I saw a patient this morning for an emergency appointment.
The emergency? Her husband is suddenly losing his job due to downsizing at his firm, which is losing contracts in the bad economy. She wanted to get her annual appointment in before March 1, when his insurance coverage ends. (She is a self-employed minister and they have no other insurance.)
Her exam was fine. We got her squeezed in for a mammogram and a bone density tomorrow. (She has had osteopenia and has been on a bisphosphonate for a number of years.)
But here was my dilemma – If her bone density is not improved, I would want to check a vitamin D level and urine NTX. If it is improving, I probably would not do these tests this year.
But by the time I get the results of her bone density, her insurance will have run out and she won’t be able to afford the tests.
So I did the tests today, even though I don’t know yet if I will need the results to manage her condition. She is also refilling her bisphosphonate for another 90 day supply, even though there is a chance I will discontinue it if her bone density is improved significantly.
Of course, their COBRA could end up coming through, in which case we could have waited and potentially saved the system the cost of those test and her meds. But she won’t hear about that coverage till next week.
She also asked if, while I was at it, I could send off “a panel of tests” that she might need in the upcoming year, but that I refused to do. She just saw her rheumatologist 6 months ago, after all.
And I can only potentially waste so much of the American healthcare dollar.
Tough choices for all.
The vitamin D/NTX tests don’t strike me as a waste in light of the downside risk of not having the needed tests after the insurance runs out. For a proper calculation we’d need to guage the chance of a not-improved bone density, the chance of not obtaining COBRA insurance and, of course, other chances and gambles not yet fathomed. We need somebody handy to do some statistical math on gambling odds. Is that why doctors cry out “STAT!” Did you offer her a carrot muffin?
We got her squeezed in for a mammogram.
Isn’t that always how it’s done?
i think it was great you were able to see her, and manage the tests she might need. also excellent you could get the mammo done on such short notice — it took over a month for me to get one scheduled, and when they found something that needs further investigation, they could not fit me in for several weeks.
Why would COBRA not come through. My understanding is you have 18 months by law. The issue is paying for it.
If a new condition coming up during these ‘omg lets get every test done we need possible while we have insurance(oh and throw in a full body scan there too…)’, than that said condition will be pre-existing if they have lapse in coverage, potentially causing problems when/if they have insurance again.
One more reason for Universal Health Insurance. However until then New York residents can join and support the Ithaca Health Alliance. I believe organizations like the Alliance are needed to show the HMO elite we have humane options to the capitalist health care system. URL http://www.ithacahealth.org/
“General or Provider membership in the Ithaca Health Alliance entitles you to request medical grants or loans for specified health problems. Please note that IHA general membership is available to residents of New York State only: persons who will affirm that they reside at the given NYS address for most of the calendar year”
I am seeing this way too often now. I’ve had a huge run of patients who come in for that “last minute pap and total body tune up” before the insurance runs out because they were laid off.