We’re doing too many screening and diagnostic tests

More tests = more money

Anyone who has read my blog over the years knows this is a subject I come back to again and again: the overuse of screening and diagnostic tests.

It’s a problem in our healthcare system for a couple of reasons.

First, the majority of healthcare providers are paid based on volume. In other words, the more patients they see, the more tests they run, the more surgeries they perform, then the more they get paid. It doesn’t matter if the outcome is poor, because they still get paid. In fact, they make even more money … Continue reading

Don’t presume your provider’s office knows best

This guest post is from a good friend of mine. She’s not in the healthcare industry, but she is one of the most savvy healthcare consumers I know. When she was telling me about some of her recent dealings with providers and insurance, I immediately asked her to write up her experiences to share with my readers! 

I don’t willingly part with my money, especially when I see a healthcare provider.

I question unnecessary tests, and I don’t want the office staff to be cavalier about spending my money. I expect the office to be familiar with my insurance plan, … Continue reading

Annual exams vs. annual wellness visits

Happy New (Calendar) Year!

It’s the start of a new year or, in health insurance lingo, the start of a new calendar year deductible. I’m reposting this from last January, because this month is the best time to start trying to schedule that annual exam or annual wellness visit (it could take weeks, after all, to get an appointment!)

I usually advise people to get any screening tests or annual exams done early in the year, just in case an abnormality is found and more testing/treatment is necessary.

Especially with the current trend towards enormous deductibles (up to $14,300 for Continue reading

Budget-busting prescription drugs

Taxpayers footing the bill

I watched this on my local news the other night: Runaway drug price hikes squeeze Washington’s budget.

Our state is one that expanded Medicaid under the Affordable Care Act (ACA), so I knew we were spending a lot. But I had no idea now much. Through the first 9 months of 2016, my state has spent $1.1 billion on prescription drugs.

Not total medical care. Just prescription drugs.

And Washington is not the only state facing a fiscal nightmare because of skyrocketing drug costs.

Almost half of that spending is for the really high-priced specialty … Continue reading

Choosing Wisely – Use less healthcare

My goal for 2017? Use as little healthcare as possible

How will healthcare change under a new president and political party?

That’s a question I can’t answer. As I wrote in my last post, both candidates had multiple-point plans to tweak/improve/repeal/replace the Affordable Care Act, aka the ACA or Obamacare.

But I don’t know what will change or when.

What I know for sure is that for 2017 my premiums will be 20% more expensive, my co-insurance and co-pays will be higher, and my current primary care doctor will no longer be in-network.

I can and will shop around … Continue reading

Do you know your drug formulary?

drug formularyThe shrinking drug formulary

Insurance companies have several ways to cut their costs.

We are all familiar with higher premiums, higher co-pays, increased deductibles, and narrower provider networks. These will all be apparent when we look at our policies for 2017.

A lesser-known strategy is to remove high-cost drugs from the drug formulary—the list of medications that insurance will cover.

Insurance companies typically work with a pharmacy benefits manager, or PBM, which acts as the middleman to negotiate drug prices with drugmakers.

Exploding drug costs

The Affordable Care Act made it mandatory that health insurance plans offer prescription drug … Continue reading

Get your hepatitis A vaccination!

hepatitis aHepatitis A outbreaks

This morning I read about a hepatitis A outbreak in Virginia. The source is apparently contaminated strawberries used to make smoothies. So far, 40 people have become sick.

This outbreak follows on the heels of another in Hawaii, where 168 cases of the virus have been linked to frozen scallops.

Let these outbreaks be a reminder or an incentive to anyone NOT vaccinated against the hepatitis A virus—get vaccinated!

The hepatitis A virus attacks your liver and causes varying degrees of nausea and vomiting, abdominal pain and jaundice. It rarely causes long-term liver damage or … Continue reading

View Prevnar 13 ads with caution

prevnar 13Prevnar 13: As seen on TV

I was watching TV the other evening and, as usual, was forced to sit through multiple back-to-back prescription drug commercials.

One that caught my attention was for Prevnar 13, which is one of the pneumonia vaccines. (13 because it protects against 13 strains of streptococcus pneumonia.)

The commercial stated Prevnar 13 was for adults aged 50 and older.

That statement’s true, but needs some clarification.

Yes, Pfizer did get FDA approval a few years ago to market Prevnar 13 to adults over the age of 50. Previously, the vaccine was only used for … Continue reading

Skin cancer screening guidelines

skin cancer“Insufficient evidence”

Many years ago I had a primary care doctor who used to perform a total body skin examination (TBSE) on me every year as part of my annual exam.

Of course, those all-inclusive physicals are a thing of the past. I haven’t had a physician perform a TBSE for a long time.

I often wondered about that. A TBSE seems like a relatively easy and harmless way to quickly screen for skin cancer. The goal, of course, is to find a melanoma, the deadly skin cancer, when it’s small and possibly curable.

Related post: A must-watch video about Continue reading

The high cost of healthcare in America

They say a picture is worth a thousand words, and the online news site Vox recently sought to open Americans’ eyes as to how much more we pay for healthcare compared to other countries.

America’s healthcare prices are out of control. These 11 charts prove it.

I can’t copy their charts, but basically they are bar graphs. The bar that shows how much patients in the US pay for similar drugs and services towers over the others like a skyscraper over a neighborhood of single-family homes. Like this:

healthcare costs graph

Vox got its information from the International Federation of Health Plans (IFHP)Continue reading

Why are EpiPens so expensive?

epipensEpiPens – lifesaving but costly

I’m allergic to bee stings, so I keep an EpiPen handy when I’m working out in my garden this time of year.

But my EpiPens are more than 3 years old now, and it’s time to invest in a new set.

Why do I say invest? Because EpiPens are incredibly expensive!

Related post: First aid for bee stings

I didn’t know that three years ago when I bought them. At that time, my health insurance did not include coverage for prescription medications (all ACA-compliant plans must now), so I paid the full price out of … Continue reading

Obamacare premium increases for 2017

Up, up and away!

Does anyone’s income go up as fast as their health insurance premium? I wish.

11.6%. That’s how much more my current health insurance provider wants to charge for my bronze high-deductible health plan in 2017.

And although 11.6% seems like a lot to me, another company in my state is requesting a 19.9% average increase on all its plans, with a 28% increase on its gold plan!

So far, the rate increases that have been made public in other states are all pretty high, averaging well into the double digits. So at least I’m not … Continue reading

Can telemedicine save you money?

telemedicineTime is money

Maybe you have affordable health insurance and a doctor you like.

But have you ever had the experience of calling for an appointment for a sore throat, a bladder infection, back pain, or some other minor ailment and being told that the doctor’s next available appointment is in six weeks?

Or you get a same-day appointment, but then have to take time off work, drive to the clinic, perhaps pay for parking, and then wait to be seen by the doctor. For a five-minute appointment.

It’s frustrating, sure, but it’s also costly when you consider the time … Continue reading

Harken Health – Betting on primary care

I just read about health insurance giant UnitedHealth’s bold but risky new insurance plan, Harken Health:

UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.

With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling is also provided, as are yoga, cooking and acupuncture classes.

At this time, Harken Health is only available in Chicago … Continue reading

The high cost of dying with dignity

I just read about another case where a pharmaceutical company bought the rights to an old, been-around-forever drug and then drastically increased the price. Argh.

A few months ago I posted about the drug Daraprim, which was bought by Turing Pharmaceuticals. Its CEO, the now infamous Martin Shkreli, raised the price from $13 a pill to over $700.

Last February, Valeant Pharmaceuticals bought the rights to Seconal (secobarbital), an 80-year-old sleeping pill. Ten years ago 90 Seconal tablets cost about 30 dollars. Now it’s closer to $3,000.

It’s believed Valeant did this in response to California’s new End Continue reading