Helping make the health care system work for you

5 reasons your teenager should get the whooping cough vaccine

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Shereen Meraji/KPCC

Beginning this week, LA Unified is offering vaccination clinics.

Believe it or not, LA Unified students go back to school in just two weeks. That means it's time to finish up any summer reading, to pull out the backpacks and other school gear and... to get vaccinated.

Below are five reasons teenagers should get vaccinated against whooping cough:

  1. It's the law! In California, all students entering 7th grade need proof of the whooping cough booster shot known as Tdap (which also protects against tetanus and diphtheria). Without it, they'll be barred from attending class. 
  2. The state is in the throes of a whooping cough epidemic. More than half the 6,170 cases reported so far this year have been among children and teens, ages 7 to 16, according to the California Department of Public Health. 
  3. The immunity conferred from childhood immunizations – or from the whooping cough itself – wears off in several years. That leaves older students susceptible to the highly-contagious respiratory disease. 
  4. Infected teenagers can expose younger family members to the disease, also known as "pertussis."  Infants too young to be vaccinated are most likely to suffer from severe and fatal forms of whooping cough.
  5. Your child may qualify for free vaccinations. Beginning today, the Los Angeles Unified School District is making it easy for uninsured children, kids on Medi-Cal and those of Native American descent to get vaccinated against the disease by offering them free vaccinations at clinics throughout the city. 

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Impatient reader's dogged persistence wins Anthem drug approval

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Photo by Chris Potter via Flickr Creative Commons

David Garden will now pay $75 for a 90-day supply of Cymbalta.

Here's a happy tale of persistence rewarded. When I spoke to Impatient reader David Garden last month, he was getting samples of Cymbalta from his doctor, and carefully cutting them in half. He was threatening to fill his prescription of the drug – commonly prescribed for depression - through an illegal supplier in Canada.

It was all because he'd switched Anthem Blue Cross plans. He went from an employer-sponsored plan to one purchased on the Covered California exchange. He later learned that the new plan did not include Cymbalta, or its generic version, on its drug formulary.

Garden has a form of muscular dystrophy, and he takes the drug to alleviate the chronic neuropathic pain associated with his disease. Suddenly, a 90-day supply of the drug increased from a $25 co-pay to $512.77.

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How to decode your health insurer's Explanation of Benefits

Employees pay directly for their health insurance in "defined contribution" plans.

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Reading an explanation of benefits, or EOB, can be very confusing.

As loyal Impatient readers know, we're a month into #PriceCheck, a collaboration with KQED and ClearHealthCosts.com. Through this project, we're building a robust database of certain health care prices in California. We started by crowd-sourcing the cost of mammograms, and now we're focusing on all types of back MRI's.

We've invited you to participate in the project. To do this, you need to enter a couple pieces of information from your explanation of benefits, or EOB: The charged price, what insurance paid, and what you paid.

Widespread confusion

We know that navigating your EOB is not easy; in fact, it can be downright frustrating.  (Side note: That's just another reason why we're so thankful to everyone who has participated in the project so far!)

That frustration bubbled up last night during a Twitter chat focused on health costs transparency, co-hosted by our partner ClearHealthCosts.com.

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Next up for #PriceCheck: Back MRI's

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Paula Steele/Flickr Creative Commons

The PriceCheck project is collecting the costs of all kinds of back MRI’s: lower back, upper back, with contrast, and without contrast.

In June, we launched PriceCheck, in collaboration with KQED and ClearHealthCosts.com.

In the first month of the project, we crowd-sourced the cost of mammograms. We asked our audience members to grab their medical bill or Explanation of Benefits, visit PriceCheck, and enter three bits of information: The total price charged, how much their insurance company paid, and how much they paid.

Mammograms: $60 or $649?

Our community provided us with valuable information. One of our contributors – Annie Brown, of Toluca Lake – told us her insurance company, Anthem Blue Cross, paid $649 for her mammogram at Glendale Adventist Medical Center.

That compares with $60 for a mammogram at the H. Claude Hudson Comprehensive Health Center. (That’s a self-pay price, and the lowest one in our database.)

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More voice frustration with Anthem and other insurers

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PhotoDu.de/Flickr Creative Commons

Anthem says it stands ready to help members who need help with issues regarding their health insurance.

Last week, KPCC reported that Consumer Watch had filed a class action lawsuit accusing Anthem Blue Cross of fraud and unfair business practices "allegedly intended to lure customers into buying its health insurance plans."

I asked Impatient readers if they’d ever felt misled by Anthem Blue Cross, or another insurance company. A number of people responded on this blog and on the KPCC Facebook page, telling us about their frustration, confusion, and annoyance regarding their insurance companies.

"I don't know if the word 'mistreated' is quite strong enough," Rachel Yonda wrote on Facebook.

Yonda said she switched to Anthem at the beginning of the year because of a "'bait and switch' situation" with Blue Shield. After moving to an Anthem EPO plan, "we are continually surprised by what isn't covered, and finding an unexpected amount of fairly routine care is subject to our deductible (so not being covered at all for the time being)," she wrote.

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