This Issue

Patient power

The root of the problem

Making every dollar count

ABC's of health insurance

Q & A

Inherited risks

Who’s in charge here?
You are

It is your responsibility to get the appropriate screenings at the appropriate time based on your age, gender, race, risk factors and family history. If your doctor does not offer the tests, ask for them. You’re the one who ultimately pays — in poor health.

Starting age*
High blood pressure
High cholesterol
Every five years
Type 2 diabetes
Every three years
Breast cancer
Prostate cancer
Colorectal cancer
Every one to ten
Cervical cancer
Every one to three years

*Frequency and starting age will differ by risk factors. For instance, if you have prostate cancer in your family, you will probably start screening at age 40 or 45.

For more information, click here.

A detailed list of screening tests

Sources: American Cancer Society, American Heart Association,
American Congress of Obstetricians and Gynecologists

Ask the question

Looking for reliable sources of
health information?
Here are a few...
Government Agencies

• National Cancer Institute

• MedlinePlus

• Centers for Disease Control and Prevention

• U.S. Department of Health & Human Services

Non–profit Organizations/HMOs

• American Cancer Society

• American Heart Association

• American Diabetes Association

• Blue Cross Blue Shield of Massachusetts

For a tutorial on evaluating health information on the Internet, click here.

Inherited risks

There are several diseases that run in families and are passed down from generation to generation. A family history does not guarantee an illness; it raises the odds. Examples of inherited diseases are:

• Prostate cancer

• Ovarian and breast cancer

• Colorectal and uterine cancer

• Diabetes

• Heart disease

• Stroke

• High blood pressure

• High cholesterol

• Kidney disease

• Depression and dementia

• Alcoholism and other substance abuse

• Miscarriage and stillbirth

• Birth defects and infertility

• Asthma

• Alzheimer’s disease

Reliable health information

Family history medical tree

Who's in charge here?

Risk factors
• Tobacco use

• Heavy alcohol use

• Combined tobacco and
alcohol use

• HPV infection
• Sun (cancer of the lip)

• Exposure to chemicals,
such as asbestos

• Poor diet — lacking in
fruits and vegetables
Another good reason to visit the dentist

“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance

The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.

Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
Remember to call ahead to confirm
time and date
of screenings.

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The ABC’s of health insurance

HMO, PCP, PPO, POS — feel like you’re wading through alphabet soup? Read on for translations of common terms.

• Health maintenance organizations (HMO) require you to choose a primary care physician (PCP), who coordinates all of your care, including visits to specialists.

• Preferred provider organizations (PPO) let you make your own choices from a network of preferred providers (in some plans, you can pay a higher fee for out-of-network care) and may not require you to have a primary care physician.

• Point-of-service plans (POS) let you choose between receiving care from participating providers (you’ll be reimbursed more for this), or non-participating providers(you’ll be reimbursed less for this).

Some plans offer lower premiums (monthly payments) in exchange for a higher yearly deductible (the amount you must pay personally before insurance provides any coverage). Some plans require co-pays, a set fee you pay for health care visits or medications. Others ask you to pay co-insurance, which means you’re responsible for a portion (20 percent, for example) of eligible expenses charged by a provider or the amount the insurer agrees to pay for specific services.

Many plans require preauthorization or precertification for certain services, such as surgery or visits to a specialist. Some pick up the tab on preventive care services, such as flu shots, cholesterol tests, or colonoscopy. Most have formularies that list pre-approved, commonly prescribed drugs.

Making every dollar count

The beginning of the end of the national recession may be in sight, but financial experts say a full recovery is still a long way off. People should be cautious with their money and look for ways to reduce their spending. This includes health care costs. Stretching health care dollars is now more essential than ever.

“Until the economy bounces back, people will be looking for ways to cut costs wherever they can,” said Dr. John Fallon, Chief Physician Executive at Blue Cross Blue Shield of Massachusetts (BCBSMA). “But when it comes to our health, we have to be smart about the decisions we make, including how we select and use our health care plans.”

Whether you sign up for a health plan through work or on your own, being a smart consumer is key. Carefully evaluate all the options available to you to find the best care for your money.

Compare available plans during open enrollment periods.

Carefully compare all available options during annual open enrollment periods (often in the fall); sticking with the same plan doesn’t always make sense. If you don’t anticipate needing to see the doctor frequently, it may be worthwhile to select a less expensive plan with higher co-pays or a higher deductible. Most health plans have formularies listing pre-approved drugs. Often, drugs are added (and sometimes dropped) annually. Remember to check formularies annually for medications you need. Staying informed — and keeping on top of selection deadlines — can save you headaches and cash.

Compare additional incentives. Many plans offer discounts for health club memberships, smoking cessation, weight loss programs and preventive screenings. Discounts may even apply to accredited complementary care providers you visit, such as a dietitian, chiropractor, masseuse, or acupuncturist. Blue Cross Blue Shield of Massachusetts offers this through the Living Healthy Naturally Program.

Once you find the right plan, follow these tips to save on costs:

1. Investigate health savings accounts. If you’re under 65 and have a high-deductible plan, you can put a portion of pretax dollars into a Health Savings Account (HSA) to pay for eligible health expenses, thus lowering your tax bill. Unused HSA funds can roll over and accumulate year to year. Alternatively, a Flexible Spending Account (FSA) offered only through employers holds pretax dollars for eligible health or dependent expenses. FSA funds not spent by year-end are forfeited. If you already have an FSA, remember to submit 2009 claims for reimbursement by March 31, 2010.

2. Stay in network. Use doctors and specialists in your health plan’s network. Out-of-network care drives up your share of the health care bill. If you’re unsure if a provider is in your plan’s network, simply give your plan a call or check online.

3. Save on prescriptions. Always ask about generics, lower-cost brand name medications and over-the-counter options. Generics, which can be as effective as brand name counterparts, come on the market frequently (and big chains like Kmart, Sam’s Club, Target, and Wal–Mart price hundreds of generics under $5 for a 30-day supply). Find out if lifestyle changes — more exercise, better diet, stress reduction — might lower dosages or erase need for some medication. Always talk to your doctor or pharmacist before making any medication changes.

4. Dial a help line.
Find out if your plan has nurse help lines to advise you on whether you should see a doctor or can self-treat using simple remedies like fluids, fever-relievers and rest. For example, members who have a plan under BCBSMA can call experienced nurses staffing the 24–hour Blue Care Line. Often a call can save an unnecessary trip to the hospital or doctor’s office — and your co-pay. Ask your plan what resources may be available to you.

5. Participate in wellness programs. Hit the jackpot with healthy choices. Exercising, losing weight and quitting smoking dramatically lower your risks for asthma, diabetes, cancer and heart problems, significantly improving your health while cutting your health care bills. Many health plans offer wellness program discounts, rebates and fabulous online tools like personalized weight loss or workout plans. Free and low-cost community programs may be available through the Boston Parks and Recreation Department, senior centers and community education centers.