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Just had a recent physical - I got a low value for a test and it kicked off more tests, a visit to a specialist, more tests and no conclusion besides 'let's wai

Just had a recent physical - I got a low value for a test and it kicked off more tests, a visit to a specialist, more tests and no conclusion besides 'let's wait and see' which I could have done without draining my HSA. If the price of care was reasonable, sure, let's be proactive but because PCPs don't really seem to do anything but refer you to a specialist and any visit to a specialist + tests will immediately trigger thousands of dollars in bills, even if you're insured you're going be paying your deductible plus like 10-30% after that. I got a random lab bill for like $650 (discounted from $2500) and in the follow up visit everyone agreed that was high but no could explain why it was that expensive - medicare's fee schedule has the same code costing $90. Until we stop this madness of providers basically charging whatever opaque negotiated random amount they want to insurers who then pass that down to charge payers after collecting a % the prices are just going to continue to go up and the broken medical system will stay fucked - with the consequence that the economics aren't going to make sense to seek proactive care.

mahathu 3y ago
> any visit to a specialist + tests will immediately trigger thousands of dollars in bills, even if you're insured you're going be paying your deductible plus like 10-30% after that. (In the US)
omgwtfbyobbq 3y ago
You can likely get labs and imaging for significantly less by going to specific stand alone lab/imaging facilities. Health care groups tend to refer you to onsite services and/or specific companies they have relationships with. It is a pain though because you have to call around to get prices. Generally, the places with the lowest cash prices will also be the places that are least expensive after you've reached your deductible, but it's good to confirm with your insurance. Medicare's fee schedule is almost always lower than what you can get, even with all cash, because the US government can set the rates they pay to some degree. It's up to doctor's/medical groups if they'll accept that or just stop taking Medicare completely.
creatonez 3y ago
Specialists are great, but it would be so much better if healthcare systems did a better job at properly looping back in the patient's primary care / family doctor in on important health decisions. Primary care physicians, when not stifled by the system, have a remarkable ability to keep track of a patient's health over the course of several years and provide a balanced, realistic view of what might be needed. The way that PCP visitations have become shorter and shorter in a more overworked and hectic environment has done a great disservice to patients.
- D13Fd 3y ago
  I think that's basically a fantasy. My experience with primary care physicians is that they barely remember who I am, and they frequently move on to other practices. It's not uncommon to see a new person each time. On my latest attempt to make an appointment they said that I am no longer a patient because I didn't come in during COVID, and that I would have to wait to get back in. I decided I'd just go without until something bad happens. So far so good.
  - creatonez 3y ago
    Yep, this is what the system has created. There's little incentive to stay within that career path, and nobody is helped by the fact that healthcare administrators and staff shortages are forcing doctors into 3 minute visitations that establish little to no connection with patients. It leads to so many "my doctors are idiots who couldn't figure out my condition" situations that are rarely caused by lack of education (not that there aren't any closed-minded doctors), but by lack of cohesiveness of the entire system. Healthcare urgently needs to go back to being a continuous process, not a series of tech support tickets.
    - thebigwinning 3y ago
      The behavior you're describing is clearly an effort to economize use of doctors time. Since there is a cartel controlling salaries hospitals are doing everything legally possible to maximize their usage and shift work to cheaper labor.
arcticbull 3y ago
The issue isn't really that they're expensive - they are, they shouldn't be. Proactive access to care is good. The article kind of hints at this, but it comes down to Bayes theorem [1]. The general population has a relatively low incidence of disease, so even tests that are fairly reliable in a population with a high incidence of disease become super inaccurate when applied to the general population. Worse, false positives generally - especially in the US, due to high financial liability risk - end up involving expensive, invasive medical follow-up tests, and the probability of a false positive multiplied by the risk of the exploratory procedures outweighs a later diagnosis. No wonder annual physicals don't do much good. High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives. However testing otherwise-healthy people for things they probably don't have isn't likely to yield good results no matter how good the test. It's just math. [1] https://en.wikipedia.org/wiki/Bayes%27_theorem https://en.wikipedia.org/wiki/Bayes%27_theorem
- orangepurple 3y ago
  This isn't what happens. A huge volume of the people that come in to US hospitals are chronically ill people with no money and very commonly no regard for their own health. Quite often they are also disrespectful and combative to hospital staff. The system pays for their extended care and the healthy majority pays huge premiums to subsidize their care. The vast majority will be paying premiums vastly out of proportion to what they will use.
  - deleted 3y ago
    [deleted]
  - Klinky 3y ago
    This sounds like a delusionally extreme take, as if there is no in-between or nuance. You're either a victimized superhuman who never gets ill or a chronically ill scumbag with no regard for your health? Hardly realistic at all.
- pbourke 3y ago
  > High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives. How do you know if you’re at high risk for something? This assumes a medically literate and motivated person will seek care based on … what? Realizing that grandpa, great-grandpa and dad all didn’t live past their 60’s? High cholesterol and hypertension can be “silent killers” - how do you know to check for them?
lostlogin 3y ago
> Until we stop this madness How? You were given a result that was concerning, and rightly wanted it investigated. You needed the test and the test cost money. How do you opt out? I live in a country with a better (though still troubled) system. I can’t see how you fix the US system, even in hand waving terms.
- chrischen 3y ago
  Medical tourism. Give the money to the airline industry instead, who have a more competitive market in terms of price.
  - lostlogin 3y ago
    That’s actually crazy. Who can manage an international trip each time they need medical help? Not everyone can afford the delay, the time, the money or the inconvenience. If you paid me and made it immediately available I still wouldn’t want to travel internationally for medical care.
    - klooney 3y ago
      Driving to Mexico isn't so bad from lots of the country- and in the North you could drive to Canada.
      - barry-cotter 3y ago
        Private medical care is in most circumstances illegal in Canada and they have large enough wait lists that people are dying in large numbers waiting for medical care. Medical tourism to Canada is a non-starter for Yanks. > “Canada is the only country in the world where it is illegal to obtain private health insurance when there are long wait-lists. That surely says something,” said Dr. Brian Day, medical director of Cambie Surgery Centre in Vancouver and past president of the Canadian Medical Association (CMA). … > He launched a legal challenge to the B.C. Medicare Protection Act, saying wait times in the public health system are too long and stopping patients from paying for those services outside the public system violates their rights. > In July, the B.C. Court of Appeal dismissed the Vancouver surgeon’s challenge. > However, in their ruling, the judges accepted that the act’s provisions “deprived some patients’ right to security of the person by preventing them from accessing private care when the public system had failed to provide timely medical treatment.” https://globalnews.ca/news/9099696/canada-private-health-care-options/ https://globalnews.ca/news/9099696/canada-private-health-car...
dietr1ch 3y ago
> PCPs don't really seem to do anything but refer you to a specialist and any visit to a specialist (Yet another, I live in the US, therefore everyone else does moment) This is one of the things that surprised me the most in the US. Doctors seem afraid to draw any reasonable conclusion and are more like salesmen. I'm sure the fact that you can sue for pretty much everything plays a role in them not being more confident. I hope that testing gets cheaper and more data gets public so we can eventually have AI doing the medical scoring and with it routing/prioritizing patients.
- twelve40 3y ago
  Is it really common to sue for testing or lab work? i mean, theranos being an obvious exception here.
  - hattmall 3y ago
    It's not common to sue for anything really. Most people don't ever sue anyway, but a small amount of people sue a lot, backed up by the armies of attorneys that advertise on daytime tv and bill boards. My wife works in liability defense and it is common that most plaintiffs have been involved in other lawsuits. Car wrecks, slip and fall, wrongful terminations, plaintiffs will often have 2 or 3 ongoing cases. They are all generally bullshit but will settle out for between 20-40k after a year or two of depositions and back and forth. One interesting thing though is that pain and suffering is typically calculated at 2x medical costs. So those crazy high bills work in your favor when you are suing someone.
- WWLink 3y ago
  I live in the US and have run into both kinds of doctor. If you end up with one that does nothing and only refers you to specialists, it's worth trying other doctors. There are definitely nerdy doctors that know a lot more and are more willing to get their hands dirty. Ultimately, even the nerd doctors will send you to a specialist if you need it. I like my current doctor a lot. He runs his own independent practice and is just generally really cool.
  - 3y ago
landemva 3y ago
>> medicare's fee schedule has the same code costing $90. People would be upset if the gas stations charged different prices after they review your auto insurance policy. With healthcare, they look at our policy and make up price numbers. Maybe this violates anti-trust laws. The State attorney generals don't seem interested in pursuing such discriminatory pricing. https://legal.thomsonreuters.com/blog/robinson-patman-act-and-what-it-means-for-today https://legal.thomsonreuters.com/blog/robinson-patman-act-an...
mise_en_place 3y ago
That lab really gouged you and your insurance provider. I use CPL and I don’t recall ever paying more than 200 for custom bloodwork, not going through insurance either. My insurance prefers LabCorp but their assays are questionable at best.
Haga 3y ago
[dead]
raverbashing 3y ago
Oh that's tough. I think the only diagnosis here is "suffering from American medical care"
andrepd 3y ago
Isn't this a problem with the economics precisely, rather than with the concept of proactive care? For all their problems, Cuba achieves excellent health outcomes. Some of that may be because of the extensive primary and preventive care.
rhaway84773 3y ago
Setting aside the cost, this is a good thing.
jl2718 3y ago
What % of that cost was the zero-value-added gatekeeper? Here is a list of prices: https://dhhr.wv.gov/bms/FEES/Documents/Clinical%20Diagnostic%20Lab%20Fees/PDF/BMS-2022%20CLFS-Rev%203.8.22.pdf https://dhhr.wv.gov/bms/FEES/Documents/Clinical%20Diagnostic... Testosterone is $46. Toxoplasmosis is a shockingly common and easily-curable brain disease: $12. Imagine, an entire population held hostage to this racket.
rvba 3y ago
You wouldnt be writing like this if they did detect something. I bet then you would be the apostle of periodic checks.
treeman79 3y ago
I had an abnormal value. Doctors kept telling me to ignore it. Despite me having a lot of issues. 2 years of battling to get tests done. End up having 3 uncommon conditions. One of which was going to kill me without urgent treatment. Drastic quality of life improvement from proper treatment. Spent years being told I was a hypochondriac for insisting something wasn’t right. That everything I was experiencing was just anxiety.

mahathu 3y ago

> any visit to a specialist + tests will immediately trigger thousands of dollars in bills, even if you're insured you're going be paying your deductible plus like 10-30% after that. (In the US)

omgwtfbyobbq 3y ago

You can likely get labs and imaging for significantly less by going to specific stand alone lab/imaging facilities. Health care groups tend to refer you to onsite services and/or specific companies they have relationships with. It is a pain though because you have to call around to get prices. Generally, the places with the lowest cash prices will also be the places that are least expensive after you've reached your deductible, but it's good to confirm with your insurance. Medicare's fee schedule is almost always lower than what you can get, even with all cash, because the US government can set the rates they pay to some degree. It's up to doctor's/medical groups if they'll accept that or just stop taking Medicare completely.

creatonez 3y ago

Specialists are great, but it would be so much better if healthcare systems did a better job at properly looping back in the patient's primary care / family doctor in on important health decisions. Primary care physicians, when not stifled by the system, have a remarkable ability to keep track of a patient's health over the course of several years and provide a balanced, realistic view of what might be needed. The way that PCP visitations have become shorter and shorter in a more overworked and hectic environment has done a great disservice to patients.

D13Fd 3y ago
I think that's basically a fantasy. My experience with primary care physicians is that they barely remember who I am, and they frequently move on to other practices. It's not uncommon to see a new person each time. On my latest attempt to make an appointment they said that I am no longer a patient because I didn't come in during COVID, and that I would have to wait to get back in. I decided I'd just go without until something bad happens. So far so good.
- creatonez 3y ago
  Yep, this is what the system has created. There's little incentive to stay within that career path, and nobody is helped by the fact that healthcare administrators and staff shortages are forcing doctors into 3 minute visitations that establish little to no connection with patients. It leads to so many "my doctors are idiots who couldn't figure out my condition" situations that are rarely caused by lack of education (not that there aren't any closed-minded doctors), but by lack of cohesiveness of the entire system. Healthcare urgently needs to go back to being a continuous process, not a series of tech support tickets.
  - thebigwinning 3y ago
    The behavior you're describing is clearly an effort to economize use of doctors time. Since there is a cartel controlling salaries hospitals are doing everything legally possible to maximize their usage and shift work to cheaper labor.

arcticbull 3y ago

The issue isn't really that they're expensive - they are, they shouldn't be. Proactive access to care is good. The article kind of hints at this, but it comes down to Bayes theorem [1]. The general population has a relatively low incidence of disease, so even tests that are fairly reliable in a population with a high incidence of disease become super inaccurate when applied to the general population. Worse, false positives generally - especially in the US, due to high financial liability risk - end up involving expensive, invasive medical follow-up tests, and the probability of a false positive multiplied by the risk of the exploratory procedures outweighs a later diagnosis. No wonder annual physicals don't do much good. High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives. However testing otherwise-healthy people for things they probably don't have isn't likely to yield good results no matter how good the test. It's just math. [1] https://en.wikipedia.org/wiki/Bayes%27_theorem https://en.wikipedia.org/wiki/Bayes%27_theorem

orangepurple 3y ago
This isn't what happens. A huge volume of the people that come in to US hospitals are chronically ill people with no money and very commonly no regard for their own health. Quite often they are also disrespectful and combative to hospital staff. The system pays for their extended care and the healthy majority pays huge premiums to subsidize their care. The vast majority will be paying premiums vastly out of proportion to what they will use.
- deleted 3y ago
  [deleted]
- Klinky 3y ago
  This sounds like a delusionally extreme take, as if there is no in-between or nuance. You're either a victimized superhuman who never gets ill or a chronically ill scumbag with no regard for your health? Hardly realistic at all.
pbourke 3y ago
> High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives. How do you know if you’re at high risk for something? This assumes a medically literate and motivated person will seek care based on … what? Realizing that grandpa, great-grandpa and dad all didn’t live past their 60’s? High cholesterol and hypertension can be “silent killers” - how do you know to check for them?

lostlogin 3y ago

> Until we stop this madness How? You were given a result that was concerning, and rightly wanted it investigated. You needed the test and the test cost money. How do you opt out? I live in a country with a better (though still troubled) system. I can’t see how you fix the US system, even in hand waving terms.

chrischen 3y ago
Medical tourism. Give the money to the airline industry instead, who have a more competitive market in terms of price.
- lostlogin 3y ago
  That’s actually crazy. Who can manage an international trip each time they need medical help? Not everyone can afford the delay, the time, the money or the inconvenience. If you paid me and made it immediately available I still wouldn’t want to travel internationally for medical care.
  - klooney 3y ago
    Driving to Mexico isn't so bad from lots of the country- and in the North you could drive to Canada.
    - barry-cotter 3y ago
      Private medical care is in most circumstances illegal in Canada and they have large enough wait lists that people are dying in large numbers waiting for medical care. Medical tourism to Canada is a non-starter for Yanks. > “Canada is the only country in the world where it is illegal to obtain private health insurance when there are long wait-lists. That surely says something,” said Dr. Brian Day, medical director of Cambie Surgery Centre in Vancouver and past president of the Canadian Medical Association (CMA). … > He launched a legal challenge to the B.C. Medicare Protection Act, saying wait times in the public health system are too long and stopping patients from paying for those services outside the public system violates their rights. > In July, the B.C. Court of Appeal dismissed the Vancouver surgeon’s challenge. > However, in their ruling, the judges accepted that the act’s provisions “deprived some patients’ right to security of the person by preventing them from accessing private care when the public system had failed to provide timely medical treatment.” https://globalnews.ca/news/9099696/canada-private-health-care-options/ https://globalnews.ca/news/9099696/canada-private-health-car...

dietr1ch 3y ago

> PCPs don't really seem to do anything but refer you to a specialist and any visit to a specialist (Yet another, I live in the US, therefore everyone else does moment) This is one of the things that surprised me the most in the US. Doctors seem afraid to draw any reasonable conclusion and are more like salesmen. I'm sure the fact that you can sue for pretty much everything plays a role in them not being more confident. I hope that testing gets cheaper and more data gets public so we can eventually have AI doing the medical scoring and with it routing/prioritizing patients.

twelve40 3y ago
Is it really common to sue for testing or lab work? i mean, theranos being an obvious exception here.
- hattmall 3y ago
  It's not common to sue for anything really. Most people don't ever sue anyway, but a small amount of people sue a lot, backed up by the armies of attorneys that advertise on daytime tv and bill boards. My wife works in liability defense and it is common that most plaintiffs have been involved in other lawsuits. Car wrecks, slip and fall, wrongful terminations, plaintiffs will often have 2 or 3 ongoing cases. They are all generally bullshit but will settle out for between 20-40k after a year or two of depositions and back and forth. One interesting thing though is that pain and suffering is typically calculated at 2x medical costs. So those crazy high bills work in your favor when you are suing someone.
WWLink 3y ago
I live in the US and have run into both kinds of doctor. If you end up with one that does nothing and only refers you to specialists, it's worth trying other doctors. There are definitely nerdy doctors that know a lot more and are more willing to get their hands dirty. Ultimately, even the nerd doctors will send you to a specialist if you need it. I like my current doctor a lot. He runs his own independent practice and is just generally really cool.
- 3y ago

landemva 3y ago

>> medicare's fee schedule has the same code costing $90. People would be upset if the gas stations charged different prices after they review your auto insurance policy. With healthcare, they look at our policy and make up price numbers. Maybe this violates anti-trust laws. The State attorney generals don't seem interested in pursuing such discriminatory pricing. https://legal.thomsonreuters.com/blog/robinson-patman-act-and-what-it-means-for-today https://legal.thomsonreuters.com/blog/robinson-patman-act-an...

mise_en_place 3y ago

That lab really gouged you and your insurance provider. I use CPL and I don’t recall ever paying more than 200 for custom bloodwork, not going through insurance either. My insurance prefers LabCorp but their assays are questionable at best.

Haga 3y ago

[dead]

raverbashing 3y ago

Oh that's tough. I think the only diagnosis here is "suffering from American medical care"

andrepd 3y ago

Isn't this a problem with the economics precisely, rather than with the concept of proactive care? For all their problems, Cuba achieves excellent health outcomes. Some of that may be because of the extensive primary and preventive care.

rhaway84773 3y ago

Setting aside the cost, this is a good thing.

jl2718 3y ago

What % of that cost was the zero-value-added gatekeeper? Here is a list of prices: https://dhhr.wv.gov/bms/FEES/Documents/Clinical%20Diagnostic%20Lab%20Fees/PDF/BMS-2022%20CLFS-Rev%203.8.22.pdf https://dhhr.wv.gov/bms/FEES/Documents/Clinical%20Diagnostic... Testosterone is $46. Toxoplasmosis is a shockingly common and easily-curable brain disease: $12. Imagine, an entire population held hostage to this racket.

rvba 3y ago

You wouldnt be writing like this if they did detect something. I bet then you would be the apostle of periodic checks.

treeman79 3y ago

I had an abnormal value. Doctors kept telling me to ignore it. Despite me having a lot of issues. 2 years of battling to get tests done. End up having 3 uncommon conditions. One of which was going to kill me without urgent treatment. Drastic quality of life improvement from proper treatment. Spent years being told I was a hypochondriac for insisting something wasn’t right. That everything I was experiencing was just anxiety.