You, Your Doctor, Your Insurance: Who is making the calls?

It’s the Golden Rule: “Those With the Gold Make the Rules.” So it’s your insurance company, or possibly Uncle Sam, in the case of Medicare.

insurance-golden-ruluNow you may argue that they got all that gold from you, which is true, not that you had much of a choice, but they’ve got it now.

So what, we might ask, is in their best interest? Obviously, the less spent on us, the better. Medicare gets to keep more money. They are worried about running out. And the insurance companies likewise get to keep more money, which makes their shareholders and executive staffs wealthier. Laudable goals, no doubt, if not especially beneficial for us.

We believe we could save them a whole lot more money. Those that practice Quantitative Medicine, as described in this blog and in our forthcoming book, are much less likely to need expensive surgeries and other such procedures, and this is where most of the money is going.

However, we are advocating spending money now, on blood testing and scans, in order to eliminate these down the line problems.

Is this a good deal? Well, the methodology works. We already know that. And the tests are getting cheaper, a lot cheaper. You could probably get a lot of testing done for under $250/quarter. Soon maybe half that. Let’s compare it to a common procedure that Quantitative Medicine will help you avoid: a heart bypass. This now routine procedure costs around $75,000. This would sure pay for a lot of blood work. This is the American price. Divide by around (at least) five for the rest of the planet. But then divide the blood work cost down too.

Insurance Not Paying For Prevention is JUST PLAIN STUPID

But, even though we think it’s a no-brainer, preventive medicine is not STANDARD-PRACTICE. Other than annual physicals, insurance won’t pay an iota for prevention. Every single test a doctor prescribes has to be triggered by a symptom. And the doctor has to justify it. After he packs you off to the blood draw center, he gets a notice, either by the insurance company, or sometimes by the blood draw center itself, asking him why the test was prescribed? What was the symptom? Now “just making sure the guy isn’t sick” or “looking for early warning signs” are not any of the acceptable responses. So this puts the doctor in the odd position of having to sort of fish for symptoms. Low energy could justify a thyroid test. Weight gain could be used for glucose. The insurance companies even dictate treatments.

The docs don’t like this state of affairs. Actually the extent to which they do not like this state of affairs is impossible to describe without a stream of profanity that would probably get us shut down by the FCC. The docs don’t want some committee in a for-profit company or some government bureaucracy telling them how to do medicine on their own patients, patients they likely know quite well. And of course, neither do we. And the docs don’t like to talk about how constrained they are these days. It’s embarrassing. If you do get them talking, you’ll likely get an earful.

We are all individuals, but are subjected to this one-size-fits-all medicine by people that we never see, people that have no idea who we are, what we are trying to accomplish. It’s ugly. Medicine is all set up to prolong all the illnesses it is failing to prevent, or in some cases actually causing.

What does this mean to someone wishing to follow the ideas of Quantitative Medicine? It means that, for the time being, until the medical world comes to its senses, you should expect to pay some out of pocket. How much and for what? We will soon publish a recommended test list, along with recommendations on how often to get the tests. Just to put it in context, expect a cost of between one and three tanks of gasoline quarterly.

This is a moving target, so keep an eye on the website, and let us know of anything you find out. We believe that a lot of testing is a key component of peak health, and we are making considerable efforts to find ways this can be affordable.

These numbers are for America. Elsewhere, gasoline costs (at least) twice as much, and medical tests cost (at most) half as much. So half a tank?

Annual physicals are covered at least, sort of, more or less. And some blood work may be covered as well.

So see what tests your doc can prescribe that insurance is likely to pay for. Show him the list. Give him the book if it’s out. (Better still, get him to buy one.) (Better still, get him to buy one for each of his patients.)

For those tests that the doc thinks can’t be justified, pay cash. The doc can write a separate requisition. Take it to the blood draw center and tell them: cash, no insurance. Get the price in advance. If it is not in line with your expectations, pester them some more. They’ve got more prices than you can imagine. Cash price, Medicare price, Medicaid price, Saudi prince price. Tell them to be creative. But go in knowing what the price ought to be and don’t get ripped off. On the site there will soon be a list of the lowest solid prices we can find for getting the tests done at the various centers. With enough whining, you ought to be able to beat that. And let us know if you did, and how.

Many of the blood draw companies will stick it to you in more ways than one, so it’s buyer

Or you can get a requisition directly from the Quest or LabCorp “retail outlet stores,” mentioned in the last post. Same tests. Same labs. This is certainly less stressful, and probably not much more expensive. When you have finally amassed all the numbers, you can go over them with your doc and go forward with a plan.

What tests can you get on your own?

For all practical purposes all of them, if—and it’s a big if—you are willing to forego attempted insurance reimbursement. If the insurance doesn’t know about it, they don’t belly ache. They don’t scold your doctor, and all is well.

Walk In Labs (LabCorp), New Century Labs (Quest) and several others, will do this for you. On-line, you find the tests you want, pay, and back comes an email with a blood draw requisition, signed by some unknown physician. You then go to a nearby LabCorp or Quest center. LabCorp is walk-in and Quest tends to want appointments. Just hand them the requisition and wince. They extract no additional cash, only blood. Results are emailed back to you (and only you) within a couple of days. And it’s relatively cheap.

It is probably not a problem for your own doctor to give you a requisition as well, so long as insurance is out of the loop. This route ought to be cheaper, but more of a hassle, unless we can get Quest and LabCorp to sign up to a reasonable cash price for a “standard” QM panel. Don’t hold your breath, but we are, at least, trying. There will be more on this topic, a lot more. We are not blogging and writing a book to enrich the blood draw industry.

About Quantitative Medicine Saving Medicare

It easily could, and with some luck, will. But there is a down side. It we are all living to 95 and beyond, what’s to become of social security? I’m going to write a book called: “Told You So!”

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