Ryan Mentock

Ryan Mentock is the practice manager of Family Care, PA. Ryan earned a BS in Business Management and Marketing from NC State University in 2006 and a MBA in Healthcare Administration from George Washington University in 2014. He enjoys reading articles on health insurance, analyzing the benefits and differences of health insurance plans, and working with health insurance companies to process claims. Yeah, we think he's weird, too. You can read more personal information about Ryan at www.ryanmentock.com.

Family Care is In-Network with United Healthcare!

Family Care is in-network with United Healthcare!

As of February 10, 2016, Family Care is now considered an in-network provider with United Healthcare! For all United Healthcare patients at our office, this means…

  • Visits at our office will now be subject to your in-network benefits on your insurance plan. You will now have full access to the benefits on your plan for services at our office!
  • In-Network co-payments, co-insurances, and deductibles will apply to your visits. No more high out-of-network deductibles!
  • Annual preventive wellness exams (for non-grandfathered plans) are covered 100%! No more denials for preventive care services!

For an average patient that came in every three months as an out-of-network patient, this means out-of-pocket savings of anywhere from $150 (for high-deductible plans) to $400 (for regular co-payment plans)!

Why did we decide to re-join the UHC network? 

If you have recently signed up for health insurance on the individual marketplace, you may have noticed that there are far fewer options available to you than there have been in years past. For the 27713 zip code, and most of the surrounding zip codes, BCBS has limited their available products on the individual marketplace to their Blue Value and Blue Local plans only. Because the Value and Local plans are affiliated with the UNC and Duke healthcare systems (and our office is fully independent), many of our patients were left without an option that would be considered “in-network” at our office.

Now, after signing an in-network contract with UHC, patients who sign up for insurance on the individual marketplace have the option of selecting a United Healthcare plan to receive in-network insurance benefits for visits at our office. We hope this helps our patients save money and get the most out of their healthcare budget.

If you are a new patient to our office, Dr. Elaina Lee and Sarada Schossow, PA-C are currently accepting new United Healthcare patients.

Please contact our office to schedule an appointment today!

Acne Prevention

Almost everyone at some point in their lives will suffer from acne outbreaks. While it can be embarrassing or frustrating, there are many easy ways acne prevention can help reduce the occurrence of breakouts. We tend to think that only teenagers should be plagued with pimples, but unfortunately, acne can be present our whole lives.

Ways to help reduce acne outbreaks:

  • I would encourage a well-balanced diet and plenty of water to keep the skin nice and hydrated. Although some people will find they break out after eating certain foods, there is no evidence that fatty or greasy or sugary foods lead to more breakouts.
  • Make sure to wash your face with hands and not a washcloth as these may be abrasive to sensitive skin. Some acne washes contain Benzoyl Peroxide or Salicyclic acid, both of which can be very harsh to the skin. They may lead to peeling and redness, along with increased sensitivity to the sun.
  • If you try an OTC acne cream, be sure to test it on one spot first before applying to you whole face to minimize adverse reactions.
  • Keep your hands off your face to reduce spreading grease and other irritants onto your face. Temptation to squeeze pimples can be hard to resist, but it can actually lead to tissue damage, infection, and scarring. Try not to pick!
  • Makeup can irritate and clog pores as well. Make sure to always wash off your makeup at the end of the day. Products that are water-based or more natural tend to be easier on the skin, as well.

Products I love and have found to be effective in helping clear my own skin include:

  • Cetaphil face wash. This is an incredible, gentle skin cleanser. It is available at almost all drug and grocery stores and is relatively inexpensive.
  • Cetaphil moisturizer. Again, this brand is really gentle on the skin. There is a moisturizer with, and without, sunscreen. It goes on smooth and does not feel like you are wearing a thick layer of moisturizer. Sunscreen is always a good idea to help prevent skin damage.
  • Neutrogena products. There are many Neutrogena products, but the ones I think are the best include the Oil Free Acne Wash for the face and Clear Body Wash, for back and chest acne. These products tend to be less drying to the skin than some of the other available washes.
  • Neutrogena moisturizer. There are several moisturizers with sunscreen in them that go on smooth and do not leave an oily residue. There are also overnight moisturizers to help fight off any dry skin.

Finally, if the OTC and home remedies are not working, you should come see us to discuss topical therapies or other medications to help reduce acne flares!

Sarada Schossow, PA-C is a primary care provider at Family Care, PA in Durham, NC. She has special interests in women’s health, adolescent and young adult health, and dermatology, including acne prevention. For more articles from Sarada, click here.

What is a “grandfathered” health insurance plan?

What is a “grandfathered” health insurance plan? 

A grandfathered health insurance plan means that the plan does not have to follow the national healthcare reform guidelines implemented by our federal government as part of the Patient Protection and Affordable Care Act (ACA) in March 2010.

There are two types of grandfathered health insurance plans:

  • Job-based grandfathered plans. Job-based grandfathered plans can still maintain their grandfathered status if the plans haven’t been changed in ways that substantially cut benefits or increase costs for plan holders and notify plan holders that they have a grandfathered plan. To keep a job-based grandfathered plan, the employer must have continuously covered at least one person in the company since March 23, 2010.
  • Individual grandfathered plans. Individual grandfathered plans can’t newly enroll people after March 23, 2010, and have that new enrollment be considered a grandfathered policy. But insurance companies can continue to offer the grandfathered plans to people who were enrolled before that date. An insurance company can also decide to stop offering a grandfathered plan. If it does, it must provide notice 90 days before the plan ends and offer enrollees other available coverage options.

While the majority of stipulations in the ACA apply to all types of health insurance plans, grandfathered plans are allowed to maintain a lower standard of coverage as a political compromise towards meaningful reform. With their grandfathered status, these plans have a different set of requirements:

It is important to understand the reasoning behind the changes made with the ACA and why our government had to do something to fix a broken system before it was too late. Before the ACA took effect, health insurers had a completely disproportionate advantage on the patient/insurer relationship. These healthcare reforms have been long overdue and were actually set up to help patients regain control from health insurers, no matter what other motives you might hear on Fox News. It is named the “Patient Protection” act, after all. You may remember some of the many ways health insurers ripped people off before the ACA:

Do any of these ideas sound fair to you? Obviously not. I think we can all agree that putting a stop to these devious insurance practices is a good thing for the healthcare industry, overall.

Despite the obvious benefits of having an ACA compliant plan, it does make sense for some people to continue coverage under a grandfathered plan. However, 3 out of 4 people with employer-based health insurance have an ACA compliant plan, along with almost everyone who is insured through the individual marketplace, so having a grandfathered insurance plan means you are going to face challenges and issues that do not apply to most of the population anymore, thanks to the ACA. Here are a few closing points to consider:

  • The majority of the advertisements, articles, new stories, and policy discussions that you see in the media regarding healthcare do not apply to you.
  • Your out-of-pocket costs will most likely be significantly higher than someone with an ACA-compliant plan.
  • Your “preventive wellness exam” is not covered by your insurance. If you have a copay or deductible, those will still apply to this visit.
  • You do not have the right to appeal any decision by your insurer. This includes denials for prescriptions, imaging, and medical claims.

Patients Asked Thrice: Healthcare Insurance and Billing Q&A

This post is part of a series entitled “Patients Asked Thrice,” which is designed to answer questions I have received at least three times from our patients. The inspiration comes from the saying: “One’s an incident, two’s a coincidence, and three’s a pattern.” If three different people ask me the same thing, I can safely assume there is at least a fourth person out there who wants to know the answer.

If you have any other questions you would like me to address, or any follow up questions to this post, please include them in the comments section below. Thank you!

Enjoy the Super Bowl!

Most of the staff members at Family Care are Panthers fans, but the guy that controls our white board and wi-fi password is a Broncos fan. The Family Care White Board has correctly predicted the future in each of the last five months, so hopefully the streak continues and the Broncos win the big game. (The Broncos fan also controls the blog, by the way.)

Either way, it is going to be a great game. Be safe and enjoy the Super Bowl!

Ryan’s Prediction: Broncos 20, Panthers 13

 

Finding In-Network Providers on the BCBSNC Website

There are a lot of things to consider when choosing a primary care provider, but one of the most important is ensuring that your provider is in your insurance’s network. One of the most frustrating things that happens to patients is finding out their provider is out-of-network with their health insurance when they show up for an appointment. They have had the same provider for years and have been very happy, but now their insurance is telling them they can’t see their preferred provider again without paying even more than they are already paying in premiums. This is not an ideal situation for either party, as the patient potentially loses their provider and the provider potentially loses a patient.

For many people with employer-sponsored health insurance plans, changing plans might be the only option available to you due to your employer’s necessary budget decisions. This post is for the rest of you on the individual marketplace for health insurance who have control over which plan you sign you and your family up for and need help finding in-network providers. Most of the frustration can be mitigated by checking with your insurance to determine your provider’s in-network status before changing insurances.

Most of Durham and the surrounding areas are insured by Blue Cross Blue Shield of North Carolina, so we’ll use the BCBSNC website for this example. The steps apply to almost any insurance, however, since most insurer websites offer a similar provider finder tool. If you have any specific questions, use the contact information on the website to call or email BCBS directly. 

1. Visit the bcbsnc.com website.

At the top right of the screen, you will see the “Find a Doctor” link. Click it.

Finding an In-Network Provider on BCBSNC.

2. Click “Find a Doctor or Facility” in the menu. 

Once you click this link, you will be able to search for a provider of any specialty type in your preferred location. On BCBSNC.com, our office is featured as “Family Care, PA” under most searches.

Finding an In-Network Provider

3. Select your plan type, or sign in to your member services account. 

If you are not sure which plan you are on, you can use your member services account to guide you. Otherwise, select your plan and proceed to the provider search page.

Finding an In-Network Provider - Select your insurance plan on BCBSNC.com

4. Fill in the search bar with the type of provider you are looking for. 

If you use the search bar once or have to refresh the page at all, be sure to re-select your chosen insurance plan before searching. Alternatively, you can follow the questions in the blue boxes in the middle of the page to determine which type of doctor is right for your current situation.

Finding an In-Network Provider on BCBSNC.com

5. If you do not know the name of the provider or facility you are looking for, select a category. 

There are also options on the right hand side of the page to sort by location, gender, and specialty. Our providers show up under most of the Primary Care designations, but the most accurate specialty would be “Family Medicine – Primary Care.”

Finding an In-Network Provider on BCBSNC.com

6. Select your provider. 

Depending on how far you narrow your search, there are potentially hundreds of options for you to choose from when finding in-network providers.

As a helpful hint, once you are on the 2nd page of any search, a new URL segment gets added to the page you are transferred to that can be changed to skip forward to a particular page. For example, in a basic search for a primary care provider, the URL for the 2nd page of the search is:

https://healthnav.bcbsnc.com/professional?network_id=3&geo_location=gps&radius=25&page=2&sort=Distance&ci=COMMERCIAL&search_specialty_id=1031

By changing the “page=2” segment to “page=#”, where # is the page you would like to visit, you can immediately skip through the alphabetical listings to your chosen letter.

7. Confirm participation with your provider. 

While this step doesn’t have anything to do with the BCBS website, it is still just as important when finding in-network providers with your insurance. Because websites aren’t always 100% reliable and the BCBS listings take several months to update, it is always best to confirm participation with your provider, as well. You should check out the list of in-network insurances at our office or contact us to ask about a specific plan to be sure that you are receiving all possible benefits from your insurance plan.

Choosing a primary care provider is an important step in your healthcare, so take some time to be sure you are making the right selection. Thanks for reading! Good luck!