Dr. Ruble will be missed

It’s time to bid a warm farewell to those of you who were my vein clinic patients. A couple of weeks ago, I finally retired completely from the practice of medicine. Over the past five years, I’ve had the privilege of caring for many of you, winding up your treatments for venous insufficiency with sclerotherapy sessions. I have met people from across the state, the eastern Dakotas, northern Wyoming and further afield. You have shared your satisfaction and pleasure with how your legs are feeling, and sometimes your concerns and frustrations as we’ve sought better solutions.

I’ve enjoyed visiting with you about your families, their accomplishments and problems, and your work and your interests. I’ve learned about farming and ranching, and the oil and gold markets. I’ve been invited to hunt birds in Poplar and told of art to see in Denver. I’ve worried with you about spouses’ health issues and sometimes nagged you a bit about your health beyond your vein problems.

I guess what I’m saying is I’ve really appreciated the trust you’ve placed in me and have enjoyed the conversations we’ve had. I wish you all the best and hope you’ll say “Hi” if our paths cross in the future.

With warmest regards, Bob Ruble

What’s new at RMVC?

In order to better serve our patients, Rocky Mountain Vein Clinic is changing the way we do our billing. Effective January 1, 2015 Rocky Mountain Vein Clinic will be moving our billing to an in-house process. We are working very hard to ensure that our patients don’t notice any interruption in the processing of their bills or the care they receive. You may; however, notice that your patient statements have changed. We also have new phone numbers for you to call if you have questions about your bill. You can contact our new billing specialist, Lisa Hawley, at our Billings location 1-877-251-8346 or (406) 252-8346 with any billing questions.

Understanding your Health Coverage

In today’s healthcare market there is an emphasis on the role of patients in making informed health care choices and managing the cost of their health care.

This has led to a shift in health insurance coverage from traditional plans with small deductibles and low out of pocket maximums, to high deductible health plans and health savings accounts. This has also led to higher patient balances and patient confusion regarding what is covered by their health insurance and what they may be asked to pay for.

Understanding “Health Insurance Lingo”

In order to become an active participant in your health care, you must first understand the health insurance lingo.

Traditional plans are plans that offer:

    • Deductible – Initial patient out of pocket expense.

Copay – Fixed dollar amounts paid for office visits.
Coinsurance – The percentage of charges the patient is expected to pay after the deductible is met.
Out of pocket maximums – The amount of cost the patient will be expected to pay in a year before the plan will pay 100% of all medically necessary costs.

High deductible health plans offer:

  • High deductible amount – Often $5,000.00 or more with services over this amount paid at 100% by the health insurance.

These high deductible plans can be coupled with:

  • Health Savings Account – Pre-tax dollars set aside to pay for medical expenses to pay for the initial deductible and some non-covered services.

Understanding “Non-covered Services”

These non-covered services are the caveat that most patients find hard to understand about all health insurance contracts. There are several ways that a service may be deemed “not covered” by your health insurance carrier. First, they may be excluded from coverage in your contract. There is a section in your contract that spells out what services the health insurance has excluded from being covered regardless of the patient’s circumstances. In this section, there is also language regarding the exclusion of cosmetic procedures, not medically necessary care, and/or experimental procedures.

This language allows the insurance company to deny payment for service that your doctor has recommended without specifically listing every non-covered service as an exclusion. However, there is hope for the informed patient/ healthcare consumer. Insurance companies must follow some form of medical policy. This medical policy describes services that could be excluded as not medically necessary or cosmetic and what medical criteria must be met in order for the insurance carrier to cover these services. For example, most insurance companies do not list treatment of varicose veins as a direct exclusion of the contract. However, all insurance companies have a medical policy that describes what criteria the patient must meet in order for treatment to be covered by the health plan.

Regional leader in vein care.

These criteria often include requirements of conservative therapy trial prior to surgical intervention.

Call your provider first about specific procedures

Although you can never know or understand all of your insurance carriers medical policies and exclusions, there are a few things that you can do to ensure that the services you have are covered by your health insurance.

First, ask your provider if they have checked to see if authorization for the proposed service is required. If so make sure there is an authorization on file prior to having treatment.

Ask your provider for a pre-determination of medical necessity

If an authorization is not required ask for a pre-determination of medical necessity (at RMVC we do this for you). In this process, the health insurance reviews your medical records along with the medical policy for the proposed service and issues a letter stating whether or not the proposed services meet their policy requirements. Finally, always ask questions of both your provider and your insurance company about coverage of the services that you are scheduled to have.

At Rocky Mountain Vein Clinic we are happy to help you with any coverage questions or concerns you might have.

Employee Update

Jen King has lived in Billings for over 15 years and has always loved working in healthcare. She has over 14 years of clerical experience with a focus in the medical field. Jen decided to increase her medical knowledge and go back to school at Montana State University-Billings, and in 2012, graduated with an Associate of Applied Science as a Medical Administrative Assistant and a certificate as an Office Assistant. She has been given multiple awards in customer service over the past 12 years. Jen joined RMVC in June of 2014, and is excited to bring her expertise to her Medical Assistant position. Jen enjoys being outdoors, taking photographs, designing websites and business cards, and spending time with her family.




Lisa Hawley, Certified Coding Specialist, CCS, CIC, CPC-HA Lisa is a Montana native who grew up and graduated from Huntley Project. Her medical experience began in 1990, joining the St. Vincent Healthcare team, where she worked for 15 years. She then moved with her family to Southern Oregon, working for Mercy Medical Center as a medical coder. She is both AHIMA and AAPC certified. Lisa moved back to Billings in 2012 to be closer to family. In her spare time, she loves to fish, float Montana’s beautiful rivers, hike, camp and other outdoor activities with her family. She also loves to read, quilt, and make jewelry.

RMVC Fun Facts:

Heredity and family health history are some of the KEY factors in a person eventually developing varicose veins? True False
A physical examination is the best way to detect or determine the root cause of your symptoms caused by varicose veins? True False
The medical treatment of varicose veins requires a complicated surgical procedure that takes all day to perform? True False
Rocky Mountain Vein Clinic has three convenient locations to serve you? True False
Long periods of sitting and standing can be a contributing factor for venous disease? True False



  1. True – There are numerous risk factors for varicose veins. The most important contributing factors are genetics and pregnancy. Notable less important risk factors that contribute to the disease are; age, obesity, smoking, and prior history of vein disease or blood clots in the legs.
  2. False – While a physical exam is important in the overall diagnosis of the condition, the most important tool used to clearly understand the underlying conditions leading to the cause of the disease is a high-quality ultrasound exam. This shows us the originating area (vein valve) that is causing the symptoms and discomfort. A good vein-mapping process ensures the right diagnosis and treatment recommendation.
  3. False – New treatment options (radiofrequency or laser) have radically changed the way varicose veins are treated. Prior to this new technology, vein stripping was used, which was a difficult, invasive, and painful procedure for patients to endure. Now, the modern treatments take about one hour, are conducted with local anesthetics, and are out-patient procedures. Simple, relatively pain-free, and immediate relief is felt. The patient is able to resume normal activities immediately.
  4. True – In November 2013, our third Clinic was opened in Bozeman, MT. This now gives us three convenient locations to deliver our services and meet increased patient demand. They are; Cody, WY, Billings, MT, and Bozeman, MT.
  5. True – As described in our first question/answer, here are many factors that can contribute to the increased risk of developing venous disease. One of the lifestyle factors is a job that involves prolonged periods of sitting and standing. To alleviate or reduce this factor, one should take breaks from either sitting too long or standing in one place – walking and exercise can also help. Regular use of venous compression stockings would also be helpful.

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