Even for the insured, the cost of copays and other out-of-pocket expenses add up quickly, whether you’re single or have a family. If you’re feeling the pinch, you’re not alone – according to a recent Kaiser Family Foundation poll, 53% of respondents said they had cut back on their health care to try and save money.

Many respondents reported an increased use of over-the-counter medications or home remedies, rather than scheduling a visit to their doctor. Others said they didn’t fill prescriptions to save money; some even skipped treatment or tests that their doctor recommended.

Ignoring your doctor’s instructions could prove risky if you have a serious medical condition. But no matter health status, you can cut down on some of the costs of healthcare without having to neglect your health. What can you do?

• When you visit a doctor, make sure you’re prepared. Take along all the information the doctor might need, including paperwork and medical records if necessary. Take note of whether your health has changed recently, including energy or weight fluctuations. If you have any questions you want to ask, make a note so you don’t forget them. Being prepared for a doctor’s visit cuts down on the need for repeat visits, and helps save on copays.
• Get your test results over the phone. Most of the time you won’t need to return to your doctor to get test results, so there’s no reason to spend money on the copayment when it’s not necessary.
• Consider setting up a flexible spending account when open enrollment comes around. Flexible spending accounts let you put pre-tax dollars aside to fund certain types of medical expenses.
• Call an organization such as the Patient Advocate Foundation (800- 532-5274) if you have a chronic disease and want some help with getting the most out of your insurance plan.
• If you’re uninsured, then consider visiting a store clinic. In some locations, retailers such as Target and Wal-Mart now run clinics where you can receive routine medical care for about half the price of a doctor’s visit.
• Try and track down locations where you can receive free medical screening. Organizations such as the American Cancer Society and the Centers for Disease Control and Prevention can help you locate such programs.
• Request a quote for affordable health insurance here. Our system is able to connect you with leading health insurance carriers from across the country, and it could save you a lot of money on premiums or health care costs.

photo credit: effekt!

How many prescription medications are you taking? How many over-the-counter herbal medications or other nutritional supplements? The alarming results of a new study on the combinations of medications taken by American seniors indicate that it’s best to be cautious about taking certain prescription and over-the-counter medications in tandem.

According to the report—which reviewed the medications taken by 3,000 men and women aged between 57 and 85—at least two million older Americans might be taking a potentially dangerous combination of prescription or over-the-counter medications. And up to one in ten older men might be taking a combination of drugs which could be potentially harmful.

Another factor affecting seniors is the fact that older people tend to take more medications overall, including both prescription and over-the-counter preparations. In the 57 to 85 age group, 91% of people take at least one medication, and more than half use five or more medications, including prescription and over-the-counter drugs.

The consequences of drug combinations aren’t always dangerous, but for older people, the side effects and interactions of drugs and over-the-counter medications are often more hazardous, due to the way metabolism changes as we age.

An example of a potentially serious drug interaction is that between warfarin, which is used to dissolve blood clots, and aspirin, which has a similar blood-thinning effect. The risk of internal bleeding can become dangerously high when both drugs are taken together. The combination of warfarin and garlic can also have a similar effect.

Other potentially dangerous combinations include:

• Aspirin and gingko biloba, taken together, can increase the risk of excessive bleeding.
• Taking Lisinopril (prescribed for blood pressure), along with potassium supplements (which may be prescribed because some blood pressure drugs reduce potassium levels), can cause abnormal heart rhythms.
• Over-the-counter niacin supplements can be dangerous when taken with statins (prescribed for managing cholesterol levels), due to an increased potential for muscle damage.

Experts say it’s best to be cautious when it comes to over-the-counter medications – don’t take them without the ok from your doctor, and make sure you ask about side effects and drug interactions every time your doctor prescribes a new medication.

photo credit: Nils Geylen

When a doctor explains treatment options to a patient, it’s often little understood; frequently glossed over; and delivered in over-technical terms. A new movement in health care is makings strides to change the status quo, and with it the decisions of a whole new group of patients.

Case Examples of Informed Consent Opportunities

Currently, the most effective early warning signal for prostate cancer is an elevated level of prostate-specific antigen in the blood. But that test is nowhere near perfect – many men with prostate cancer test negative for PSA, and men who are overweight and have developed prostate cancer often have reduced PSA levels. Up to 25% of men with prostate cancer test negative for elevated PSA.

The medical world is full of situations like these, where tests and diagnoses are not as clear-cut as patients might think. If you knew that some blood tests were unreliable, would you still choose to take them? What about when the situation is more serious than a simple blood test – what if you had to choose between several rounds of chemotherapy, or the removal of one or both breasts, as a treatment for breast cancer?

The Solution to Improving Patient Decision-making

The fact is, with medical science becoming increasingly sophisticated and more highly technical, it’s harder for patients to keep up. What’s the solution? A growing movement of doctors is pushing for a solution that has become known as informed consent 2.0. The idea is to promote more extensive patient education in the form of decision aids – guidelines written in plain English, rather than overly technical medical language, to help patients fully understand the positives and negatives of their options for medical treatment.

The goal, say the doctors, is for patients to view these guides before they visit their doctor, so that during the appointment more time can be spent on patient decisions rather than explaining their options. At New Hampshire’s Dartmouth-Hitchcock Medical Center, for example, every woman who is diagnosed with early-stage breast cancer views a video decision aid before ever seeing a surgeon. The video includes information about treatment options – tumor removal followed by chemotherapy or full – breast removal and explains that both options produce almost equal survivability results.

Programs such as these are even more important in light of the results of a recent study from the University of Michigan which suggests that many patients making common medical decisions over medication and other treatments are not well informed. Many patients, for example, said their doctors rarely discussed the disadvantages of various treatment options.

photo credit: Lisa Brewster

Trees are good for your health – they suck up carbon dioxide and release oxygen, help reduce greenhouse gases and provide welcoming shade during the summer. But those aren’t the trees that have recently been in the news for helping to improve the health of many Americans. This time it’s family trees that are up for discussion – and electronic ones, at that.

Importance of Knowing Your Health History

The importance of knowing your family medical history can’t be emphasized strongly enough, according to Acting Surgeon General Steven Galson, whose office has been in charge of a new initiative to promote the use of a website where users can grow an electronic family tree to find out where their health risks lie.

The government’s new free service is hoping that people will compile their own family tree at home, and share the information with their families. Compiling an extensive and accurate family tree is even more useful than genetic testing to predict what your medical requirements might be in the future, experts say. It’s a highly useful tool for doctors, too, since it saves time and also provides lots of useful information about potential health risks. You can even use it as you’re applying, or looking into various family health insurance plans.

Significant Benefits of an Online Family Health Tree

The most significant benefit, perhaps, is that it’s likely to be more accurate than anything you remember off-the-cuff in a doctor’s waiting room. And by sharing the information with relatives from both sides of the family, it’s easier to compile an accurate family health tree that includes all the information that’s important.

The family health tree site at https://familyhistory.hhs.gov makes it easy to compile this information. The electronic tree you create can be easily mailed to relatives, who can add their own information into the tree. The information is entirely private, too. Information is downloaded to the user’s own computer, rather than being held on the web site.

Even more useful is the fact that a single click can “re-index” the tree to concentrate on showing the health risks of any relative on the tree – so it’s useful for everyone, not just the person who creates it.

Another benefit is the fact that environmental and lifestyle factors can be added to the tree – factors that are often forgotten during doctor’s visits. The family tree can be printed out or even emailed directly to your doctor, ensuring that none of that valuable information is lost.

photo credit: Wolfiewolf

The Healthy People program recommends that adults get 30 minutes of moderate exercise (such as walking) five times a week, or at least 75 minutes of vigorous exercise (such as running) every week. It seems, however, that the majority of people still aren’t meeting these goals.

The U.S. Centers for Disease Control and Prevention recently released its figures for the most and least fit metropolitan centers in America, and the results indicate that many people aren’t getting as much exercise as recommended by the Healthy People 2010 initiative.

America’s Most Fit Cities

So where are the fittest cities in America, according to the CDC?

The Top Ten Healthy Cities Are

1. Boulder, CO
2. Provo-Oren, Utah
3. Anchorage
4. Barnstable Town, Mass.
5. Lincoln, Nebraska
6. Portland, Maine
7. Fort Collins, Colorado
8. Grand Rapids, Mich.
9. Albuquerque, N.M.
10. Casper, Wyoming

In all ten cities, between 57% (Casper) and 67% (Boulder) of the population are exercising regularly, meeting the goals of the Healthy People initiative’s 150 minutes of moderate exercise per week. In addition, between 31% (Casper) and 43% (Boulder) are getting regular vigorous exercise.

America’s Least Fit Cities

And the Least Fit Cities?

1. Chattanooga, TN.
2. New Orleans, Louisiana
3. Baton Rouge, LA.
4. Lake Charles, LA.
5. Hickory, N.C.
6. Birmingham, Alabama.
7. Mobile, Ala.
8. Tuscaloosa, Ala.
9. Jackson, Miss.
10. Fort Smith, Ark.

In the “bottom ten” cities, the CDC reports, between 40% (Memphis) and 37% (Chattanooga) are getting regular moderate exercise. And in every city, less than 25% of the population is getting regular vigorous exercise.

Want to make a difference to your health in 2009? Stop dieting – studies show it doesn’t work in the long run, and yo-yoing weight can even be harmful to your health. Instead, decide to make healthier food choices more often than you currently do. Over time, increase your percentage of healthy food choices until you’re at a point where you’re getting a good balance of calories and nutrition. These types of goals are much more sustainable than restrictive diets, and are much more likely to stick in the long term.

When it comes to exercise, choose something you really enjoy doing, rather than what the latest magazine workout program tells you to do. If you exercise in a way that’s fun, you’ll be far more likely to keep up with it throughout the year.

photo credit: Ed Yourdon

The medical breakthroughs that get reported in the media rarely end up being the miracle cures they’re often portrayed as. In 2008, however, there were several important advanced made in medical science that could have a significant impact on public health in years to come.

1. The question of whether organic food is good for you has finally been answered: A review of studies on nutrient content of organic fruits, vegetables, and grains has confirmed that these have up to 25% more nutrients than conventionally-grown produce.
2. Another long-held myth—about the efficacy of antibiotics for sinus infections—was also dispelled in 2008. Over the course of nine studies involving 2,500 participants, it was found that antibiotics didn’t significantly hasten recovery. According to allergist Neil L. Kao, MD, taking a decongestant or mucus thinner, along with a painkiller as needed, is just as beneficial.
3. If weight loss is your resolution for 2009, look into adding resistant starch—found in beans, green bananas, and potatoes—to your diet. This type of starch is digested very slowly, helping to suppress your appetite, and can help stabilize blood sugar levels, too.
4. Women take note: a new risk calculator, known as FRAX, has been developed to help doctors determine whether women are at risk of osteoporosis, and whether preventative treatment may be necessary.
5. If you receive a diagnosis of diabetes, it’s important to know the results of three major studies that were completed in 2008. All three reinforce the importance of taking control of blood sugar levels as soon as possible, and managing blood pressure, cholesterol, and triglyceride levels as well.
6. Also from the field of diabetes research comes the news that body fat percentage may be a more reliable indicator of risk than body mass index. Mayo Clinic researchers studied 1,101 women with a BMI of less than 25 (considered a healthy BMI), and found that those with higher than 30% body fat were at higher risk of metabolic syndrome and diabetes.
7. Unfortunately for people with arthritis in one or both knees, a result study showed that arthroscopic surgery doesn’t provide any real benefit in most cases. If you’re affected by this condition, the study concluded, you’re better off with physical therapy and medication for pain management.
8. Another potentially major breakthrough is in the field of multiple sclerosis treatment, where current medication can prevent relapse of major symptoms in around 30% of people with the disease. A new drug, called fingolimod, has so far been able to prevent relapses in more than two thirds of patients, for three years, according to results of clinical trials.

photo credit: a.drian

Nearly two million Americans have lost their jobs over the last year: around 500,000 in the last couple of months alone. That’s a staggering number of people who have lost their livelihood, perhaps their sole source of income.

Among their worries is the question of what’s going to happen to the healthcare their employers provided. Families with young children, in particular, may find the doctor’s bills piling up, with no healthcare insurance to cover them.

According to the Kaiser Family Foundation, every 1% increase in the unemployment figure translates into another 1.1 million people who don’t have healthcare insurance. The national unemployment rate was at 6.7% in November 2008 – an additional 7 million people without that crucial insurance.

If you don’t have employer-provided healthcare, it’s likely you’re going to have to pay a significant amount of money for an individual plan – but the alternative, of having no coverage at all, is surely worse in the long run. If you’re in this position, what can you do about accessing affordable healthcare?

What are Your Healthcare Options?

• Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) you’re entitled to have your employer healthcare benefits extended for 18 months after your job ends. However, your employer won’t be paying their share of the premium – so you’ll be looking at a significant increase in your premium costs.

To be eligible under COBRA, you must have been working at a company employing at least 20 people (some states extend eligibility to smaller companies), and have been enrolled in an employer-sponsored health plan when you were laid off.

• If you’re not eligible for COBRA, in most cases your only alternative is an individual health plan. Your costs for this will depend on your age, health, and location. If you’re older or have a pre-existing condition, you can expect to pay a hefty price for your insurance.

You may also find that you have fewer options than you did when you were eligible for employer healthcare, so it’s important to carefully review potential plans and check out whether things like prescriptions are covered.

• Government assistance may provide for your children, at least. In most states the Medicaid eligibility level for children is twice the poverty level (equating to around $42,000 for a family of four). However, it’s much stricter for adults – even an unemployment benefit may disqualify you.

• Some states also provide limited government assistance – this varies from state to state. In Florida, for example, the Medically Needy program provides help for participants after they’ve paid a certain amount in medical bills each month.

• For senior citizens and the disabled, Medicare may be an option.

photo credit: Mike Licht, NotionsCapital.com

Prescription medications are expensive, and many doctors seem to become “prescription-happy.” These doctors’ first response to a patient complaint is usually to prescribe something new if something doesn’t work the first time. Even if you’re just taking one or two medications, you could be paying more than you need if you are taking brand name drugs, instead of generics.

According to a recent study, led by Dr. Aaron Kesselheim of Brigham and Women’s Hospital and Harvard Medical School in Boston, this is particularly true when it comes to medications prescribed for the treatment of heart and cardiovascular conditions. According to the researchers, there is no evidence to suggest that brand name drugs work any better than their generic counterparts.

The Brand Name vs. Generic Debate

What exactly are generic drugs? They’re drugs on which the patent has expired. When a pharmaceutical company develops a new drug, they hold the exclusive patent on that drug for a certain number of years. After that time, the exclusive rights are lost, meaning that other companies can manufacture the drug under a different name. These are termed generic drugs, because they are no longer associated with the brand name company which originally developed them.

The new generic drug might have a different shape and color, or may have different fillers or binders added to the active ingredients. In most cases, however, there is no difference at all in how well the generic drug works in comparison to its brand name counterpart. Big-name pharmaceutical companies have gone to extensive lengths to try and prove that generic drugs are inferior, but the results of the new study suggest that’s just not true.

So what’s the difference between brand name drugs and generic drugs? Just one thing – the cost. The cost per pill of a brand name medication might be a few dollars, but for a generic drug prescribed for the same purpose, the cost might be only a few cents. While 66% of drugs prescribed in America are generic, they account for less than 15% of the money spent on all prescription drugs.

This doesn’t mean, however, that you should rush to your doctor and demand that they prescribe only generic drugs for you. It’s always most important that you receive the medications your doctor feels will work best for you – whether brand name or generic. Although, of course, if you’re taking an expensive brand name medication, there’s no reason why you can’t ask your doctor if there is a cheaper generic alternative that might work just as well.

What the research really shows is that if you’re taking medication for a heart or cardiovascular condition, you can feel secure whether it’s brand name or generic. You don’t have to worry that your treatment is inferior just because you’re taking an inexpensive generic medication.

photo credit: ragesoss

Surgery and a week-long hospital stay can equal a bill of tens of thousands of dollars. Even with insurance you can still end up paying several thousand in out-of-pocket expenses. Insurance companies typically negotiate with hospitals for lower bills – but most people don’t realize they can do that too.

Tips for Negotiating Health Care Bills

The first and most important step is simply asking. According to a survey from the Consumer Reports National Research Center, only 31% of Americans have tried to negotiate medical bills – but of those who did try, 93% were successful, and a full third saved over $100. When you apply this to the massive expense of a hospital stay, it could mean a very significant saving.

Around 80% of doctors prescribe generic drugs, but only 40-50% consider price when they recommend diagnostic tests or in-patient care. Ask your doctor if less expensive options are available when discussing your options.

When it comes time to settle your bill, however, your doctor may not be the person to talk to. Particularly if a hospital is involved, it’s far more likely you’ll need to speak to someone in charge of billing, with the power to make adjustments to your bill.

Finally, offering cash is often a good strategy, if your own finances allow it. Cash is generally easier for hospitals to deal with, so you have a negotiation advantage if you offer to pay this way.

Understanding Your Hospital Bill

And what of the bill itself? It is an unfortunate fact that some hospitals to go to outrageous lengths to obscure their own bills so that customers don’t know what they’re paying for – allowing the hospital to overcharge for its services. How can you overcome that impossible hospital language?

• Check your insurance policy before your hospital stay, and read the section on exceptions and exclusions closely, to find out what’s not covered.
• Phone the billing department of the hospital and ask what your room charges are, and what they cover.
• Bring your own disposables, such as tissues and toothpaste, if the room charge doesn’t cover them. Hospitals charge particularly outrageous prices for those items.
• Bring your own prescription medications from home, to avoid paying hospital prices for them.
• Make sure all the medical personnel involved in your case participate in your insurance plan.
• Keep a record of tests, treatments, and medications you receive.
• When you receive your Explanation of Benefits (EOB), read it closely. This tells you what the hospital is charging, what’s covered by insurance, and what you’ll have to pay.
• Do not, under any circumstances, pay your bill before you leave the hospital (not even if you’re told you must). Your negotiating power is gone once you pay the bill.
• Once your bill arrives, compare it to your records and the EOB.
• Call the hospital billing department and ask them to explain any costs you don’t understand, or can’t see a reason for.
• Demand a fully itemized bill – which all hospitals in every state are required to supply by law.
• As a last resort, appeal in writing to the patient ombudsman.

photo credit: weegeebored

If you’re a woman and you have health insurance or are contemplating getting health insurance, here’s an important question to think about. When you think of the term “pre-existing” condition, what comes to mind?

These days it’s probably diseases like diabetes, as well as health problems such as high cholesterol, excess weight, and the like. Serious health problems, diseases that can seriously impact on your quality of life, can require expensive or ongoing treatment — right? Yes…but that’s not all. And you might be shocked to find out what, for women, constitutes a pre-existing condition.

One Woman’s Unexpected Health Costs

In 2001, Jacqueline Ruess received surgery to remove a suspected ovarian tumor. Thankfully, that tumor wasn’t as dangerous as her doctors had first thought.

However, there was an additional problem in the works. Ruess subsequently found out that the surgery, which with hospital and doctor bills came to more than $15,000, was not covered by her insurance. Worse, she found out that she had never been covered for gynecological problems—and she had never even known!

So what happened here? Did she have a major pre-existing condition such as prior cancer, endometriosis, or polycystic ovary syndrome? A potentially serious health issue of any kind?

Nope. She had one instance of irregular periods—an extremely common (and usually inconsequential) issue which affects up to 30% of women at some point during their reproductive years.

The Health Insurance Company’s Side of the Story

The company that managed her insurance policy claimed that because her doctor had once noted an instance of “dysfunctional uterine bleeding” (a fancy way of saying irregular menstruation), she was ineligible for any gynecological cover.

At the time her doctor made that notation Ruess was under heavy emotional stress (a common cause of irregular periods), and her doctor had also noted that there was nothing medically wrong with her. So when her insurance policy application asked about abnormal menstruation she didn’t note down that single instance, simply because her doctor had said there was no underlying medical issue.

Now, there is no doubt that this is standard insurance company practice, and if you hold back on pre-existing condition information, and you’re found out, you will lose your cover — no matter how inconsequential you think that information is.

This specific instance might be a case of insurance companies gone wild, but the message is still the same basic cautionary tale: don’t hold back any information.

Unfortunately for women like Jacqueline Ruess, it’s sometimes too late to remedy the situation. In a final ironic kicker, the insurance company claimed she owed them several hundred dollars because her premiums would have been higher had she noted the information in her application.

photo credit: CJ Sorg