Joanna Weiss’s July 29 op-ed column “Mysteries of a high deductible” points out serious issues with health care plans that have high deductibles and unwise choices patients make as a consequence. Typical of these plans, “routine” exams and tests are covered in full, right from the start. However, for any “diagnostic” test (done because of an abnormal finding on physical exam or on prior testing), patients with deductible plans are responsible for the full cost of the tests until they have reached their deductible, after which the health insurance plan covers any additional costs.
In the past, if a patient came in for a mammogram and was found to have an abnormality that might be further illuminated by additional mammogram images or by an ultrasound, this testing often was done right away. However, this is now usually done at a separate visit.
I have had patients decline additional testing, even though it is being recommended to detect possible breast cancer, because further testing would be deemed diagnostic and fall under a deductible.
Other patients, for whom I had recommended mammograms, breast ultrasounds, or both because of lumps I’d found, have refused the tests because they were considered diagnostic.
I am grateful to Weiss for highlighting the vagaries of health care plans with high deductibles. Even in the relatively affluent community in which I practice, economic realities play a big part in the decisions of many of my patients, although the consequences of their decisions could cost them their lives.
I don’t think our patients should be forced to make such horrible decisions. What we health care providers might term an “unwise choice” might just be food on the table for a patient’s family for the next few months.