For a brilliant analysis of the art of ghostwriting by Big Pharma, read this post at Dr Carlat’s blog. And while you’re at it, put him on your blogroll. This is an important blog.
Monthly Archives: December 2007
Medicare and the Annual Gyn Exam
This post is for all you baby boomers out there who are enrolling into Medicare after having seen your gyn every year since college for an annual exam, and for all you Medicare veterans coming to my practice for the first time since your previous doctor retired. There’s something you need to know –
Medicare only pays for routine breast and pelvic exams and pap smears every 2 years.
It’s true. Here it is, from Medicare’s web site –
Medicare helps pay for a Pap test, pelvic exam, and clinical breast exam once every 24 months.
Most women don’t need a routine pap smear every year. So I’m happy to have you forgo that testing on an annual basis. In fact, if your paps have always been normal, we can even go 3 years between paps.
But I still recommend you have a breast exam every year, and a pelvic if you still have all those parts.
What if I’m high risk?
If you are high risk for cervical cancer (see below for the definition of high risk), you get a pap every year.
But if your paps have always been normal, and you see me for only a routine check up less than 2 years since your last routine check up, Medicare just won’t pay.
What About Problem Visits?
Now, if you a medical problem, Medicare will almost always pay for your visit. So don’t be afraid to come in if, for example, you have a urinary tract infection. Or a yeast infection. Or have a pessary, osteoporosis, breast cancer, abnormal paps, abnormal bleeding or are on hormone replacement and you need to come in more often than once every two years. We have a diagnosis code to support the medical necessity of those visits, and we’ll all be fine.
In fact, if you come to see me for a “check-up”, but also have other problems that we deal with on that visit, I can “carve out” the portion of the visit that medicare will pay from the preventive part they won’t – so you won’t get stuck with the whole bill.
The ABN (Advance Beneficiary Notice)
If you’re here for preventive services, my staff will ask you to sign a form called an ABN, or Advanced Benificiary Notice. This is to prove to Medicare that we informed you which services were not covered and that you agreed to pay for them if Medicare won’t.
If we don’t have the signed ABN in your chart, we can’t bill you, so please understand when we ask you to fill one out. Every single year.
If, after reading the ABN, you decide to forgo the preventive services, that is absolutely your choice. We’ll happily see you next year for these services.
What about your secondary insurance?
Good question. You may have a secondary insurance that will pick up what Medicare pays. On the other hand, your secondary may not pick up the uncovered portion of your visit. Since everyone’s plan is different, that part is up to you to figure out.
Apologies
I’m really sorry about this, but there is absolutely nothing I can do. I can’t make up a code to get your visit covered if it is not.
And I really don’t know how your last doctor got Medicare to pay for you to see him every 6 months for the past 10 years when you don’t have any gyn problems.
I only know that these are the rules, and I have to play by them.
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Read Medicare’s Information Booklet for Women
High Risk Definition: You are at increased risk for cervical cancer, according to Medicare’s guidelines, if you have not had a pap for 7 years or have not had 3 normal paps in a row. Also, if you started having sex before age 16, have had more than 5 lifetime sexual partners or an STD, or are a DES-daughter, you get a pap every year.
Apple Torte
Thanks for Bureka Boy for a marvelous recipe, and as usual, a great how-to that makes baking gorgeous desserts like this a snap.I brought the torte to a Hanukkah dinner party tonight, and it was a huge hit with all ages. (Hint- keep the sides on the springform pan for risk-free transport.)
Go ahead, try it. It’s not hard to make at all….
European Apple Torte
I strongly encourage you to read the recipe at Bureka Boy’s site – it’s complete with beautiful prep photos and hand holding instructions. I’m putting an abbreviated version here for easy printing.
Crust Ingredients
- 1/2 c butter, soft
- 1/3 c sugar
- 1 pkg vanilla sugar, optional
- 1/2 tsp vanilla
- 1/8 tsp salt
- 1 c all purpose flour
Cheese layer ingredients:
- 1 pkg (8 oz/25o g) cream cheese, room temp.
- 1 tbsp lemon juice
- 1 tsp vanilla
- 1/4 c sugar
- 1 egg
Apple layer ingredients:
- 2 large baking apples* (plus 1 extra, just in case)
- 1/3 c sugar
- 1/2 – 3/4 tsp cinnamon
- 1/4 c sliced almonds
Crust: In a large mixing bowel using the paddle, together the butter, vanilla, sugar and salt. Mix until well blended. Add the flour and mix only until blended. Place the dough in an ungreased 8 1/2″ springform pan. Pat and press the dough evenly across the bottom of the pan and up the sides about 1 1/2 inches. make sure it is even. And not too thick between the bottom of the crust and the walls of it. You will think you don’t have enough dough, but trust me, you do. Just keep working it and thin it out to cover. Set aside.
Cheese filling : Mix everything together in a medium sized bowl using the paddle for 2 or 3 minutes. It needs to be perfectly smooth and not grainy. Place the cheese filling in the unbaked crust, smoothing it using a rubber spatula. Set aside.
Preheat the oven to 450F at this point.
Apple layer: Peel and slice the apples 1/8 inch think. Layer the apples around the outer perimeter, carefully overlapping them. When you get to the first apple you layered, lift it to add the last one. Repeat a second layer just inside the first. Arrange the few apple slices in the innermost layer nicely. Mix the sugar and cinnamon together and with a spoon, distribute the mixture evenly all over the apples.. It will look like too much – don’t worry it is not. Finally, sprinkle the almonds evenly over the apples.
Bake for 10 minutes only @ 450 F and then reduce the heat right away to 400 F and cook for another 25 minutes. Remove from the oven to a baking rack and let cool completely. Gently run a knife around the cooled torte and release the spring siding. Let the torte sit several hours in the fridge for it to firm up properly before eating it. It is best served slightly cold or at room temperature. Dust with confectioners sugar if you like or serve with whipped cream dollops. I serve mine plain.
I Want to See It More Than Once
My new favorite movie of all time. Now I know what I want for Christmas.
A Latke by Any Other Name…
Tonight is the first night of Hanukkah, and of course that means latkes.
Hanukkah is one Jewish holiday where I feel right at home food-wise, since I grew up eating latkes. Of course we didn’t call them latkes – we called them potato pancakes, and they are a standard in the Slovak kitchen. My Grandma used to come up and make them for us in our kitchen sometimes on Saturday nights. We were so anxious to eat them, I don’t think we even waited to all sit down at the table together – we just lined up next to the electric fry pan with our plates and practically grabbed them from the spatula as Grandma was laying them onto paper towels to drain!
My Grandma grated her potatoes by hand using the small holes of the grater and never drained the liquid. This meant she needed a fair amount of flour to sop things up, and ended up with a rather thick, dense, floppy and wonderfully delicious pancake.
The potato pancakes I make now are a bit different than the ones I grew up with. They are based on my mother-in-law Irene’s recipe, and they are pretty perfect if you ask me. Actually, Irene didn’t really give me a recipe, just approximate amounts and a gestalt. But I decided to try and nail down the amounts tonight as I made them.
The trick is to use the large grating blade of the food processor to shred the potatoes and onion, and thento drain away the liquid. Eggs hold the potatoes together and coarse motsa meal fills in the spaces without the heaviness of flour. Cook the latkes in an electric fry pan – it’s really so much easier and safer than doing it over the stove and you get a more consistent pancake as long as you don’t overload the pan. If you do it right, what you end up with is sort of a latke nest, with lots of crevices of crispiness on the outside and a few wonderful soft pockets of old time potato pancake in the middle.
Sour cream and homemade applesauce are the only other things you need. My kids, of course, also like ketchup.
Latkes (or Potato Pancakes)
For this batch, I used Yukon Gold potatoes and Streits Motsa meal that I borrowed from my friend Rachel down the hall. (Without Rachel I would never cook – she never runs out of anything…) I had never used that brand, and I like it – it is a coarser grind than Manichevitz, and so instead of just sopping up the egg and clumping together, the meal sort of stayed aloof on the outside of the shredded potatoes. This made for a less dense pancake. I also used canola oil because it is healthier, and noticed no difference from the traditional vegetable oil. You can vary the amount of onion depending on your tastes. Mr TBTAM likes his on the oniony side.
3 pounds potatoes (I used Yukon gold tonight)
2 eggs, lightly beaten
1 1/2 large onions
A little less than 1/4 cup Motsah Meal
salt
Pepper
Canola oil for frying
Peel potatoes. Shred using the food processor and remove to a large bowl. Shred the onion the same way and add to the bowl. Open out a large clean dishtowel onto the counter and dump the potato onion mixture on it. Top with a second clean towel and lightly roll to mop up the excess liquid (Don’t overdo it, you need a little of the potato starch and liquid for things to stick together.) Dump back into the bowl and add the eggs and the motsah meal. Season with salt and pepper.
Heat about a 1/2 inch of canola oil in electric frying pan at highest heat (mine goes to 400 degrees Fahrenheit). Scoop some of potato mixture into a large spoon, then put into the oil, flattening with the back of the spoon. Cook until the edges start to crisp and the underside is light brown, then gently flip and cook the other side.
Remove from pan to a cookie sheet lined with paper towels or newspaper. Keep warm in a low oven while cooking the rest of the potato pancakes.
Serve with sour cream and warm homemade applesauce.
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This of course, is not the only way to make latkes.
4Bureka Boy has a great round up of recipes and methods on his blog, as does Slashfood, whose latkes look suspiciously like mine.
4Epicurious does a nice job on technique, and uses a mixture of butter and oil to fry in their Classic Potato Pancake recipe.
4For healthier versions, see Got No Milk (no fat) and Diabetes Daily (lo-carb in the comments section).
4And, for a genuine latke making lesson from a genuine Jewish Mother, watch Feed Me Bubbie– Latkes.
Happy Hanukkah!
Cookies from an Angel
I’ve been invited to submit a recipe to Leonard Lopate’s Holiday Cookie Recipe Swap. I love Leonard’s radio program, so it was a thrill to get the email from his staff asking that I submit a recipe and help spread the word about the swap.
Picking a recipe was easy – Angel Fingers. When I was little, my Grandma made Angel Fingers at Christmas, along with shaped sugar cookies and a wonderful, crisp brown cookie she called a “Sand Tart”. I loved them all, but I only have the Angel Fingers recipe, handwritten by Grandma on an index card that is becoming increasingly yellowed with age.
My dad’s mom was a one of a kind. Never afraid to speak her mind, she was famous for such lines as “You have such lovely teeth! Are they your own?” and to her parish priest “If I’d known you when you were younger, you’d never have made it to the Cemetery.”(She of course meant to say Seminary.)
My Grandma loved her garden, her little bird, her crossword puzzles and the Phillies. And she could stand on her head even in her early 60’s, a skill she demonstrated to us during sleepovers at her house after we did her nightly calisthenics with her.
Grandma held a much less strict view on Catholicism than my parents, who insisted we attend church every single Sunday while I was growing up. And so I will never forget that Sunday morning when I came downstairs after spending the night and Grandma told me we were skipping Mass that day.
“God is in the birds, the trees and the flowers”, she said, spreading her arms out toward her garden. “We don’t need to go into a building to be with him.” So we sat on her porch that beautiful sunny morning looking at the garden, listening to the birds and reading the funnies.
I don’t go to church anymore now, having lost organized religion long ago. But I never lost my Grandma’s religion. I still believe that God is in the flowers, the trees and the birds.
And he’s also in these little cookies – cookies from my Grandma, who taught me to see holiness in the world around me.
Angel Fingers
Submit your favorite holiday cookie recipe by December 6, along with the reason why the recipe is special. Then tune in to WNYC on December 11 and listen to Leonard and Ruth Reichl talk cookies.