Re: Changes to our Financial Policy
As its prone to happen occasionally, we’re making changes to our financial policy. These come in response to the multiple changes to insurance policy coverage as well as the continuous shift in payment responsibility to our patients. As you as an insured party, may have become accustomed to, DEDUCTIBLES, CO-INSURANCE and CO-PAYS are commonplace and very high. To that end as of January 1st, 2018 we will require our patients to please provide a valid credit card to keep in their secure file. This credit card or debit card will be used once your claims are processed by your insurance and your responsibilities have been defined. This in turn will streamline our payment collection and billing. We hope, with your cooperation and understanding this will be a simple and painless task. We have amended our Financial policy to accommodate these clause. Additionally, a new form will be made available to you where you can fill in the pertinent information and sign your agreement.
Besides that, we have also made clearer some of our most common NON-MEDICAL fees, including our LATE CANCELLATION policy, fee for COPY OF RECORDS and LATE PAYMENT FEES. We hope once you review our amended policy you will see its simple to understand. You can follow this link for a copy. FINANCIAL POLICY
Thanks for your time,
The Billing Office
As we’re becoming more and more used to insurance company deductibles and coinsurance, we have to be even more aware of our medical expenses. Health care today is more convoluted and confusing than ever. One of the issues many patients are facing is the decision of seeing a doctor who is on staff at a hospital or hospital system as opposed to a doctor in private practice. As we have noticed in our area, many hospital systems are acquiring private practices. This is obviously to better their presence in their area and capitalize on the existing population of patients the private sector has. Health care is a business, we should all as patients understand and accept that. Now then, as we’re in the middle of receiving services, the provider (be it doctor or hospital) getting paid for said service and the insurance paying said services we need to be cautious about expenses as we would with any other goods or services we receive. Why are we mentioning this?
The truth of the matter is, when a hospital staff doctor sends a bill to the insurance he/she is billing their part plus a fee for the facility. By comparisson, when a private practice doctor bills for their services, they are billing only for their services, and normally they’re not allowed to invoice for the facility fees. As we understand it from multiple sources we have read a hospital’s invoice for facility fees when a patient is seen by their staff doctor at their office. The facility fee pertains the use of the hospital premises, staff and supplies. While this sounds like a logical fee for some, keep in mind the cost for your visit may be as much as 3 or 4 times higher than when you see a private doctor at his office.
Take a look at this article published by the ORLANDO SENTINEL:
While this article is now about 2 years old, it describes a practice and matter that is important for all of us to understand before we see a doctor. As it describes, even the same doctor who, last month was in private practice and today is a hospital staff doctor will show different fees for the same service. This may be true even if the doctor has not changed physical location. Please keep that in mind as some of these costs add up very easily and your portion will obviously rise with it. Ask about this before seeing your doctors.
Its the hurricane season. We sometimes take this for granted as we do not get the brunt of it. Most of it stays down south and the Caribbean. Today its Maria, a week ago it was Irma and Harvey was earlier this month. However even if their winds don’t touch our geographical area, they touch our hearts. Having several staff members with families in the Caribbean Islands, Puerto Rico, Texas and Florida we understand the stresses and concerns. Our hearts and thoughts are with all of you. Here from our computer screens, we see what the news casters can show us. Some of us have been in these storms ourselves, hearing the winds blasting outside while we huddle in the safest spot possible waiting for it to pass.
These things while unfortunate, always bring us together and always makes us stronger. We hope and pray that all the people now suffering the storm will have a bright day later and will come out unharmed.
Once more our hearts are with you!
Urinary incontinence is defined as the involuntary loss of urine which the patient describes as being “wet”. Urinary control is maintained by an intact nervous system which directs the muscles and sphincters of the pelvis. If there is compromise of the nervous system (neurologic disease such as Parkinson’s, Alzheimer’s, Diabetes, etc.) or the muscles/sphincters (trauma, surgery, radiation, infection) then urinary control may be adversely affected.
In addition to the above, there are general causes of incontinence which often vary by gender particularly as men/women age. In men, there may be overflow incontinence in which the bladder is blocked often by an enlarged prostate. In women, there may be stress incontinence, caused by laxity of the pelvic muscles which occurs with age and is often accentuated as a result of childbirth.
Both men and women suffer from urgency incontinence (i.e., getting to the bathroom in time). This occurs as the bladder becomes fibrotic (less compliant) with age. As a result of this, older adults can’t postpone urinating and void more frequently that younger people. The same is true for older people whose bladder awakens them at night and often interferes with what had been ‘normal’ sleep habits.
There is treatment available for all forms of incontinence and urinary urgency and frequency. These run the gamut from behavioral therapy, timed voiding, medication and surgical procedures.
Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. The most common symptoms include blood in the urine and pain with urination.
[Risk factors for bladder cancer include smoking, prior radiation therapy, frequent bladder infections, and exposure to certain chemicals (paints, aniline dyes). The most common type is transitional (urothelial) cell carcinoma. Other much less common types include squamous cell carcinoma and adenocarcinoma.]
Diagnosis is typically by cystoscopy with tissue biopsies. Staging (how far the tumor has spread) of the cancer is typically determined by medical imaging such as abdominal/pelvic CT scan or MRI.
Treatment depends on the stage of the cancer. The basic staging of the disease is either invasive or non-invasive. If the latter, limited endoscopic surgical removal (transurethral resection) may be all that is required. If the tumor is high grade or multifocal (multiple areas) within the bladder then some form of intravesical therapy (medication instilled directly into the bladder) may reduce the frequency and severity of any recurrence as bladder tumors have a high propensity to return. If the tumor is invasive (i.e. into the bladder wall) treatment may include some combination of surgery, radiation therapy, chemotherapy, Surgical options may include additional transurethral resection, partial or complete removal of the bladder, with/without urinary diversion. Typical five-year survival rates in the United States are 77% for all grades/types of bladder cancer but less than 50% for those patients whose disease has penetrated (muscle invasive) into the bladder wall.
World-wide Bladder cancer, as of 2015, affects about 3.4 million people with 430,000 new cases a year. Age of onset is most often between 65 and 85 years of age. Males are more often affects than females. In 2015, bladder cancer resulted in 188,000 deaths.
In the past decade, considerable progress in patient survival has been made with the use of chemotherapy prior to bladder removal for those with invasive disease. Progress has also been made with the various forms of urinary diversion.
kidney stone fragments from a 1.1cm stone blasted with laser during a ureteroscopic procedure
Kidney Stone Treatment is not the same for all
Just the other day we had a few kidney stone cases at the hospital. These were causing all sorts of pain, infections and kidney problems in our affected patients. It was time to get them out surgically since they would not budge on their won due to their size. We use different treatment as appropriate per patient. This, even if the stone is in the same spot or of the same size. One of our cases in particular, required us to blast the stone with a laser and remove it in pieces.
What happens at times with the kidney stone
You can always have an expectation on what will happen to the stone and what the next steps will be. We blasted the kidney stone. The stone was broken into several small pieces instead of being pulverized or breaking into just a few. We proceeded to carefully remove each of them. Then we make sure kidney, ureters and bladder are clear of them. We leave some kidney stone fragments to flow out on their own, when appropriate. However at times pieces left alone may cause problems in the future. As in the case of our patient the other day, we removed them to prevent further problems.
We recommend that any person with a potential kidney stone to visit a doctor. If left untreated, a kidney stone could cause more than pain. Some patients may suffer from blocked ureters and/or urinary retention and even severe infections. We can remove many kidney stones. If that is not an option then we’ll use other methods, including laser blasting.
In that note we wish patients all over the best of recoveries. Come back for your follow up visit!
T. Greene, MD
The Doctors and Staff at New York Urological Associates PC wish everyone a very HAPPY 4th of JULY. May you enjoy the day in good health and in the company of those you love.
DEFINING ERECTILE DYSFUNCTION
Erectile dysfunction (ED) is defined as the inability to have an erection satisfactory for penetration. It is a very common complaint in men and fortunately, one that can be restored in most situations.
The causes are often psychogenic (anxiety, fear of not satisfying one’s partner, depression, etc.) or physical (trauma to the external genitalia , radiation injury, pelvic surgery, etc.). Rarely, the cause may be hormonal, i.e., secondary to a low serum testosterone (male sex hormone) level. Regardless of the cause, treatment is often effective in a single office session.
Erectile dysfunction can occur transiently as a result of the above causes which can be treated by reducing the psychogenic cause or if physical, have the ED treated by medical, injectable or surgical therapy. For example, erectile dysfunction (ED) in men who are anxious or who are afraid of “under-performing” can often be discerned on history and treated by reassurance and by reducing one’s fear of failure. If this approach is not successful, a small dose of medication used to increase blood flow to the penis is often enough to convince the patient that he does not have an ailment which can’t be corrected.
Medical therapy to improve penile blood flow has been the major advance in men’s health over the past several decades. There are a host of Food and Drug Administration approved medications around which can be utilized but the dosage and timing of these medications must be coordinated by a physician so that the incidence of negative side effects is kept to a minimum.
Hormonal therapy (testosterone supplementation) can often restore potency in men who have “low” serum testosterone levels. Testosterone is not absorbed orally so there is no testosterone medication a man can take by mouth. Testosterone therapy is provided in the form of a gel, drug patches or by deep tissue (muscle) injection. For those patients that do not respond to oral medical therapy, a vacuum pump device will often be satisfactory. The pump is a bit cumbersome but many couples find it to be acceptable.
Direct injection into the penile tissue of medications used to increase penile flow is another approach particularly in men who find the oral medications ineffective and/or who do not wish to use a vacuum pump. Men have to be taught by a physician how and where to inject the medication which one does prior to each sexual encounter. The erection provide by this technique is often very firm and can last for several hours. The downside to injection therapy is that it does cause a small amount of pain (particularly following the first few injections) and may stimulate the formation of some penile scar tissue. For those patients who do not respond to any of the above treatments, implantation of a surgical prosthesis (silicone rods) is the remaining option. This is a surgical procedure which is performed under an anesthetic in a hospital or ambulatory surgical care setting. The advantages are that no medication is involved and “one is always ready”. The downside is that this is a surgical procedure and there is a slight risk of infection since the rods are foreign bodies. If this does occur, the prosthesis may have to be removed.
Most cases of ED can be treated successfully. Usually one or a few physician visits can remedy the situation to everyone’s satisfaction.
Prostate cancer is the most common non-skin-related cancer in men in the United States. It is also the second leading cause of cancer death in men. One in seven men will be diagnosed with prostate cancer. African-American men face a one-in-three chance of being diagnosed. Over 29,000 men die each year from prostate cancer, but early detection may save lives.
Recent reports about PSA (prostate-specific antigen) testing may confuse patients about the value of prostate cancer screening. The PSA test is not perfect. However, when used correctly, this blood test gives important information. The PSA test can help diagnose, assess the risk of, and monitor prostate disease such as cancer. Men should talk to their urologist about whether to get screened or not. Talk with your urologist about the benefits and risks of testing. You should also talk about factors that can increase your risk for prostate cancer, including:
– your family history of prostate cancer (Did your
father, brother or other relative have prostate
– if you are African-American;
– a high BMI (a measure of your body fat)
– your age; and
– your previous health history
A number of things can change PSA levels and should be kept in mind when reading the results. High PSA levels can be caused by more than just prostate cancer. Other causes of higher PSA levels include:
– prostatitis (inflammation of the prostate) and other
types of urinary tract infections (UTIs);
– benign prostatic hyperplasia (BPH – enlargement of
– injury; or
– treatments such as prostate biopsies (tissue samples)
or cystoscopy (a test to look inside the urethra and
Men choosing the PSA test should know their results could be influenced by some important factors, such as:
– Blood PSA levels tend to rise with age.
– Larger prostates make more PSA.
– Change in PSA levels over time (known as PSA
velocity) can be markers of both cancer risk and how
quickly a cancer may be growing.
A prostate biopsy (tissue sample) is the only way to know for sure if you have prostate cancer. The decision to go ahead with a prostate biopsy should be based mostly on PSA and findings on a digital rectal exam (physical exam of your prostate). Other factors to take into account include your family history of prostate cancer, your race, results of any prior biopsies and other major health issues you may have.
The choice to use PSA for early detection of prostate cancer is a personal choice. While PSA screening has been shown to have benefits, it also carries risks.
Possible benefits of having a PSA test:
– A normal PSA test may put your mind at ease.
– A PSA test may find prostate cancer early before it
– Early treatment of prostate cancer may help some
men slow the spread of the disease.
– Early treatment of prostate cancer may help some
men live longer.
Possible risks of having a PSA test:
– The PSA test is not perfect. A normal PSA result
may miss some prostate cancers (a “false negative”).
– Sometimes the test results suggest something is
wrong when it isn’t (a “false positive”). This can
cause unneeded stress and worry.
– A “false positive” PSA result may lead to an
unneeded prostate biopsy (tissue sample).
– A positive PSA test may find a prostate cancer that
is slow-growing and never would have caused you
– Treatment of prostate cancer can cause side effects.
Short- or long-term problems that can occur are
issues with getting erections (“ED”), leaking urine,
or bowel function.
Before you decide to have a PSA test, talk with your urologist about the benefits and risks of testing. Also talk about your individual risk of prostate cancer, including your personal and family health history.
This blog is in response to the following article:
LinkedIn.com Article – click here to read
In this article the writer goes over the the hurdles our healthcare providers go through to get paid for their day to day claims. Some of these hurdles are affecting our patient care adversely. In many cases even treatment plans are affected because insurance do not cover certain medications or procedures. This leaves our patient community in a healthcare limbo since the plan doesn’t “want” to pay for a service and the patient also does not want to be responsible. As the article goes on to indicate, many providers who were polled would like a single payer system. While we don’t necessarily agree with this assessment for our practice, we do believe our current healthcare hodgepodge helps only the health insurance community and not the patients or the doctors who render their services in good faith and in the best interest of our patients.
Our practice which has a large young and middle age patient population is plagued with the current HIGH DEDUCTIBLE issue. This means that our patients are responsible for the first $2000 to $5000 worth of medical services. In most instances patients don’t satisfy their deductibles before seeing one of our doctors. Many of them do not need that many services in a year. This causes a payment lag for the doctors services which in turn hurts the medical practice as a whole. Many patients are finding it hard to pay for medical services immediately once the claims have been processed.
Another issue discussed is related to the time and effort spent on trying to get the insurance plan to approve and pay for services and medications. This alone consumes several hours a week of the doctors’ and their staff. This time could be better spent caring for our patients. Add to that constant records requests and all sorts of questioning and second guessing the doctor’s judgement and yes, they go mad!
We’re interested in our patients and would like to see some progress in the healthcare machine that will put the patient’s health and the doctors’ efforts first. Our patients need care, our doctors need to be compensated for the care they provide. Web searches, deferred treatment and ER visits do not cut it. But thats the way things are going because of our current circumstances. Things need to improve.