I've already met my (pretty high) deductible for 2012. What health related things should I consider doing for the rest of the year?

January 24, 2012 4:50 PM

I've already met my (pretty high) deductible for 2012. What health related things should I consider doing for the rest of the year?

I'm 30 years old, male, and have a high deductible insurance plan ($5100 deductible) that generally means most years I pay everything out of pocket. This year I had my tonsils out, so I'm covered 100% for the rest of the year.

I'm curious as to whether there's any preventative care, or anything interesting I should consider for the rest of 2012. Not looking to fleece my insurance company, just looking for valid things I might not normally want to pay for out of pocket. "Would be nice to dos" instead of only the "have to get it done ASAP" type things I normally get handled medically.

Other health info that might be useful, I'm fairly healthy, lift weights and run, but I'm about 35 pounds overweight. Had what I think was a fluke blood clot in my lung in 2008 from a long car ride, otherwise no major medical history.

posted by imabanana to health & fitness (16 answers total)

Might as well get a physical and blood work. If you travel a lot you could consider getting vaccinated for hepatitis (A and/or B).
posted by pombe at 4:55 PM on January 24, 2012

Is there a history of intestinal issues in your family? My husband had his first colonoscopy when he was 30 because of a family history of cancer.
posted by TooFewShoes at 5:11 PM on January 24, 2012

Do you snore or have symptoms that suggests sleep apnea or similar problems which might warrant a sleep study?
posted by needs more cowbell at 5:14 PM on January 24, 2012 [1 favorite]

MOLES. Full-body check, have anything suspicious biopsied and/or removed. (Suspicious ones they often just remove, then biopsy, since moles are small and getting enough tissue for a biopsy may require so much mole you might as well just have it off.) If you have a significant other have him or her come with to help the doctor look for bad-looking ones. (True story: when I couldn't go with to my husband's mole-check, I circled all the ones I didn't like in green ink.)

If the doctor or dermatologist deems is suspicious, my insurance pays. If it's "cosmetic" (which means I don't like it but there's nothing officially suspicious), I pay for the removal. But you can bundle all the removals in one visit and only pay for part of it.

Re-up your vaccinations, especially DPT if your friends are starting to have kids (pertussis is a problem). Your kid-having friends will thank you when they're fretting over a cough going around and you're like, "Let me hold the little nipper while you go shower, I had my DPT booster last year."
posted by Eyebrows McGee at 5:14 PM on January 24, 2012 [5 favorites]

Are you employed? Laser surgery. Health coach for the weight problem. Physical therapy for weight-related joint issues. Free biometric screening. Have an Employee Assistance Program? Check into therapy (my company gives 8 sessions free -- you could use those up and then use your coverage opportunity for more). And yes, dermatologist, chiropractor (depending on your plan). Good luck, good health!
posted by thinkpiece at 5:20 PM on January 24, 2012 [1 favorite]

Are you bow legged, have super flat feet, any gait problems? If yes, check out physical therapy.

Chronic neck, back, anything aches or pains or stiffness? See a DO and have them check you out for any dysfunction in your joints or musculature.

Have you had your heart checked out if there is a history of heart attacks in your family, or if you are overweight/smoker/otherwise at risk.

Colonoscopy. First prostate exam. Detailed blood work. Get baselines for your testosterone, psh, thyroid, cholesterol, etc, etc, etc. All of it. The whole deal.

Nthing vaccines if there is any chance you might consider wanting to think about traveling to any foreign country in the next (however many years each vax is good for, some need to be repeated.) Some adults lose their immunity from childhood vaccines, so have yours checked out. You might think you're protected from something that you actually susceptible to. If you'll be thinking about volunteering with an animal rescue or spending time in the wilds, get the rabies vaccine now, because that one is very expensive. You also do not want to be rushing to the emergency room after an encounter with a raccoon or strange dog.

Allergy testing and therapy. If you get sniffly a few times a year it might not be a common cold, it might be exposure to allergens. And a year of shots might nip that in the bud. Doubly so if you've always known you're a little sensitive to something like particular flowers, or dust.

Is eye care covered in your health plan? If you need glasses, some will pay. But if you need corrective eye surgery, you might be more likely to be covered by health insurance.

Get your flu shot in the fall. Get a physical exam now and then get another one before the year is out. That way you might be able to justify going 13 months before the next one (and so put it to early 2014).

Visits with a nutritionist are often covered for certain health concerns. So if you're a touch overweight, have a family history of....something... or maybe are even just thinking about changing your workout routine but want to ensure you adjust your food intake appropriately, your doctor might be able to refer you.

Caveat emptor. Get written (faxed or emailed) confirmation from your insurance carrier that you are covered for the things you want. Do not rely on them telling you on the phone that the company will pay. Doubly do not rely on information received by your doctor's office. Remember that insurance companies do not make profits by paying claims. And despite what their advertisements would have you believe, your health is not their number one priority. They care about their bottom line above whether you even live or die. Get it in writing or fully expect to pay the entire cost of each procedure or treatment you undergo. Additionally, have a copy of your policy to refer to, in the event that you believe something is covered and they tell you it won't be (see above re: how these companies make profits).
posted by bilabial at 5:50 PM on January 24, 2012 [3 favorites]

Is your insurance policy an employer-sponsored plan (a group plan you get through work) or an individual plan (you bought it on your own in the commercial market)?

Until the federal health care reform law fully rolls out in 2014, individual plans can refuse to renew your policy if they deem you too high a risk.* Lots of health care claims can flag you as "high risk." Keep this in mind if you're on an individual plan, or if you anticipate needing to buy one before 2014.

*Some states already mandate "guaranteed renewal," but most don't. Unfortunately I don't have a list of which do and which don't. But if you *are* on an individual plan, I'd recommend doing some research (maybe on the website of your state insurance commissioner) before diving in and getting every service you think you could use.
posted by celilo at 6:19 PM on January 24, 2012

I would vote for checking on any needed vaccines (seconding the idea of DPT even if your tetanus is up to date), and flu shot.

Full physical. You probably don't need the following: testicular exam, colonoscopy, or prostate exam (see below). It might seem like doing more preventative health services is always a good thing, but it's not, because the tests are not 100% accurate, and you can end up getting procedures like ultrasounds, CT scans, and even biopsies that are unnecessary, not to mention the emotional aspect of a false positive.

You might find this page on the U.S. Preventative Services Task Force Recommendations for Adults to be helpful. Each type of screening is listed with recommendations and rationale. It's pretty easy to read and use.
posted by treehorn+bunny at 6:21 PM on January 24, 2012

celili: I'm self employed, so it's an individual plan. I will definitely look into that.

Thanks everyone else, some very helpful info here.
posted by imabanana at 6:24 PM on January 24, 2012

bilabial: "Are you bow legged, have super flat feet, any gait problems? If yes, check out physical therapy. "

In addition to your legs/feet, have you noticed any wrist pain or arm pain from computer use? Get checked for an RSI, or neck/back disc issue. Physical therapy can really help with those as well. In fact, maybe a consultation with an ergonomics expert regarding your computer setup or other work environment. An ergonomics expert may be a physical therapist anyway, and I'm not sure if something like that would be covered without having been referred by a doctor for a particular problem, but it's something to check.

In addition to physical therapy for gait issues, orthotics might be covered, depending on your plan. Are you a runner, or plan to take up running? This would be the year to start/ramp up training, and shake out any of those foot problems.
posted by SuperSquirrel at 6:32 PM on January 24, 2012

My bad--I did a little more digging and I was wrong: I had confused "guaranteed issue" and "guaranteed renewal." The federal HIPAA law ensures "guaranteed renewal" (requires the opportunity for you to buy the same plan year after year, regardless of health/use of services). It's "guaranteed issue" (the oppty to buy a plan the first time) that is state-by-state until 2014.

However, your plan may still raise your premium upon renewal as a result of your health/cost of care in the previous year. Check out this page for more info: http://101.communitycatalyst.org/key_regulation_concepts?id=0001.

Look for the section that starts "Guaranteed renewal does not mean guaranteed premiums." (You'll see that varies by state, too.)
posted by celilo at 6:33 PM on January 24, 2012

...maybe *check into* a consultation with an ergonomics expert...
posted by SuperSquirrel at 6:33 PM on January 24, 2012

celilio: Yeah, they have raised my rates I think by the max allowed by law every year. That's part of why it's not going to bother me to spend some of their money this year, if I can.
posted by imabanana at 6:43 PM on January 24, 2012

Get blood work done for celiac disease and check for nutrient deficiencies. Lots and lots of different diseases are caused by those two and it takes years to diagnose.
posted by Neekee at 7:15 PM on January 24, 2012 [1 favorite]

Get an EKG to establish what your baseline is while you are young and healthy.
posted by vignettist at 9:29 PM on January 24, 2012

Just because you've hit your deductible threshold, doesn't mean everything is going to be on the insurer. It comes down to what is, or isn't actually covered under your policy. As a hypothetical...It might be that audiology testing isn't an included coverage in your policy. That cost will be entirely on you, despite it being a medical procedure and your having met your deductible.

Check your policy closely to make sure whatever you plan on getting done is actually included under your coverages.
posted by Thorzdad at 6:28 AM on January 25, 2012 [1 favorite]