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Take a picture of that vial…and other advice for “active patients”

November 1, 2012 in Medical Care

“I think the consumer needs to be vigilant. Much as they were with medication errors and prescription mis-fills, they now are more aware that they should understand the drug and how it’s used and who dispensed it and who made it.”

When we heard Bill Gouveia say this during an interview about the meningitis outbreak, we stopped and stared at the radio. How are we, patients, supposed to be vigilant about the source of drugs doctors inject into us, sometimes when we’re out cold?

So we called Gouveia, a former member of the Massachusetts Board of Pharmacy who currently teaches at the Northeastern University School of Pharmacy.

Just what did he mean by “consumers need to be vigilant”?

“This comes from the medication safety movement,” says Gouveia. Specifically, he recommends:

1) when a physician says he’s going to inject you with something, ask to see the vial before it is opened
2) copy the information on the label or take a picture of it with your phone
3) if the packaging is different than what you’ve seen before, if the supplier has changed, ask why Read the rest of this entry →

US Healthcare: an oxymoron

October 19, 2012 in Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt

It was very exciting to read about Amanda’s grass roots Twitter research.  Amanda, you have started an activist conversation that we, the people, need to have.  Comments from so many people on what Amanda started touched on a deep and growing moral and economic issue for which we must demand answers: loss of a job means loss of insurance, medical debt, loss of shelter and bankruptcy is not a rarity, unaffordable insurance premiums as the norm for the middle class, poor medical care for the disenfranchised, etc.  I will add another observation.  Do you know that if you have a very serious mental illness, have MassHealth, and need to be in hospital, you may wait 2-3 days in an ER for a bed?  Or, if you have poor insurance, be treated in the ER, and when you are medicated and are saner, sent home? There also were a couple of comments from folks who wanted to know why the US did not have systems of care like The UK and Canada.  People want to move to Vermont where there is a progressive move toward single payer healthcare for everybody.  There IS an organization in the US committed to healthcare for all. PNHP was started by public health physicians in 1985!

Does anyone wonder why there is no political will in the US? PNHP started in 1985 with the inception of “managed care”, also viewed by many of us as for-profit healthcare. In this case “healthcare” is an oxymoron, isn’t it? Read the rest of this entry →

Share Your Medical Bill Story in 2012 Cost of Care Contest

October 15, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Member Stories

In listening to you, we’ve found, time and time again, that outrageously high medical bills are not a rare occurrence in this country. Many glitches and loopholes in today’s American health care system often leads to unexpected, mysterious billed amounts that threaten individual families and force many Americans to the brink of bankruptcy or worse. But too often, those with serious medical financial problems have no outlet for their rage and consternation.

Now, a non-profit consumer advocacy group called Costs of Care is sponsoring a contest that’s based on listening to the American patient – yes, you! Anyone who has ever had to deal with a surprise high-dollar bill for medical care is invited to participate.

The Costs of Care 2012 Essay Contest provides a listening ear for struggling Americans, and even a chance to win a portion of $4000 in cash prizes. Contest creators seek “anecdotes,” not policy positions, about big medical billing problems, and “high value healthcare decisions.” Judges include former U.S. Secretary of Health and Human Services Donna Shalala and other panelists, including doctors and health care officials. The deadline for this contest is November 15, so would-be contestants have just a short time to send in their stories of up to 750 words for consideration.

What’s behind the Contest

In soliciting stories from American patients, Costs of Care and other participants are seeking to put needed pressure on today’s community of medical providers. Read the rest of this entry →

An unusual medical encounter

October 10, 2012 in health care costs, Medical Care, Member Stories

My son was diagnosed at age one as having life threatening allergies to peanuts. He was given skin tests after what appeared to be a reaction to peanut butter. The tests showed he was allergic to everything. So, we spent the next 14 years religiously keeping him away from all nuts. Being an underutilizer, I never took my son back for further testing as given his history of asthma, it was unlikely he would outgrow this allergy. And, he never had another reaction. This summer (at age 15) my son went on a canoeing trip in the adirondacks…..miles away from any medical facility. To my shock, it was here that He decided he had had enough of his “special diet” and gave himself a “food challenge” by eating two peanuts. What happened? Nothing. When he proudly announced that he was no longer allergic to peanuts upon returning home, I was ready to murder him. How could he take such a risk? But, after calming down, I also wondered what had happened. Had he been misdiagnosed as a baby? Had he outgrown his allergy? Both his skin and blood tests provided evidence that he has this allergy, didn’t they? We made an appointment with a specialist, someone who could answer all our questions.

This appointment was really what I wanted to write about. Those who know me know that I am an underutilizer of health care services. So I was leery seeing this specialist. Would he want to run a zillion more tests? Would they want my son to undergo another food challenge? Well, not this allergist. Read the rest of this entry →

How much does gender matter when choosing an OB/GYN?

October 3, 2012 in Medical Care

2012 will be my 15th year as a Urogynecologist – an OB/GYN who specializes in the treatment of incontinence and pelvic prolapse.  Every so often a patient will ask me or one of the staff members in my office “wouldn’t I be better off going to a female doctor for these problems?” This is a legitimate question.  As a male practitioner of women’s medicine and surgery, here are some of my thoughts:

One assumption you might make is that women must be inherently better as OB/GYN’s because of their personal experience of being female, but this isn’t as much of a plus as it might seem.  Sometimes your personal experience may actually impair your ability to empathize with someone having a different experience from you. If I was female and never experienced painful menstrual cramps and you (my patient) were terribly bothered by them, I might discount your experience.  Deep understanding and empathy come from participating in the care of thousands of women with gynecologic problems and all the different experiences they have, and choices that they make. 
 
Let me be clear.  I am NOT in any way implying that males are inherently BETTER as OB/GYN’s. All successful physicians derive their competency from the sum of their experience of listening to thousands of patients. I have not heard any discussion about whether or not only people who have had cancer can truly be competent as oncologists.  Read the rest of this entry →

How to Protect Yourself from Higher Than Expected Medical Bills

September 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

If you are insured and visit your local emergency room at a hospital network in your area of residence, you expect to pay the stated co-pay that shows on your insurance card, right? This is, in some senses, a reasonable expectation, but it’s not always what happens. News media outlets around the country have aggressively broadcast many cases where huge out-of-network charges for secondary providers have led to excessive medical billing amounts for patients who simply visited the wrong hospital at the wrong time.

The Problem: Hospital Network Staff Outsourcing

This major problem, that results in more out of pocket dollars than expected, really has to do with how hospitals staff. Hospitals may simply bring in outside doctors, nurses, technicians and other staff who aren’t effectively on staff at that facility, in order to help fully staff an emergency room or other hospital department. This is a convenient fix for hospitals, but what’s enraging is the idea that hospital administrators don’t think about the dramatic impact that out-of-network charges can have on patients.

What happens with out-of-network charges is that when outside physicians or other staffers happen to provide care to a particular patient, that patient is simply billed for the balance of that care because of an automatic insurer denial. Insurance companies won’t usually pay for the work of out-of-network professionals, but hospitals hire them anyway. Read the rest of this entry →

“Take me to MGH”

September 13, 2012 in Health Insurance, Medical Care, Member Stories

One day my husband came home from work and announced that he wanted to get a tattoo.  Greg was a neuroradiologist at Massachusetts General Hospital — more of a science nerd than an ink lover — so this caught my attention.  He said he wanted to have a tattoo right across his forehead that said:

“IF FOUND DOWN, TAKE ME TO MGH.”

A volunteer tests out Greg's tattoo design.

If he ever collapsed somewhere, he said, he wanted to be sure that he was taken to Mass General, and not to the nearest community hospital.

Greg had started working at a lab at MGH when he was in medical school, and he had done his radiology residency and fellowship there, so his ties to the hospital went back a long ways.  But this bit about the tattoo was more than just institutional loyalty.  He was convinced that the care at Mass General was better than at many of the smaller hospitals.

He proved his commitment to MGH one night when he became a patient himself.  One evening I came home and found Greg lying on the bathroom floor writhing in pain.   On the 1-to-10 scale of pain, he said he was at a 10.  He clearly needed to be seen by a doctor, so he managed to get himself out to the car, and I started heading to the nearest emergency room.  “No,” he said. “Take me to MGH.”  Every bump in the road caused him to moan in pain, and and every extra minute of the drive was excruciating, but even in unbearable pain, he was adamant that he wanted to go to Mass General. Read the rest of this entry →

Will Medicare Changes Result in Better Quality?

September 3, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

As the price of health care in America keeps rising, you may be among those that are frustrated by the kind of generic approach taken by  health insurance companies and government entitlement programs. The traditional fee-for-service format of health care reimbursement means that the best hospitals and doctor’s offices don’t get rewarded and the lower performing offices don’t have consequences. But, this is all likely to change with new Medicare rules that are slated to pursue more of a ‘meritocracy’ in the way that health care dollars get paid out.

New Medicare Rules

Reports from the Centers for Medicare and Medicaid Services show that Medicare is going to begin making some changes in the way that it reimburses health care providers starting late this year. In what Medicare officials call a ‘value-based purchasing’ program, Medicare will consider various aspects of a provider’s operations in setting the reimbursement rates for that particular office. Key factors will include observation of outcomes, or in other words, whether the procedures and services performed at an office actually help patients to recover from illnesses and improve quality of life.

Responses to the Changes

For you, this represents a major change and a big potential edge in making sure you get what you deserve for the money, especially when you have out of pocket expenses. On the downside, though, some providers are arguing that hospitals and offices in rural areas, or those with other significant disadvantages, may be punished unfairly. Read the rest of this entry →

How Much is Health Insurance Coverage Really Costing You?

August 30, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

Just when you think you have the health care business figured out, new reports come out showing even more dark details about how American patients are simply charged massive amounts of money for health care services on a pretty arbitrary basis.

The newest wrinkle in this story actually turns the conventional wisdom about payment for health care on its ear: where many assume that most uninsured patients get the highest bills, new reports are showing that, in many cases, the “cash-up-front” deals given to cash-paying patients may be as little as less than half of a contractually agreed price that the hospital would bill the insurance company. Why is this a problem? Because it means that many of those who pay high deductibles, premiums and coinsurance on a health plan may still be paying more for each service, visit or procedure than someone who doesn’t have any insurance at all. It also injects a huge monkey wrench into the now established idea that everyone needs health insurance to make health care affordable. On the flip side, if you have a high deductible but choose to self-pay a medical bill, how will you ever meet your deductible? This is particularly troublesome should you have a catastrophic event. Read the rest of this entry →

Practice is Proactive in Patient Relationships

August 25, 2012 in health care costs, Health Insurance, Medical Care

The Commonwealth Fund’s 2010 study found that almost 50% of US adults were either underinsured or uninsured.  This is a 7% increase from 2007 for the underinsured population. It used to be that having coverage was simply enough. Today, however, having the right type of coverage and amount are key factors in choosing a plan. What happens when you don’t have coverage for a specific procedure? One forward thinking practice in the Chicagoland area takes the time to explain your options and provides the cash discount rate – up front. Before you even ask. That’s mightily refreshing given the lack of communication in many healthcare organizations. And, it’s a win win for both parties. The practice receives a bill paid in full without expending additional dollars in the collections process and the patient is educated a little bit more on how the billing and insurance process works. Let’s hope that more practices implement this customer service level in the near future.

10 Essential Questions To Ask During Any Hospital Visit

August 24, 2012 in health care costs, Hospital Bills, Medical Care

The hospital can be a scary, intimidating place, especially if you don’t spend a lot of time there. Depending on why you may have ended up in the hospital, there are certain questions you’ll want to ask your doctor and the medical staff. Questions To Ask During a Hospital Visit

  1. Are all the signs normal? You’ll want to know about all your vital statistics. How is your blood pressure, body mass index and breathing?
  2. Details about your problem: Ask the doctor treating you what may be causing the problem that forced you to visit the hospital. Could there be more than one issue affecting your health? Being kept in the dark can help compound your stress and make visiting a hospital even more severe.
  3. Learn more about the tests: Some of the testing done in a hospital can be uncomfortable and invasive. Find out first how accurate the tests are for diagnosing an issue. How safe are the tests you’ll need to undergo and what could some of the side effects be?
  4. Get the facts after diagnosis: If you are diagnosed with a serious condition, find out what the next course of action will be. Ask about the long-term outlook and what treatment options are available.
  5. Ask about each treatment option: Find out what the pros and cons of each treatment option available to you. What are the risks associated with each treatment and how do they weigh against the benefits?
  6. Get the facts about pricing: Read the rest of this entry →

Hey ACOs, what can you do for me?

August 20, 2012 in health care costs, Medical Care

I keep hearing that one day soon we’ll all be members of an Accountable Care Organization (ACO). These are big or biggish health care groups that include doctors, hospitals, labs, rehab and other things I need. The deal, as I understand it, is that I get everybody coordinating my care “under one roof”, but I’m not supposed to go outside that roof for care. I know, some ACOs let patients continue to have unlimited choice, but that doesn’t seem to be the model.

If I’m going to give up the option of going wherever I want, then what I get under that one roof better look pretty good. So, you ACOs out there, that are getting ready to sell me on your services, here’s what I’m looking for:

1) A primary care doc who responds pretty quickly to my calls, emails, texts or Skype (or has a fabulous nurse practitioner or physician’s assistant who gets right back to me). Someone who routinely asks how I’m feeling, not just whether my body is OK. Someone who makes eye contact and can explain what’s going on with words I understand.

2) A dentist who does the same (and who shares records with my doc.)

3) Evening and weekend office and lab hours.

4) An electronic medical record I can view at home and add to as needed. The record will show the prices of the tests or treatments my doctor recommends and the ones I receive.

5) A patient coach who will help me get a second opinion Read the rest of this entry →

Medical Care Risks (C.diff in USA hospitals)

August 16, 2012 in Medical Care, News

A report in the current issue of USA today on the front page has the heading ‘One bacteria, 30,000 deaths’, with the subtitle ‘When Health Care Makes You Sick.’  The story is illustrative for two important terms.  The first is nosocomial infection, also known as hospital acquired infection.  The second is iatrogenics, which is illness caused by medical examination or treatment.  These are real problems for all of us real people..

Health professionals and hospitals do wonderful things that improve health and well-being.   I personally have had tremendous support and benefit from physicians, hospitals, medical therapies, and medicines on multiple occasions.  But dangers are always there lurking to strike the patient unexpectedly. I have been known to reject medical advice  and/or delay medical care, in my own self-interest when I believed the risks outweighed the benefits.  These are difficult decisions, but I try to take into account the risks to me..

Often, but not always, it is accepted that the patient has the right to decide for him/herself.  Sometimes the patient will make a wrong decision just as the medical system can generate bad choices.  For example, Steve Jobs is reported to have regretted delaying surgery for so long while seeking alternative therapy.  To me, the point is that no decision maker is right all the time.  But in case of doubt, who is better to make the tough decisions than the person personally taking the risks.

References:

>>>http://www.usatoday.com/news/health/story/2012-08-16/deadly-bacteria-hospital-infections/57079514/1

>>> http://www.telegraph.co.uk/technology/apple/8841347/Steve-Jobs-regretted-trying-to-beat-cancer-with-alternative-medicine-for-so-long.html

Managing High Health Care Costs on Your Family’s Budget

July 22, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt

Recent news on the costs of health care, in the U.S. and around the world, is focusing on what experts call “double digit levels” of annual increases. This is bad news for us, and troubling for the country as a whole. What it translates to is annual increases over 10%, where health care costs could conceivably double in a decade. Since this kind of price spike has been going on for a while already, many American families already consider major medical care to be priced above their ability to afford it.

Who Pays the Bill? 

Part of the particular desperation that has surrounded the American medical industry in the past few years has to do with who usually pays the bill.

In the past, employer group plans provided coverage for the majority of Americans. A few decades ago, this model was built on stable, long-term contracts between workers and companies, where those who stayed loyal to a business could expect to keep a job for life. Also, employers paid a major part of all premium costs.

In the present, however, we’ve felt the rise of health care prices. First, employers started to lower the premium amounts they were willing to pay. As jobs went overseas, employers laid off workers. Then, as the economy grew weaker, more lost jobs. An unemployment rate of over 10% means much more than lost wages: it means that many thousands of American families are suddenly left without coverage.

Meanwhile, the group plans that are left often do not pay the majority of premiums and often include high deductibles, which are also extremely expensive for the average family. In fact, some employers hardly pay anything toward premiums at all, while others provide “mini-medical” plans or other virtually useless coverage, or move full-time positions to part-time and thus avoid offering plans.

What Can You Do? Read the rest of this entry →

Maintain Open Communication with Medical Bill Debt

July 14, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt

The Affordable Care Act is cracking down on some of the most aggressive ways that hospitals categorized as charitable or nonprofit facilities for tax exemption can seek to shake money out of patients. Reports of the new laws also often offer some of the most common advice to protect you and your family from unfair or excessive medical debt.

Always Talk to Your Providers

One of the biggest pieces of advice is to always ask up front about available charity and financial assistance programs. It’s a great idea to ask about health care costs, and detail payment options, before you sign up for any given course of treatment. But beyond this, dialogue with the provider is also a key to keeping medical bills from showing up on credit reports. It’s true that even with the best back channel dialogue, some hospital administrators will still send bills to collections, but having an open communication with the provider will prevent this in the majority of cases where reasonable financial offices simply ask that patients keep in touch about their debt and pay to the best of their ability.

Make Sure You Are Covered

Essentially, the Affordable Care Act can be seen as a double-edged sword – depending on what side of the table you are on. Read the rest of this entry →

The dark ages of health care transparency

July 2, 2012 in Insurance Bills, Medical Care

Over and over again, the health insurers, my employer and leaders at the State House tell me that one key to controlling health care costs is getting patients to look for the best value in health care.

Well folks I’m trying and getting a little tired of banging my head against the wall I hit when I ask my insurer or doctor or hospital how much anything costs.

Last week I spent 30 minutes on the phone trying to figure out how much my insurer would pay a counselor for my daughter. The counselor is “out of network” (a situation more and more of us are encountering) so I have to appeal to get help paying for my daughter’s visits.

There’s a question on the appeal form that asks, “Will your provider accept the network rate?” I’m happy to ask her, but I need to know what the rate is, so I call the 1-800 number on the back of my card. Here’s a summary of the ridiculous conversation I had with the agent (who was nice and tried to be helpful)

Me: (after explaining the form) I am calling to find out the network rate for providers who counsel adolescents. How much do you pay?

Customer Service Agent (CSA): Oh I can’t give you that, there are hundreds of possible codes that could apply to your daughter’s counseling visit. Read the rest of this entry →

How to be Your Own Best Advocate

June 15, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medicare, Member Stories

Being Your Own Advocate

In case you haven’t been paying attention to changes in America’s health care system, there’s a general idea that needs to get out to as many people as possible: the gist of it is that, in most cases, today’s consumer needs to be much more engaged in their care and ready to act as their own advocate in order to get the health care and treatment that they need, no matter what their health is like.

You may have heard something like this already: from all corners of the health related media, patients are hearing that they need to “be their own advocates” and get vigilant about not just what they pay for health care, but what kinds of health care they receive and whether or not it fits their specific needs.

But what does it mean to be your own advocate? Looking beyond the cliché, you can obtain good, concrete ideas of how to go about interacting with a family doctor in ways that will help you get better access to the health care you need.

Patient Engagement: What it Involves

The good news on this front is that you may already do a lot of what you need to do to advocate for yourself in a healthcare environment. Read the rest of this entry →

Tips on getting out of network care?

June 13, 2012 in Health Insurance, Medical Care


My family is luckily very healthy and we like our primary care doctors. I have not had any reason to see a doctor who is not on the list approved by my health plan. But now my daughter needs to see a counselor who is connected to a hospital where she make get treatment. The counselor is not in my insurers’ network, so I’m filling out the “Out of Network Request” form – any tips?

Are You Being Treated by a Subcontracted Doctor?

May 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medicare

A recent story from Dayton, Ohio, caught our attention, where according to news reports, some patients remain responsible for emergency room charges when a hospital happens to ‘subcontract’  doctors who may not accept health insurance at all. This adds another layer to the oftentimes confusing in network vs. out of network debate. In many cases, especially in an emergency situation, patients who visit a local hospital or facility may experience unexpected costs after they are cared for by a doctor who may not be ‘in their network’, even if the facility itself is listed as an in network provider. There’s been a lot of discussion whether this, which may seem deceptive, especially to those without specialized knowledge in the medical billing and health insurance field, is fair. In fact, state officials, like in New York, are  looking to pass legislation which mandates better transparency for out of network charges. Taking the time to understand your health insurance plan and what defines a covered provider or facility can save you hundreds if not thousands of dollars in non-covered charges.

It seems providers tend to respond to these scenarios in two ways: Some indicate they will change their policies to include more transparency while others claim to be bound by federal laws that do not allow them to reveal to patients whether an on-call doctor or a physician on shift will accept their insurance or not.

We find the second argument to be completely unacceptable at face value. In fact, it’s reasonable that consumer advocates would expect state regulators to crack down on these well documented examples of seemingly unfair provisions in delivering medical services. It’s not outside the realm of possibility that a patient facing bankruptcy after a bill like this would have a basis for legal appeal, especially as new legislation is introduced and passed. It’s vitally important that you discuss your options and ask questions before treatment to minimize impact to your financial future. How prepared are you in the event of an emergency room visit?

Overused and Unnecessary Medical Procedures

April 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare, Member Stories

Nine physician specialty societies are each reporting a top five list of commonly used procedures that are often unnecessary. These societies represent 375,000 physicians across the country.

Some of the procedures cited include:

  • Brain scan after fainting (without other relevant symptoms)
  • Antibiotics for sinusitis (while typically resolving itself in two weeks, 80% of patients are prescribed antibiotics. CT scans are also usually unnecessary.)
  • Admission and pre-operative chest X-rays (routine X-rays are not needed.)
  • Colonoscopies (not recommended but once a decade.)
  • Cardiac stress tests (they do not need to be part of a checkup for a healthy adult.)
  • Lower back pain (unless another ailment is suspected, X-rays are not needed in the first six weeks.)

Unwarranted testing can lead to stress, over treatment, higher medical bills, and even unneeded invasive procedures.

In fact, the natural tendency to screen for heart disease prior to having any symptoms, like getting a stress test as a 50th birthday present, hasn’t “panned out,” according to a preventive cardiologist at Northwestern Memorial Hospital.

Study members suggested that patients and doctors have to thoroughly discuss any tests/procedures even if they are suggested by patients because they are not always needed.