What are Your End-of-Year Health Care Priorities?

Coordinate With Your Doctor and Your Insurance Company

As the final weeks of 2019 approach, it is a perfect time to assess our health care goals for the year. What screenings and procedures should be priorities this year? What tests are appropriate? Will insurance pay for them?

The internet may provide responses to some medical questions, but these can be misleading and cause confusion. There is too much unconfirmed information out there. Your primary care provider (PCP) can help you sort through all of this. This is a PCP’s area of expertise, after all.

Here are suggested strategies to help you make the most of your discussions:

• First, make a list of questions to ask your PCP. Remember, your doctor is your advocate and your partner in health care decision-making. Don’t be afraid to seize the opportunity to have open and honest discussions.
• Second, prioritize and organize all of the contact information for the specialists your doctor recommends. Include outpatient locations, hospital services, imaging facilities and labs. Your doctor’s office will likely provide the details. This will help you stay on track.
• And finally, it helps to understand your health insurance coverage benefits as much as possible. Be prepared to review your policy and ask about deductibles, copays, co-insurances, and preferred locations.

Screenings

We’ll get to the topic of insurance deductibles later, but in its simplest terms, some health care services may be cheaper late in the calendar year if you’ve paid off this year’s deductible already. Ask your doctor about health screenings that are appropriate for your age, gender and wellbeing, and schedule them before January 1 if this year’s deductible is fully satisfied.

Nancy J. Rist, M.D., and Renuka Kakarala, M.D., practice at Internal Medicine Associates at Brinton Lake, in Glen Mills, Pa., part of the Crozer Health. Here are the screenings they recommend, and some information for you to discuss with your doctor. Remember, every situation is different, so this advice may not be exactly right for you.

Colon Cancer Screening: Colonoscopy is the gold standard for detecting cancer in its earliest and most curable stage, before any symptoms show. According to the American Cancer Society, the survival rate for colorectal cancer is 90 percent when detected early. Because most colorectal cancers develop from polyps, the initial goal of a colonoscopy is to detect and remove polyps before they become cancerous, making it both a screening tool and treatment in one. For most, this screening should begin at age 50. For others who have increased risk, such as strong family history, screening could begin much younger.

While colonoscopy is the most recommended tool for colorectal cancer screening because it can be used to identify and remove polyps, there are other screening options available: such as sigmoidoscopy, stool testing and CT scanning. Discuss with your doctor which screening method would be best for you.

Screening Mammogram: Professional societies lack uniform agreement regarding the age at which breast cancer screening should begin. The American College of Obstetrics and Gynecology recommends average-risk screening begin at age 40, while the U.S. Preventative Services Task Force (USPSTF) recommends screening begin at age 50. Experts do agree that women should have a mammogram at least every other year. All women should be familiar with their breasts and call attention to any changes with their doctor.

DEXA Scan: This checks your bone density to see if you are at risk for osteoporosis. According to the National Osteoporosis Foundation, 50 percent of women and 25 percent of men older than 50 will break a bone as a result of osteoporosis. Who should schedule a DEXA scan?

• Women aged 65 and older, or menopausal age with certain risk factors,
• Men with certain risk factors, and
• Some adults older than 50 with fractures.

Cervical Cancer Screening: Two screening tests can help detect cervical cancer early.

• The Pap test (or Pap smear) looks for pre-cancers, or cell changes on the cervix that might become cervical cancer if they are not treated appropriately, and
• The HPV test looks for the human papillomavirus, which can cause these cell changes. 

Both tests can be done in a doctor’s office or clinic beginning at age 21 for women. The general rule of thumb is every three years for a Pap alone. When a Pap and HPV test are combined, the frequency can be every five years. This may change, however, if any abnormal findings are present or any abnormal symptoms occur.

Prostate Cancer Screening: Prostate cancer screening (with a prostate-specific antigen blood test, or PSA) has a role in detecting early prostate cancers. The American Cancer Society recommends you talk to your doctor about the risks and benefits of the screening to decide if it is appropriate for you. This discussion should take place at age 50 for men at average risk, but younger for those at higher risk.

Lung Cancer CT Screening: According to the American Cancer Society, lung cancer is the leading cause of cancer deaths in the United States - more than breast, prostate, and colon cancers combined. The USPSTF recommends yearly lung cancer screening with a low-dose CT Scan for people who:

• Have a history of heavy smoking, and
• Smoke now or have quit within the past 15 years, and
• Are between 55 and 80 years old.

Check with your insurance, since not all plans cover this screening. Many centers offer this at a reduced fee to offset the lack of universal coverage.

Lipid Screening: High cholesterol is a risk factor for heart attacks and strokes. According to the Centers for Disease Control (CDC), cholesterol testing should be done:

• Once between ages nine and 11 (before puberty),
• Once between ages 17 and 21 (after puberty), and
• Every four to six years in adulthood.

Discuss what age to begin screening since this can be different for men and women, and for those with strong family histories. Frequency for higher-risk patients may vary, too.

Screening for Abdominal Aortic Aneurysms: The USPSTF recommends one-time screening for abdominal aortic aneurysm with ultrasonography in men ages 65 to 75 years, with a history of smoking.

Screening for Diabetes: The USPSTF recommends screening for diabetes for adults who are older than 40 and overweight or obese, and for women who are pregnant. The CDC suggests screening for those with risk factors including a first-degree relative with diabetes, high-risk ethnic group, and a history of gestational diabetes.

Diagnostics

“The difference between screening tests and diagnostic tests is important to understand,” said Dr. Rist. “Screenings help you and your doctors rule out health concerns that you may be at risk for. Diagnostic tests are used to figure out what you’re already dealing with. So, for example, if a screening mammogram or a breast self-exam reveals a suspicious lump, a diagnostic mammogram, ultrasound, MRI or biopsy will define what kind of lump you have,” she explained.

“Once you and your doctor are aware of health challenges that you need to stay on top of, talk about the timing of specific diagnostic studies,” she advised. Examples include:

• Upper GI scope for chronic heartburn,
• Diagnostic breast imaging for personal or family history of breast cancer or to evaluate and perform surveillance of benign masses,
• Sleep studies, if you snore or have a history of apnea, and maybe even
• Genetic testing, if you fall in a high-risk group such as a strong family history of cancer.

“The next step is to address any diagnosed conditions with your doctor,” said Dr. Kakarala. “Many chronic conditions require testing for surveillance. There are many possible situations when this can occur. Make sure that you stay engaged and schedule regular visits for your chronic conditions. Screenings and diagnostics that can be performed before your visit may optimize your time together,” she said.

Understand Your Insurance

When health insurance affects the prioritization of your health needs, then you and your doctor should create a plan together. Again, remember that your doctor is advocating for you. There may be times when an insurance decision can be reversed and other times when different strategies can be implemented. The point to remember is to stay connected, said both Drs. Rist and Kakarala.

Whether you’re insured by Medicare, a commercial program through an employer, or an Affordable Care Act plan, it pays to know the details, especially as you near year’s end. If you can’t readily find answers to these questions, don’t hesitate to call customer service at your insurance company. Have your policy ID numbers handy.

The concept is simple: with your doctor’s approval, you can try to schedule preventive and non-urgent health care needs after your deductible is met, typically late in a calendar year, in order to save money before it resets. The trickier part is knowing what questions to ask, and in what order.

Review your health insurance documentation or call customer service to find answers to these questions:

• How much is my health insurance deductible every year?
• What month does my deductible reset (calendar year, fiscal year, academic year)?
• How much have I paid into my deductible so far this year?
• How much of my deductible remains before it resets, or have I already met it?
• How much are my co-pays per type of service?
• Does my policy cover non-pharmaceutical supplements that my doctor may suggest I take?
• If I have a flexible spending account, how much do I have left to use before the end of the year, and what health care services can I spend it on?

After you’ve armed yourself with this information, a conversation with your doctor about what to schedule during the final weeks of your insurance year could help you save money and keep you healthier next year.

Nancy J. Rist, M.D., and Renuka Kakarala, M.D., practice at Internal Medicine Associates at Brinton Lake, in Glen Mills, Pa., part of the Crozer Health Medical Group. Call 610-579-3589 for an appointment.

This article was originally published in Chester County Life’s September/October 2019 edition