Thursday, August 31, 2006
Patients should appeal those denied claims

By Dr. Anthony Policastro
Nanticoke Memorial Hospital
Medical Director

Patients will often receive letters of denial from their insurance company. There are two reasons that care may be denied. The first is that the particular service was not covered. This can happen in two ways. One of those ways is related to a service that is usually not covered by any insurer. Cosmetic surgery is an example. Rogaine for baldness is an example. Other drugs such as Viagra are examples. In addition certain conditions require separate insurance. They are not covered by medical insurance. Dental problems fall into this category. Mental health treatment falls into this category. In either one of these circumstances, the denial will not likely be overturned. If it is not a covered service, it cannot be paid for. An appeal of the denial is not likely to be successful. The second way has to do with a service that is covered. However, the insurer may feel that it is not medically necessary. In those cases, they will deny the service. Most of these situations are not clear-cut. It may be obvious that it should be covered. However, the insurer will say that it is not. These are the stories that make the news. In these instances, there is always an opportunity to appeal the decision. In fact most insurers have several levels of appeal. Unfortunately, there are a lot of patients who do not appeal. Suppose an insurance company denies 100 cases. Assume that half of the people appeal the denial. Then assume that all of those people get the service paid for after appeal. That still means that the insurance company does not have to pay the bill for the other half. The lesson here is that the appeal of a denial is important. There are times when the insurer will expect to pay the bill on appeal. However, if they do not get the appeal, they will not have to overturn the denial. They will not have to pay the bill. You should also exhaust every layer of appeal. For example the first appeal often just goes to the Medical Director. A second level of appeal will usually go to a panel of specialists in the area of the problem. They will likely look at things a little differently. It is important to remember that filing appeals is a part of healthcare. If you feel that your service should have been paid for, do not hesitate to do so.

Fit Fest September 9
Delaware Technical & Community College, Georgetown, will have a free, family-oriented health and fitness event underwritten by a grant from Carl M. Freeman Foundation. Professional staff from Bayhealth Medical Center, Beebe Medical Center, and Nanticoke Health Services will do personal adult health screenings for blood pressure, cholesterol, glucose, and bone density. Fitness activities for children and adults; health exhibits and information available on health-related topics. Prizes, awards, freebies; food available for purchase. Rain or shine. The date is Saturday, Sept. 9, from 10 a.m. to 3 p.m.

Memory Walk
The Alzhemier's Association, Delaware Valley Chapter, will be hosting the 2006 Memory Walk on Saturday, Sept. 30, in Rehoboth Beach. The walk will begin at 10 a.m. from Grove Park, with registration starting at 8:30 a.m. Alzhemier's disease affects more that 4.5-million Americans of every race, gender and culture. Up to 16-million American's will have the disease within 50 years, unless we find a way to stop it. The Chapter offers free programs and services to approximately 288,000 individuals with Alzheimer's or related dementia, and their caregivers, in the tri-state region. Put your best foot forward and join us for Memory Walk 2006. To support the Memory Walk 2006 register online at, or for more information contact the local office in Georgetown at (302) 854-9788.

Nanticoke Memorial Hospital to offer Family and Friend CPR Class
Nanticoke Memorial Hospital's Training Center will offer a community CPR classes to anyone interested in learning CPR on Saturday, Sept. 16, from 9 a.m.-noon, at the Nanticoke Resource Center, 620 W. Stein Highway, Seaford. Cost is $5. Proceeds to be donated to the American Heart Walk 2006. This program contains information on how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking. The course is open to anyone caring for infants and children, including family members, grandparents, siblings, new or expecting parents, babysitters and neighbors. This program is a fun, dynamic way for families, friends and communities to learn CPR but do not need a course completion card. To register or for further information contact the NMH Training Center office at 629-6611, ext. 8919. Pre-registration is required.

PSA screenings September 28
Nanticoke Health Services will provide PSA screenings on Friday, Sept. 28. The blood tests will be offered at the Nanticoke's Cancer Care Center * 1st Floor, adjacent to the hospital from 8 a.m. till 5 p.m. The fee for the test will be $5. Results will be mailed approximately two weeks after the event. Prostate cancer is the most frequently occurring cancer in men. Between 1980 and 1990, prostate cancer incidence increased 65 percent. It is believed that this increase was the result of improved early detection. There is expected to be a further increase related to the use of the prostate specific antigen blood test. Prostate specific antigen (PSA) is a substance that is produced by the prostate gland. Men normally have a small amount of this substance in the blood. PSA levels differ according to age and tend to rise after the age of 60. PSA can be affected by several conditions in the prostate such as the normal enlargement in the prostate, which occurs with aging. Infection or inflammation and surgery to the prostate can also cause increased levels. There is no specific level of PSA that tells whether prostate cancer is present; however the higher the level, the more likely it is that cancer may be developing. Nanticoke Memorial Hospital encourages men over the age of 50 to take advantage of this service. If you are 40-years-old and at high risk of developing this cancer you are also encouraged to participate. African-American men are at high risk for developing prostate cancer, as are men who have a family history of the disease. For additional information on the PSA screening contact the Cancer Care Center at 302-629-6611, ext. 2588.

NMH Auxiliary Membership Day
Sept. 13 has been designated Membership Day by Nanticoke Health Services Auxiliary. Members will gather at 11:30 a.m. at the Methodist Manor House on Middleford Road (next to Nanticoke Hospital) for luncheon followed by a business meeting. Guest speaker will be Debbie Holbrook, director of Forensic Nursing at Nanticoke. Ms. Holbrook, a registered nurse, has had extensive training in the field of forensic nursing, and is a leader in this growing area involving rime victims. Janet Hubbard, president of Nanticoke's Auxiliary, will preside during the business meeting and greet newcomers. Membership is open to those desiring to become a volunteer at Nanticoke. Callers will be contacting members. Luncheon of chicken marsala with veggies, salad and pie will cost $8.

Nanticoke hosting benefits for the American Cancer Society
Nanticoke Memorial Hospital will be hosting two fundraising events to benefit the American Heart Association Heart Walk. On Saturday, Sept. 30 "Pumping Up The Volume" concert will be held at the Seaford Middle School auditorium. The vocal talents of Nanticoke employees and their families are sure to entertain the crowd with sounds of Country, Rock 'N Roll, Contemporary Christian and Classical music. There will be music for everyone. Emcee for the evening will be WBOC's Jimmy Hoppa. Cost is $20 for admission. Tickets are available by calling the hospital at 302-629-6611, ext. 2550 or via email at The second fundraiser will be a Bingo on Thursday, Oct. 5, starting at 7 p.m. at the Seaford Moose, located on Rt. 13A in Seaford. The evening will consist of 20 exciting games and will feature several baskets Longaberger products as prizes. Advance tickets are $20 per person, $25 at the door. Advance ticket includes a chance to win the Large Hamper and the Autumn Treats set with Wrought Iron legs or one of the several door prizes. Nearly 30 chances to win. Refreshments will be available. For ticket information contact the hospital at 302-629-6611, ext. 2404 or via email at MorrisR¨ All proceeds for the two events will be donated the American Heart Association Heart Walk 2006. The AHA Heart Walk is the signature fund-raising event for the American Heart Association and the Heart Walk promotes physical activity and heart-healthy living in a fun family environment. This year more than one-million walkers will participate in more than 600 events across the country, raising funds to save lives from this country's No. 1 and No. 3 killers, heart disease and stroke.

NMH Jewelry fund raising sale
Fund raising "Jewelry Sale" in the Nanticoke Memorial Hospital Main Lobby, Thursday, Sept. 7, and Friday, Sept. 8, from 7 a.m.-4 p.m. Presented by InDesign and sponsored by the Nanticoke Health Services Auxiliary. It is open to the public. All items are $5 each (50 to 80 percent off department store prices). Cash, checks, credit cards and payroll deduction accepted.