10/04/11 5:07pm
10/04/2011 5:07 PM

Dear Marci,
I just received a letter in the mail labeled ‘Annual Notice of Change.’ What is this?

Dear Riley,
The Annual Notice of Change is a notice your Medicare Advantage plan or Medicare Prescription Drug plan sends you every year. The notice explains how your plan’s coverage and costs are changing for next year. Your plan must make sure you get your notice in the mail by Sept. 30. It’s very important that you read your notice and consider all your options, since many plans make changes every year and your current plan may not be your best choice for 2012. Your notice comes at the end of September so you can determine whether it is best to keep or change your plan for next year during the fall open enrollment period between Oct. 15 and Dec. 7.

When you review your notice, pay particular attention to the summary of the new formulary for covered drugs. The plan’s formulary may have changed for next year and new restrictions may have been added. Be sure the new formulary still allows you to get the drugs you need. If you do not see one or more of your drugs on the summarized formulary, call your plan or check its website for a full list of covered drugs and, if necessary, consider switching to another drug plan.

You should also review the notice for consolidations and terminations. Plans from the same company that offer nearly identical benefits continue to be consolidated to help simplify the choices available to consumers. If your plan is consolidated with other plans, you will automatically be enrolled in a plan from the same company that has benefits most like those you had. Even though you will automatically be enrolled in another plan, you have the right to choose and enroll in a different plan during the fall open enrollment period.

Terminated plans no longer participate in Medicare. If your plan has been terminated, you can use the open enrollment period to enroll in a new one. In this case, you are also entitled to a longer enrollment period that lasts through Feb. 29, 2012, to find a new plan.

Dear Marci,
Will Medicare cover counseling to help me quit smoking?

Dear Toni,
Yes, Medicare covers counseling to help you quit smoking.

Medicare covers counseling for two attempts to quit smoking per year. Each attempt includes four sessions, which comes to eight sessions every 12 months. You can receive counseling at a clinic, the outpatient department of a hospital or a doctor’s office — including offices of physicians, psychologists or clinical social workers. A doctor or an approved Medicare provider must perform the counseling.

If you have Original Medicare, you no longer pay coinsurances or deductibles for smoking cessation counseling if you have not been diagnosed with an illness that is caused or complicated by smoking, and if you see a Medicare-recognized doctor or other health care provider. Medicare also covers smoking cessation counseling for people with Medicare who have been diagnosed with a disease or condition caused or aggravated by smoking. In this case, Medicare will pay 80 percent of the approved amount for smoking cessation counseling, after you meet your Part B deductible.

If you are in a Medicare Advantage private plan, contact your plan to see what rules and costs apply. Starting in 2012, Medicare Advantage plans can’t charge you for preventive services that don’t have cost-sharing under original Medicare.

Marci’s Medicare Answers is a service of the Medicare Rights Center, the nation’s largest independent source of information and assistance for people with Medicare.

09/26/11 9:44am
09/26/2011 9:44 AM

September is addiction month and the power of change and changing the force of addiction is important. When someone is asked to give up the substance to which they’re addicted — whether it’s food, shopping, alcohol, drugs or nicotine — they undergo an enormous pressure to evoke change in their lives.

Imagine being in a pool and someone jokingly forces your head beneath the water. The joke goes on too long and you begin to struggle for air. But the person continues to hold you under and now you’re fighting to breathe with all your strength. Suddenly that person releases you and you gasp in air, wonderful oxygen, and you feel complete and safe again. The fight you put up was a response to a change in your access to oxygen. You fought against what seemed a threat to your life.

Now imagine what an addict might feel when treatment withdraws the substance of choice. The addict feels the same type of struggle to survive. The nerve receptors in the brain scream for opiates or alcohol or the adrenaline rush of an out-of-control compulsion. The fight is just as intense as yours to breathe.

Irrational as it might seem, the addict’s struggle is to survive — and he or she needs that addictive object. To the addict, it seems that life will cease without it. Reason is not prevalent here. Addiction is prevalent and it’s a powerful force that resists change. As you felt relief to breathe again after being released from under the water and life seemed balanced, so does the addict when high. This is the balance of life for addicts, being medicated with alcohol or drugs or soothed by shopping, smoking or another compulsion.

As a professional counselor, when addicts talk to me, the conversations frequently revolve around change. Change is the force that motivates us in all directions. We’re always changing; no breath is the same, and no day a copy of the last. As humans, we grow and evolve positively or negatively each day.

Our task in treating recovery is to assist addicts through the painful process of accepting these changes in their lives — to help them find a balance in sober, stable conditions and view their previously addicted self as abnormal.
We are asking the addict to let go of a perfect friend — addiction — and turn alone to find peace and contentment in a world that feels entirely new. This change is astronomical.

It’s no wonder addicted people slip and fall back into their old lifestyles. Non-addicts may find it difficult to understand how they could leave behind family, responsibilities, employment and loved ones. Remember, addiction is not rational.  It’s run by a different standard. Reckless as addiction may be, and hopeful as recovery is, respect must be paid to the challenge of change. Hopefully, as we recognize this challenge, our patience and tolerance will increase.

Jack Hoffmann is a licensed and certified social worker who is director of behavioral health providers and clinical relations at Eastern Long Island Hospital.

08/19/11 1:08pm
08/19/2011 1:08 PM

This is the first of a two-part series dealing with proper foot care. Part II will appear in the Sept. 1 edition.

Cycling is an excellent means of exercise, but a cyclist needs to select not only a bicycle that meets his or her specific needs, but proper shoes — the most important piece of cycling equipment. Cycling shoes must have a stable shank to efficiently transfer power from your feet to the pedals. The lack of shank support in sneakers allows the foot to collapse through the arch while pedaling, which may cause arch pain, tendon problems, or burning under the bottom of the foot. A rigid shank protects your feet from the stress of pedaling.

Investing in a cycling-specific shoe is a good idea if you have had pre-existing problems with your feet or wear orthotic shoe inserts. Most orthoses control the arch and heel and, for cycling, usually require critical forefoot balancing. Riders with mild bunions or hammertoes should select a wider, deeper shoe that will accommodate the deformity.

Select a shoe that’s right for you among models designed for racing and mountain biking. For the casual rider without known foot problems, cross-training shoes provide the necessary support across the arch and instep in a shoe that can be used for other purposes. They also provide the heel lift that cycling shoes give. Combination cycling-hiking shoes have become popular and meet the needs of the casual rider.

The use of toe clips and their degree of sophistication begin to separate the casual rider from the more serious devotee. Toe clips range from traditional clips to newer shoe-cleat ensembles — “clipless systems” — that resemble ski bindings. Many companies model their units on the French manufacturer Look. A Look-compatible unit will offer the most diverse combinations of shoes and clips from which to choose.

Proper shoes and clips or cleats working as a unit are important to achieve maximum efficiency in transferring power generated by the hips to the foot. For most efficient pedaling, shoes should extend fully under the ball of the foot.

Biomechanics, the study of external forces on the living body, plays a crucial role in efficient, satisfying cycling. When you’re seated on a bike, your hands on the handlebars, your shoulders and the front axle should all be in line.

By enhancing the biomechanics of the foot, podiatric physicians specializing in sports medicine can improve the mechanical functions of related body parts. If, for example, an experienced cyclist’s knees hurt after a 30-mile ride, the problem may be a biomechanical imbalance. A podiatric physician can alleviate the pain by correcting the imbalance through prescription orthotic shoe inserts. Training and conditioning methods should also be evaluated.

To preclude pain before it starts, podiatrists advise stretching the major muscle groups used in cycling — gluteals, quadriceps, calves and hamstrings — before and after getting on the bike. Riders should start slowly and work up to a normal rate of pedaling. The seat is at the proper height when knees are slightly flexed and hips are over the knees.

Podiatrists recommend the use of a pulse monitor for a cycling-based training regimen. Some models strap around the chest, while smaller units wrap around the wrist or the thumb to display the pulse rate as you ride.

Dr Peter Kilfoil is a podiatrist with offices in both Southold and Riverhead and has been a member of the American Academy of Podiatric Sports Medicine since 1984.

08/10/11 3:31pm
08/10/2011 3:31 PM

Are your bones at risk?

Last year, the Center for Disease Control and Prevention reported there were more than 2 million emergency room visits, 18,000 deaths and more than 300,000 hip fractures resulting from falls. In fact, one in three adults over the age of 65 is predicted to experience a fall, and women are 50 percent more likely to fall and suffer an injury, according to the CDC’s National Center for Injury Prevention and Control.

Broken bones and hip fractures are a physical consequence to a fall, but there are also psychological issues that can be just as damaging to the quality of life. The fear of falling can create a domino effect that begins with reduced mobility, leading to a loss of physical fitness and ultimately diminishing independence.

But falls are preventable. Exercise alone can prevent falls as it increases your strength and balance. Also, you and your doctor should discuss the medications you’re taking, their side effects and whether or not they could play a role in your overall sense of balance and equilibrium.

Other preventive measures are as uncomplicated as annual eye exams to ensure appropriate vision and home safety evaluations to reduce slipping and fall hazards. Be sure to screen for osteoporosis and make sure you’re taking the correct amount of calcium and vitamin D supplements. A vitamin D deficiency has been shown to increase your risk of fractures if you do fall.

Lastly, speak with your doctor about the simple test called DEXA, which stands for dual energy x-ray absorptiometry. It takes between five and 15 minutes and can easily assess your bone mineral density. This test can be performed at your local hospital.

Dr. Bellamy Brook is the medical director at Peconic Landing in Greenport and a graduate of New York College of Osteopathic Medicine in Old Westbury. He is board certified in family practice, providing care in geriatrics and urgent care medicine and has offices in both Cutchogue and Riverhead. He is affiliated with Eastern Long Island Hospital.

07/19/11 3:37pm
07/19/2011 3:37 PM

The average American consumes more sugary foods than ever before, equaling about 22 teaspoons – a little less than 1/2 cup – of added sugar each day. That’s 20 percent more than we ate in 1970 and adds up to 350 calories a day from sugar alone. For cancer prevention, those added calories are bad news.

If you’re like the average American, you may be eating sugar without realizing it because it’s hidden in many purchased foods. For anyone who wants to limit sugar intake for a healthy weight, find out how you can identify added sugars hiding behind a different name.

Evidence suggests that sugar by itself doesn’t lead to cancer or “feed” cancer cells, but sugar calories can add up quickly. Extra calories can lead to overweight and weight gain and that leads to an increased risk for several cancers. Today a third of the country’s adult population is classified as obese and child obesity rates are on the rise.

Scientists now know that fat tissue is a metabolically active tissue. Fat cells produce high levels of some hormones and proteins called cytokines that may trigger chronic inflammation, which is linked to increased risk of cancer and other chronic diseases. There’s convincing evidence linking body fatness with colon, postmenopausal breast, endometrial, esophageal, kidney and pancreatic cancers.

In an effort to avoid food and drinks that promote weight gain, avoid sugary drinks and limit energy-dense foods, which typically contain high amounts of sugar. However, this may be easier said than done.

The best way to limit your sugar intake from packaged foods is to read ingredient and nutrition labels. But when added sugar can hide behind almost 100 different names, this task is far from easy.

The ingredients on the label of a food product are listed in descending order with the largest amount first. If a sugar is among the first ingredients listed, or there are many different types of sugar listed, the product most likely has a lot of added sugar.

There are plenty of naturally-occurring sugars, such as the fructose found in fruits or the lactose in milk. Those sugars are considered to be part of a healthful diet and won’t be found in the ingredient list. If you do see sugar in the ingredient list, you can be sure it was added to the food; this is the type of sugar you want to limit in your diet.

Common sweeteners in food products include syrup, malt, cane, caramel, juice, honey, molasses and agave nectar. Others often end in “ose,” such as fructose, lactose, sucrose, maltose, glucose and dextrose.

To decrease sugar intake compare nutrition labels of various brands. One teaspoon of sugar equals four grams, so in foods where sugar is added you can estimate how much added sugar is in the product.

The American Heart Association recommends women consume no more than six teaspoons of added sugars a day (25 grams) and men consume no more than nine teaspoons (37 grams). That corresponds to about 100 calories for women and 150 for men. (A teaspoon of sugar is 16 calories.)

Substituting sparkling waters with a splash of fruit juice, no-calorie sodas, unsweetened or lightly sweetened tea or coffee or water are always  good choices.

When you do eat sugary foods, keep the amounts small. Consider satisfying your sweet tooth more often with naturally sweet fruits instead. You’ll be getting vitamins, fiber and phytochemicals that may also help reduce your risk for cancer. Unsweetened frozen and canned fruits are easy to keep on hand and have as a snack or dessert option.

This column is provided by the American Institute for Cancer Research is a cancer charity that fosters research on the relationship of nutrition, physical activity and weight management to cancer risk.

07/11/11 8:05am
07/11/2011 8:05 AM

American Institute for Cancer Research certified nutritionist and registered dietician Karen Collins provides information on healthy choices to make in planning your meals and snacks.

Q: What kinds of vegetables are suitable for grilling?
A: Some of the classic vegetable choices for grilling include asparagus, corn on the cob, onions, mushrooms, peppers, zucchini and eggplant. Most of these can be grilled whole, as well as chopped and cooked in a grill basket or cut into chunks and skewered to make vegetable kabobs. Brush or toss them with a small amount of olive oil. Cooked on a grill at medium-high heat, most are ready after about three to five minutes per side. More dense vegetables like onions, sweet potatoes and eggplant may need double that time or more, depending on how large the pieces are. You can even grill vegetables in advance and serve them at room temperature on their own or in salads. Grilling brings out marvelous flavors in many vegetables, and it does not lead to the development of cancer-causing substances formed when meat and poultry are grilled.

Q: Is there any difference in the antioxidant levels of regular and decaf coffees and teas? Also, despite the antioxidant benefits, isn’t the caffeine still bad for you?
A: Compared to decaf, regular green tea contains about three times as much EGCG, the antioxidant phytochemical that has shown cancer-prevention effects in some laboratory studies. Similarly, decaf black tea, which contains another, less-studied antioxidant called theorubigin, has about 50 percent less than its regular counterpart. Limited research suggests that chlorogenic acid, one of the main antioxidants in coffee, may be lower in decaf coffee as well. However, even with decaf versions, the true antioxidant benefits you receive depends on how much you drink.
As for concerns about caffeine, when consumed in moderation, it may not be as bad as you think. Some studies now suggest that caffeine’s purported role in increasing blood pressure may not be linked as strongly to coffee and tea. Note that people with sleep difficulties, however, do need to be careful about the amount and timing of caffeine consumption. Also, most health experts suggest that pregnant women limit total daily caffeine from coffee, soft drinks and other sources to about 300 milligrams, the equivalent of three 6-ounce cups of regular coffee.

Q: Are iced-coffee drinks a sensible treat if I’m watching my weight?
A: A simple iced coffee or even an iced latte made with skim milk isn’t a problem if you leave out added flavorings and whipped cream and choose the smallest size. A 12-ounce iced latte or cappuccino made with skim milk usually contains about 130 calories; if made with 2 percent milk it might be closer to 160 calories. But if you add flavored syrups, whipped cream topping and other ingredients, the calorie content rises sharply. Portion size is key. The largest size at most of today’s popular coffee bars is usually 24 ounces and sometimes more. Order a large, and you could be getting up to 700 calories, lots of additional fat and almost a half-cup of sugar. Even if you skip the whipped cream, these jumbo servings still provide about 450 calories. While you may be looking for a light, refreshing snack, what you may get is a drink that’s equivalent to one or two portions of dessert. To enjoy iced coffee drinks without wreaking havoc on your diet, order nonfat versions, skip the whipped cream and slowly savor a small portion. If you’re very thirsty, quench your thirst with a cool glass of water first and then you’ll be able to fully savor your icy treat.

The American Institute for Cancer Research is the cancer charity that fosters research on the relationship of nutrition, physical activity and weight management to cancer risk.

07/06/11 10:51am
07/06/2011 10:51 AM

Dear Marci,
Original Medicare won’t pay for a health care service I received. What can I do?

Dear Xiang,
If Original Medicare will not pay for care you received, you will find this out when you receive your Medicare Summary Notice. If you think the care you received is medically necessary, you should not take no for an answer.
• Find out if it is possible that there was a billing mistake. Sometimes providers accidentally use the wrong service codes when filling out Medicare paperwork and this can result in Medicare denials. A denial can sometimes be easily resolved by asking your doctor to double-check that your claim was submitted with the correct codes. If the wrong code was used, ask your doctor to resubmit the claim with the correct code.
• If the provider believes that the claim was correctly coded or is unwilling to re-file the claim, your next step is to appeal. The Medicare Summary Notice will have instructions for how to appeal. Follow these instructions and then mail the signed original to Medicare at the address on the MSN. Make sure you request your appeal within 120 days of receiving the MSN. If possible, get a letter from your health care provider saying that you needed the service and why and send this with your MSN.
Keep photocopies and records of all communication with Medicare, whether written or verbal, concerning your denial. Send your appeal by certified mail or delivery confirmation.
You can’t appeal to Medicare to cover services or items that are never covered, such as hearing aids.

Dear Marci,
My provider just asked me to sign an Advance Beneficiary Notice. What does this form do?

Dear Marjorie,
An Advance Beneficiary Notice (ABN), also known as a “waiver of liability,” is a notice that suppliers and other medical providers are required to give you when they offer you services or items that they know or have reason to believe Medicare will determine to be medically unnecessary for you, and therefore, will not cover.
Providers are not required to give you an ABN for services or items explicitly excluded from Medicare coverage. In addition, ABNs apply only if you are in Original Medicare, not if you are in a Medicare private health plan such as an HMO or PPO.
If you do not get an ABN to sign before you get the service or item from your provider, it’s not specifically excluded from coverage, and Medicare does not pay for it, then you don’t have to pay for it. You may need to file an appeal to show that you should not have to pay.
If the provider does give you an ABN that you sign before you get the service or item, and Medicare doesn’t pay for it, then you will have to pay your provider for it.
There will be an option on the ABN to check whether or not you want your doctor to submit a claim to Medicare for the service. You should always select that you want your doctor to submit the claim to Medicare. If you don’t, your doctor isn’t required to submit the claim. You should check this option, because Medicare may still pay for the services after all.
If you sign an ABN but ask your doctor to bill Medicare and Medicare then denies coverage, you can always appeal.

Dear Marci,
How does Medicaid work with Medicare to cover my health care costs?

Dear William,
All states offer a variety of Medicaid programs, and several can help people with Medicare. If you qualify for a Medicaid program, Medicaid can help pay for costs and services that Medicare doesn’t cover.
For services that both Medicare and Medicaid can cover — such as doctor visits, hospital care, home care and skilled nursing facility care — Medicare will pay first and Medicaid will pay second by covering your remaining costs, such as Medicare coinsurances and copayments.
If you have Medicare and Medicaid, you should be able to go to any doctor or provider who takes Medicare, Medicaid or who is in your Medicare private health plan’s network without having to pay the Medicare coinsurances or deductibles. You may still have to pay the Medicaid copayment for the service, depending on the rules in your state. However, if you go to see a provider who takes Medicare and Medicaid, the provider is most likely to bill correctly.
Medicaid can cover much more long-term care than Medicare does. Medicare requirements for coverage of long-term care services, such as home care and skilled nursing facility services, are generally stricter than Medicaid’s and the coverage itself is much more limited.
Medicaid will also pay for medical services not covered at all by Medicare as long as they are covered by Medicaid. Such services may include routine dental services and transportation to and from doctor appointments.
If you have both Medicare and Medicaid, Medicare, not Medicaid, will cover your drug costs. Having Medicaid will automatically qualify you for Extra Help, the federal program that helps with the cost of Medicare prescription drug coverage (Part D).

Marci’s Medicare Answers is a service of the Medicare Rights Center, the nation’s largest independent source of information and assistance for people with Medicare.

06/20/11 12:44pm
06/20/2011 12:44 PM

Recent experiences have started me thinking about the importance of communal activities in enhancing the quality of our lives. Whether this activity takes place in a physical therapy setting or talking to the cashier at the local supermarket, it’s the sharing of one’s life with others through storytelling that creates healthy connections.

After more than 25 years of practicing in a healing profession, I’ve learned that enthusiasm and shared laughter enhance the rehab experience and everyone goes home feeling better.

I love the communal activity I see going on around me on the North Fork, and I have recently witnessed similar communications while walking on a boardwalk in New Jersey and on visits to Nassau County and to Brooklyn, where I’ve overheard groups of older people sitting together in the morning sharing stories while sipping coffee, their chairs in a circle. They’re always dressed for the weather, with light clothes when the sun is shining or sweaters and jackets in cooler weather. They’re laughing and at times moving closer to one another to capture an important moment in a story. They all live, at the most, a few blocks from their chosen gathering spots and can get there easily, either independently or with the help of family or friends, to share a morning ritual.

After one of these experiences, I called my mother-in-law, thinking she is isolated living in her apartment building in Albany and assuming she was without such a gathering place to go to after church. It has been years since her husband and her son, my husband, passed away. She tells me of her day and, yes, there are immediate concerns — her teeth, her hearing aides — and, of course, the sweetest stories about her new grandchild, Isabella, who is now 6 years old. But most of our conversation is about the new people she is meeting on the bus to the shopping center, or in the bingo room in her living facility. She lives in an apartment building in Albany city, with a diverse group of tenants. There is a city-funded bus that takes the tenants to various shopping centers.

She hasn’t cooked in years. She had moved from a moderate house in suburbia, where she entertained as many as 30 people almost every weekend for Sunday dinner, to a small apartment in Albany to be close to my brother-in-law. She has the Greek recipes that have been handed down for years, and the other ladies on the bus have their recipes to share. That’s what they talk about and share. They are women of diverse cultures sharing recipes, sharing spices, gabbing and seeing each other for the first time. Will they purchase the new spices, will they cook outside their norm? Maybe not, but they have shared what has been their life, and nurturing with food has often been the center of those lives. Going home, writing down the recipe and handing it over the next shopping day is a mission and the ultimate sharing. It makes me realize that such sharing goes on in all environments if people give themselves over to the experience.

I am so blessed to work in an environment where stories are shared. We share stories with patients and they share stories with each other. The stories most of the time start out with the obvious “Why are you here?” We then go on to discuss specific body parts or joint replacements and the shared symptoms in a discussion that often culminates in agreement that “it’s tough to get old.” Then almost ultimately the talk goes to food, whether it be new restaurants or farm stands or recipes; soon everyone in the room is chiming in. The one thing that all humans do is eat, and the desire to make that experience better for others is the most common form of caring.

The psychologist Eric Erikson named eight stages to define life and its conflicts. He felt that life stages one through six gear up to stage seven’s conflict, which he named “generativity versus stagnation.” Generativity is defined as care and concern for people besides family and self and develops during middle age. It is the positive side of the conflict, and I believe it can be experienced every day by getting out and sharing stories — listening compassionately and laughing about how alike we all are.

Denise Plastiras is a physical therapist at Maximum Performance in Greenport.