Memo to Health Insurers: Pay Attention to Us

Young woman looking stressed with a "help" cardboard sign

The text came from our 20 year old. His girlfriend had gone to her doctor to get the implantable birth control, Nexplanon, which (as every parent of a teenager might be happy to know) is nearly foolproof for 3 years. Needless to say, we were thrilled.

The problem?

It cost $1,500 and insurance wasn’t paying.

The Explanation of Benefits that Was Anything But

Impossible, I said (after all, there’s not much I know about but health insurance and the Affordable Care Act [ACA] are two). The ACA requires that most health insurers/employers provide all FDA-approved contraception with no out-of-pocket cost.

It took several back and forths between the girlfriend, her father, and me, including copies of the statement from the insurance company, before I figured it out. She was only seeing the insurance company statement, called an explanation of benefits (EOB), showing what was billed and what was paid. She didn’t owe a thing.

And therein likes one of the many problems with health insurance today. It’s unnecessarily complicated and confusing. After all, … Continue Reading

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blog health insurance healthcare system; patient-centered care

Doctors Are Angry. I Get That. But . . .

surgeonI knew this would be the toughest audience yet in my three years of teaching/speaking about the US healthcare system and healthcare reform. I even put on a flak jacket at the beginning of my talk as a way of breaking the ice (and protecting myself; I mean, these guys pack scalpels!). And I made it through the two-hour talk and their anger without losing my composure or my sense of humor (thank god for that sense of humor).

Now I’m sitting in the airport waiting for my flight home and find myself tearing up. Not because the doctors were mean or cruel — they weren’t — but because of how much distance there is between  reality and perception, how much anger is out there, how too many people rely only on anecdotes and commentary instead of facts to develop opinions, and how scary it is to look at where we are and where we need to be — and realize that, more and more, it is unlikely we will ever get there given the rhetoric and anger in this country.

The doctors this morning, most of whom have been in practice … Continue Reading

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ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; malpractice insurance Obamacare patient-centered care patient-centered healthcare Uncategorized

Should You Listen to Your Doctor?

moneyWhen I speak about the US healthcare system, I always like to tell the story of my mother. A couple of years ago, she emailed my sisters and I. “Good news!” she wrote. “My nuclear stress test was normal!” (The test  involves injecting a radioactive dye into a vein after which a special camera scans the heart to determine if there are any blockages).

At the time, my mother was 70 and, with the exception of very-well-controlled high blood pressure (that she’d had all her life), extremely healthy. No sign of heart disease. No angina. No shortness of breath. In short, no indications for an expensive, invasive, potentially dangerous, test. So why, I asked her, did she have the test? “Because my doctor told me it was time,” she said.

At which point I began banging my head against the wall.

Even regular stress tests (where you run on a treadmill or ride a bike) are only recommended in people with heart disease or symptoms of heart disease, same with an EKG. Yet a survey of nearly 1200 people ages 40 to 60 with neither found that 39 percent had an EKG … Continue Reading

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healthcare costs healthcare reform healthcare system; patient-centered care patient-centered healthcare Unnecessary tests waste

Time to Get Our Patientzilla On!

I just finished talking to a woman about her experience traversing our paternalistic medical system. She’d been having very strange symptoms for months — dizziness, numbness and tingling in her head and hands, blurred vision. After a particularly scary episode, she went to the emergency room where the ER doctor, in her words, basically dismissed her by telling her she had none of the risk factors for a stroke — she was only 40, in good health, a nonsmoker. “It’s probably anxiety,” he told her. “Of course I’m anxious!” she said. “I have two little girls in the waiting room scared to death because they’ve never seen their mother like this and I’m scared because I don’t know what’s going on!”

Nonetheless, she left without any idea of what was going on, convinced it was all in her head. Another visit a week later to another emergency room, where this time the doctors performed a battery of tests, including a CT scan, MRI, blood work, etc. Again, nothing.

A few weeks later, with the symptoms now so bad she had to hold a coffee cup in two hands, she saw a neurologist. Again, a battery of tests. Again nothing. By … Continue Reading

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double standard gender bias patient-centered care patient-centered healthcare

What I Learned About the Healthcare System From My Aunt’s Shoulder Surgery

I’m here in the cold northeast helping my 80something aunt out for a couple of days as she recovers from shoulder replacement surgery. It’s been a great real-life example of the good and the bad in our  healthcare system.

The good part is that the surgery went well and the hospital arranged for post-discharge physical and occupational therapy, as well as a home health nurse to check on my aunt, all of whom are great.

But the main problems come with the coordination of care for my aunt, as well as the communication. Our changing healthcare system relies on greater patient empowerment and patient-centered care. That, in turn, relies on educating patients about their condition. That so did not happen here. Here’s where I think the failures occurred:

— My aunt’s doctors did not set realistic expectations. She talked to several people who’d had the surgery before who told her what a breeze it would be. So when she experienced swelling, bruising, nausea, pain, etc., she thought something was terribly wrong and she panicked. Her doctors — and the nurses — should have prepared her for what such a major surgery would involve, particularly for someone her age.

— Her … Continue Reading

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healthcare reform healthcare system; patient-centered care patient-centered healthcare

Would You Buy a Car the Way You Buy Medical Care?

I was at book club the other night, pouring another glass of Chardonnay, when my friend told me that in August she was diagnosed with three blocked arteries, one of which is 100 percent blocked. I could rant about the fact that she’s been walking around like this for three months with only a beta blocker and statin as treatment, but that’s fodder for another blog.

When I talked to her she had an appointment with a cardiologist in our area. “Oh, he’s wonderful,” she said. because that’s what she’d heard from other people. What she didn’t realize, however, is that “wonderful” doesn’t mean good. She didn’t know how often he performed the procedure she might need; how well his patients did with or without surgery; what ties he might have to the pharmaceutical or medical device industry that could bias his recommendations; if he’d had any malpractice suits against him and how they’d turned out.

Choosing a doctor based only on what your friends tell you is like buying a car based on its color, something few of us would do. Instead, we research cars to find out which gets the best gas mileage, its safety record, its cost. … Continue Reading

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CABG doctor offices healthcare system; patient-centered care patient-centered healthcare quality