Q: Are there any options open to me when it comes to paying my bill?
A: Bills can be paid via check or credit card. You may mail in your payment or pay online using our secure payment portal. Payment plans can be developed on a case by case basis.
Q: I send in payment on my account but I continue getting bills stating I owe that amount. Why?
A: Often it takes up to 30 days to post payments to an account. Your payment and the bill probably crossed in the mail. This happens more often than one realizes. You can contact your provider to have them trace the payment to ensure it has been posted to your account. Please have a check number, date and amount paid when making that contact.
Q: I understand that my benefits state that I’m not responsible for any transfer amounts showing on bills. Why then do I get billed for this added amount?
A: We suggest you contact us to review your explanation of benefits. It may be that we are not a contract group with your insurance company. We can help you determine the answer with a call.
Q: Is a copy of my medical record available from DPI?
A: You should directly contact the healthcare facility where your procedure was performed or you can contact your primary care physician to obtain a copy of your medical records and history.
Q: My insurance company participates with the facility where I had my surgery but not the anesthesiologists. Please explain that to me.
A: Typically, anesthesiologists and groups bill separately from hospitals or clinics but participate in most of the same insurance plans. However, it is possible your anesthesia provider maybe out of network for your insurance plan. You are entitled to file an appeal with your insurance company for additional payments on your behalf. In some cases, we can help file the appeal on your behalf.
Q: My insurance didn’t cover what I thought they would for my procedure. What can I do about that?
A: That must be discussed directly with your insurance carrier. Anesthesia bills are processed based on the type of insurance policy you have in place.
Q: My surgical procedure was performed months ago and I’m just now getting a bill for the anesthesiologists services. Why is that?
A: Our billing is only issued after a claim has been fully processed by your insurance company. We are dependent on their processing timeline before we can issue our billing.
Q: There was only one anesthesiologist present when I had surgery. Why do I get a bill for two anethesiologists?
A: It may be that a team of an anesthesiologist and a CRNA (Certified Registered Nurse Anesthetist) were present during your surgery. As such, both billed for their services and often insurance companies require both to bill separately for their services. However, the TOTAL of the anesthesia charges will not be greater than if the bill was submitted under just the CRNA or just the Anesthesiologist.
Q: Why do I have to provide insurance information so many times? I gave that information when I had my surgery. Now I get more requests for insurance information.
A: While healthcare providers and physicians often try to share insurance information for the convenience of patients, there are times when the information is again requested to ensure that the information is current, accurate, and that your information is protected by not being given out to random callers. Anesthesia providers often bill separately from a hospital or physician and your insurance information is necessary at that time.
Q: Are my chances of a caesarean section increased with an epidural?
A: Numerous studies have not shown any increase in chances of cesarean sections due to epidurals.
Q: Are there any side effects from an epidural?
A: Epidurals have been shown to be safe, effective ways of controlling pain during labor and delivery. As with any procedure or medication, there are occasional side effects that vary from individual to individual or that may not be present at all.
Low Blood Pressure. Medication given into the epidural space may lower your blood pressure. When you’re in pain, your blood pressure rises. So a slight decrease in blood pressure with an epidural is not a problem because such a small decrease will only bring your blood pressure closer to what it was before you started having labor pain. But if your blood pressure drops too low, it may reduce blood flow to the placenta, which in turn may reduce the amount of oxygen delivered to your baby. If this should happen, you will be given fluids and/or medication through your IV to raise your blood pressure back to normal levels. This is why your blood pressure is closely monitored when you get an epidural.
Slowing of the Baby’s Heart Rate. If your blood pressure drops too low with an epidural, it may reduce blood flow to the placenta and reduce the amount of oxygen delivered to your baby, which in turn may cause your baby’s heart rate to slow. If this should happen, you will be given fluids and/or medication through your IV to raise your blood pressure and your baby’s heart rate back to normal levels. This is why your blood pressure is closely monitored when you get an epidural. Keep in mind, though, that an epidural is not the only reason as to why your baby’s heart rate may slow down. There are other causes unrelated to an epidural that could slow down your baby’s heart.
Itching Because of Medication. Medication given into the epidural space may cause you to itch. If this should happen, it is usually short-lived and should subside after 30 minutes. If it doesn’t, or if it is too unbearable for you, then you can ask for medication to help alleviate the itching.
Inability to Urinate. One way in which an epidural blocks pain messages from traveling up the spinal cord to the brain is by blocking pain nerves that carry pain messages. In doing so, epidurals may also block nerves that tell the bladder to empty and so you may be unable to urinate with an epidural. This should be no cause for alarm because women in labor usually get a urinary catheter inserted into the bladder to drain their urine.
Headache. Headaches from epidurals or spinals are caused by leakage of spinal fluid through the hole in the dura created by the epidural or spinal needle. The dura is the layer of tissue that surrounds the spinal fluid and keeps it in place. With an epidural, there is usually no hole created in the dura because every attempt is made, while inserting the epidural needle into the epidural space, to avoid puncturing the dura with the epidural needle. Despite best efforts, though, puncturing the dura with an epidural needle during epidural insertion still happens 1%-2% of the time. Should this happen, leakage of spinal fluid through the hole created in the dura usually results in a headache. With a spinal, even though a hole is created in the dura by the spinal needle to allow for medication to be injected into the spinal fluid, because the spinal needle has a very small diameter, the hole made in the dura is relatively small. That is why the chance of a headache with a spinal is very small. The headache from an epidural or spinal is usually worse when you sit or stand, so lying down relieves the headache. If left untreated, the headache will usually disappear on its own within 1 to 2 weeks as the hole in the dura heals. If the headache is mild, caffeinated beverages, medication such as ibuprofen and/or other over-the-counter pain relievers and bed rest will usually help relieve the headache. If the headache is severe, what is recommended is an epidural blood patch. An epidural blood patch is performed by drawing some blood from your vein and injecting it into the epidural space. The blood forms a clot to plug the hole in the dura and prevent further spinal fluid from leaking out. This usually relieves the headache.
Back Soreness. You may feel soreness in the lower back at the place where the epidural needle was inserted. This soreness is similar to a bruise and usually fades away in a couple of days. It may be treated with acetaminophen. A heating pad may also be helpful.
Q: How does an epidural work?
A: With an epidural, medication is given into the epidural space, which is located in the spinal column that runs down your back. The epidural space is just outside the dura, a layer of tissue that surrounds the spinal fluid. When medication is given into the epidural space, it blocks pain messages from traveling up the spinal cord to the brain. It is the brain that enables you to sense pain in your body. And since the brain does not receive pain messages, you do not feel the pain.
Q: How effective is the pain relief from an epidural?
A: With an epidural, pain messages are blocked from traveling up the spinal cord to the brain. And since it is the brain that enables you to sense pain in your body, with an epidural you are unable to sense the pain of labor, making pain relief very effective. It is important to note that pain is the primary message intended to be blocked. Some women do report being able to feel pressure, especially in their lower abdomen, during active labor. Epidural medications do not remove the feeling of this pressure 100% of the time; it is important that you communicate clearly and often with your anesthesia providers if your sensations become painful so that they may adjust the dose and volume of the medication being delivered through your epidural catheter. The other approach to treating labor pain is to give pain medication into your bloodstream by injecting the medication through your IV. Medication given this way cannot block pain messages from reaching your brain. It can only blunt the perception of pain in the brain. Therefore, it is not very effective in treating the pain of labor when compared to an epidural. That said, there are instances when you may still feel the pain of labor after getting an epidural. Should this happen, every effort will be made to make you comfortable.
You May Need More Medication. The standard dose of medication that is given will provide pain relief in most women. However, certain women may experience greater labor pain than the dose of medication that is given. If this is the case, you will be given more medication to help relieve the greater pain you experience.
The Position of Your Baby. If your baby’s face is looking in the direction of the ceiling and the back of the head is facing the opposite direction, you may experience pain in your lower back that may be difficult to treat with an epidural. Also, if your baby happens to be pressing directly on a nerve, it may be difficult to treat this type of pain with an epidural. However, every effort will be made to make you more comfortable.
Rapid Progression of Your Labor. The more labor advances, the more it hurts. In most women, the dose of epidural medication that is given is sufficient to alleviate the increasing pain they experience as their labor progresses. However, on occasion labor may advance so rapidly that the dose of medication given may not be enough for the rapidly increasing labor pain. Should this happen, you will be given more medication to make you more comfortable.
Pain Relief on Only One Side of Your Body. If the tip of the epidural catheter is too far over to one side in the epidural space, then medication may get only to one side of the spinal cord. In this instance, you may still experience pain on the other side of your body. Should this happen, the epidural catheter will be pulled out a bit to bring the tip closer to the center to deliver medication to both sides of the spinal cord and achieve pain relief on both sides of the body.
Dislodging of the Epidural Catheter. If an epidural stops working after some time, it may be because the epidural catheter may have come out of the epidural space. If this happens, the catheter will be reinserted.
Q: How is an epidural given?
A: The following is what you can expect when you get an epidural:
Monitoring. Before you get an epidural, two devices will be placed on you to monitor your vital signs: a blood pressure cuff and a pulse oximeter probe. A blood pressure cuff will be placed around your upper arm. When the device takes your blood pressure, the cuff will briefly squeeze your arm very tightly. Your blood pressure will be taken every 5 minutes for about 30 minutes. A pulse oximeter probe, which resembles a cushioned clothespin, will be placed on one of your fingertips to measure the amount of oxygen in your blood and your pulse rate. Your baby’s heart rate will also be monitored while you get an epidural.
Positioning. You will be positioned in one of two ways, either sitting or lying on your side. The purpose of both positions is to help you round out your lower back as much as possible. This outwardly curled position of your lower back widens the spaces between the spinous processes. Spinous processes are the little bumps that you can feel running down the center of your back. When the spaces between your spinous processes are widened, it is easier for the epidural needle to be directed toward the epidural space. If you are in a sitting position, you will be asked to dangle your arms in front of you. This relaxes your shoulders forward and helps push out your lower back. If you are lying on your side, you will be asked to curl into a fetal position.
Cleaning and Numbing. Once you are in position, your back will be cleaned with an antiseptic solution. This solution will feel cold on your back. Then a drape will be placed over your back. The skin over the area of your back where the epidural needle will be inserted will be numbed by injecting a small amount of numbing medicine into the skin. As the numbing medicine is injected, you will feel a slight sting and burn for just a few seconds. Most women say that this is the only uncomfortable part of the epidural procedure and that it hurts less than having an IV inserted.
Epidural Needle Insertion. After the skin over your back has been numbed, the epidural needle will be inserted through the numb area. You will feel a sensation of pressure when the needle is inserted, but you shouldn’t feel pain. If you do feel pain, you should tell the anesthesia provider so that he or she can give you more numbing medicine. Once the epidural needle is in the epidural space, a tiny catheter will be threaded through the needle into the epidural space. This catheter is a thin and flexible tube through which medication will be given into the epidural space. As this catheter is being inserted into the epidural space, you may experience a “funny bone”-like sensation in your back, hip or leg. If this happens, it will pass quickly and should be no cause for alarm. After the catheter is inserted, the needle will be removed, leaving a few inches of catheter in the epidural space. Then the portion of the catheter that is outside your back will be secured to your back with adhesive tape.
Delivery of Pain Medication. The end of the catheter that is outside your back will be attached to a device that will continuously deliver medication into the epidural space to maintain continuous pain relief throughout your labor and delivery. With an epidural catheter in your back, you do not have to worry about lying on your back or moving around.
Q: How long does the pain relief from an epidural last?
A: Because a catheter is left in the epidural space, medication can be given into the epidural space to treat labor pain for as long as is needed. The end of the catheter that is outside your back will be attached to a device that will continuously deliver medication into the epidural space to maintain continuous pain relief throughout your labor and delivery.
Q: If I move when I get an epidural, is there a chance that I could become paralyzed?
A: No, you will not become paralyzed. It is difficult to remain completely still when you are feeling the pain of labor. Despite this, there has been no report of someone becoming paralyzed because they moved while getting an epidural.
Q: Is an epidural the only method of pain relief available during my labor?
A: Actually, you have options. Medication for pain relief can be given into your blood by injecting it through your IV. Medication given this way cannot block pain messages from reaching your brain like an epidural. It can only blunt the perception of pain in the brain.
Q: Is it ever too late during labor to get an epidural?
A: Because medication given into the epidural space can take up to 15 minutes to start working, epidurals in the past were not considered a good choice for pain relief in women who were far advanced in labor and close to delivery. However, with recent advances in epidural techniques, there are ways to provide faster pain relief. One such technique is called a combined spinal epidural as explained below.
Q: What is a combined spinal epidural?
A: With a combined spinal epidural, after the epidural needle is inserted into the epidural space, a spinal needle is passed through the epidural needle and through the dura to reach the spinal fluid. Medication is then given into the spinal fluid through the spinal needle. Medication given into the spinal fluid works much faster than medication given into the epidural space, allowing for faster relief of labor pain. The spinal needle is then withdrawn and a catheter is threaded through the epidural needle into the epidural space. The epidural needle is then removed, leaving a few inches of the catheter in the epidural space. The portion of the catheter that is outside the back is then secured to the back with adhesive tape, and the catheter is used to deliver medication into the epidural space to provide continuous pain relief once the medication given into the spinal fluid wears off. The benefit of this technique is that it provides faster pain relief than just an epidural.
Q: Will an epidural affect my baby?
A: Medication given into the epidural space to relieve labor pain does not readily get into the bloodstream, and so very little can reach your baby to directly affect your baby. However, if your blood pressure drops too low, it may reduce blood flow to the placenta and reduce the amount of oxygen delivered to your baby, which in turn may cause your baby’s heart rate to slow. If this should happen, you will be given fluids and/or medication through your IV to raise your blood pressure and your baby’s heart rate back to normal levels. This is why your blood pressure is closely monitored when you get an epidural.
Q: Will an epidural slow down my labor?
A: There are three stages of labor. The first stage of labor begins when you start having regular contractions that cause the cervix, the outlet at the base of the uterus through which the baby passes into the vagina, to dilate (open up). The first stage of labor ends when the cervix is fully dilated to 10 cm. The second stage of labor, also known as the pushing stage, begins when the cervix is fully dilated to 10 cm and ends with delivery of your baby. The third stage of labor is the interval between the birth of your baby and delivery of the placenta. Studies have shown that epidurals do not significantly prolong the first stage of labor. Epidurals may prolong the second stage of labor by 15 minutes. However, studies that have shown epidurals to prolong the second stage of labor used much higher doses of medication than are used today.
Q: Will I be able to push with an epidural?
A: You may not be able to push that effectively with an epidural, and the reasons for this are twofold. An epidural may diminish the sensation of pressure as the baby descends and/or may cause muscle weakness. If an epidural blocks the feeling of pressure that normally occurs as the baby descends, women who find it easier to push effectively when they are able to feel this pressure because it serves as a focus for their pushing efforts may not be able to push effectively. On the other hand, women who find this pressure a hindrance to pushing effectively may prefer to have this sensation blocked by an epidural. One way in which an epidural blocks pain messages from traveling up the spinal cord to the brain is by blocking pain nerves that carry pain messages. In doing so, an epidural may also block the nerves that control muscle function, resulting in muscle weakness. To minimize this effect, the smallest dose of medication that will effectively block pain nerves but not affect muscle function is used. If you are unable to push that effectively, the second stage of your labor may be somewhat prolonged.
Q: Will I end up with a backache following an epidural?
A: Studies have not shown that epidurals cause backaches. Studies have shown that the chance of developing a backache is identical regardless of whether an epidural is used. Women may develop a backache as a result of the stress the weight of the baby puts on the muscles and ligaments of the spine, but not as a result of an epidural.