Skin Cancer: The facts
• Skin cancers are common in our community due to our high altitude
• Changes in moles or wounds that do not heal require medical attention
• Prevention is important; if you work or play outside, sunblock is critical and should be reapplied every two hours
• These cancers don’t go away, they only get worse, and are harder to treat when ignored
Q. What is the largest organ in the human body?
A. The skin
Dr. George Linhardt
Your skin covers a large surface area and is subject to scrapes, cuts, sun, snow, hot sidewalks and spills of all types. It’s important that we don’t overlook our skin when considering our overall health.
Skin cancer is the most common form of cancer in the United States, and living in a high altitude, sunny environment puts us at a greater risk. Other risk factors include:
Sun exposure – spending a lot of time outdoors
Blistering sunburns – if you experienced several blistering sunburns as a child or teen
Skin color – if you have fair skin, blond, red or light brown hair, blue eyes or freckles
Artificial tanning – if you use tanning booths, beds or sunlamps
With all that we know about what can cause skin cancer, gone should be the days of baby oil , a book, and a day in the sun.
While there are several kinds of skin cancer, these can be divided into three common types:
Basal cell cancer – This type of cancer is locally aggressive, meaning if you leave it alone, it will just get bigger. It may not spread to other organs but may be become more and more difficult to treat, becoming unsightly, bleeding and disfiguring. Local excision (conservative surgical removal) is the usual treatment. Depending on the location, other approaches may be used such as medication or freezing with liquid nitrogen. These cancers may appear as chronically flaking skin or a sore that will not heal or constant bleeding.
Squamous cell cancers are more aggressive and can spread to other parts of the body and lymph glands. They can appear as a non-healing or bleeding ulcer. They may have a ridge around the center that is raised. A low volcano may be a good analogy of what these look like. Unlike the basal cells, the surgery needs to be more aggressive with a larger margin clear edges) around the specimen. The skin cancer and the surrounding edges may be checked at the time of the surgery with a frozen section (immediate analysis) or await the final definitive examination. It is important not to ignore these as they can grow in locations that may make treatment very difficult and disfiguring as well as life threatening. Sometimes plastic and reconstructive surgery is required to properly treat these cancers.
Melanoma is the third type of skin cancer and is becoming more prevalent. It is usually dark , and irregular. A crushed black berry on the skin is a good description. It is often raised above the level of the skin, various shades of color. It is can be seen on the palms of the hands and soles of the feet. Any dark moles in these areas are reason for serious concern. Melanomas can be slow growing or rapidly spread and cause death. They can spread to the lymph nodes under the arm or in the groin. They can be found on the trunk as well as the arms and legs. They are categorized as to how thick they measure under the microscope as well as what levels of the skin they penetrate. Deeper and thicker melanomas require the lymph nodes to be evaluated as well.
Dr. Linhardt is a general surgeon offering services weekly at Driggs Health Clinic and Teton Valley Hospital. To learn more about Dr. Linhardt, please click here or www.georgelinhardtmd.com.
When it comes to making improvements in our billing process, our most valuable resources are our patients and their families. Concerns, complaints and suggestions from our patients have led to changes throughout our entire business cycle including changes in our processes, staff training, and software changes. We get patient complaints for less than one percent of all bills we send out, but we know that doesn’t help if you are the one with a billing issue.
If at any time you or someone you know has a question about their Teton Valley Health Care bill, please be sure to give us a call or send an email or letter requesting assistance. While it may feel therapeutic to turn to your neighbors or Facebook friends, we appreciate direct communication otherwise we won’t know about the problem and can’t fix or answer the concern.
Here’s an overview of how our billing cycle works, along with definitions of different billing terms.
When we send the first statement after a patient visit, it’s a detailed list of services. Every statement thereafter is a summary of the balance remaining, not a detailed list. We believe this provides patients with necessary data, but it doesn’t overwhelm patients by repeating the same details multiple times. If you ever need a detail for any of your visits, we’re happy to provide that for you along with any assistance in understanding the details.
We don’t send a statement for a service until the claim has been processed by the patient’s insurance. This helps to ensure that a patient is only billed for the amount they owe TVHC and that any insurance issues (eligibility, deductibles, and coverage terms) are dealt with before we ask you for payment. We do everything we can to provide a correct claim to your insurer immediately after the care is rendered. We want to see the insurer quickly and correctly process the claim as much as the patient does. If we’ve received incorrect billing information (this is why we always ask for your insurance information when you check in), if the insurance doesn’t process the claim correctly, if the insurance company needs additional information such as accident verification data, or if there are any other problems with the claim, it can take several months for the insurer to process and pay for the claim.
You’ll know when your insurance has processed your claim when you receive an Explanation of Benefits (EOB) that shows what you may still owe after your insurance has paid for any covered services. If you disagree with your EOB, you should contact your insurance provider for clarification. Most claims (bills) are sent to the insurance company and processed by the insurance company within 3 weeks of the date of service, so you should expect a TVHC bill 3-4 weeks after your visit.
Once the patient’s claim is processed by the insurer, or if the patient is uninsured, we send out the first statement with a list outlining the provided services. We then call each guarantor (the person listed as responsible for payment) within two weeks of that first statement to ensure that the statement was received, that it’s correct, and to see if there are any questions regarding the statement. This is not a “collections call”; it’s a courtesy call from our billing office offering to help you with any questions about your bill. If the statement is received and correct, we offer to accept payment immediately (we do accept most major credit cards).
We continue to reach out to the guarantor by phone and in writing (at least monthly) until the balance is paid or a payment plan is established. We work with patients who are unable to pay their bill by offering payment plans, assistance in applying for insurance, or through our financial assistance program. However, if a patient or guarantor doesn’t respond to our letters or calls, or fails to make necessary payment, we refer the person to a collection agency after 120 days. This is an action of last resort.
In addition to your hospital or clinic statement, you may also receive statements from other providers such as radiologists and pathologists. Multiple statements and potentially multiple explanations of benefits from insurance companies can complicate the process.
We want our patients and their families to be as satisfied as possible with our care and we’re available to help you navigate the statements, instructions and explanations that you may receive. We want to hear from you.
As a resident of Teton Valley and as the CEO of Teton Valley Health Care, I am concerned about how TVHC is perceived. If people in our community have a poor perception of our services, prices, or staff, they won’t come to us for their care. I understand that how we treat our patients determines how you (and the people you talk to) feel about the hospital. Like any service organization, if we don’t meet or exceed your expectations, you won’t be happy. Teton Valley Hospital is a great little community hospital with a lot to offer. Our infection rates are always low (last year it was 0% …) and our clinical quality is high. Our patient satisfaction scores are consistently above 94% for both hospital and clinic services. We have very good equipment and staff. We have a 7×24 emergency room, clinic hours 7 days a week, and we employ over 150 people. In terms of the delivery of medical care and County economic impact, our 75 years of existence have been a crucial asset for Teton Valley.
I know that in the past we had billing issues and operational missteps. I know a number of people in the community were faced with those issues and because of their poor experience with TVHC they’ve chosen not to use our services. The good news is that we have made significant improvements in billing and other processes. The bad news is that many people don’t know that we’ve made clear, consistent improvements, and we believe we’re able to offer a better all-around patient experience.
It takes time to earn and maintain trust, especially after trust has been broken. If you avoid using our hospital or clinics because of a past experience or what you’ve heard second-hand, please give us the opportunity to change your mind. We’re still not perfect, but we are a lot better.
This year, TVHC is going to focus even more on you, the patient, and your family. You’ll see the following changes:
We are training all staff to improve the customer experience. Just like 5-star hotels train their staff to make the customer experience better, we are training all of our staff to better serve you and understand your personal needs. If one of our staff does not meet your needs, please let me know.
We’re improving the look and feel of patient rooms and exam areas such as our blood draw room, clinic admissions, and medical imaging suites. We are replacing our X-ray/fluoroscope with up-to-date equipment and we’re redesigning the X-ray room. The lab room is now complete. Look for the new X-ray equipment and redesigned room in May, and the Driggs clinic changes in June.
We will be adjusting our prices for imaging (e.g., X-ray, cat scans) services to make them more competitive. Look for announcements this summer.
We are investigating new evening clinic hours to accommodate everyone who works during the day.
Teton Valley Health Care is celebrating its 75th anniversary of service this year. We were built by a determined, conscientious community through much self-sacrifice and commitment, and we completed our first year of patient care in 1939. We’ve been through a lot of change together.
Like you, we have to anticipate changing times and that often includes making changes in course and improving how we perform. If you haven’t been here for a while, please consider visiting with us and let me know what you think of us now.