life.
If you’re worried the doctor is going to think less of you because of your diaper bag, don’t. Trust me when I say the doctor has seen just about everything type of diaper bag there is, from designer duds to the ones you get at a lower priced store. It’s not going to faze them one bit. It might get a good discussion going, but it won’t faze the doctor whatsoever.
It’s perfectly ok to cry when your child gets their shots. I don’t like shots either, and I’m an adult. I always have to close my eyes when anybody gets a shot. Why? I faint at the sight of any needle, period. I’d rather not have someone pick me up off the floor because I saw a needle, just saying.
Never lie to your child that shots won’t hurt, it does, but only for a minute or two. Lying to your child about shots will weaken your child’s trust and they will always wonder about everything else you say. One of my friend’s doctors told the child the shot wasn’t going to hurt. Calling out the doctor on the lie made the doctor think about that lie. Never did find out if he quit saying that shots didn’t hurt to children.
If the doctor or the assistant can’t get blood from your child, ask for a smaller needle like a butterfly needle to be used. People tend to forget that a child’s blood vessels are A LOT smaller than an adult’s.
If they need to take blood from the hand or foot, they need to ask permission from the parent first. Getting blood from either of these places is quite painful and sometimes you get a massive bruise if they nicked a vein. I myself, have to get blood drawn from the back of my left hand simply because my lovely veins putter out in the crook of my arm. If they get half a vial of blood from the crook of my arm, they consider that lucky. However, if they need more than one vial of blood to test, they automatically go to the back of my hand now because the veins puttering out in the crook of my arm just isn’t going to cut it when they need lots of blood taken. I always pick the left hand because I’m right handed and if I have to sign anything, I’d rather not be in any form of pain in order to sign paperwork!
Make up an index card of allergies for each child ( including medicine allergies). I suggest using the 4×6 index cards because the cards are bigger that the 3×5 cards. You’ll run out of space to write on the smaller index cards. Doctors love stuff like this because it can be scanned into your child’s chart. Let the front desk know if there’s writing on both sides so they can scan both sides into the child’s electronic chart.
If your child has an unusual name, put how to pronounce it on the first paperwork. That will help when you get called back. There is nothing more embarrassing than getting chewed out by a parent when they pronounce the child’s name wrong. My own child has an unusual name and people get flustered when they say it wrong. I just chuckle and tell them they gave it a good try, I’m used to having my child’s name mispronounced and I just shrug it off as no big deal. Some parents however blow it all outta proportion……need I say more?
When going to a new doctor and the office says to come in 20 minutes early for paperwork? Better make it at least a half hour before the appointment time. 20 minutes makes for a rushed parent and sloppy writing on the paperwork and that doesn’t help anybody in the billing office if we can’t read the messy writing. A half hour to 45 minutes is a good time frame to come early so you can get through all that lovely paperwork.
If possible, ask the office if they can mail you the forms ahead of time so you can fill out the paperwork at home, it then can be the 20 minute time frame ahead of the appointment. Some offices have the paperwork online to download and fill out and print out for when you come to the office.
Make sure immunizations are up to date. Because down the road, the school district is going to need that immunization record.
If you’re a single parent, please don’t freak out when the office asks for a copy of the divorce decree. It’s to cover us when insurances contact us to make sure the right parent is getting the statements. ( and they do contact the billing office with questions, oftentimes the insurance doesn’t realize there’s a divorce decree involved and they want to know why the kids last name is different or they payer is not the custodial parent)
Another thing as a single parent: Don’t bash the other parent. It makes you look bad and it shows the doctor you’re a poor sport. And let me tell ya, doctors HATE poor sports. It makes the visit miserable for both you and the doctor, just a warning for ya.
If the other parent lives in another state or is in another area: inform the doctor of that, or else the doctor is going to want both parents in the office for discussion when it’s not possible with one parent living so far removed from the area.
If it’s an abusive situation, SPEAK UP! The doctor wants not only you and your family safe, he/she wants their staff to be safe too. I’ve heard of too many doctor’s been accosted because the abused parent didn’t think to speak up and paid the price when they were shot in front of the doctor.
Remember, all doctors are mandatory reporters. A lot of parents forget that little tidbit in divorce situations. Don’t make false statements, it will come back to bite you in the butt.
Remember to make the most of the time you have with the doctor. You only get 20 minutes tops in most cases. If your child is new to them, they will take more time
If you have questions, write them down! And do the most hard questions first. Most often from my vantage point in the back office, the parents rattle through the easy questions and then the doctor has no more time for your family and is heading out the door and onto the next patient with the parents going….Wait! and then the hard questions don’t have answers because you ran out of time during the office visit. Do the tough and hard questions first, the other questions can wait til later and another appointment.
If you want the other parent to know the doctor’s orders reports etc, you need to put them on the paper for HIPAA where they’re allowed to be in the loop. Otherwise, the other parent will not be told anything per HIPAA guidelines. And that makes for some tough choices and a lot of shouting. I’ve seen many parents escorted out the door because they discovered they were not on the HIPAA sheet and raised a real stink about it. If there is a divorce decree involved, the other parent must be told what the doctor says or you will be held in contempt. (and that’s never fun y’all. I’ve seen a lot of that from my vantage point of the back office)

We have all heard the travel horror stories when someone who has a medical condition travels and how things get messed up.

As a medical coder, I’ve been in enough doctor offices in my career that I share some of the doctor’s best tips for traveling with a medical condition, that I have gleaned over the years.

Do not put your medications in your checked in bag. I don’t know how many times I have heard of a patient that put their medications into their checked bag, and then the checked bag gets lost, which means the medication also went missing. It brings major panic to a patient. One of my co-workers had her mom do this, the mom flew in to visit my co-worker and her checked bag got lost. Well, it became an urgent situation because my co-worker’s mom had epilepsy. My co-worker called the airline to explain the situation and that they needed to find her mom’s bag because it had her mom’s medicine in it. When the airline was going “well….” my co-worker the calmly explained her mom has epilepsy and if her mom died having a seizure because the airline refused to find her mom’s checked bag that had her mom’s medicine, the airline would get sued for wrongful death. When the urgency of why they needed the bag came through loud and clear, along with a possible lawsuit, miraculously the checked bag that had been lost, was found within the next 5 hours.

Bring all the medicine supplies you need with you. And I do mean everything, extra needles if you’re a diabetic, catheters, extra stuff you need so you know you have them and don’t have to go looking for a pharmacy that doesn’t know your history. I remember a story that I read a few months ago, a person who had a colostomy bag had it popped y a security person. the person was on his way to his daughter’s wedding, and the liquid poop and pee was all over his clothes from when the security guy popped the colostomy bag. The guy was humiliated. His daughter who had witnessed all this, immediately called her local senator and emailed him the footage she’d taken of the incident. when they got to the airport of city the wedding was to be held, senators were there to greet him and his family, and they brought fresh clothes for him to change in, had a doctor present to check him out to make sure there had been no infections in the colostomy bag( thankfully it was covered with a towel the entire flight in case it leaked more) and they were whisked off to the wedding venue like VIP’s because of what had happened. And the national security people got a tongue lashing from the government on how this had been handled in the first place and all security agents around the country got training on colostomy bags so the incident would never happen again to another patient who had one. I remember shaking my head with sadness and horror over what had happened to this guy and his family after reading of the incident in the newspaper online.

Get a note from the doctor. I realize this sounds really super silly, however, I have seen the benefit of having a letter from the doctor to show security, what the condition is, what medicine you need on your person, if you have an insulin pump or pace maker and why you can’t go thru the scanner with either of those, and that they were put in surgically( you’d be surprised how many security people think you can just pull those out to show them….)

If you have an insulin pump/Pace Maker, you CANNOT GO THROUGH THE SCANNER, the insulin pump/pace maker will malfunction with the magnets from the scanners at the airport. I have heard several horror stories and read a few horror stories of people being humiliated by security personnel who smashed a vacation’s worth of insulin, or triggered a heart attack because they forced the person with a pace maker through the scanner( and then security gets a call from the higher ups because the rightfully furious family members called and complained. )I worked for a doctor that fielded calls from all over the USA to confirm the insulin pumps and pace maker could not go through the scanner by security people who thought it was a complete joke. I wish I was kidding about that one…however, I’m not kidding, not by a long shot. It put patients in a dangerous position and it would have been quite dire if something had happened and the patient died in the air on the airplane.

Know where the nearest local hospital will be on your travel/vacations. Just in case you need medical care right away.

Bring your medical history list(hospital EMR’s DO NOT talk to each other from across different states….) I’ve had more calls come into the office about a patient and they were just confirming that the patient was telling the truth. I always shake my head on that one. It would be wonderful if all the Emergency room EMR’s talked to each other all over the country.

Check with the doc to see if you can even travel at all…. I have to admit that this one is the hardest for all the tips for people. There’s a lot of things that go into a decision from the doctor….and sometimes, it’s not a pleasant surprise when the doctor tell you that you can’t travel period! from my position in the back office, I can attest that there are several swear words flying to the doctor after a patient has been told they can’t travel period because of their health. Yes, most of the words are f-bombs or other swear words as the patient leaves the doctor’s office.

Consider getting travel medical insurance. Some people might consider it pricy, however, I’ve known many patients who have gotten medical travel insurance and were quite thankful they had it when something went wrong on vacation! So please, if the option of travel medical insurance presents itself, please at least look into it or go ahead and get some type of travel medical insurance to bridge the gap if your medical insurance refuses to pay anything simply because you went on a trip or vacation.

If you have metal inside you from a hip replacement, surgery, bring a letter from the doctor explaining why you have the hardware inside you in the first place. I have a sibling that has 2 metal hips from when a growth plate broke in their leg. When it happened to the other leg, the doctor wrote up a report for a medical trade magazine describing the case and the findings. My sibling has a small laminated card that they carry explaining about the titanium hips at such a young age for when my sibling has to go through the scanners at the airport. My sibling says it’s not exactly fun when they have to get scanned with a wand because the screws holding the metal hips would come out due to the small magnet in the scanners. Thanks to the small laminated card, my sibling doesn’t get hassled much once security sees the small laminated card with an explanation from the doctor. Without that little laminated card, I am pretty sure my sibling would be hassled much more than they are.

Alert security ahead of time about your medical condition and what you can and can’t do in order to be safe. Just giving the security team a heads up makes for a better experience. It may not be perfect, however, if the security team gets the heads up before you travel, it can mean all the difference of missing your flight or not!

So that’s all the travel tips in a nutshell. Your call to action is: if you’re traveling soon, print out this tip list and refer to it while traveling, make sure security gets a heads up(especially if you’re diabetic, have a pacemaker, that sort of thing so they can help and assist if needed) and your trip will be as memorable as you could have hoped and dreamed about.

As a medical coder, just when I think I have seen it all, another curveball comes at me and I’m amazed at how much people DON’T know.

So I decided that people need to know the 10 biggest mistakes I see come across my desk all the time, and try to educate the world so people don’t get themselves into trouble with medical insurance, on the stuff they don’t realize what they’re doing is a mistake, that can cost them dearly if they don’t realize what they’re doing is a mistake of epic proportions in some cases.

So here’s to helping you, and your wallet from getting hit too hard by the mistakes I see people making every time I come into the office!

Mistake #1: Lacking a general understanding of common insurance terms
Don’t worry, no one is saying you have to develop an intimate knowledge of all the health insurance terms that are detailed on sites like healthcare.gov. That said, it could be well worth your while to read up on the terms that can be found there like:
Co-insurance
Co-pay
Deductible

Understanding them is a very important part of how much a given health plan costs.
For the record, deductible refers to the amount you have to pay for any care you receive before your insurance provider will cover the remainder of its cost. Co-pay is a specific, set fee you pay at the time of service. Co-insurance is the amount you’ll have to pay after you pass your policy’s deductible.

Mistake #2: Deciding that because you’re young or healthy (or both) you don’t need health insurance
It’s easy to assume when you’re young or healthy or both that you don’t need to bother with health insurance. The fact is, you never really know when you’re going to become ill. The last thing you want to worry about at that point is how you’re going to pay for medical care. Sadly, I see this come back to bite people ALL the time. They don’t have insurance and then they need emergency surgery or there’s been a freak accident and then they get the rudest wake-up call they will ever get when they see the bills. All that stuff from the unexpected surgery or the procedures to help them out from their freak accident is frightfully expensive and most of the time, I get handed the now shell shocked patient to set up a payment plan of some sort to help them pay off the bill they weren’t expecting.

Mistake #3: Picking a plan because of its low premiums
Hardly anyone recommends choosing any type of insurance plan based on how affordable its premium is, and health insurance is no different.
The reason: those monthly payments are just a portion of the costs that are sure to be tied to any treatments or services you receive moving forward. As mentioned earlier, you’ll also likely have to contend with and prepare for other expenses like co-pays, co-insurance, or deductibles, depending on your personal healthcare needs.
That’s not to suggest a high premium is always the right choice. But you should always carefully consider all of your options before picking a particular plan.

Mistake #4: Skimping on coverage limits
Buying health insurance is a good idea. Buying enough health insurance coverage is better. Many people, however, make the mistake of not purchasing enough coverage.
This is a big deal because if you skimp on coverage, because it can leave you open to some shockingly high out-of-pocket costs. Having an idea of what exactly you need to cover can also help when choosing a plan and making sure what you need to have covered for your healthcare will be covered. There is nothing worse than me or another medical biller/coder having to tell someone that the procedure or the surgery wasn’t covered by insurance. That’s never fun for me or anybody else to deliver that news because it turns out the situation was much worse than what was expected.

Mistake #5: Dragging your feet when it comes to the health insurance marketplace’s “open enrollment periods”
Waiting to buy insurance until you need it never has been a great idea.
What happens if you fail to purchase a policy during an open enrollment period? You may have to sit tight — and uninsured — until the next one rolls around, and that could mean a wait of nine months, if your timing is particularly bad. I honestly would NOT risk it by staying uninsured, because as I’ve seen time and time again, not being insured WILL come back to bite you if you aren’t prepared for some unexpected bills!

Mistake #6: Misunderstanding the difference between “preventative” and “diagnostic” care
That doesn’t mean you should expect that every “preventative” service is offered at no or little cost.
Even when no co-payments or other charges are associated with this type of service there are times when it leads to additional care that’s considered diagnostic rather than preventative. That’s the kind of care you’ll be charged for, so be sure to ask your physician or specialist up front about the costs that are likely to be tied to any future or follow-up visits.
As an example, a patient goes for a routine checkup. That qualifies as preventive care. During the appointment, the patient complains of frequent headaches. The doctor then treats the headaches with tests and medication. Those headache tests and medication may qualify as diagnostic care, which isn’t always covered. The check-up would be covered but diagnosing or treating the headaches wouldn’t. Avoid situations like this by doing your homework with both your doctor and insurer before you make an appointment. It will save the headache later on by finding out it was a billed as a diagnostic care, not a preventative care, and therefore, probably not covered by your insurance plan.

Mistake #7: Neglecting to ask or figure out if a particular physician or specialist is “in network” or not
You should have that down pat before you ever set foot into a hospital or physician’s office. That’s because of the differing impacts in-network and out-of-network care can have on your wallet.
You NEVER want to find out your favorite doctor or specialist is not covered on your insurance plan….. having seen and caught many people mid-faint when they find out the hard way that their favorite doctor or specialist isn’t covered, at all, on the plan they chose(not fun I assure you), even if they were promised the doctor would be covered, and they found out later that just wasn’t the case, which makes for some very angry patients. Always check it out first BEFORE you sign up for a particular plan. If you don’t, it can and will come back to bite you if you didn’t check it out first that your favorite doctor /specialist was on the plan or not!

Mistake #8: Ignoring flexible-spending accounts when they’re made available to you
Flexible-spending accounts may not be quite as appealing as they used to be. But that doesn’t mean you shouldn’t take advantage of them when they’re offered to you.
Why? They still allow you to set aside money, tax free, that you can use later to pay off all sorts of health-related bills that insurance won’t cover, for starters. Also, the contributions you make to these accounts can reduce the amount of money you owe to Uncle Sam at the end of the year.

Mistake #9: Failing to make sure any medications you have to take are covered by your health plan
If you take one or more prescription medications, make sure they’re included on the list of covered drugs before buying a policy. If you’ve already got a policy, make sure your medications are on the insurance company’s formulary before filling prescriptions. If they aren’t, check with your doctor to see if there are any acceptable alternatives.)
Although this information usually is included on an insurer’s website, that isn’t always the case. To be absolutely sure, give someone there a call so can be sure one way or the other. Take the 20 to 30 minutes or so and call your insurance carrier and bring yourself peace of mind knowing you’re covered for your medicine, instead of finding out the hard way, at the pharmacy counter, that your medicine isn’t covered. That’s never a pretty picture. I’ve been witness to many tears while waiting for prescriptions and the person had to pay out of pocket because their medicine wasn’t covered by their plan.
A related mistake to avoid: using a pharmacy or mail-order service that isn’t “preferred” by your insurance provider. (Preferred ones can save you a lot of money.)

Mistake #10: Being too eager to pay your bills
It probably seems strange to suggest that “paying your bills too quickly” could ever be considered a mistake, but that’s basically the case when it comes to health insurance.
What should you do instead of paying your healthcare bills as soon as they arrive on your doorstep (or shortly thereafter)? You should wait to send in payment until after you’ve received an explanation of benefits, or EOB, from your insurance company.
This document details the services you received, how much the healthcare provider charged for them, and how much of that amount your insurance company is willing to cover.
I sincerely recommend waiting for your EOB because you may find errors while reviewing it, and you’ll probably want to have them taken care of before you send in your payment. Nobody wants to pay for an error on the bill ya know?

A few years ago, my co-worker hung her head in frustration.
I looked over and asked what was wrong, seeing my co-worker was clearly distressed.
“ I can’t get this lady’s insurance verified! They’re claiming she’s not a US citizen even though she was born in Arizona!” she started to cry.
I asked her to hand me the verification form she was looking at. She did. I quickly saw the problem. Arizona had become the 48th state of the United States on February 14th 1912. The patient had actually been born in 1910, two years BEFORE Arizona became the 48th state. She was actually older than the state of Arizona. I quickly explained that to the insurance, they erroneously thought she wasn’t a US citizen, even though before becoming a state, Arizona was considered part of the USA as a US territory, not Mexico territory. So in fact the insurance had it wrong. We went to look for the doctor and showed him what we had discovered. He quickly got on the phone with the representative for the insurance and quickly pointed out that the insurance was wrong in its thinking and to correct the error immediately because we had a surgical claim to send out. He also pointed out the lady held a Medicare card in her possession, so at some point she had proved she was a US citizen even though she was actually 2 years older than the state she lived in.
So even though you aren’t older than a state, how can YOU make sure things go smoothly for not only the doctor’s office, for your insurance as well?
Here’s a few tips:
Make sure your birth date is correct in the system! Believe it or not, if people can’t read your writing on the forms, sometimes your date of birth can be input wrong. Sometimes it takes the doctor’s office trying to verify your insurance before your appointment when the mistake pops up. And no, contrary to popular belief, we in the billing office can’t change it for you. That’s your lovely thing to fix. Since the insurance won’t hear it from us in the office, they MUST listen to you. Each insurance has its procedures on what they need to get the date of birth corrected in the system. I’ve seen dates off by 5–7 years, making you older or younger than your real age. It’s been very enlightening to say the least.
If you have more than one insurance card, make sure all the cards match EXACTLY. I’ve seen all sorts of stuff when I’ve helped put in information. I realize people like using the nickname on the insurance card, I get it, I truly do. Unfortunately for Insurances, you need to use your legal name for people to find you in the system. When the cards don’t match, it makes it really hard for the insurances to find you in the different systems. Medicare for one, is EXTREMELY picky on this one. If for the guys you are a Jr, a III or IV or VIII, it needs to be on the card or else the system is going to tell us you don’t exist to them, and that’s creating more problems than it helps. Same with hyphenated names. If your name is hyphenated and it’s not on the card, they won’t be able to tell us anything for the billing side at the doctor’s office.
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Fun fact: The longest name I ever saw was 26 letters, and that was all they could fit on the insurance card. The patient’s name was actually much longer than that! I had him write it out, and I later counted it, it had 38 letters. I didn’t even try to pronounce it. I just called him by the nickname he wanted to be called by. I can only imagine what the people processing the claims thought when they saw it!
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Hyphenated names are more common now than they used to be. If it’s hyphenated on the insurance card, we aren’t gonna be able to find you when we need to call and verify your insurance before your appointment. I worked in an office where we literally tried 7 times to get this lady’s insurance verified. The billing manager ended up having to call her and explained until we had her insurance verified, we couldn’t make the appointment. We needed to see the actual insurance card. The lady reluctantly came in with the card, and only then did we find out on her Medicare card, her name was hyphenated. All we had on the form was her current last name. None of us had any idea she had a hyphenated name, it had never come up. Once the lady understood why we had so much trouble trying to get her insurance because we didn’t know on the card her name was hyphenated, she was A LOT nicer, because she was shooting lightning bolts at us with her eyes until she realized she had caused the problem, it wasn’t the office being difficult and not wanting to verify her insurance. Once we knew her name was hyphenated, it made it much easier to verify she in fact had Medicare insurance.
If you have a common name, but with a different spelling, let them know. Sometimes over the phone, the person will hear Jay when it’s actually spelled Jai, or Kelly and you spell it Kehle, Kellie or Keli. When I took names while on the phone, If it was a common name, I’d ask if the name was spelled the traditional way, or differently. When your name is spelled wrong in the system, it creates problems on the other side at the insurance because they spelling of your name doesn’t match, and it will kick out the claim with a denial.
If you have an unusual name, or your name has silent letters in it, please spell it. It makes it much easier on the office than having the patient screaming at us because we spelled your name wrong. If we have it wrong in the system, you better believe when we send the claim out to be paid by your insurance, it’s spelled wrong on the claim. Better to correct us when we first put it in the system to avoid problems down the line when the insurance kicks back the claim with a denial because your name doesn’t match the insurance system.
When we ask you, the parent for your information instead of your child’s, please realize by law we can’t ask for the child’s social security number. I’ve been blasted by so many parents before they saw the printout of the law stating we can’t ask for children’s social security number. It’s to protect them, the child, from identity theft. It’s not like we’re going to send you straight to collections…..so please don’t kill the messenger when they ask for the parent’s info. We are just trying to follow policy.

When a company’s reputation of being a toxic office proceeds it, you know something is out of whack. Did you know Doctor offices can sometimes be toxic too? That fact shocks some people actually. There are signs to look for so if you encounter a toxic office, you can turn tail and take your healthcare elsewhere. Going to a toxic doctor office will undermine your health faster than anything else will. Toxic environments up the level of stress and depression and fatigue, not only in the team that works for the toxic doctor, it adversely effects the patients too. So next time you go to a toxic doctor office, tune into what your feeling, because our bodies are fine tuned to pick up stress signals and toxic vibes.

“Hey! you heading to the Northwestern side clinic again?” My co-worker fell into step besides me.

“Yep.” I replied.

“Doesn’t it bother you they doctor treats her people the way she does?” She asked as we kept walking toward the elevators that would take us to our cars.

“It does, however those poor team members at the clinic realllllly need help learning the new system they just put in and I’m training them so they know how the system actually works, not from cheat sheets that do nothing to help.”

“Does the agency know what going on with the clinic?” My co-worker asked.

“Yep, they do indeed know what’s going on.” I replied

“What did they say?” She wanted to know

“Considering they were floored at what I told them, they told me I didn’t need to go back, however I explained these people desperately needed training on the new system that they have, and I’ve worked with that system so I’m staying for the week as per the contract.”

“You’re a brave woman…..” my co-workers voice trailed off as we reached the company cars we had to drive to the job sites we worked at as contracted medical coders. and we went our separate ways for the day.

So if you’re the patient and you’re going to a toxic office, are there signs it’s toxic? Thankfully, yes, there are indeed signs the doctor office is a toxic one.

Here are some of the signs to look for. There are many signs of a toxic office, however, I’m just going to highlight the most common of the signs………

You’ve Just Got a Bad Feeling About Things
Part of the danger of a toxic environment is that sense that you’re losing ground without anything actually happening. It’s time to trust your gut!
Here’s what to look out for:
An overwhelming sense that something is wrong.
A sick feeling in your stomach after you enter the front door of the doctor’s office
Feeling like you’re on alert.(and for good reason, you never know what could trigger a rage outburst from one of the office staff)
Feeling like there’s something “not being said” (no, it’s not your imagination. If you feel like this, make note of it and find out what is going on and why your gut is telling you with a neon flashing light feeling)
A strong urge to seek help or discuss the situation frequently with friends.
Sweaty palms, racing heartbeat or other abnormal physical signals of stress or anxiety.
If you have a strong sense of disengagement, or if any of these signs ring true for you, you may be in a toxic environment, and the time to act is now!

Watch for De-Energized and Unmotivated Workers
This usually indicates a fear-based culture lacking the practice of encouragement and respect often found in a caring environment led by strong servant leaders.
A toxic doctor office culture does not welcome people to offer their ideas, input, creativity, or strengths to the overall environment.

Watch for People Who Hoard Information
This is particularly worrisome if your doctor office is doing it. Here’s the real reason why they withhold information: it’s about power and control. And control at any level, across any function, or between peers is one of the most effective ways to kill trust.
I personally dealt with this when my first husband was told he was terminal with liver cancer. Because none of the team of doctors had said a word, we had no clue whatsoever what we were going to be told. Being blindsided was an understatement. I was very sad that nobody had told us for two months just how bad things were getting. When the doctor who broke the news (that my 1st husband’s cancer was terminal) realized we had no clue whatsoever of how bad things really were, he called the rest of the team in and chewed them out right in front of us. He was completely appalled we’d be kept in the dark for so long. And that’s when he broke the news that my first husband had weeks to a month to live before the cancer took him.

Communication breakdown: Why don’t people care? One reason is that the higher-ups don’t communicate well, or at all. A non-toxic office is one where there is, among other things, an open line of communication between staff and patient.

High turnover: The correlation to №1 is that the toxic office has a tough time keeping people around; either they quit or are fired. If you are looking for a job and find out that the place has a high turnover rate, run, don’t walk, to the nearest exit. This is most commonly seen if the patient goes to the doctor office every month and is startled to see brand new people at the front desk that weren’t there the month before and it continues like that for months….

Intimidation station: Another sign that office is toxic is that it is run on intimidation. There are many ways to motivate people, and yes, frightening them is one, but it sure isn’t fun and studies show it doesn’t work nearly as well as positive reinforcement. I worked in an office a few years ago where the stress level was always way lower when a certain doctor was on his weekly rotation at the hospital. Whenever this certain doctor was in the office, the stress level went through the roof and even patients felt it in the waiting room that the staff was walking on egg shells anytime this doctor was in the office. It was also eye opening when many of the patients he had switched to other doctors in the practice because that certain doctor belittled the patients as much as he did the staff!

Policies trump people: Toxic offices thrive on bureaucracy. Policies become a crutch and a wall to hide behind, masking all sorts of bad behavior. And the worst thing is the phrase “That’s policy, sorry, nothing I can do about it.” If you ever hear this coming from staff, run…… don’t walk to the nearest exit and switch doctors immediately if you can(some people aren’t quite as fortunate to do that if it’s the only specialist in town.)

With the end of they year a few months away, many people are now thinking of taxes to be paid coming up in the future. Are there things you can itemize for your taxes? Actually yes, there is! A few words of wisdom…. DO NOT wait til December 31st to make the request. The billing offices for doctors are going to be quite busy with not only month end stuff, they also have year end stuff as well. Calling and asking for the papers to itemize for taxes on December 31st will get you hung up on or a grumpy medical biller on the other end of the phone. So call a few days ahead or a few days after the new year to get on the list so the doctor office can print those out for you. It will usually take a week to process your request. Most offices require a request in writing for record keeping, so call and ask what policy is for that particular office. Most offices wait til after the 1st of the new year to send the thing you requested. Why? Because they are still putting in payments and other paperwork into the system so they can run end of year reports. They want every payment accounted for through the end of the year before they send out the paperwork for tax stuff. It helps their records, and yours, to have accurate and up to date information for year-end reports and information.

So here’s a list of what you can and can’t itemize: You may be able to deduct expenses you paid that year for medical and dental care for yourself, your spouse, and your dependents.

You may deduct only the amount of your total medical expenses that exceed 7.5% of your adjusted gross income. Medical care expenses include payments for the diagnosis, cure, mitigation, treatment, or prevention of disease, or payments for treatments affecting any structure or function of the body. Deductible medical expenses may include but aren’t limited to the following:

1. Payments of fees to doctors, dentists, surgeons, chiropractors, psychiatrists, psychologists, and nontraditional medical practitioners

2. Payments for in-patient hospital care or residential nursing home care, if the availability of medical care is the principal reason for being in the nursing home, including the cost of meals and lodging charged by the hospital or nursing home. If the availability of medical care isn’t the principal reason for residence in the nursing home, the deduction is limited to that part of the cost that’s for medical care.

3. Payments to participate in a weight-loss program for a specific disease or diseases diagnosed by a physician, including obesity, but not ordinarily payments for diet food items or the payment of health club dues

4. Payments for insulin and payments for drugs that require a prescription

5. Payments for false teeth, reading or prescription eyeglasses or contact lenses, hearing aids, crutches, wheelchairs, and for a guide dog or other service animal to assist a visually impaired or hearing disabled person, or a person with other physical disabilities

6. Payments for transportation primarily for and essential to medical care that qualify as medical expenses, such as payments of the actual fare for a taxi, bus, train, ambulance, or for transportation by personal car, the amount of your actual out-of-pocket expenses such as for gas and oil, or the amount of the standard mileage rate for medical expenses, plus the cost of tolls and parking

7. Payments for insurance premiums you paid for policies that cover medical care or for a qualified long-term care insurance policy covering qualified long-term care services. However, if you’re an employee, don’t include in medical expenses the portion of your premiums treated as paid by your employer under its sponsored group accident, health policy, or qualified long-term care insurance policy.

You may not deduct funeral or burial expenses (people have actually tried this, it did not end well).

You can only include the medical expenses you paid during the year (you would be amazed how many people have tried to put more than one year on taxes. Don’t do it, it’ll come back to bite you in the butt.) You can only use the expenses once on the return. And they are serious about this one. I know of a patient that tried to do this twice on two different tax forms. It did not end well, use their tale as a caution and only use expenses once on the tax year you are currently doing.

So with a little planning ahead, you can have the information for taxes in your hands by the time you need to start doing your taxes after the beginning of the year.

After many hears from my vantage point of the back office, I kept hearing ” I don’t know what to ask!!” So here ya go, my take on the main questions to ask the doctor every year during your annual appointment.

So here’s a list of what patients have said over the years (and the ones that doctors respond to the most.) Use or improvise a variation of any of the questions for your next visit.

“How are my LDL levels?” LDL (or low-density lipoprotein) cholesterol is referred to as “bad” cholesterol. That’s because if it builds up in your arteries, it can lead to some serious heart problems. And every year, you should make sure that you ask your doctor how your LDL levels are looking. Talking to your doctor openly and honestly about your cholesterol will help you “prevent the majority of bad things—stroke, heart attack, and premature death, for example—from happening.

“What would my ideal blood pressure be, and how do I get there?” In addition to asking about your LDL levels, you should also ask your doctor annually about your blood pressure and, if it’s high, what you can do to lower it. I started to ask this myself when my blood pressure was dangerously high at one appointment several years ago. The office nurse checked 3 times, with 3 separate types of blood pressure cuffs and all three came up with the same exact reading! It was almost freaky just how the exact they all were.

“Which tests do I need and which are optional?” Don’t blindly consent to every test your doctor suggests. “It is important to ask about the benefits and risks of a test] so that you as a patient understand what a test is for and what it will determine, you can “make an informed decision as to whether to provide consent to participate.” If you feel unsure about a test after hearing the benefits and risks, your safest bet is to get a second opinion. If I’m unsure, I always go get a second opinion if that helps any.

What are the side effects of this medication? This is a question that not only should you ask your doctor not just annually, but every time you start taking a new medication. All Medicines have a myriad of side effects. And depending on if you can live with certain side effects or can’t take certain medicines because of other underlying issues with your health, speak up!

“Are my blood sugar levels healthy?” It’s recommended that adults get their blood sugar levels tested every year or every three years starting at age 45, depending on risk factors. While there are many symptoms of diabetes—like fatigue, extreme thirst, frequent urination, blurry vision, and weight loss—many people with diabetes have no idea that they have it. Considering more than 100 million adults in the U.S. currently live with diabetes or pre-diabetes, catching any problems early could greatly benefit your health. So even if you’re not in your mid-40s, it’s worth bringing this topic up to your doctor annually.

“What are the side effects of this medication?” An important question in my opinion. Sometimes, you need to alert or remind the doctor what medicine you’re already taking, because sometimes medicines can counteract other medicines and put your health at risk!

“Why do I need this medication?” If you’re unsure why a doctor is prescribing you a certain medication, just ask. “People who don’t understand why they are taking certain medications are likely to stop them, which can have a potentially deadly outcome. Patients who prematurely stop taking their anti-platelet medications after having a stent in their coronary artery can have a heart attack.

“What is my ideal weight?” Everyone’s ideal weight is different. That number depends on several things, ranging from height and age to bone density and preexisting medical conditions. You should make it a point to ask your doctor about your ideal weight every year. Doing so will give you a realistic number to strive toward—one that won’t require you to rely on crazy diet fads and unsustainable amounts of time spent at the gym.

“Are there any activities I should be avoiding?” Most people already know that they shouldn’t be smoking, binge drinking, and eating fast food long before they walk into their doctor’s office. However, some specific situations call for patients to avoid other activities that might not immediately send up red flags. If you have heart disease, for instance, some doctors note that exercising in an extremely warm climate can make it difficult to breathe. Talk to your doctor annually about which activities you should avoid in order to live a long, healthy, and happy life.

“Is there anything I should warn my family members about?” Many health conditions—ranging from breast cancer to hypertension—are influenced by genetics. If your doctor diagnoses you with a new condition or illness, make sure you ask them about whether your family needs to be tested, too.

“Are my bowel movements normal?” Though there is really no such thing as a “normal” bowel movement, you should talk to your doctor if you’re worried that your bathroom habits are a symptom of something more serious. And indeed they can be: The clinic notes that some of the conditions that can cause bowel changes include food allergies, gallbladder issues, pancreatitis, inflammatory bowel disease, and bowel obstruction.

“How is my thyroid function?” It’s very important to make sure that your thyroid is working properly. This gland, which produces hormones that keep your organs functioning, can wreak some serious havoc inside your body if it’s underactive or overactive. I’ve had cousins that need to be on medicine, and I’m asking about this very thing the next time I go in for my own annual exam.

“Should I be worried about my sleeping habits?” If you’re worried that there’s something wrong with your sleep habits, then you should definitely talk to your doctor about it. Sleep problems make you tired during the day, yes, but they can also be the cause of a condition or an indicator of bigger health issues.

“Should I see a specialist?” Sometimes your primary care physician just doesn’t cut it. If you think that your health issues require a specialist, then ask your doctor for a referral. There’s a reason why doctors like allergists and gastroenterologists exist, so don’t be afraid to ask your primary provider about professionals with specific specialties!

“Is a mammogram a sufficient breast cancer screening for me?” Patients should talk to their doctors before they schedule a mammogram every year. Though the X-ray technology has come a long way in detecting bumps and lumps, breast surgical  “mammograms can miss concerning findings” and that those with symptoms should get evaluated by a medical professional. What many people don’t know is that “patients who are at a higher risk of breast cancer need more than a mammogram.” If breast cancer runs in your family, talk to your doctor about an additional screening with an MRI since a mammogram may not cut it. you should always ask your doctor about the latest in breast cancer screenings just to make sure that you’re staying on top of things. Women should consult with all resources available—including their healthcare provider—in order to reach a personal decision about their own health goals.

“What can I do to improve my health?” While this may seem like a simple question, the answers you receive will help guide you. And even if your doctor’s answers are obvious—drink less, exercise more, etc.—hearing these things from a professional might just be the spark that encourages you to make some necessary changes in your life.

Making an appointment for your annual doctor’s visit is the first step toward taking care of your health. But once you’re actually at the doctor’s office, if you’re not actively asking questions and getting educated about your wellbeing, you’re doing yourself a major disservice. After all, what you do and say during your appointment can have a major impact oIt began when I saw the bag a patient was holding a few years ago. It was HUGE.

How often do people think of making room for their insurance in their overall budget for themselves and their families? Surprisingly, most people forget to add it to their household budgets, because for most people, a co-pay for a doctor’s visit just doesn’t come up all that often. So most people don’t even think to include it in their budgets at all. For all I’ve seen over my many years of being a medical coder, I highly recommend people start looking at adding the insurance co-pay into their family budgets, if for no other reason as calling it the “don’t get burned by co-pays” column.

If you have an elderly family member who is thinking of switching insurance coverage, please look at what it would truly cost  your senior citizen members of your family if it’s a high amount, because many older family members go far more often to the doctor than most people. And if they live on a fixed income, not looking at how the insurance co-pay fits into their budget can completely implode that fixed income budget with sad repercussions for your family members….case in point below:

I’ve seen too many heartbreaking stories in my almost 20 year career in the medical field, with most of years as a medical coder when a well meaning family member convinces them to go with a higher co-pay amount.

I looked at the older parent and middle aged son seated across from me, he was sure his high copay amount would convince his mom to switch to another insurance. She of course wanted nothing to do with the plan. The copay amount in question? $90.00

So I asked them to do an experiment I came up with years ago while working with many elderly patients over the years in doctor’s offices

“Ok, so $90.00 is an acceptable co-pay for your mom?”

“Yes!” He replied confidently

“So you think it’s a one time and done type of thing?”

“Well, isn’t it? ” Her son wasn’t quite so sure now….

“I wish I could say in a perfect world, yes, one time would be enough. However, we just don’t live in a perfect world. A perfect world only exists in peoples minds, it’s not realistic sadly enough.”

“Ok, humor me for a minute….your mom has to have a procedure for 5 days straight. How many times will she have to pay the copay?”

“Once?” The son asked hopefully.

I shook my head. “It’s a $90.00 co-pay every day she goes for the procedure, so that’s five days at $90.00 a day copay, how much will that cost your mom in that 5 day period?”

The son went deathly pale and he started to sweat. “$450.00” he whispered.

“Exactly, so how will you mom eat or pay the rest of her bills on a fixed income?”

“I see what you mean of having your copay fit the budget, and on mom’s fixed income, the $450.00 for a 5 day procedure or cancer treatment, it’ll obliterate her budget if I insist on the $90.00 for everything covered, but at what expense will that mean to my mom’s care, to my mom?”

” I don’t know.” I answered him honestly “Something to think about, isn’t it?”

He nodded. Two very sobered people walked out of my small home office that day, however, they returned a couple weeks later for me to help them figure out what would be best for his mom’s budget and still get the kind of care he thought his mom deserved.

Out of pocket maximum is the set amount of money you will have to pay in a year on covered medical costs. In most plans, there is no copayment for covered medical services after you have met your out of pocket maximum. All plans are different though, so make sure to pay close attention to plan details when buying a plan.

A deductible is the amount you pay for healthcare before your plan benefits take effect. … Your plan may have an office visit copay and a separate, urgent care copay, and sometimes a separate emergency room co-pay among others. Coinsurance is the percentage of covered healthcare costs you pay after your deductible has been met. Co-insurance IS NOT the same thing as a co-pay. many people get those two terms mixed up all the time and then I have to explain the difference between the two.

A co-payment, or co-pay, is the flat amount you pay at the time of a medical service or to receive a medication. Each health insurance plan establishes these fees up front — they are often printed on your health insurance card. Insurance companies use these co-pays in part to share expenses with you. In addition to cutting a small portion of the costs, the co-pay is also used to prevent people from seeking care for every trivial medical condition they might encounter. In this way, co-pays can save an insurance company a substantial amount of money. However, while the co-pay has been found to lower costs by making people think twice before running to the doctor over a case of the sniffles, they might also prevent people from seeking necessary medical attention. For example, a person with a chronic condition may need to see four doctors over the course of a month, all of which require a $25 co-pay. However, if that patient cannot afford $100 each month, he or she will most likely skip one, if not all, of those appointments. Co-pays can often total hundreds of dollars each month if you have several health ailments. In these cases, many patients begin to pick and choose which medications they deem necessary, making for a potentially dangerous situation. But most would say that the alternative — no health insurance — would be worse.

Is copay included in deductible? In most cases, copays do not count toward the deductible. When you have low to medium healthcare expenses, you’ll want to consider this because you could spend thousands of dollars on doctor visits and prescriptions and not be any closer to meeting your deductible.

Some common questions I get when it comes to co-pays……

Do you still pay a copay if you have 2 insurances? Honestly speaking from my point of view as a medical coder in the back office? It depends on what insurance you have. Not all insurances think of co-pays between insurances in the same way. The other plan can pick up the tab for anything not covered, but it won’t pay anything toward the primary plan’s deductible. If both plans have deductibles, you‘ll have to pay both before coverage kicks in. You don’t get to choose which health plan is primary, meaning the one that pays first. Does secondary insurance pay for copays? Yes, you can use secondary insurance to pay your deductibles. Plans that offer cash benefits can be used to pay for out-of-pocket costs such as deductibles and copays. So that’s cop-pays in a nut shell….your call to action tis time is to go check and see if your co-pay is compatible with your present budget. No sense getting burned if it can be avoided. and keep checking on how co-pays will affect your budget anytime open enrollment comes around.