Tag Archives: Healthcare

A little rant about health care, mammograms, paranoia and unfounded faith in technology

When someone blames Obamacare for their high  health insurance premiums, I want to scream.

It’s not politics that increased my health insurance premium by $78.37 in the middle of the year (yeah, I didn’t know they could do that either, but my monthly premium  — for the exact same plan that covers me alone — went up 34% in July, the equivalent of nearly $1,000 a year).

At least, it’s not only politics. It’s wiz-bang innovations that patients demand and/or doctors recommend for no reason other they sound good.

Image by Prevention magazine

Image by Prevention magazine

Need an example? How about computer-aided-detection, aka CAD, for mammography. Computers do everything better, right?

Wrong.

CAD for mammography, which aims to double-check radiologists’ screening results, didn’t improve accuracy by any measure, according to the largest study to date of the controversial tool, published Sept. 28 in the journal JAMA Internal Medicine. I’ve been seething about the report shared in the Star Tribune ever since.

The JAMA Internal Medicine report found that CAD for mammograms added at least $400 million to the nation’s annual health care tab. Someone is paying that $400 million, people, and if you think it’s not you, you don’t know how insurance premiums are set. Insurance companies are out to make money, and they don’t pay for procedures out the goodness of their hearts — they pay for them out of your premiums.

You might be tempted to blow off that $400 million number, but think of it this way: There are about 35 million women in the U.S. between the ages of 50 and 74 (the age frame of women recommended to get mammograms). That $400 million means $11 every year for every middle-aged woman in the country. For just one unnecessary type of procedure among dozens, if not hundreds.

Not only does CAD not improve a radiologist’s accuracy in finding cancers on mammograms, it actually reduces it, probably because they’re depending on the computer as a crutch. “Radiologists’ sensitivity, or the proportion of times they correctly identified cancer, was 83 percent when they used CAD — and nearly 90 percent without it,” reporter Jonel Aleccia wrote.

Aye yi yi.

I’ve been suspect of mammograms since my last one three years ago, preformed after I found a lump in my breast (it was more of a bump, actually). It turned out to be a harmless bruise, but I paid $517 for an unnecessary ultrasound that discovered nothing except peace of mind (read that outrage here). In most cases — not all, I get it — but in most cases, a woman or her partner finds the lump first and the mammogram just confirms and pinpoints it. It’s one of the reasons breast cancer screening guidelines changed a couple of years ago from beginning routine screening (i.e. mammograms) for women of average risk at age 40 to age 50 and from being performed annually to every two years. Mammograms simply aren’t the be-all, end-all of breast cancer detection.

Some women are still insisting they want mammograms more often than the guidelines. The science just doesn’t back it up for healthy women (i.e., no family history, not taking hormone therapy, not at high-risk of carrying the BRCA gene, etc.). News flash: If you want a mammogram before age 50 or more often than every other year, you can still get one — pay for it yourself! Why should my insurance premium bear the cost of your paranoia?

So what can a logical woman do about health care procedures that do nothing to actually improve her health? Well, for starters, we can take control of our health care by being informed. Ask how much a procedure is going to cost before going ahead with something just because you’ve met your deductible for the year. As for CAD for mammograms, you  have a right to ask for a CAD-free mammogram, which is not only good for the community bottom line, it’s good for you because it encourages the radiologist to be more careful.

And the next time you’re tempted to blame politics for the cost of your health care, look in the mirror. I’ve seen the enemy, and it is us.

$2,569: Another lesson in the healthcare maze

Regular readers may recall my rant about the hidden costs of American healthcare when I discovered a lump in my breast a couple years ago and felt rushed into getting what turned out to be a completely unnecessary ultrasound. Because of the way the procedure was coded, my health insurance was conveniently (for it) let off the hook to pay for it—but I didn’t discover this until after the procedure.

Lately, I’ve heard a lot more about how consumers have no idea how much their health care costs because of the way healthcare providers and insurance companies handle the labyrinth process, which makes the story I’m about to bring you all the more relevant.

Uncle Al wrote up the following story after he regaled me and my Beloved recently with the details of a mysterious little tube of medicine he had on his coffee table. When I read it, I suggested the world needed to know about the sneaky ways American health care gets its money so I’m sharing his story here on Minnesota Transplant.

Please welcome guest blogger (and entertainer) Uncle Al:

$2,569 — always ASK your doctor

I’ve had this little mole shaped like a pencil eraser right in the smile line of my right front cheek for a while. It was a problem because I smile a lot and I also managed to nick it with my razor on a regular basis, too … ouch! With its plentiful blood supply, the mole—once nicked—bled for about 10-15 minutes … and then would start bleeding again if I touched it later in the day. How embarrassing for someone else to tell you over lunch that what you are eating is making your face bleed!

So in January, I went to the dermatologist for a “whole body” mole check (something my sister recommended—she’s a retired RN), and they found a suspect, possibly precancerous mole on my shoulder. I also asked about that pesky facial mole, and another mole right in the middle of my chin (which I have almost successfully shaved off over the past many decades—I won’t say how many!). And I also mentioned that I have this seemingly overly-sensitive spot on the very top of my head which I cannot see (girls: I don’t have a hand mirror) so I asked the nurse to look at it. Minutes later “Pssst!” went the liquid nitrogen on three of those spots up there and after a bit of slicing and cauterizing, both those facial moles were gone. Other than a little pin prick to numb things, all went well as far as any pain. Gone. Thank you, Lord!

The nurse practitioner (never saw the dermatologist) is the sweetest, nicest lady. She performed the two facial mole-ectomies. She also suggested a cream to prevent any future cancer spots on top of my head. I thought, “Cool, I better pay attention.” She commented that it was expensive. Since I opted to go directly (no referral) to this dermatology clinic (based on an excellent experience my son also had with them about a year ago), I asked how much the medical cream would cost. She didn’t know and said not to worry—that my medical provider would cover it: “No problem … since you have a precancerous mole and these tiny sensitive spots on the top of your head, it will be covered. We will do a biopsy so we know for sure.” I thought, heck if it is that expensive, maybe I’ll just pay for that ointment or cream today, write a check … what’s a couple hundred bucks for some ointment and no hassles from my insurance provider (since I did not go there on referral from my primary physician).

Again, I said, “I understand there’s a deductible, and it’s expensive. How about I just pay for it today?” I’m still thinking a little tube, the size of a Chapstick container cannot cost that much money, now can it!?

So she suggested again that I just allow the dermatologist’s office, to submit it to the pharmacy and my medical provider will likely cover it completely and then I can deal with any questions later. Seemed logical, so I paid my doctor visit portion of the bill and walked out the door with just a little circle Band-Aid where that pesky “used to be bloody mole” was located … a new man! I felt so good!

A week later, the doorbell rang. I had to sign for the prescription, and I eagerly opened up the box, slid out the 30-gram tube of medication (for us Americans that is 1 ounce) and read the instructions and side-effects carefully. I put a dab on my finger after I opened it (no returning it now you know) and … no pain. Hmmm…not bad. I continued treatment.

Two weeks later I got a notice from my healthcare provider. Yep, they paid it all! Phew! Good! Then I read the second page of the billing statement dated January 22, 2015. This is 10 days after my appointment. I read that with one prescription I had almost exhausted my prescription drug plan coverage and with another $131 of prescription medicine expenditures in 2015, they will move me into the next higher class of coverages (meaning I pay much, much more for any medicines needed in the “remainder of the year.”) WT*? (Pardon me!) What the hell has just happened? I’m only into the 22nd day of the year. The bill for one ounce of CARAC CRM 0.5% costs … get ready …

$2,569!

Can you hear the expletives still echoing?

Yes, $2,569 for a tube of Chapstick in cream form! OMG. I wish she would have said, “Be sure to bend over when the postman arrives!” because that cost would have caused me to rethink my decision to get the medicine!

I think Americans, including myself, have lost sight of what medications actually cost out there in the market place. We are all “neatly hidden” from the actual costs of medicines, and we are allowing drug companies and insurance companies to screw us over. Ditto to the hospitals that charge us for each tissue, Q-tip (excuse me, “sterile swab”) and every time our blood pressure gets checked (by a machine nowadays).

Anyway, nothing I can do about it now. The minute I signed for that postal package, I was screwed. I can’t return it. I didn’t have a bill yet to even know what I was actually signing for when the medication arrived at my door. I learned a valuable medical life lesson in this little mole-ectomy experience, and I hope you now did, too:

Always ask how much any medication actually costs!

I am not convinced I really need to put a little $85 dab on my head each morning (then, like a good beer, in minutes it’s gone!)

Are you kidding me? Ask!

__________________

Minnesota Transplant note: Uncle Al is a dear man living in a beautiful place where his head is regularly exposed to sunshine. Let’s hope his ridiculously expensive skin balm does the trick in one tube. Because there won’t be a second!

Excuse me, there’s a fly in my health care

Whatever opinion you hold of Obamacare or Obamneycare, the health insurance industry in this country is screwed up.

I was forced to wade into the murky waters of acquiring individual health insurance when my former employer didn’t pay the corporate premium on March 1. My share of the premium continued to be deducted from my paycheck and the speedy bureaucratic efforts of the health insurance company ensured I wasn’t aware of this development until I was notified of the policy cancellation by the health insurance company on May 23, meaning I was unknowingly uninsured for 12 weeks.

Following the panic and lamentations caused by this lapse, my former employer decided to fob off its responsibility for providing a health insurance program to its employees, so I was on my own. The insurance company informed me that COBRA wasn’t an option either.

Fortunately, I’m married to an insurance agent who secured a short-term insurance policy for me the next day. The application was a mere two-pages. For the relatively reasonable rate of roughly twice what I was paying through my former employer, I qualified for a no-nonsense high-deductible program for up to six months that would have paid for my coma care if I was hit by a Mack truck (minus the 20% co-pay and $5,000 deductible).

My husband is self-employed so I couldn’t get on his policy. Not knowing what the future holds for my employment, I applied for a more-or-less permanent individual health insurance policy.

This application was 17 pages long and required disclosures of my height; weight; use of drugs, alcohol and tobacco; participation in dangerous or extreme sports including but not limited to skydiving, bungee jumping and scuba diving; and every detail of my health history for the past five years. Fortunately, I am made of hearty Minnesota stock and am in excellent health; even with a complete lack of upper-body strength I can do 16 push-ups, which is perfectly normal for a 44-year-old woman. If my low cholesterol level were a sumo wrestler, it would have you in a full-nelson in 10 seconds flat. Don’t even ask about my blood pressure — the undead have a faster pulse rate (I don’t jog 20 miles a week for nothing!).

I did, however, see a counselor twice last year when worry about my prodigal stepson prevented me from eating and sleeping (I got over it), and I was diagnosed with periodontal disease (a second opinion found that to be bogus and I now have dental hygiene habits rivaling any anal-retentive dental hygenist in the industry). I am also adjusted by a chiropractor once every six weeks. These minor (in my opinion) health disturbances were disclosed on my application.

A nurse then called me and asked me 50 questions (not kidding) about my health disclosures (“are you still seeing the counselor?” “when did your sleep return to normal?” “did you ever considered suicide?” “how often do you see a chiropractor?” “how would you characterize your pain on a scale of 1 to 10?” “have you ever seen an accupuncturist?”).

Of course, there are disclaimers all over the place about how preexisting conditions may not be covered and failure to disclose information could mean retroactive cancellation of the policy.

So, apparently, I can only qualify for individual health insurance if I am completely healthy and would, in no way, ever get sick. They can dump me if I don’t pay, and they can dump me if they end up having to pay for something I already had.

Yikes.

Following the Galileon inquisition by the nurse, I waited around for two weeks biting my fingernails (maybe I shouldn’t reveal that — is nail-biting a symptom of mental illness? — let’s say I was holding my breath — yeah, my lung capacity is amazing, too) while they considered my application.

Finally, I got this one-sentence email:

“Welcome!  You have been approved for coverage with an effective date of 6/20/2011.”

What’s funny (funny, I guess, is relative, but it’s funny to someone who communicates for a living as opposed to practicing law for a living) is that the one sentence came with the following disclaimer:

“The information contained in this communication is confidential, private, proprietary, or otherwise privileged and is intended only for the use of the addressee.  Unauthorized use, disclosure, distribution or copying is strictly prohibited and may be unlawful.  If you have received this communication in error, please notify the sender immediately.”

So by revealing this on my blog, I may be violating the law, but if I’m a criminal, I understand and agree that to the best of my knowledge and belief, true and complete, I am a very healthy criminal.

Sheesh.

All this for the low, low price of merely four times what I was paying with my former employer to get a high-deductible plan that covers nothing except minimum preventative care within the network of participating doctors and hospitals and not including vision care, dental care or brand-name pharmaceuticals.

So … (you thought I was at the end of the story, didn’t you? Oh, you don’t know how screwed up our health care system is, do you?) … to cover these little incidentals (like visits to the chiropractor, optician, dentist and pharmacist) even for a very healthy specimen like myself, I opened a health savings account at the bank, which will at least save me having to pay income taxes on my health care costs.

That required an in-person visit to the bank to complete a 2-page application and came with nine pages of articles, definitions, provisions, amendments, eligibility details, instructions and disclosures. It was like dining on a tapas portion of a mortgage closing where you sign you name until your hand hurts and then go home with a ream of papers you shove in the first drawer you see, never to look at again.

But the good news is, I walked to the bank and back. And iced my hand (just kidding). That’s what healthy people do.

So, if you’re employed and paying a low, low rate for your family’s health insurance (or even a highway-robbery-type rate) and wondering why the hell the government has to dirty its hands in the issue of health care, this is why: Even healthy, middle-age contributing members of society struggle to get health insurance if they don’t get it through an employer. And sick people probably can’t get it at all. And if the government plan now in place isn’t perfect, it’s something, and it really cannot be worse than what we have, and I have hopes that it might be better. I hereby authorize the healthy authenticity of this opinion.