Tuesday, April 15, 2014

Diagnostic versus screening

The winter that would not quit. Four inches over everything this morning . And ice beneath the snow!
Fortunately the roads were too warm for it to stick to them
So Obamacare is to provide no cost screening for various health conditions, the two biggies being breast cancer and colon cancer. My mammogram this fall was going to be my first screening one since the diagnosis 5 years ago. Yay! For free! But then they found something (which after much money and anxiety turned out to be nothing) so not only was I on the hook for all the follow-up tests and biopsy, they made me pay for the screening mammogram too. I complained for naught to both the hospital and the insurance.

But the colonoscopy is yet another matter. I am at no particular risk for colon cancer besides my age (Steve on the other hand has several risk factors). I've been over 50 for some time. I have scheduled a few of them but always had to cancel at the last minute. Two years ago, I decided I better get one and made sure it was coded for the 'free' screening, appropriate as I have no symptoms. But then I got a call from the hospital to make sure I brought $3500 with me. But it's a screening one! They say sometimes (no statistics on how likely that was) they need to take a closer look or there might be a polyp, both common, and if that happens, I have to pay $3500 or more if a biopsy is involved even if no cancer is present.

OK I guess I can afford it though I can think of many other uses for that money. But many people can't. If they think they might be charged, are they going to get one? Or sometimes they are not warned in advance and face a very nasty surprise and this is even when no cancer is found. I told my primary not to even bother writing me out a requisition, I won't get one. He mailed me one a few weeks later. I have since found out that as of this year, even if they find a polyp or need to take a closer look at a dicey area, they still have to code it as screening colonoscopy meaning no extra cost to the patient except for maybe a biopsy. Still some of the costs of the procedure such as the anesthesia still could be billed. These things should be clarified in advance. And it certainly doesn't pay to complain to your primary about gut pains, blood, etc because then he can't write a script for a screening one, it has to be a diagnostic.

And routine tests. Assuming you have no history of diabetes, high blood pressure, anemia, high cholesterol, etc, screening is free. But since I have had Graves' Disease, I always have to pay for those blood tests even though I get the same results every time. Obamacare covers a 'free' check-up yearly. But some are finding that if they go into it with a list of complaints that need to be investigated further, it is no longer a well check-up but a 'sick' office visit that will be charged. Does this encourage or discourage one to share with your physician?

Well if it had to snow, today was a good day for it as I was going to the Y. This will be my last week. Assuming it won't continue to snow, I will transition to being a bicyclist instead.

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