Superbill Best Practices

Choosing to work with a provider not covered by your insurance has advantages and disadvantages. It can be gratifying to do your research and select the practice that best meets your needs, and in some ways, simplified to know exactly what you owe from the start. However, paying the full amount for services can add up.

Every patient is eligible to receive itemized medical receipts, or superbills, detailing their care with us. These receipts can be submitted to most insurance plans for reimbursement consideration, as well as qualify for select employee wellness incentives or tax credits. Because reimbursement costs the insurance companies money, the process is often tedious. We’ve put together our top four suggestions on how to maximize your returns, taking full advantage of your plan:

1. Gather your paperwork

Most insurance companies still require you fill out a paper application with your plan information to mail in along with your superbill. We recommend printing and filling out one application, leaving the date blank. Make copies of this, and reuse for each submission adding the individual dates each time. 

2. Read the fine print

Double check which payment options you select for your reimbursement. Some forms offer the choice to make payments to the providing clinician instead of the patient, aka YOU. Selecting the wrong option could require you to wait much longer to receive payment. 

3. Increase your odds

Submit your receipts individually, as soon as you receive them. It's a 6 week process, at minimum, and your insurance could require more information from your clinician.Having to resubmit decreases your chance of payment.

4. Pay it forward

Share any feedback from your insurance company with our team. Remember, they are looking for any reason to not pay out on claims. If they don't cover the services billed, we can work with you to better understand what they will cover in the future

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As the Director of Operations + Patient Success, Shannon navigates our Out-of-Network team. After pairing you with the best provider for your goals, she continues to be an essential part of your care by ensuring you have all the information you need for insurance claims.

For specific questions, or for help managing an existing claim, schedule a call

How Can I Heal?

This week, Dr. Heather McGill shared in conversation with Crina Okumus on her podcast How Can I Heal. The two discussed Heather’s vision for how to build robust, durable athletes through three healthy habits. Read more about Okumus and her podcast below:

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THIS PODCAST IS A WEEKLY CONVERSATIONS WITH PEOPLE THAT I ADMIRE TO IMPROVE YOUR OWN LIFE FOR THE BETTER.

Subscribe on Apple Podcasts

To give you a little background about me. I have an experience for more than 15 years in the fashion industry, running my company successfully selling in more than 40 countries and being highly profitable. 

One day, I received a call that my father died in a car accident and my whole life completely changed. I started to ask myself who am I and why I am here? The process of healing took more than five years, during which I was also facing my inner calling to move away from fashion and figure out what is next for me.It was certainly not an easy journey and I thought that I will never figure out what I will do for the rest of my life. But one day, I chose to listen to my heart and let it guide me to my future.

And with that decision, everything started moving in the right direction. 

The biggest insight I had during this time was that I could not change the world. I'm too small for that. But I can certainly change myself and the people around me who would be inspired by my story. And that’s when I decided to start a series of interviews with people that I love and who have made a big change in my life. 

So I hope you will join me in my journey and find inspiration in the stories of known personalities but also those of normal people. And please share your own journey with me and let's make a little change and make this world more beautiful. It’s up to us to make this change happen.

With love,
Crina

Make It Subtle

The show must go on! For so many performers and athletes, sitting on the sidelines isn’t an option. Kinesiology taping can be a beneficial treatment modality to help minimize time off when combined with progressive reloading. A 2018 case study demonstrated successful conservative management of FHL tenosynovitis with care including kinesiology taping, manual therapy, rehabilitative exercise, and laser therapy. The patient was able to continue two hours of dance training per day within the first two months of treatment, and gradually build back to 6 hours per day without re-aggravation of the condition.

Figure 2 Kinesiology tape application to the FHL. The ankle was dorsiflexed and pronated with no stretch in the tape as it was applied. This application provided a “lifting” of the skin as the patient assumes a plantarflexed ankle position.

When working with performers, presentation matters. While neon colored kinesiology tape may be permissible for other athletes, dancers may need to prioritize appearance. Enter KTape MySkin. This simple design change allows for all athletes to receive the support and care they need to perform at their highest potential.

Dance medicine providers or teams can order a mixed box to ensure that each performer has a color that matches their skin tone, allowing the audience to focus on the dancer rather than their injury.

To learn more, check out this article: 

1. Wentzell M. Conservative management of a chronic recurrent flexor hallucis longus stenosing tenosynovitis in a pre-professional ballet dancer: a case report. J Can Chiropr Assoc. 2018;62(2):111-116.

Flexor Hallucis Longus Tendinopathy: Part II

If the symptoms from the last post sound familiar, it’s important to seek care to prevent the condition from advancing. The good news is FHL tendinopathy does not require imaging for diagnosis. You can see a PT or AT directly- they’ll evaluate and diagnose your condition, and will refer you to a physician as needed.

After assessing your leg, your clinician will be able to ascertain contributing factors that led to the injury and how to address them with an individualized exercise program including neuromuscular re-education and functional training. Neuromuscular re-education helps reprogram the way you move- focusing on specific muscle activation and timing. This strategy takes the whole kinetic chain into consideration, looking for inefficient habits that may seem unrelated to your injury.

For example, many athletes diagnosed with FHL tendinopathy present with excessive pronation- or arch collapsing- a faulty pattern that can contribute to overloading the FHL in running. Strengthening the hip, pelvis and core muscles, combined with improved running mechanics can reduce this problem for the long term!

If you are able to see a clinician in-person, manual therapy may be beneficial to reduce inflammation, muscular tension, and any joint stiffness.  

Until your appointment, follow these recommendations at home:

1. Rest from the aggravating activity - running, dancing, etc.

2. For pain management, try over the counter NSAIDs (ie Advil, Aleve)

3. Use contrast therapy to reduce inflammation:

   • Submerge foot for 10-15’ total following the pattern below:

     • 2-3’ in ice water

     • 2-3’ warm water

     • 2-3’ ice water

     • 2-3’ warm water

     • 2-3’ ice water

4. Self-massage the outer calf by rolling with a tennis ball or something similar on the floor

5. Perform a seated calf stretch with a towel at the toes, being sure to pull the big toe back with the foot

Flexor Hallucis Longus Tendinopathy

Often called “dancers tendonitis” due to its prevalence in classical ballet dancers, FHL tendinopathy actually happens to various athletes whose sports require repetitive push-off and extreme plantar flexion (pointing of the foot), such as sprinters, soccer players, gymnasts, and even swimmers.  

Image Credit

The Flexor Hallucis Longus (FHL) muscle is located in the back of the lower leg, originating from the fibula and traveling behind the Achilles tendon. The FHL tendon then passes the inside of the ankle through the tarsal tunnel, and travels along the instep of the foot, ending at the big toe. Its function is to flex the hallux - or big toe. It also has an important role in controlling mid-foot pronation and supination.

Because of these roles, the FHL functions as a powerful convertor of force from the rear foot to the big toe. However, repetitive pushing off the foot and toes can sometimes lead to irritation. This can be worsened when combined with eversion - or an outward motion of the toes relative to the ankle. Often, young dancers will evert when attempting to achieve greater “turnout”, but this also can be seen in runners as excessive pronation - or “arch collapsing” - most often due to strength deficits in the stabilizers of the limb.

If you’ve irritated this muscle-tendon unit, you may experience pain within the foot or at the back of the ankle depending where along the tendon inflammation has occurred. Some may also experience the big toe “getting stuck” with active movement, or swelling and a crunchy-sensation along the inside of the ankle. Flexing the big toe against resistance, or forcing the foot into a pointed position may also be painful.

While the exact physical cause of FHL injury is under debate, it is believed that the tendon can snag either at the ankle in the tarsal tunnel,  in the mid-foot, or at the sesamoids (two teeny round accessory bones) of the big toe. When combined with repetitive motion, this entrapment of the tendon creates micro-trauma. If left untreated, this can lead to tissue damage. The body's inflammatory response begins to heal these micro-tears, sending more blood and nutrients to the area. This inflammation of the tendon is what is called tendinopathy. 

Restriction of the FHL routinely occurs in three spots:

Image Credit

• Tarsal Tunnel at inside of ankle, star.

• Intersection of FHL with neighboring Flexor Digitorum Longus tendon, triangle.

• Attachment of FHL to the first bone (proximal phalange) of the big toe, square.

To learn more, check out these articles and texts:

1. https://www.sportsmedtoday.com/fhl-tendinopathy-va-132.htm

2. Quirk R. Common foot and ankle injuries in dance. Orthop Clin North Am. 1994 Jan;25(1):123-33.

3. Pagenstert GI, Victor V, Hintermann B. Tendon injuries of the foot and ankle in athletes. Clin Ortho Trauma. 2004; 52(1):11-21.

4. Simpson M, Howard T. Tendinopathies of the foot and ankle. Am Fam Physician. 2009 Nov 15;80(10):1107-1114.

5. https://www.sportsinjurybulletin.com/the-flexor-hallucis-longus/#:~:text=Overuse%20conditions%20in%20the%20FHL,posterior%20or%20postero%2Dmedial%20ankle.

6. Bone Joint Surg. 78A:1491-1500, 1996

7. Am J Sports Med. 1977;5:84-88

8. J Orthop Sports Phys 1983; 5: 204-206

9. Norris R. Common Foot and Ankle Injuries in Dancers. In: Solomon R, Solomon J, Minton S, eds. Preventing Dance Injuries. 2nd ed. Champaign, Ill: Human Kinetics; 2005: 39-51

10. Foot Ankle Int. 2005; 26: 291-303