9 Health Insurance Terms to Understand

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Are terms like “co-pay” and “deductible” throwing you off? Do you dread your 26th birthday because it means you’ll have to shop for your own health insurance?

If you’re like a lot of 20-somethings, you’re not alone. In a recent study of adults between the ages of 19 and 30, researchers found that 48% can’t define “deductible,” and 78% don’t know how to describe “coinsurance.”

In order to help patients improve their understanding of health insurance, our office at St. Thomas Medical Group has put together this convenient glossary of health insurance terms. Have a billing question? Don’t hesitate to ask us next time you’re visiting with us in the office!

Your Quick & Easy Health Insurance Glossary

Let’s take a few minutes to look at some of the most common health insurance terms and what they mean.

  • ACA. Short for the “Affordable Care Act,” the ACA – also referred to as “Obamacare” – began to come into effect in 2014 (after being signed into law in 2010). Under the ACA, health insurance policies are frequently purchased by consumers through the government-run Health Insurance Marketplace (if you do not have health insurance coverage through parents or an employer). If you choose to shop for an alternative provider outside the Marketplace, you will want to confirm that your plan is ACA-compliant before purchasing.
  • Claim. A “claim” describes the process of asking your insurance provider to pay for a medical service. Sometimes the physician’s office will file a claim for you. (If you aren’t sure, it never hurts to ask.)
  • Copay. Many medical services – like a visit to your primary care provider at St. Thomas Medical Group – may have a copay. This is a flat rate that you pay to access the service; your insurance provider covers the remainder.
  • Coinsurance. Once you’ve reached your plan’s deductible (see below), you may pay “coinsurance” – a percentage of a healthcare expense. For example, if you have a 25% coinsurance rate, then you would pay $250 of a $1,000 bill, and your insurance plan would pay $750.
  • Deductible. This is the amount of money you must pay out of pocket before your health insurance plan kicks in. Generally, plans with higher deductibles have cheaper monthly fees and plans with lower deductibles are more expensive.
  • In-Network Provider. Health insurance plans often have “in-network providers,” which include physicians, hospitals, pharmacies and other healthcare professionals with whom the insurance company has already negotiated lower rates.
  • Health Savings Account (HSA). This is a personal savings account that you can deposit pre-tax dollars into. The money can be used to pay for a wide range of eligible medical expenses when you need it.
  • Out-of-Pocket Maximum. This is the most amount of money you can pay for health costs in a year. This figure includes deductibles, copayments and coinsurance. If you spend this amount of money, your insurer should cover the rest of your expenses.
  • Premium. This is the amount you (or your employer) pays per month for your health insurance policy.

Find a Primary Care Physician in Nashville, TN

For more information, see a primary care doctor in Nashville at St. Thomas Medical Group. Call +1 (615) 297-2700 for more information or to schedule an appointment. Our physicians have offered quality care at the intersection of Green Hills, Sylvan Park and Belle Meade for over 40 years.

Asthma: What Parents Should Know

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If you’ve ever witnessed (or experienced for yourself) the wheezing and breathlessness typical of asthma, then you know all too well how scary this common health issue can be. At St. Thomas Medical Group, pulmonary specialists are helping children and adults in Nashville treat their asthma.

Today on the St. Thomas Medical Group blog, let’s take a closer look at this lung disease.

Fast Facts About Asthma

The Centers for Disease Control and Statistics reports…

  • 6.2 million children under the age of 18 in the United States have asthma.
  • 8.4% of children under the age of 18 in the United States have asthma. (For comparison, 7.6% of adults age 18 and older have asthma.)
  • 2 million ER visits are caused by asthma.

Unfortunately, “the number of people with asthma continues to grow,” reports the CDC. Not only is asthma on the rise, but experts believe that many asthma attacks could be prevented with better education. For example, the CDC tells us that, “In 2008 less than half of people with asthma reported being taught how to avoid triggers. Almost half (48%) of adults who were taught how to avoid triggers did not follow most of this advice.”

At St. Thomas Medical Group, we believe that better patient education can lead to better outcomes.

What are the symptoms of asthma?

In children, symptoms may include:

  • Frequent coughing
  • Whistling/wheezing sound with exhalation
  • Shortness of breath
  • Chest pain, congestion or tightness

In some cases, children with asthma may have trouble sleeping (due to shortness of breath or coughing). Difficulty catching breath may interfere with a child’s ability to play or exercise with peers. Respiratory infections may be more complex with longer illnesses and recovery periods among children with asthma.

How is asthma diagnosed?

Asthma can be difficult to diagnose. At St. Thomas Medical Group, a pulmonologist may inquire about your child’s health, symptoms, and family history. Asthma has a tendency to run in families, though not every family member will have it. Lung function tests, which measure exhalation rates and lung capacity, may also be used to aid in diagnosis. Other conditions may have to be ruled out first.

What treatments are available for asthma?

There is no “cure” for asthma. However, your child’s pulmonologist may be able to provide you with quick relief and long-term control medications that can help reduce the frequency and severity of asthma attacks.

  • Quick-relief medications – such as steroids and bronchodilators (“inhalers”) – can often provide symptomatic relief during an attack. In some cases, your child’s doctor may advise using a quick-relief medication prior to exercise or activity.
  • Long-term relief medications, such as corticosteroids or leukotriene modifiers, can also help reduce inflammation in the airways and prevent attacks from occurring. (Please note, these are only a few examples of medications used; only a physician can prescribe appropriate medication for asthma.)

See a Pulmonologist In Nashville, TN

To schedule an appointment with a board-certified pulmonologist in Nashville, contact St. Thomas Medical Group by calling +1 (615) 964-5864 or by making an appointment online.

3 Things to Know for Colorectal Cancer Awareness Month

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March is Colorectal Cancer Awareness Month!

We can use this month to make a difference by spreading awareness about colorectal cancer and encouraging people to take action.

Did you know that colorectal cancer is the third most commonly diagnosed cancer in the United States? It is also the second leading cause of death from cancer. Only lung cancer claims a higher mortality rate.

For 2018, the American Cancer Society predicts that there will be approximately 97,220 new cases of colon cancer and 43,030 new cases of rectal cancer. To put this into perspective, approximately 1 in 20 people will be affected by colon cancer in their lifetime. The good news is that it is preventable with screening.

Colorectal Cancer Risk Factors, Screening, and Treatment

While colorectal cancer affects the lives of over 140,000 Americans each year, the reality is that it is preventable. This month, help us raise awareness. Here’s what you need to know:

  1. Colorectal cancer is preventable, treatable, and beatable. The key preventive strategy is “screening, screening, screening.” One of the most acceptable choices is to get a colonoscopy every 10 years beginning at age 50 if you have average risk. Other screening choices include fecal DNA testing and stool hemoccult testing (FIT). Why get screened? These tests are designed to catch colorectal cancer early when it is easiest to fight the disease. Detection of polyps and subsequent polyp removal by colonoscopy is the best strategy to prevent colon cancer before it forms since all colon cancers start as polyps.
  2. There are some colorectal cancer risk factors you can change. The links between dietary habits, weight, and exercise and colorectal cancer risk are considered some of the strongest for any type of cancer. Lifestyle-related risk factors include being overweight or obese, physical inactivity, diets high in red meats, smoking, and heavy alcohol use.
  3. Some colorectal cancer risk factors you cannot change. While you can live a healthier lifestyle to decrease your risk, there are still some risk factors that are out of your hands. For example, the risk of colorectal cancer increases with age. While younger adults can get it, it’s much more common after 50. The average age of diagnosis is 68 for men and 72 for women. Family history also plays a role, as nearly 1 in 3 people diagnosed with colorectal cancer have family members who have had it. A personal history of inflammatory bowel disease (IBD) or colorectal polyps also mean that you are at an increased risk of developing the cancer. Finally, inherited syndromes such as Lynch syndrome or familial adenomatous polyposis increase your risk as well.

To set up or discuss colonoscopy, call +1 (615) 383-0165 for Dr. Mertz and Dr. Pruitt at St. Thomas West, +1 (615) 329-2141 for Dr. Bailey and Dr. White at St. Thomas Midtown, or +1 (615) 250-4108 for Dr. Eskind and Dr. Granda at St. Thomas West.

To set up fecal DNA testing or hemoccult tests for detection of cancer, please discuss this with your primary doctor. You can also schedule an appointment online.