What Pro2 is Up2

Deductible Renewals:
With 2014 nearing, we wanted to take this opportunity to address an important insurance issue that a new calendar year always brings. Whether you have an individual or employer-sponsored Health Insurance plan, there are certain things to keep in mind as we close out 2013.

There are many qualifications and limitations regarding what health insurance covers and to what extent. Certain requirements must be satisfied before the insurance company will begin paying benefits. A deductible is a fixed dollar amount the policy holder must pay out-of-pocket for eligible services before the insurance company will make payment on covered medical expenses. [For example, if your policy has a $500.00 deductible, you must pay $500.00 worth of healthcare expenses before your insurance will start paying out.]

For most policies, the medical plan’s deductible is based on a calendar year regardless of when your coverage became effective. All calendar year deductibles will therefore be renewed on January 1, 2014. If you are unsure about your policy, please contact your insurance carrier for more information.

Update Your Information:
We're dedicated to providing the highest quality products, equipment, and services to our customers. In order to do so, we rely not only on our tremendous staff, but also on the very patients that we service. It's extremely important that you keep your account with us updated.

Insurance Policy: It’s always a good idea to keep yourself as informed as possible when it comes to your insurance policy. It’s just as important to keep our office up-to-date on any changes that may take place. Many insurance policies renew, change, or terminate at the end of the year. This could mean changes in your financial responsibility as it relates to our products and services.

Contact Information: The quality of our service also relies on being able to communicate with our customers. Any change in your address or phone number (temporary or permanent) should be reported to our office as soon as possible to avoid potential issues with deliveries, billing, etc.

Payment Information: Please keep our Billing Office notified of any changes in your billing information. This includes billing address changes, new debit/credit card information (new card number, expiration date and/or security code), and new bank information.

Formal pulmonary rehabilitation programs have been in existence since the mid-1990s, but a rudimentary form was used to treat tuberculosis as far back as the 1880s. Over the years, diagnostic tools and intervention methods have been refined and the therapy has expanded its use to a wide range of respiratory conditions from chronic obstructive pulmonary disease (COPD) to cystic fibrosis (CF) and many others in between.

For the most part, traditional pulmonary rehab programs serve the same patient population and follow a similar treatment protocol. Richard Novitch, MD, pulmonary rehabilitation director and director of the pulmonary function laboratory and blood gas laboratory at Burke Rehabilitation Hospital in White Plains, New York, explained that the treatment is directed toward patients suffering from a reduction in quality of life due to COPD or other lung diseases. "It's a way to help people develop coping strategies with the limitations of life activities," he said. "Regardless of age and underlying diagnosis, the quality of life issues are the same."

Shortness of breath often prompts a referral from a pulmonologist, internist, or primary care physician. Patients sometimes ask to self-enroll; however, in order to comply with Medicare guidelines, which drive pulmonary rehab protocols, the patient must have a physician referral.

Medicare Part B may cover the cost of pulmonary rehab if certain conditions are met. The patient must have a diagnosis of moderate to very severe COPD (validated by pulmonary function tests), and must be documented to meet Medicare's GOLD Classification II, III, or IV. Medicare also requires all pulmonary rehab programs to include physician-prescribed exercise, education, and training customized to each patient, along with psychosocial and outcome assessments. Moreover, the exercise plan must designate mode, target intensity, duration of each session, and frequency.

The physician must review the treatment plan every 30 days. A total of 36 visits are allowed with an additional 36 upon receipt of a letter recommending more rehabilitation. Other insurers may cover pulmonary rehab, and many often follow Medicare's protocol requirements.

Risks in pulmonary rehab programs are virtually nonexistent, said Novitch. "Patients exercise to tolerance of risk. The lungs act as governor on an engine. If the patients are sick, they don't show up. Also, Medicare guidelines require a doctor to be within walking distance- 300 feet- of a program," Novitch noted, adding that other clinical professionals are in attendance at all times.

To keep reading the full article, click here to visit RT Magazine online.



Hanlon, Phyllis. (2013, October 14). Pulmonary Rehab: Expanding Its Clinical Impact. [Web log post]. Retrieved November 21, 2013, from http://www.rtmagazine.com/clinical/19206-pulmonary-rehab-expanding-its-clinical-impact.