Don’t reach for Life Line screenings

I first posted about Life Line screenings two years ago. I’m re-posting today as this post still gets a lot of traffic and I wanted to reopen the comments. 

life line screeningsOvertreating, overspending

I just received an invitation in the mail!

Not to a party or a wedding or anything fun, but to a Life Line Screening event being held at a local church. The letter says they’re holding a spot for me on this particular date, but I must call NOW to confirm and register, because spaces are LIMITED!

“These aren’t just routine medical procedures—they can help save your life”

Oh, boy. There is so much wrong with Life Line Screenings, I don’t know where to start.

The five “life-saving” procedures they boast are relatively simple and non-invasive screenings tests for a variety of conditions:

  • stroke/carotid artery ultrasound
  • abdominal aortic aneurysm (AAA) ultrasound
  • peripheral arterial disease
  • atrial fibrillation EKG
  • osteoporosis risk assessment

They especially push the carotid artery ultrasound to assess stroke risk, and the letter warns “Your risk of suffering a stroke is high—it affects 1 in 5 women, and 1 in 6 men—and takes a terrible toll on families.”

Fear is always a good marketing tool, isn’t it?

Sure these tests may be painless and relatively inexpensive, but the truth is they are either not recommended for the general population or not recommended at all.

Kenny Lin, MD, who blogs at Common Sense Family Doctor (one of my favorite go-to blogs for evidence-based health care advice), posted the following information about Life Line Screenings:

1. Stroke screening…doesn’t help because most patients with asymptomatic carotid artery blockages will not suffer strokes. Although the screening test is “non-invasive and painless,” the confirmatory test, angiography, is not (it actually causes a stroke in a small number of patients) and unnecessary carotid endarterectomy can lead to death.

2. Abdominal aortic aneurysm screening is only recommended in men ages 65 to 75 who have ever smoked, because aneurysms are much less common in younger, female, and non-smoking populations. Even in men who are eligible for the test, it’s important to weigh the potential benefits against the potential harms of corrective surgery, which has a not insignificant mortality rate itself.

3. “Hardening of the arteries in the legs,” or screening for peripheral vascular disease with an arterial-brachial index, hasn’t been proven to prevent heart attacks but will certainly lead to many false positive results.

4. I’ve never even heard of atrial fibrillation (irregular heart beat) screening, which I presume is doing a screening EKG, which is also totally unproven. Absolutely no organizations recommend this.

5. Screening for osteoporosis with bone density testing is the only test on the list that’s actually worthwhile for a large number of adults, especially women over 65. But it’s not appropriate to do this test without a prior consultation with a clinician who can discuss the risks and benefits of undergoing this type of screening. And there are still questions about whether men benefit to the same degree as women, or at all.

He includes links to evidence-based studies by the United States Preventive Services Task Force (USPSTF).

Related post: “The Treatment Trap”

Marketing tricks

My “invitation” came with some manipulative helpful patient education materials. But it’s not educational material so much as marketing. One sheet asks the question: “What do doctors have to say about these preventive health screenings?” Well, I don’t know because that question is answered with half a dozen quotes from clients/patients rather than the doctors themselves.

What do doctors actually say? Dr. Lin concludes his post by saying:

In a nutshell, that’s why companies like Life Line have no business portraying these services as “preventive health screenings,” in my church or any other community setting. It’s one thing to draw blood for a cholesterol test and take someone’s blood pressure (which will cost a whole lot less than $149), and quite another to offer these other procedures which are, at the very least, a waste of money and quite possibly harmful.

Harriet Hall, MD, who writes for the blog Science-Based Medicine says:

If screening reduced morbidity and mortality, that might be a reason to get screened, but they are not claiming that. [Life Line] can’t claim it, because there is no evidence to support doing these tests in the general population.

For a screening test to be worthwhile, it has to meet several criteria.  You want to know the predictive value of a positive test in the population being screened.  You want to know not just whether it picks up an abnormality, but whether picking up that abnormality will allow earlier treatment that will make a difference in outcome. You want to know whether false positive tests will lead to harmful invasive procedures. Bottom line: does the test do more good than harm?

These tests are worthwhile when used by doctors to help diagnose patients with symptoms or patients at high risk, but when used to screen the general population of mostly healthy people, they are likely to be useless or even to do more harm than good.

The materials also include the badge of the Better Business Bureau, saying “Life Line Screening meets all accreditation standards in trust and integrity by the BBB and has been rated an A+.”

But meeting the business standards of the BBB has absolutely nothing to do with meeting evidence-based standards for screening exams.

Read the fine print!

Life Line’s claims remind me of the Quack Miranda Warning. That’s the universal disclaimer on supplements and herbal remedies that don’t fall under regulation by the FDA.

The disclaimer (always in fine print on the back of the box or bottle) reads:

This statement [whatever the product is claiming it does] has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

When you read it, you are left wondering (I hope), “Well, why should I buy it then?”

Life Line’s letter includes the same type of disclaimers.

Life Line Screening does not participate in the Medicare program and the cost of our screening services is not covered or reimbursable by Medicare.

Medicare and health insurance generally do not allow for coverage of vascular screenings.

Life Line Screening does not file insurance claims nor provide referrals to any physician’s group or hospital.

We direct all participants with abnormal results to take the report to their physician.

In other words, we’ll take your money and perform a test that neither Medicare nor any other insurance will cover because it is not medically indicated or useful, and then if something’s abnormal we’ll let you and your doctor worry about it and repeat this test and perform more tests because your doctor most likely won’t trust our results, anyway.

Check out my Resources page for links to good evidence-based screening information websites.

Bottom line:

  • Talk to your primary care doctor. Know your health risks and which screening tests are right for YOU.
  • Talk to your insurance company. Many evidence-based screening tests are covered free of charge.
  • Save your money. If you receive Life Line Screening’s “invitation” in the mail, toss it in the garbage.

Sláinte,

Frugal Nurse

For more in depth information about the risks—financial and physical—of overscreening, check out one of these excellent books:

Facebooktwittergoogle_pluspinterestmail

Comments

Don’t reach for Life Line screenings — 32 Comments

  1. I disagree with you as related to the tests not the company. My friend’s mother 10 years ago walked into the church in Kanzas. She was told that both her carotid arteries were 96% blocked. They called her doctor and sent her by ambulance to the hospital. She had both arteries done 1 week apart. She was told she was very lucky. She had no symptoms. Her friend had a blood clot that was found. Since then my friend and I and others we know have had lifeline screening every 2 years. We show it to our doctors, they look at it and say since the report has not changed, take it in 3 years.
    It may not be necessary or wise for some.I believe that your blog is very one sided. Talk about the company and their pricing. Talk about the pros and cons about early screenings, but don’t tell people to wait for symptoms. They can have the tests and show thier doctor. Let their primary care physician make that call for further testing. My other friend test showed a small AAA. Her doctor ordered a CT scan and they decided it was small and to watch it. Had it been bigger they would have operated. No symptoms.

  2. Your blog presenting Dr. Lin’s information is hardly newsworthy & as manipulative as his. Life Line is run by Seton Hospital & is just a preventative avenue. Life Line does not suggest surgeries & anyone with two brain cells to rub together would know further tests would be done (by their doc) prior to surgical recommendations.

    As an RN with an MSN, 30 yrs in ICU & ED, & as a nurse paralegal, I find you & Dr. Lin dangerous. I’m sure physicians are against it because they are losing money when those people utilize the tests & don’t pay (more) at a physician’s office. What your purpose is, beyond false adoration, I have not the faintest idea.

    If someone can afford 5 tests for preventative guidelines, who are YOU to suggest they don’t? Thousands of people have minimal insurance or live on Medicare & SS & don’t have money to go to their primary, then Cardiologist (has to be referral), then pay facility fees for very expensive tests. That is even if their doctor gave a rip about someone over 65 (unlike multiple other countries)………The fact is none of those tests would be ordered by their doc (& paid by insurance companies-crooks in the U.S.) without sysmotoms. Forewarned, a different story.

    • Dinah, I appreciate your passionate advocacy for patients. I also agree that our healthcare system is broken, expensive and too many players (doctors and hospitals) are motivated by profit alone.

      However, as Dr. Lin points out, the 5 bundled tests offered by Life Line Screenings are not supported by the United States Preventive Services Task Force (USPSTF) for the general population, and therefore cannot be considered standard of care. Dr. Lin’s comments provide links to the specific USPSTF pages.

      I stand by my opinion that people need to know their individual risks and have a conversation with their primary care providers about which screening tests are appropriate. As long as the ACA stands, health insurance and Medicare are pretty generous paying for screening tests that are given A or B grades by the USPSTF.

      For the uninsured who wish to use Life Line, I would still recommend them knowing which screening tests are most useful for their age/gender/risk (per the USPSTF) and only ordering those specific tests, rather than buying a bundled package that may include tests they don’t need.

      The purpose of my post is not to tell people what they can or cannot do. I just believe all of us need to be better informed when we make costly healthcare purchases. Best, FN

  3. I was so happy to finally find a site where I can post a warning about Life Line screening. In my opinion, they are a money-making scam. Try to find a company phone number where you can call to be taken off the list, for example. Once they get your name, you’ll continue to get regular mailings from them. I no longer open those–mark refused, return to sender.
    Life Line uses fear to keep bringing patients back. In my case–bone density. Yet my REAL bone density test was so good my physician told me he didn’t think I’d never need another one.
    Another time, they sent me another patient’s test information.
    DO NOT WASTE YOUR MONEY on LIFE LINE. it’s not a lifeline, it’s a NOOSE. Use a physician or nurse practitioner you trust instead to determine what medical tests you actually need.

  4. thanks frugal nurse I worked for then and they toss the blood components in regular garbage scary right

  5. The life line marketing may be misleading but your article is just as misleading, if not more. The purpose for screenings is to establish a baseline. If an asymptomatic patient has plaque built up in their carotid arteries that is not causing a significant blockage, that does not mean the test was some sort of fraud. Finding out you have a mild amount of plaque can lead to a yearly follow up which could help prevent a stroke. And in no way would any surgeon EVER perform a carotid endarectomy based off of a preventative ultrasound. To suggest that this is even remotely what could happen to someone is so wrong it is making me laugh. At worst, a patient with a possible critical finding may have a CT or CTA to confirm findings and will onot have endarectomy if stenosis is approx or greater than 80%. There are absolutely benefits to have these screenings. I do not agree with the way Life line has set up there operation but I believe cash screenings should be available to the public to establish a baseline. Let us remember Medicare reimbursement requirements is ridiculous across the board.

    • And let us not forget that these tests are not covered because Medicare and private payers do not want to pay for it until disease has reached a critical point which is why these numbers cited are also ridiculous. Having to pay for yearly Aorta scans or carotid scans is bad business for our govt so they establish an age of 65 for males as the age you should receive a baseline screening. Absurd! I have seen countless patients in their 30s, 40s, and 50s with AAA’s or plaque build up.

  6. Life Line is also committing a deep fraud. You pay your $149 for tests NOT covered my Medicare; but they bill Medicare for $149 for you WELLNESS check-up, when there isn’t one. In fact, what my mother just went through is just plain fraud. The ABI test wasn’t standard, she never one had her blood pressure checked yet the results came back telling her how to control high blood pressure. When she went for her annual Wellness check with her physician, she gave them the screening results–the doctor just laughed. Her blood pressure hasn’t been above 117/72 for her entire life. Her cholesterol is on the higher side but hereditary and she has never been directed to take anything for it. She is 88 and unbelievably healthy. So without doing a blood test and never taking any blood pressure how could these tests even be valid? What bothers me the most is the deception. This is how they approached my mother (any many others, just read the BBB complaints) oh, we have time another test today, it’s completely free. So my mom took it. She spent 15 minutes in a room with a nurse practitioner asking questions. Nothing more. Well, they billed Medicare for $149 for her Wellness checkup which wasn’t a Wellness checkup at all. And when my mom went for her real checkup with a doctor, Medicare wouldn’t cover it. So she called Medicare to ask why it was denied, they told her LifeLine had billed them for $149 for Wellness checkup. The lady asked my mother if she wanted to file a fraud complaint. She wasn’t sure. When she came out to visit me and told me what was going on, the conversations she had with a John Becker at LifeLine I was livid. They had a 3-way conference call with Medicare and this guy told the patient accounts/insurance specialist to just file it again – he told her to do it twice. And she said, NO, that is fraud. He laughed and said send it in, they’ll pay it. So, this is the kind of company you are dealing with. Also, for all of you thinking well any kind of advance prevention is good, I agree, but since their testing is limited, and I think somewhat substandard, you actually may be getting fraudulent testing all the way around, outside of the fact they are robbing you twice, and the government. What a great scam they have going on. How sad, don’t fall for it.

    • Oh, I forgot one really major thing. On the original form my mother signed for her tests, she did NOT check the Medicare box because there was no need to, Medicare didn’t cover these tests. Well, after he conversation with Mr,. Becker they sent her a copy of that original form–but the nurse, a Ms. Melissa Squires, FNP, check the box and wrote in the date (my mother missed that) and wrote next to my mother the word self. They cannot do this. You cannot fill in any part of a medical form that the patient is supposed to fill out. That is brazen fraud. And I know why, after my mom agreed to the extra free test, Ms. Squires went back and checked the Medicare box so they could submit a Wellness checkup and get their complete $149 back. FRAUD, all the way around this company stinks. And the real stupidity – on the bill receipt to my mother’s credit card, the Wellness didn’t show up as part of her testing that day. Now that is fraud.

    • Hi Cyndy. All I can say is Wow, and thanks for sharing your mom’s story. I’m surprised-not surprised that LifeLine would hijack the Medicare Wellness Visit. Which is terrible because you only get one WV per calendar year, so it’s being wasted on those unnecessary LifeLine tests. Maddening. And very possibly fraud, as you are saying. I will add my voice to yours–don’t do business with LifeLine Screenings! It’s not good health care, and it doesn’t save you money. Thanks again for commenting, Cyndy. Cheers, FN

  7. I appreciate your taking the time to write such a thoughtful, detailed blog. I received this offer in the mail, and after Googling and finding your article, I will do just as you suggested–toss it in the garbage.

  8. These test save lives everyday literally some spend the money and find nothing year after year yet continue to screen with lifeline screening for preventative health purposed. I have NEVER been able to walk into my doctors and say hey based on medical guidelines im at risk for A B C D can you preform a ultrasound just to “check” and actually get my request granted. these screenings allow people the ability to be proactive and take more control of their personal risk. These screenings aren’t forced on anyone they are offered. I hear positive testimonials and life changing results all the time about the screenings. If you want to do them take advantage if you don’t then don’t its very simple.

    • Hi Annette, thanks for your comment. I appreciate that you want to be proactive about your health, and that’s great! The problem with the carotid ultrasound (and the other tests Life Line sells) is that it is NOT a good screening test for stroke. I know it seems odd, but studies have shown that you can have clear carotid arteries and have a stroke, and vice versa. So if the ultrasound shows a partial blockage, and you aren’t having any symptoms, you might end up having surgery or other treatment that is more harmful than doing nothing.

      So I disagree that any of these screening tests is harmless if it leads to unnecessary anxiety, treatment and cost.

      The best screening for stroke at this time is knowing your personal risk factors, such as age, family history, blood pressure, cholesterol, and a lifestyle assessment–weight, diet, exercise, smoking, etc.

      I hope this answers your question. In other comments I have listed some links to good resources about other screening tests, which I hope will help you continue to be proactive about your health. Best, FN

  9. I certainly appreciate your site and attempt to help people make good medical decisions. I would ask that you try to avoid using somewhat vague words like “most”, “less”, “more”,…These can be interpreted incorrectly. Eg. Is “most” the same as 51% or greater? Anyway, I appreciate your attempt to raise consumer awareness but you lost me on your lack of concise data on some of your arguments.

  10. Medicare does allow for a one time AAA screening, which is appropriate. Abdominal aortic aneurysms are a silent killer and ultrasound does not carry any risks. Screening exams for carotid and peripheral vascular disease are not necessary for the majority of the population. If your doctor hears a carotid “bruit” he will send you for a formal exam. If you have claudication, your doctor can send you for a formal arterial exam. The lifeline company will tell the consumer that they need to be followed for minimal plaque and that simply is not true. I feel it is unethical to cause these older patients stress and worry so they can get them to come in once a year to be followed for minimal vascular disease that isn’t going to cause them any life threatening problems.

  11. After reading your statement about the Carotid Artery, you never really state whether that simple procedure does detect a possible blockage. Doctors are not proactive because insurance companies don’t want to pay for anything that may not be a real death possibility issue. Therefore we take it upon our selves to be proactive. I had the tests done a few years ago and they found I was a-okay. I have received another offer ($99 for the 5 screenings.)heading for 60,good way to be proactive with my health. Are you saying that the carotid artery check will not let you know if a possible train is coming and I need to get off the tracks?

    • Hi Chris, thanks for your comment and question. Let me quote from Dr. Harriet Hall of Science-Based Medicine (link is in the post):

      Ultrasound can show a narrowing of the carotid artery. I guess that’s nice to know. It’s also nice to know that if you have no symptoms, it’s probably not going to make a difference. Even if the artery is 60-99% blocked, surgery may only reduce the risk of stroke by 1% a year, and the surgical risks may outweigh any benefit. If you have symptoms from carotid artery narrowing, surgery might be life-saving. But then you probably would have consulted your doctor about the symptoms in the first place instead of going to a church to get a screening test. If you have an asymptomatic narrowing that does not require surgery, you can work on reducing your other risk factors for stroke, but that would be a good idea anyway, even if you didn’t know what your carotid arteries looked like.

      Dr. Lin also emphasized that if you aren’t having any symptoms, it doesn’t matter what your carotid arteries look like under the ultrasound. That’s why it’s just not a useful test.

      I understand that you want to be proactive about your health–that’s great! But the screening tests offered by Life Line DO NOT provide useful, evidence-backed information. At best they’re harmless; at worst they are a false sense of security.

      I listed some resources in a comment a few below this one that can guide you to knowing which screening tests might be most appropriate for you. Look at those and take that information to your doctor and see if you can work out a reasonable screening schedule that works for your budget.

      Cheers, FN

      • Im confused as to why early detection is not important to preventative health. The most ACCURATE way to detect blockage would be a actual picture of the artery because even doctors know that just “listening” does not always provide an accurate result. The key to stroke prevention is early detection. Life screening is just that a SCREENING to give patients correct documentation that there is a higher risk for stroke because even a mild blockage is there and medication can be prescribed or whatever is suggested by the attending physician. If someone decides to take advantage of a PREVENTIVE health screening why not?

  12. Thanks, Frugal Nurse for your posts. I spent $249.00 on these screenings. Had the 5 screenings and 3 more on the up-sell. None of my doctors seemed excited when I submitted the reports; and after reading your comments, I now know why. They read it and filed it. I won’t be going back. It was a horrible experience!! Tests took only minutes to do. My appointment was 11:15 a.m.; they guaranteed I’d be out by 1:30 p.m. As I waited with about 100 people in the gymnasium of a church, we all watched as they let in more people with appointments; as many as the room would hold. I was one who didn’t “walk out” incomplete and I went home at 5:15 p.m. It’s definitely a unique “for profit business.” Other than my blood pressure being high (which might have been caused by a 36 hour fast), there were no other problems. There’s got to be another way.

    • Wow. Thanks for sharing your experience. It sounds like they are (sadly) doing a good business, and will no doubt keep doing it. Life Line’s screenings are simply not worth the time or money. There are useful screening tests–when used on the right people at the right time. But many screening tests, even the good ones, are being overused at this time. What are we to do? Be informed as much as possible. I listed some good resources in the comment below this one. But also know your family history; that can determine which screening tests might be most appropriate for you. And ask lots of questions or do some research before getting any screening test–What does the test look for? Are you at greater risk than the general population? At what age should the test be started? How often should it be done? Does the test frequently result in false positives or false negatives? There is no perfect solution, but Life Line is definitely not the way to go. Thanks again for your comment. FN

    • Hi Cassandra, that’s a good question. There are a number of useful screening tests, but they are most effective when based on your age, family health history and personal health history. For example, the current recommendation for screening mammograms is every other year for women between the ages of 50 and 74. But if you have a family history of breast cancer, you may want to start at age 40 and have one every year. Colonoscopies to screen for colon cancer are recommended at age 50 and then every 10 years. If you are at an increased risk of colon cancer, you might want to have one before age 50, or have them more frequently. Talk with your physician about which screening tests are most appropriate for you; together you can make a plan that best meets your health care goals.

      For more information about recommended screenings tests–the who, why and when–check out these websites: The United States Preventive Services Task Force (USPSTF); The Centers for Disease Control (CDC) Prevention Checklist; Choosing Wisely–Screening tests; and Healthcare.gov–Preventive Health Services. Best, FN

  13. hello,my ent uses ultrasound for sinus and ear and throat problems.as my age.took ultrasound an looked at my heart.told me i hade 50% blockage in to arteries.went to cardio doc,laughed at me and my doc.done ekg,ask if i had a heart attack,nope,done cat test,i wrote on paper what ent told me cardio dock said 50%.handed him paper.7/2014 test done,6/18/2015 cab 2 open heart surgery.simple test do make a difference.

  14. I disagree with you completely. Working in cardiology as long as I have you realize that heart disease is a silent killer respect especially among women. These are simple tests to be pro active.

      • I would love to hear how your medical training taught you that EKG are not one of the primary first test used to screen for cardio related pathology.

        • Added: Why do you think the very frist thing done when a patient presents in the ER with angina related chest pain is an EKG/ECG?

          • Thank you for your comment, Dr. Redmond. Please let me clarify. The “EKG” used by Life Line Screenings to screen for atrial fibrillation is described per their website as follows: “A non-invasive procedure used to detect irregular heartbeat (a major risk factor for stroke), an Atrial Fibrillation screening is performed by attaching EKG electrodes above your wrists and ankles.” That is not the same as an ECG performed in an ED or physician’s office.

    • Hi Ray, nice to hear from you. Yes, there is too much screening being done by mainstream health care already–we certainly don’t need an additional for-profit only company selling more. Best, FN