Does your physician know what you pay for health care?

by Mark A. Kelley, M.D.

This blog previously appeared on HealthWeb Navigator.

All of us should understand our own health care costs. However, the issues can be complicated: e.g. insurance premiums, deductibles, co-pays etc.

Physicians have a different perspective. Like any professional, they focus on how they are paid. Insurance companies require doctors to submit many details with their bills. Physicians rely on sophisticated billing systems to furnish that information, because without it, they are not paid. In a nutshell, patients worry about paying the bills and doctors worry about sending out the bills.

This raises a key question. How much do doctors know about your insurance and what you must pay?

Of course, the doctor can explain his/her own bills to you. Your doctor’s office has checked your insurance and knows what how they should bill your insurance company. Surprisingly, the doctor may not know much your hospital insurance coverage, or your deductible. Most physicians and their staffs have not been trained to gather this information because it does not affect physician payment. .

But things have changed. With high deductible insurance plans, patients have more risk for out-of-pocket costs. A blood test, x-ray or medication can come with a large bill if it drops into your deductible.

The prices may astound you.  A friend recently enrolled in a high deductible insurance plan. She refilled prescription, which previously cost her a $40 co-pay. With her new insurance, she had to pay $250 for the same refill because it was part of her deductible. The price was so high because the insurance company passed all the drug cost on to her.

Why is this important? It is wise to know what you are paying for — and health care is no exception.  Health care bills can mount quickly and squeeze the family budget. Sometimes, families face the tough choice of either paying the rent or seeing the doctor.

Physicians are seeing more of their patients struggling with health care bills. This pressure may discourage them from seeking medical care. Tight finances are becoming a health care risk, even for families with decent incomes.

How can patients and doctors work together to control the “costs of care”?

Here are a few suggestions:

  1. Know the details of your own insurance policy, especially “out-of-pocket costs”such as co-pays, coinsurance and deductibles. If you have any questions or concerns, contact your insurance company.
  2. When your doctor recommends a test, procedure, or treatment, make sure you know what it involves, why you need it, how effective it will be and how soon it must happen. These are questions that any good doctor would be glad to answer. The timing of the test or procedure may be important if you have already paid out your deductible before the end of the year. In that case, you may not have to pay anything for the service.
  3. Cost may (or may not) influence your decision to get a test or procedure.  For example, for an urgent life-saving procedure, cost may not even enter your mind. However, some tests or procedures may not be so convincing. In those cases, cost might influence your decision. If so, discuss the cost issue with your doctor who may suggest less expensive alternatives. The timing, location and type of service may all influence the cost: most often for planned (elective) procedures, x-rays or some medications.
  4. If health costs worry you, talk to your doctor. Don’t be afraid to bring up the issue. You are not alone. Many more patients are asking about costs these days. Physicians welcome solving these challenges with you. They can be very helpful if they understand your concerns.

 

Learn how physicians are addressing this problem on the website Costs of Care.

 

Sexual Assault Awareness & Prevention Month

CONTENT WARNING: This blog discusses rape and other forms of sexual violence.

 

Since 2001, April is recognized as Sexual Assault Awareness and Prevention Month. Over the past year and half, the #MeToo movement has grown to bring sexual violence, abuse, and toxic behavior into the forefront of American culture, but there is still much misinformation and stigma to combat to ensure the health and safety of everyone affected. Rape is the most under-reported crime, with 63% of sexual assaults not being reported to police. Despite misconceptions, the prevalence of false reporting is low — between 2-7%. The consequences of sexual assault reach far into the lives of survivors, families, and communities and have a major effect on public health.

 

Victims of sexual harassment and assault are often thought of as women, but men can also be affected. Statistically, one in five women and one in 67 men are raped at some point in their lives. Nearly 50% of women and 20% of men experience sexual violence other than rape.

 

Vulnerable communities are disproportionately affected by sexual violence:

  • 44% of lesbains and 61% of bisexual women compared to 35% of heterosexual women;
  • 40% of gay men and 47% of bisexual men compared to 21% of heterosexual men;
  • 47% of transgender people are sexually assaulted at some point in their lives.

 

People of color also experience an unequal level of sexual violence in the United States:

  • 29.1% of black women, 12% of black men;
  • 37.5% of Native American women, 12.4% of Native American men;
  • 23.4% of Hispanic/Latina women, 7.4% of Hispanic/Latino men;
  • 30.2% of mixed race women, 9% of mixed race men;
  • compared to 24.8% of white women, 7.5% of white men.

 

Sex workers (escorts, exotic dancers, dominatrixes, pornographic actors, phone sex operators, nude models, etc.) are often ignored when it comes to sexual violence and have their jobs conflated to sex trafficking on a policy level, endangering people working consensually in the sex industry and their livelihoods. By omitting the sex worker community from conversations about sexual assault prevention and rape culture, it perpetuates the stigma and culture of violence that allows violence to be perpetrated against them.

 

People with a history of being victimized by sexual harassment or assault are three times more likely to have depression and twice as likely to have anxiety. Trauma can happen whether or not an individual is physically harmed, and can have lasting effects on one’s emotional or physical wellbeing. A recent study from the Journal of the American Medical Association (JAMA) found women with a history of sexual assault have higher blood pressure and poorer sleep. Unwanted sexual attention that may appear “complimentary” on the surface can affect a person’s self-esteem, body image, or sense of self-worth.

Accompanying body image and self-esteem issues, sexual harassment can lead to disordered eating or lack of appetite. Harassment can take pleasure out of experiences survivors would otherwise enjoy and cause them to withdraw from activities or places they frequent, going so far to change daily habits to avoid discomfort. One’s mind’s perception of sexual harassment as a threat can lead to chronic elevation of the stress hormone cortisol which can lead to inflammation throughout the body, lower immunity, and raise the risk for serious conditions like heart disease and cancer.

 

A disturbing trend in our culture is the blaming of survivors of sexual violence for their victimization. Sexual predators and other perpetrators of sexual violence are often given the benefit of the doubt with their supporters citing how “good” they know the accused to be, asserting that the victim is not “innocent” enough, or making victims feel responsible for their own assault.

Victims are assigned blame because of what they wear, how they behave, or where they go — none of which makes one responsible for someone assaulting them. Alcohol consumption is involved in half of all sexual assaults and is often used to shift blame away from a perpetrator, though studies have shown perpetrators of sexual violence report using alcohol at the time of the assault 10-30% more than victims. In fact, anti-social behavior and negative views about women are much stronger predictors of sexual violence than alcohol use. These factors and more contribute to rape and sexual assault being the most under-reported crime in the United States — which in turn fosters more victim blaming.

 

There are ways to take an active role in increasing safety for yourself and those you care about. The most important way to raise awareness is to talk openly and clearly to young people about consent, how to respond if someone is pressuring you or someone close to you, and following safe practices while traveling or interacting online.

It is also important to educate on what acts constitute sexual violence. A majority of Americans recognize sexual intercourse without a partner’s consent (84%) and unwanted touching, groping, or fondling (83%), but fewer are aware that voyeurism and verbal harassment also are considered assault (64% and 54%, respectively). A third of men do not recognize pressuring a partner for consent (i.e., sexual coercion) as assault.

 

For those who have been the victim of a sexual assault or other violent crime in the United States, there are victim compensation programs in all 50 states and Washington, D.C. These programs help victims of rape, assault, child sexual abuse, drunk driving, domestic abuse, as well as families of homicide victims. Compensation programs can cover medical bills, mental health treatment, and often includes crime-scene cleanup, travel costs to receive treatment, moving expenses, or even the cost of housekeeping or child care if the victim is unable to do so. The programs are often flexible with their eligibility, though most require reporting the crime to police within a specified time frame and cooperating with the investigation. You can find NeedyMeds’ listings for the crime victim compensation programs in our Diagnosis-Based Assistance Database under Violent Crimes. For more support, call the RAINN (Rape, Abuse, and Incest National Network) 24-hour hotline at 1-800-656-4673.

What Is Public Health?

For over 20 years, the first full week of April is National Public Health Week in the United States. Public health was defined in 1920 as “the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals.” Analyzing the health of a population and the threats it faces is the basis for public health. Public health professionals work to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services, and conducting research. Public health also works to limit health disparities by promoting healthcare equity, quality, and accessibility. You can look at public health narrowed down to any population — from a neighborhood, country, or our entire planet.

 

Many factors affect public health, and people are unlikely to be able to directly control those factors. Social and economic environment, as well as physical environment, can be determinate in their quality of health. Higher income and social status are linked to better health, and those in poverty suffer poorer health outcomes. Low levels of educations are linked with poor health, more stress, and lower self-confidence. Whether there is clean air, clean water, safe and healthy homes and workplaces, or even maintained roads and other transportation options, all contribute to the health of the residing community. The presence of support networks, whether they be families, friends, or community resources, all strengthen public health. Cultural customs, traditions, and the beliefs of the family and community all affect health as do genetic inheritances, including the likelihood of developing certain illnesses. Access to affordable healthcare and people’s personal behavior also affect the public health of their community .

There are many areas throughout the U.S. that do not have access to clean air or potable water; safe homes, workplaces, or streets. Children are not to blame for their level of education, nor are families who can’t afford to leave an area without access to affordable healthcare or support. A large part of promoting public health is to increase access, improve support of determinant factors and advocate for those who suffer without them.

 

Discrimination and implicit bias affect public health and have been associated with higher rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for people of color, LGBT people, and women and can have long-lasting effects on individuals and their community. Xenophobia contributes to fears of immigrants as carriers of communicable diseases, despite many immigrants coming from countries with higher vaccination rates than those recorded in many parts of the United States. Public health is also affected by the prevalence of other infectious diseases, some that have been eliminated through hygiene and access to healthcare which can spread among homeless populations who have access to neither.

 

The effects from climate change have a tremendous impact on global public health: worsening chronic illnesses, increasing the spread of mosquito/tick/rodent-borne diseases, disrupting food and water supplies, and increased stress and trauma for people living all over the world. People who are already at risk for poor health due to social and economic factors — poverty, racism, unsafe housing and neighborhoods, and lack of access to quality medical and mental health care — will likely fare worse in a changing climate than those with greater resources.

 

 

The United States has some unique public health concerns, including gun violence. Before 1996, the Center for Disease Control and Prevention (CDC) was charged with researching gun violence much in the way that the CDC researched deaths from car crashes and the life-saving effects of seatbelts and child car seats. Following a 1993 study that connected gun ownership with a higher risk of being the victim of a homicide by a family member or intimate acquaintance, the National Rifle Association (NRA) responded by lobbying for the elimination for the CDC’s Center for Injury Prevention. While the Center for Injury Prevention remained, the 1996 federal budget included an amendment forbidding the CDC from “advocating or promoting gun control.” While not explicitly barring the research of gun violence, the language of the amendment created an environment where few within the CDC are willing to risk their careers by pushing for research that could reach conclusions that may be misinterpreted as advocating for gun control laws as opposed to fulfilling its mission of advocating for public health. The CDC still ranks gun violence as a leading cause of death in the United States. Americans are more likely to die by an assault with a firearm than riding inside an automobile, and only marginally more likely to die from an accidental gunshot as opposed to being the victim of a mass shooting. Any death by firearm is more likely in the U.S. than the combined risks of drowning, fire and smoke, stabbing, choking on food, airplane crashes, animal attacks, and natural disasters including hurricanes, tornadoes, earthquakes, floods, or lightning strikes. When comparing crime on a whole, the United States has an average amount compared to similar countries; the only outlier in U.S. crime is gun violence.

 

Communities and the United States as a whole can promote public health through education and policy initiatives. NeedyMeds encourages Americans to be active in the legislative process: If you have an opinion on important public health issues in the United States, call 202-224-3121 to reach the U.S. Capitol switchboard; from there you can be connected to your elected House Representative or Senator’s office. You can find contact information for your local representatives by searching your state online. You could also find contact information for your local health department.

We at NeedyMeds work in a diverse office with people of varying backgrounds and views. NeedyMeds’ mission is to educate and empower patients in need, with a vision of affordable care for all. It should be clear that our mission is tied inextricably to public health and the endeavor to promote and improve public health systems throughout the United States.

 

The NeedyMeds website has a database of over 17,000 free, low cost, or sliding scale clinics. Search your ZIP code for clinics in your area to find free or low-cost medical attention. There are nearly 6000 free/low-cost clinics listed that offer mental health services. The free NeedyMeds Drug Discount Card can be used by anyone to help save money on their prescribed medication — even over-the-counter medicine — regardless of immigration status. The card is available physically via mail, in a printable form, or as a smartphone app for Apple and Android devices. For more help finding information, call our toll-free helpline Monday-Friday 9am-5pm Eastern Time at 1-800-503-6897.

LGBT Health Awareness Week 2019

The last week of March has been LGBT Health Awareness Week since 2003. We have explored some of the barriers to healthcare for the transgender community in previous blog posts, but it remains important to bring awareness to the unique healthcare needs of lesbian, gay, bisexual, and transgender people and the health disparities that continue to affect the lives of so many Americans.

 

Experts report that LGBT people often avoid seeking out medical care or refrain from “coming out” to their healthcare provider. This compromises an entire community of lesbian, gay, bisexual, and transgender individuals who are at increased risk for several health threats when compared to heterosexual or cisgender peer groups: Gay men are at higher risk of HIV and other sexually transmitted infections; lesbians are less likely to get cancer screenings; transgender individuals are among the least likely to have health insurance along with risks from hormone replacement and atypical cancers. Even as youths, LGBT people are at higher risk of violence, depression, substance abuse, homelessness, and other suicide-related behaviors.

 

The Affordable Care Act (ACA) had helped over 10 million Americans gain insurance during the Obama administration, including many LGBT people. The ACA prohibited health insurance marketplaces from discriminating on the basis of sexual orientation and gender identity. The 2015 Supreme Court ruling of Obergefell v. Hodges recognizing marriage between gay and lesbian couples throughout the United States led to more married couples to access their spouse’s health insurance.

 

The Trump administration has since dismantled many protections for equal access to care for LGBT people. Shortly after Trump took office, regulations to ban discrimination in Medicare and Medicaid were stopped and the White House declined to enforce the ACA’s anti-discrimination mandate. Throughout his first two years, senior advisors for LGBT health were reassigned to less effective positions and questions regarding sexual orientation were removed from federal surveys. In late 2017, President Trump fired the Presidential Advisory Council on HIV/AIDS (PACHA) which concerned advocates believe is part of an “effort to erase LGBTQ people.” The mass dismissal followed six members resigning the previous summer, citing the Trump administration’s apparent disinterest in helping the HIV/AIDS community.

In January 2018, it was announced the Department of Health and Human Services (HHS) would form a new Conscience and Religious Freedom Division that would functionally allow doctors to refuse treatment for those that go against their religious beliefs — further limiting access to care and undermining the civil rights, health, and well-being of LGBT people, women seeking reproductive health services, and others.  Since last year, HHS websites have removed pages that hosted information on LGBT health and related links, and changed language regarding the ACA’s ban on sex discrimination — specifically removing language about gender identity protections and transgender medical care. Trump’s HHS reportedly considered defining gender as binary, “either male or female, unchangeable, and determined by the genitals that a person is born with,” denying the existence of transgender and intersex people, in defiance of the scientific and medical evidence embraced by the American Medical Association and American Psychiatric Association. Additionally, the Trump administration eliminated references to inclusion and protection from discriminatory housing practices in the Department of Housing and Urban Development’s mission statement, and filed a brief with the U.S. Supreme Court arguing that the Civil Rights Act which prohibits discrimination based on “race, color, religion, sex, or national origin” does not protect individuals on the basis of gender identity, threatening transgender people’s right to be free from unequal treatment.

In President Trump’s 2019 State of the Union address, he asked Congress for a commitment to eliminate new HIV transmissions by 2030. This month, the administration began filling seats on the Presidential Advisory Council on HIV/AIDS — over a year after disbanding the group — and released a proposed budget that included $291 million for the Ending the HIV Epidemic plan in 2020 but also called for cutting 12% from HHS funding. The budget proposal also calls for massive $1.5 trillion cuts to Medicare and Medicaid which covers 25%-40% of Americans diagnosed with HIV, respectively, while also cutting $45 million from the Housing Opportunities for Persons with AIDS program which provides grants to communities for projects to address housing needs for those living with HIV/AIDS. The impact of cuts to public insurance programs and the safety net would not only negate many of the benefits gained from the addition of the HIV funding that has been proposed but could halt the progress made toward defeating the virus that disproportionately affects LGBT individuals.

 

The LGBT community continues to rank among the most underserved populations in terms of healthcare. Homophobia/transphobia and stigma can negatively impact one’s ability to receive suitable care. Over 27% of transgender people in the U.S. report being denied healthcare. Mental health is a major concern for LGBT individuals often dealing with physical or emotional abuse, body dysmorphia, depression, or feeling unsafe at school or work, and there are still areas of the United States where finding sympathetic and appropriate help can be prohibitively difficult. If you are looking for a LGBT-friendly medical center, the Human Rights Campaign (HRC) has an interactive map with locations of over 1600 healthcare facilities in the United States. The HRC also has information on finding insurance for transgender-related healthcare, which can be a challenge for many transgender people even after the ACA.

 

To further help those in need, NeedyMeds has a growing list of programs in our Diagnosis-Based Assistance database for transgender/gender non-conforming people that offer various forms of assistance such as financial aid or legal services. We also list academic scholarships available for LGBT youths looking to continue their education. NeedyMeds’ unique crowdfunding platform HEALfundr is also available for individuals trying to raise funds for their transition and other members of the LGBT community to receive appropriate healthcare. For more information, call our toll-free helpline at 1-800-503-6897 (open 9am to 5pm ET, Monday through Friday).

Poison Prevention & Medication Safety

Poisoning is the number one cause of injury-related death in the U.S.. National Poison Prevention Week,  sponsored by the National Poisoning Prevention Council during the third week in March, promotes poison prevention tips and the free emergency services provided by poison control centers, including the Poison Help hotline at 1-800-222-1222. Text POISON to 797979 to save the number in your smartphone.

In the time it takes to read the information above, at least two people will call a poison control center. That’s one person every 14 seconds, according to the American Association of Poison Control Centers’ National Poison Data System (NPDS).

America’s poison control centers managed over 2.6 million encounters in 2017, of which 2.1 million were human exposure cases. And while human exposure calls to poison control showed a 2% decline from 2016, health care facility (HCF) human exposure cases increased by over 3% in this same period, representing almost a quarter of all human exposure calls. Calls with more serious medical outcomes have increased by nearly 4.5% every year since 2000.

Although young children (younger than 6 years) comprise a disproportionate percentage of the cases, poisoning affects ALL age groups, from infants to seniors. Most poisonings occur in one and two year olds, but poisonings in teens and adults are more serious.

 

The Most Common Causes of Poisoning

Cosmetics and personal care products lead the list of the most common substances implicated in pediatric exposures. Cleaning substances and pain medications follow. These exposures are nearly always unintentional.

The most common substances implicated in pediatric poisonings.

For adults, pain medications lead the list of the most common substances implicated in poison exposures. Sedatives and sleeping medications, antidepressants, and cardiovascular medications follow. Often, these exposures are intentional.

A list of the the most common substances implicated in adult poisonings.

 

Poison Prevention & Medication Safety Tips

A poison is any substance that can harm someone if it is used in the wrong way, by the wrong person, or in the wrong amount – including prescription and nonprescription medications.

The following BeMedWise medication safety tips are intended to help you prevent accidental poisonings We encourage you to keep them in mind and share them with others.

 

  1. Ask houseguests to store purses, briefcases, or bags that contain medicines up high, away and out of sight from your children. The same rule applies when your children are visiting a friend or relative’s home.
  2. Buy products in child-resistant packaging whenever possible. But remember, child-resistant is not childproof, and is designed only to keep children away from the product for a short time before a parent notices.
  3. Use child-resistant packaging properly by closing the container tightly after use.
  4. If you think someone has been poisoned, call 1-800-222-1222 to reach your local poison center. Text POISON to 797979 to save the number in your smartphone. This national toll-free number works anywhere in the U.S. 24 hours a day, 7 days a week, 365 days a year.
  5. Read medicine labels before use and follow directions exactly. Make sure you are not taking more than one product at a time with the same active ingredient.
  6. Tell children what medicine is and why you must be the one to give it to them.
  7. Never call medicine “candy” to get a child to take it.
  8. Never leave medicine out on a kitchen counter or at a sick child’s bedside.
  9. Always turn the light on when giving or taking medicine. Check the dosage every time.
  10. Put on your glasses to read the label when you need to take a medicine so that you know you have the correct amount of the right medicine.
  11. Never take more than the prescribed amount of medicine.
  12. Never “borrow” a friend’s medicine or take old medicines.
  13. Tell your doctor what other medicines you are taking so you can avoid harmful or dangerous drug interactions. This includes prescriptions, over-the-counter medicine, vitamins, and herbal products.
  14. Clean out the medicine cabinet periodically, and safely dispose of medicines that are expired or no longer needed. Refer to the U.S. Food and Drug Administration for advice on safe disposal of unused or expired medicine.. For information on safe disposal of needles used outside of healthcare settings, visit SafeNeedleDisposal.org or call 1-800-643-1643 from 9am-5pm Eastern Time. Email inquiries: info@safeneedledisposal.org.
  15. Always relock the safety cap on a medicine bottle. If the medicine has a locking cap that turns, twist it until you hear the click or you cannot twist any more.
  16. Don’t remove medicine from a child-resistant package and put it in another type of easy-to-open container.
  17. When taking or giving medicines, don’t put the next dose on the counter or a table where a child could reach them.
  18. Use only the measuring device (dosing cup, dosing syringe, or dropper) that is included with your medicine. If a measuring device is not included or you do not receive one, ask for one from your pharmacist. Don’t substitute another item, such as a kitchen spoon.
  19. If you don’t understand the instructions on the medicine label, or how to use the dosing device (dosing cup, dosing syringe, or dropper), talk to your pharmacist or doctor before using the medicine.
  20. Never share or sell your prescription medicines.
  21. Only buy prescription and over-the-counter medicines from a legitimate pharmacy, including online pharmacies. Counterfeit medications are a serious problem in the U.S. and are usually made with harmful ingredients that can kill you. Learn more at the Partnership for Safe Medications and How to Buy Medicines Safely From an Online Pharmacy (FDA).
  22. Keep medicines in their original bottles or containers whenever possible. If you transfer medicines to another container, such as a pill minder or organizer, store them in a place that is too high for a child to reach or see, since these containers are often not child-resistant. If possible, ensure the storage location has a safety latch.
  23. Some medicines are dangerous when mixed with alcohol. Consult your doctor or pharmacist before drinking alcohol if you are taking a prescription or over-the-counter medicine.
  24. Talk to your doctor before taking any vitamins or herbal supplements. They can interact with your medicine.

 

Resources for Taking Action

Free Printable Resources Library – A Be MedWise collection of health education and medicine safety brochures, tools and tips.

Downloadable Communications Toolkit Take Action to Prevent Opioid Misuse and Abuse by informing patients, their families, caregivers, and others how to manage these serious medications, keep them out of reach from children, family and visitors and then dispose of unused opioids correctly so they don’t get into the wrong hands or damage the environment.

Resources for Action – From the Centers for Disease Control and Prevention (CDC), Allied Against Opioid Abuse, (AAOA), Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Surgeon General, Community Anti-Drug Coalitions of America (CADCA), and more.

Your Medicine: Be Smart. Be Safe. – You can learn more about how to take medicines safely by reading this guide. It answers common questions about getting and taking medicines and has handy forms that will help you keep track of information. Keep this guide with your medicines in case you have any questions, concerns, or worries.