Cost-Conscious, Self-Managed Care

[SteveNU]

It could be that one factor that has led to such high use of tests is that so many consumers had low or no deductible health coverage from work. Combine this with our obsession to reduce or completely eliminate uncertainty, especially in the physicians office, and this would explain a great deal of the excessive testing that goes on in the US.

As the saying goes, If you think health care is expensive now, wait until it's free....

I think most people could care less how much it costs since the insurance company is paying the bill. I doubt many people even ask about cost, I know I almost never have in the past.

Probably another driving factor is the use of the Internet to self diagnose every little ache and pain which leads to people asking for unnecessary tests.

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[athena53]

I've used the Internet for the opposite- it keeps me from unnecessary trips to the doc. I diagnosed a case of frozen shoulder 2 years ago and got rid of it with exercise- found it all on the Internet.

I agree, though, that when it's "free", most people don't assess whether something is worth it. Interesting that in an earlier post, someone mentioned a doc cutting back on tests ordered after finding out that the patient would be paying it all out of pocket. Makes you wonder how important the eliminated tests were.

ETA: DH was getting weekly treatments for a leg ulcer (now healed nicely) and when he asked the practitioners what a visit cost, the answer was, "It should be covered almost completely by your Medicare policies". What kind of an answer was that?

 

[pullmyfinger]

Yes, we definitely need to be aware of out of pocket costs. I also have a Group Health plan in Washington and mine is a bronze high deductible plan with a $4500 per person deductible. I was planning to go in for a preventative visit which is supposed to be covered in full prior to the deductible, to establish care with a new PCP in January. I did some research and found that if there is ANY mention of a pre-existing condition during a "free" preventative care visit the visit is no longer "free" and the patient will be billed. So what is the point of going in if you can't talk? And then if they order any tests how will you know what you are responsible for?

I am also not impressed by the billing and general record keeping of GH. We have had this insurance since last April, and almost every month we get a statement that we are delinquent. We always pay our premium on time. So each month I sit on hold for customer service and they confirm that we are paid up and say that many people have had problems with the billing. They have also sent us 3 sets of insurance cards since January, all the same. Doesn't inspire confidence.

This situation forced me to investigate care at the VA which I have been entitled to, but never used before. For DH, we're hoping that he doesn't need any care this year.

 

[imoldernu]

I check with BCBS Federal before we go for any new procedure. The rules for co-pays seem very plain, but the devil is in the interpretation. For example, even the tiniest intentional scrape or cut by an in-network Dr. counts as "surgery" at $150 a co-pay. So, removing 5 polyps or skin tags (say) would be 5 x $150. Getting a cast on my wrist was considered "surgery."

So far, we haven't needed to see an out-of-network Dr. but it could happen. In that case, you can bet I'd ask a lot of questions!

Amethyst

+1
I treasure my "brown spots"... @ $150/per, could pay for the Dr's new Tesla.

 

[travelover]

............I did some research and found that if there is ANY mention of a pre-existing condition during a "free" preventative care visit the visit is no longer "free" and the patient will be billed. So what is the point of going in if you can't talk?...........

This sounds crazy. I just had my annual physical and most of the time was spent talking about ongoing health concerns and medications that I am taking to control those conditions.

 

[rodi]

I check with BCBS Federal before we go for any new procedure. The rules for co-pays seem very plain, but the devil is in the interpretation. For example, even the tiniest intentional scrape or cut by an in-network Dr. counts as "surgery" at $150 a co-pay. So, removing 5 polyps or skin tags (say) would be 5 x $150. Getting a cast on my wrist was considered "surgery."

So far, we haven't needed to see an out-of-network Dr. but it could happen. In that case, you can bet I'd ask a lot of questions!

Amethyst

Kaiser Permanente doesn't cover skin tag removal at all. Mine were noted in the record, but I was told removing it would be cosmetic rather than medical. They're happy to give you a list of clinics/dermatologists that will take care of it for you - on your own dime.

I'm ok with that.

 

[r2021t]

Of course if there had been a problem and he hadn't requested the test, he might've been sued for malpractice.

A lot of these 'double check' tests are CYA due to fear of lawsuits.

I don't disagree with your main point. Tort reform needs to be an important part of this. But the doctor has insurance for errors he makes or is alleged to have made. That young woman should not be out of pocket 5k because the doctor wanted to "CYA".

Honestly, I'm inclined to believe that was not a part of his thinking. It is probably as simple as the poster stated. He was just confirming his final diagnosis/treatment regiment. It was a thoughtless act. Nothing more. He, like many doctors, haven't caught on that Obama Care is not free and it is costing real people real money. Mine certainly hasn't. So much so that I'm considering shopping for a new one.

 

[pb4uski]

Kaiser Permanente doesn't cover skin tag removal at all. Mine were noted in the record, but I was told removing it would be cosmetic rather than medical. They're happy to give you a list of clinics/dermatologists that will take care of it for you - on your own dime.

I'm ok with that.

DW removed a couple for me last week. Cleaned the area and a sharp pair of scissors with alcohol and then snip-snip.

 

[athena53]

He, like many doctors, haven't caught on that Obama Care is not free and it is costing real people real money. Mine certainly hasn't. So much so that I'm considering shopping for a new one.

Except it always did cost real people real money- when there were no or low copays or employers bore most of the premiums, it just didn't cause as much pain to the individual patient. It's about time providers figured this out.

 

[travelover]

Except it always did cost real people real money- when there were no or low copays or employers bore most of the premiums, it just didn't cause as much pain to the individual patient. It's about time providers figured this out.

Exactly. It pains me to hear people act like paying for medical care started with the ACA.


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[r2021t]

Exactly. It pains me to hear people act like paying for medical care started with the ACA.

Well, it certainly wasn't my intention to cause anyone pain with my comment. But it is certainly foolish to not recognize that the entire landscape of health care and the ensuing payment for such has not changed significantly.

As I worked for the last three decades I understand the payment of my healthcare was not "magic". I know exactly what it was. An additional enticement to work for the organization I was employed with. An accoutrement to my salary. Medical insurance was always a factor in my decisions to change jobs unless the pay was so substantially better that it didn't matter. That only happened to me once. And I certainly never would have worked somewhere that didn't offer it.

Are you saying it is not somehow different now? That premiums and out of pocket expenses are not substantially more? I get the impression, forgive me if I'm not correct, that you and, perhaps athena53, are taking what I said as some slam on Obamacare. That wasn't my intention. If you simply believe I'm just ignorant, that's okay. I'm not.

I think we are all just becoming "business owners" in the sense that an expense we gave little thought to before because it was shopped for, supplemented and supplied by someone else is now in the forefront of our planning because we are bearing more of the cost. We are in a learning curve, us as consumers and and health care professionals as providers. That was my point.

 

[MichaelB]

I think we are all just becoming "business owners" in the sense that an expense we gave little thought to before because it was shopped for, supplemented and supplied by someone else is now in the forefront of our planning because we are bearing more of the cost. We are in a learning curve, us as consumers and and health care professionals as providers. That was my point.

There is a lot of truth in that statement. Those of us with individual policies seem to be more aware (painfully so) of the cost of healthcare in the US. Even when there is a subsidy, we still see the real (and barely affordable) price first. The same is not true of employer provided or Medicare.

Here's a link to a survey KFF does every year (link). Lots of very good information and data. Exhibit 1.11 shows the average premium for employer provided healthcare since 1999. You will see that premiums have been high for many years, also growing at a rapid rate. ACA policies from the health exchanges have costs that are similar to the employer premiums. In fact,the only things notable that has happened recently regarding healthcare costs is the rate of increase has slowed considerably since the introduction of the ACA. In my humble opinion this is coincidence, has less to do with the reform and more to do with the fact that healthcare has become unaffordable, so the price increases are forced to slow.

 

[harley]

Kaiser Permanente doesn't cover skin tag removal at all. Mine were noted in the record, but I was told removing it would be cosmetic rather than medical. They're happy to give you a list of clinics/dermatologists that will take care of it for you - on your own dime.

I'm ok with that.

Interesting. I have Kaiser (Mid-Atlantic) and I've had them remove skin tags three times. Just mentioned them to my PCP, she gave me a recommendation for the dermatologist, and I made an appointment and they froze them off. No big deal.


Total cost, whatever the copay was at the time.

 

[Brat]

I think the location of skin tags or 'barnacles' is a factor. I had barnacles on my face and got a referral.

 

[Beldar]

...we both use clinics such as CVS Minute Clinics for minor things.

Can you elaborate on your experience with the quality of care at these convenience clinics? I've noticed they have popped up around here, and since DW & I will be on a HD plan beginning next year & I'm curious what type of care these and other Urgent-Care type facilities may offer. Tnx.


_B

 

[Walt34]

DH is on Medicare but we both use clinics such as CVS Minute Clinics for minor things.

I'd be desperate before I went to the CVS around here for any kind of medical treatment. Staff turnover is very high and even the pharmacists rarely last longer than a year. This strongly suggests that it's a lousy place to work, staff is underpaid, or both. The doctors office says they have more issues with CVS messing up prescriptions than anywhere else. CVS also made 24/7 Wall St. "12 worst places to work" spot last year.

I only go there because my prescription plan is run by CVS and I'd have much higher copays if I went elsewhere. I'm seriously considering doing that anyway but I'm not sure any of the others would be much better.

YMMV.

 

[zinger1457]

I'm curious what type of care these and other Urgent-Care type facilities may offer.

Most Urgent Care facilities only deal with minor illnesses and injuries like colds, flu, sprains, minor cuts and scrapes, etc. The benefit is you can usually get same day treatment and it's probably a lot cheaper than going to the emergency room.

 

[travelover]

..........Are you saying it is not somehow different now? That premiums and out of pocket expenses are not substantially more? I get the impression, forgive me if I'm not correct, that you and, perhaps athena53, are taking what I said as some slam on Obamacare. That wasn't my intention. If you simply believe I'm just ignorant, that's okay. I'm not. ...........

I don't think that "medical insurance" and "Obamacare" can be used interchangeably unless one is trying to make some kind of a political point. The costs for medical care keep going up faster than inflation and employers are getting tired of eating the extra premiums cost and hope that making employees share the pain will make them shop for medical care with cost in mind. I agree, it sucks, but the problem did not begin with the ACA and will not disappear without the ACA.

 

[athena53]

I definitely did not interpret your post as a slam against ObamaCare. It's not perfect but it did solve some major problems with the system (definitely not all of them!).

I do think that somehow the changes brought about by Obamacare have accelerated the shifting of costs from employers and insurance payouts to directly from your out of the patient's pocket. If I were idealistic I might expect that it would cut costs in the long run as we become better consumers and the insurance company's overhead is removed from part of the costs but it hasn't happened yet. As we've noted here and elsewhere, it's hard to be an educated consumer when they expect you to write a blank check.

 

[bmcgonig]

There's a website called walkinlab.com where you can go and order blood tests. They take your money by CC and then refer you to the local Quest or whatever. You don't need your docs prescription to go there as they get around that by having "their doctor" order it. My PSA cost $110 at the normal doctor recommended place , but only $37 here.

Also, on the Blue Shield website there's a way of comparing local places for the cost of X-rays, MRIs, blood tests etc. Quite interesting to look at the major differences locally. Definitely stay away from hospitals for any tests.


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[r2021t]

I don't think that "medical insurance" and "Obamacare" can be used interchangeably unless one is trying to make some kind of a political point.

Well, I wasn't. And since that was not my intent I won't argue the point.

The costs for medical care keep going up faster than inflation and employers are getting tired of eating the extra premiums cost and hope that making employees share the pain will make them shop for medical care with cost in mind. I agree, it sucks, but the problem did not begin with the ACA and will not disappear without the ACA.

You really should go back and read what I said. I know you are upset that I used the words "Obama Care" but your comments have little to do with my posts.

Nothing, actually.

To clarify what I said in comment #57, Obama Care, the ACA or whatever honorific you would like to give it, is not free. That is what I said. I meant it is not a government program or invisible entity that is paying for these over-priced and, often times, unnecessary procedures. We are. You, me and the young woman I was commenting about. Doctors and care givers need to remember this. As far as my comments in #61, I did not, in any way, "interchangeably" use "medical insurance" and "Obamacare". Not once. If anyone made such a correlation, it was you that did so, not I.

I'm not going to apologize because you took offense where none was intended. And I really don't want to argue with you. But, really, you made this a political issue for no reason.

Not a big deal. We can certainly move on. Do you like Scotch? I don't know where you live but I'll travel to bend an elbow.

 

[travelover]

Well, I wasn't. And since that was not my intent I won't argue the point...........

Oh, so you'd like to see physicians more aware of the costs for medications and procedures that they prescribe? Well I would, too!

I had lunch with an intern recently and I asked him why he thought that medical costs were so high. He said it was simple, the insurance companies were charging too much.

 

[HadEnuff]

Many years before anyone ever heard of Obama, or "Obamacare", I had a large deductible plan. I was due for a colonoscopy. Just for the hell of it I called the doc and the facility where it would be done and attempted to get an estimate of what the bill would be. They would not provide one. Basically, nobody actually knew what it would cost because they are in contract with so many different insurance companies at so many different negotiated rates, they were clueless, and they simply REFUSED to tell me up front what the charge would be for an uninsured patient.
I began to think that they thought I was a reporter writing a story on their ridiculous pre-insurance charges, and were worried they were going to read about this in the local newspaper.

 

[athena53]

I had lunch with an intern recently and I asked him why he thought that medical costs were so high. He said it was simple, the insurance companies were charging too much.

One of my FaceBook contacts posted an item stating compensation of CEOs of 4 major health insurers and blaming high premiums in CEO pay. I did a little math and responded that if those 4 companies covered 80% of the US population and we reduced their pay to zero, it would decrease the average policy by $71. (Even if it's 40% due to Medicare, Medicaid and the uninsured, it's not a major dent in annual premiums.)

When I posted a link to a Harvard study calculating the extra costs on our healthcare system due to obesity and its consequences (I think it was $1.5 billion in 2009) she was livid. I had to back off.

 

[pb4uski]

Your friend can't be right.... MLR requires that at least 80% of health insurance premiums (for individual health insurance, 85% for large groups) be spent on care so that leaves 20% or less for overhead and profit/return on capital.