“Covid fees” added to your medical bill

 My husband’s periodontist has raised his rates to offset the costs of “covid-proofing” his office. Among other modifications—which I guess include personal protective equipment—the doctor has installed fancy air purifiers. Apparently, adding charges to patients’ bills have become commonplace. They’re called “covid fees,” and they range from a few dollars to nearly $1000.

These fees are often billed directly to the patient and are not covered by insurance. For example, one dentist tacks on an additional $45 to patients’ teeth-cleaning bills. In some states, this is a violation of consumer protection laws. Some insurers reimburse part of these added fees, which, in dental offices, range from $12 to $45. If the insurance company does reimburse, they pay between $7 and $10—that is, if you have dental insurance. We do not.

While such charges have become commonplace in dental offices, they’re also cropping up elsewhere, such as assisted living facilities. One resident was charged a $60 fee for personal protective equipment on top of a one-mile ambulance ride that already cost $1,759 before the fee. Another woman was charged a one-time $900 fee for masks, cleaning supplies, and meal delivery.

Of course, dentists and other medical establishments are taking a financial hit because of the pandemic. But—I don’t know—adding a covid fee to our bills just doesn’t sit right with me. I object.

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About those Covid-19 tests

 I haven’t had one, not that I haven’t tried. Here’s the deal with them: There are three kinds of tests—

PCR virus test. PCR stands for polymerase chain reaction, a system that analyzes DNA—the DNA of the virus in this case. It can detect an active infection from a sample you get by swabbing your nose or back of your throat. Because the samples go to a lab for analysis, it takes several days to get the results back. With PCR tests, false positive rates are extremely low and are usually caused by mishandling the specimens in the lab. False negative results can occur during the first week of infection, usually because the virus isn’t yet present in detectable quantities. According to a study in the Annals of Internal Medicine, the probability of a false negative PCR result is 100 percent on the first day of infection and decreases to 20 percent by the eighth day. This test is considered the most reliable.

Antigen test. An antigen is a substance that causes your immune system to produce antibodies against it. The antigen test looks for certain molecules on the surface of the virus. This test also requires nasal swabbing. Positive results from antigen tests are highly accurate, but the test has about a 50% rate of false negatives. In other words, negative results don’t rule out infection. Though less accurate than a PCR test, you get results in minutes, sort of like a pregnancy test. A number of companies are producing these tests. 

Molecule test. It's a do-it-yourself test that checks for virus RNA molecules. You swab your nose, stick the swab in a container containing a chemical that changes color depending on the results, which take 30 minutes. The FDA just approved one of these tests: the Lucira COVID-19 All-In-One Test Kit. A positive result probably means you have the virus; a negative result does not necessarily mean you don't.

As to my experience: We were all set to have tests prior to a trip but cancelled the trip as well as our tests. At the same time, in the interests of science, I’d signed up to take the test for the Stanford CATCH study, which is tracking the spread of Covid-19 in the San Francisco Bay Area. But the couriers who deliver the test kit and pick up the sample couldn’t find my house.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Your nails know

 Recently, a specialist looked at my sister’s fingernails for a clue in diagnosing her ailment. Yes. The condition of your fingernails can signify various maladies:

·       White nails (the whole nail): liver diseases, such as hepatitis; low protein stores; kidney failure.

·       Yellow nails: respiratory disease such as chronic bronchitis; fungal infection.

·       Blue nails: lung issues, such as emphysema; heart problems; excessive silver consumption; bacterial infection of the nail; Wilson’s disease (a genetic condition that causes high levels of copper in the body).

·       Dark lines under the nail: possible sign of melanoma, but can also be moles, trauma, or medication-induced changes.

·       Clubbing (see photo below): lung disease; inflammatory bowel disease; heart disease; liver disease; thyroid disease; HIV/AIDS.

·       Horizontal indentations: diabetes; severe injury; past illness or medication exposure; zinc deficiency.

·       Pitting: psoriasis; connective tissue disorders.

·       Spoon shape (depressed and scooped out): iron deficiency anemia; hemochromatosis; heart disease; hypothyroidism.

·       Separation from nail bed: thyroid disease; psoriasis; injury or infection; reaction to drugs or consumer products.

I didn't say anything about how nails change as we age. My fingernails have curved inward from the sides. I found no information on that. 

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Be patient!

 People are designed to be impatient. We do not like slow elevators or slow internet connections. We do not like waiting in lines or waiting on the phone for the customer support representative. But impatience comes at a price. According to Dr. Amit Sood, a researcher at the Mayo Clinic, impatience can result in anxiety, illness, injury, loneliness and even death. “An episode of explosive anger, stress or impatience can increase your risk of heart attack and sudden death by two to eightfold for the next few hours.” Most of us know that stress increases blood pressure and heartbeat. But studies have also shown that impatient people have shorter telomeres—the structures at the end of chromosomes that protect the end of the chromosome from deterioration.

Impatience is linked to lack of control, uncertainty, and boredom—conditions we humans try to avoid. (Researchers gave test subjects—all men—the choice to sit alone and get bored, or to give themselves a painful electric shock. About 70% chose the electric shock.)

During this coronavirus pandemic, our patience is sorely tested. But Dr. Sood tells us that being patient is a choice and that the pandemic offers a “tremendous opportunity” to practice patience. If you’re not good at that, try learning to be resilient. “You do not have any bullets, you do not have any swords. You can’t fist-fight with this virus…You can empower your billions of immune cells to fight with this virus. And when you are resilient, your immune cells are stronger in waging that war.”

I am not a patient person. I don’t like waiting for golfers ahead of me to get out of the way. I’m impatient to make a play in Words with Friends rather than taking my time to look for the best move. But I think I am a resilient person. So maybe it all balances out. I hope.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Arthroscopic surgery on knees--forget it

In arthroscopic surgery, a procedure that was started in the 1970s, the surgeon makes a couple of small incisions in the knee and inserts a fiber-optic arthroscope to take a look around, then washes out the joint with about ten quarts of saltwater to remove bits of cartilage, bony fragments, calcium crystals, and inflammatory cells.  He or she may also smooth out frayed cartilage and meniscus that cover the top and sides of the knee.

By 2002, fourteen studies had shown that arthroscopic surgery offered substantial pain relief. None, however, compared people who had had the arthroscopic surgery with those who hadn’t. In 2002, however, researchers at the Houston Veterans Affairs Medical Center and Baylor College of Medicine attempted to make this comparison using three groups of patients—180 in all. Two thirds had arthroscopic surgery, either just the washing or the cartilage cleanup. One third had a sham surgery: incisions, but nothing else (although the medical team acted as though they were performing all the treatments). One surgeon, the orthopedic surgeon for an NBA team, performed all procedures.

During the next two years the patients were evaluated for knee pain and function. It turns out, there was no difference in outcome. As reported in the New England Journal of Medicine, editors wrote, “Although smoothing cartilage and meniscal irregularities may sound appealing, larger forces within and outside the joint environment, such as malalignment, muscle weakness, instability, and obesity, which are not addressed by this type of surgery, may have greater effects on the clinical outcome…[the procedures] may simply remove some of the evidence while the destructive forces continue to work.”

Since then, according to my source, Dr. Paul Offit, “…fourteen randomized, controlled clinical trials and twelve observational studies, involving 1.8 million people, found that arthroscopic surgery for knee arthritis, with or without repair of a torn meniscus, was no better than physical therapy alone. Arthroscopic surgery, therefore, is no longer recommended for the treatment of knee arthritis. Yet, it remains one of America’s most common outpatient surgical procedures.” 

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.