How should health insurance be used?

[daennera]

Last night DF and I were discussing how health insurance should be used. I had gone to the doctor with quite a bit of abdominal pain and against the doctor's advice, I decided to take "wait and see" versus going through all the testing for possible appendicitis. I did not think I was showing enough specific symptoms for me to go through with all that just to find out a had a 48 hour stomach bug. By bedtime last night I was feeling almost 100% and was really really glad I declined to go to the ER.

Anyways, I make it a point not to overuse health care. I do have awesome insurance through my employer, but I try to only see a doctor when I really feel that its necessary. And I always try to use the least expensive option possible. We have quite a few outpatient clinics in the area and I will always use those versus an ER whenever I can.

Even if I did not have insurance, health care is still relatively reasonably priced. An office visit will cost only about $50-$60 at a clinic. I know I got a chest x-ray once and they had billed the insurance company for $200, I paid $115 of that. Still, that chest x-ray was the only thing that got my pneumonia diagnosed. So it would have been worth it even without insurance.

Now DF has a Cpap machine for his sleep apnea. And he told me that there was no way that he would have ever gotten diagnosed or done any of the testing without insurance. His thinking is that his dad snored, and so does he and survived 30 years without it....... Never mind that snoring can be an indicator of other more serious problems.........

He then muses that he might be eligible for a machine upgrade. So I asked him if he needs a machine upgrade and will the actual cost of a new machine be proportional to the benefit he might get out of it. He doesn't know. He just knows he eligible for an upgrade.

He actually pays for his premiums too, whereas I don't. I would think he would be more interested than I am in keeping his health care costs down so they don't have to see ANOTHER increase like the one they had last year.

Am I way too overly concerned about using health care as efficiently as possible, or is he not concerned enough?

[Deleted]

I like your attitude. I'm glad insurance is there, but using medical resources takes more than my time and whatever my co-pay is. DH is 72 and has some chronic health problems that make them treat him extra-cautiously (for good reason) and I'm pretty horrified by the cost of an overnight in the hospital that doesn't involve surgery or other fancy treatments.

A few years ago I was in London on the subway and realized I felt so crappy I was close to fainting. Fortunately I found a seat on the train so I didn't collapse, got off at the next stop, and eventually dragged my rear back to my hotel room, where I spent the whole day in bed, sleeping on and off. My diagnosis- a migraine brought on by a late-night call the night before when I was in Bangalore, about 3 hours of sleep before flying to London, very little sleep on the plane, and dragging 2 suitcases (one loaded with 4 bottles of scotch) all over London before settling in the day before. I was just worn out.

I shudder to think of what would have happened if I'd fainted on the subway- probably would have ended up being taken to the hospital because I'm 57 and grey-haired. Instead, I got on a plane to Zurich the next day and felt fine.

Sometimes "ignore it and it will go away" is a good strategy.

[The Walk of the Penguin Mich]

I think that you need to look at this from another manner....

What would have happened had your 'wait and see' turned out the opposite way? Then, rather than having the tests, going in for a quick appendectomy and gotten tossed out of the hospital 24 hours later. Instead, you wind up with a raging case of peritonitis, where you get put on expensive antibiotics and are hospitalized for a week. Any 'savings' for testing would automatically be eliminated due to the condition becoming much worse than if it had been caught early.

I have chronic joint problems, but for my general health I rarely run to the doctor for 'minor' problems. I can't remember the last time I went to my GP for anything other than a quick BP check and refill of meds.

About the Cpap machine, it sounds like neither you nor he knows the advantages of a more advanced machine. If he's eligible for an upgrade, it may be because he's got a very basic model and the more advanced one is either quieter, smaller, easier to clean or has other advantages. It may cost more, but it may not be immediately offered by his doctor until the doctor knows that he'll use it.

[daennera]

I have found that "wait and see" is usually best. I can honestly say I have never been diagnosed correctly the fist time I've seen a doctor. And again, I wasn't showing any strong signs of appendicitis. My symptoms were extremely vague and had actually lessened over the course of the day before I even saw the doctor. I was pretty skeptical of his concerns, and I'm glad I was. I was really hoping he would prescribe an antibiotic for a stomach bug. I'm kinda upset I did not get what I wanted.

And as far as the new c-pap machine goes, he would have to look into any advantages it would offer. Although his insurance would cover the entire cost, he still shouldn't be spending that kind of money on a machine if it does not offer substantial benefits over the one he has now.

[Deleted]

I like the 'old' major medical plans... moderate deductables, but covers the important, er, expensive stuff... but i also do see having preventative stuff covered fully IF it is shown to effectively drive down overall costs (ie. fixing the stone chip in your windsheild before it cracks and falls out...) In other words, I wouldn't want your husband to be so put off for having to pay for his screening/diagnostics, that he doens't go until he has a HUGE problem that required expensive intervention.

[The Walk of the Penguin Mich]

I was really hoping he would prescribe an antibiotic for a stomach bug. I'm kinda upset I did not get what I wanted.

Chances are you had a virus and antibiotics would not have been effective. Your doctor did the right thing.

Antibiotics are very much overprescribed and many times it's because the patients thinking that they know what's best and doctors prescribing them as a placebo, to keep their patients happy.

So essentially you were doing the same thing that your DH did. You went to the doctor despite getting better and wanted a drug that wasn't likely going to help you.

[daennera]

Yes, I was getting better but still in pain (a 3-4 on the pain scale after 24 hours still warrants attention). If I had as little pain then as I do now I would not have bothered with the doctor. At the same time, I expect that a doctor treat me for the problem that I'm having, not go on some wild goose chase for appendicitis when I'm not showing even a single definitive symptom.

And no, I do not want my body to be subject to a secondary bacterial infection while it's fighting off a viral one. Antibiotics would have been most prudent in this case. And I have never been prescribed a placebo. I would know it and have no problems calling a doctor out on that kind of BS.

And please he's not my husband. Nor will he ever be my husband. He is DF and will remain as such.

[daennera]

I'm not fortunate, just smart. Really, at the time he saw me there was not real reason to think appendicitis. And I would be PISSED if I had gone through a surgery I didn't need. Unimaginably pissed.

[telephus44]

I agree with your assessment. I think as far as testing goes, it should be linked to probabilties. Yes, I know that this won't catch everything, but it would be more efficient and cost effective.

My DH was kicked in the groin region by our young son a few years ago. After 2 days, the pain was still incredibly bad, so we went to the ER. After an exam, they decided that even though it was probably not testicular tortion, based on his age, physical appearance, and onset of symptons, that they were going to do an ultrasound check "just in case." That to me is testing that isn't needed and just runs up healthcare bills. I think there should be some guideline like "If the probability of this is less than x%, don't run the test"


I also think that we should pay more for small things out of pocket. If we had a better system of small clinics for sinus infections, twisted ankles, etc. and we just paid out of pocket for basic small stuff rather than having to go to the doctor every time we needed eye drops or anti-biotics, I think healthcare costs would drop dramatically. I love the CVS Minute Clinics and those types of places. I think we should be encouraging more of them to be built and used.

[daennera]

No, appendicitis is not easy to diagnose, but "vague stomach pain in the central region" most certainly does not warrant scanning for appendicitis. I would need more specific symptoms in order to go through all that.

[Deleted]

Jan 19, 2011 11:22:11 GMT -5 Lady Gaga Gaga Snerd said:

We need some type of Urgent Care facilities, etc. For awhile, those popped up and then closed. That really needs to be promoted.

Could the lack of those facilities be due to some laws in your state? telephus44 mentioned using them and we have them here in Kansas, too- generally inside a drugstore. I've used them twice in the last couple of years for poison ivy; the cases I get tend to spread all over and the itching keeps me awake night after night, so I head it off with prednisone. Those clinics (which I irreverently refer to as Doc in the Boxes) are great when you have a pretty good idea of what you've got and what prescription you need. It wouldn't have been able to help your son with IV hydration, though.

[telephus44]

Well, given that testicular tortion normally arises spontaneously (not because you got kicked in the junk) and that it is usually in adolescent males (not someone who is 35), and that when you look at a man's testicles you can see a physical difference in ones that have testicular tortion - yes, it's a pretty long shot. I don't know the exact odds. But say it's one in 10,000. Does that merit a $2000 ultrasound to confirm what they are pretty sure ISN'T the case? I don't think so.

And honestly - I don't expect the doctor to be infallible. If he did have testicular tortion and was the one person in 10,000, I wouldn't blame the doctor for not ordering the test. It becomes the process of finding the line of what is reasonable to test for. If I go to the doctor with a migraine, should they give me a cat scan in case it's a brain tumor? Like in daennera's argument, all "vague stomach pain in the central region" should not be instantly scanned for appendicitis.


I think part of it is that we as society have faith in modern medicine to catch every illness and make a 100% accurate diagnosis immediately, so we constantly run every test under the sun to rule out all possibilities.

[The Walk of the Penguin Mich]

Also, given the consideration that if the OP DID die from a burst appendix, her having gone to the doctor and the doctor not recommending the test would make him liable for not ruling appendicitis out. And I suspect that many would be willing to jump on the malpractice bandwagon in order to get a payout from their lack of recommendation.

Since the test was recommended by the doctor and the OP chose not to take it, any repercussions from that do fall back on the patient.

Despite what many say, defensive medicine DOES need to be practiced.

[Gardening Grandma]

I doubt that the average person has this issue. Most of us don't have incredibly good insurance. Mine certainly does not pay for a lot of things.
I have a physician who prefers to take the least invasive (also least expensive) approach to a problem. I concur with her approach.

I do have to take issue with the OP's statement that "health care is still reasonably priced". No - it is not. Per capita, we pay more for health care (with no better results) than any other industrialized country in the world. So, no, health care is definitely NOT "reasonably priced"

[daennera]

I find it reasonable. Reasonable enough that I am willing and able to pay for most health care. Short of major surgeries or cancer treatments, stuff like prescriptions, labs, scans, etc I do not find to be outside of my ability to pay for.

But then again, I shop my health care, and how many people can say they do that?

[The Walk of the Penguin Mich]

And no, I do not want my body to be subject to a secondary bacterial infection while it's fighting off a viral one. Antibiotics would have been most prudent in this case.

But you got better, right? You were getting better without treatment, which suggests that you just needed to let the virus run its course.

Unless you're immunocompromised, most people do not need antibiotics but yet many doctors will prescribe antibiotics as a placebo. Patients would get better without them or with them and don't think of the repercussions of of overprescribing. Many simple bacterial infections get better on their own but many seem to think that they need antibiotics for anything.

This line of thought has contributed to the increased resisitance of many bugs to the bacteria and the doctors are (fortunately) starting to move away from prescribing antibiotics that the patients think they need.

[Angel!]

The doctor was probably doing a combination of covering his ass while trying to appease you by recommending the tests for appendicitis. If you had appendicitis & been sent home without him mentioning the possibility you may have died & it would have been his fault. He probably didn't have much else to offer you, stomach bugs are generally viral so antibiotics would have been useless & he wanted to give you some options since you felt the need to make the visit, so you were at least somewhat concerned.

My neighbor's son was at the doctor for a 2nd time in 2 days because he was extremely ill & the mother asked that he be tested for diabetes because it runs in the family. The doc said no because he was too young to have diabetes, said he just had the flu & needed to rest & sent them home. The following night at 2 AM, the son had to be rushed to the ER because his blood sugar was off the charts & had to spend a week in the hospital to recover & spent several more days in a special pediatric hospital in another town. The mother was understandably furious & has done quite of bit of complaining to the doctor's office & medical boards, etc because the doctor refused to order the test at her request. Ordering a potentially unnecessary test can cover your ass even if the patient declines to take the test.

[Gardening Grandma]

But then again, I shop my health care, and how many people can say they do that?

Most people can't because the insurance company limits who they can go to.

[The Walk of the Penguin Mich]

But then again, I shop my health care, and how many people can say they do that?

I guess it depends upon what your issue is. My dad spent years trying to get his blood pressure under control by using doctors who did not know what they were doing. It wasn't until he started seeing specialists, at an increased cost, that they finally got his problem under control.

Right now, I'm looking at going in for a hip replacement on a funky joint in a couple weeks. I looked for and found the most experienced orthopedist that could take care of my problem. Cost really was not an issue (other than trying to keep within my network), because it is more imperative to find someone who will not f*** up my joint than the costs.

[daennera]

You can still shop your health care. My insurance covers all of the hospitals and outpatient clinics in the area. I still go to the one that I know is most cost effective and charges the insurance the least.

Also, for the stuff I do pay out of pocket for, like dental care and eye care, I can shop that too.

I figure my job does me the favor of paying for my premiums, I therefore feel that I should keep their costs down as much as possible.

[daennera]

I'm talking about little stuff (colds, stomach aches, earaches, etc).

For bigger stuff, it would still be more cost effective to pay for a more experienced doctor than to have to pay to fix a problem another doctor created.

[Gardening Grandma]

You can still shop your health care. My insurance covers all of the hospitals and outpatient clinics in the area.

How nice for you! My insurance gives me one urgent care center to go to. It's 35 miles away. The closest one is not covered. Same with physicians and specialists.

You are fortunate to have good coverage, but your posts come across as smug and superior.

[daennera]

Okay, then pay for the care from the center that's closest to you. It's not like I was born with insurance, I did have to pay for this kind of stuff out of pocket for most of my adult life. Shopping health care can be frustrating, but it CAN be done. It just takes more time than shopping for shoes, that's all.

[whoisjohngalt]

You can still shop your health care. My insurance covers all of the hospitals and outpatient clinics in the area. I still go to the one that I know is most cost effective and charges the insurance the least.

Are you serious?? You would rather go to the cheaper one than better one?

I guess to each their own, but I would think health care would be the last thing people would be cheap about

Lena

[The Walk of the Penguin Mich]

I'm talking about little stuff (colds, stomach aches, earaches, etc).

You go to a doctor for colds? It's more cost effective to just let it run its course.

Last spring, I spent 3 days running to the bathroom with severe stomach cramps. It was a virus going around campus, several other people had had it. As long as I stayed hydrated, then it made no sense to see a doctor for it. The virus would last 3 days whether or not I see a doctor, so why go to one when they couldn't do anything for me other than tell me to wait it out?

[daennera]

No, I don't go for colds. Good grief! But people do go for that sort of thing. I've also never had an earache, but mentioned it anyways.


Lena,

Yes I choose the cheapest option because all the hospitals in my area are definitely way above your average hospital in the US. They're all big award winning hospitals, lots of research grants and awards, etc. I'm going to get roughly the same care no matter where I go, so I'm going to choose the cheapest one.

If I needed some surgery that could be planned, you'd better believe I'd be shopping each of those hospitals to see who had the best deal. Again, they are all considered top notch hospitals. No reason to pay more for the same care.

[whoisjohngalt]

That makes a lot more sense.

Lena

[Gardening Grandma]

I'm talking about little stuff (colds, stomach aches, earaches, etc).

I don't know ANY adults who'd go to the dr for colds, stomach aches etc. (In children, earaches can be serious if not treated.) So I'm not sure who that comment is aimed at.

Okay, then pay for the care from the center that's closest to you.
If I felt it was a severe emergency, then that's exactly what I'd do. But that's hardly "shopping around".

Shopping health care can be frustrating, but it CAN be done. It just takes more time than shopping for shoes, that's all.

Really? Do you call the office and ask, "How much do you charge for a visit?", "How much for a mamogram?" How much time do you spend comparing costs. Oh, and you're healthy. Say you've discovered a lump. They do a biopsy and learn it's cancer and want to operate asap. Do you say, "Wait a minute. How much is this gonna cost? I need to comparison shop" Really?


Yes I choose the cheapest option because all the hospitals in my area are definitely way above your average hospital in the US. They're all big award winning hospitals, lots of research grants and awards, etc. I'm going to get roughly the same care no matter where I go, so I'm going to choose the cheapest one.

Again, How nice for you!

[daennera]

Yeah, if I was getting a mammogram I would call each of them and ask how much. Why is that such a weird thing to do? Even after I meet my $500 deductible I still have to pay for 20% of my care, so I do have some kind of a vested interest in the ultimate cost of the care.

I needed work done on my mouth that my original dentist quoted at $1500. I shopped around; probably called 10 different specialists and eventually found a dentist who I am extraordinarily happy with, who specialized in the treatment I needed, and did it for $975. It really pays to shop these things.

And if any surgery is going to be planned, you have the time to shop around. Pick the hospitals you know are good and within your network and call your insurance company and ask how much it will cost, or call the hospital if you are paying out of pocket.

[The Walk of the Penguin Mich]

And if any surgery is going to be planned, you have the time to shop around. Pick the hospitals you know are good and within your network and call your insurance company and ask how much it will cost, or call the hospital if you are paying out of pocket.

Have you ever had surgery? That's not the way it works. You choose a surgeon and go to the facility that he works out of, you don't get to choose the hospital. If I call the hospital that is cheapest, I may not get the doctor I want. Since I want the best doctor I can find, I'm going to look for the best doctor that works out of a hospital in my insurance network.

My orthopedic surgeon is not in my network, so I'll have more out of pocket costs. Because he is not in my network, he's giving me a break on the price of about $2000. Fortunately the hospital (which will be the bulk of the costs) IS in my network.