I know healthcare billing in the US is f-ed up but Stanford is particularly bad.
I can get the price of my fast food burger to the penny - but good luck getting a quote on something that will cost 50,000.
I did medical billing for a bit and in my space 70% of the issue was stupid politics
I'm due for an ICD battery replacement later this year or early next year and trying to figure out where to get it done.
We should crowdsource a guide to navigating healthcare in Northern California, it’s utterly fucked up.
Even getting a primary care physician is impossible, nobody is taking patients and the websites of any place (sutter, ucsf etc) don’t reflect any accurate info about who could actually become a primary care provider for you.
The best healthcare situation I experienced was via Cedar Sinai while we lived in Los Angeles.
I got a physical in Oct 2020, but the coronavirus spiked and it took me until April 2021 to go in and do the labs. One Medical screwed up the billing, coding them as diagnostic instead of preventative (or however that works).
I got nasty letters from both LabCorp and One threatening to send me to collections and ding my credit and all that. I'd text One and they'd be like "oh, just ignore those. We'll fix it." Months go by. "Just ignore them. We'll get to it."
It's such a massive what the fuck.
I'm not 50 years old yet, so I had to pay for it myself. A magical experience, since it's the first time I ever saw a medical bill in my life.
It was two pages long. Everything from taking blood to the medication and doctor was listed there, but the price at the end was only 200€. I thought it was a joke and expected a lot more.
How or why do you think an echo is preventative care? While insurance plans are free to define any additional menu of services as preventative - an echo is not included in the minimum set required by the federal government - which are procedures based off of US preventative services task force guidelines - there are no published guidelines that include an echo.
I wish you luck on your billing problem but I think you’re going to hit a wall on your own definition of “preventative”.
> It's fully preventative in my case.
Fully preventative is not a term of art either for delivery or billing - but there is a difference in categorization between screening tests given to the entire population (ie colon, mammo) and screening given to those with personal risk factors or family history (LD chest CT, echo for congenital HD), and then further on surveillance for personal history of a pre-disposing condition (ie surveillance echo for prior potential fatal arrhythmia).
This is where it starts to get complicated - but the need for an echo every 2 years is not normal. I can't really divine your specific history from the information given - and it isn't necessary - but a history of cardiac arrest alone is not an indication for serial echocardiography. There are numerous specific circumstances where it is recommended, and then there are the cases where it is not consensus recommended but there is controversy. I assume because your insurance company is willing to touch it at all it falls in the former - but we are way off the ranch here in terms of the scope of routine preventative care/health maintenance.
As to whether it should be this way, probably not. If a surveillance echo is clearly indicated to prevent costly sequelae (unfortunately answering this question isn't nearly cut and dry as most think), then it makes sense that an insurance or public health agency would want to do this. Curious if you know if your indication for serial echocardiography falls under the European guidelines? Maybe move there /s. Is Stanford your only reasonable place to obtain an echo?
The simple answer to this is that “preventative” in the case of billed medical services has a specific and clearly defined meaning - it does not even mean all services that ever would be considered preventative. This definition will be found in your insurance paperwork and corresponds at least to the site I posted - so a further philosophical discussion is irrelevant.
To your actual question - No, the echo is usually pallative. However, right off the bat I'll say this is an overly reductionist and not terribly useful schema for classifying the delivery of medical care. While it might be good as a way for the general public to think about prevention, it’s way too oversimplistic to be useful beyond that.
An aside, palliative has a specific and different meaning within medicine: roughly, treating symptoms without a goal of cure. Reducing a broken arm or removing an inflamed appendix is not palliative care in that sense.
But even if we widen the scope of palliative to be treatment an echo would be neither. An echo is diagnostic - it doesn’t prevent nor treat heart failure or disease. Often when an echo is ordered it leads to some form of treatment for some found disease, in which case if we’re going to stick to the simple classification would be “palliative” - we’re using it to guide treatment, we can’t prevent something that we already see.
> If he had violent symptoms it would clearly be palliative
It's just not that simple. Echos are sometimes used to further evaluate or manage asymptomatic disease, for instance A-fib or a concerning murmur. We're using the echo to rule out suspected coexisting conditions, that's not prevention, and it's not treatment either at that point. Also, echos usually have some symptomatic indication - and they don't have to be violent, whatever that means.
> it can only be preventative
Can you actually think of a disease that an echo would be used to prevent?
But again, in practice we don’t think of delivery of medical care in such grossly general terms - it’s doesn’t simplify in a useful way.
Yes, checking the extent of mitral valve prolapse (which I have, doesn't warrant valve surgery yet but it's expected I may need valve repair in 10-30 years if it gets worse), ejection fraction, early detection of dilated cardiomyopathy (which I'm known to be genetically predisposed to), etc.
Ejection fraction is not a disease, but let's call it heart failure. An echo evaluating for heart failure is a good example where we can use it as a diagnostic tool to prevent further progression - but again through other interventions - and if we're evaluating for abnormal ejection fraction we haven't prevented it.
Another example might be evaluating for a shunt to prevent stroke. However we don't routinely screen everyone for this.
Echo for inherited cardiomyopathies is a good example of primary or secondary prevention.
There are definitions within medicine that matter for defining appropriate use criteria, but all this preventive vs palliative is arguing loose semantics - the people you’re up against have already put in place the policy to avoid most of that.
This is about the 6th time this has happened. It's always 15+ e-mails back and forth, then threatening lawyers, then they back off.
I'm wondering if it would be faster if I just take it directly to a small claims court. I am insured and it is preventative care, so I believe I'm entitled to pay nothing. Advice welcome.