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

Sad but true – CYA medicine works

A few months ago I posted about CYA—Cover Your Ass—medicine being one reason why too many diagnostic tests are ordered and health care costs are high.

CYA medicine is when the doctor or doctors are pretty sure what your problem is, but they order extra scans and x-rays and blood tests anyway because “failure to diagnose” is one of the leading causes of medical malpractice suits. They aren’t going to take any chances, and who can blame them?

Related story from KevinMD: This is why doctors practice cover your ass medicine

Besides, they don’t pay your resulting medical bill, so … Continue reading

Confused by mammogram guidelines?

October is Breast Cancer Awareness Month, so I can’t let it pass without commenting on the American Cancer Society’s (ACS) recently updated screening mammogram guidelines.

Before, the ACS recommended annual mammograms starting at age 40.

Now they recommend annual mammograms for ages 45 to 54, with screening mammograms done every other year after age 55.

But, they add, women should still have the choice to start screening at age 40 and have yearly mammograms thereafter.

The confusion arises not only because the ACS is a bit wishy washy on its guidelines, but because the American College of Obstetricians and Gynecologists … Continue reading

What if Your Hotel Bill Was Like a Hospital Bill?

I couldn’t help but laugh when I ran across this video from Costs of Care: What if Your Hotel Bill Was Like a Hospital Bill?

I swear I recently had a very similar conversation with a health insurance company regarding the cost of a new wheelchair for my elderly aunt!

Although insurance covered the bulk of the cost (well over $5,000) my aunt still owed close to $2,000. The bill had a list of about 20 items related to the wheelchair, but neither side admitted to knowing anything about exactly what each charge was … 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

Another drug skyrockets in price

A year ago I posted about the worrying trend of generic medications—a mainstay of affordable health care—rising in price by 100%, 200%, 1000% or more. My husband’s levothyroxine, for example, has increased in price by over 600% since 2013.

The common and used-to-be-dirt-cheap antibiotic, doxycycline, has gone up a whopping 6,000%!

Unfortunately, this trend has not stopped.

The latest old-drug, new-price story is that of Daraprim (pyrimethamine). Last month Turing Pharmaceuticals bought this drug and immediately jacked up the price from $13.50 per tablet to $750, an increase of over 5,000%.

The New York Times, I think, had the … Continue reading

Is it wise to remove wisdom teeth?

I participate in a world-wide group of health care providers that exchanges information about the high costs of health care and overtreatment in our respective countries. (It’s not just an American problem!)

One provider recently shared for our consideration a paper that stated too many third molars (aka wisdom teeth) were being unnecessarily removed in the US.

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion.

In addition, more than 11 million patient days of “standard discomfort or disability”—pain, swelling, bruising, and

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Praluent – Treating cholesterol just got more expensive

Earlier this summer the Food and Drug Administration (FDA) approved the first of a new type of cholesterol-lowering medication, the PCSK9 inhibitors.

The drug companies Sanofi and Regeneron got that honor with their drug Praluent (alirocumab). But not too far behind will be Amgen with Repatha (evolocumab) and Pfizer with borocizumab. (Who names these drugs, anyway?)

Although Praluent is not yet available in pharmacies, its announced price tag has the medical community (and insurers) in an uproar. Pharmaceutical executives are doing their best to rationalize the expense—spend a lot of money up front and maybe save more money down … 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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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

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