Professional Patient

Protect Your Neck and Back by "Log-rolling" out of Bed

After my neck surgery, getting out of bed required a fancy schmancy technique: log-rolling. In log-rolling, you essentially roll onto your side at the edge of the bed and then push yourself up to a sitting position. Then you can easily step out of bed. This technique ensures that your neck stays straight and strong - no twisting, and no using your neck to pull the rest of your body up and out of bed.

Getting back into bed can be done, log-rolling in reverse - sit on the side of the bed with your feet and legs hanging off, then swing your feet up onto the bed while dropping your shoulder down onto the bed. Then you can gently roll onto your back.

The About.com Neck and Back pain area includes a step by step photo guide to the log-rolling technique. It's much easier to understand in pictures.

You don't need to be a neck patient to benefit from the log-rolling technique. Anyone who has back pain may enjoy log-rolling as an easier way to get into or out of bed every day.

Get Your Medical Life Organized in 2009: How to Keep Your Information Together

As a follow-up to my earlier post about deciding what medical information to keep and what to record, I would like to explain my system for keeping it all together and organized. (My system is entirely paper-based. I'm sure there are electronic methods for tracking and archiving your medical paperwork, but I haven't had the time to find them.)

My system:

My system is pretty basic. It includes the following:

Binder #1: A "go with me" calendar/note-taking tool that I can add pages to or remove pages from. I use an 8-1/2" by 11"  Levenger Circa notebook with a leather cover (Circa is a fancy cross between a three-ring binder and a spiral-bound notebook), but any three-ring binder or ring-bound planner (like a Franklin Covey ring-bound planner, Day Timer planner, or Day Runner planner) will do. 

Binder #2: A "stay at home" binder/notebook that I can add pages to or remove pages from. This serves as my "archive" for old calendar pages, notes from doctor's appointments, etc. I use a plastic-covered Circa notebook for this.

Two storage boxes: These need to be large enough to hold letter-sized paper. One box stores medical paperwork for the current year, and one box holds medical paperwork for the previous year. I use two ridiculously large and cheap cardboard boxes that I got from my local IKEA. They are similar to these Lingo boxes from IKEA that sell for $4.99 per two-box pack. 

How I use them:

Binder #1: This is my go-to planner for my life outside of work, which includes my medical life. It includes 

• a set of to-do lists (I have a to-do list for medical things and a to-do list for everything else) 
• a calendar for tracking medical appointments. I use an electronic calendar template that lets me print a month-at-a-glance calendar across a two-page spread. (See DIY Planner.com for tons of free electronic planner page templates that you can print out at home, including dynamic calendar tools that let you set the size, line width, etc. for calendar pages.)
• lined pages for taking notes during medical appointments
• address book pages (for medical and nonmedical contacts)

I use plastic tabs to divide these sections in my planner.

Binder #2: This is the archive. As my printed calendar pages expire, I move them to this binder. I also store my notes from doctor's appointments here as well. If you take neat notes during your appointments, you can transfer them directly to this binder. I take terribly messy notes, so I actually recopy or summarize the notes on new paper (using the contact log pages in this set of DIY Planner electronic templates) and store THAT in binder #2. 

You can add any other paperwork that it's critical to save (that you need to have organized and scannable). I sometimes store contact information here for doctors that I saw in past years but no longer visit. You never know when you might need to list all the doctors you have ever seen for a particular problem! If you have insurance that requires referrals, preuthorization forms, etc., this is a good place to keep them as well.

The boxes: This is where I put explanation of benefit statements (EOBs), prescription receipts, bills, benefits booklets, and all of the other pieces of medical paper that are handed to me during doctor's appointments or that arrive in the mail. You never know when you might need to prove that you already paid that bill or copay, might need an EOB as reference when you call your insurance company (or your doctor) about a billing problem, etc. Also, you may be able to deduct your out-of-pocket medical expenses on your tax return. Having the bills, receipts, and EOBs in one place allows you to quickly total your expenses at the end of the year. (After I do this, I move the out-of-pocket documentation into a folder with the accompanying tax return.) 

I like to keep a box for the previous year as well as the current year because it can take a long time for billing problems to arise and then get resolved. I once had a doctor who waited a year before billing my insurance for an office visit! Can you imagine?

How do I use these tools? Let's follow a typical example:

1. Need to see new doctor. Call and schedule appointment. Note doc's name, location, reason for visit, and time on my calendar in binder #1.

2. Get referral for doctor's visit. Xerox it and place the copy into binder #2 for safekeeping. (Tuck original into my purse to take with me and give to the doctor on the day of the appointment.)

3. Go visit doctor. Give them the original referral. Bring binder #1 with me and take notes during the appointment. Pick up doctor's business card. Pay office visit copay and get receipt for payment.

4. A day or two after the appointment, review my notes, and decide they are a mess! Write a neater summary of the notes and place this in the archive binder (#2). (Recycle paper with the original notes.) Also, add doctor's business card (or information from it) into the address section of binder #1.  And file receipt for copay in this year's box. 

5. When the EOB arrives for the office visit, place it in this year's box. 

 

Later on....

6. Need to go back to doc for follow-up visit. Call and schedule appointment (note on calendar in binder #1). Get referral.

7. Day before the appointment:  Review notes from previous visit (saved in binder #2) before the appointment to remember what we talked about last time and what we need to address this time.

8. Day of the appointment: Bring new referral with me (having filed a copy of it in binder #2). Bring binder #1 with me, take notes during visit, pay copay, and get receipt.

9. After the appointment: Review notes taken during visit - recopy/summarize and add to binder #2 (put behind first set of notes relating to my visit with this Dr.). File receipt in this year's box.

10. When the EOB arrives for the office visit, file it in this year's box. 

Much later on (at the end of the year): 

11. Pull all evidence of out-of-pocket expenses out of this year's box, and add it up. Save the proof of expenses and total amount wherever you are keeping your tax return paperwork. Keep all other paperwork in the box and move the box aside. I still need to do this for 2008. 

12. Empty previous year's box (for example, I am about to empty out my box that contains records from 2007). 

13. Start filing your new year's paperwork (for me, 2009) in the now-empty box. 

The SSDI Work Activity Report (Form SSA-821)

If you receive SSDI benefits and then are able to return to work, you must notify your local Social Security office. They will want to track how much you earn at your job and determine when/if you earn too much to remain on SSDI.

The Work Activity Report (Form SSA-821) is how Social Security keeps tabs on your earnings. I got one in the mail a few days ago. And like any other gem from the Social Security office, this one requires that I complete the form and return it in no more than 15 days. 

Interestingly, when I called my Social Security office last February and told them I was returning to work, they asked me to send my pay stubs to them once a month so they could track my earnings. So why do they need a form that asks me to write down how much I've earned each month that I've been working?!? Don't they have that information? (They must have brain fog, too! Arrgh.) 

Unlike most Social Security forms, this one is pretty straightforward. You tell them who you have worked for since returning to work, and explain how much money you have made (pre-tax earnings per month). If you have spent your own money for equipment or transportation that makes it possible to work with your disability, you will need to explain that on the form as well. (These are called "impairment-related work expenses," or IRWE. Learn more: Impairment Related Work Expense, from the Work World website, published by the Employment Support Institute at Virginia Commonwealth University.)

Social Security asks for your earnings information to determine if you have entered a "trial work period", or TWP, which occurs when your earnings reach a particular level (in $2008, that level was $670 per month or more; in 2009, that level is $700 per month or more). Entering a TWP puts you on the path to having your SSDI benefits terminated (eventually... read on). 

You can have 9 months of TWP-level earnings while still receiving SSDI benefits. After 9 months, you enter a 3-month grace period in which you still receive SSDI benefits. The grace period constitutes the first 3 months of a 3-year extended period of eligibility, or EPE. During the EPE, you will receive an SSDI payment for any month in which your earnings fall below a level called "substantial gainful activity," or SGA. (For 2009, you achieve SGA by earning $980 per month or more.) If at the end of the EPE, you are still earning money at the SGA level, you will be terminated from the program altogether. 

IRWE allow you to effectively get around the SGA earnings cap in some situations. As the Minnesota Work Incentives Connection's Impairment Related Work Expense page explains (better than I could):

"If you receive Social Security Disability Insurance (SSDI), you are usually ineligible for a benefit check if you earn more than the Substantial Gainful Activity (SGA) level.  With an approved IRWE, SSA doesn’t count earnings you use to pay for certain expenses, which allows your SSDI benefits to continue even though you are earning more than the SGA level."

Additional Resources:

SGA - SSDI, from the Work World website.

SSDI Work Incentives, from the Work Ability website (a project of the Utah Work Incentives Initiative) 

SSDI Work Incentives, from the Work World website.

Work Activity Report - Employee, from the Survivorship A to Z website, has some tips for completing the Work Activity Report (SSA-821). 

Get Your Medical Life Organized in 2009: What to Keep, Toss, and Record

It’s easy to get buried under an avalanche of medical appointments and paperwork, especially if you have one or more chronic conditions that require regular care. Who did you see? When? What did they tell you? Did insurance pay for the visit? Did you pay for the copay while you were there (where is that darn receipt)?

The questions get even more complicated if you are preparing for a major surgery, are planning to change insurance plans this year, or will be applying for short-term, long-term, or Social Security disability income. How many doctors have you seen in the past year to treat your condition? What is the contact information for all of them? Did you get insurance preauthorization for that big surgery? When did you last see your surgeon post-op?  Which of your health insurance plans was active when you saw the surgeon the last time?

This is the year to get your medical life in order, so these questions never catch you unprepared again. I’ve developed an informal system for tracking and recording medical information and paperwork. I hope you can use some portion of it to get your own medical life pulled together this year.

First, understand what information is valuable and what can be let go of. (In my next post, I will explain how I organize the stuff that's worth keeping.)

Keep

• Benefits information - information from your employer or other insurance provider about your health plan, coverage limits, copays, network, customer service information, etc.


• Bills


• Doctor's business cards


• Explanation of benefit (EOB) statements


• Insurance cards - for older insurance plans you might have held earlier in the year (keep your current insurance card in your wallet)


• Prescription receipts – the little labels or slips of paper included with your prescription that show the prescription name, number, pharmacy information, copay, etc. See sample prescription receipt from Opus Health. (Don’t peel the label off your prescription bottles – there should be a duplicate in your paperwork.)


• Prescription reorder forms  - for mail-order pharmacy refills


• Proof of payment - receipts showing payment for office visit copays; and cancelled checks, bank statements, or online confirmation statements showing proof of payment for medical bills


• Referrals - keep a photocopy of any referral form so you can send it to insurance if billing issues arise


• Completed records request forms (so you can answer your own question when you say “Those records haven’t arrived yet. How long ago did I request them?”)


• Other – signup forms for participation in research studies, etc.

Why do you want to keep all of these things? So you know how to contact your doctor, understand how your insurance should work and can resolve any billing problems when they occur, know which insurance plan (with which member ID) was in effect on which date, can reorder your medications, know what information you are owed (records, etc.), and can easily complete a year-end tally of medical out-of-pocket expenses when you do your tax returns.

Toss

• HIPAA Privacy practices booklets - Every medical office gives you a Notice of Privacy Practices booklet when you visit for the first time. (They are required to do so by law; see Notice of Privacy Practices for Protected Health Information [45 CFR 164.520] for more information.) Recycle it. If you need to view a copy of it at a later date, call and ask the doctor’s office to send you one again. (If the person answering the phone gives you a hard time about it, ask to speak to the HIPAA Compliance Officer. This person might also be called the HIPAA Coordinator or HIPAA Privacy Officer.)


• Meaningless hospital agreements - Every time I visit Johns Hopkins Hospital, I have to sign a form that warns me to pay attention to my personal belongings while on hospital property. I don’t need a copy of that in my file drawer.


• Assignment of benefits forms - You will often need to sign paperwork that says you authorize the doctor’s office to bill your insurance for the doctor’s appointment. (You assign your benefits to them. See a sample form from National Biological Corp.) Of course you want this to happen. You don’t need a copy of this in your file drawer, either.

Track/Record

• Appointments – who, where, when (track for doctor’s appointments as well as any x-rays, tests, bloodwork, etc.)


• Contact information for all doctor’s offices – address, phone, fax, email, etc.


• Notes about your medical appointments – what did you discuss, on what date? When do you need to see the doctor again?


• Prescription information – name, dose, frequency for all medications you take. See sample Individual Medication History Form, from the Virginia Society of Health System Pharmacists.


• Past medical history – basic information about past surgeries, medical procedures, illnesses, and other health conditions   


• Referrals/Preauthorizations – when was a referral ordered, to which doc, for what reason? How many months or visits was it good for? When did you use those visits? (See sample referral request form - the Maryland Uniform Consultation Referral Form.) When was the preuathorization for that big surgery approved? By whom?

Why do you want to track all of this stuff? So you can remember what happened at your last doctor's appointment and follow-up accordingly; tell any disability insurance examiner exactly who you saw, when, over what period of time, for what issue, and how the disability examiner can contact that doctor to verify your information; understand when/if you need to request a new referral before seeing a doctor or a new preauthorization before you have a procedure done; and spend your doctor's appointments talking about your present symptoms rather than struggling to remember what prescriptions you take and what health issues run in your family.

All or Nothing, vs. the Messy Middle

America seems to be an "all or nothing" kind of place. You're a patriot or a terrorist, you're "hot, or not," you're in or out, you're sick or well. And there's a sense that if you're aren't going to be the best at something, why even bother? (A mindset that brings perfectionists and procrastinators into an uneasy truce.)

But we all know life is more complicated. I can be eligible for SSDI and still be willing and able to work part-time. I can look healthy and vibrant (I'm 5' 9" tall and a lithe 145 pounds, with no gray hair yet) and still be that same person who has more than one chronic illness. I can be a smart person who works hard at her job, but with mixed results (in my most recent performance review, my boss told me my writing is "still good, but not as outstanding as it was" before I went on medical leave). 

I also find this all or nothing mindset cropping up in my marriage over and over... my husband takes an idea to extremes (let's buy an RV so we can take a two-week cross-country vacation this summer), and I say "No, I think that's not a great idea." He's the all, and I'm the nothing. ;) This is really unproductive in our relationship, and I realized last night that the answer, the happiness, the peace lies somewhere in the messy middle--let's rent an RV for a short weekend escape and see how we like it. Rather than debating our ideas over and over in an endless stalemate (he sees RV travel as this awesome lifestyle, I see it as a major headache), let's actually put them into action in some small way. Let's try a little dose of reality and see what happens. 

I think that to live successfully with a chronic illness, we have to give ourselves permission to step into the messy middle of our present lives. We have to give up the idea that we can do everything perfectly, the way we did before we were healthy. (That's the all.) We have to give up the idea, too, that if we can't do things really well, we might as well stay home and be sick. (That's the nothing.) We have to step into the contradictory mess that is our lives at the moment. There is so much fun, excitement, love, happiness, and peace at our fingertips, ripe for the taking. And yes, it's almost certainly going to be paired with equal measures of turmoil, angst, awkwardness, embarrassment, and even failure. That's just part of the deal. 

I'm having a hard time muddling through the messy middle of my life right now... I'm not great at my job (just OK), I'm not the most exciting person to be around, I'm not a terrific housekeeper, I'm not even a great lover. But I'm having so much fun... doing things just to do them (try a new recipe, take on an assignment at work, learn a new way to exercise) is so freeing. And every now and then, I surprise myself and do something really, really well. And when I don't, I can laugh (eventually) and move on.