3 Quick Hits To Improve Your Work Outs and Health

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Some of us are seeking better health and wellbeing via diet and exercise. Often the numerous workout protocols and dietary options can be confusing. We can easily get into a rut or wind up spending a lot of money on equipment, trainers or memberships. I learned my lessons taking my son to a few performance enhancing shops during his quest to be a nationally recruited football player to a Division I school. He already had successes in high school but the Division I world was quite competitive, notwithstanding the need to have your own plan for marketing your skills to your favorite schools. I learned a lot and even spent time in their “adult fitness” program, during which I had the chance to meet some professional athletes in different sports. The take-away messages you may want to consider:

  1. Don’t forget your core—often we work on particular exercises to get a certain look or reach a goal. We need to break from the tendency to follow a regimen by taking one day a week out of our routine for core work that is totally different from the usual routine. I found that jumping rope gave me a different work out that could be expanded by changing from traditional to heavy ropes. There are tons of core exercises to check out.
  2. Develop your own form of gassers—those are the exercises where you push yourself to exhaustion, such as running between two points until winded. Hey, you don’t have to go over the top!  Another effective one is progressively raising the elevation on the treadmill while running 30 seconds of sprints alternating with 30 seconds of rest.  The body recovers just enough to make the next run, but cardiac output still stays relatively high even during rest, so you still burn calories and increase endurance. The goal is to keep the heart rate up for the entire exercise.  We run two sets at each level and work our way up in half step increments on the incline and speed: 4, 4.5, 5, 5.5 and so on. I also like going to the local high school and running sprints up the stadium steps with rail pushups as the break between sprints. Of course, you can start by walking and work your way up to running.
  3. Check out fitness blogs or You Tubes to find different exercises to vary your routine. It helps to break up muscle memory.  Many personal trainers will give you different work out combinations over a few sessions or even one visit. It’s important to prearrange the reason for the use of their time. It’s easy money for them and if you like what they did, you’ll come back for more later, or give them a referral.
  4. I know this is number 4 but at the end of the day, consistency and persistence are the hallmarks of your fitness foundation. So keep up the good work. And put in your time. It always pays in compound interest in the end! Take it from me, at 61, my wife and  I do a boot camp on weekends whenever we can, beside our weekly routines. It keeps us feeling like we’re 40!

3 Important Health Insurance Facts You Need To Know!

My recent experiences with health insurance plans have been a big eye opener. I’m not a novice at this, having worked in upper management of corporate behavioral health benefits. Any time you deal with insurance, you are not on a level playing field.   Insurance companies have armies of actuaries and legal staff to ensure that their taking on your risk is profitable.  That’s okay, as we get benefit in return, a benefit we hope never to use beyond routine health maintenance.

But when you need to use it, as I recently did, there are a few important areas to fully understand.  Three major ones can make a significant financial impact on your use of services:

1.The deductible and out-of-pocket costs are not straightforward.

If you choose to go with a provider or facility that is out-of-network, the out-of- pocket expenses applied to your deductible are subject to limitations placed by your insurance company under the “reasonable and customary” stipulations. The hospital or health care provider may be billing you for service at rates your insurance deems too high for customary reasonable fees.  It will limit the amount it will apply to your deductible.  This means that an X-ray read by a Radiologist may be billed at $250.00, but you only get $150.00 applied to your deductible under the reasonable and customary rule.   You still have to pay the full amount as billed. The only way around that is to negotiate the rate for Provider and facility fees before the procedure. Most will be willing to work with you if you offer to pay cash or credit card at the same rate their insurance contracts reimburse. The advantage to them is the fast turn-around and no need to file claims or wait for a check in the mail.  Your insurance company can give you the in-network rate for services as a guideline, or consult online resources such as The Patient Advocate Foundation. www.patientadvocate.org

2. Not all providers may be covered or participate in your insurance.

When you arrange for a test that involves several activities of care such as a colonoscopy, your PCP is just the first step. The GI specialist will see you and refer you to a Surgi-center for the test. That center may be on your health plan. However, the anesthesiologist may not. It’s important to clarify with the Surgi-center that you want an in-network provider for all services or get in writing that it will accept the in-network rate for the service.  That will ensure that you don’t wind up with extra payments. Remember, most practices use a billing system and collections agency, so the billing churns through the system based on what response comes electronically from the insurance company. Unless you have an agreement up front, you may be in for a surprise or unnecessary hassle.  

3. Coverage during an emergency.

Lastly, in an emergency, whenever you can, clarify with your insurance regarding an in-network provider or facility. If you are unable to do so before receiving treatment, do so as soon as possible afterwards. It could require a transfer to a different facility. In the best of circumstances, it would result in your insurance agreeing to cover your care as if you were at an in-network facility and provider. That could lower your cost for services. It also puts the insurance company at the negotiating table with the hospital about how they will get paid.  Most people don’t know that if an in- network provider is not available within a reasonable distance, your insurance must cover the care as if in-network or make arrangements to transfer you at their expense. Again, hidden charges can happen, such as X-Ray or ECG readings from your ER visit that are billed separately from the ER visit itself.  All those papers you sign on entering the ER commit you to paying the bills received if not covered by insurance. Balance billing is also possible if it’s not in-network.  It’s hard to negotiate when you are on your back in pain. You are at a disadvantage, but that does give you a little more flexibility with those billing offices once insurance does its thing on the coverage. Again, “money now”, at the reimbursement rate for their local reasonable, customary fee is better than no, slow or collection pay. Most healthcare facilities and providers take some form of insurance and discount their fees to be in the network. In return, they get more patients with a payment attached to them. Don’t think you don’t have any leverage. Your ability to pay immediately with cash or credit card allows the process of “cash flow,” which often trumps the slower flow of billing insurance.

3 Important Health Insurance Facts You Need To Know!

My recent experiences with health insurance plans have been a big eye opener. I’m not a novice at this, having worked in upper management of corporate behavioral health benefits. Any time you deal with insurance, you are not on a level playing field.   Insurance companies have armies of actuaries and legal staff to ensure that their taking on your risk is profitable.  That’s okay, as we get benefit in return, a benefit we hope never to use beyond routine health maintenance.

But when you need to use it, as I recently did, there are a few important areas to fully understand.  Three major ones can make a significant financial impact on your use of services:

1.The deductible and out-of-pocket costs are not straightforward.

If you choose to go with a provider or facility that is out-of-network, the out-of- pocket expenses applied to your deductible are subject to limitations placed by your insurance company under the “reasonable and customary” stipulations. The hospital or health care provider may be billing you for service at rates your insurance deems too high for customary reasonable fees.  It will limit the amount it will apply to your deductible.  This means that an X-ray read by a Radiologist may be billed at $250.00, but you only get $150.00 applied to your deductible under the reasonable and customary rule.   You still have to pay the full amount as billed. The only way around that is to negotiate the rate for Provider and facility fees before the procedure. Most will be willing to work with you if you offer to pay cash or credit card at the same rate their insurance contracts reimburse. The advantage to them is the fast turn-around and no need to file claims or wait for a check in the mail.  Your insurance company can give you the in-network rate for services as a guideline, or consult online resources such as The Patient Advocate Foundation. www.patientadvocate.org

2. Not all providers may be covered or participate in your insurance.

When you arrange for a test that involves several activities of care such as a colonoscopy, your PCP is just the first step. The GI specialist will see you and refer you to a Surgi-center for the test. That center may be on your health plan. However, the anesthesiologist may not. It’s important to clarify with the Surgi-center that you want an in-network provider for all services or get in writing that it will accept the in-network rate for the service.  That will ensure that you don’t wind up with extra payments. Remember, most practices use a billing system and collections agency, so the billing churns through the system based on what response comes electronically from the insurance company. Unless you have an agreement up front, you may be in for a surprise or unnecessary hassle.  

3. Coverage during an emergency.

Lastly, in an emergency, whenever you can, clarify with your insurance regarding an in-network provider or facility. If you are unable to do so before receiving treatment, do so as soon as possible afterwards. It could require a transfer to a different facility. In the best of circumstances, it would result in your insurance agreeing to cover your care as if you were at an in-network facility and provider. That could lower your cost for services. It also puts the insurance company at the negotiating table with the hospital about how they will get paid.  Most people don’t know that if an in- network provider is not available within a reasonable distance, your insurance must cover the care as if in-network or make arrangements to transfer you at their expense. Again, hidden charges can happen, such as X-Ray or ECG readings from your ER visit that are billed separately from the ER visit itself.  All those papers you sign on entering the ER commit you to paying the bills received if not covered by insurance. Balance billing is also possible if it’s not in-network.  It’s hard to negotiate when you are on your back in pain. You are at a disadvantage, but that does give you a little more flexibility with those billing offices once insurance does its thing on the coverage. Again, “money now”, at the reimbursement rate for their local reasonable, customary fee is better than no, slow or collection pay. Most healthcare facilities and providers take some form of insurance and discount their fees to be in the network. In return, they get more patients with a payment attached to them. Don’t think you don’t have any leverage. Your ability to pay immediately with cash or credit card allows the process of “cash flow,” which often trumps the slower flow of billing insurance.

Alcoholism and Mental Health

The blog posted earlier today is the seventh of nine installments of blogs on this Voiceamerica session found on mymindmyhealth.com.

Mental Illness, Drug Use and Spirituality

A big frustration in the work that we do is that drug use is so normalized in our culture. Many people don’t see it as a component of their lifestyle they should report to their health care professional, whether it’s because on the weekend they are with friends doing the same thing or they haven’t had any troubles yet. They are in denial. “Everybody else is doing it…It’s prevalent in our community…Movie stars do it…It can’t be that bad…It couldn’t be a contributing factor to what I’m going through.” People don’t realize that drugs of abuse go to the same part of the brain where mental illness occurs. That’s a big issue for us in the treatment field.

When mental illness occurs, what are some of the areas of “higher power” that can help restore a person’s sanity? What are some of the cultural components of that? The mind is an interface to a transcendent component of self, that spiritual part that inhabits the vessel of the body.   We’re on this journey. The mind has a particularly important role to play in making that journey spiritually fulfilling for the individual. A lot of the yearning that the human aspect of the mind has is going to be in the area crucially impacted by drug and alcohol use. Also, it can be difficult to treat mental illness if the addiction is hidden. One of our colleagues in the Addiction world, Chana (pronounced “Hana,” like the road to Hana, Hawaii) Carro is a licensed independent Substance Abuse Counselor, with over 24 years’ experience. She says, “The oxygen of addiction is deception. Addiction is a deception by the person regarding their own well-being. It’s a deception regarding their families and regarding people who are trying to help.” Not only do addicts think it’s not important to their mental illness diagnosis, but they have a stake in not discussing and not even letting themselves know how bad the situation is or is becoming. In order to create a dwelling place for God, you have to have a “sound mind.” Peace, patience, kindness, goodness, gentleness, and self-control are all part of practicing a more virtuous life.

Patients who are mentally ill, but who are not involved with drugs and alcohol, demonstrate less rebelliousness, less aggressiveness. They may not see reality in a clear and healthy way, but they are reporting what’s accurate and true for them. As Chana explains, “Once addiction or drug use is in the mix, the person himself doesn’t know what is true, not because the chemistry of their brain is altered as in schizophrenia or in an active episode of bipolar disorder, but they don’t even know what’s real in their brain. Without being able to bring a sound mind to the art and science of living a spiritually sound life, it’s really a complicated process. When people are encouraged to tease out of their co-occurring disorders the part that they can have control over, which is to get into recovery from the drugs and alcohol, then you have a much less complicated picture in terms of trying to treat the mental illness.” Medications can be very helpful in achieving a level of stability that permits them to go forward in their lives, to find a spiritual path that is meaningful or nurturing. At that point, their mental illness may be more qualitatively controlled than when there is active addiction in the mix.

Vernon and Louise Barksdale

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