Helping make the health care system work for you

#PriceCheck: How to avoid paying for your flu shot

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Want to protect yourself and loved ones against the flu?

The best thing you can do is get your annual flu shot, the Centers for Disease Control and Prevention says. The Affordable Care Act tries to make it easy for people to follow that advice: Under the federal health law, the seasonal flu shot is considered preventive care, so it's covered at no extra cost to you.

But as with most things in health care, the devil's in the details.

When is your flu shot free?

Generally, if you have an HMO plan, you'll need to visit a doctor or facility in your insurance network to get your free shot.

Kaiser Permanente members, for example, can get the vaccine at no extra cost at Kaiser facilities.

"We believe this is important to enable us to maintain records of when our members received this preventive care, especially for our must vulnerable populations - small children, the aged, and those with respiratory issues," Kaiser spokeswoman Amy Thoma says in an e-mail.

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FAQ: The American Cancer Society's new mammogram guidelines

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The debate over when women should start getting mammograms and how often they should get them took another turn Tuesday when the American Cancer Society updated its guidelines in an article in the Journal of the American Medical Association.

The organization pushed back its suggested age that women be screened for breast cancer and made changes to how often it recommends they be tested. 

So what are the new recommendations?

The American Cancer Society now recommends:

  • Women at average-risk for breast cancer start getting annual mammograms between ages 45 and 54. That's a change from the Cancer Society's previous (2003) guidelines, which advised women to start getting screened at age 40.
  • Women get mammograms every two years after age 55, continuing that regimen as long as they are healthy and have a life expectancy of at least 10 years. The old guidelines said women should get screened annually as long as they are in good health.
  • Average-risk women of all ages should not get a clinical breast examination. This is a change from the previous guidelines, which called for periodic exams for women in their 20s and 30s, and annual exams for women 40 and older.

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A new tool to help doctors, patients weigh cancer drugs' value

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How can someone diagnosed with cancer decide which treatment is right for him? An initiative from 26 leading cancer centers aims to provide doctors and patients with a new way to evaluate the efficacy of different treatments - including an assessment of cost. 

The National Comprehensive Cancer Network – which includes facilities like the City of Hope Comprehensive Care Center in Los Angeles and the Stanford Cancer Institute in Stanford, Calif., - unveiled the tool Friday. Its new Evidence Blocks are a graphic measurement of five factors that providers and patients can consider when weighing different treatment options.

The Evidence Blocks score different treatments on their effectiveness and safety, as well as the quality and quantity of evidence supporting them. The final factor they evaluate, affordability, is not typically considered when doctors and patients discuss treatment. This measurement is an estimate of the overall total cost of a therapy, including acquisition, administration, toxicity monitoring and hospitalization.

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Still too many C-sections at California hospitals

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For some pregnant women, giving birth by Cesarean section is critical, even life saving. But at far too many hospitals in California and across the nation, lots of women are having C-sections when the procedure is not medically indicated, according to newly released data.

The Leapfrog Group is trying to measure how often women are having these unnecessary C-sections. Last week, it released statewide and hospital-level statistics detailing how often first-time moms with lower-risk pregnancies – defined as those that have reached the 37th week or later and consist of one fetus in the head-down position – give birth via C-section.

The group's findings come at a time when experts are cautiously optimistic that the country's C-section rate might be on the decline. Nationwide, the C-section rate among first-time moms with low-risk pregnancies jumped by 44 percent over a decade, from 19.5 percent in 1999 to 28.1 percent in 2009. Since then, it's been slowly dropping, hitting 26.9 percent in 2013.

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Are cash-only doctors better for consumers?

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Wellness GM via Flickr Creative Commons

A lot of people consider health insurance to be a necessary evil.

Yes, it can be expensive and frustrating to use. But when patients need medical care, they're generally glad they're insured.

Some doctors, though, are bypassing insurance all together.

These physicians are setting up cash-only offices with the goals, they say, of regaining financial control over their practices and spending more time with their patients.

"Medicine can become so much more accommodating to the consumer when you get all of the strange effects of the way the payer system works out of the way," says Tom Blue, chief strategy officer for the American Academy of Private Physicians, the professional society for cash-only doctors.

What is a cash-only office?

This model comes in several names and forms. It's sometimes known as concierge medicine or direct primary care. It's most common among primary care doctors, but some specialists are going this way, too.

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