Co-Pay Is Required Before Making A Telehealth Appointment
DEAR DR. ROACH: My sister was trying to make a telehealth appointment with her primary care physician. The receptionist called her back to inform her that she needed to pay a co-pay of $30 for the appointment first. I didn't know that this was the new norm for these. Is this true?
If this ever happened to me, and I am able, I would get into my car and head to urgent care before I would do this. It is really sad. I don't know which other way to describe this and remain polite. -- M.S.
ANSWER: It is often the case that people need to pay a co-pay to see their primary care doctors, either for an in-person or telehealth visit. There are some exceptions depending on insurance, and sometimes an "annual checkup" doesn't include a co-pay.
I looked at several insurance companies, and some of them have a higher co-pay for a primary care visit, while others have a higher co-pay for an urgent care visit. Personally I think you are better off with your own primary care doctor who knows you, which would make the visit more efficient. In my opinion, insurance companies shouldn't charge you more for seeing your own primary care provider.
Emergency room care tends to be the most expensive of all and should be reserved for actual emergencies.
DEAR DR. ROACH: I see smart watches that are advertised to measure heart rates, oxygen saturation, blood pressure, and even glucose levels. Are these things accurate? -- A.K.
ANSWER: The quality of wearable devices like smart watches has dramatically increased in recent years. For heart rates, they are pretty accurate if they are using electrical impulses. A study using the newest generation of technology found 99% accuracy compared to a clinical device.
Some watches come with the ability to measure a common rhythm disturbance (atrial fibrillation). The accuracy for this has been reported to be between 70% to 90%; however, as the devices and algorithms get better, the quality will soon rival clinical devices (except that watches are usually removed to be charged and can't detect an abnormal rhythm when they aren't on).
Similarly, oxygen saturation measurement by wearable devices has achieved near-parity with clinical devices, with a mean error of less than 4%. However, due to an ongoing legal battle, many watches no longer have this functionality.
The blood pressure function, unfortunately, hasn't yet reached the point where it can be relied upon. Its accuracy in a recent study found approximately 80% sensitivity for high blood pressure (missing 20% of people) and a specificity of 40%. (It was wrong 60% of the time when it said that the blood pressure levels were high.) However, I suspect that it won't be too much longer before these become much more accurate.
Blood sugar measurement is even further away than blood pressure, with the devices not yet able to reliably measure blood sugar. However, continuous glucose monitors (wearable devices with a tiny needle, usually worn on the arm for up to two weeks) can accurately send information to your phone. These are appropriate for people with diabetes, especially people whose diabetes isn't perfectly controlled.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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