Kegels are not the only answer for incontinence, in fact there are times when they can make incontinence worse!

Our bodies have the innate ability to rebuild when damaged. In physical therapy we take advantage of that, and the post outlines how we do it.

We find in our practice on an increasing and daily basis a request by our patients to have us attempt to explain and/or resolve their healthcare insurance issues. Years ago, when there were less insurance products available, we as clinicians felt like we had a level of working experience with these products and could sufficiently answer our patient's questions. And, remembering that we are clinicians and not insurance specialists, we often could then and still do, defer and point them in the right direction with their particular product resource. There has been an evolution in the healthcare arena since the 70's that began with physician providers having tremendous earning power. That scenario changed with the advent of managed care and providers earnings dropping to 40 or 50 cents on the dollar. The next generation of big earners was the pharmaceutical industry trying to recover the funds they spent on years of research and development, particularly on products that did not prove to be especially beneficial. And that brings us to the latest player in the healthcare earnings market...the insurance companies. The insurance industry is of particular interest to the patients of Pittsburgh in that we have a unique situation in our area of hybrid entities that are both the clinical body and the insurance carrier. By this time, everyone has to be aware of the negative advertising campaigns we have seen and heard on television, the radio and in print between UPMC and the Highmark/Allegheny Health giants. While we heard a daily onslaught of why the public should be afraid for their future ability to get good care and why one system was better than another many individuals were just too confused and opted for third party insurers that would allow them freedom of choice. They chose not to be bullied by entities making millions of dollars and limiting the patient to go to clinics only in their system or they would not be covered or by directing the patient to selected clinics under their umbrella and applying different levels of deductibles, co-insurance and co-pays to influence your right to choose through the application of financial hardships. Some insurances make a distinction between "in-network" and "out-of-network" clinics and only cover your care when you go to an in-network provider. Even when you go to an in-network provider, there are often multiple levels of coverage, which typically confuse the patients and providers, allowing the insurance companies to pass off much of the cost to the patient. In many areas of the country, clinicians have opted out of these cumbersome insurance products and provide care for their patients on a "cash" basis. This means that the patient is treated, they pay the provider out of their own pocket, and then they turn the charges in to their insurance company on their own to get their payments re-imbursed. Often times, the clinic will provide the patient the necessary paperwork and lend some guidance but the service that was once done as part of your healthcare visit is now passed on to the client. This extra consumer burden has been born out of the complexities of the current insurance environment. The reality is that at this point clinicians are getting paid less (or the same) and need to staff more people to decipher the billing polices required by the insurance carriers. The facts are that your caregivers in the Pittsburgh healthcare market are not charging more and are not earning more per patient or office visit. We are all playing by the same rules when we enter into an insurance agreement with a given company to see our patients. We agree to follow a usual and customary fee schedule that the industry has established. We all tend to think of our health insurance card as something that must certainly cover all of our healthcare expenses when the circumstances justify the need but that is simply not the case. No matter how you spin it, your health insurance premiums are rising, and you are not getting more services for the costs. Even when your premium seems to have stabilized or taken a small dip in a given year, what is commonly reflected is that your clinician is being asked to take some form of discount and the patient is being asked to make up the difference by a cash payment on their visits. Another side effect of the strangulating insurance issues in Pittsburgh is that many of our young and talented healthcare professionals are choosing to train here and leave the area for greener pastures and many of our homegrown clinicians take their expertise elsewhere. I have experienced this first-hand by watching two of my sons graduate from one of our Eastern suburb high schools and go on to medical school training at a Pennsylvania institution only to make the career choice to practice out-of-state when they completed their anesthesia residencies. So, are we getting the best care available in Pittsburgh or just the best care the insurance industry is willing to cover? I think it is time for the healthcare consumer in Pittsburgh to "step up" and become better informed about their care. It is the patient's responsibility to understand their insurance purchase and what it allows. Your clinician's office can provide support to help you get through some of the confusion but we all need to be more proactive with our insurance carriers, our legislators and the Pennsylvania Insurance Commission. At Alliance Physical Therapy, we pledge to work with our patients to do our best to avoid putting them in a position that compromises their healthcare because of insurance/financial constraints. As a small player in a large game, our goal is to take the high road and work to do that which is right for the patient. You have a right to choose where you get your care...so make sure you ask all the right questions and consider Alliance for your rehabilitation needs.