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Better Read Than Dead! Keeping abreast of the new guidelines November 19, 2009

Posted by Admin in Cancer, Diary, Health Quote of the Week, Healthonymous, huh?.
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How many mammograms have I had in my life? At least 26, and most likely between 30-40. I want my mammograms read and to have them be part of our new health insurance plan. The United States Preventative Services Task Force has issued new guidelines for women to follow for breast cancer screening. Their position is that too much screening generates excess anxiety, testing, false positives, and doesn’t save enough lives to warrant screening for women between the ages of 40-49.

If I had followed that advice, given my two cancer diagnoses, I might not be here to write this blog.

At 40, I had survived a cancer with a 2cm tumor (found by self-examination at age 26) and a smaller more aggressive cancer at 39, found by routine screening for a cancer survivor. I did not have any false positives, unnecessary biopsies or guilt. Anxiety, of course.

As Lynne K. Varner wrote in The Seattle Times on November 18-

“Women are not responsible for false-positive readings. The solution is not to take away a woman’s choice to have  a mammogram, but rather to work to reduce the rate of false readings.”

In the New York Times on October 20 of this year,  Dr, Otis Brawley, of the American Cancer Society, was quoted:

“The issue here is, as we look at cancer medicine over the last 35 or 40 years, we have always worked to treat cancer or to find cancer early,” Dr. Brawley said. “And we never sat back and actually thought, ‘Are we treating the cancers that need to be treated? ”

(more…)

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GINA, Coverage and Me Update November 5, 2009

Posted by Admin in Cancer, Health Insurance, Money.
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Wow! I opened an innocuous, slim envelope from my insurance company yesterday-an Explanation of Benefits or EOB. My DNA test from September to discern whether I have the  (Breast Cancer) BRCA mutations is covered in full! No more funds out of pocket! (search under DNA or GINA for previous posts)

I could have been liable for up to $350, and the blood test bill was  $3120. After a provider “adjustment”, the insurance company will pay them $2964.00.

No deductible, no co-insurance, only the two co-pays for the office visits of $40.

If you are going to have a system that keeps cancer patients alive long enough to be survivors, then these follow-up procedures should be covered (with appropriate privacy for the patient) in order to practice further early detection and possibly even prevention.

[picapp src=”3/9/1/1/Rep_Hoyer_hosts_7c52.JPG?adImageId=7129555&imageId=6278902″ width=”234″ height=”388″ /]

I waited eleven years for this test.

Relief is spelled GINA!

Ovarian Cancer and the CA 125 test November 4, 2009

Posted by Admin in Cancer, Health Insurance, Healthonymous.
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I am in a research study which is watching a number of women like me who are at higher risk for ovarian cancer. For me, this is due to my status as a two-time early-onset breast cancer survivor. (In a future post, I will address the difference between relative risk and absolute risk).

Suffice to say, they tell me that I am at higher risk. This is my second research study in my home town for ovarian cancer. The first one lasted four years and I had blood drawn quarterly to check my CA 125 level.

What is CA-125? (more…)

October Expenses-Scary! October 31, 2009

Posted by Admin in Blog Math, Cancer, Diary, Health Insurance, Money.
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  • ER visit week of 10-5-09:   co-pay before entering the treatment room $100, Dr. fee $266-my percentage of 20% after “negotiated adjustment” =  $34.02, IV drugs ?
  • Co-pays for 2 Office visits for cellulitis and 1 for DNA Test results: $60
  • Flu shot (regular)-no separate bill yet (I think)
  • Plus antibiotics (2 different types), extra pain meds (neither of which worked) $40
  • DNA test-not yet paid by insurance company $3100 (my maximum will be $350) but I haven’t been billed yet because the insurance company is hassling the lab that performed the service (the one that said they had my back). Classify this one as: “hanging over my head”
  • Regular Rx renewals $39.91 (for three months each)
  • Office visits for Ovarian Cancer research study: annual ultrasound of ovaries and CA 125 blood Test : FREE (classify this one to rule things out). More on the CA 125 test in a future post.
  • Bill for September dentist (annual exam, X-rays and cleaning) $45.40 out of pocket (insurance paid $181.60)
  • Co-pays for two therapeutic lymphedema massages: $60

Scary total: $513.00

Weekly Expenses October 30, 2009

Posted by Admin in Blog Math, Cancer, Diary, Money.
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This week’s expenses were not as scary as Halloween week could be. I had a regular massage for my back and my lymphedema on Monday.  One side effect of blogging is that I spend more time in front of the computer. This causes my shoulders to hunch over and my chest muscles to contract. The massage helps to loosen them back up. (But I probably need to get back in the pool.)

Co-pays this week only $30.00 for the massage. I ordered a refill of the other prescription I take by mail. A three-month supply is around $19.00. But I overpaid the company last month so it won’t cost anything-they already have my money! Great for cash flow-but poor planning, nonetheless.

Weekly expenses: $30.00

Monthly total coming this weekend-that might be scary!

Flu: US vs. the UK Who wins? October 29, 2009

Posted by Admin in Health Insurance, Healthonymous.
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Brits 1 US  0.

In this post, I am comparing Flu.gov to the National Pandemic Flu Service websites. You may recall my post on the Flu Friend program provided by the NHS in the U.K.

If you live in America, you can visit Flu.gov and use a “Self-Assessment” tool, which is for “informational purposes only”.  It is not a substitute for your health care provider or your insurance company, that would interfere with the “free market” or some such thing.

Bottom line-you can check your symptoms and then what? It says to:

  • Call your Doctor
  • Go to a walk-in clinic
  • Call 911

But if you visit the UK site called the National Pandemic Flu Service, it is a different story. Their purpose is different:

This service will assess the patient’s symptoms and, if required, provide an authorisation number, which can be used in England to collect antivirals from a local Antiviral Collection Point. (also known as a pharmacy in the patient’s neighborhood)

(It’s good in all of the UK-just localized by England, Wales, Scotland and N. Ireland.)

The site lets you know that you will need to know 4 things about the patient. (There is a culture difference-in America it is a self-evaluation with only two questions for the individual. In the UK, they understand that someone else might be caring for you).  I could not go further in the assessment because I could not state that I was in the UK and might have the flu or be caring for someone who might have the flu.

The UK wins hands down-plus for the web-phobic you can call a number staffed by live people and they might also give you that ID code for anti-virals-in other words they do diagnose over the telephone.. One of the anti-virals  is Tamiflu. About $10 per dose- in the US.

[picapp src=”0/a/d/1/Demand_Increases_For_2b53.jpg?adImageId=6964235&imageId=4663486″ width=”234″ height=”152″ /]

So in the UK, the system is designed for the convenience of the patient, and here, for the convenience of whom?

A Pain in My Head: Three Things I Learned October 20, 2009

Posted by Admin in Health Insurance, Women.
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Recently I had an illness, which was accompanied by the worst pain ever. I attended a talk this past weekend by a professor in what might be the leading program on pain management in the country. My question to her was what is the best way to talk to a physician about pain? I told 4 different providers that I had a headache on one side of my head and that it came as often as once per minute and that was not descriptive enough. They did ask some questions about eyesight etc. that seemed to rule out the risk or occcurrence of an aneurysm or a stroke.

Her advice was threefold:

  1. Be Specific and Descriptive: such as “a stabbing, searing recurrent pain two inches above my right eye”.  Using a “key word” such as headache, seems to lead physicians down a specific path that may not be the path you need to travel.
  2. Remember that doctors receive very little pain management training-it is not even a residency speciality like obstetrics, surgery, urology, pediatrics etc. So s not always the first tool they go for in the toolbox. In fact, sometimes the “last resort” is to send the patient to pain management. The “Interventional” Pain Management programs may be able to get you to a diagnosis more quickly.
  3. Nerves can cause pain. In my case, I probably had nerve pain related to the swelling caused by the infection. I was initially given Vicoden for the pain, as acetaminophen was not acting on the pain. That made me feel woozy, but with a searing, recurrent pain. So I was still in pain, but I couldn’t complain as loudly. One of the physicians discussed nerve pain with me, but this one was the 4th one that I had spoken to last week. Apparently Vicoden doesn’t work on nerve pain.

The DNA Test Results… October 10, 2009

Posted by Admin in Cancer, Health Insurance, Healthonymous, Women.
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Here is the news I received yesterday. To recap, I have waited about 11 years to be tested for the two known gene mutations that go with breast cancer. Why did I wait? Privacy and non-discrimination protection for genetic testing did not exist in 1998.

In an earlier post, I described what I learned about the GINA legislation, passed in May 2008.

The test results are…..drum roll… negative. Meaning that I don’t have those mutations. Whew. While my lifetime risk is still elevated (for ovarian cancer), the BRCA genes have been ruled out for now or until the test changes (it has changed twice in the last 11 years).  If I had the mutations, then I would have been asked [again] about considering oophorectomy (removal of the ovaries).

The insurance company has requested the results (which they are legally not entitled to), and the testing lab says they “have my back” on this. So not to worry, right? Nonetheless, I will worry about it a little bit. It is so rare to hear “we have your back” in the context of an insurance conversation.

NIH public domain photo

NIH public domain photo

If you want to make someone in your life feel good, tell them that you have their back!


Colonoscopies ‘R Us Update 2009 and 2013 October 8, 2009

Posted by Admin in Cancer, Diary, Health Insurance, Healthonymous, Money.
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2009: The reckoning has come in the mail. The colonoscopy will only be $267.30! I guess you have to amortize it over the ten years of not having to go back.

Only $26.73 per year or  just pennies per day…… Can you tell I’ve listened to a public radio pledge drive?

To learn more about colon cancer, visit the STOP colon cancer site.

2013: Are my friends who have refused to have colonoscopies wrong? At least in 2013, we know that alternatives are being investigated. As a cancer survivor, I find the idea of a ten-year pass very appealing. However, you must still pay attention to things like diet, exercise and  your family medical history.

I may have mentioned this in another post, but I did not learn about my family cancer history, until being diagnosed with it myself in my 20’s (the immortal decade).

To ER or Not to ER? October 6, 2009

Posted by Admin in Diary, Health Insurance, Money.
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It costs $20 for me to see a doctor during the day.  After hours, it is $100. Yesterday, I ended up doing both. Even as we drove the Emergency Dept, I was trying to calculate whether it was worth it.  My driver said, sensibly, that it was good to rule things out, like whether the headache was a migraine and were the antibiotics working on that suspected staph infection. Luckily the headache did not impress anyone and I was given two extra drugs via IV drip–Vancomycin and a drug in the Cephalosporin class. But there was still a pain in my head.

After 2 hours of the IV and a little drama from her wimpiness (me) while the IV found a home, I was discharged to go home and sleep. That didn’t work so well.

On the mend, but the totals for the month are off to a bad start. My driver is the best!

Daily Total $120 for copays, $6.00 for parking= $126.00

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