Cost sharing and narrow networks

It’s that time of year—open enrollment for health insurance.

If, like me, you buy an individual health plan for yourself or your family, and you have been informed by your insurance company that your current plan will no longer be available, you are once again shopping for a plan that meets both your needs and budget.

The new plan I’ve been offered has both a higher premium and a higher deductible, but as far as I can tell our provider network will remain the same. That’s important, since my husband has a doctor he really likes. I had to change … Continue reading

The shingles (herpes zoster) vaccine

shingles herpes zosterA painful but common condition in older adults is shingles or herpes zoster. I’ve known several elderly people afflicted with this, and I will absolutely get the vaccine as soon as I turn 60!

The vaccine, Zostavax, is FDA-approved for ages 50 and up, but the Cleveland Clinic recently advised that it’s not cost effective for anyone under 60 to get immunized.

Why? Because Zostavax is too expensive. On average, it costs about $200, and that doesn’t include the cost for the office visit or vaccine administration that some clinics charge.

The vaccine is effective for 10-12 years, so … Continue reading

The FDA wants new sugar rules

It’s not too late to give the Food and Drug Administration (FDA) your opinion on its latest effort to require that more information be provided on food labels.

Last year, food labels began listing the amount of added sugar per serving (usually listed in grams).

Now the FDA proposes that labels also show sugar as a percentage of the recommended daily intake or value (%DV). Labels already do this for most vitamins and minerals, fats, fiber and sodium.

Sugar’s %DV would be based on the US Dietary Guidelines Advisory Committee’s recent recommendation  that people limit sugar to 10% of their … Continue reading

Changes in your 2016 out-of-pocket maximum

It’s almost that time of year when insurance companies start sending out information about next year’s plans and what may or may not have changed in their policies, such as premiums and benefits.

A little-known new rule of the Affordable Care Act (ACA) will take effect on January 1, 2016, and might affect your health insurance plan and health care costs.

Specifically, this rule takes away what’s been called the “umbrella limit” on out-of-pocket maximums for families.

If you currently have a family policy with a family out-of-pocket maximum (up to $13,200 in 2015), even if only one family … Continue reading

The high cost of cancer

I’ve posted before about how expensive it is to be treated for cancer.

Recently, a patient posted on the health blog KevinMD about her experience dealing with not only the stress of metastatic ovarian cancer, but the struggle to stay afloat financially.

I am one of many people today “living” with cancer. I want to focus on the impact cancer has on my personal finances, and this is probably true for any chronic illness, not just cancer.

Never in my wildest dreams did I think I’d be diagnosed with stage 4 ovarian cancer at 51 years old. I really

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The industrialization of health care

Have you ever felt that going to see your physician or going to the hospital is like stepping onto an assembly line?

Well, the metaphor of being a car (or a hamburger) is a pretty accurate one. Two articles I read this week discuss how health care leaders have been turning to the big manufacturers—Toyota, for example—to increase efficiency, production and profits.

Kaiser Health News (KHN) puts a positive spin on this trend:

As public hospitals…try to cut costs and make patients happier, administrators have turned to an unlikely ally: Toyota. They are adapting the car maker’s production system to

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Mega-insurance companies versus mega-health care systems

Two big health insurance mergers are in the works: Aetna plans to buy Humana for $33 billion, and Anthem will take over Cigna for a whopping $54.2 billion.

The number of major health insurers in the US will soon be three, down from five.

So much for more competition, huh?

What’s happening in the health care delivery system mirrors the insurance industry. The biggest health care corporations are furiously buying up smaller hospitals and physicians’ groups.

From their points of view, it makes sense: Each side believes being bigger will give them the upper hand in reimbursement negotiations (that is, … Continue reading

Cover your a** health care

“Cover-your-ass health care” or “save-my-ass medicine” are terms used to describe all the extra diagnostic tests (blood tests, CT scans, MRIs, etc.) ordered by physicians to rule out possible (but unlikely) life-threatening conditions.

Such as going to the emergency department with a headache and getting a CT scan to rule out an aneurysm or a brain tumor.

Or, as in this video example, being worked up for a heart attack when the most likely diagnosis is a simple case of heartburn. (Warning: video contains some bad language!)

The ER physician in the video is certainly … Continue reading

Know your health insurance

Two recent stories from Kaiser Health News caught my attention because they underscore the burden placed on patients to understand exactly what services their health insurance does or doesn’t cover.

Of course everyone should know their health plan’s benefits, but with so many different types of plans, and the hair-pulling-out frustrations of narrow networks, it can be really difficult. Unfortunately, the financial consequences of making a mistake are heavier than ever.

The first story tells of a … Continue reading

A routine urinalysis is unnecessary

This week the National Kidney Foundation (NKF) started a public health campaign called “Everybody Pees.”

The highlight is a short video featuring a catchy song and colorful South Park-esque kidneys peeing in all sorts of places—parks, swimming pools, on top of a car, etc.

OK, it’s cute, kind of. But here’s my problem with this video (other than the it’s a cartoon more appropriate for six-year-olds): a routine urinalysis is NOT recommended to screen for kidney disease.

But that’s what the song seems to tell us to do:

The smartest place to pee

Is at

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Big Pharma’s “sneaky ways”

High drugs costs are one of the leading causes of higher health care costs overall. Not only are more people taking prescription drugs than ever before, the drugs are getting more and more expensive.

That’s why it’s so infuriating to read about drug companies using “devious” tactics to make sure their profitable blockbuster drugs can evade competition from the less expensive generics (although even many generic drugs are skyrocketing in price). And it’s equally gratifying to know that sometimes they don’t get away with it!

A few days ago the New York Times ran a good editorial on a … Continue reading

Surprise medical bills

One of the premises of Obamacare was that if patients were expected to pay more towards their health care—have more “skin in the game”—they would shop around for the best prices and spend less.

If only.

I posted about how difficult, if not impossible, it is for patients to shop for health care. Prices are not as transparent as some policy makers would like to think.

Related post: Researching health care costs

A recent article in Kaiser Health News confirms this:

Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them

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Obamacare premium increases for 2016

Here we go again!

Every May, health insurance companies file their requests for premium increases for next year’s plans.

I’ve been watching my state’s website for the Office of the Insurance Commissioner. Rate increases for all health plans—group, small business, and individual (both on and off the health exchange)—are posted for public review and comment.

The insurance commissioner has until late summer to either approve, disapprove or modify the increase. Insurance companies are required to give their subscribers a 90-day notice of any premium increases.

My insurance company is asking for a 9.6% rate hike. Our family’s premium will go … Continue reading

Balance billing

More and more frequently I come across stories of patients who have inadvertently received care from “out-of-network” providers. And it can be a costly mistake.

When you are billed for the costs that your insurance company has denied, that’s called “balance billing.”

My insurance company doubles the deductible for out-of-network care; instead of $10,000, our deductible becomes $20,000. But insurance companies aren’t required by law to put a limit on a patient’s out-of-pocket spending when it comes to out-of-network care. In theory, you could get hit with tens of thousands of dollars in medical bills even though you have insurance.… Continue reading

Elisabeth Rosenthal on the problems of Obamacare health insurance

Take time to read Elizabeth Rosenthal’s latest installment of her “Paying Till it Hurts” series in The New York Times: Insured, but not Covered.

If you are like many Americans struggling with high-deductible, narrow-network health plans, you might relate to the families she writes about.

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

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