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W. Orange, NJ 07052
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Summit, NJ 07901
Bayonne, NJ 07002
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Clark, NJ 07066
Robert J. Rubino,
Audrey A. Romero, M.D., F.A.C.O.G.
Jacqueline Saitta, M.D., F.A.C.O.G.
Allan D. Kessel,
Priya R. Patel,
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"I didn't know that!"
Elizabeth Blackwell was the first woman in the U.S. to receive a medical degree. She received her MD from the Medical Institution of Geneva, New York, in 1849.
March is an important month. Not only is March 20th the first day of spring, but the month has been declared "National Women's History" month, "National Red Cross" month and "National Nutrition" month. In this issue, we address all three.
Our first article sheds some light on the new health insurance changes, authored by our
COO, Paul Francischetti
. We also discuss skin conditions during pregnancy and highlight the work of the Red Cross. In our Healthy Living section, we talk about the 6 essential nutrients our bodies depend on for proper functioning. And, you'll find a new interesting "Medical Fact".
As always, we will continue to provide topics that are current, informative and important to your good health.
Shedding Light on Health Insurance Changes
by Paul Francischetti, COO, The Rubino OB/GYN Group
The Affordable Care Act ("ACA"), also known as "Obamacare", has now become the law and has wide ranging implications on health insurance. The Act actually has little to do with the costs of providing health care. The majority of the law addresses the cost of health insurance to consumers and mandates that Americans purchase compliant health insurance policies. While few can argue with the goals of affordable health insurance and its availability, most of the debate on the ACA centers on how it achieves those goals.
This article is meant to address some basic questions about the new law and how it impacts your care with The Rubino OB/GYN Group. The implementation of the ACA will continue to evolve, as will the information in this article.
The widest impact of the ACA is that it requires Americans to purchase or obtain compliant health insurance. A compliant policy is one that meets the minimum requirements for health insurance coverage as defined by the government. The result of this requirement is that some Americans are losing their coverage since their policies are not compliant with the law. The ACA however, does not require insurance companies to cancel non-compliant policies; those companies that have canceled polices are merely choosing to do so based on the assumption that non-compliant policies are obsolete.
Americans who choose not to obtain health insurance at all, or to keep a non-compliant policy, are subject to a monetary penalty to be implemented through the tax code and enforced by the IRS. Thus the choice for the non-insured or under-insured (with non-compliant policies) becomes both economic and related to concerns in avoiding an investigation by the IRS. They must decide which option has the least fiscal impact:
- having no insurance at all
- maintaining a non-compliant policy and paying the penalty, thus attracting the attention of the IRS
- obtaining a compliant policy
Recognizing this dilemma, the ACA attempts to address it by setting up Health Insurance Exchanges where the non-insured or under-insured can obtain compliant policies (AKA "Obamacare Policies") that are initially subsided by the federal government through tax credits. These subsidies will be removed over the next few years, under the assumption that premiums for these policies will be driven lower due to a large pool of participants signing up (so far there is little evidence to support such a trend).
In addition, there is hope that by mandating coverage, large numbers of people who don't really need it or want it will sign up for compliant coverage, thus keeping premiums low (another way of subsidizing the premiums). The ACA also expands the availability of Medicaid policies to this group by openingthe eligibility criteria (the ACA funds the Medicaid expansion by reducing Medicare funding for seniors).
In New Jersey, three companies offer compliant policies through the Health Exchange offered by the government:
- Horizon Blue Cross Blue Shield
- Health Republic
The Rubino OB/GYN Group participates with these policies; however we still do not participate with Medicaid.
Most Americans whose health insurance is provided by their employer will be able to keep their policies if those policies are modified to be compliant.
Women's Health Issues
Some provisions in the ACA are directed to women's health issues, and therefore, will impact your visits with The Rubino OB/GYN Group. These provisions include:
- The Act mandates that compliant policies cover preventive care at no out-of- pocket cost to the consumer. In gynecological terms, this means your basic annual gynecological exam (which consists of a breast and pelvic exam and a Pap smear) will be covered every year if you have a compliant policy (every two years for Medicare patients) with no copay, coinsurance or deductible. If your doctors provide a somewhat more comprehensive annual exam (as is the policy at The Rubino OB/GYN Group) a small portion of the exam may still be subject to out of pocket costs depending on your individual policy; this remains unchanged by the ACA.
- In regard to pre-existing conditions, under the Act, if you apply for a compliant policy, you cannot be denied coverage for a pre-existing condition. For example, if you do not have insurance and become pregnant, or have a history of heavy menstrual bleeding, you cannot be denied access to a compliant health insurance policy. Also, services provided to you in connection with your pre-existing condition will be covered under a compliant policy, subject to whatever cost sharing provisions your policy has (i.e. copays, coinsurance, and deductibles).
- A third area involving women's health issues regards contraception. Compliant policies must cover contraceptive services provided by your physician, subject to your policy's cost sharing provisions (i.e., not "free"). It is important to note that the ACA does not mandate coverage for infertility. This is still an area that is subject to the individual parameters of your particular coverage. We encourage patients with fertility issues to closely check the provisions of their policies prior to receiving any services.
As the ACA is primarily concerned with preventive services, there is little in it that specifically addresses obstetric services, and gynecological services not considered preventive. These services remain subject to copays, coinsurance, and deductibles as defined by your policy. You may find, however, that these cost sharing provisions may result in higher payments than you have been used to prior to the ACA, especially if you purchase a Health Exchange policy.
Increase in Cost Sharing
Increase in cost sharing (how much you pay directly to the doctor versus your insurer) has been a trend in health insurance policies over the past few years and the ACA will no doubt accelerate that trend. Health Exchange policies may have even higher deductibles.
All policies offered through the Health Exchange feature deductibles. This is by design, as higher deductibles keep premiums lower,a result of patients paying more out of their pocket directly to the provider. It is important to be aware that it can become a hidden cost to those who need to use their policies for other than preventive services.
This trend of higher copays, deductibles and coinsurance has both short term and long term implications for your relationships with your doctors.
- In the short term you will notice (and probably already have) that you are receiving more frequent and costlier bills from your doctors than you have in the past.
- In the long term you will begin to see more doctors requiring upfront payments, before services are rendered, to offset the delays and difficulties of collecting fees from consumers that used to be paid directly by health insurers. This may become one of the most significant unintended consequences of the ACA, and is certain to have an impact on your relationship with your doctors over time.
There is certainlymuch more to cover about the ACA and its implications on both your health care and your pocket book. We encourage you to understand the ramifications of the ACA and how it directly impacts you. As always, the billing staff at The Rubino OB/GYN Group is available to help with specific questions you have regarding your coverage for OB/GYN services and the billing statements you receive from our group.
| Skin Conditions During Pregnancy
During pregnancy, a woman's body goes through many changes that may affect the skin, hair and nails. Many of these are related to the skin, due to a surge in hormones, but will disappear after the baby is born. Common skin conditions include:
Dark spots, or hyperpigmentation, may appear on breasts, nipples or inner thighs which come from an increase in the body's melanin. Melanin is a natural substance that gives color to the skin and hair. More than 90% of women will get dark areas.
Brownish marks or tan patches that appear around the eyes, nose and cheeks are called chloasma or "mask of pregnancy". Time in the sun can make them darker. These patches are harmless and will usually fade a few months after delivery, but may not go away completely.
It is common for women to notice a faint, dark line running from their belly button to their pubic hair. This linea nigra is actually always there but darkens during pregnancy.
As your stomach expands rapidly during pregnancy, it may become stretched and start to scar. These stretch marks usually start as red/purple in color and then turn glossy and streaked in silver or white. It is common for most women to experience stretch marks on their stomach, buttocks, breasts or thighs by the third trimester. Although there are many products marketed toward relieving stretch marks, there is no proof these treatments work. It is common practice to apply oils and creams to lubricate the skin while it stretches to help prevent scarring.
Hair and Nail Growth
Hormone changes during pregnancy can cause a faster growth in hair and nails. Often hair will be thicker and hair growth will occur in areas that normally do not have hair.
The increase in the amount of blood in the body during pregnancy can cause changes in blood vessels. Tiny red veins known as spider veins may start to appear on the skin. These spider veins typically fade after pregnancy.
The weight and pressure of your uterus can slow blood flow from your lower body and cause the veins in your legs to become swollen, sore and blue. These varicose veins may also appear near the vagina and rectum.
PUPP or pruritic urticarial papules and plaques of pregnancy, occur in 1 our of every 200 pregnant women. They are small red bumps or hives on the skin that can cause itching or burn and sting and appear on the abdomen, legs, arms and buttocks. Your doctor can prescribe a cream if they are very uncomfortable. They typically go away after you give birth.
A skin tag is a small flap of tissue that hangs off the skin by a connecting stalk. Skin tags are benign (non-cancerous) and are usually found on the neck, chest, back, under the breasts, and in the groin. They are common in pregnant women and usually painless unless something rubs against them.
Cholestasis is the most common liver condition that occurs only during pregnancy. Symptoms include severe itching on the palms of the hands and soles of the feet that can also spread to the trunk of the body. Symptoms usually start during the third trimester but often go away a few days after delivery. Cholestasis may increase the risk of preterm birth. It can usually be diagnosed through a blood test.
Acne, psoriasis and dermatitis may also worsen during pregnancy.
If you have concerns about the conditions listed above, please make an appointment with one of our doctors.
Red Cross Month
March is Red Cross Month is an annual proclamation that began in 1943 with President Franklin D. Roosevelt and continues 70 years later. As a nationwide non-profit with a rich history spanning more than 130 years, the Red Cross depends on the generous contributions of time, blood and money from the American public to support its lifesaving services and programs.
In 1906 a largely ceremonial office of president was added to the Red Cross leadership. In 1913, President Wilson agreed to serve in this role. This began a tradition that continues today whereby the president of the United States serves as honorary chairman of the American Red Cross.
The American Red Cross responds to nearly 70,000 disasters big and small in this country every year. It provides 24-hour support to members of the military, veterans and their families - in war zones, military hospitals and on military installations around the world; collects and distributes about 40 percent of the nation's blood supply and trains millions of people in first aid, water safety and other life-saving skills.
During Red Cross Month, the American Red Cross is recognizing the country's everyday heroes - heroes who reach out to help people in need.
Red Cross Month is a great time to become part of the Red Cross. You can become a Red Cross volunteer, give blood or a donation. The Red Cross also offers classes in CPR, lifeguarding, babysitting training, nurse assistant training and instructor training.
Dr. Rubino is a board member, volunteer and sponsor of the Summit Colonial Chapter of the Red Cross for several years.
The Red Cross "Celebrate Red!" gala is on April 3rd at The Park Savoy Estate in Florham Park. For more information or to buy tickets click here.
For more information on how you can get involved with the Red Cross, go online to your local Red Cross chapter.
Healthy Living: Nutrition Month
There are 6 essential nutrients our bodies depend on for proper functioning: Water, Carbohydrates, Protein, Fats, Vitamins and Minerals.
Water is the largest single component of the body. Up to 60% of our bodies are made up of water. Muscle holds the highest concentration of water while fat tissue holds some of the lowest amounts.
The amount of water a person has in their body varies based on their proportion of muscles to fat tissue. Water has a variety of functions that are essential to life:
- Regulates your body temperature
- Transports nutrients in our bodies
- Flushes out waste
- Helps our immune system and brain
- Helps your joints work
As little as a 5-10 % loss can cause dehydration. When you are thirsty, it's a sign your body is already dehydrated.
Carbohydrates provide the energy we need for physical activity and organ function.
- Our bodies break down carbohydrates in order to make glucose (the end result of carbohydrate digestion) for energy
- Carbohydrates are necessary for the normal metabolism of fat
2 Types of Carbohydrates
- Complex Carbohydrates / "Good Carbs" = starches like cereal, bread, beans, potatoes, and starchy vegetables. Good carbs are fiber-rich carbohydrates, like those found in many complex carbohydrates. Good carbs are absorbed into our systems more slowly, which helps us avoid escalations in blood sugar and provide a lasting form of energy.
- Simple Carbohydrates / "Bad Carbs" = milk, fruits and some vegetables are natural, simple carbs and are still healthy because they are rich in other nutrients such as vitamins, minerals and fiber. Bad carbs are foods that are refined or processed, such as white rice or white bread, and foods with added sugar such as desserts, candy, soda and sugary cereals. They offer little nutritional value, while adding extra calories to our diet; making them "empty" calories. Empty calories contribute to excessive weight gain and other associated health risks.
After water, proteins are the most abundant substances in most cells. It is what our body's tissues are made up of...our muscles, organs, immune system and, our hair, nails and skin. Protein builds strong muscles and repairs your body.
What foods have protein?
- Protein is made up of amino acids...there are 20 amino acids, of which 9 are essential, which means the body can't produce them on its own so you have to get them from food.
- Protein is found in milk, eggs, peanut butter, chicken, fish, meat, yogurt, cheese, legumes, nuts, seeds and grains
Fats are necessary for our body to survive - they transport fat-soluble vitamins and form cell membranes. Fat is also the coating under our skin and in our organs to insulate and protect our bodies. Fats are the major stored form of energy in the body. Some fats are really good for us and some are not so good:
- Good Fats (polyunsaturated and monounsaturated - the healthiest): olive oil, nuts, milk, olives, avocado
- Bad Fats (Saturated): butter, beef, pork, fried foods, mayo
- Trans fatty acids (the most unhealthy): manufactured during food processing (ie. hydrogenated fats)
Vitamins are non-caloric, organic compounds that help our bodies grow, maintain and repair. There are two types of vitamins:
- Fat-soluble: Vitamins A, D, E and K - can be stored in the liver. Therefore, an overdose on these vitamins can lead to toxic levels in the body.
- Water-soluble: not able to be stored - they are excreted by the kidneys.
Minerals are inorganic compounds that assist processes and are part of the structures of the body (iron in blood and calcium in teeth and bones).
The body best absorbs vitamins and minerals when provided through natural sources than pill form. Eating food triggers satiety, which prevents consuming toxic levels of nutrients, something pills can't do.
|Video for The Rubino OB/GYN Group |
We recently completed a new video for the practice that provides an overview of our services, doctors and philosophy. The video can be viewed on the home page of our website:
We hope you enjoy seeing the practice on a more personal level and welcome your feedback! Simply reply to this newsletter.
|Office Announcements |
Dr. Howard Fox Retires
Dr. Fox will be retiring as of March 14th. His office hours in Clark will be covered by Dr. Huang and Dr. Patel. Appointments are also available in West Orange, Summit and Bayonne. Please join us in wishing Dr. Fox a fond farewell.
The Rubino OB/GYN Group is now offering vitaMedMD™ in all 4 office locations. VitaMedMD offers patients high quality physician recommended products at an affordable price. Available products include Women's Multivitamin, Prenatal Plus, Prenatal One, Menopause Relief and Iron 150.
Emmi Video TutorialsEmmi is a free, online video tutorial that makes complex medical information simple and easy to understand. Emmi provides clear and concise step-by-step information on common health topics and procedures right on our website. Click here to find out more.
Save Time with Online Appointments, Consultations &Personal Health Records
To schedule online appointments, consultations or view your personal health records at your convenience, just visit the home page of www.rubinoobgyn.com. You can also call 973-736-1100 now to schedule an appointment at any of our four locations.
"Important Announcements" on Our Website
You can find important new developments and time-sensitive announcements (such as office closings) right on the upper right hand portion of our home page.
If you would like to add your business or service to the website,
please e-mail us at email@example.com.
Products Available on Our Website
For more information visit the products page on our website.