Employer wellness screening and pregnancy
August 27, 2013 2:01 PM Subscribe
Medical mefites: How much will my pregnancy skew my employer-sponsored health plan wellness program biometric screening (blood tests only)?
First, yes, I can ask one of my doctors this, but this is all happening so fast that I don't have time - the deadline for the labs are before I could explain it to any of my docs. THIS IS NOT A MEDICAL TREATMENT QUESTION - no decision I make will affect my health. It's a general question as to what might show up in a pregnant woman's blood work. Sorry it got long.
My employer has a wellness program, under which participants can get an insurance premium discount if the meet certain health standards (it violates HIPAA in various ways, but that's another story). Under this particular program, the weight (BMI incentive) and BP are self-reported, so I'm not worried about that (I already reported them).
However, I wonder about the bloodwork part. I just found out that I am pregnant (only 5 weeks, but yay!). While I know that my condition would have to be taken into account for a reasonable alternative standard under HIPAA (i.e. I'd still be able to get the discount), I'm not that interested in revealing my pregnancy to anyone yet (except my husband), much less my employer. It's a self-funded plan, so while I know the plan and the employer are separate entities, my confidence in their discretion, based on past first and secondhand experience with information sharing between the TPA and vendors and my employer is not great. I know people have volunteered the information to the lab worker, who makes a note, etc, I just really don't trust the plan with this information.
As a bonus, because I have an autoimmune condition for which I stopped taking my biologic (Enbrel) while trying to conceive, my sed rate and white cells would certainly be high, though I don't think that would affect anything related to the wellness program discount.
Oh, I also have subclinical hypothyroid and a slight Vit D deficiency, for which I take levothyroxine and Vit D. My endo is also ordering bloodwork to see if we need to adjust because of the pregnancy.
So, at 5-6 weeks pregnant and having not taken Enbrel for months (I do have swollen joints, fluid, etc), what are the chances that the labs below would show up as out of a healthy range? I think HDL and LDL are the only labs tied to the wellness reward (in addition to BMI, DP and being a nonsmoker), so I don't think any white blood cell or anemia stuff would hurt me. Other than chronic conditions mentioned above, I am a healthy, mostly vegetarian, extremely fit woman in my mid-late 30s. I have been taking prenatal vitamins for 3 months.
I googled all the tests, but could only come up with a few answers as to what they are and what might affect them:
CMP12
LP
7AC
Mg
T4
CBC/Pl
Tl;dr: I have to get bloodwork done to earn a health insurance discount the results of which I am nervous because I just found out I am pregnant (5-6 weeks). Could the above tests be so skewed to the extent that I should tell the labworker (and just be anxious that my employer will find out) OR might they be in the normal range, so should I sit tight and explain/appeal the results as "abnormal" if it comes up (and have to make a bigger deal of it at that time).
I know noone can predict what my bloodwork will show, I'm looking for "X tends to rise/fall in the first trimester, which could affect test Y, above."
First, yes, I can ask one of my doctors this, but this is all happening so fast that I don't have time - the deadline for the labs are before I could explain it to any of my docs. THIS IS NOT A MEDICAL TREATMENT QUESTION - no decision I make will affect my health. It's a general question as to what might show up in a pregnant woman's blood work. Sorry it got long.
My employer has a wellness program, under which participants can get an insurance premium discount if the meet certain health standards (it violates HIPAA in various ways, but that's another story). Under this particular program, the weight (BMI incentive) and BP are self-reported, so I'm not worried about that (I already reported them).
However, I wonder about the bloodwork part. I just found out that I am pregnant (only 5 weeks, but yay!). While I know that my condition would have to be taken into account for a reasonable alternative standard under HIPAA (i.e. I'd still be able to get the discount), I'm not that interested in revealing my pregnancy to anyone yet (except my husband), much less my employer. It's a self-funded plan, so while I know the plan and the employer are separate entities, my confidence in their discretion, based on past first and secondhand experience with information sharing between the TPA and vendors and my employer is not great. I know people have volunteered the information to the lab worker, who makes a note, etc, I just really don't trust the plan with this information.
As a bonus, because I have an autoimmune condition for which I stopped taking my biologic (Enbrel) while trying to conceive, my sed rate and white cells would certainly be high, though I don't think that would affect anything related to the wellness program discount.
Oh, I also have subclinical hypothyroid and a slight Vit D deficiency, for which I take levothyroxine and Vit D. My endo is also ordering bloodwork to see if we need to adjust because of the pregnancy.
So, at 5-6 weeks pregnant and having not taken Enbrel for months (I do have swollen joints, fluid, etc), what are the chances that the labs below would show up as out of a healthy range? I think HDL and LDL are the only labs tied to the wellness reward (in addition to BMI, DP and being a nonsmoker), so I don't think any white blood cell or anemia stuff would hurt me. Other than chronic conditions mentioned above, I am a healthy, mostly vegetarian, extremely fit woman in my mid-late 30s. I have been taking prenatal vitamins for 3 months.
I googled all the tests, but could only come up with a few answers as to what they are and what might affect them:
CMP12
LP
7AC
Mg
T4
CBC/Pl
Tl;dr: I have to get bloodwork done to earn a health insurance discount the results of which I am nervous because I just found out I am pregnant (5-6 weeks). Could the above tests be so skewed to the extent that I should tell the labworker (and just be anxious that my employer will find out) OR might they be in the normal range, so should I sit tight and explain/appeal the results as "abnormal" if it comes up (and have to make a bigger deal of it at that time).
I know noone can predict what my bloodwork will show, I'm looking for "X tends to rise/fall in the first trimester, which could affect test Y, above."
Mod note: Few comments removed, answer the question or move on please
posted by jessamyn (staff) at 2:21 PM on August 27, 2013
posted by jessamyn (staff) at 2:21 PM on August 27, 2013
Your triglycerides might show up high, which is normal for pregnancy. I would wait it out and explain later, if necessary. My employer does this, and yes, our discount is for simply having the screening done.
posted by peep at 2:23 PM on August 27, 2013 [1 favorite]
posted by peep at 2:23 PM on August 27, 2013 [1 favorite]
Mod note: This is a followup from the asker.
Obtaining the actual health standard, is, in fact, the way to get the discount in this case. This is a HIPAA wellness program. We are required to have a certain BMI, BP, and some aspects of the bloodwork (again, triglycerides but maybe other stuff?) to get the discount, with the legal requirement that someone must have a reasonable alternative standard if they "fail" to meet the standard for a medical reason (e.g. pregnancy).posted by cortex (staff) at 2:31 PM on August 27, 2013
Thanks for the answers so far.
Out of curiosity, I went back & looked. I was 22 weeks pregnant during the screening. My HDL was a bit low (43, should be >50) and my triglycerides were 271 (should be <150!). The following year(s) everything was normal, just to give you a baseline (e.g. triglycerides were 133).
posted by peep at 2:35 PM on August 27, 2013
posted by peep at 2:35 PM on August 27, 2013
Is the discount sufficiently high that you'd be willing to risk telling your employer that you're pregnant in order to get the alternative standard? Or is it that you're afraid someone will be able to tell from the screen (or from you failing the screen) that you're pregnant? If you're married and in your thirties someone in the office probably already suspects you're pregnant and the test results probably won't be the deciding factor one way or another.
posted by mskyle at 2:41 PM on August 27, 2013 [1 favorite]
posted by mskyle at 2:41 PM on August 27, 2013 [1 favorite]
I would be very surprised if early pregnancy caused any of those tests to fall outside of the normal range in a fit young vegetarian woman. Possibly the triglycerides in the lipid panel, but if you fast as directed you should be OK.
The only other thing I would be even a little concerned about is the T4, since thyroid hormone requirements tend to increase in pregnancy, but the TSH is an order of magnitude more sensitive to these fluctuations than the T4 so I would suspect that even if you do need a bit more thyroid hormone it wouldn't show up in the T4. But you are already on thyroid supplementation so that is easily explained.
It's not clear to me why they're bothering to do all that bloodwork if all they're going to look at is the HDL and LDL, but whatever.
posted by The Elusive Architeuthis at 3:14 PM on August 27, 2013 [1 favorite]
The only other thing I would be even a little concerned about is the T4, since thyroid hormone requirements tend to increase in pregnancy, but the TSH is an order of magnitude more sensitive to these fluctuations than the T4 so I would suspect that even if you do need a bit more thyroid hormone it wouldn't show up in the T4. But you are already on thyroid supplementation so that is easily explained.
It's not clear to me why they're bothering to do all that bloodwork if all they're going to look at is the HDL and LDL, but whatever.
posted by The Elusive Architeuthis at 3:14 PM on August 27, 2013 [1 favorite]
The person who is taking your sample for the screening likely does not have any decision making capabilities as far as your discount goes. My employer is a corporation and all disputes with regards to the results and the resulting consequences were handled by the folks who handle our HR. Your HR or the screening company should have an appeals process. I attempted to appeal a result of my screening (long story) and one of the appeal options was visiting my Dr. and having him provide reasoning behind my results to the appeals department.
posted by txtwinkletoes at 3:17 PM on August 27, 2013 [1 favorite]
posted by txtwinkletoes at 3:17 PM on August 27, 2013 [1 favorite]
We have the same test through my husband's insurance. We've been doing it for a few years now. We can do ours in person, send in results from our own personal doctor doing lab tests or send it in via postal mail where you prick your finger, put it on a sample card and mail it in. Actually one year, it was in some weird sample tube thing that drew the blood in until a line showed up, sort of like a pregnancy test would.
Anyway, a couple things:
- We annually participate in this program. I feel it's invasive on a couple levels even so.
- Blood was always collected independently of BMI, BP, non-smoker pledge, etc.
- When I was pregnant, I didn't mention I was pregnant. I was about 5 months along at the time of testing and nothing came back flagged for an explanation.
- I've done the blood screening while on other medications that I never disclosed. Nothing came back flagged for an explanation.
- I've sent back a bad sample, meaning I knew I didn't get the correct amount of blood on that card. If I recall, I was sick and had the baby already and the deadline was upon us to post mark it, and seriously, I just wasn't going to seriously stab myself in the finger hard. Just wasn't happening. I figured worst case scenario, they'd flag me for another test due to insufficient sample. Well they did flag me for insufficient sample, but did not request another and still gave us the discount. So, hey, awesome.
Long story short, I vote for sit tight and see what happens. I honestly think it's not all that heavily scrutinized based on my experience with it over the years.
Congrats on the baby! Kids are a trip!
posted by jerseygirl at 3:57 PM on August 27, 2013 [1 favorite]
Anyway, a couple things:
- We annually participate in this program. I feel it's invasive on a couple levels even so.
- Blood was always collected independently of BMI, BP, non-smoker pledge, etc.
- When I was pregnant, I didn't mention I was pregnant. I was about 5 months along at the time of testing and nothing came back flagged for an explanation.
- I've done the blood screening while on other medications that I never disclosed. Nothing came back flagged for an explanation.
- I've sent back a bad sample, meaning I knew I didn't get the correct amount of blood on that card. If I recall, I was sick and had the baby already and the deadline was upon us to post mark it, and seriously, I just wasn't going to seriously stab myself in the finger hard. Just wasn't happening. I figured worst case scenario, they'd flag me for another test due to insufficient sample. Well they did flag me for insufficient sample, but did not request another and still gave us the discount. So, hey, awesome.
Long story short, I vote for sit tight and see what happens. I honestly think it's not all that heavily scrutinized based on my experience with it over the years.
Congrats on the baby! Kids are a trip!
posted by jerseygirl at 3:57 PM on August 27, 2013 [1 favorite]
Congratulations!
This link outlines all the individual components of all the tests, with links to more information about each one. You're getting a comprehensive metabolic panel, a complete blood count with platelets, a lipid panel, a thyroxine level, and a couple of other random things (magnesium, etc.).
One of the components, alkaline phosphatase, is routinely quite elevated in pregnant women in the third trimester, but not before that.
I am unaware of any way in which a very early pregnancy could meaningfully alter the results of any of these tests.
posted by jesourie at 4:12 PM on August 27, 2013
This link outlines all the individual components of all the tests, with links to more information about each one. You're getting a comprehensive metabolic panel, a complete blood count with platelets, a lipid panel, a thyroxine level, and a couple of other random things (magnesium, etc.).
One of the components, alkaline phosphatase, is routinely quite elevated in pregnant women in the third trimester, but not before that.
I am unaware of any way in which a very early pregnancy could meaningfully alter the results of any of these tests.
posted by jesourie at 4:12 PM on August 27, 2013
2nding the Elusive A., and adding that she is a doctor (NYD, and neither am I) because she didn't mention it.
On a non-medical note, what's the worst that could happen if you don't mention it - perhaps something like triglycerides comes back as elevated, and couldn't you make the decision at that point whether to talk to your employer about the fact that it could be pregnancy related and therefore, shouldn't 'count' against you? I can understand you not wanting to mention this to anyone if you don't have to at this point, but it seems to me that you could make the decision after the fact in the unlikely event that there is an abnormality.
posted by treehorn+bunny at 5:21 PM on August 27, 2013
On a non-medical note, what's the worst that could happen if you don't mention it - perhaps something like triglycerides comes back as elevated, and couldn't you make the decision at that point whether to talk to your employer about the fact that it could be pregnancy related and therefore, shouldn't 'count' against you? I can understand you not wanting to mention this to anyone if you don't have to at this point, but it seems to me that you could make the decision after the fact in the unlikely event that there is an abnormality.
posted by treehorn+bunny at 5:21 PM on August 27, 2013
It is pretty common for the white blood cell count to rise in pregnancy.
It is not an indicator of pregnancy but could spark the medical people to ask for follow up evaluations. It did when I had was early in a pregnancy.
posted by SLC Mom at 6:23 PM on August 27, 2013
It is not an indicator of pregnancy but could spark the medical people to ask for follow up evaluations. It did when I had was early in a pregnancy.
posted by SLC Mom at 6:23 PM on August 27, 2013
This thread is closed to new comments.
As for the medical testing folks telling your employer...I'm thinking it's not really something you should be overly concerned with.
If the tech asks, explain that you're in your first trimester, but I doubt anyone will ask. I'd be surprised if the blood work is beyond, Cholesterol, Triglycerides and a fasting blood sugar. That's all they are where I work.
It's not going to be a full blood panel. I'll be SHOCKED if it is.
While you don't want your employer to know that you're pregnant, in the grand scheme of things, it will out eventually. But I honestly believe that this blood test will not reveal that.
posted by Ruthless Bunny at 2:15 PM on August 27, 2013