ADVENTing: Maximizing Your Deductible

It's the time of year when cooler weather is upon us, the holidays are around the corner and you've met insurance deductible. Dr. Madan Kandula and Dr. Ethan Handler of ADVENT discuss how to maximize your deductible and why now is the time to start your journey to living better:

"The year is, it's fall now, right? Is it fall, technically?

 

It is fall. Yeah, summer's over. It was chilly this morning when I was walking my dog.

 

There you go. It's usually a good sign.

 

Yeah, so end-of-the-year insurance deductible; all that jazz, right? Do you hear about that? Is that a common theme among our patients?

 

It's a common theme in the sense that most people have a ticking clock, so everybody, of course- if you use your deductible throughout the year, you're golden in the sense that if you have some issues and you run through your deductible, you can get whatever you need to get done before the year's end. The challenge that we have is when patients try to come in and see us and there's two weeks left in December and they're like, 'I want to come down and get something done,' and they can't because we can't go through the appropriate steps to get things authorized and get a procedure done for them to help them prior to January 1. Right, so it's like too little, too late, kind of a thing.

 

Yes, so this month, next month, October. Let's say on average, insurance companies- at least this is my understanding- anywhere between zero, which is more Medicare, but then most commercial insurances, two to six weeks to get authorization if they want something done. So, you have to give yourself that much of a time-lag,so that's why we're making a push to communicate to patients, 'Hey, get in here if you want something done before year's end because we have to have a buffer between the amount of time is takes to get authorized and get you in.'

 

Yeah, I know that we were talking earlier, but I think there are many people who don't even know that our services are covered by insurance sometimes. I think sometimes people hear our messaging and they think that it's sort of, I don't know, cosmetic. I think there's a confusion among a lot of folks; they think about elective things and it confuses them with sort of, I don't want to say, unneccessary, but cosmetic things and we do play that. We dance that dance to some extent.

 

If somebody has snoring without sleep apnea and we're doing treatments for just the snoring by itself, that's the one thing that we deal with in The Breathing Triangle® space that wouldn't be covered by insurance. But, if somebody has sleep apnea; if somebody's got nasal obstruction. sinus issues, all that stuff; that is what health insurance is for and a lot of times, for a lot of folks, at this time of year, the year that's already happened has left some scars on their bank accounts and on other people in their family, and so it's sometimes recognizing how the year's played out. For many folks, if you've had stuff- healthcare issues that you had to take care of that your insurance deductible may be met. And, if its met, there's sometimes never a great time to go and take care of yourself, but if the deductible's met- time is ticking here-  and getting it taken care of, makes a lot of sense.

 

Yeah.

 

If you can do that- I think sometimes people let life happen to them, but if you kind of take the bull by the horns, sometimes it helps costs.

 

Yeah, I think the core of what we address is quality of life issues, and so, one thing I discuss with patients, when you talk about elective and cosmetic, and and is this covered, is this not covered, I tell people that this isn't heart surgery that you have to have tomorrow or you're gonna die. It's a quality of life issue and again, like you're saying, hey, if you've run through your deductible, maybe it's time to take care of you. Maybe you have a kid or family member or somebody else who has had some issues this year and you've had to do those things and you, yourself, have taken back seat to addressing those quality of life symptoms.

 

Right.

 

But you can't underestimate good sleep quality. You can't underestimate breathing through your nose, that's for sure and those two things do go hand in hand.

 

Right.

 

Hey, it's an elective procedure, it's not cosmetic so it is covered.

 

Yup.

 

But a lot of surgeries are elective in that sense. Whether is an ACL repair or something else.

 

Sure.

 

You don't have to do any of those things but quality of life decisions for patients and now I say that's what we're doing. Dealing with quality of life issues.

 

Yup, absolutely.

 

The other part of that is the end of the year is coming and so for a lot of folks, they start thinking about resolutions. There's times of the year I feel like you kind of start thinking a little bit more, you know, existential, ponder things, and then the stuff that we do is all about that, a good night's sleep, breathing properly so you can live your life properly or work it out, all that stuff that people find excuses to not get taken care of but it's the other side of that coin- one side of the coin is deductibles may be met; perfect time to use something that way. The other side of that coin is end of year's coming; it's a good time to kind of prepare yourself for, not just the year ahead, but kind of the life ahead sort of a concept. Because, like I said, there's a hundred reasons to not do something and we recognize that, too. I think when we're seeing folks who actually get in and have taken the effort, the reluctant effort, to call, to reach out, or just set up an appointment online. In fact, when we think about those folks and think about the effort that it takes many of them to make that first move, it's a big deal and most people don't take action because the easy thing to do is to not take action. So, for somebody that does- part of what we try to do here is, from the moment of first contact through the whole process is understanding that people will try to find every and any reason to not do the right thing.

 

Right.

 

And so therefore, when somebody's taken that, what we think is the right move, they're reaching out to us and taking that hand and making sure we take good care of 'em. But again, I think there's reasons to not do it and so whenever there's a situation where those reasons sort of fade, that's a good time to really to do something.

 

I think what's fortunate too is that insurance does cover- lots of insurances cover the office-based procedures that we do so I think that's another thing to keep in mind is that these patients, doesn't mean you have to come have surgery because that's also, patients may meet their deductible and they may have a problem but they still don't want to go the operating room.

 

Yeah, absolutely.

 

So really it's like 'Hey, majority of insurances out there cover these office-based procedures. It means very little down time, you get back to doing your normal life.' For me, I always tell people, 'Hey, I've had done what I'm talking about, right?' And I had it done on Thursday night, I grabbed you, we did it in the room here, worked the next day, a full day, did procedures, did clinic so like you get on with your normal life and do it in a very reasonable manner. So we've lowered the barrier to be able to address those quality of life concerns for these people.

 

Yeah, absolutely. That's important any time of year, but it's especially important, you know holidays come and, again, on the flip side is that you have these holidays coming up and there's all sorts of commitments time-wise; I don't have time to have a real deal surgery and be out and all that stuff. We get it. And again, sometimes we forget. I sometimes forget how the rest of the world works in relation to how the rest of the world treats folks medically who have separate relations we have. We take it for granted that our thought is aligned with most patient's thought that if we can do something, if there's a solution that exists that they ought to know about it; if there are a few different ways you can play it, you want the sort of intersection between results and minimally invasive, or little downtime, like all that kind of stuff and that's what office absolutely does which again, we take it for granted here but that's not how the rest of the world works. The rest of the world is sort of flipped opposite where they're thinking about surgery or nothing kind of a thing."

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