preventive care

[Khan]

I just got my 2007 package from the medical insurance plan.

Am entitled to free preventive care including an annual physical.

Should I get an annual physical?

How do I shop for one?

What should be included?

 

[REWahoo]

What should be included?

I think an extended warranty would be nice to have.

 

[Rich_by_the_Bay]

Tricky area. For more than you want to know, check here. In brief, for a screening procedure to be useful, it has to:

• be for a disease which is treatable (no sense screening if we can't help you even if it's positive)
• be for a disease whose outcomes are better when treated early rather than waiting for symptoms to appear (otherwise don't bother screening, just wait til it appears and treat it)
• be a test with a generally acceptable cost and risk
• be accurate enough that the benefit to most patients is not offset by the harm to those who have the occasional and inevitable false result

You'd be amazed at how few screening procedures pass muster here. Colon cancer, blood pressure, cholesterol are some. Mammograms and PSA are controversial. X-rays probably of no use. Glucose, maybe. Pap smears probably worthwhile every 3 years. Stress tests - no dice without risks or special circumstances. Total body CT and coronary calcium CTs: no evidence. You get better results if you target the tests at the higher risk groups.

So, if you doctor recommends a lean but thoughtul minimal test profile, he/she is probably on track.

 

[JohnEyles]

I just got my 2007 package from the medical insurance plan.

Am entitled to free preventive care including an annual physical.

You definitely should. But don't be so naive as to really think it'll be free.

For example, they wouldn't cover EKG for me - don't want to go into my
details, but it's idiotic to think EKG isn't indicated for me. Still, it cost me
about $65 for a pretty complete physical - can't really complain.

 

[Goonie]

I just got my 2007 package from the medical insurance plan.

Am entitled to free preventive care including an annual physical.

I just got that from my employer, too. Along with a premium increase notice!

They said "We're giving it to you for FREE......oh, yeah....and we're increasing your premiums."

I have to go in to talk to them and find out if this applies after retirement also, since we're 'supposed' to have the same coverage as now. And my FIRE date is 116 days away!!! If it does apply to retirees...."And I'd like that in writing , too, please!!!"

 

[Buckeye]

Also, decide what information/results you want on record.

 

[mykidslovedogs]

I just got my 2007 package from the medical insurance plan.

Am entitled to free preventive care including an annual physical.

Should I get an annual physical?

How do I shop for one?

What should be included?

Is it an individual or a group plan? A few things to think about:

1.) If it is an individual plan, read the plan document carefully. Many states mandate cancer screenings like mammograms and prostate screenings and that's it. Other plans say they will pay for preventive care (such as the office visit) upto $300.00/year but only AFTER the deductible is met. And lab and x-ray that is not done in the doctor's office typically will apply to your deductible.

2.) Here is another gotcha. If you talk about anything but your preventive care during your preventive exam with your doctor, you doctor is going to bill the visit as ROUTINE care vs. PREVENTIVE care, which could cause your insurance carrier to apply the visit to the deductible instead of paying for the visit without it being subject to the deductible. I had that happen to me firsthand on my HSA plan the first year I got it, and it wasn't the insurance company's fault. I talked to my doctor about acid reflux during my preventive exam, so she billed it as "routine" instead of "preventive". Thus the visit applied to my deductible instead of being paid without being subject to the deductible. When I complained to the doctors office, they refused to rebill the claim as preventive and told me if I had wanted to talk about non-preventive care during my office visit, I should have made a separate appointment.

3.) Group plans typically have better preventive coverage than individual plans, because they almost always pay for the office visit 100% after copay.

4.) Lastly, don't expect your insurance carrier to pay for a preventive colonoscopy without meeting your deductible first. Colonoscopies almost always hit the deductible before coverage kicks in. Some carriers are starting to pay for Colonoscopies upfront, but not very many yet. And...some individual plans do not cover preventive colonoscopies at all. In that case, you should see if your doctor will bill it as diagnostic instead of preventive. Then, it will be covered, but likely subject to the plan deductible first.

 

[Khan]

Is it an individual or a group plan? A few things to think about:

1.) If it is an individual plan, read the plan document carefully. Many states mandate cancer screenings like mammograms and prostate screenings and that's it. Other plans say they will pay for preventive care (such as the office visit) upto $300.00/year but only AFTER the deductible is met. And lab and x-ray that is not done in the doctor's office typically will apply to your deductible.

2.) Here is another gotcha. If you talk about anything but your preventive care during your preventive exam with your doctor, you doctor is going to bill the visit as ROUTINE care vs. PREVENTIVE care, which could cause your insurance carrier to apply the visit to the deductible instead of paying for the visit without it being subject to the deductible. I had that happen to me firsthand on my HSA plan the first year I got it, and it wasn't the insurance company's fault. I talked to my doctor about acid reflux during my preventive exam, so she billed it as "routine" instead of "preventive". Thus the visit applied to my deductible instead of being paid without being subject to the deductible. When I complained to the doctors office, they refused to rebill the claim as preventive and told me if I had wanted to talk about non-preventive care during my office visit, I should have made a separate appointment.

3.) Group plans typically have better preventive coverage than individual plans, because they almost always pay for the office visit 100% after copay.

4.) Lastly, don't expect your insurance carrier to pay for a preventive colonoscopy without meeting your deductible first. Colonoscopies almost always hit the deductible before coverage kicks in. Some carriers are starting to pay for Colonoscopies upfront, but not very many yet. And...some individual plans do not cover preventive colonoscopies at all. In that case, you should see if your doctor will bill it as diagnostic instead of preventive. Then, it will be covered, but likely subject to the plan deductible first.

Group plan (I'm a retired federal employee).

It specifically mentions 'Colorectal cancer screenings, including anesthesia and facility' with no deductible. It does have to be PPO.

Turns out I could have gotten the flu shot for free.

 

[REWahoo]

Here's what the AARPians recommend:

If you have a family history of a particular disease, an underlying health condition or other risk factors, consult your doctor about test frequency or about other tests you may need.

For everyone 50-plus
Eye exam: Every 2-4 years but every 1-2 years for 65 and older
Hearing test: Every 10 years
Skin exam: Every year
Dental exam: 1-2 times a year
Diabetes screen: Every 3 years but every 1-2 years for 65 and older
Cholesterol check: Every 5 years
Blood pressure check: Every 2 years at least
Colorectal cancer screening: Every 5-10 years; fecal occult blood test every year; sigmoidoscopy every 5 years; colonoscopy every 10 years

For women only
Mammogram: Every 1-2 years
Pelvic exam: Every 1-3 years (less frequently for those 65 and older if negative on previous screens)
Pap test: Every 1-3 years
Bone mineral density: At least once by age 65. (Women who are 65 or older should be tested at least once for osteoporosis.)

For men only
Prostate cancer check: Guidelines vary, discuss with your doctor.

Rich, is this in line with what you would recommend?

 

[Rich_by_the_Bay]

Here's what the AARPians recommend:

Rich, is this in line with what you would recommend?

Pretty much. Mammography is not evidence-based but is so politically and medicolegally sensitive that most advise it as you cite [edit: see my additional post below for more detail - it may work for some, but the evidence is not definitive for some groups]. Colon: some say that a normal colonoscopy every 10 years eliminates the need for fecal occult blood testing and certain make sigmoidoscopy unnecssary. Prostate screening is controversial; I tend to have a good talk with every man over 50 including the potential for abnormal PSA --> biopsy --> risk/infection --> false alarm as well as uncertainty whether early detection actually saves lives; very hard to know your PSA is a little high and NOT do something about it.

Appropriately OMITTED as screening tests are EKG, stress tests, coronary CT, carotid ultrasound (though each of these has a place for diagnosis in other settings).

Bear in mind that these are often modfied due to existing conditions, risk, emotional issues for reassurance, etc. And, it's not so much a matter of my personal strategy but rather what the admittedly imperfect evidence shows these days.

Future: hopes for a more accurate PSA, noninvasive coronary testing, and a fecal DNA test for colon cancer, and breast MRI as a screening test among other things.

 

[rs0460a]

abnormal PSA --> biopsy --> false alarm as well as uncertainty

Been there - done that...

- Ron

 

[Caroline]

Mammography is not evidence-based but is so politically and medicolegally sensitive that most advise it as you cite...

Appropriately OMITTED as screening tests are EKG, stress tests, coronary CT, carotid ultrasound (though each of these has a place for diagnosis in other settings).

VERRRRYYYY interesting on the mamography, Rich. I read a book by a statist.. statis... guy who does statistics a few years back. He saw no value for women under 50, and found it questionable for women 50-60. He cited false positives, exposure to radiation, etc. as risk factors.

I first got a mammogram at 40 (provider's recommendation) but when I read this I decided not to get another until 50. WELL! Every time I go in for something else its "why haven't you had your mammogram - you're overdue?" I cite the statistics, they become adamant, I still refuse... These things become ingrained in the system, it seems. (On the other hand these folks are face-to-face with the disease every day, so it's probably hard for a caring person not to want to screen everyone in sight.)

I'll be 50 in a couple months and think I'll get one every 3 years / 5 years or so... no family history...

As to the omitted tests, I have those every five years because I've been part of a longitudinal study for the last two decades. They took a bunch of us under-30s back then and followed us to better understand the who, what, and when of heart disease as we develop it.

I started to gently decline any test having to do with radiation about 10 years ago. I'm also asking my dentist to go light on the xrays under the resoning that I'd rather risk toothache than cancer. Is there anything else on the list I should consider dropping? The rest seem inoccuous to me. Even than, as you say, any irregular result would be well-nigh impossible to ignore.

 

[Goonie]

I just got that from my employer, too...............I have to go in to talk to them and find out if this applies after retirement also, since we're 'supposed' to have the same coverage as now.

Well, I talked to the ins committee, and they said that the wellness benefit most certainly DOES carry over into FIRE!!! That makes me soooo happy!!!

The wellness bennie is for $500/yr....NO deductible....NO co-pays. Anything over the $500, then goes to regular ins with standard deductible and co-pays.

 

[Rich_by_the_Bay]

Well, for clarity, absence of definitive evidence for the effectiveness of screening mammography does not mean it doesn't work, just that there is uncertainty. My own interpretation of the evidence is that it probably does reduce the risk of breast cancer death in selected women, albeit at the price of extra surgey and radiation exposure, and the evidence is not definitive as to which groups truly gain net benefit or how often to do it.

All major North American scientific panels recommend routine screening with mammography for women age 50 or above. Women in their 40s - controversial, but it is recommended by the AMA, American Cancer Society, and other big groups. The American College of Physicians and the Canadian Task Force recommend waiting til age 50.

If I were a woman at standard risk, I would get a mammogram every 1-2 years starting in my 50s. Your own doctors may agree or disagree with this for you. But so many individual factors apply that this really is an area where you need to discuss it with your doctor.

If you screen 1000 women for the next 10 years, the likelihood of having your life extended as a result of screening ranges from about 1% (young) to 7% (older) (from Harris, R et al, Ann Intern Med 1995; 122:539). That's a lot of screening, extra surgeries and cost, but if you are one of those few percent, you win.

 

[lazygood4nothinbum]

if you take your car to a mechanic, he's gonna be able to find something wrong even if that something wrong might have lasted well enough for the life of the car.

unless you know you have something wrong which needs immediate repair, i'd avoid the physical for at least 6 months so that they don't find the dreaded pre-existing condition.

 

[LeatherneckPA]

Appropriately OMITTED as screening tests are EKG, stress tests, coronary CT, carotid ultrasound (though each of these has a place for diagnosis in other settings).

Rich, I'm intrigued. I was just in the ER 2x in one week last month for chest pains and shortness of breath. Admitted me and then they did ALL of those things you id'd above. Why do you say they are ineffective as screening tests? I'm assuming you have the appropriate initials after your name.

I second your statement about the "stress of waiting and false positives". It was a horrible week for me. Hospitals are definitely NOT for relaxing.

And worse than that is when you have three DRs (nuc med, cardio, and personal) and they all have different opinions. It appears, for now anyway, that my pers dr has got me straightened out though. Simple, stress related angina. Who'd a thunk it?

 

[Rich_by_the_Bay]

Rich, I'm intrigued. I was just in the ER 2x in one week last month for chest pains and shortness of breath. Admitted me and then they did ALL of those things you id'd above. Why do you say they are ineffective as screening tests?

My statement was, "Appropriately OMITTED as screening tests are EKG, stress tests, coronary CT, carotid ultrasound (though each of these has a place for diagnosis in other settings)."

Screening means a test done on an apparently healthy person without relevant symptoms or unusual risks, for the purpose of prevention or early diagnosis of a treatable disease. Your situation is completely different and does not apply here in any way. Acute chest pain in the emergency room is not screening.

Keep the faith .

Hope that helps.

 

[LeatherneckPA]

OK, I see the difference now.