Seven of Nine; Not Bad

Thanks to an Israeli med student who sent me this link to "Nine Secrets Health Insurers Don’t Want You to Know." No offense to Jeri Ryan, but aside from two whoppers, much of the advice seems sound to me.

Here are the nine points:

1. Don’t pay if you don’t have a say.
2. You may be eligible for more coverage.
3. To get tested, talk up your symptoms.
4. Stall first, answer questions later.
5. Letters are your best bet.
6. Doctors can be good weapons.
7. A little research can go a long way.
8. There are ways to get drugs cheaper.
9. An advocate can help you win.

I don't much care for the phrasing of #6; I think it would be more accurate to call us "advocates," but I suppose they want to save that word for #9. #8 is based on the somewhat insulting assumption that doctors are powerless against pharma assimilation; (resistance isn't futile at all.) But the downright insulting ones are #3 and #7.

Here's what they mean by "talk up your symptoms" in #3:

Your insurer doesn’t want to pay for a colonoscopy if it’s not necessary. But if your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, here’s how to get one covered: Mention to your doctor that you’ve had some blood in your stool and a lot of gas lately—or simply that your bowel habits have changed. Your plan has to pay for the test if you have gastro complaints, health experts say. (Only 21 states require insurers to cover colonoscopies for general screening.)

In other words, lie to the doctor. Very bad idea.

It is MY JOB to put your mind at ease. Never mind about paying for an unnecessary procedure; trust me: you DON'T want to have a colonoscopy unless you really need it. Too many people seem to feel it is their responsibility to diagnose themselves, decide what treatment they need and then simply convince the doctor to provide it. Not so fast. An intelligent patient with the internet at his or her disposal can sometimes do a half-decent job performing those tasks, but certainly not always! (Please note my willingness to admit that not every patient and not every problem require my full expertise and experience to bear on them.) Still, I'm far more than a rubber stamp. Accurate diagnosis -- and therefore effective treatment -- depends first and foremost on patient history. Never "talk up your symptoms" trying to tell a doctor what you think he ought to hear. Never. Please. Not only does it seriously undermine your treatment now, but by destroying your doctor's trust in your accuracy as a historian, he will never be quite sure of you. Believe me; you don't want that. You wouldn't want your doctor lying to you; why should we tolerate it from you?

#7, "A little research can go a long way," is along the same lines:

If you want a special CT scan or MRI, your doc probably won’t authorize it unless it’s an absolute must. Persuade her with expert info from the American College of Radiology’s Appropriateness Criteria, says Anne Roberts, executive vice chair of the department of radiology at the University of California, San Diego. Used primarily by doctors but open to the public, it’s an up-to-date list of the types of imaging that are right for various conditions. (Ed: The link in the article doesn't work, but this one does.) Arming yourself with the info doesn’t guarantee coverage, but it’s a proactive step in the right direction.

News flash: you cannot have ANY diagnostic test just because you "want" it. Ever. Damn straight I won't "authorize" it (actually, I "order" tests; insurance companies "authorize" payment for them) unless you really need it. Trust me: you don't want the excess radiation; the hours stuck immobile in a tiny tube, whatever the procedure is if it's not medically necessary. Once again, it is MY JOB to figure out what is wrong with you (or what may be wrong) -- which requires accurate information from YOU -- and what to do about it, including ordering any tests. It is also MY JOB to "put your mind at ease" if the likelihood of some condition you're worrying about is so low it doesn't warrant an expensive test.

MY JOB. The fact that other docs may do it badly does not change MY JOB one iota.

But the rest of the article seems to have some good points.