PREVENTING OSTEOARTHRITIS IN THE KNEE

WHAT IS IT?

Osteoarthritis is the medical term for the more common "arthritis" and refers to the general deterioration of cartilage that leads to damage on articulating surfaces of joints. 

Osteoarthritis can occur in any joint, some as small as the bones in the hand/fingers, and as large as the hip and knee joints. 

Preventing osteoarthritis in the knee, or delaying onset, is a lifetime practice, as many of the causes that lead to deterioration of bone articulating cartilage are due to overuse during youth, adolescence, and early adulthood. Other increased risks come from lifestyles, and habits that are typically formed at a younger age. 

INCREASED LIFESTYLE RISK FACTORS INCLUDE, BUT ARE NOT LIMITED TO: 

• Extremely active lifestyle, where the joints take a beating
  • Participating in physical activity that heavily load the joint, such as running, put large loads onto the body that continuously put stress on the cartilage and articulations of joints, running the articulation cartilage thin.
• Extremely sedentary lifestyle, where the joints receive very little to no load
  • Sedentary lifestyles tend to lead to a decrease in bone density, and a decrease in bone density leads to an increase risk of osteoarthritis
• Ligament, tendon, or cartilage tears
  • Tearing your ACL, MCL, and PCL all show an increase risk for early onset osteoarthritis, as the joint lacks stability, and therefore overloads cartilage 
• Misalignments
  • Having leg length discrepancies, wearing shoes that lack arch/medial support, etc. lead to increased pressure on one side of the body compared to the contralateral side, and results in deterioration of cartilage
• Musculoskeletal discrepancies
  • Having weak muscles on one aspect of the leg compared to the other leads to decreased stabilization in the knee, which leads to increased load on one aspect of the joint. 
  • This is the highest, non-impact cause that is correlated with an increased risk of developing osteoarthritis in both adults and children

WHAT CAN YOU DO? 

Prevention is key. Having musculoskeletal evaluations, leg length, joint alignment measured by a physical therapist prior to your child starting physical activity is key to identifying potential problems early. Children are resilient, physically, but those same joints may not be so quick to heal at age 40, and like wearing sunscreen, it's extremely necessary to attempt prevention at a young age. 

Preventative physical therapists, including us here at CHAMPION, can take your children, or even you through preventative programs to help decrease risk, delay onset, or even delay surgical repair. 

TIPS TO RECOVER FROM A WORKOUT

Proper recovery following a workout is as essential as the workout itself. Whether you are beginning to work out for the first time or are altering your regimen, proper recovery is crucial to sustaining a long-term workout plan.

Why It's Important:

During exercise, the body undergoes a controlled amount of stress. Tissues in our bodies need this stress in order to improve their function and your performance. In fact, when you exercise, your muscles actually undergo “micro-trauma” due to the imposed demand of your activity. Recovery is your chance to build yourself back up stronger than before; it is the link between short-term, immediate benefit and long-term, lasting outcome.

The following tips can help you attain maximum benefit from your workout and reduce the risk of developing an injury.

Stretching

Stretching is an important part of recovery, but it rarely receives the time or attention it deserves. The purpose of stretching is to maintain the flexibility of tissues that are tight or stiff from an activity or prolonged position.

There are a variety of methods of stretching (using the hamstring muscle as an example):

• Static/Isolated Stretching: Static, or isolated stretching is holding a stretch position for a long period.  (Example: A static hamstring stretch would be when you sit on the ground with one leg pointing outward and you simply reach for your toes and hold for at least 30 seconds.)
• Dynamic stretching: Dynamic stretching is using movement to combine muscle groups. (Example: A dynamic stretch for the hamstring would be walking toe touches, as you bend down and grab your toe with every step for 2 to 3 seconds.)
• Foam Rolling: Foam rolling is a type of self-mobilization and massage. (Example: To foam-roll the hamstring muscle, you will simply put a foam roller under your legs and let your weight rest on top so the foam roller will push out any knots in your hamstring.)

A very general rule for stretching is dynamic stretching before exercise, static stretching after exercise, and foam rolling throughout. Utilizing various stretching strategies will allow you to maintain and improve your mobility.

Refueling (Hydration and Nutrition)

Proper fueling before exercise is important to optimize performance, but nutrition for recovery from exercise is often overlooked. Our bodies rely upon a well-balanced array of nutrients, vitamins, and minerals to aid in rebuilding the parts of our body that have been stressed during exercise. Refueling after a workout with a well-rounded set of carbohydrates, proteins, and healthy fats will help your body reap the most benefit from your hard effort

Water is also absolutely essential to overall health. In particular, following exercise, proper hydration is key to replace the fluids that you have lost during your activity. Water also helps regulate your temperature, maintain healthy joints, and eliminate wastes that build up in your system during activity. Pay special attention to your total water intake if you are exercising in extreme hot or cold climates or if you feel as though you may be getting sick. Make a habit of keeping a water bottle in your purse, gym bag, car, or workplace for easy, reliable access.

RICE

RICE stands for Rest, Ice, Compression, Elevation. If you find yourself having pain or swelling following exercise, particularly in a joint like your knee, ankle, or shoulder, you may consider using this four-part strategy to decrease inflammation and pain. If you continue to have symptoms several days following a workout, it may be important to seek the advice of a healthcare provider to further examine your complaints..

(See "The Difference between Soreness & Pain During Exercise" for more detailed information.)

Listen to Your Body

The only person who knows how your body feels after a workout is you. Allow yourself to listen to your body, and appropriately. This includes recognizing the signs of fatigue, pain or soreness and increasing recovery time between exercise bouts. This may also mean pushing yourself to work harder when you feel well. Don’t succumb to peer pressure at the gym. Trust yourself and what your body is telling you. When you are starting a new exercise program, don’t be afraid to ask your physical therapist for helpful hints on how your body may give you feedback after exercise, and how you should respond to that information.

Cross Training

Even if you love to run, your body may not like you running seven days a week. No matter what your exercise of choice may be (walking, running, swimming, cycling, weightlifting, yoga, recreational sports, etc.), you may considercan benefit from finding another form of exercise.

Cross training doesn't require a special shoe. It’s simply about challenging your body with different tasks so that certain tissues are not over-stressed, which often leads to overuse injuries. For example, a swimmer will benefit from strength training in addition to the hours spent in the pool in order to build different muscle groups and allow momentary rest for those that are used repetitively in the pool. Remember to do the exercises your body needs, not just the exercises you want to do. A physical therapist can help you determine where you have deficiencies or might be at risk for overuse injuries based on your workout regimen.

Planning Ahead

When life is busy, it’s hard to schedule enough time in your day to workout at all, let alone take care of yourself afterward. Try to plan your day or week so you have adequate time following each workout to implement the strategies above. This way you won't feel as rushed and cut out important recovery activities.

Sleeping

Often taken for granted, sleep is your body’s prime opportunity to recover.

When the body is at rest, the repair of our muscular, cardiovascular, skeletal, and immune systems can go to work. The CDC recommends that, in general, teens have 9-10 hours and adults 7-8 hours of sleep each day. These guidelines are especially important if you are demanding more of your body through regular exercise or stressful daily activities.

To get the most out of your shut-eye, strive for consistent bedtimes, avoid stimulating activities in bed (like TV and electronic devices), and a comfortable environment. You may find that you sleep better on days that you exercise, and will definitely notice a more effective, pleasant exercise experience if you are giving your body the rest it needs and deserves.

Fortunately, not only is your physical therapist trained to design an individualized exercise program for you, but she will also provide guidelines and strategies to ensure that you recover in the most effective way.

THE FEMALE ATHLETE TRIAD

The "female athlete triad" is a term used to describe three distinct but interrelated conditions, including, low energy availability, menstrual dysfunction and low bone mineral density. Low energy availability is a term that is used to describe the condition that occurs if a female has low stored energy (low body weight for height), and/or low energy intake (insufficient calorie intake) and/or high levels of energy expenditure (lots of physical activity and/or exercise). The state of low energy availability can result in disruption of the normal menstrual cycle or delay the onset of a female’s first menstrual period. This is referred to as delayed menarche. Delayed menarche is defined as not having had your first menstrual period by age 15. In those females who have had their first period, but have low energy availability, their periods may get farther apart, or they may go away completely. Periods that occur every 35-90 days are referred to as “oligomenorrhea”. Periods that are farther than 90 days apart, or completely absent, are referred to as “amenorrhea”.

Low energy availability may occur unintentionally as a result of inadequate dietary intake relative to very high levels of exercise training. More often, it occurs as a result of intentional dietary restriction in the setting of disordered eating or an eating disorder such as anorexia nervosa or bulimia nervosa. A number of health problems can occur as a result of low energy availability leading to disrupted menstrual function. Infrequent or absent menstrual periods can result in low estrogen levels in the blood, which in turn leads to lower than expected bone mineral density. Amongst athletes, especially those that perform a weight bearing and/or impact sport like long distance running or basketball, the combination of these activities and low bone mineral density increases the likelihood of getting bone stress fractures. Stress fractures are serious injuries and can be a season ending and in some, a career ending injury.

Any female athlete is at risk for the female athlete triad. However, athletes who participate in aesthetic sports like gymnastics, figure skating, diving and dance, or in sports where leanness confers a competitive advantage like long distance running, are more likely to be affected by any component of the triad. We recommend that female athletes in high school and college undergo yearly preparticipation screening with a team physician or sports medicine physician who screens for the triad with the questions listed in Table 1.

Table 1: Female Athlete Triad Preparticipation Physical Evaluation Questions

• Have you ever had a menstrual period?
• How old were you when you had your “first menstrual period ?"
• When was your most recent menstrual period?
• How many periods have you had in the past 12 months?
• Are you presently taking any female hormones (estrogen, progesterone, birth control pills)?
• Do you worry about your weight?
• Are you trying to or has anyone recommended that you gain or lose weight?
• Are you on a special diet or do you avoid certain types of foods or food groups?
• Have you ever had an eating disorder?
• Have you ever had a stress fracture?
• Have you ever been told you have low bone density (osteopenia or osteoporosis)?

Athletes identified as having any one component of the triad, should be carefully screened for the other aspects. While disruption of the menstrual cycle is a relatively common consequence of low energy availability, it’s important to make sure that other conditions are not resulting in menstrual disruption, specifically pregnancy and thyroid disease. Similarly, there are other conditions that can result in lower than expected bone mineral density. These conditions should be considered by a healthcare provider when evaluating an athlete with low bone mineral density.

Comprehensive evaluation of the athlete affected by the triad includes a physical and laboratory evaluation by a healthcare provider. Usually, an evaluation of dietary intake by a registered sports dietitian, and oftentimes an evaluation by a mental health professional, is done, especially if there is evidence of disordered eating or an eating disorder. Bone mineral density is often assessed using a tool called a dual-energy x-ray absorptiometry (DEXA)scan. The DEXA scan provides a number of scores. In the high school, college and young adult female, the “Z-Score” is used to make clinical decisions and NOT the “T-Score”. A Z-Score greater than 0 is normal. A Z-Score between -1 and 0 is still considered normal, but in the setting CONTINUED FROM PAGE 1 of the Triad should prompt discussion about the relationship between low energy availability, menstrual function and bone health – this is especially true if a prior DEXA is available for comparison and was previously greater than 0. A Z-Score between -1 and -2 in a weight bearing athlete is concerning and would indicate that bone health has been negatively affected. A Z-Score less than -2 indicates significant bone loss. Treatment of the triad should be focused on establishing adequate energy availability to meet energy demands of exercise, activities of daily living and in the younger athlete, growth. Although every person’s energy (or calorie) needs are different, research has found that achieving energy availability of 45 kilocalories per kilogram of fat free mass per day is associated with regular menstrual cycles. Fat free mass can be calculated (by measuring body fat percentage) or estimated. An example of this is provided in Figure 1.

Figure 1 : Calculating Energy Availability to Achieve Menstrual Regulation

18 years old
120 lb female
120 lb ÷ 2.2 = 54.5 kg
18% body fat
Fat Mass = 54.5 X 0.18 = 9.8 kg
Fat Free Mass = 54.5 – 9.8 = 44.7 kg
45 kcal X 44.7 kg = 2011 kcal/day

In this example of a 120-lb 18-year-old female, she would require 2011 kcal per day to support healthy reproductive function. A recent paper (2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad) written by members of the Female Athlete Triad Coalition, and published in the British Journal of Sports Medicine, Clinical Journal of Sports Medicine and Current Sports Medicine Reports, and endorsed by several medical professional societies also outlines the use of medications that may be considered in the treatment of women and girls who are affected by the Triad. However, it bears repeating that the primary treatment efforts should be focused on achieving adequate energy intake and adequate stored energy relative to energy expenditure. Medications such as birth control pills to initiate or regulate menstrual function should be used in those cases as outlined in the consensus statement.

The consensus statement also provides physicians with guidance regarding clearance and return to play for athletes affected by the triad. The paper developed a “Magnitude of Risk” tool that includes known risk factors that can be identified and scored leading to Risk Stratification and Recommendations. The risk factors included in this tool include: 1) presence or history of an eating disorder or disordered eating; 2) Current body mass index (BMI); 3) Age of first menstrual period; 4) Number of menstrual periods in the past 12 months; 5) Bone mineral density as measured by DXA scan; 6) History of bone stress fractures or stress reactions. Using the Magnitude of Risk and Risk Stratification tools, a physician can then inform the athlete where she lies on the continuum, and develop a plan to achieve health and guide safe participation in sports or exercise. In conclusion, exercise and sport participation improve health and quality of life for females of all ages.

The female athlete triad can be a consequence of participation, the same way that knee injuries can be a part of football participation. We should not discourage females from participating in sport, instead we should screen for risk factors and the conditions that make up the triad, and treat it appropriately.

PT BEFORE SURGERY

Yes, please! 

Mild meniscal tears and moderate knee osteoarthritis send some people under the knife, when all they really need is physical therapy.

A recent study in the New England Journal of Medicine found no significant difference between individuals who received surgery and those who received physical therapy alone, thus avoiding the unnecessarily invasive procedure and related costs.

Dr Edward Laskowski, codirector of the Mayo Clinic Sports Medicine Center, told Men's Journal that physical therapy might prove equally effective for other knee injuries, including MCL, PCL, and cartilage tears (Try Physical Therapy Before Surgery - April 29, 2013).

"If you have good range of motion, physical therapy may very well settle down the symptoms over time," Laskowski said.

In a May 2, 2013, episode of Move Forward Radio, the lead physical therapist in the trial discussed the findings of the study.

Learn about physical therapist treatment of meniscal tears and osteoarthritis of the knee.

RECOGNIZING CONCUSSIONS IN STUDENT ATHLETES

A concussion is a mild traumatic brain injury caused by a direct blow to the head, face, or neck. In the United States, an estimated 300,000 sports-related concussions occur annually.

In high school gender-comparable sports, girls have a higher concussion rate than boys. Female athletes have also been shown to have a greater recovery time in postconcussion symptoms as compared to males.

Signs of a Concussion

Concussion symptoms usually appear within minutes of the injury; however, some symptoms may take several hours to occur. Any athlete who has lost consciousness during a sports-related impact should be examined for a concussion or a spine injury. A headache is the most common complaint of an athlete with a concussion. If you suspect your child has suffered a concussion, they may exhibit the following symptoms, which may worsen with stress or activity:

• Loss of consciousness
• Headache
• Feeling in a “fog”
• Difficulty remembering
• Behavioral changes (irritability, rapid changes in mood, exaggerated emotions, aggressiveness, depression, decreased tolerance to stress, etc)
• Nausea/vomiting
• Difficulty with balance
• Pupils that are enlarged or not equal in size
• Double or blurred vision
• Slurred speech
• Difficulty falling asleep
• Excessive drowsiness

What to do if you suspect a concussion in an athlete:

• Do not allow them to return to any sporting event. 
• The athlete should be allowed to rest until there is a resolution of symptoms. This allows the brain to recover. Rest involves allowing time to sleep or take frequent naps. Minimizing distractions, such as television, Internet, reading, or phone use is important.  
• It is unnecessary to wake the athlete up every hour. This disturbs sleep patterns, which can interfere with the healing process of the brain.
• The athlete should avoid pain relievers, like aspirin or other anti-inflammatory medications. These may increase the risk of bleeding in the brain.
• The athlete should not be left alone following the injury. Symptoms should be monitored closely. If they worsen, the athlete may need to be evaluated in the emergency room to determine if a more serious brain injury exists.  

PT FOR ATHLETES

If you’re an athlete, you know that long periods of training followed by performing at peak levels can take a toll on your body. Whether you’ve experienced an acute injury or have become hurt as a result of overuse, the professional physical therapists from Champion Performance and Physical Therapy in Prairie Village, Kansas can help you get back in the game with their effective sports physical therapy programs.

If you’re an athlete considering sports physical therapy, take a look at some of the ways in which you could benefit from treatment at Champion:

• Less Downtime: Sports physical therapy helps athletes regain muscle strength without damaging the injured area further. This will help you proactively work to repair injured tissue and get back to your training or active recovery period faster and with less downtime.
• Better Odds For A Full Recovery: Instead of letting an injury “ride its course,” physical therapy takes a proactive approach to healing and thus increases your odds of making a complete recovery. Under the care of a physical therapist, you’ll also know exactly when you can resume your normal activity levels again, whereas athletes who don’t seek physical therapy often try to do too much too soon and risk re-injuring themselves.
• You’ll Receive Tailored Treatment: Some athletes make the mistake of trying to rehabilitate their injured body part on their own, but this approach overlooks the fact that each body and injury is unique. The professionals at Therapy Works utilize a number of different treatment methods and have the skills, knowledge, and experience to tailor their sports physical therapy program to the unique needs of each patient.

Click on the contact information tab on our website menu for a full list of contact options. 

www.kcchampionperformance.com

WHAT EXACTLY IS A PHYSICAL THERAPIST?

As described by the American Physical Therapy Association

Physical therapists (PTs) are health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.

PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

Physical therapists provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a physical therapist practices.

The Physical Therapy Profession

Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. Physical therapists:

• Diagnose and manage movement dysfunction and enhance physical and functional abilities.
• Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health. 
• Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.

The terms "physical therapy" and "physiotherapy," and the terms "physical therapist" and "physiotherapist," are synonymous.

As essential participants in the health care delivery system, physical therapists assume leadership roles in rehabilitation; in prevention, health maintenance, and programs that promote health, wellness, and fitness; and in professional and community organizations. Physical therapists also play important roles both in developing standards for physical therapist practice and in developing health care policy to ensure availability, accessibility, and optimal delivery of health care services. Physical therapy is covered by federal, state, and private insurance plans. Physical therapists' services have a positive impact on health-related quality of life.

As clinicians, physical therapists engage in an examination process that includes:

• taking the patient/client history,
• conducting a systems review, and 
• performing tests and measures to identify potential and existing problems.

To establish diagnoses, prognoses, and plans of care, physical therapists perform evaluations, synthesizing the examination data and determining whether the problems to be addressed are within the scope of physical therapist practice. Based on their judgments about diagnoses and prognoses and based on patient/client goals, physical therapists:

• provide interventions (the interactions and procedures used in managing and instructing patients/clients),
• conduct re-examinations,
• modify interventions as necessary to achieve anticipated goals and expected outcomes, and
• develop and implement discharge plans.

Physical therapy can be provided only by qualified physical therapists (PTs) or by physical therapist assistants (PTAs) working under the supervision of a physical therapist.

FALLS ARE COSTLY IN MORE WAYS THAN ONE, BUT -

THEY CAN BE PREVENTED.

One-third of adults over the age of 65 are likely to fall this year, according to data from the Centers for Disease Control (CDC), and they probably won’t be the only ones harmed.

"It's important to realize that falls among older persons, with their staggering physical, emotional as well as economic consequences, have the potential to impact not only patients, but all members of a family,” Robert Glatter, MD, wrote in Forbes (“Why Falls Should Be Part Of The Doctor-Patient And National Conversation For Older Persons” – July 28, 2015).

Falls cause everything from scrapes and bruises to broken arms, and 95% of hip fractures. Indeed, with falls leading to more than 700,000 hospitalizations per year, related medical costs exceed $30 billion.

The good news is that research shows that older adults can proactively prevent falls and their dangerous consequences with the help of a physical therapist.

A systematic review of randomized controlled trials ("The effectiveness of physical therapist-administered group-based exercise on fall prevention: a systematic review of randomized controlled trials” – October-December 2013) demonstrated that group-based exercises led by a physical therapist are effective for decreasing fall frequency, increasing balance, and improving quality of life. The results also suggested the group-based exercises promoted greater patient satisfaction and exercise adherence. Additionally, physical therapists can evaluate a person’s fall risk and create an individualized plan to improve your balance and strength.

HAMSTRING INJURIES RESPOND BETTER TO EXERCISE, ACCORDING TO APTA

Platelet-rich plasma injections might sound like cutting-edge treatment for hamstring injuries, but according to the APTA, a 2012 systematic review of 10 randomized clinical trials indicates that rehabilitation exercises actually have a superior effect on acute hamstring injuries (“Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis” – July 21, 2015).

Specifically, lengthening exercises and progressive agility and trunk stabilization exercises have been identified in previous studies as appropriate “for daily practice” to treat acute hamstring injuries. However, the authors of the above study discourage the use of platelet-rich plasma injections, in which a patient’s own platelet-enriched blood is injected into an injured part of the body with the intent to promote healing, finding that the injection is ineffective.

Hamstring injuries are one of the most common lower body injuries, particularly affecting athletes participating in sports, such as football, soccer, or track. After tearing a hamstring muscle, a person is 2 to 6 times more likely to suffer a subsequent injury. Participants from the reviewed studies were all associated with sports.

Physical therapists can design individualized treatment programs for hamstring injuries that may include range of motion, muscle strength, manual therapy, and function training.

UNDERSTANDING HEALTH INSURANCE TERMS

Navigating your way through health insurance benefits can be a challenge. It is very important to understand the terminology especially when deciding which benefits will work for you and finding a plan that will best meet your needs. This brief glossary will provide insight for some of the more common terms when dealing with health insurance.

co-insurance: in indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.

co-payment: in managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars.

consumer driven health care (CDHC): refers to health plans in which employees have personal health accounts such as an health savings account, medical savings accounts or flexible spending arrangement from which they pay medical expenses directly.

deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.

denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons.

eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.

exclusions: services that are not covered by a plan.

flexible spending arrangements (FSAs): an account that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.

gatekeeper: in managed care, it refers to the provider designated as one who directs an individual patient's care. In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.

health maintenance organization (HMO): a form of managed care in which you receive your care from participating providers.

health savings account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

managed care: a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.

member: a term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.

non-participating provider: any health care provider or organization that does not have a contractual agreement with an insurance company to provide care to eligible patients for a contracted or discounted fee. Patients can receive services from non-participating providers if they have out-of-network benefits as a part of their insurance plan or if they wish to pay cash for the service but they will miss out on in-network discounts. (Same as "out of network provider")

open enrollment: a set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying event.

out-of-pocket: money the patient's pays toward the cost of health care services.

participating provider: a health care professional or organization that has a contractual agreement with an insurance company to provide care to eligible patients under certain defined conditions and often at discounted and/or contracted fees. (Same as "in network provider")

payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.

policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.

preferred provider organization (PPO): a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if member sees non-participating providers.

premium: the cost of an insurance plan shared by employer and employee.

provider: one who delivers health care services within the scope of a professional license.

reimbursement: refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.