Does Insurance Cover That?


Inevitably when I’m asked what I do and respond that I’m a private patient advocate, one eyebrow raises, followed by “What’s that?”

My “Private Patient Advocate” elevator speech goes something like this:

“Private patient advocates are independent professionals that help patients and their families clarify options for managing their healthcare as well as the cost of their care. This might mean things like sourcing a doctor for a second opinion, facilitating better coordinated care, researching nursing homes, or negotiating insurance claims and medical bills.” read more

Before you jump in…Re-thinking preventive health screening


An advertisement arrived in my mail recently from a local hospital system offering a special promotion on  “heart disease, stroke, and aneurysm prevention package testing.” The tests included were extensive, and the mailing screamed not to wait to schedule these “life-saving screenings.” And, by the way, these tests are normally valued at over $2100 but were offered through this promotion for the low, low price of $179.00! My doctor has never mentioned most of these tests to me, but I found myself wondering about the state of my arteries and heart and whether having these tests might not be a good idea. read more

Caveat Emptor! (Or…a new twist in paying for healthcare)


Monica* had driven herself to the emergency room at a local hospital late at night after experiencing severe abdominal pain. She was worried she might have appendicitis, and her insurance company nurse line had advised her to go to the emergency room. A CT scan, MRI, and blood work were ordered, and intravenous pain medication was started. After several hours, her tests showed that she had a ruptured ovarian cyst, not appendicitis, and she was discharged home.

So here’s the “gotcha” moment, a new twist in paying for healthcare. When Monica was checking out, the clerk asked if she’d like to pay cash for her visit for a 75% discount, or to have the hospital file the visit to her insurance. Her insurance deductible was $2500 and she hadn’t had any healthcare costs yet this year. read more

Location, Location, Location!


Why *Where* you Get Your Health Care Matters to Your Pocketbook

That old saying about real estate value is true in health care, too.

I had the mistaken idea some years ago that if my doctor ordered an MRI, the cost was the same wherever I had it done. I only paid a copay, so why did it matter?

It actually does matter especially since insurance coverage has changed.  More and more policies demand higher patient higher deductibles, as well as coinsurance, or a share of the costs rather than a flat copay.

I recently did research for a patient whose doctor had ordered X-rays and an MRI which were important to developing a treatment plan for a complex condition. Her insurance coverage required she pay 20% of the allowed charges (what the insurance company had contracted with the  provider to pay for the studies), and she was concerned how much it might be. read more

What Milton Bradley Knew

game of life 4

When my sons were little, one of our favorite board games was the Milton Bradley game of “Life.” You select your playing piece, a small plastic car, then a spin of the wheel determines how far ahead you move on this simulated journey of life – choosing trade school or college, getting married or staying single, having children, planned or unplanned, establishing a career, buying a house — the steps that were part of the prescribed order of the day to a “successful” life.  The object of the game was to get to the end of the journey with cash still on hand. read more

“Feeling the love” vs. “Feeling the trust”


A year ago, my 27-year old son injured his knee playing soccer. After months of conservative treatment and continued pain, an MRI showed a fracture in the cartilage in his knee, an uncommon problem for a person his age.  We worked together to prepare for his appointment with a well-referred orthopedic surgeon, and my son took good notes.

He called to tell me that two surgical options had been recommended, both FDA approved, one more “typical” and one more “experimental.”  In fact, the doctor enthusiastically offered participation in a clinical study on the newer procedure, which from his experience he believed showed potential for longer lasting results. Still, both procedures were going to require significant recovery and rehabilitation, and the experimental procedure may or may not be covered by our insurance. read more