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IF I HAVE PRIMARY OR SECONDARY INSURANCE COVERAGE, WHY DOESN’T THE SECONDARY CARRIER PAY MY CO-PAYS?
Most often secondary insurance carriers will not pay an account balance until you have met the required deductible and paid the applicable office co-pay. Office visit co-pays are your responsibility and are often contractually required by HMO plans. However, you may want to check with your secondary insurance carrier regarding their specific policy for dealing with primary insurance deductible amounts.
WHY DO INSURANCE COMPANIES DELAY PROCESSING MY CLAIM UNTIL THEY RECEIVE ACCIDENT INFORMATION FROM ME?
When your claim is being processed for an injury that possibly resulted from an accident, most insurance carriers would write you and request accident details. This information is needed to assess the insurance carrier’s liability. If your injury is the result of an automobile accident, the health carrier would not be responsible for processing the claim, but rather the auto insurance carrier. Also, if you are injured in a business establishment, whether it is a work-related or a slip-and-fall, again the health insurance carrier may not be responsible for the claim. This is why it is very important to respond to your insurance carrier’s request for accident details in order that the claims be evaluated and processed in a timely manner.
I HAD AN ON-THE-JOB INJURY, AND WHEN I CALLED TO SCHEDULE MY APPOINTMENT, I WAS TOLD THE WORKERS’ COMPENSATION ADJUSTER OR MY EMPLOYER WOULD HAVE TO ARRANGE MY APPOINTMENT. WHY IS THIS A ORTHO ONE POLICY?
All Workers’ Comp appointments must be authorized by a Workers’ Comp Adjuster or the employer prior to an appointment being scheduled for an injured employee/patient. When the adjuster or employer calls, we set up a Workers’ Comp account, collect the billing/insurance information, and receive authorization for Ortho One to treat you. In most cases, the injured employee/patient does not have access to this information; therefore, requiring the adjuster or employer to schedule the appointment on your behalf.
WHAT WEBSITE ADDRESSES WOULD YOU SUGGEST TO ACCESS MORE GENERAL MEDICAL INFORMATION?
There are many websites available to consumers. Please find several listed below you might want to explore.
www.aaos.com American Academy of Orthopaedic Surgeons
www.drugstore.com
www.HealthGate.com
www.understand.com
www.webmd.com WebMD
WHAT IS A DRUG FORMULARY?
A drug formulary is a list of prescribed medications, both name brand and generic products, which the insurance carrier agreed to cover the cost. Most insurance carriers have a drug formulary, and the list is updated on a regular basis. If your doctor prescribes a medication that is not on your carrier’s formulary, more than likely, you will be required to pay out-of-pocket for the prescription, unless authorized prior to the prescription being filled.
WHAT IS ERGONOMICS?
Ergonomics is a defined study of work. It is the science of designing a job to fit a particular worker/employee, rather than physically forcing the employee’s body to fit the job. Ergonomics incorporates a number of scientific principles which include physiology, biomechanics, and psychology to establish distinctive work standards for employees. By studying the tasks that are required to perform a specific job and adapting the work station, tools and equipment required for that job, one can significantly reduce the potential for work-related musculoskeletal disorders, such as carpal tunnel syndrome, tendinitis, and back injuries. The most common types of work that are most likely to pose ergonomic hazards are manual labor, manufacturing and production work, heavy lifting, twisting movements, and those requiring long hours of working in awkward positions.
WHAT IS THE DIFFERENCE BETWEEN A SPRAIN AND A FRACTURE?
What is the difference between a sprain and a fracture?
A sprain is an injury to the ligaments and soft tissue surrounding a joint. A fracture is an actual break in a bone. Sprained ligaments are soft tissue and are not visible on X-rays; however, broken bones are hard, dense tissue which is visible on X-rays. X-rays are the best way to distinguish between a sprained ligament and a broken bone. Both injuries are usually treated with a splint or cast to immobilize the injured area to promote healing.
WHAT IS ARTHROSCOPIC SURGERY?
What is arthroscopic surgery?
Arthroscopic surgery is a minimally invasive procedure that is performed with a surgical device called an arthroscope (camera), which is approximately the size of a pencil. This procedure is the most commonly performed surgery in orthopedics, and is the most frequently used to treat shoulder, knee, elbow, wrist, hip, and ankle joints. Your surgeon is available to view the inside of the joint on a video monitor where he/she can inspect, remove, repair, or reconstruct damaged parts of a joint through several small incisions of approximately one-half inch. Arthroscopic procedures are most often performed on an outpatient basis, allowing you to return home the same day.
WHAT IS THE RECOMMENDED AGE FOR A TOTAL JOINT REPLACEMENT?
The average age of patients undergoing total joint replacement is 65, and, most often, the need for this surgery is to relieve the symptoms of osteoarthritis. However, other conditions, such as rheumatoid arthritis, death within the bone (avascular necrosis), fractures, post-traumatic arthritis, or juvenile arthritis, may necessitate a joint replacement in a patient, sometimes in their teens or twenties. These cases are rare, but they do occur.
WHAT IS OSTEOPOROSIS?
Osteoporosis is defined as weak or thin bones, which are more susceptible to fracture with only minimal injury. Osteoporosis is most commonly diagnosed in women who are post-menopausal age; however, men can be affected, as well. A bone densitometry test can be performed to evaluate how thin your bones are. This is a specialized X-ray that generates a picture by using X-ray beams and detects how much the X-ray beam changes after it has passed through the bones. The change in the X-ray beams’ intensity shows how dense or thin the bones are that are being studied. The three most common sites for bone densitometry test are in the spine, hip, or wrist. This test is very helpful in assisting your physician to diagnose osteoporosis and implement a treatment plan to build up your bones.
WHAT ARE SYNVISC/HYALGAN INJECTIONS?
This is a series of three injections that is used to treat osteoarthritis of the knee. These injections are used to replace the natural chemical hyaluronan that is found in the body in high volume within the joint tissues and the fluid that fills the joint. In patients with osteoarthritis, there may not be enough hyaluronan in the joint fluid and tissues; therefore, causing wear and tear on the bones within the joint. The body’s own hyaluronan acts as a lubricant and shock absorber in the joint and is necessary for the joint to operate properly. These injections are most often performed on patients that have not received significant pain relief with the use of medication, physical therapy, or corticosteroids that are injected directly into the joint.
WHAT IS PLANTAR FASCIITIS?
Plantar fasciitis is a condition of gradual onset that is most often diagnosed in middle-aged patients who stand for extended periods of time, have high arches and are overweight. The patient will have tenderness over the inside of heel, and on rare occasions may experience localized swelling of the heel area. Various treatments for plantar fasciitis include a decrease in high-impact activities, non-steroidal anti-inflammatory medications, stretching exercises, heel cushions, and appropriate shoe wear. The use of anti-inflammatory medications helps to decrease inflammation in the heel area, as well as, relieve pain. The purpose of heel cushions is to reduce the impact load on the heel. In extreme cases where plantar fasciitis is interfering with the patient’s qualify of life after six months to one year of conservative treatment, surgery is indicated.
WHICH IS THE BEST TO USE FOLLOWING AN INJURY: ICE OR HEAT?
Most often, ice is recommended for the first 48-hours following an injury, as cold helps to control swelling, as well as pain. The application of heat to a ‘fresh” injury may actually increase swelling as it causes the blood vessels to dilate and increases blood flow to the area, therefore, causing increased swelling. Cold has just the opposite effect. Heat is most often used to decrease muscle spasms.
I HAVE A TOTAL JOINT REPLACEMENT. WHY IS IT NECESSARY TO TAKE ANITBIOTICS PRIOR TO DENTAL PROCEDURES OR OTHER SURGERY?
Infection may occur in total joint replacements long after surgery. If the joint replacement is exposed to bacteria in the bloodstream, an infection can occur. It is uncommon for an infection to occur long after surgery; however, it is possible. For this reason, it is recommended that patients who have had a total joint replacement take antibiotics prior to dental or other surgical procedures.
WHAT CAUSES A STRESS FRACTURE?
Stress fractures are microscopic fractures of bone resulting from repeated “stress”, and are usually from bearing your own weight. Stress fractures most often occur in the feet and can be caused by trauma or overuse resulting from hiking, jogging or just being on your feet for prolonged periods. A stress fracture is most often too tiny to show up on a routine X-ray, so a bone scan may be ordered for further diagnosis. These types of fractures are most often treated by keeping weight off your foot as much as possible for a few weeks and the use of a hard-bottom walking shoe or sturdy tennis shoe. In some cases, a cast may be applied to give the foot additional support while it heals.
WHAT EXACTLY IS A GANGLION?
Ganglions are benign, fluid-filled cysts. These cysts grow from the tendons or the lining around bones and may occur anywhere, but are most commonly seen on the top of the wrist. A cyst is a sac usually filled with thin, watery fluid, but the fluid in a ganglion is a thick, clear jelly-like substance. These cysts may be aspirated (drained); however, they may recur, or they can be surgically removed.
WHAT IS SCOLIOSIS?
Scoliosis is curvature of the spine. This condition can affect adults, but is most common in young people, especially girls between 10 and 16 years of age. Scoliosis is usually detected on school screening exams or by a child’s pediatrician. This is followed up by an orthopedic examination and X-ray to assess and measure the degree of the curve. The most common type of spinal curves is the “S-shape” and “C-shape”. These curves are measured in degrees and can range from 10 degrees up to 50 degrees. Depending upon the magnitude of the spinal curve, medical treatment may include simple observation, bracing, and, in severe cases, surgical intervention.
WHAT IS TENNIS ELBOW?
Tennis elbow is a common term for a condition caused by repetitive use of the arm and forearm muscles that result in pain of the elbow. You don’t have to play tennis to get this, but the term came into use because it can be a significant problem for some tennis players. The medical term for this condition is lateral epicondylitis. Tennis elbow is cause by abrupt or subtle tearing of the muscle and tendon area around the outside of the elbow. Repetitive arm, elbow and wrist movements use to perform activities, such as hammering, vacuuming, and sweeping, as well as movements used by golfers and baseball players, can produce symptoms. This problem is most often treated with rest, nonsteroidal anti-inflammatory drugs, physical therapy, and cortisone-type medications injected into the sore area. Tennis elbow is rarely treated with surgery.
WHAT IS GOUT?
Gout is a condition that causes sudden, severe attacks of pain redness and swelling of the joints. Most often, gout affects a single joint in an episode and is commonly seen in the big toe. The cause of gout is due to an accumulation of uric acid within the joint fluid. Uric acid is a substance produced by our bodies to transport waste material, which is usually excreted via the kidneys. When the uric acid level becomes too high, gout or joint pain may occur. Diagnosis may be determined by removing a small amount of fluid from the affected joint to be sent to a laboratory or by a blood test to determine the uric acid level. Gout is usually treated with nonsteroidal anti-inflammatory medications. Allopurinol is a medication that is widely used after an attack of gout to prevent future attacks.
WHAT IS AN ORTHOPEDIC DOCTOR?
An orthopedic doctor, also known as an orthopedist, is a medical doctor (MD) or a doctor of osteopathy (DO) who specializes in the musculoskeletal system—bones, joints, muscles, ligaments, tendons, and nerves.
WHAT IS AN ORTHOPEDIC SURGEON?
Orthopedic surgeons are specialized in the musculoskeletal system; many orthopedists specialize in certain areas of the body, such as foot and ankle, hand and wrist, back, or neck and spine. Additionally, orthopedic doctors may focus on a specific field of orthopedics, like pediatrics, sports medicine, and trauma.
WHAT IS THE EDUCATIONAL TRAINING OF AN ORTHOPEDIC SURGEON?
Board-certified orthopedic surgeons have successfully completed a minimum of 13 years of formal education:
Undergraduate: Four years of study in a college or university
Medical School: Four years of study in a school of medicine
Orthopedic Residency: Five years of study at a major medical institution
Board-certified, fellowship-trained orthopedic surgeons have completed:
Undergraduate: Four years of study in a college or university
Medical School: Four years of study in a school of medicine
Orthopedic Residency: Five years of study at a major medical institution
Fellowship Training: One year of specialized education in an accredited fellowship program
All orthopedic surgeons continue their medical education yearly to stay current in orthopedic knowledge and skills.
WHAT IS A BOARD-CERTIFIED ORTHOPEDIC SURGEON?
Once a doctor has completed an orthopedic residency at a major medical institution, the American Board of Orthopaedic Surgery offers a written test to become board-eligible. If the written test is passed, the doctor becomes “eligible” to take the oral test, after two years in practice. When the doctor passes the oral exam, the doctor becomes “board-certified” and is considered a diplomat of the American Board of Orthopaedic Surgery.
The intent of the certification process, as defined by the board members of the American Board of Medical Specialties, is to provide assurance to the public that a certified medical specialist has successfully completed an approved educational program and an evaluation, including an examination process designed to assess the knowledge, experience, and skills requisite to the provision of high-quality patient care in that specialty.
WHAT IS A FELLOWSHIP-TRAINED ORTHOPEDIC SURGEON?
A fellowship-trained orthopedic surgeon is a doctor who has completed a minimum of 13 years of education and has completed an additional year of specialty training in a specific field of orthopedic surgery in an accredited fellowship program.
There are fellowships in all areas of orthopedics, including foot and ankle, hand and wrist, back, and neck and spine. Additionally, orthopedic surgeons may focus on a specific field of orthopedics, like pediatrics, sports medicine, or trauma.
WHAT IS THE EDUCATIONAL TRAINING OF AN ORTHOPEDIC SURGEON?
Board-certified orthopedic surgeons have successfully completed a minimum of 13 years of formal education:
Undergraduate: Four years of study in a college or university
Medical School: Four years of study in a school of medicine
Orthopedic Residency: Five years of study at a major medical institution
Board-certified, fellowship-trained orthopedic surgeons have completed:
Undergraduate: Four years of study in a college or university
Medical School: Four years of study in a school of medicine
Orthopedic Residency: Five years of study at a major medical institution
Fellowship Training: One year of specialized education in an accredited fellowship program
All orthopedic surgeons continue their medical education yearly to stay current in orthopedic knowledge and skills.
WHAT IS A BOARD-CERTIFIED ORTHOPEDIC SURGEON?
Once a doctor has completed an orthopedic residency at a major medical institution, the American Board of Orthopaedic Surgery offers a written test to become board-eligible. If the written test is passed, the doctor becomes “eligible” to take the oral test, after two years in practice. When the doctor passes the oral exam, the doctor becomes “board-certified” and is considered a diplomat of the American Board of Orthopaedic Surgery.
The intent of the certification process, as defined by the board members of the American Board of Medical Specialties, is to provide assurance to the public that a certified medical specialist has successfully completed an approved educational program and an evaluation, including an examination process designed to assess the knowledge, experience, and skills requisite to the provision of high-quality patient care in that specialty.
WHAT IS A PHYSIATRIST (PHYSICAL MEDICINE & REHABILITATION PHYSICIAN)?
A physiatrist is a medical doctor specializing in nonsurgical pain management, physical medicine and rehabilitation, and neurological studies.
WHAT IS THE PRIMARY CARE SPORTS MEDICINE DOCTORS?
What is a primary care sports medicine doctor?
A primary care sports medicine doctor is an expert in the field of sports medicine. Either through advanced fellowship training or through years of clinical experience, a primary care sports medicine doctor has learned the skills to take care of athletes of all ages, sports, and levels of competition. Primary care sports medicine doctors often serve as team doctors to professional sports teams or are personal doctors to elite-level athletes.
WHAT IS A PHYSICIAN ASSISTANT?
A physician assistant, commonly referred to as a PA, is a healthcare professional licensed to practice medicine under doctor supervision. Physician assistants can treat patients and write prescriptions. PAs are trained to recognize when patients need the attention of a supervising doctor or specialist. Physician assistants see patients in the office as well as assist the doctors in surgery.
WHAT IS A PHYSICAL THERAPIST?
A physical therapist is licensed by the state, specializing in therapy programs for musculoskeletal injuries and disorders, sports injuries, post-operative rehabilitation, and massage therapy.
WHAT IS AN OCCUPATIONAL THERAPIST?
An occupational therapist is licensed by the state and specialized in the treatment of the upper extremity (hand, wrist, elbow, and shoulder) and work injuries. The services provided by occupational therapists include patient education, joint range of motion, adaptive techniques, splinting, and workplace evaluations.
WHAT IS ORTHOPEDICS?
Orthopedics (alternatively, orthopaedics) is a medical specialty focused on the diagnosis and treatment of conditions, disorders, and injuries of the muscles, bones, joints, tendons, ligaments, and nerves.
A doctor who specializes in this medical specialty is called an orthopedic (alternatively, orthopaedic) surgeon or orthopedist.
WHAT IS ARTHRITIS?
The word arthritis literally means "joint inflammation." Arthritis refers to a group of more than 100 rheumatic diseases and other conditions that cause pain, stiffness, and swelling in joints.
Rheumatoid arthritis is a disease that damages the lining surrounding our joints while also destroying our bones, tissue, and joints over time.
Osteoarthritis is a progressive condition that slowly damages the cartilage surrounding the ends of bones and is common in the hip, knee, and spine.
WHAT IS BURSITIS?
Bursitis is an inflammation or irritation of a bursa, which is a fluid-filled sac located around joints. Bursitis causes a reduction in or a loss of motion at the affected joint. Bursitis typically occurs in the heel, hip, knee, shoulder, and thumb.
WHAT IS CARTILAGE?
Cartilage is a soft, rubbery, gel-like coating on the ends of bones, where they articulate, that protects joints and facilitates movement.
WHAT IS A LIGAMENT?
A ligament is an elastic band of tissue that connects bone to bone and provides stability to the joint.
WHAT IS A TENDON?
A tendon is a band of tissue that connects muscle to bone.
WHAT IS TENDONITIS?
Tendonitis, medically spelled tendinitis, is an inflammation or irritation of a tendon. Chronic strain, overuse or misuse of a tendon leading to a repetitive stress injury, or a serious acute injury can lead to a weakness, tear, or swelling of the tendon tissue, resulting in pain and stiffness near the tendon. Tendonitis usually occurs in the elbow, hip, knee, shoulder, thumb and wrist, but can occur in any tendon.
DO I USE ICE ON MY INJURY? DO I USE HEAT ON MY INJURY?
The general rule of thumb is to use ice in the acute stage of an injury (within the first 24 – 48 hours) or whenever swelling is showing. Ice helps to reduce inflammation and swelling by decreasing blood flow to the area that is injured. The general guideline is to apply ice indirectly (not directly on the skin) for 20 minutes, remove the ice for at least 20 minutes, and repeat as necessary.
Heat is used to increase blood flow, which helps promote pain relief after inflammation and swelling subside. Heat is also used to assist in warming muscles up prior to exercise, any physical activity, or physical therapy.
WHAT IS ARTHROSCOPIC SURGERY?
Arthroscopic surgery is a surgical procedure that is commonly performed to diagnose and treat problems within the joint. By using high-tech cameras, the orthopedic surgeon inserts a small instrument, called an arthroscope, into the joint.
The arthroscope contains a fiber optic light source and small television camera that allow the surgeon to view the joint on a television monitor and diagnose the problem, determine the extent of injury, and make any necessary repairs.
WHAT IS A BONE DENSITY SCAN?
A bone density test is used to diagnosis osteoporosis, which is a disease that causes weakening of the bones that can ultimately results in fractures. In the past, osteoporosis could only be detected after a person’s bone broke. However, by using a bone density test, it is possible to know one’s individual risk of breaking bones before one breaks.
A bone density test uses X-rays to measure the amount of calcium and other bone mineral packed into the segment of bone. Common areas that are tested using a bone density scan include the spine, hip, and forearm.
WHAT IS A CORTISONE INJECTION?
Corticosteroids, more commonly referred to as, cortisone, is a steroid that is produced in the body naturally. Synthetically produced can also be injected into soft tissues and joints to help decrease inflammation.
While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendonitis (medically referred to as tendinitis), and arthritis to reduce swelling, pain, and joint stiffness.
WHAT IS A CT SCAN?
A computed tomography (CT) scan, also known as CAT scan, produces images that are similar in detail and in quality to an MRI. However, the CT scan takes a 360-degree picture of internal organs and the spine and vertebrae. CT scans provide cross-sectional views of the body and provide clearer imaging than an MRI.
WHAT IS AN EPIDURAL?
An epidural is a steroid injection used to help decrease the inflammation of spinal nerves to help relieve pain in the neck, back, arms, and legs from conditions such as herniated discs, spinal stenosis, and radiculopathy. Cortisone is injected directly into the spinal canal, and some patients only need one injection to relieve pain. However, it normally requires two or three injections to provide significant pain relief.
WHAT IS A FUSION?
A fusion is a procedure in which bones are fused together with bone grafts and internal devices (such as metal rods and screws) to heal into a single solid bone.
WHAT IS INTERNAL FIXATION?
Internal fixation is a treatment to hold pieces of a broken bone in the correct position with metal plates, pins, or screws while the bone is healing.
WHAT IS JOINT REPLACEMENT SURGERY?
Joint replacement surgery is a surgical procedure that is performed to replace an arthritic or damaged joint with a new, artificial joint, called a prosthesis. Joint replacements can be performed on every joint in the body, but most commonly performed in the knee, hip, shoulder, and elbow.
Joints contain cartilage, a soft, rubbery gel-like coating on the ends of bones, where they articulate, that protects joints and facilitates movement and over time, or if the joint has been injured, the cartilage wears away and the bones of the joint start rubbing together. As the bones rub together, bone spurs may form, and the joint becomes stiff and painful. Most people have joint replacement surgery when they can no longer control the pain with medication and other treatments and the pain is significantly interfering with their lives.
WHAT IS AN MRI?
Magnetic resonance imaging, commonly referred to as a MRI, is an advanced technology that uses magnetic fields and radio waves (like microwaves and the AM and FM bands on your radio) to visualize the inner workings of the body.
The pictures produced by MRI help the radiologist clearly and accurately detect and define the differences between healthy and diseased tissues, especially in the soft tissues. It can reveal many health problems at their earliest, most treatable stages.
WHAT ARE NSAIDS?
Non-steroidal anti-inflammatory drugs (NSAIDs) are non-prescription, over-the-counter pain relievers, such as aspirin, ibuprofen, and naproxen sodium. They are popular treatments for muscular aches and pains as well as arthritis and help in reducing swelling, pain, and joint stiffness.
WHAT IS OSTEOTOMY?
Osteotomy is a procedure to correct bone deformity by cutting and repositioning the bone.
WHAT IS OUTPATIENT SURGERY?
An outpatient surgery is a surgery that does not require the patient to stay in the hospital overnight; it is commonly known as an ambulatory surgery. Outpatient surgery has grown in popularity due to the improvement in technology and the rise in outpatient surgery centers, known as ambulatory surgery centers (ASC).
WHAT IS SOFT TISSUE REPAIR?
Soft tissue repair is a treatment to mend or fix soft tissues, such as tendons or ligaments.
WHAT IS AN AMBULATORY SURGERY CENTER (ASC)?
An ambulatory surgery center (ASC), also known as outpatient surgery centers or same-day surgery centers, are healthcare facilities where surgical procedures not requiring an overnight hospital stay are performed. The type of procedures performed in ASCs are broad in scope; however, several orthopedic procedures done today are performed in ASCs.
WHAT IS AN X-RAY?
An X-ray is a procedure performed that uses a safe form of radiation to provide a two-dimensional picture of your body to use as a screening tool to evaluate for causes of many common disorders, such as bone breaks, joint and spine injuries or conditions, and arthritis or osteoporosis.