I just saw an ad for Zoomcare. They’ve been in operation in the Portland area for quite a while and accept regular Medicare. I’ll have to check them out if I get booted from my current doctor after the Big Medicine buyout closes.
intercst
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While telemedicine is useful in some situations, there is no substitute in primary care for a doctor who actually listens to your heart with a stethoscope. Not to mention many other hands-on procedures. Is Zoomcare the next step in primary care physicians glued to their computers and never touching a patient?
Wendy
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Again it’s important to read and do your research before making assumptions on your health care options.
Zoomcare is in-person medical clinics. I believe it’s now pretty hard to get Medicare to pay for any telemedicine visits, since the pandemic has been declared “over”.
It’s actually been a while since anyone put a stethoscope on me. I don’t have any cardiovascular or respiratory problems. My health care is largely managed with a panel of periodic lab tests which of course are providing a lot more detailed information than a simple stethoscope. And my doctors are confident enough that I’d speak up if I had worrisome symptoms, so why waste the time?
Also interesting that medical researchers are now questioning the value of the annual physical exam since doctors rarely uncover anything with a chance exam. Most medical problems seem to be diagnosed when a patient goes to a doctor complaining about a pain or symptom.
The annual Obamacare Preventive Screening Exam didn’t seem to do much more than tell you to get the recommended vaccinations and check your weight and blood pressure. Sure, they offered the odd, free colonoscopy, but I bet many declined the invitation.
I’ve got a scale and blood pressure cuff at home. If I get really ambitious, maybe I’ll buy a stethoscope and one of those headbands with the reflector. {{ LOL }}
intercst
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Blood work is the only reason I go for my annual exams. I achieved significant improvement with my cholesterol, glucose and d3 results by significantly changing my diet and exercise habits in response to my lab results. I now get 3 or 4 pages of lab work results and zero in on whatever falls outside the norm.
If I were king for a day we would be placing much more emphasis on primary care and healthcare before we get really sick.
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Sure. But as I’ve pointed out many times on these discussion forums, you can order your own lab work on line at a cost of slightly more than the Medicare reimbursement, and the blood draw and analysis is done by the same Lab Corp or Quest Diagnostics operation your doctor or hospital uses. You’re not dealing with a fly-by-night operation if you go this route.
And you don’t even need to get a doctor to write the lab order. If you know what you need and can check the boxes on the lab form, the online company has a doctor on retainer that’s approving the lab orders in mass for probably $1 each and earning a healthy income with little effort. I’d call that “living the dream” except that it’s “wage & salary income”
I’m surprised that the Obamacare screening doesn’t at least include 3 common lab tests that would catch a lot of hidden problems at a cost of $50 (Chem Panel 14, Complete Blood Count (CBC) with differentials, and a routine urinalysis) but I guess medical researchers have determined that it doesn’t pick up enough “hits” to warrant the $50 price tag across the whole population.
intercst
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I did not know that I could order all those tests myself at a cost of ‘only slightly more’ than I get by using my doctor to order them. My doctor is doing it for me, and it does include cbc and comp.
She is also smarter than the average bear, and is only a two mile walk from my home, so I have sufficient reason to continue visiting her at this point.
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You’re demonstrating a touch of faulty reasoning here. Periodic labs tests can certainly provide detailed information that give an early heads-up …on the problems the particular biomarkers being measured are associated with. However, as Wendy (and my husband) has demonstrated, a timely laying on of stethoscope can detect a life-threatening situation that cannot be detected by periodic lab tests and doesn’t necessarily present with worrisome symptoms…until it does. In fact, I believe that Wendy mentioned she’d had stethoscope free primary care visits for a while before her aortic stenosis was picked up at a clinic (not her regular physician?)
I know that when our physician said something like “Good Gawd…that’s a loud murmer!”, dh insisted on a listen before he believed it, as did the daughter (the family cardiologist) He (dh) would’ve said that he had no cardiac or respiratory problems. Granted, these are individual/outlier type examples but, as far as the individual/outlier is concerned…they’re 100%.
FWIW, I’d never heard of Zoomcare (but one has to assume there’s some degree of Zooming involved) I checked online for local examples to see if dh had heard of them and the offices in Denver and Boulder have “temporarily closed” on their websites.
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Actually, if you’re on traditional Medicare and not some Medicare Advantage scam, all lab work is covered 100% – even if you haven’t yet met your Part B deductible of $257 for 2025. There’d be no reason to order them yourself after age 65. But with pre-age 65 unlimited price gouging health care there were substantial savings by eliminating the insurance company from the transaction.
intercst
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Yep. There’s a nationwide shortage of Primary Care physicians – I suspect it’s “lack of staff”. You can’t expect rent-seeking behavior on the part of Private Equity to heal the nation.
I believe Zoomcare predates Zoom teleconferencing by a decade or so. The “Zoom” refers to the ability to quickly get an appointment – or at least it used to.
intercst
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There are caveats to this…and probably only pertain to self ordered testing as a physician would/should know ahead of time. Simply ordering random tests (that a person has maybe read about) that have no obvious reason for ordering it ahead of time, is likely to incur a bill.
Would not apply to standard screening (I assume) but when I requested the Lp(a) and Apo-b…and additionally a circulating insulin test, just in case…I made it clear that I was aware of the possibility of out of pocket costs. Wasn’t the case…perhaps it’s more “standard” than I was knew. The CAC scan was not covered…as I was aware ahead of time.
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I didn’t have any symptoms when I worked out heavily 5 times a week so my PCP didn’t bother to put a stethoscope on me. It was a chance exam by an ARNP who put a stethoscope on me when I went to the walk-in clinic for a UTI that discovered my potentially-fatal heart murmur. I wrote her a very grateful thank-you note. Also gave my PCP a gentle talking-to on the need for doctors actually examining patients.
I have done the same on-line-order blood tests you mentioned for 20 years.
Wendy
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This is true if a doctor orders the lab test for a specific medical reason but you can’t just get a test out of curiosity.
For example, my doctor ordered a lipoprotein(a) test for me when I asked her to but I had just been diagnosed with a potentially-fatal heart problem so this was part of the diagnostic picture. If you tried to get the same test your doctor would probably deny you – in which case you would have to pay for the test yourself.
I’m planning to shell out $100 for DH to get the online screen because it’s easier to do it that way. He refuses to see a doctor until he has the blood test in hand (which makes sense). Dragging him into any kind of health care is next to impossible since he refuses to go. Which is the biggest heartbreak of my life since he is 72 with moderate COPD and still smokes. Don’t scold me about “the skim,” @intercst, because it’s worth it to me if only he will do it.
Wendy
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My dad retired during the pandemic just before his 82nd birthday. He could not properly diagnose over the phone. He thinks others might be more able to do so.
However, finding an insightful diagnosis in psych in person is difficult.
My CAC test in very late 2019 was out of curiosity. I paid for it out of pocket. The cardiologists have used it very insightfully.
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Meet the Stethophone.
{ The device was approved by the US Food and Drug Administration (FDA) as a breakthrough software as a medical device in June 2023. The device uses the phone’s built-in microphone to capture heart and lung sounds, which can then be analysed and shared.
…
market for regulated medical apps is expected to be worth about $12.2bn by 2030, as per GlobalData market analysis. Concurrently, the AI market was worth approximately $93bn in 2023, as per GlobalData analysis.}
Software created visualizations of the sounds.
AI to be part of next version.
Edit to add:
I searched my Play Store for “stethoscope apps”. There are 6 or so, that I saw.
Steve Jobs be proud!
ralph
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Yes. Anything Medicare pays for has to have the right diagnostic and procedure code. But if they don’t, the major labs like Quest and Lab Corp will spit out an advance notice of coverage letter telling you the “price gouging cost” and giving you the option to decline the test. I’ve done this several times. It’s always easier to come back when everyone agrees on the right codes, than to get it fixed after the fact.
intercst
2 Likes
just had my annual physical. I like going, my doctor is about 40 years old, nice looking, smart, friendly, easy to talk to. I do get a kick out of the “mental acuity” tests the assistant runs. Draw a picture of a clock at 10:15, remember 3 words ( house,purple,table ). She tells you the words first, then gives you the clock assignment, then asks for the 3 words after that.
I got them all correct. Does that mean I should be the next President ?
( for some reason, I can’t bring myself to brag about this great accomplishment of mine, in real life. I guess I’m not ready to be Prez )
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The CAC test is a good screening tool.
AI Overview
Medicare usually does not cover coronary artery calcium (CAC) tests for primary prevention. However, Medicare may cover a CAC test if it’s medically necessary and not a screening exam.
Additionally, it’s not just Medicare…although apparently (as in according to my cardiologist) some group plans are starting to pay.
This is the confusion that arises from diagnostiic vs procedire codes (and it’s not just lab tests) “Medically necessary” is a bit of a nebulous term when dealing with patients with multiple co morbidities or who are diagnostic conundrums or outliers.
Most folk have probably seen an episode of House, right…where his patient base seemed to be restricted to folk with obscure symptoms and diseases with a frequency of 1 in the western hemisphere. He’d spit out a battery of test requests (all of which turned out “negative”) …and, in all likelihood, none of which would be covered. It’s like a test to confirm or exclude a diagnosis will only be covered if the diagnosis has already been made
The various electronic records systems are geared towards this (as glorified cash registers) and make it near impossible to request what, in certain cases, might be the very test the patient actually needs because a definitive diagnosis hasn’t yet been made. This is where things can get tricky and, if you’re not careful (like in letting your physician know you’re willing to cover the cost of the test if necessary) an erroneous diagnostic code(s) can end up in one’s patient record, with all the problems that causes down the line, just so the codes “match”.
I made sure this didn’t happen to me (again) as I mentioned upstream. When I asked for the Lp(a), Apo-b and circulating fasted insulin to be added to my bloodwork when I thought I would try to get to the bottom of this “mildly elevated LDL-C” that no one else saw as a Red Flag, it wasn’t the lipoproteins I thought wouldn’t be covered so much as the circulating insulin. If I didn’t resemble the typical clinical picture of a person with “high cholesterol”, I really didn’t resemble the person who’s on a fast track to T2D. Not fat/never fat, athletic lifestyle, healthy eater…and HbA1c and fasting glucose in the “normal” range and not rising. However, I was aware that even this nice clinical picture can miss the canary in the coalmine of Insulin Resistance. As unlikely as it was, if you don’t look, you don’t know.
As it turned out, my HOMA-IR showed excellent insulin sensitivity…but the other extra tests cleared up the confusion. I didn’t receive a bill (so presumably Medicare came up with the usual pittance) but, better yet…got my diagnosis, which was the important outcome.
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I had my “Establishing Primary Care” visit with ZoomCare this afternoon. The provider was a young Certified Physician Assistant with prescribing privileges. She adroitly got my 2 generic medications entered into the computer and off the Express Scripts and my Part D drug plan, which was my primary objective for the visit.
We then spent about 30 minutes going over my 200 page medical file dating back to the 1970’s. The only thing she questioned was the rare parotid tumor I had excised in 1991 (i.e., Castleman’s disease) which isn’t surprising since even most pathologists won’t encounter one during their career (incidence of occurrence = less than 1 in 100,000)
Overall she seemed competent, so I’ll be using her instead of my previous Primary Care MD who has been dragged up into a Private Equity buy out of his office practice with a focus on shifting everyone to a Medicare Advantage plan.
Also, it’s been my experience that you don’t have much trouble seeing a specialist with traditional Medicare, it’s Primary Care that’s the problem. I wonder if that’s because the “Deny, Delay, Depose” business strategy on referrals, that comes with a 33% denial rate leaves lots of open appointments for the traditional Medicare patients who don’t need an insurance company authorization?
intercst
3 Likes