What is the Meaning of Preventative Care?

I am a Health and Life Insurance Broker, so I have worked with individuals in some tough situations. Declining health is one of the leading issues that can destroy a person’s financial wellbeing. I understand the importance of staying in good health, and it goes beyond how you look.

Recently, I had an appointment with a cardiologist to get an Exercise Stress Test and a Heart Monitor. I have a history of strokes, Congestive Heart Failure, and Brain Aneurysms in my family, so I wanted to check my heart health to make sure that I was doing all the things necessary to keep my health in good shape. I have been reading several news articles and scientific journals citing the prevalence of younger people having strokes and heart attacks as well; therefore, I was curious about how well my heart was working. The last two times I have gone to see a doctor, they showed concern about my Heart Rate being very low, and I was told to have this checked by my gynecologist and an Emergency Room physician.

I arrived at my appointment ahead of time, and as soon as I walked into the office, I noticed that the waiting room was packed. Many of the people in the room looked to be 55 and over. I was the youngest there, so everyone looked surprised to see me there, naturally. I was greeted by a nice receptionist lady who told me to sign in. She looked overwhelmed with the volume of people checking in, but she was still kind and caring.

She asked me quietly if I was ready to pay my coinsurance, and she told me the prices. I was shocked because I was expecting to pay the copay for a specialist, which was $60, but the amount she gave me was close to $200. I told her that I thought it was $60 for a specialist visit, and she informed me that that was the amount they were supposed to bill based on what a third-party billing company reported the payment should have been. She must have sensed that I wasn’t going to pay that amount, so she gave me the number to call the third-party billing company. I called the third-party billing company and got a guy that sounded like he was from India on the line. I told him the situation, and he informed me that they had to have the insurance company on the line to confirm the information. I called the insurance company and tried to conference the call, but by the time I was able to get a representative on the line, the third-party billing company dropped off the call. How frustrating! By this time, my appointment time had already passed, and the doctor’s office was calling me to see if I still wanted to do the appointment.

The lady at the front desk proceeded to take the payment of $60 for the copay. I explained to her that the insurance company agreed that the specialist copay was what I should have paid for the appointment instead of the coinsurance amount of $200. At this point, I don’t know if I will have to pay the coinsurance amount later or if they will accept the copay of the $60 for the visit. What was most concerning is that there is no way for me to know what I will be charged before I have the appointment. Although my Summary of Benefits for the plan states that I will pay a $60 copay for services done at a specialist’s office, they could still charge me the deductible because to the insurance company it is coded as a diagnostic test even though it is done at a specialist’s office. The crazy part is that this is actually a preventative service that should be at NO COST to me.

“Mrs. Lovett,” the technician, called my name to come into the patient area. I went through a stress test on a treadmill where the technician steadily increased the incline and speed while I walked and ran until I reached my maximum heart rate of 175 bpm. She was a bit standoffish at first but warmed up after I mentioned how important getting regular checkups is to our overall health. The test lasted about 15 mins. The doctor came in about 5 minutes later, quickly looked at the scans and said that everything looked good. My ‘pacemaker’ appeared fine. The technician then attached a heart monitor to my chest and gave me instructions as to how to clean myself around it and replace the adhesive. I was told to return the heart monitor after three days of data had been gathered, and I would need to schedule another appointment to get the full results. Meanwhile, I still have no idea how much this will all cost me in the end. Going through this process, I imagined how it must feel to be a person who is not well, who may have just gotten out of the hospital from surgery or recovering from a stroke trying to navigate this situation. How would I have the energy to handle endless calls to the insurance company or waiting on hold for the doctor’s offices and advocate for myself? Sure, some people have family or friends that can help, but what about those who have no one?

As I looked across the waiting room filled with patients in their 50s, 60s, and beyond, I noticed that most of them were alone. A couple of them had oxygen tanks with them. One woman was outside waiting on her Uber smoking a cigarette. I wondered how many of these individuals could have prevented their current situations had they had access to the care they needed at a younger age.

This brings me to ask the question of what is preventative care? I am a proponent of doing your annual physical and getting mammograms if you are a female. But what is considered preventative care according to the standards set by the Patient Protection and Affordable Care Act of 2010? Based on the definitions provided in the Affordable Care Act (ACA) preventive care includes abdominal aortic aneurysm one-time screening for men who smoked, alcohol misuse screening and counseling, aspirin use, blood pressure screening, cholesterol screening, colorectal cancer screening for adults 45 to 75, depression screening, diabetes type 2 screening for adults 40 to 70 years old that are overweight or obese, diet counseling for adults at higher risk of chronic disease, falls prevention, Hepatitis B screening for people at high risk, Hepatitis C screening, HIV screening, PrEP(pre-exposure prophylaxis) HIV prevention medication, immunizations, lung cancer screening for adults 50 to 80 at risk for lung cancer because they are heavy smokers or have quit in the past 15 years, obesity screening and counseling, sexually transmitted infection (STI) prevention counseling, Statin preventive medication for adults 40 to 75 at high risk, syphilis screening, tobacco use screening, and tuberculosis screening for certain adults without symptoms at high risk. These are all important screenings to have; however, many of the issues addressed with these ‘preventive’ measures can’t catch many of the issues that are plaguing younger people in this country. Colon cancer is increasing in patients at a younger age than previous generations. Waiting until you are 50 years of age or older to be able to get a colonoscopy at no charge is too late. Finding out at age 45 that you have kidney disease can be life-threatening.

I believe that technology should make healthcare cheaper and more accessible to more people. I believe that preventive care should include yearly biometric tests that check your cholesterol, blood sugar, and BMI. You should be able to get a complete scan of your body for cancerous cells and abnormalities at no cost. We should be able to get help if needed without having to schedule multiple appointments to get one thing accomplished. How I see it is that if you go to a Primary Care Doctor, they should be able to do a full diagnostic assessment of your health from head to toe. The same way you can take your car to a mechanic to do a diagnostic test to see if your car is running properly. They check your oil, your brakes, and every part of the car’s engine. They check the transmission, and they make sure that if your fluids are low that they refill them. It should be the same with our ‘Preventive’ care. We should get a full blood panel that will check for various diseases and abnormalities. Everything should be checked from our thyroid to our kidneys to our heart. Our flexibility should be checked, our mental health should be checked. Every screening that is available as a preventative service should be provided at that annual checkup. It should be mandatory for every citizen to go in once a year to get this checkup. In this manner, doctors and their patients can take control of situations earlier and drive down the exponential costs that can manifest in casualties from violence, hours of lost work productivity, mental health issues, and the overall degradation of society. Research has shown, and I believe that many of the problems we face as humans can be traced back to our physical, mental, and emotional disparities. Now, more than ever, with technology synergizing into the consciousness of human existence, we need to be voraciously vigilant about the consequences of refusing to notice or acknowledge the impact that our individual health has on our communities and society as a whole.