Medical Matters - Affordable Healthcare?

  • Parent Category: News
  • Published: Friday, 17 May 2013 11:38
  • Written by Ted Fleischaker


This month's column contains a bit of advice, a bit of commentary and a bit of a warning — all aimed squarely at anyone who plans to visit a doctor's office, have a test for anything or pick up a prescription. And that biggest bit of advice is to find out what you can do and what you can't, as well as what it's going to cost you, before you make plans. Otherwise you might just find yourself reporting for that physician's appointment or procedure only to find out that unless you pay out of pocket it's not happening.
A friend of ours found out his dad's company changed insurance as of the first of the year — but dad never told him. Now he has a $77 doctor's bill he needs to pay as they changed his deductible from $0 to $1500 a year. Dinged!
At our house meanwhile insurance no longer will cover Nexium, which we've taken for acid reflux for years. They say they'd gladly cover several "as good" other meds for "only a $5 co-pay" but there's an issue: the ones they are willing to pay for don't work for us — one causing severe side effects and the other being less useful than sugar cubes. Of course, we CAN still get Nexium if we are willing to pay out-of-pocket to the tune of $1000+ for a 90 day supply. Dinged again!
So what is the point here? To remind readers that health plans change and so does coverage. And often it's not for the patient's benefit at all. Despite guarantees from Washington, a lot of the shenanigans insurance firms, employers and government pull are bad and only going to get worse, leaving us to hope for national health one of these days and meanwhile to tell readers that they'd better stay on top of what their (or their spouse's, if they are fortunate enough to have care extended to them) coverage will and won't do and pay for. And if you think for even one minute things are getting better, we'd suggest you have it all wrong. At our house and many others' the red tape associated with The Affordable Healthcare law is bad and getting worse.
Included in all this are simple, almost laughable, things. We were informed by our physician last visit that she now has to ask us our date of birth "every time I come into the room." Asked what that means she said "well, I have to ask it to confirm it's you when I first greet you and do the basics, then say I leave to get a flu shot to give you, again I have to ask when I return just so the officials know it's really you who got the shot!"
The regulations also now require that each visit we be asked "Are you in an abusive relationship?" As our doctor is very gay-friendly and sees us as a trio, it was only after a huge burst of laughter that we all said in chorus during a recent visit, "YES!" That, of course, brought even more laughter, but we aren't sure what she put down as our reply.
And speaking of putting down, say goodbye to the pen, pad and grunted "uh-huh" when you talk to the doc. By later this year fines will be levied against practices where they still use paper and not iPads or laptops when they keep medical records. At least one physician we asked in Louisville told us she was planning on paying the fine because at age 66, she declined to fork over the $100,000+ it would cost to change records from 30+ years of practice to the electronic format.
So what should you do?
As we already said: confirm and reconfirm coverage if you have health insurance. Also see what options you have. Maybe your insurance firm will allow a 90-day refill of on-going scripts but only if you use their mail order service. Also, see what generics they will cover if they refuse name brand pills. Synthroid, a common thyroid supplement, seems high on the "hit list" of pharmaceutical plans and while at least two doctors have told our family that they feel generic versions are not as good, the choice is between payment or non-payment by our health insurance. All this means that while the health coverage folks are staying within the letter of the law and allowing doctors to diagnose and prescribe, they are de facto doing the job by denying coverage for anything they feel is too costly. Same thing goes for procedures and routine tests. Doctor send you for blood work? Great, but call first and see if you have coverage or that needle in the arm will not only cost you a few ounces of blood, but will shoot right into your wallet and could cost $1,000 or more for the tests.
Also don't forget to negotiate. Yes, you read that right: Ask your doctor's office what choices you have or what they'll do for you. You may be shocked to find out that just as you don't have to buy that shirt at one department store but can instead get one elsewhere, you can sometimes shop prescriptions and care to save big bucks. Most doctors have "negotiated rates" with healthcare firms, then you hand over a co-pay. The two together amount to what the doc gets when you see him or her. If you want to save you might be able to negotiate a much lower price if you skip insurance and pay for that office visit. It never hurts to ask as at least one doc we know of gets $95 for an extensive office visit if you pay with insurance, but if you just pay out of pocket, she asks $65. She saves filing, waiting and hassle and you save cash, so it's win-win.
Also look at pharmacy plans and shop those. You know the ones where you get a 60- or 90-day supply for one cheaper co-pay. Each drugstore chain has their own list of "approved" meds on that list. They say it's much better to use one pharmacy and stick with them because interactions and problems can be easily spotted by their staff and computers. We totally agree, but what if the "pay one price for 90 days" works for some of the meds you take at ding store A, while others are on ding store B's plan, but not on As? You might find driving a few blocks can save you 10, 20 or even 50% so always ask and investigate. There's no humiliation using two drugstores. Just be sure your doctor's office checks for interactions and prescribes accordingly.
The same is tine with the mail-in pharmacies so many health plans push these days. Cost for 90 days of something you routinely take might be lower as you may have only one co-pay, but what if the generic they ship you is inferior to what you get up the street at the local pharmacy? We know one mail-in drugstore which sent such a cut-price generic nasal spray that it was lacking even the usual pleasant smell while another sent out a skin cream generic made in India. Note: There's nothing to say any of these prescriptions will not work as well as what the patients reporting them had been getting, but always ask if you suspect too many corners are being cut. It might be worth paying the extra $20 the nasal spray patient told us about because he doesn't like what he was sent. And as for the salve, that one was dispensed to this writer who told his pharmacist he wants something made in the U.S., even if it does cost more.
Finally, always remember that you are the customer. You pay the healthcare plan, the doctor and the pharmacy. That means you can shop and ask for a better price, a different doctor or a discount. You may not always get what you want, but it never hurts to ask. Stay knowledgeable about your care and needs, then remember at the end of the day it's your choice — one you might pay more for, but what's peace of mind worth?
To keep our lawyers happy, be advised that the recommendations which are contained in this column are suggestions, but are not to be taken as medical advice. Always consult your physician or a healthcare professional before undertaking any physical fitness or other exercise program.