Are you an engaged consumer in healthcare?

The other day I had an occasion to have to go to the doctor.  My leg had been bothering me for about a week and it was starting to get worse.  It felt like I had a constant charlie-horse in my calf.

For those of you that are wise in the ways of self-diagnosis, you have already concluded that I’m an idiot because the symptom I am describing is often brought on by a blood clot in the leg – which, it turns out, is very dangerous to ones health – even fatal.  

I had been on the road for a week visiting four different cities in the mid-west and I was tired, but having just learned from a friend of mine that I could die at any moment I called the clinic, made an appointment and went in to get checked out.

What does this have to do with being an engaged consumer Ernie?

I’m getting there…I need a little back-story.

Soooo, I get to the receptionist desk and check in and she asks that innocuous question they always ask.

Mr. Harris, do you still have the same insurance?

At this point I dutifully pulled out my new insurance card for the gap policy I had just bought to cover me while I was transitioning into my new role.  I was so proud of myself, I didn’t let my coverage lapse and had secured insurance that was both cost effective and beneficial to me – or so I thought.

I’m sorry sir, this is a hospitalization only plan – I need your other insurance card for your primary plan.

You know when you when you were a kid and you’re just walking along one day and a thought out of left field comes racing through your brain?  It screams at you, “Oh No! I forgot to clean my room and my mom is gonna kill me!”  You’re in big trouble and your spine tingles, you break into a cold sweat and your brain starts going a million miles and hour to figure a way out.

That was me at that point in time.  How could I have been so stupid?  I bought a health insurance plan that only covered me if I was hospitalized?  I felt like I was about to be hospitalized because I was so sick to my stomach. I learned at that moment that even though I’m “…in the business…” I am not immune to being a disengaged consumer.

I informed the young lady behind the desk that that is the only coverage I have so I guess I will just pay cash.  That wave of nausea came back over me as I mentally pictured thousands of dollars being sucked out of my wallet by the evil health insurance ogre.

But alas, this story has a happy ending.  Instead of suffering silently, when the Nurse Practitioner came in to examine me, I was upfront and honest with her about my current insurance and financial situation.  Because of that, she took the time to explain to me not only what she was doing and why, but how much it will cost.  She then left to consult with the doctor about the best way to help control the cost of this episode.  They determined that should this be a small, non-life threatening clot that they could try a simple course of treatment to see if it would resolve itself easily.  If it was a deep vein thrombosis (sounds scary right – that’s a fancy way of saying you have a big ‘ole blood clot in a major vein that could break off at any moment and kill you) then they would tell the imaging office to admit me directly from there so that my maximum exposure would be the deductible on the plan.

Sounds cool, right?  Well the really cool part is I followed up with this question:

So if I hadn’t told you about my current situation, what would you have done?  

They proceeded to tell me that they would have ordered the same sonogram to confirm diagnosis, but then they would have written me two prescriptions for blood thinners that needed to be taken by injection.  These run about $100 a shot and are accompanied by a visit to a specialist for instruction on how and where to inject yourself which would have run another couple hundred dollars.  A second sonogram a week later to confirm the blood clot was being reduced or gone and a follow-up appointment with the clinic to wrap it all up with a nice bow.  

Instead of several thousand dollars of care, what I ended up selecting is an alternative plan that met my quality of care needs and risk tolerance level.  What they described to me went something like this:

Before all these more powerful tools and treatments were available, we would normally have told you to go put a compression stocking on and take one 325 mg aspirin per day for about a week to see if the clot could be dissolved that way.  Since we have these new tools and treatments, let’s do one sonogram to confirm the location and severity of the clot and then if it’s not DVT, then we can try the aspirin approach because that almost always works anyway.

I considered the two options carefully and went for the sonogram (total cost of $250), confirmed it wasn’t life threatening and then spent $15 on a pair of really attractive black knee-high stockings that make me look like I’m 92 years old and $3.49 on a bottle of 325 mg aspirin.  I followed the instructions and the symptoms began to subside within the first day and a week later I was back to my normal self.  No need for a follow-up scan, office visit or any other costly medicines.

Now I could be 100% sure by doing all those things but what is the real value in that.  Sure, we are talking about my life here, but we make value decisions about our lives all the time.  When you get in the car and decide that you don’t really need to limit your highway speed to 65 mph, 80 mph is just fine – you’re risking your life.  When you decide to eat that last helping of leftovers that’s “..probably still good…” you risk serious illness and yes, potentially death.  So why is this scenario any different?  It’s different because over the past 40 years, we’ve been conditioned by a managed-care mindset that it’s our right to have all this healthcare and its the job of health insurance to just pay for it all.  I ask you this – when do we reach the point of diminishing returns?  Or perhaps, have we already passed it?

I would encourage everyone to have these types of conversations with their care provider, even if you have a comprehensive medical plan – there’s no wrong approach here.  If you still decide to go for the full battery of tests, treatments and visits, that’s your choice.  What makes things better in my opinion is that you made an informed choice and didn’t just consume all kinds of healthcare that you might not have needed or wanted.

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