Why is it important to take your medication to your doctor's appointment?

We are here today with Dr. Crayton with The Arthritis & Infusion Center talking about why it is so important to bring your actual medication bottles with you to each doctor’s appointment visit.

1.)    To watch for those drugs with similar names

2.)    To avoid any unwanted drug to drug interactions

3.)    Just because it is over the counter medication doesn’t mean it is safe

Thank you for joining us for this Health Tip with the Arthritis & Infusion Center.  If you have health or medical question that you would like more information on email them to us and we will feature your question on an upcoming blog post. 

WHAT MAKES DR. CRAYTON UNIQUE?

He is:

• The most tenured and experienced Rheumatologist in the region.
• The only Rheumatologist who also has a Masters Degree in Hospital Administration
• Adept in really listening to what his patients are saying – “If they say they hurt, I believe them,” says Dr. Crayton.
• A true patriot – serving in the U.S. Army as well as the Army Reserve.  He particularly enjoys his association with the Bay County Chamber’s Military Affairs Committee as well as his interaction in treating veterans.

• A Rotarian who embodies the Rotary theme of “service above self”
• He initiated the “Spread the Warmth” campaign that will be providing lap robes to area nursing homes each winter.
• An avid supporter of the Bay Arts Alliance and sponsored their entire 2010-11 as well as 2011-12 seasons.
• A member of the Board of Directors for the Bay County Chamber of Commerce (2012) and B.A.S.I.C.
• Actively involved with other area charities and, along with his wife, have endowed several scholarships in healthcare fields.

BETTER YET -- Do you want to find out for yourself why Dr. Crayton is so individually unique to his patients?  Understand that Pain is not normal.  Let The Arthritis and Infusion Center help!  873-6748 – www.DrCrayton.net

What is a Prior Authorization?

Have you experienced this statement “I’m sorry, but this requires a prior authorization.”  This very common phrase has become a major complication in the medical community and it is now becoming a heavy burden on the shoulders of patients.

According to insurance companies, Prior Authorizations, also known as P.A.’s, are an extra precautionary step in your overall medical care.  The insurance companies may attach the P.A. requirement to any medical procedure or medication.  Then, they will require the ordering physician to either produce a medical record or conduct a peer –to-peer conversation to justify the medical need.  Examples of such prior authorizations would include:  name- brand medications, MRI scans, and “elective” surgery. 

What does this extra step mean to the patient?  A prior authorization essentially puts a hold on the medication or procedure until the physician meets the necessary requirements set by the insurance company.   The patient will not receive the medication, or be permitted to have the medical procedure, until the P.A. has been satisfied.  Therefore, there is a disruption to your medical care.

What should you do if your medicine or medical procedure requires a P.A.? 

1.   Contact your physician.  Do not assume that your pharmacy or medical facility (such as a diagnostic imaging center), has contacted them.  Make sure they are aware of the issue in detail.

2.   Ask questions.  There are instances that will require the physician to rely on the patients’ past medical history to prove the need for the medication or procedure.  Ask your physician if there is any information you can provide to help speed the P.A. along.

3.   Follow up.  Things fall through the cracks from time to time.  After five to seven business days, call and follow up on the status of the P.A. 

4.   Be patient.  P.A. request are used heavily by insurance companies and your physician’s office has to address each and every request.  It is estimated that each request takes an office staff member approximately 15-25 minutes to complete.

The Arthritis and Infusion Center prides ourselves in “fighting” for the rights of our patients.  We will take the time to complete Prior Authorization requests and prove the need for the medication or procedure.  This personal attention to the needs of our patients is what makes the team at The Arthritis and Infusion Center stand above the rest.

What is the difference between Deductibles, Co-Payments, and Co-Insurance?

It’s that time again.  Each New Year brings about the dreaded rollover of deductibles. The Arthritis and Infusion Center has a few important tips and explanations to help you navigate through the world of insurance.  

A basic understanding of the most common insurance terms will ease tension and frustration at the beginning of the year.  The most frequent terms referred to by your insurance and medical providers are Deductibles, Co-payments, and Co-insurance.  

Deductibles

A deductible is a set amount of money, determined by your insurance provider, which is due from the patient before the insurance provider will start to pay.  In simple terms, you, the patient, must pay that set amount of money, from your pocket, before your insurance will pay any money toward your medical bills.  Typically, deductibles run for a calendar year, and will zero out each January 1^st. 

Example:  Your annual deductible is $500.  Your medical bill is $120 and you have not met your annual deductible.  You will be responsible to pay your medical provider the $120 bill until you have satisfied the $500 deductible.  You will still have $380 remaining before the deductible it is met.

 Co-Payments

Typically, a co-payment is a fixed dollar amount attached to a medical office visit, procedures, or medications.  “Co-pays” do not apply toward the annual deductible. Co-payments are a separate expense to the insured. Co-payments are often a money saving advantage for patients that do not require frequent medical treatment.

Example:  A regular office visit to your primary- care physician has a co-payment of $20.  You are required to pay the $20 and your insurance provider will pay the remainder of the visit. 

Co-Insurance

This is much different than co-payments.  Co-insurance is a percentage of a medical bill that is due from the patient after the annual deductible is met.  Depending on the particular policy, a co-insurance may apply to physician visits, procedures, and medications.  Once the annual deductible is met, the insurance provider will pay the medical provider according to the set contract.  After the insurance provider has paid their portion, it is then the responsibility of the patient to pay the percentage remaining (co-insurance).  A very popular co-insurance scenario for insurance providers is an 80/20 split.  This means the insurance provider pays 80% of the bill and the patient pays 20%.

Example:  Your monthly treatment costs $500.  Your annual deductible is met and your insurance company pays at a rate of 80/20.  Your co-insurance is 20% of the allowable amount.

Understanding your medical expenses can be very confusing.  Don’t be afraid to ask questions in order to obtain a full explanation of charges, payments, and amounts due from you.  A good rule of thumb: always ask medical providers questions before you have a procedure.  Ask about possible charges, if prior-authorization is required, and their in-network status.  A little legwork, prior to your visit to a physician, could save you thousands!