Reducing overall medical costs. Do we do anything?

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dm200
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Reducing overall medical costs. Do we do anything?

Post by dm200 » Sat Oct 13, 2018 2:18 pm

One, of many I believe, reason for high US Medical costs is overuse of services. While what any one individual does or does not do is a drop in the bucket, if more of us change things - then maybe it will help.

If it makes no difference to us financially, are there any things we, as individuals, do (or do not do) that (even marginally) reduce overall medical costs?

On my plan, blood tests cost me nothing. So, there is no financial incentive for me to have fewer tests. What I do, though, is tell my PCP to skip running several blood tests that I know one of my specialists will order when I see the specialist.

I also wonder what is "magic" about the one year free (to patient) annual physical. I still do it every 12 months, but am considering stretching it out a few months.

123
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Re: Reducing overall medical costs. Do we do anything?

Post by 123 » Sat Oct 13, 2018 2:23 pm

dm200 wrote:
Sat Oct 13, 2018 2:18 pm
...I also wonder what is "magic" about the one year free (to patient) annual physical. I still do it every 12 months, but am considering stretching it out a few months.
It's probably more "magic" to the physician. "Voila" a periodic revenue stream.
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Re: Reducing overall medical costs. Do we do anything?

Post by simplesimon » Sat Oct 13, 2018 2:30 pm

I don't consider seeing a doctor unless a problem persists for more than a couple of weeks and even then I start googling stuff.

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sat Oct 13, 2018 2:33 pm

123 wrote:
Sat Oct 13, 2018 2:23 pm
dm200 wrote:
Sat Oct 13, 2018 2:18 pm
...I also wonder what is "magic" about the one year free (to patient) annual physical. I still do it every 12 months, but am considering stretching it out a few months.
It's probably more "magic" to the physician. "Voila" a periodic revenue stream.
Also, fairly easy to remember. Years ago, as I aged, there was one specialist I saw ever 12 months for a screening. He advised seeing him every year. Now, with different plan and that same specialty - my current specialist says my PCP can do this screening during annual health assessment - and only need to see him if there is an issue that is noticed.

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Re: Reducing overall medical costs. Do we do anything?

Post by Erwin007 » Sat Oct 13, 2018 2:58 pm

The two things that most people could probably do to reduce medical costs the most are to not smoke and to be at their ideal body weight.

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sat Oct 13, 2018 3:05 pm

Erwin007 wrote:
Sat Oct 13, 2018 2:58 pm
The two things that most people could probably do to reduce medical costs the most are to not smoke and to be at their ideal body weight.
Yes - never smoked and have been at good body weight for the last seven years. Also, have done many things to be healthy and reduce risks.

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Re: Reducing overall medical costs. Do we do anything?

Post by sport » Sat Oct 13, 2018 3:13 pm

dm200 wrote:
Sat Oct 13, 2018 2:18 pm
On my plan, blood tests cost me nothing. So, there is no financial incentive for me to have fewer tests. What I do, though, is tell my PCP to skip running several blood tests that I know one of my specialists will order when I see the specialist.
What I have done is ask my PCP for the blood test requisition. Then, when the specialist orders a blood test, I give the lab both requisitions at the same time. I get stuck only once, and the tests are not duplicated.

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Re: Reducing overall medical costs. Do we do anything?

Post by RobLyons » Sat Oct 13, 2018 3:14 pm

Good suggestions above. I would add
-reduce your own consumption (food, alcohol)
-eat a more plant based diet, cut saturated fat, add more lean protein
-increasing activity (20+min daily) with several strenuous cardio sessions weekly
-reduce bodyweight
-use a health care spending account
-visit the MD as rarely as possible
-never use the ER unless a true emergency
-advocating to family, friends, coworkers the same good practices discussed
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Re: Reducing overall medical costs. Do we do anything?

Post by Mike Scott » Sat Oct 13, 2018 3:17 pm

Healthy diet, life style and exercise etc etc and you may still need medical care. Keep up with preventative and ongoing maintenance health care. Go see your doctor/dentist/optometrist when you need them.

What is the difference between preventative screening and overtesting?
Was that skin biopsy a couple of weeks ago wasted because it came back negative?

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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sat Oct 13, 2018 3:21 pm

-visit the MD as rarely as possible
Yes -- BUT do your best to also know the circumstances when you SHOULD consult your Physician. An early death or disabling condition is not worth saving money. Also, when you do consult a physician, be fully prepared - make notes ahead of time and take notes when I see the Physician.

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sat Oct 13, 2018 3:23 pm

Mike Scott wrote:
Sat Oct 13, 2018 3:17 pm
Healthy diet, life style and exercise etc etc and you may still need medical care. Keep up with preventative and ongoing maintenance health care. Go see your doctor/dentist/optometrist when you need them.

What is the difference between preventative screening and overtesting?
Was that skin biopsy a couple of weeks ago wasted because it came back negative?
I think about that too ;)

By certain false logic, I never should have had life insurance since I did not die.
I never needed to see an Ophthalmologist every year for monitoring a condition - since it was never a problem.
... and so on. ;)

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simplesimon
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Re: Reducing overall medical costs. Do we do anything?

Post by simplesimon » Sat Oct 13, 2018 3:29 pm

If all the focus is on outcomes, then financial rationalization goes out the window.

Let's keep the discussion on what people are willing to "gamble" on to help save costs.

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Re: Reducing overall medical costs. Do we do anything?

Post by Kennedy » Sat Oct 13, 2018 3:30 pm

Use your PCP as a first step instead of immediately jumping to a specialist.

I know two young people on Medicaid. They are both in their 20s. Both told me how they had just made appointments with various specialists. Girl number one told me she was going to see a podiatrist (along with two other specialists). When I asked why, she said, "Why not? It's free. I heard they clip your toenails for you" She wasn't having any foot problems. Stupid girl.

Girl number two just told me she made an appointment with an endocrinologist. I asked why, and she said she wondered if her "thyroid was off." I asked if she had visited her PCP for thyroid labs, and she said, " Nah, it's free so I just booked an appointment with the specialist."

It makes no sense to me that Medicaid in my state does not require a visit with a PCP as a gatekeeper. But no worries... it's "free."
Last edited by Kennedy on Sat Oct 13, 2018 3:39 pm, edited 1 time in total.

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Re: Reducing overall medical costs. Do we do anything?

Post by ResearchMed » Sat Oct 13, 2018 3:31 pm

dm200 wrote:
Sat Oct 13, 2018 3:23 pm
Mike Scott wrote:
Sat Oct 13, 2018 3:17 pm
Healthy diet, life style and exercise etc etc and you may still need medical care. Keep up with preventative and ongoing maintenance health care. Go see your doctor/dentist/optometrist when you need them.

What is the difference between preventative screening and overtesting?
Was that skin biopsy a couple of weeks ago wasted because it came back negative?
I think about that too ;)

By certain false logic, I never should have had life insurance since I did not die.
I never needed to see an Ophthalmologist every year for monitoring a condition - since it was never a problem.
... and so on. ;)
And then there are those of us (self and extended families) where "routine/preventive monitoring" DID reveal something that might have been (in a few cases WOULD HAVE BEEN) untreatable/fatal in the not too distant future.

If one were given a "health roadmap" when born, then there'd be no need for ongoing monitoring.
But we aren't there yet, and I doubt we ever will be, due to environmental and random factors.

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Re: Reducing overall medical costs. Do we do anything?

Post by Mr.BB » Sat Oct 13, 2018 4:27 pm

"If it makes no difference to us financially, are there any things we, as individuals, do (or do not do) that (even marginally) reduce overall medical costs?"

Exercise, drink more water, eat more fresh foods, reduce simple sugars in your diet
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Re: Reducing overall medical costs. Do we do anything?

Post by sawhorse » Sat Oct 13, 2018 4:35 pm

These questions often come across like they're smug and bragging and/or completely out of touch with people who suffer from debilitating medical problems.

I am in my 30s. I have never smoked a single thing in my life. My BMI is in the low 20s. The amount of alcohol I have drank in my entire life would fit into two beer bottles.

Yet here I am with tens of thousands in medical costs a year WITH insurance. Unable to work. In pain. Struggling with mobility problems, neurological problems, and bodily function problems.

When feces hits the fan, there isn't a whole lot you can do to really cut back on your medical expenses. However, if I have to give a few tips, here they are.

1. If you have health problems, get the best coverage insurance even if the premiums are a lot higher. When you are ill, your ability to fight insurance companies and verify coverage are greatly diminished.

2. Try to find a PCP who can handle a lot of problems themselves rather than refer you to a specialist each time. I used to have one but then I moved and haven't been able to find one since.

3. Order expensive medications from foreign countries if they aren't covered by your insurance.

4. Consider medical tourism if you can physically and logistically take the trips.
Last edited by sawhorse on Sat Oct 13, 2018 4:37 pm, edited 1 time in total.

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sat Oct 13, 2018 4:36 pm

Kennedy wrote:
Sat Oct 13, 2018 3:30 pm
Use your PCP as a first step instead of immediately jumping to a specialist.
I know two young people on Medicaid. They are both in their 20s. Both told me how they had just made appointments with various specialists. Girl number one told me she was going to see a podiatrist (along with two other specialists). When I asked why, she said, "Why not? It's free. I heard they clip your toenails for you" She wasn't having any foot problems. Stupid girl.
Girl number two just told me she made an appointment with an endocrinologist. I asked why, and she said she wondered if her "thyroid was off." I asked if she had visited her PCP for thyroid labs, and she said, " Nah, it's free so I just booked an appointment with the specialist."
It makes no sense to me that Medicaid in my state does not require a visit with a PCP as a gatekeeper. But no worries... it's "free."
Yes, in general. I think the analogy is correct: "When you are a hammer, everything looks like a nail"

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sat Oct 13, 2018 4:38 pm

sawhorse wrote:
Sat Oct 13, 2018 4:35 pm
These questions often come across like they're bragging and/or completely out of touch with people who suffer from debilitating medical problems.

Yes - there is a balance needed so that nobody comes across as insensitive to those suffering.

HIinvestor
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Re: Reducing overall medical costs. Do we do anything?

Post by HIinvestor » Sat Oct 13, 2018 4:59 pm

My H, my kids and I also have chronic medical conditions thru nothing we or any of our many MDs can figure. We are all close to ideal weight, eat well, rarely partake of alcohol, have never dabbled in drugs or tobacco, etc.

We do see our internist as directed. We also see our specialists as directed. We have remained pretty healthy even with our conditions but feel it would be foolhardy not to go to our MDs as directed, so they will be able to help us when conditions flare up or worsen.

Having good medical coverage at decent rates is very helpful to us in maintaining our health. We do take the minimum Rx we can to keep ourselves as healthy as possible and of course we exercise regularly.

Tips:
1. Make sure you and your provider(s) are in synch as to treatments.
2. Review your treatments at least annually to decide whether revisions are in order.
3. If your provider shrugs his/her shoulders and doesn’t help you through tough times, get a new provider sooner than later.
4. If you can’t afford your treatments, ask providers about less expensive options—don’t assume skipping treatments or splitting doses or pills is OK. Sometimes higher dose pills CAN be safely split but for coated or time-release Rx, they should NOT be cut.
5. If you are low income/assets, check the drug company website of your Rx for discounts/programs you may qualify for—May save a bundle.
6. Check your State Dept of Health and ask them what insurance and medication assistance programs there are and who to speak with.

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Re: Reducing overall medical costs. Do we do anything?

Post by staythecourse » Sat Oct 13, 2018 5:34 pm

Erwin007 wrote:
Sat Oct 13, 2018 2:58 pm
The two things that most people could probably do to reduce medical costs the most are to not smoke and to be at their ideal body weight.
Correct. The 2 leading causes of preventable morbidity and mortality (sickness and death) in this country is: Obesity and tobacco smoking. That plus hypertension and diabetes which cause many chronic diseases make a quartet of treatable issues if regular follow up and compliance is done by the patient.

To the OP, great intentions, but if I am remembering correct (maybe wrong) 50% of ALL medicare costs come from some 5-10% of medicare beneficiaries. So if the interest is getting in better health go for it. If it is to move the needle in health care costs will need to be done at a much larger scale systematic operation from top down to help identify AHEAD of time that large cost subgroup.

Good luck.
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Re: Reducing overall medical costs. Do we do anything?

Post by sawhorse » Sat Oct 13, 2018 5:40 pm

HIinvestor wrote:
Sat Oct 13, 2018 4:59 pm
4. If you can’t afford your treatments, ask providers about less expensive options—don’t assume skipping treatments or splitting doses or pills is OK. Sometimes higher dose pills CAN be safely split but for coated or time-release Rx, they should NOT be cut.
Really good advice. Prescription medications are one of my biggest expense. Ask if there are cheaper alternatives. You may have to do a little research yourself as doctors often don't know how expensive medications are. For example, there is a much less expensive version of the Epipen called Adrenaclick, yet it was staggering how few doctors knew about it until the Epipen price increases became big news.

Goodrx is a great resource for comparing drug prices.

If a drug is not covered by your insurance, check prices on Goodrx to compare pharmacies and have your doctor send it to the cheapest pharmacy or give you a paper prescription so that you can price shop at different pharmacies.

Prescription drugs filled at the pharmacy are the one area in health care where it's easy to find out prices in advance and shop for the best price.

For expensive non-covered medications, try getting them from another country. I get a $1200 non-covered prescription from Canada for $500.
Last edited by sawhorse on Sat Oct 13, 2018 8:35 pm, edited 1 time in total.

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Re: Reducing overall medical costs. Do we do anything?

Post by sawhorse » Sat Oct 13, 2018 5:46 pm

Keep in mind that the bulk of medical expenses happen in the last few years of life. Someone who leads a very healthy lifestyle is more than likely still going to rack up enormous expenses toward the end of their life. In fact, they may rack up more expenses than someone who led an unhealthy lifestyle and died quickly and young.

The best thing you could do to reduce health costs is to die young suddenly. Barring that, have a living will that spells out the extent to which you want life preserving measures. Without a living will, doctors will always err on the side of keeping you alive.

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Re: Reducing overall medical costs. Do we do anything?

Post by Dottie57 » Sat Oct 13, 2018 6:16 pm

I take my medication as stipulated. With allergies/asthma I will have enough problems that an office call will be necessary. Also try to stay away from thosewith colds - which cause asthma problems for me.

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Re: Reducing overall medical costs. Do we do anything?

Post by JoMoney » Sat Oct 13, 2018 6:27 pm

I don't think avoiding preventative care is the answer.
It is a multifaceted issue, but I think there is a point to be made about the fraud that is out there. If people reported it when they suspected something, and with good governance to actively fight it, it could go quite a ways to take a bite out of the costs.
https://www.aarp.org/money/scams-fraud/ ... fraud.html
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Re: Reducing overall medical costs. Do we do anything?

Post by dodecahedron » Sat Oct 13, 2018 6:55 pm

dm200 wrote:
Sat Oct 13, 2018 2:18 pm
One, of many I believe, reason for high US Medical costs is overuse of services. While what any one individual does or does not do is a drop in the bucket, if more of us change things - then maybe it will help.

If it makes no difference to us financially, are there any things we, as individuals, do (or do not do) that (even marginally) reduce overall medical costs?

On my plan, blood tests cost me nothing. So, there is no financial incentive for me to have fewer tests. What I do, though, is tell my PCP to skip running several blood tests that I know one of my specialists will order when I see the specialist.

I also wonder what is "magic" about the one year free (to patient) annual physical. I still do it every 12 months, but am considering stretching it out a few months.
My Medicare Advantage PPO provider provides a $75 cash incentive for an annual PCP visit. I assume the HMO has done some kind of cost-benefit analysis that it is financially worthwhile for them to provide incentives for this.

Why might they offer this--I can think of several reasons---might be a combination of them.

1) the Advantage plan´s provider has statistical evidence that the annual wellness visits reduce their health care costs for treating problems down the road
2) their reimbursement formula from the federal government provides rewards to Advantage plan providers whose members do these annual visits
3) offering this kind of incentive attracts the mix of compliant plan members who are statistically likelier to be more compliant about more challenging situations and attracts the kind of patients doctors like, thereby helping them keep physicians in their network

2015
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Re: Reducing overall medical costs. Do we do anything?

Post by 2015 » Sat Oct 13, 2018 9:00 pm

sawhorse wrote:
Sat Oct 13, 2018 5:46 pm
Keep in mind that the bulk of medical expenses happen in the last few years of life. Someone who leads a very healthy lifestyle is more than likely still going to rack up enormous expenses toward the end of their life. In fact, they may rack up more expenses than someone who led an unhealthy lifestyle and died quickly and young.

The best thing you could do to reduce health costs is to die young suddenly. Barring that, have a living will that spells out the extent to which you want life preserving measures. Without a living will, doctors will always err on the side of keeping you alive.
I dislike the term "healthy" because people usually mean having a diet coke with their burger and fries (or a salad at McDonald's). "Healthy" means different things to different people. I do not believe one has to "die young suddenly". Some of us who have been on diets consisting of living plants and vegetables, seeds, legumes, lean foul (among other things) for most of their lives do not consider what the majority of Americans eat "healthy". In fact, we view it to be tantamount to a slow poisoning, or dying slowly over time. I can find nothing that will increase the quality of one's life and health beyond diet and ongoing exercise (no, that does not mean taking your phone to the gym).

I have absolutely no intention of racking up any kind of healthcare expenses at any point in my life. I do not consider that living. A living will and California's right to die law will take care of my end of life quality of life. I have controlled every aspect of my health throughout my life and that will not change under any circumstances. Unlike many, I am not in awe of the health care profession or of health care providers. Like Charlie Munger, I do not respect professional boundaries, and consequently garner the highest respect and collaboration from my providers.

Your second paragraph is spot on. When I was engaging in elder care earlier this year a living will allowed me to control every aspect of care up until death. It was made clear to every caregiver that my elder's wishes would be carried out in their entirety without exception. The living will provided me with the power to oversee that and execute on that.

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Re: Reducing overall medical costs. Do we do anything?

Post by sawhorse » Sat Oct 13, 2018 9:11 pm

2015 wrote:
Sat Oct 13, 2018 9:00 pm
I have controlled every aspect of my health throughout my life and that will not change under any circumstances.
What an arrogant statement said from a position of good fortune. Many people do not have that good fortune. I hope you don't suddenly develop a debilitating, as of now incurable, non-fatal medical condition through no fault of your own. I became bedridden with neurological problems and bodily function problems in my early 30s. A few years earlier I had climbed mountains.

Some people are born with or develop illnesses at a very young age and literally do not spend a single day of their lives in good health no matter what they do.

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Re: Reducing overall medical costs. Do we do anything?

Post by 2015 » Sat Oct 13, 2018 9:25 pm

sawhorse wrote:
Sat Oct 13, 2018 9:11 pm
2015 wrote:
Sat Oct 13, 2018 9:00 pm
I have controlled every aspect of my health throughout my life and that will not change under any circumstances.
What an arrogant statement said from a position of good fortune. Many people do not have that good fortune. I hope you don't suddenly develop a debilitating non-fatal medical condition through no fault of your own. I became bedridden with neurological problems and bodily function problems in my early 30s. A few years earlier I had climbed mountains.

Some people are born with or develop illnesses at a very young age and literally do not spend a single day of their lives in good health no matter what they do.
You're correct and I should correct that statement, as it's not entirely true. I had the misfortune of losing complete control of my health in my late 30's. It was perhaps the most grueling experience of my life, occurring at the then peak of my life, and If there's a hell, I've been there. I deteriorated to the point of being about two months away from dying but the gods decided it was not my time. My stance on what I view as living is educated by that experience, having recovered and vowed to never go through anything like again.

OTOH, based on my own experience, I would encourage you to not give up. My recovery was viewed as nothing short of a miracle (really!). I recovered and literally overnight it was like it never happened. I went from one day being on death's door to (later) being in the best health of my life. I hope my experience will give you hope. You may be one day be climbing mountains again.

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Re: Reducing overall medical costs. Do we do anything?

Post by toofache32 » Sat Oct 13, 2018 11:29 pm

Eat well and don't drive fast. Always wipe, stay off the pipe.

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Re: Reducing overall medical costs. Do we do anything?

Post by toofache32 » Sat Oct 13, 2018 11:31 pm

Kennedy wrote:
Sat Oct 13, 2018 3:30 pm
Use your PCP as a first step instead of immediately jumping to a specialist.

I know two young people on Medicaid. They are both in their 20s. Both told me how they had just made appointments with various specialists. Girl number one told me she was going to see a podiatrist (along with two other specialists). When I asked why, she said, "Why not? It's free. I heard they clip your toenails for you" She wasn't having any foot problems. Stupid girl.

Girl number two just told me she made an appointment with an endocrinologist. I asked why, and she said she wondered if her "thyroid was off." I asked if she had visited her PCP for thyroid labs, and she said, " Nah, it's free so I just booked an appointment with the specialist."

It makes no sense to me that Medicaid in my state does not require a visit with a PCP as a gatekeeper. But no worries... it's "free."
And this is why "free" care is so expensive. No skin in the game. And some want this for everyone.

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JoMoney
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Re: Reducing overall medical costs. Do we do anything?

Post by JoMoney » Sat Oct 13, 2018 11:53 pm

toofache32 wrote:
Sat Oct 13, 2018 11:31 pm
Kennedy wrote:
Sat Oct 13, 2018 3:30 pm
Use your PCP as a first step instead of immediately jumping to a specialist.

I know two young people on Medicaid. They are both in their 20s. Both told me how they had just made appointments with various specialists. Girl number one told me she was going to see a podiatrist (along with two other specialists). When I asked why, she said, "Why not? It's free. I heard they clip your toenails for you" She wasn't having any foot problems. Stupid girl.

Girl number two just told me she made an appointment with an endocrinologist. I asked why, and she said she wondered if her "thyroid was off." I asked if she had visited her PCP for thyroid labs, and she said, " Nah, it's free so I just booked an appointment with the specialist."

It makes no sense to me that Medicaid in my state does not require a visit with a PCP as a gatekeeper. But no worries... it's "free."
And this is why "free" care is so expensive. No skin in the game. And some want this for everyone.
Even more than anecdotally, there have been studies that suggest that's the case
http://science.sciencemag.org/content/e ... ce.1246183
Medicaid Increases Emergency-Department Use: Evidence from Oregon's Health Insurance Experiment
...We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.
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Re: Reducing overall medical costs. Do we do anything?

Post by brandy » Sun Oct 14, 2018 7:44 am

HIinvestor wrote:
Sat Oct 13, 2018 4:59 pm
My H, my kids and I also have chronic medical conditions thru nothing we or any of our many MDs can figure. We are all close to ideal weight, eat well, rarely partake of alcohol, have never dabbled in drugs or tobacco, etc. ...snip...
Eliminate as many chemicals as you can from your bodies, your home, your laundry, your school /hobby supplies, etc. An easy test starts in the bathroom, on your dresser, and in your kitchen, with a box or bags: read the labels of the items you use: hair and body products, cleaning products including laundry, floor, scouring powders, dish soaps, air cleaners/fragrances/incense, etc. Scented clothing, shoes, back packs, markers, crayons, etc. If the product label indicates fragrance, put it in the box. Put them all in the box or bags, set outside, away from doors and windows for 2-3 weeks.
There are natural products that are probably less expensive and easily available: vinegar, lemon juice, baking soda, borax, salt, olive oil (skin), cornstarch (body powder), etc. And for this test, if needed, there are fragrance free products available in health food type stores as well as some grocers. Soaps, shampoos, laundry and dish products.
The chemicals used in making commercial fragrances cause MANY health problems, from sneezing to sniffling, to bladder, digestion, respiratory, erectile, various disorders, and learning problems.

This simple test may eliminate a few to many of your conditions. The length of time may not be quite enough especially if you go out of the house into work environments where others still use them. It will take your body a bit longer to eliminate them from itself. And if your conditions do not lessen, you still have your products.
HIinvestor wrote:
Sat Oct 13, 2018 4:59 pm
Tips:
1. Make sure you and your provider(s) are in synch as to treatments.
2. Review your treatments at least annually to decide whether revisions are in order.
3. If your provider shrugs his/her shoulders and doesn’t help you through tough times, get a new provider sooner than later.
I have learned I need to be really clear about what I think will help me. I had been having trouble with several toes on one foot. The doc ordered x-rays. Of my ANKLE. I didn't find THAT out until I was in the x ray room. :x

livesoft
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Re: Reducing overall medical costs. Do we do anything?

Post by livesoft » Sun Oct 14, 2018 8:13 am

simplesimon wrote:
Sat Oct 13, 2018 3:29 pm
Let's keep the discussion on what people are willing to "gamble" on to help save costs.
I have read discussion where people only decide to change their eating and exercise habits when they have been diagnosed with a chronic ailment. Without the lab/doctor diagnosis, they would never change. I almost think the patient should be lied to and given a fake chronic ailment to make them change.
Wiki This signature message sponsored by sscritic: Learn to fish.

Lynette
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Re: Reducing overall medical costs. Do we do anything?

Post by Lynette » Sun Oct 14, 2018 8:49 am

I am not going to go for a doctor for a wellness / regular test this year. Two years ago after retired, I went for my first wellness test on Medicare. Due to billing errors, Medicare denied some of the coverage and it was a real hassle sorting it out. So I decided all of these tests were unnecessary each year. So this year I am skipping:

1. Annual wellness test.

2. Mammogram - no history of breast cancer in my family.

3. No skin exam - I had surface level one melanoma about 30 years ago and do not think exams are necessary at this stage. Each time I go the dermatologist finds some or other mole to take out and send for biopsy. I have not been for sever years.

4. No additional tests such as bone density, etc.

I will go to my PCP for the wellness test next year and maybe bone density and colonoscopy if due.

5. I may go for a flu shot.

I will go for a regular eye exam as I may need cataract surgery next year.

The reason I am not going is that I think they are unnecessary, wastes my time and I strongly dislike having to deal with Medicare billing issues. I know I am fortunate to be healthy but I exercise and try to follow a healthy diet.

Retired2013
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Re: Reducing overall medical costs. Do we do anything?

Post by Retired2013 » Sun Oct 14, 2018 8:57 am

How many people skip their flue shots? Covered by policy and could save you a trip to doctor office or hospital $$$. Cost to insurance company $30 and very well worth it. It's priced into the premium.

staythecourse
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Re: Reducing overall medical costs. Do we do anything?

Post by staythecourse » Sun Oct 14, 2018 8:59 am

Lynette wrote:
Sun Oct 14, 2018 8:49 am
I am not going to go for a doctor for a wellness / regular test this year. Two years ago after retired, I went for my first wellness test on Medicare. Due to billing errors, Medicare denied some of the coverage and it was a real hassle sorting it out. So I decided all of these tests were unnecessary each year. So this year I am skipping:

1. Annual wellness test.

2. Mammogram - no history of breast cancer in my family.

3. No skin exam - I had surface level one melanoma about 30 years ago and do not think exams are necessary at this stage. Each time I go the dermatologist finds some or other mole to take out and send for biopsy. I have not been for sever years.

4. No additional tests such as bone density, etc.

I will go to my PCP for the wellness test next year and maybe bone density and colonoscopy if due.

5. I may go for a flu shot.

I will go for a regular eye exam as I may need cataract surgery next year.

The reason I am not going is that I think they are unnecessary, wastes my time and I strongly dislike having to deal with Medicare billing issues. I know I am fortunate to be healthy but I exercise and try to follow a healthy diet.
It is your body and can do whatever you want and more importantly get away with such irresponsibility. Just curious if you get diagnosed with breast cancer or fractured hip in the future due to breast cancer and osteoporosis respectively will you be denying treatment since you opted out of the screening tests that have been shown to detect the disease earlier AND shown starting treatment improves morbidity of that disease? Considering BOTH would have been diagnosed earlier as screening tests you will have INCREASED the medical coverage needed to treat both conditions. So on a thread that is asking how to "reduce overall medical costs" you give a GREAT example of what to do to INCREASE medical costs. This is why I mentioned on an earlier post there needs to be systematic change to decrease health care costs one is MORE patient responsibility.

Thank you for reminding me why patients as a majority can NOT be responsible for their own care. I lived by that as a physician and haven't been wrong yet and posts like this one back it up.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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midareff
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Re: Reducing overall medical costs. Do we do anything?

Post by midareff » Sun Oct 14, 2018 10:14 am

Lynette wrote:
Sun Oct 14, 2018 8:49 am
I am not going to go for a doctor for a wellness / regular test this year. Two years ago after retired, I went for my first wellness test on Medicare. Due to billing errors, Medicare denied some of the coverage and it was a real hassle sorting it out. So I decided all of these tests were unnecessary each year. So this year I am skipping:

1. Annual wellness test.

2. Mammogram - no history of breast cancer in my family.

3. No skin exam - I had surface level one melanoma about 30 years ago and do not think exams are necessary at this stage. Each time I go the dermatologist finds some or other mole to take out and send for biopsy. I have not been for sever years.

4. No additional tests such as bone density, etc.

I will go to my PCP for the wellness test next year and maybe bone density and colonoscopy if due.

5. I may go for a flu shot.

I will go for a regular eye exam as I may need cataract surgery next year.

The reason I am not going is that I think they are unnecessary, wastes my time and I strongly dislike having to deal with Medicare billing issues. I know I am fortunate to be healthy but I exercise and try to follow a healthy diet.
To each their own BUT:

The average male life in the Russia is 63 years... in the Ukraine it is about 2 years longer and I asked about this as I happened to be hospitalized in the Ukraine during a cruise from Odessa to Kiev. ... and spent a couple of days in what was described as the finest private hospital in Odessa since they even had cardio and blood labs on premise.

The differences were attributed to more medicine and more diagnostic screenings in the Ukraine. The more diseases you catch early the better chance of treatment.


1. Annual wellness test. You have your reasons and I have mine. I'd never skip this and have blood work done 2 to 4 times a year. Caught my prostrate cancer early and obtained correct treatment and have had zero PSA readings for about the last three years. Let it go and skip screenings and perhaps it metastasizes.

2. Mammogram - no history of breast cancer in my family. I would never let my wife skip her yearly mammo or PAP. Early diagnostics are all important and your genetic history is not the number 1 indicator.

3. No skin exam - I had surface level one melanoma about 30 years ago and do not think exams are necessary at this stage. Each time I go the dermatologist finds some or other mole to take out and send for biopsy. I have not been for sever years. Again... if something "pops" up we go. In fact, I have an appointment for next week.

4. No additional tests such as bone density, etc. Again, you do it your way and we will do it ours. We have had bone density screenings and many other screenings including scheduled colonoscopy and endoscopy.. Perhaps we just want to stay alive more than you do.

5. I may go for a flu shot.

I will go for a regular eye exam as I may need cataract surgery next year.

Don't hardly know how to respond to this.... my scheduled eye exam revealed wet macular degeneration that eventually blinded my mother. There is a treatment now and I get regularly scheduled eye injections... going on 2+ years now. That eye is still between 20/25 and 20/30 and stable with an increasing interval. We always go for flu shots, pneumonia vaccinations and so forth. You may wish to keep yourself at higher risk than we do and that certainby is your right. We choose to control our blood pressure, cholesterol, cardiac risks and stay in front of diagnostic screenings and so forth.

Skip your recommended screenings and such at your own risk...... and that includes periodic dental xrays, cleanings and exams. You may get lucky and be one of those who lives to 105 without any medical attention that a screening or routine test could have helped. We choose not to be in the risk pool you have created for yourself.

Medical care is expensive, dental even more so this there isn't decent insurance available to provide a risk pool. We will be just over $20K this year and have run in that general neighborhood the last 6 years since I/we retired. It is what it is and we won't miss a test, exam, check-up or medication regardless to save costs. Thankfully, we don't have to and we want our risks kept as low as possible.
Last edited by midareff on Sun Oct 14, 2018 10:51 am, edited 2 times in total.

sport
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Re: Reducing overall medical costs. Do we do anything?

Post by sport » Sun Oct 14, 2018 10:31 am

Lynette wrote:
Sun Oct 14, 2018 8:49 am
I may go for a flu shot.
A relative of mine was in her 30's when she died from the flu.

Turbo29
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Re: Reducing overall medical costs. Do we do anything?

Post by Turbo29 » Sun Oct 14, 2018 10:40 am

duplicate
Last edited by Turbo29 on Sun Oct 14, 2018 10:41 am, edited 1 time in total.

Turbo29
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Re: Reducing overall medical costs. Do we do anything?

Post by Turbo29 » Sun Oct 14, 2018 10:40 am

staythecourse wrote:
Sun Oct 14, 2018 8:59 am
... since you opted out of the screening tests that have been shown to detect the disease earlier AND shown starting treatment improves morbidity of that disease? Considering BOTH would have been diagnosed earlier as screening tests you will have INCREASED the medical coverage needed to treat both conditions.
Not all doctors agree.
Just as a gambler rarely hits the jackpot in Vegas, a patient who undergoes cancer screening is rarely the lucky one whose life is extended from the test, and much more likely to figuratively lose his or her shirt. Common harms of screening include false positive results, risks associated with subsequent diagnostic procedures, and possible unnecessary treatment (and associated side effects) for "cancer" that looks dangerous under the microscope but is actually destined to never cause health problems.
Why every screening test is a gamble
http://commonsensemd.blogspot.com/2015/ ... amble.html

BTW, this doctor is not some quack, he served on the U.S. Preventive Services Task Force (USPSTF).

Look up the recommendations on some of the screening tests below. Some common ones have grades of "C" or "D". Of course medicine is an art as well as a science but this can give you a starting point when discussing tests with your doctor.

https://www.uspreventiveservicestaskfor ... eRec/Index
Last edited by Turbo29 on Sun Oct 14, 2018 10:51 am, edited 4 times in total.

Kennedy
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Re: Reducing overall medical costs. Do we do anything?

Post by Kennedy » Sun Oct 14, 2018 10:42 am

sport wrote:
Sun Oct 14, 2018 10:31 am
Lynette wrote:
Sun Oct 14, 2018 8:49 am
I may go for a flu shot.
A relative of mine was in her 30's when she died from the flu.
A friend's six year old son died from the flu as well. He was previously perfectly healthy. The boy was on a ventilator within two days of becoming symptomatic. He died the next morning. The friend was a nurse. The boy had not been vaccinated for the flu. It devastated their family.

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sun Oct 14, 2018 10:46 am

My late father was, generally, in excellent health. While he had great respect for the medical professions, especially in his later years, he would only see a doctor if he believed he would die otherwise. Worked for him - he lived to almost 90.

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midareff
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Re: Reducing overall medical costs. Do we do anything?

Post by midareff » Sun Oct 14, 2018 11:00 am

dm200 wrote:
Sun Oct 14, 2018 10:46 am
My late father was, generally, in excellent health. While he had great respect for the medical professions, especially in his later years, he would only see a doctor if he believed he would die otherwise. Worked for him - he lived to almost 90.
My father hated them in his later years as well. ... unfortunately, he felt he had lived long enough from his mid 80's on. Alzheimer's turned his lights out just past 88 and he made it to about 94, but never knew any of it. Perhaps if there had been better drugs then it might have been different, or maybe not. I do know I don't need of want the last 6 years he had.

staythecourse
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Re: Reducing overall medical costs. Do we do anything?

Post by staythecourse » Sun Oct 14, 2018 11:14 am

Turbo29 wrote:
Sun Oct 14, 2018 10:40 am
staythecourse wrote:
Sun Oct 14, 2018 8:59 am
... since you opted out of the screening tests that have been shown to detect the disease earlier AND shown starting treatment improves morbidity of that disease? Considering BOTH would have been diagnosed earlier as screening tests you will have INCREASED the medical coverage needed to treat both conditions.
Not all doctors agree.
Just as a gambler rarely hits the jackpot in Vegas, a patient who undergoes cancer screening is rarely the lucky one whose life is extended from the test, and much more likely to figuratively lose his or her shirt. Common harms of screening include false positive results, risks associated with subsequent diagnostic procedures, and possible unnecessary treatment (and associated side effects) for "cancer" that looks dangerous under the microscope but is actually destined to never cause health problems.
Why every screening test is a gamble
http://commonsensemd.blogspot.com/2015/ ... amble.html

BTW, this doctor is not some quack, he served on the U.S. Preventive Services Task Force (USPSTF).

Look up the recommendations on some of the screening tests below. Some common ones have grades of "C" or "D". Of course medicine is an art as well as a science but this can give you a starting point when discussing tests with your doctor.

https://www.uspreventiveservicestaskfor ... eRec/Index
This is a classic example of someone not knowing statistics. Screening tests are meant as high SENSITIVITY tests. That means one is going to find false positives. The key is to not MISS a person with the disease you are screening for, i.e. false negative.

For a cancer screening test it has to be shown to not ONLY pick up those with the disease BUT also show that by picking it up it makes a difference in outcome. There is no role for a screening test to pick up a disease early and the outcome be the same, i.e. shorten the latency period.

As I mentioned earlier there is quite a bit of controversy on the Task Force. There is a huge political connection with the organization and that is why they almost always try to curtail screening to decrease incidence of the disease and thus hopefully decrease cost.

Hey if you want to believe them go ahead. I said then if the disease is going to be missed by not taking the screening that is recommended by your doctor then you should do the noble thing and NOT get treatment as the cost is higher for everyone else since you decided not to get the testing done that is meant to catch the disease earlier AND decrease the morbidity of the disease. Of course, that take REAL personal responsibility which eludes nearly everyone.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sun Oct 14, 2018 11:19 am

staythecourse wrote:
Sun Oct 14, 2018 11:14 am
Turbo29 wrote:
Sun Oct 14, 2018 10:40 am
staythecourse wrote:
Sun Oct 14, 2018 8:59 am
... since you opted out of the screening tests that have been shown to detect the disease earlier AND shown starting treatment improves morbidity of that disease? Considering BOTH would have been diagnosed earlier as screening tests you will have INCREASED the medical coverage needed to treat both conditions.
Not all doctors agree.
Just as a gambler rarely hits the jackpot in Vegas, a patient who undergoes cancer screening is rarely the lucky one whose life is extended from the test, and much more likely to figuratively lose his or her shirt. Common harms of screening include false positive results, risks associated with subsequent diagnostic procedures, and possible unnecessary treatment (and associated side effects) for "cancer" that looks dangerous under the microscope but is actually destined to never cause health problems.
Why every screening test is a gamble
http://commonsensemd.blogspot.com/2015/ ... amble.html
BTW, this doctor is not some quack, he served on the U.S. Preventive Services Task Force (USPSTF).
Look up the recommendations on some of the screening tests below. Some common ones have grades of "C" or "D". Of course medicine is an art as well as a science but this can give you a starting point when discussing tests with your doctor.
https://www.uspreventiveservicestaskfor ... eRec/Index
This is a classic example of someone not knowing statistics. Screening tests are meant as high SENSITIVITY tests. That means one is going to find false positives. The key is to not MISS a person with the disease you are screening for, i.e. false negative.
For a cancer screening test it has to be shown to not ONLY pick up those with the disease BUT also show that by picking it up it makes a difference in outcome. There is no role for a screening test to pick up a disease early and the outcome be the same, i.e. shorten the latency period.
As I mentioned earlier there is quite a bit of controversy on the Task Force. There is a huge political connection with the organization and that is why they almost always try to curtail screening to decrease incidence of the disease and thus hopefully decrease cost.
Hey if you want to believe them go ahead. I said then if the disease is going to be missed by not taking the screening that is recommended by your doctor then you should do the noble thing and NOT get treatment as the cost is higher for everyone else since you decided not to get the testing done that is meant to catch the disease earlier AND decrease the morbidity of the disease. Of course, that take REAL personal responsibility which eludes nearly everyone.
Good luck.
Yes - while "screening tests" might save your life, false (or misleading) positives could be harmful. Even tests (such as CT scans) for one purpose could "find" things where more tests are indicated.

Interesting (and disturbing) article https://www.washingtonpost.com/news/pos ... e6602c5ecb

Turbo29
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Re: Reducing overall medical costs. Do we do anything?

Post by Turbo29 » Sun Oct 14, 2018 11:20 am

staythecourse wrote:
Sun Oct 14, 2018 11:14 am

This is a classic example of someone not knowing statistics. Screening tests are meant as high SENSITIVITY tests. That means one is going to find false positives. The key is to not MISS a person with the disease you are screening for, i.e. false negative.

For a cancer screening test it has to be shown to not ONLY pick up those with the disease BUT also show that by picking it up it makes a difference in outcome. There is no role for a screening test to pick up a disease early and the outcome be the same, i.e. shorten the latency period.

As I mentioned earlier there is quite a bit of controversy on the Task Force. There is a huge political connection with the organization and that is why they almost always try to curtail screening to decrease incidence of the disease and thus hopefully decrease cost.

Hey if you want to believe them go ahead. I said then if the disease is going to be missed by not taking the screening that is recommended by your doctor then you should do the noble thing and NOT get treatment as the cost is higher for everyone else since you decided not to get the testing done that is meant to catch the disease earlier AND decrease the morbidity of the disease. Of course, that take REAL personal responsibility which eludes nearly everyone.

Good luck.
I have actually corresponded with Dr. Lin. I would trust his grasp of statistics over some person with an anonymous screen name claiming to be a doctor. I brought up his viewpoint on one test with my doctor. The doctor agreed that it was a valid view and accepted my decision not to have the test.

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sun Oct 14, 2018 11:26 am

I have actually corresponded with Dr. Lin. I would trust his grasp of statistics over some person with an anonymous screen name claiming to be a doctor. I brought up his viewpoint on one test with my doctor. The doctor agreed that it was a valid view and accepted my decision not to have the test.
I have also had this kind of discussion with my doctors as well.

A CT scan (for another purpose) last year showed cysts on my left kidney. They were going to order more tests to investigate. I then recalled a CT scan (with another provider) about 15-20 years ago. I called the imaging place and they still had the report. I got a copy (no charge) and dropped it off at my current specialist. Had the same cysts 15-20 years ago - so no more testing needed. Really glad I had such a good memory.

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Re: Reducing overall medical costs. Do we do anything?

Post by Lynette » Sun Oct 14, 2018 11:59 am

Maybe I did not make my situation clear. I am not going for a Medicare Wellness Test this year. I will go next year and go for whatever screening/tests my doctor recommends. My employer virtually forced us to go as we got lower rates if we went. I faithfully went for all of the tests/screenings recommended. One year my employer had the HMO/PPO's exclude people who were regarded as being in excellent health. I was in that category. So for one year I did not go for any tests/screenings.

I have been with my PCP for about 25 years and he knows my health very well. Going onto Medicare was a twelve month saga of phone calls/visits/appeals etc. The problem was that I retired when I was 73 instead of the standard 65. It took me four months to get my Medicare B card. Some clerk at my employer had given the incorrect dates of my employment and the person at SS put it into a pile and did not bother to inform me. So after several visits and calls and several times of submitting many pages of the proof that I had coverage, I finally got my Medicare B card.

Then I naively went in for my Medicare Wellness Test. The doctors office billing clerk billed the codes incorrectly. The doctor did not follow the required procedures as he has known me for all of these years. For example, he did not give me an EKG. My results had improved on a previous visit as I had done a lot of swimming. It took me four appeals that were all turned down to realize that I was losing. I went for all of the required tests in 2017 that included bone density, mammogram and eye exam. I have not been for a skin screening for several years.

My employer had excellent and low-cost to employees for Healthcare. I never had any problems with the HMO. In addition, I have to pay Medicare IRMAA as I have pensions for which I worked till 73.

So frankly I strongly dislike Medicare especially having to deal with all of the billing issues. So part of my reluctance to go to a doctor is because of the problems I have encountered with billing. If I don't go to a doctor, I don't have to deal with this.

I'm putting off having to deal with Medicare enrollment - for a while.
Last edited by Lynette on Sun Oct 14, 2018 1:38 pm, edited 1 time in total.

staythecourse
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Re: Reducing overall medical costs. Do we do anything?

Post by staythecourse » Sun Oct 14, 2018 12:00 pm

Turbo29 wrote:
Sun Oct 14, 2018 11:20 am
staythecourse wrote:
Sun Oct 14, 2018 11:14 am

This is a classic example of someone not knowing statistics. Screening tests are meant as high SENSITIVITY tests. That means one is going to find false positives. The key is to not MISS a person with the disease you are screening for, i.e. false negative.

For a cancer screening test it has to be shown to not ONLY pick up those with the disease BUT also show that by picking it up it makes a difference in outcome. There is no role for a screening test to pick up a disease early and the outcome be the same, i.e. shorten the latency period.

As I mentioned earlier there is quite a bit of controversy on the Task Force. There is a huge political connection with the organization and that is why they almost always try to curtail screening to decrease incidence of the disease and thus hopefully decrease cost.

Hey if you want to believe them go ahead. I said then if the disease is going to be missed by not taking the screening that is recommended by your doctor then you should do the noble thing and NOT get treatment as the cost is higher for everyone else since you decided not to get the testing done that is meant to catch the disease earlier AND decrease the morbidity of the disease. Of course, that take REAL personal responsibility which eludes nearly everyone.

Good luck.
I have actually corresponded with Dr. Lin. I would trust his grasp of statistics over some person with an anonymous screen name claiming to be a doctor. I brought up his viewpoint on one test with my doctor. The doctor agreed that it was a valid view and accepted my decision not to have the test.
For someone claiming to be a doctor I must say I get paid a lot of money to do my job. :D

I don't really care what you do but it might be nice to edit your comment asDr. Lin or his medical board won't appreciate it. It is ILLEGAL for any doctor to give advice on a medical issue without a full evaluation. He could get reprimanded or suspended for doing what he just did if the medical board gets a complaint about it so as a favor to him I might be inclined to remove his name since he tried to help you out.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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dm200
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Re: Reducing overall medical costs. Do we do anything?

Post by dm200 » Sun Oct 14, 2018 12:01 pm

Lynette wrote:
Sun Oct 14, 2018 11:59 am
Maybe I did not make my situation clear. I am not going for a Medicare Wellness Test this year. I will go next year and go for whatever screening/tests my doctor recommends. My employer virtually forced us to go as we got lower rates if we went. I faithfully went for all of the tests/screenings recommended. One year my employer had the HMO/PPO's exclude people who were regarded as being in excellent health. I was in that category. So for one year I did not go for any tests/screenings.
I have been with my PCP for about 25 years and he knows my health very well. Going onto Medicare was a twelve month saga of phone calls/visits/appeals etc. The problem was that I retired when I was 73 instead of the standard 65. It took me four months to get my Medicare B card. Some clerk at my employer had given the incorrect dates of my employment and the person at SS put it into a pile and did not bother to inform me. So after several visits and calls and several times of submitting many pages of the proof that I had coverage, I finally got my Medicare B card.
Then I naively went in for my Medicare Wellness Test. The doctors office billing clerk billed the codes incorrectly. The doctor did not follow the required procedures as he has known me for all of these years. For example, he did not give me an EKG. My results had improved on a previous visit as I had done a lot of swimming. It took me four appeals that were all turned down to realize that I was losing. I went for all of the required tests in 2017 that included bone density, mammogram and eye exam. I have not been for a skin screening for several years.
My employer had excellent and low-cost to employees for Healthcare. I never had any problems with the HMO. In addition, I have to pay Medicare IRMAA as I have pensions for which I worked till 73.

So frankly I strongly dislike Medicare especially having to deal with all of the billing issues. So part of my reluctance to go to a doctor is because of the problems \I have encountered with billing. If I don't go to a doctor, I don't have to deal with this.

I'm putting off having to deal with Medicare enrollment - for a while.
I have a Medicare plan (Cost - much like advantage) - no billing problems or complexities. :)

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