Kategoria: Foot and Ankle Overview

Medicare and Medicaid are both government-sponsored health insurance programs in the United States, but they serve different populations and have distinct eligibility requirements. This blog post will explore the key differences between these two crucial healthcare programs.

Medicare is a federal health insurance program primarily designed for people aged 65 and older, regardless of their income level. It also covers younger individuals with certain disabilities and those with End-Stage Renal Disease. Funded through payroll taxes, Medicare is divided into different parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage).

On the other hand, Medicaid is a joint federal and state program that provides health coverage to eligible low-income individuals. Unlike Medicare, Medicaid eligibility is based on income and resource limits, which can vary by state. Medicaid serves a diverse population, including children, pregnant women, elderly individuals, and people with disabilities who meet specific financial criteria.

One of the main differences between the two programs lies in their funding and administration. Medicare is entirely funded and run by the federal government, ensuring consistent coverage across all states. Medicaid, however, is jointly funded by federal and state governments, with each state having the flexibility to design its own Medicaid program within federal guidelines. This results in variations in coverage and eligibility requirements from state to state.

In conclusion, while both Medicare and Medicaid aim to provide health insurance to vulnerable populations, they differ in their target demographics, eligibility criteria, and administration. Medicare primarily serves older adults and some disabled individuals, regardless of income, while Medicaid focuses on providing coverage to low-income individuals across various age groups. Understanding these differences is crucial for individuals seeking to navigate the complex landscape of healthcare coverage in the United States.

Physical therapy can be a crucial part of recovery and pain management for many individuals. However, one common concern for patients is the cost associated with these treatments. Understanding the potential expenses can help you better prepare for your physical therapy journey.

The cost of physical therapy can vary widely depending on several factors. These include your location, the type of treatment needed, the duration of your therapy, and whether you have health insurance coverage. On average, a single session of physical therapy can range from $50 to $350. Without insurance, you might expect to pay between $75 and $150 per session. If you require multiple sessions per week over several months, these costs can quickly add up.

Insurance coverage can significantly reduce out-of-pocket expenses for physical therapy. Most health insurance plans cover physical therapy to some extent, but the specifics can vary. You may be responsible for a copay (typically $10 to $75 per session) or coinsurance (usually 10% to 50% of the total cost). It’s crucial to check with your insurance provider to understand your coverage and any limitations, such as a cap on the number of covered sessions.

For those without insurance or with high deductibles, there are ways to manage physical therapy costs. Many clinics offer cash discounts for patients paying out of pocket. Some therapists provide package deals for multiple sessions, which can lower the per-session cost. Additionally, exploring community health centers or physical therapy schools may lead to more affordable options. Some patients also find success with fewer in-person sessions supplemented by a home exercise program designed by their therapist.

Ultimately, while the cost of physical therapy can be significant, it’s essential to consider the long-term benefits. Effective physical therapy can prevent the need for more expensive treatments down the line, such as surgery or long-term medication use. It can also improve your quality of life and ability to work, potentially offsetting the initial investment. When considering physical therapy, discuss your financial concerns with your healthcare provider and explore all available options to find a solution that works for both your health and your wallet.

This article was written by Vraj Parikh, an undergraduate at The University of North Carolina at Chapel Hill and member of the Healthcare Administration Leadership Program at Genesis.

Imagine you wake up in the middle of the night with severe abdominal pain. After a few hours of trying to ignore it, you decide to call an ambulance to take you to the emergency room. The doctors quickly diagnose you with appendicitis, and you are taken in for surgery. Within hours, you are informed that the operation is a success, and you can go back home within a couple of days.

This seems like a scenario with a happy ending, right? You received prompt medical care, and your health issue was resolved. You might expect this to be a typical hospital experience and a natural right, but the reality is much more unsettling.

Imagine it is a few weeks after you have been discharged from the hospital, and you receive your bill in the mail. To your shock, it’s for an astronomical amount. Despite having health insurance, the bill includes charges for the ambulance ride that took you to the hospital. It turns out that the ambulance service was out-of-network, and your insurance plan did not cover it.

This unexpected expense is known as a surprise bill. A surprise bill occurs when a patient receives a bill for medical services performed by out-of-network providers even though they received care at an in-network facility. Although current protections like the No Surprises Act tackle most of the prevailing forms of surprise billing, ground ambulance services are not covered under current protections.

So, how can someone avoid unexpected debt when they have no choice but to call an ambulance for emergency care? The short answer is they can not. According to Amin et al., the frequency of ground ambulance rides in the United States is exceptionally high, with ambulances transporting about 3 million people with private health insurance to the emergency room yearly. The researchers discovered that about half (51%) of these emergency ground ambulance rides included an out-of-network charge for ambulance-related services, which leaves privately insured patients at significant risk of receiving a surprise bill. In other words, “as many as 1.5 million privately insured patients who are brought to an emergency room by an ambulance may be at risk of getting a surprise medical bill each year” (Amin et al.). To put this into context, this is more people than the entire population of Philadelphia. This staggering number underscores how healthcare is a “business game” and a matter of “luck” rather than a universal right.

The No Surprises Act banned surprise billing by out-of-network providers in emergency rooms but did not consider that “one-in-ten emergency room visits for privately insured patients begin with an ambulance ride” (Amin et al.). The problem can not be fully solved if the foundational issue of transportation is not addressed. Lawmakers argue that the “varied types of ground ambulance services, existing local and state regulations, and a lack of cost data” (Hoadley and Stovicek) make it challenging to include provisions for ground ambulance transportation and emphasize leaving it up to the states. This strategy has failed miserably, as approximately less than “a third of states have protections in place” (Hoadley and Stovicek) to limit ground ambulance surprise billing. Adding to the concern, “in seven states (Washington, California, Florida, Colorado, Texas, Illinois, and Wisconsin), over two-thirds of emergency ambulance rides included an out-of-network charge for ambulance-related services that may pose a surprise bill risk” (Amin et al.). Even in states with local regulations on ground ambulance billing practices, these laws may only protect specific types of ground ambulance rides, which often excludes those covered by self-insured health plans.

Federal action is urgently required to protect our health. Congress must expand the No Surprise Act to emergency ground ambulance services to uphold our country’s commitment to ethical healthcare practice. America should view healthcare as a right where everyone can heal without unnecessary financial plight.

Cites:

Amin, Krutika, et al. “Ground Ambulance Rides and Potential for Surprise Billing.” Peterson-KFF Health System Tracker, 5 Jan. 2022, www.healthsystemtracker.org/brief/ground-ambulance-rides-and-potential-for-surprise-billing/#Among%20people%20with%20large%20employer%20coverage,%20the%20share%20of%20ground%20ambulance%20rides%20with%20an%20out-of-network%20charge,%202018.
Hoadley, Jack, and Nadia Stovicek. “Expanding the No Surprises Act to Protect Consumers from Surprise Ambulance Bills.” Commonwealth Fund, The Commonwealth Fund, 15 Feb. 2024, www.commonwealthfund.org/blog/2024/expanding-no-surprises-act-protect-consumers-surprise-ambulance-bills.

Introducing Genesis Orthopedics & Sports Medicine’s fourth and newest physical therapy clinic, conveniently located in the heart of Oak Brook, Illinois. Our state-of-the-art facility is designed to provide exceptional care and personalized treatment plans for patients seeking to recover from injuries, manage chronic conditions, or enhance their overall physical performance. With a team of highly skilled and compassionate physical therapists, we are committed to helping you achieve your goals and improve your quality of life.

At our Oak Brook clinic, we offer a comprehensive range of physical therapy services, including orthopedic rehabilitation, sports injury treatment, post-surgical rehabilitation, and preventive care. Our advanced equipment and innovative treatment methods ensure that you receive the most effective and efficient care possible. Whether you’re an athlete looking to get back in the game, an individual recovering from surgery, or someone seeking relief from chronic pain, our dedicated professionals are here to support you every step of the way on your journey to optimal health and wellness.

Location details below:

2311 W 22nd St.
Suite 103
Oak Brook, IL 60523

Phone: (877) 377-1188
Fax: (630) 377-7360

We are thrilled to introduce the newest member of our practice, Dr. Juraj Zahatnansky, a highly skilled and compassionate physician who brings a wealth of expertise in sports medicine. With an impressive educational background that includes a Doctor of Medicine degree from the Third Faculty of Medicine at Charles University in Prague, Czech Republic, and a Bachelor of Science in Biology from Cornerstone University in Grand Rapids, Michigan, Dr. Zahatnansky has demonstrated a strong commitment to the field of medicine and a passion for helping patients achieve optimal health and wellness.

Dr. Zahatnansky’s extensive graduate medical education and training further highlight his dedication to providing exceptional care. He completed his Primary Care Sports Medicine Fellowship and Internal Medicine Residency at the Western Michigan University Homer Stryker M.D. School of Medicine in Kalamazoo, Michigan, where he honed his skills in diagnosing, treating, and preventing a wide range of medical conditions. Additionally, Dr. Zahatnansky has served as a team physician for several local organizations, including West Aurora High School, the Kalamazoo Wings, Western Michigan University, Kalamazoo College, and Kalamazoo Central High School, showcasing his ability to work with diverse populations and provide tailored care to athletes at all levels. We are confident that Dr. Zahatnansky’s extensive knowledge, compassionate bedside manner, and dedication to patient-centered care will make him an invaluable asset to our practice and the community we serve.

We’re thrilled to introduce Eric Witte, DPT,MBA,CPHQ as the newest addition to our team at Genesis, stepping into the role of Chief Operating Officer!

Eric is deeply committed to enhancing patient care alongside our team. Eric previously was the Vice President of Enterprise Healthcare Value with UnitedHealthcare, built and led a national consulting practice with Optum for their Value-Based Care multispecialty medical groups, and was a hospital CEO with Kindred. Eric also maintains his physical therapy licensure.

The mission of Genesis is to free our patients to be more active, more athletic, and to move freely in their bodies – accessible to everyone, not just the select few. Eric wholeheartedly shares this vision, and we couldn’t be more excited to extend a warm welcome as he embarks on this exciting new chapter with Genesis Orthopedics & Sports Medicine.

Benita Gorgas is our June patient of the month!

A parking enforcement officer, Benita was on the job this past winter, taking a picture of a parking sign. It was a cold, very windy day, and she was under time restrictions. As she hurriedly turned on the sidewalk, she tripped over an uneven crack in the concrete. Benita fell hard on her left knee, and unfortunately suffered a torn meniscus. 

Benita’s doctor referred her to Genesis, where she met with Mr. Douglas and Dr. Horner. Of her experience with the professionals at Genesis, Benita relayed that she has never in her life met nurses and doctors who were so nice, and “not just because it’s their job, but because they have such down-to-earth personalities.” She says that the folks she has interacted with at Genesis “treat you with respect; they laugh and joke with you, they don’t treat you like a patient – they treat you like family.”

Dr. Horner suggested trying physical therapy before pursuing surgery for her knee. She is currently in physical therapy, and will follow up with Dr. Horner soon, as she continues to experience knee pain even with PT and wearing an orthopedic brace.

While we are sorry to know that Benita is still experiencing symptoms from her knee injury, we are pleased that she has had such a positive and welcoming experience at Genesis. As for Benita, she notes that she “loves going there [to Genesis]… once I’m well, I’m going to miss them!”

From all of us here at Genesis, we wish Benita the best in her road to recovery, and thank her for trusting us with her care!