Search Results for: "skin cancer"

April 12, 2016 By e-Patient Dave 6 Comments

The difficulty of shopping when they hide the facts: that skin cancer RFP in the NY Times

$5,000-$7,000? $1200-$1500? $868? What should it cost to remove a simple skin cancer? What if you can’t find out?

Long-time readers know that in 2012 I was on high deductible insurance – and I don’t mean Obamacare-style $3,000 deductible, I mean $10,000 deductible. I chose that gladly, because I had laboriously analyzed the five plans available to me. I know insurance is a game of sharing risks, so I analyzed (it took all my Excel skills) and chose.

What happened next is described in a column in today’s NY Times by Tina Rosenberg, Shopping for Health Care: A Fledgling Craft: within months I discovered I had a skin cancer on my face. I became a highly motivated shopper, and quickly discovered nobody could tell me what would be on my bill.

The details are in several skin cancer posts here. But Tina Rosenberg writes about social problems, and I want to draw attention to the nature of this social problem: it withholds power from the person whose health is at stake, and that’s just plain wrong.

Here’s the World Bank’s definition of empowerment, from a January post:
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March 11, 2014 By e-Patient Dave 64 Comments

How much should/could this pathology cost? (Skin cancer biopsies)

I’m going to START with three clarifications, because sometimes people don’t read footnotes. :-) Read before proceeding.

I’m NOT saying there’s anything wrong here – don’t anyone assume that every time I blog, it’s a warpath. :) I’m just asking a question. My guiding principle on medical treatments and costs is that people should know what their options are, so I’m presenting my situation and asking.

I’m also NOT asking for treatment advice – I’m only asking about costs and whether it sometimes makes sense to get pathology done elsewhere. (We’ve already discussed treatments and I’m satisfied.)

As I’ve said before, I’m NOT recommending that anyone else act as I choose to.

Also, regular readers know that as a former cancer patient in New Hampshire, my insurance options were limited, and I chose $10,000 deductible, so all of this will come out of my pocket. As I’ve blogged many times before, this turns out to be a nifty way to discover how the money actually flows in American healthcare, which is usually really hard to find out.
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Below is the pathology report from some biopsies I got in January. The bill is $416 list price; after the usual insurance discount, my balance due is $312.

My questions:
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February 11, 2012 By e-Patient Dave 57 Comments

I’ve started an RFP for my skin cancer

Be sure to scan the 57 comments readers added, below.

The other day I announced my new skin cancer diagnosis and discussed how I’ll blog my approach to it as an e-patient.

I’ve decided to explore my options by doing what companies do when they’re shopping for a solution: they write a Request for Proposals, and let vendors reply. But in this case what I published isn’t cast in stone – I invite discussion and suggestions. And, significantly, I start with the context: partnership; participatory medicine –

I’m approaching this through an RFP process because I believe in “participatory medicine,” in which patients play an active and responsible role in all aspects of healthcare. I believe patients should play an active role in making care more cost-effective and patient-centered, by being responsible about costs and by saying what they want.

Here’s the RFP, in Google Docs. At top right of that page there’s a place to leave comments, or discuss here. Thanks for helping!

Update: This triggered an enormous amount of discussion on social media, additional posts here (with the results of my shopping), and even an article four years later in the New York Times, which I posted about with additional thoughts and resources. [Read more…]

February 9, 2012 By e-Patient Dave 58 Comments

Time to practice what I preach: I have skin cancer again.

Photo of the lesion, Nov. 15 (click to enlarge, if you really want)

Update Feb. 11: I’ve decided to publish what I want to find in a provider: see this post.

Be sure too to read the substantial information contributed below in comments, some by e-patients and some by participatory providers. This process is interesting to observe!

An odd consequence of speaking at medical conferences is that sometimes my face is displayed, real big, on monitors at the front of a room. That happened in November at the Aligning Forces for Quality (AF4Q) annual meeting in Washington.

At the end, Lisa Letourneau MD, MPH of Maine Quality Counts raced up, pointed to my jaw, and said “You should have that checked. I think it’s a basal cell.” (That’s the least serious type of skin cancer – see Wikipedia: “Basal-cell carcinoma (BCC) is the most common type of skin cancer. It rarely metastasizes or kills.”) A few days later I took the picture at left, and started watching.

I had a basal cell removed from my nose 30+ years ago. (More on this in a moment.)

To me it was just a shaving cut… but, I realized, it wouldn’t heal. For the next two months I was a slug (a not-engaged patient!), but I did take pictures, and son of a gun it did not get better, even when I thought it was finally going away.

When I had my annual physical recently, I asked my doctor, and he looked and said, “Get a biopsy.” I did, this week, and today they called. Yup, it’s a basal cell. Thanks, Dr. L!

Remember how you’ve always heard that a warning sign is “a sore that won’t heal”? I guess they mean it. I kept kidding myself, thinking I was continuing to re-injure it shaving. (Not bright, I know.) Then, just before the physical, I ran across a summer photo, and there it was. So I guess it was there longer than I realized.

I’m going to blog this experience, as I try to practice what I preach: get engaged, learn what I can, explore my treatment options, connect with other patients.

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November 15, 2021 By e-Patient Dave 9 Comments

Time to practice what I preach, again: this time it’s glaucoma.

I have a new diagnosis. This post starts with a little history for context.

Ten years ago, three years into evangelizing patient engagement based on my kidney cancer story, I posted Time to practice what I preach: I have skin cancer again. Noting the pattern that highly engaged patients everywhere follow, I blogged that it was time to …

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July 13, 2018 By e-Patient Dave Leave a Comment

“What will this cost?” Episode 4 of Power of the Patient, with Clear Health Costs

Episode 4 of the Power of the Patient podcast is live here.

Want better control over your health costs? Investigative journalism has finally come to healthcare, and it’s winning prizes bigtime.

My guest Jeanne Pinder is a former New York Times editor whose company Clear Health Costs has just won the Edward R. Murrow award for investigative journalism, for their contribution to the “Cracking the Code” series in New Orleans. [Read more…]