Greetings, Dr. Roach My parents, who are in their 80s, have diabetes and cancer, among other conditions that need close observation.
Medicare only pays for their blood tests every six months, according to their primary care physician, and they would be responsible for paying for any further tests. Their doctors approve blood tests as needed in the meantime, often only a few weeks apart.
This Medicare policy restricting necessary lab testing is something I’ve never heard of, and it sounds risky and at odds with the provision of necessary medical care. Does their doctor’s advice make sense, or should they look for another one? — M.M.
ANSWER: Certain standard blood tests are restricted by Medicare in the US. Medicare, for instance, covers the cost of an HIV screening once a year, a hepatitis C screening once in a lifetime, and two diabetes screenings annually.
Screening is no longer suitable, though, if both of your parents have diabetes; instead, they require diabetes monitoring, which is typically advised many times a year. When a qualifying diagnosis is made in order to monitor a condition, Medicare does cover laboratory tests.
I think there may be some miscommunication occurring here. Undoubtedly, some of my patients ask me to order more blood tests than I believe are required. A routine complete blood count, for instance, is not necessary for most people, but patients are accustomed to receiving them and naturally want to confirm that everything is in order.
From a medical perspective, ordering blood tests is far simpler than discussing the reasons why they shouldn’t be ordered. (Many people find it difficult to comprehend that a minor deviation in a routine lab test could result in costly, unneeded, and potentially intrusive follow-up testing.) However, it is unethical at worst and a cop-out at best if your parents’ doctor is making a false claim that the insurance won’t cover it.
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Greetings, Dr. Roach I have a history of osteoporosis and am a little woman in my 80s. I have a healthy uterus and have never had children. Due to the possibility of cancer, my primary care physician does not recommend hormone replacement treatment (HRT) for a person my age. However, I have heard that ladies with similar medical histories are now receiving HRT therapy.
For this ailment, my friend is receiving treatment with a HRT patch from a physician at the University of California, San Diego. There have been no negative side effects, and her bone health has significantly improved. What recommendations do elderly women like me currently have regarding HRT and cancer risk? — No name.
ANSWER: While estrogen works well to prevent osteoporosis, it is not as good as other treatments for osteoporosis that has already developed. Progestin and estrogen must be administered to women with intact uteri. This combination raises a woman’s risk of blood clots, heart attacks, and strokes in addition to her risk of breast cancer.
I don’t think estrogen is the best option for an 80-year-old woman when considering the hazards and advantages. When bisphosphonates like alendronate (Fosamax) are prescribed and properly monitored to the right person, the long-term safety data is outstanding.
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
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