Understanding how insurance companies work.

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Whenever a doctor is dealing with insurance companies, their reports must be consistent with the guidelines set for by the insurance companies in order to be paid. The doctor’s fees must be consistent within the insurance’s parameters for the “usual, customary, and reasonable” fees, or the insurance company will not pay for all the doctor’s bills.

This also holds true for insurance companies’ parameters for length of treatment, kinds of treatment, and who will be the treating doctor all depending on the various traumatic injuries. If the doctor’s treatment exceeds the normal parameters for a stated diagnosis, the insurance company will claim over utilization for that diagnosis and will not approve the claim, and will ultimately refuse to be responsible for the claim and that has nothing to do with the patient’s actual condition..

Many doctors object to the insurance company parameters as being too conservative and often wonder how the insurance company even arrived at this policy guideline. The answer is simple. In the US we have a clearing house of insurance statistics which monitors every claim from its diagnosis coding, treatment coding, treatment time periods, and then arrived at the average parameters and then compare it with the patient’s care.

These treatment guidelines are also influenced by politics, money available, insurance coverage purchased, With Obamacare, there will be added features that are not fully recognized until it goes into effect and the whole health industry from patients compliance to Obamacare, insurance compliance to Obamacare, Doctors and their complaince to Obamacare, and all the other companies involved in providing health care products and services.

The future of Health care is going to be undergoing changes that will soon be all too evident as to its effectiveness, efficiency, and its over all improvement to patient’s health.

The Effectiveness of Chiropractic Care

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What can be said on effectiveness about chiropractic practice for acute and chronic back and neck pain, and cervicogenic headaches including migraine, is:

a)   Chiropractic manipulation is at least as effective as any other treatment, with better results than any treatment with which it has been compared.

b)   With chronic pain it provides patients with a period of relief from pain and disability that represents a window of opportunity for long-term relief.

c)   If chiropractic management is multimodal, including patient education and motivation, prescription and monitoring of exercises, and the use of supportive modalities and therapies such as massage and acupuncture as may be needed in individual cases, and other psychosocial interventions, this can bring long-term relief.

Pediatric Patients and Chiropractic

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Introduction:   Chiropractic is a common parental choice as a therapeutic intervention for numerous pediatric conditions. No studies investigating parent satisfaction with pediatric chiropractic care have been published to date.

Method:   All infants aged 0-36 weeks and presenting to a chiropractic teaching clinic on the south coast of England between January 2011 and October 2013 were eligible for inclusion. Parents completed questionnaires, which rated their own and their infant’s characteristics prior to, and at the end of, a course of chiropractic care. Non-parametric tests were used to analyze before and after care scores.

Results:   A total of 395 results were collected in this study. Satisfaction scores of 10/10 (“completely satisfied”) were reported by 75.1% (n=295) of the parents. There was a significant improvement in parental distress (Median=5.0 before care, Median=2.0 after care, Z=-13.7, p<.001, r =-.49) and infants’ sleep quality (Median=5.0 before care, Median=3.0 after care, Z=-10.5, p<.001, r =-.38). Satisfaction scores were found to have a small correlation with sleep quality (rs =-.21) after care, as well as a moderate correlation with distress (rs =-.31) and improvement scores (rs =.42), p<.01.

Conclusion:   The parents in this study appear to be satisfied with the care their infant received. However, the satisfaction scores and improvement scores are only moderately correlated, which indicates that there are other factors influencing the level of satisfaction.

Blind Spot

Energizing Life

Please check your blind spot. As you know, with driving the ability to see what is in the blind spot could be a matter of life or death. A blind spot in a vehicle is an area around the vehicle that cannot be directly observed by the driver while at the controls, under existing circumstances.

So take this little test. Turn your head to look over the shoulder without your eyes going to the corners or you twisting your torso.  The blind spot size depends on a lot of different factors but one of the important factor is the ability to freely move the neck within the 90 degrees either to the right or left of facing forward. If you have less than 90 degrees of functional neck rotation, the size of your blind spot will increase. Increased blind spot increases the chances of not seeing the car that is at your back…

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Pain is radiating down my arms/legs

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Radiculopathy is characterized by motor and/or sensory changes in the neck and arms or the legs and feet, which results from extrinsic pressure on the nerve root. This pressure is typically caused by disc material, swelling, or osteophytes. A large study in Rochester, Minnesota, has reported the annual incidence of cervical radicular symptoms to be 83.2 per 100,000 population, and its prevalence most significant within a 50- to 54-year age group. In the study, 90 percent of patients were asymptomatic or only mildly incapacitated. Surgery is not often required for resolution of cervical radiculopathy symptoms.

Symptoms

Radicular pain, the characteristic symptom of cervical radiculopathy, is often confused with radiating pain in clinical practice. Because specific treatments are exclusively indicated for radicular pain, an accurate distinction is important. True radicular pain follows dermatomal patterns and is usually — though not always — unilateral. Onset is often insidious but may also be abrupt, and the pain is frequently aggravated by arm position and extension or lateral rotation of the head.

There are three primary types of pain:

  1. Local Pain is caused by irritation to the structures in the back including bone, muscles, ligaments and joints. The pain is usually steady, sharp or dull, felt in the effected area of the spine and may change with changes in position or activity.

  2. Referred Pain can be pain caused by non-spinal pathology that is referred to the back, such as an abdominal aortic aneurysm. Referred pain can also be pain originating in the spine that is felt in distant structures. For instance upper lumbar pain is frequently felt in the upper thighs, and lower lumbar pain is felt in the lower buttocks. Sacroiliac joint pain is often referred to the inguinal and antero-lateral thigh area. Referred pain rarely extends below the knees, where as nerve root pain can be felt in the calf or foot.

  3. Radicular Pain is caused by irritation of the nerve roots (radix) and is usually more severe than referred pain, and may have a more distal radiation. Radicular pain usually circumscribes the territory of innervation of the given nerve root (in a dermatomal distribution). This type of pain is often deep and steady, and can usually be reproduced with certain activities and positions, such as sitting or walking.  In addition, radicular pain is frequently exacerbated by any maneuver that raises the pressure of cerebrospinal fluid (or the interabdominal pressure), such as valsalva, sneezing, or cough.

Radicular Pain Distribution

Radicular pain radiates into the extremity (thigh, calf, and occasionally the foot or to the arm, forearm or hand) directly along the course of a specific spinal nerve root. The most common symptom of radicular pain is sciatica (pain that radiates along the sciatic nerve – down the back of the thigh and calf into the foot) and arm pain and paresthesia of the hand. Sciatica is one of the most common forms of pain caused by compression of a spinal nerve in the low back. It may result from compression of the lower spinal nerve roots (L5 and S1). With this condition, the leg pain is typically much worse than the low back pain, and the specific areas of the leg and/or foot that are affected depends on which nerve in the low back is affected. Compression of higher lumbar nerve roots such as L2, L3 and L4 can cause radicular pain into the front of the thigh and the shin.

Radiculopathy is pain running down either your arms or legs.

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The difference between the chiropractic and the medical approaches to health care is never more clear than with the treatment of radiculopathy.

The medical approach entails their version of “conservative” treatment, including pain medications, prolonged spinal injections, or perhaps a prescription for physical therapy. Then, if their conservative treatment does not alleviate the pain, decompressive surgery, such as laminectomy and/or discectomy/microdiscectomy, may be recommended.

Chiropractors aptly describe radiculopathy as “nerve root irritation”, and the chiropractic approach for resolution is straightforward. If you have a rock in your shoe, and your foot hurts… do you need physical therapy, medications, or spinal injections? NO!!! You need your doctor (who is supposed to be the Sherlock Holmes of illness) to determine the CAUSE of the nerve root irritation (the rock), and to remove that obstacle from your path, so you can return to health.

Review the rest of this page to explore the real differences between these 2 approaches to health care, and the difference in their success rates. The conclusions will surprise you!

Learning and behavioral problems and how Chiropractic could help

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A documented case study published in the October 4, 2006 issue of the peer reviewed publication, the Journal of Vertebral Subluxation Research (JVSR), describes the results of chiropractic care on an 8-year-old boy with many learning and behavioral disorders. Additionally, his mother reported that the boy also suffered from, severe headaches, neck pain, constant blood shot eyes, stomach pains, an inability to sit still, incoordination, behavioral problems and learning difficulties. She noted that the child’s medical doctor had no explanation for these problems.

It was noted that the majority of the boy’s problems started after a fall he had 18 months earlier. The mother also noted that her son had normal development, activity and learning skills until the accident. Finally the mother brought the boy to a chiropractor. The chiropractor performed an examination and x-rays. It was noted that there was a restriction in neck movement and tenderness over certain neck vertebrae. After review of all the findings it was determined that vertebral subluxations were present.

Care was initiated for corrections of subluxations with visits initially starting at once per week for the first two months. However, as documented in this case, positive changes started occurring quickly. After the third adjustment the boy’s mother brought in the spelling tests the child had taken. The tests prior to care showed severe problems as the child could only get two or three correct out of ten. After the second adjustment, the child scored a 100% and his tests continued to show drastic improvement. His teacher even noted that the boy was able to, “sit still and concentrate without disturbing the other children.”

The child continued to receive reports from school commenting on his academic improvement as well as his social interactivity. The authors of the case study noted that there were many possible explanations for the results seen in this case. However, they noted that other than the usage of over the counter medications reported by the mother, the young boy did not take any prescribed medication. The only change that directly correlated with the improvement in this young boy was the introduction of chiropractic care.