Look out for yourself - testing can be off the record

Real threat for health care is how insurance companies define pre-existing conditions now. There are many ways to protect yourself while also getting the needed information.

Transcript

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Hi, Angelique Clemens, the host of the podcast, Can I Borrow Your Skin? And this week, and one of the big reasons why I wanted to address minority health has a lot to do with the pre-existing conditions that were put in place under George W. Bush to his presidency. And the reason why this was important is because insurance companies at the time took the pre-existing condition statute and decided, because they are for profit to decrease what they paid for. And so they decided that having a genetic marker for something was the same as having a pre-existing condition. So let's talk about that in detail. So, first of all, just because you have a gene, it does not mean you will get the condition, the disease that's called dominance. And even if you did get it, it doesn't mean that it will be that bad. That's called penetrance. And I'm gonna bring those words up again in a few months, and so that's important. So to be denied health care, number one, for you to have to be charged more, number two, and number three, for your care to be decreased based on your insurance level, just because you did a genetic test, was fucking insane. Absolutely insane. And so there was also this thing that was put in place with the pre-existing conditions laws was the idea that you can max out on insurance. Now, what does that mean? It means that a lot of people nowadays pick the deductible that's either the lowest so that insurance pays for so much of things, or they pick the highest so that their insurance premiums are cheaper. Well, this is actually called a lifetime max out. It meant that the insurance company would only pay so much money, and I think at the time it was $1 million, and then they didn't have to pay for any health care for you for the rest of your life. And a lot of people are like, oh, well, that's a lot of money. Let me give you an example on why that's not a lot of money. Say you have to have a kidney transplant. There are a lot of conditions that would um require you to get a kidney transplant. It is one of the more common transplants that are actually done. And so a kidney transplant in the United States right now is about $450,000. So that's gonna be $142,500 for the hospital, $130 uh, about $135 for the organ itself. You're gonna pay $88,000 for the 180 days post-care. And then you have about $22,000 for the doctor. Now, anti-rejection medication, which you will pretty much be on for the rest of your life, costs between $18,000 and $21,000, $22,000 per year. And then, and that's going to be immediately after, and then it decreases as your body stops trying to attack the organ and starts to recognize the organ as your own, then it gets to about $10,000 to $15,000 per year. And if you spend, if you have insurance, you will spend probably only about 20,000, 20% of that is out of pocket until you reach your max. So if you have a deductible of, you know, say $1,000 with out-of-pocket max of $4,000, you're only going to pay about four grand because your 20% is way, um, it would be way more than that um $440,000. Well, if you had an out-of-pocket max of, you know, if you if you had a lifetime max of $1 million, just having a kidney transplant would pretty much put you at your your lifetime risk. And you also of max, and then you have to understand too, there are some insurances that won't pay for the maintenance medication. That's what it's called. They will only pay for the transplant itself. Like, for example, Medicare will not pay for the medication, but they will pay for the surgery and only a small percentage of the surgery. Then you have some insurances that won't pay for the um surgery unless it's deemed required for your life. And so then that's when you start getting into people having to rob Peter to pay Paul when it comes to health care. And um, I will tell you that there are some great institutions out there, and you can actually get genetic testing without the knowledge of your health system or your insurance company and just pay for it out of pocket. Um, I did that myself. Um, you have companies like Color, um, Color.com, and they do a fair amount of testing and it's only a couple hundred bucks. You get the results, they come straight to you in your email. Your doctor doesn't have to know about it, your insurance company doesn't have to know about it, but then you have that knowledge to make decisions that you need to make um based on those test results. I've you everyone seen the commercial for cola guard? If colon cancer runs in your family, you can do a cola guard test. I know that at 45 years old, if you are at um, you know, average risk for colon cancer, they tell you at 45 to start getting the testing. Um, me personally, when I turned 45, I did cola guard. They give you the results, you can give them to your doctor or not. That's really up to you. But it's good to have the knowledge. Um, but sometimes you don't want certain things in your chart. And that's important because not wanting certain things in your chart could actually save you a lot of money. Um, it keeps it also increases the amount that you have to get to to max out. I think they changed it from having the million dollars. I think insurance companies have to have um increased amounts of money before you max out. And there's some insurance companies that don't actually have the max out option. And so you have to really look at that when you start looking at insurance. I will tell you, Good RX, they have a bunch of commercials out there for prescriptions, is important because, like I said, Medicare will not pay for your maintenance medication if you have a transplant. They'll only pay for the procedure itself. I would like to say that none of the brand names I mentioned here gave me any money to mention them. I mentioned them because as someone of good conscience that knows these resources, I could not not share them with you. Double negative, what what? So I want to tell you that there are a lot of options out there. Um, and I I myself I do did some research on some of them, but I didn't do research on all of them. So it's important as you start going through your healthcare journey for you to look at some of the things that are available to you out there, some of the things that it might behoove you to keep out of your chart. Genetic testing might be one of them. There are a lot of health systems that do have geneticists on staff where they will put down all of this information to help, you know, guide your care. There are some heart disease markers that color does test for as well. Um, there's other cancers besides breast and ovarian cancers that they test for. There are some places that will test for prostate markers. Um, PSA um has be been debunked by the American U Medical Association. I know doctors still test for it. I personally don't see a lot of um use for that test just based on the things that I've read and their false positive and false negative rates. Um you know, prostate exams are still the best way to go. I know a lot of people don't like the idea of the prostate exam, but at least it's not a coposcopy, fellas. Buck up. So at the end of the day, I think that it is very, very important for you to understand what your insurance maxes are, to understand the way the pre-existing conditions clauses work with your health insurance and to make decisions on testing once you understand that information. And to also understand as you're moving from one insurance company to the other, whether it's because you've changed jobs, whether you and your spouse have looked down and seen whose insurance is better, see what those um requirements and things are with your new insurances as well, because there are some things that stay in your chart perpetually. Usually, you know, blood test results and things like that stay on your chart perpetually. So, you know, if you had a pre-existing clause on one insurance but not the other, that would follow you if it's in your charts and how it's in your chart. And so there's certain things that you should look at, should look into, and know about. And that's why sometimes getting testing outside of your insurance might be hoove you to do. So that's my little tidbit for uh this third week in April. Short, sweet, but very informative. Thank you guys so very much. Like, subscribe, follow. Bye.