Saturday, June 13, 2015

Get the most for your (insurance) money!

If there is one thing I have learned being in private practice, it is how insurances work. For us, for the patients, billing, how to save money...everything. Today, I would like to give you some tips on what you should know about insurance...and maybe save you some money!

First, it is imperative that you understand everything about your insurance policy. The ins, the outs, the deductibles, the co-pays, the co-insurance... everything. Many times I realize when patients come to our office they are completely clueless as to how their insurance works. For instance, most of the time only a routine annual physical exam is covered at 100% for insurance purposes. Even then, the annual labs that go along with that routine physical may not be covered. Therefore, the OFFICE VISIT is covered, but the annual labs that go along with this visit may not be. However it is impossible for the physician most times to be able to tell you how much these labs would cost. These are questions that you should ask your insurance company prior to having them drawn. Please bear in mind that at a lot of doctors offices, if you go in for an annual physical yet have a complaint or concern that needs to be further assessed, the physician many times will not bill a routine physical. Instead, they will bill an "office visit" which again may be subject to the deductible or co-pay, etc. You should clarify with the office staff prior to live leaving what will be billed. Also, do not forget that there are different "rates" for families and individual policies!

Next, you should know whether you have co-payments or co-insurance. There is a big difference between the two. Most of the time, if you have a co-payment you do not have a deductible for office visits. If you have co-insurance you usually do have a deductible for office visits. For instance if on your card it says that a family medicine doctor is subject to $20 copay, you can bet that every time you go to the doctor you will pay $20 and usually nothing else unless additional studies were ordered. If you have a co-insurance you are usually subject to a certain deductible prior to the co-insurance before any coverage by the insurance will take place. After that deductible is met you may be subject to what is called co-insurance. For example, let's say you have a $1000 dollar deductible for the year which you have already met. You go to see a doctor and the office visit is $100 (this number, again is not a random number, it is what the insurance company has contracted with the doctor and can vary greatly). Since your deductible was met, you will be subject to the 20% co-insurance for the contracted rate of $100, thus, you will owe $20. Make sense?

Finally, WHERE these tests are done is very important. Going back to contracted rates, usually any tests done inside the walls of a hospital will cost much more money than ones that are at an outpatient facility. For instance, I own an ultrasound machine in my office. Many times I have to order ultrasounds of the thyroid gland or the abdomen. Having these tests done in my office cost a lot less money than having these tests done in the hospital. Why? Because the hospital has a higher contracted rate of reimbursement with the insurance company than I do. Therefore the same test done in my office cost $150 were in the hospital and they cost upwards of $300-$400. Even more important, the costs vary from one hospital to another, so IF you are subject to a deductible, shop around! So, you should always try and have diagnostic test done at an outpatient facility or in a doctors office. I not only do ultrasound in my office to help with my reimbursement, and also help save my patients money.

Now, you must realize that these numbers usually do vary greatly for office visits and diagnostic testing (labs, x-rays, CT scans, etc). So, just because you have copay meant for office visits does not mean that you were have call payment for diagnostic test. Many times diagnostic testing is subject to deductible and co insurance. Again you should know your own individual policies so you can be more aware of how to save yourself money.

I hope this helps, and I would be more than happy to answer any questions...if I know the answer!

Until next time.....


Tuesday, December 30, 2014

New Year...New You?

I'm just going to forego apologizing (again) for my lack of posts recently....{who would have known having a baby would be so time consuming?? haha}....and get right to it.

This is the time of the year that we all make our New Year's resolutions, so I have decided to take the top three resolutions and give you all some advice!

1.  Stop Smoking. Obviously, this is a biggie, and one of the hardest. But you know what? Good for you for making, hands down, the best decision of your life. The most important thing when making the decision to quit, is to pick a date. This date does not necessarily have to be January 1st, but whatever day it is, write it down and stick to it. Also, talk to your doctor about your options. You may be a candidate for prescription medication that can help you to stop. Also, your doctor may have other resources such as community groups, and will be able to help you when it comes to nicotine products (patch, gum, etc). Also, don't forget about alternative treatments such as acupuncture and hypnosis. I have some patients that have had tremendous results with these paths also!

2. Workout. Ah...what everyone vows to do, yet few accomplish long-term. I think the most important thing when making a commitment to lose weight is not to go so crazy right away. Usually, what happens is people make a mad dash and go crazy working out for 3 or 4 weeks almost every day for an hour. Soon, they realize this is not sustainable or conducive to their lifestyle and give up. Instead, be realistic from the beginning about workouts. Plan your day so that the workouts do not become so tedious or inconvenient. Make the workouts part of your daily routine. Honestly, the best time to workout is in the morning before's hard to get that going, but in the end, it becomes easier and easier. Let's face it. At the end of the day, the LAST thing you want to do is go to the GYM!

3. De-Stress. By far, in my opinion, the absolute hardest thing to do. Why? Because so many things contribute to stress. Family (ah hemm...husbands and wives), children, schedules, work, bosses, etc...etc. Rule number one? Take time for yourself. Even if you can't do this every day, make time at least once a week for yourself. Go for a walk. Get a pedicure. Go for happy hour with friends. YOU need time for YOU. Also, make a commitment to get a good night's sleep every night. A good night's rest is not only good for your appearance, but also your mood. No one likes a grumpy Tiffany, and that's exactly what happens when I do not sleep well! Also, lack of quality sleep has been linked to diabetes and weight gain (eek!). Take home point: stress is inevitable in your life. Learning how to control your stress with relaxation, sleep and having "you" time is key to your de-stress success!

I wish you all the happiest and healthiest new year. Stay tuned for some great stuff in 2015!!!

Much love...xo!

Saturday, August 16, 2014

Welcoming Mr. Harrison!

Wow! Life has changed I truly understand LOVE.

On July 7th, at 9:16 am, my husband and I welcomed the most perfect little boy into the world. Say hello to Harrison Jason Ruiz!

My apologies for the delay in posts you can see I have been very busy.

Thank you all for your love and support. Medical topics and blogs to soon follow...if I can just take my hands off of him long enough to type!!


Wednesday, June 18, 2014

Our Oz Obsession

It seems like for the past 5 or so years, our country can not get enough of the beloved Dr. Oz. He was an "Oprah child", as I like to call the likes of them (you Dr. Phil and Iyanla whatever-her-name-is)...and you know when you are in Oprah's good graces you are pretty much set for life.

Here's my problem: he is a cardiothoracic surgeon. A SURGEON. He cuts people for a living. Now, I can not comment on his surgical skills or his expertise, because I haven't seen his results nor have I ever worked with him...(nor could I ever be a surgeon...bad idea...). But I will say, I always found it a little weird that a heart surgeon would speak on national television about "female issues", sinus problems, headaches, and every other type of medical condition you can think of. Why? Because he is a HEART SURGEON. He has the same training I do when it comes to medical problems that are out of his scope of practice....the same things we all learned in medical school. The same things you can google and wiki and read about...and you do prior to every doctors appointment (hence why every patient thinks they are dying of some sort of cancer).

Now, when it comes to the current problem at hand, the issue that he touts random, and non-scientifically proven, supplements and remedies for weight loss and other medical ailments...I agree with the senators who scolded him. Why? Because he is a well-recognized physician that the general public looks up to. They (we) rely on him for advice. They (we) trust what he says because he is a physician. They (we) look up to him as a role model. Should we look up to him? Should we hang on every word he says? Easy The problem is that he is in a place of power, on a platform you might say. When he uses this platform and power to send messages to the general public that may not be true or reliable, and even in some cases, detrimental, then we have a serious problem.

But let's face it people, the public is to blame too. On what planet do you think that there is a "magical green coffee bean" that will cause you to melt off fat, as if it some "miracle" drug. REALLY? Shame on you. We hang on the words of celebrities as if it is written in the bible. (Fashion too...have you guys seen what you are wearing lately...I'm sure some celebrity made some of these terrible fashion statements "cool"). If you have not learned by now that hard work and dedication are the keys to most everything in life (weight loss included), then let this be your lesson. Also, let's remember that all supplements and even medications are not created equally for everyone. What may be helpful to one patient might be VERY dangerous to the next. This is rarely addressed on his show. Are they safe to take with your current medications? Are they safe for someone with kidney or liver disease?

I'm sure that he and his producers have the same issues with his show that I have with my blog. Content. It's hard to come up with relevant ideas and topics to discuss. That's why I often ask for blog topics or questions. So, it's no surprise that the show has turned to "ooo...what's the cool and trendy supplement now?" on the show...just for content. And you know what? America eats. It. Up. They will not go to the doctor for an annual physical, or get their mammogram, or take their statin, but they will take raspberry ketones. Seriously. What the hell are raspberry ketones? Well I'll tell you one thing...whoever manufacturers them or grows them..or whatever you have to do to get making a KILLING. Why? Because Dr. Oz said they will make you lose weight. And hell, if he says it, then it MUST be true. $$$

While I am at it, no shakes (this is very trendy's actually a pyramid-scheme with parties and all...hilarious), herbs, supplements, or other trendy pyramid-scheme diet fads will ever stick. Ever. Do you really plan on drinking pre-made shakes for the rest of your life? Diet and exercise are a LIFESTYLE change. Nothing will take the place of that.

Let me make a two things very clear:
1. I am not bashing Dr. Oz. I am sure he is a phenomenal physician and surgeon. I am just saying that I think he is a little too enthusiastic about some things that have not been proven...and could potentially hurt people.
2. I am not against supplements. What I am against is taking random things from your nutritional supplement store because some random doctor told you they were good for you. Don't you think YOUR doctor who knows YOUR history and problems may know the best thing for you? If you don't then you should find another doctor.

Once right. Watch your portions. Exercise. Don't drink soda. Watch the carbs. DO NOT SMOKE. Know your numbers. De-stress. Pretty simple, really.

I wish you all a very happy and HEALTHY ((hot)) Summer!

Saturday, May 31, 2014

Heart-y Humor

Recently, I asked for some opinions for a blog post on Facebook. One friend and reader said that she was part of an expo where they are doing "laughter yoga", and was wondering if laughter and happiness can lead to better heart health. What a great question!

Just as we know that stress can lead to a multitude of heart about one case here...can we assume that a happy life can lead to a happier and healthier heart? Actually, we can! There have been multiple studies which have shown that people who laugh do indeed have a lower incidence of heart disease. One study showed that people with heart disease are 40% less likely to laugh than people without it. Laughter decreases stress and anxiety, both of which can increase hormones in the body which can raise blood pressure and lead to heart disease.

The University of Maryland did a very interesting study. They took 2 groups of people and had one group watch a drama, "Saving Private Ryan" and the other, a comedy, "There's Something about Mary". After the movies, the blood vessels of those who watched the comedy behaved normally, expanding and contracting. Those who watched the drama, however, had tense blood vessels, restricting flow.

There have also been studies relating laughter to better sleep habits as well as decreased blood sugar levels, both of which are extraordinarily important to a healthy heart.

So, to answer my friends question...YES! Laughter likely does indeed help to keep our hearts healthy.  More so than just laughter, it is probably an overall positive attitude and decreased stress levels that allow us to laugh, and this is likely the reason for the healthier heart. (But don't think that you can just go see a comedy instead of going to the's not THAT closely related!).

Thanks for the great idea for the post! Now, can you tell me what the heck "laughter yoga" is?!

Until next time....keep smiling and laughing!


Monday, April 28, 2014

The e-cig Debacle

Let me start off with a little dialogue of how some questions go for a first time patient in my office:

Me: Do you have any medical problems?
Patient: No, I'm healthy.
Me: Have you had any surgeries?
Patient: Tonsil surgery when I was 10.
Me: Okay, what about any allergies?
Patient: Pollen.
Me: Any allergies to medicines?
Patient: Nope.
Me: And you don't smoke and never have, right? (Notice how I phrase this one...)
Me: >:-(
Patient: Well.....okay. Maybe. A cigarette here and there. But I've cut down! I was smoking a pack a day. Now, maybe a cigarette a day. The e-cigarettes and vapor have helped a lot!

Honestly, it's hilarious. The looks I get the way I phrase that question. And I growl. That's right. Growl. And we laugh..and then I stop and say "yeah, not funny. Stop that crap. NOW".

BUT, what is hard is giving recommendations on the new vapor and e-cigarettes. Why? Well, because frankly there is just not a lot of information and research on them. I did recently get an e-mail with this title: 

"FDA To Announce Long-Awaited Regulations On E-Cigarettes, Other Tobacco Products"

oooo! I was giddy. What does the FDA have to say?? Eh, but then I got bored because it was all about how they are going to regulate them, just like they do regular cigarettes, and not anything about the health aspect. So, I had to do some of my own research.

Basically, an e-cigarette (electronic cigarette) or vaporizer are devices which deliver synthetic nicotine via a mouthpiece. When a use inhales, it triggers a sensor that heats liquid (synthetic) nicotine, and the user gets a puff of hot gas that feels like tobacco smoke. The "smoke" is actually a substance called PEG, which allows the user to "blow out" just like they would with a cigarette. And, that's it. No carcinogens. Just the PEG stuff (which is in a lot of stuff like saline solutions, cosmetics and mouth washes), synthetic nicotine and artificial flavorings. So it is BAD for you?

My take on this? It HAS to be better than regular cigarette smoking. And, they have been shown to administer less nicotine than regular cigarettes...BUT, the nicotine is the issue. Although the yucky cancer-causing ingredients *may* be absent (I say this because when the FDA doesn't regulate you REALLY know whats in it?), the nicotine is what causes other health issues like cardiovascular disease, high blood pressure and dementia. Remember also, that it is the nicotine that is addictive. So, generally, using e-cigarettes does not help someone to stop smoking, because they just pick up the e-cigarette and keep going with that. What concerns me too, is that the e-cigarettes are becoming a fad, and teenagers are picking up this habit. Right when we were starting to go in the right direction! personal (professional?) opinion? If you MUST pick one, then go for the e-cigarettes...but let's face reality...the best option is nothing at all! (But, com'on you already knew that!)

Until next time...


Friday, March 28, 2014

Where are your calories hiding??

I have noticed an on-going trend with my patients. A lot of times, they swear that they are eating healthy, but when you really begin to delve into a person's eating habits, you can find some pretty scary calories lurking where you may not know they exist.

One example is my patient who "forgot" that she snacks on cheese and crackers with her glass of wine nightly. Breakfast-good. Lunch- good. Her dinner was so-so...but the snack BEFORE dinner was loaded with calories. Because, let's face it folks, you do not just have one or two pieces of cheese and have 20. Be honest.

mmm....Veggie Juice!
Also, I know that "juicing" is the big thing now. AWESOME. I am all for it. But let me make myself extraordinarily clear...juicing at home is WAY different then picking up a smoothie from the local smoothie joint! First of all, the best juices are at least half veggie juice and have no added sugar. Most smoothies from your favorite chain have added cane sugar or syrup. A lot of times, they will advertise "all-natural agave syrup". Okay, great. All-natural. Sugar packed? Yep! Your typical smoothie from any chain store has approximately 50 grams of sugar. Seriously.

Now, let's talk about yogurt. I love yogurt. LOVE IT!!  BUT...and that's a big BUT...I always eat a Greek yogurt that has a lot of protein too. Why? Because both kinds (plain, non-Greek and Greek) do have a lot of sugar. The only way for me to stay full is to have a breakfast with protein, and let's face it, the regular yogurt is all sugar and no protein.

Watch out for these hidden calories!!
Extras. I will tell you, hands down, that if someone is "watching" their weight, the biggest downfall they have is not knowing how many calories are in the crap that they add to their food. Number 1 enemy? Salad dressing. Look at your dressing label. Compare caesar and ranch to balsamic vinegar. Typically the former have at least 50% more calories (and usually fat, too!) than the latter. Ketchup is another culprit. Did you know that 1 teaspoon...not tablespoon...teaspoon....of ketchup has 15 calories and about 4 grams of sugar? Now, many teaspoons do you put on your burger, fries or hot dog? (Actually, why are you eating that stuff anyway?!)

To keep it simple, do a calorie log. Do it for a few days. Do not change anything you typically eat. But just write it down and look up by the box or by google how many calories you are eating each may (and likely will!) surprise you!

Happy eating!