Tens of millions of us endured the annual paper chase of tracking down and sorting through receipts and forms so we could file income tax returns. Here’s another paper exercise that promises more personal benefits than just staying out of trouble with the taxman: chasing down, saving and following up on our medical records.

Yes, there are simple, common-sense ways to track our health information and stay healthier as a result.

In this newsletter, we’ll run through the basics: Nab those medical records. Figure out how to make them both portable and secure. Ensure you have information on current vaccinations for yourself and your loved ones. Jot down in your cellphone or on a sturdy piece of paper all the prescription medications, as well as the OTC drugs and supplements, you are taking. Set up a way to keep track of your medical expenses, whether for tax purposes or to optimize your use of tax-advantaged health savings accounts.

And more: With patients reporting long waits for care appointments, create a calendar of all your dates for medical treatment as well as scheduling when you might need doctor time (sports physicals, eye exams). Double-check your health coverage, especially if you are experiencing big changes in your employment or other major aspects of your life.

This is vital for those dealing with major illness, injury, significant treatments (including surgeries) or who suffer with chronic conditions.

Having this material can have significant financial benefits. As the IRS reports on its website:

“If you itemize your deductions for a taxable year on Schedule A (Form 1040), Itemized Deductions, you may be able to deduct expenses you paid that year for medical and dental care for yourself, your spouse, and your dependents. You may deduct only the amount of your total medical expenses that exceed 7.5% of your adjusted gross income. You figure the amount you’re allowed to deduct on Schedule A (Form 1040).

“Medical care expenses include payments for the diagnosis, cure, mitigation, treatment, or prevention of disease, or payments for treatments affecting any structure or function of the body.”

As the IRS explains, the qualified deductions that taxpayers may take include their health insurance premiums, transportation to medical care, and items as varied as “false teeth, reading or prescription eyeglasses, contact lenses, hearing aids, crutches, wheelchairs, and for a guide dog or other service animals.”

Consult with your accountant or lawyer if in doubt about any medical deductions on your taxes. But you won’t benefit from any federal largess without documenting your expenses. So, start collecting the paperwork, pronto, even if that just means tossing a lot of stuff into a big file box for sorting later (or consider starting a filing system now … for some other reasons, as the next item describes).

In brief, both health programs allow consumers to set aside money in accounts to cover medical costs — provided patients can document their spending. The accounts allow patients to claim reimbursement for an array of sometimes surprising expenses — everything from condoms to varicose vein removal.

There are important caveats to these programs, and users must read the fine print with care. The flexible or FSA accounts typically carry use-it-or-lose-it requirements, meaning that patients must estimate carefully their annual medical costs and deplete whatever they have set aside in a given time (roughly a year or so, perhaps with a grace period into the next year).

Any unspent money in FSAs is forfeited to employers. No matter how much you love your boss or company, don’t give them your hard-earned dollars. It is sad that too many workers do this, forfeiting, according to some published estimates, a total of more than $3 billion annually.

Too many folks also go on hasty, end-of-year FSA spending sprees, buying new glasses, getting their teeth cleaned, or stocking their medicine cabinets with first aid kits of eligible over-the-counter drugs or supplements. Why not, instead, set up a family or personal calendar for important medical care (see the next item, please)?

By the way, the health savings or HSA accounts may be worth a conversation with your accountant, financial advisor, or lawyer. They can be beneficial longer-term for higher-earners, especially those in the “gig economy,” and those who can set aside larger sums — not only for medical care but also for investment.

Getting medical services these days is no snap. In fact, provider appointments are taking on average a month to schedule — much longer than in recent years.

For savvy patients and their loved ones, this is yet another reason to create and maintain a medical calendar, with scheduled preventive care getting prominence.

The kids in a household, for example, typically will need regular check-ups, including for robust vaccination. They may need pediatrician time for physical exams for summer camp, team sports, studies in distant locations, or enrollment in schools.

Youngsters and their parents also may need regular expert time for vision, hearing, and dental care.

Adults, too, should determine what regular medical services they receive and might be able to calendar, pronto, especially if they involve harried specialists. Dermatologist visits at summer’s end? Allergist visits before spring and summer blooms? Is it time to see the gynecologist-obstetrician? Cardiologist and oncologist check-ins, as recommended?

It can be stress reducing to get these appointments in the calendar well ahead of time — and not under the gun of deadlines. Patients can see other benefits of knowing ahead of time about medical appointments. Ask the office scheduler when doctors may have a mutually convenient and more relaxed time in their day.

A huge gripe these days from patients concerns the speedy, even brusque treatment that doctors give them. This is not just bad feelings. Research shows that a primary care doctor will spend on average 18 minutes with them in an office visit. Primary care physicians, especially, have said that they find unsustainable the overwhelming patient loads required to satisfy corporatized ownership or even to keep small practices afloat. One study has estimated that these important practitioners would have to put in almost 27 hours in a day to meet all their demands.

Having a longer ramp-up time for an appointment gives patients a chance to consider and jot down their most pressing medical concerns. This can help ensure that these get addressed during an office visit.

The National Institute on Aging has posted online valuable resources to assist not only older but all patients in optimizing their medical appointments, with “articles and printable worksheets that deal with recording family health history, choosing a new doctor, discussing life changes during a doctor’s visit, prioritizing which concerns to share and tracking medication,” as the Washington Post reported.

The drug list

With almost half of Americans taking prescription drugs, and a quarter of us taking three or more medications (and 12% prescribed five or more meds), patients would be wise to keep a list of everything they consume, including OTC products and supplements.

Savvy consumers might want to keep details of their Rx list, including the names of the meds and the dosages prescribed, on their smartphones (easily accessible at the pharmacy, a new doctor’s office, or while traveling).

Your doctor or someone in her office may ask about your prescription list and you should get it reviewed every time you visit, especially if a new drug is ordered for you. Drug interactions can be serious and reviewing your prescription list is a good way to avoid this issue.

Make time with your pharmacist to get her to review the list, too. It’s wise to ask your doctor periodically what medications you can forgo. Too many patients don’t do this, and they put themselves at needless risk as well as waste money by continuing meds they might not need. Good doctors don’t hesitate to “de-prescribe” drugs.

For parents, scheduled appointments can be a way to bolster their good record-keeping that will matter a lot to their children — potentially for longer than many of us might imagine.

Talk to your pediatrician about getting and keeping your kids’ treatment files, especially records on any illnesses, injuries, or conditions that are lasting or that your provider calls notable. Information on these matters could be invaluable as your kids grow up or move around, and even when they are adults.

As the world has learned during the coronavirus pandemic, keeping reliable vaccination records also is important. The federal Centers of Disease Control and Prevention has handy information on its website, which can be viewed by clicking here.

These medical records, however, do not belong to medical providers — they are patients’ “property.” And since these records are so crucial to care, patients should be able to get them, read them and have the information explained, in detail, as part of their fundamental right to informed consent. This means they are told clearly and fully all the vital facts they need to make an intelligent decision about what treatments to have, where to get them, and from whom.

In my book, The Life You Save, Nine Steps to Finding the Best Medical Care – and Avoiding the Worst, I list getting and reading these medical records as step one to improve your medical care.

Seeing and studying your medical record can provide you with invaluable information and insights about your health and conditions, treatment, and how well you and your doctor are communicating and understanding each other. You’ll learn a lot about how good your doctor is or isn’t. You’ll get an eye-opening, new view of your doctors and your care.

Talk to your providers, correct errors and misapprehensions, and stay atop those records to ensure, for example, that doctors don’t order duplicative tests or procedures, or that nurses and other clinical staff don’t list wrong medications or treatments.

Access and accuracy

Health care reformers have pushed hard to ensure that patients get greater access to their medical records, including what can be perplexing or even inaccurate, hasty doctor notes and observations.

Heather Gantzer, a doctor practicing at Methodist Hospital in St. Louis Park, Minn., and immediate past chair of the American College of Physicians’ Board of Regents, told the MedPage Today medical news site:

“100% of medical records have errors. Some of them are nuisances, but some are really impactful and might make a huge difference for [example for] the person who was said to be on antibiotics but was not.”

Researchers, for example, have raised alarms that doctor notes that are part of patient records too often display racial bias that can be detrimental to treatment.

In two published dives into tens of thousands of medical records, researchers found that black patients were 2½ times more likely than their white counterparts to be labeled with at least one negative description, and African-Americans with diabetes were more likely than whites to be labeled with medically disapproving terms including nonadherence, noncompliance, failed or failure, refuses or refused, and, even combative or argumentative, the New York Times reported.

Patients wanting to see their medical records, depending on their hospitals and doctors, may find them more accessible than ever via ever-expanding online electronic portals.

Big health care systems have raced to offer greater convenience to “customers” with extensive access to their records. The federal government also has put medical providers under the gun to not only broaden and deepen patients’ access to their records, but also to ensure that incompatibility among various systems does not create roadblocks to sharing information with those allowed to see it.

Indeed, as more health-related information gets digitized — think X-rays, test records and the like — these will be part of patient records. They also should be conveniently accessible to all of a patients’ given medical providers, potentially eliminating costly, wasteful, invasive, and even painful repeat exams, tests, and procedures.

While a laptop provides big promise for patients tapping easily into their records, pragmatism insists that medical bureaucracies will be resistant and challenging.

As Stat, a medical and science news site, reported:
“Under federal rules taking effect [Oct. 6, 2022], health care organizations must give patients unfettered access to their full health records in digital format. No more long delays. No more fax machines. No more exorbitant charges for printed pages. Just the data, please — now. ‘My great hope is that this will turn the tide on the culture of information blocking,’ said Lisa Bari, CEO of Civitas Networks for Health, a nonprofit that supports medical data sharing. ‘It’s a ground level thing to me: We need to make sure information flows the way patients want it to.’”

Stat also reported that health organizations have thrown up too many unacceptable obstacles for patients who want access to information that really belongs to them. The institutions may be acting in their own interests, rather than those of their most important clients or customers — patients.

Truly useful data

Instead, advocates hope laws and initiatives to open the records could be a boon to consumers:

“It is the jumping-off point … that lets consumers in health care benefit from the fluidity they’ve had for decades in banking: They can move their information easily and electronically and link their accounts to new services and software applications.”

That, realistically, won’t happen in a snap, Stat reported. Patients still can expect to encounter roadblocks in getting their records from resistant medical providers. The 21^st Century Cures Act, the federal law that advocates hope will throw open doors, provides exemptions to some records disclosures, which slowly, slowly, slowly have become more available in limited but increasingly wide fashion.

The federal government offers a helpful website that can get you started (click here to access the information). Basically, though, you will be checking with your doctor, hospital, and medical system to see how you can get paper copies of your medical records.

If you can get them through a patient portal, can you access the information online, across the country or around the world? This could be important if you have medical issues while traveling. Can you copy your medical records into an encrypted, password-protected device, like a portable memory stick that you can carry with you on business or leisure trips?

The firm provides lots of information on its website about dealing with problematic medical care (click here to access the information).

But it starts with an upset patient or family member memorializing the problem. Do so while the situation is fresh in mind. Stick to facts that can be verified.

Jot down notes about staff or administrators or officials with whom you registered your concerns, with dates, times, and their responses.

If there’s back-and-forth correspondence, especially if it is electronic, be sure this material gets saved somewhere on your computer system where it won’t get erased and cannot be altered. Print this stuff out and file it.

While you’re keeping outstanding records, by the way, don’t neglect keeping copies of any materials your doctor or other specialist may give to you if your treatment involves a medical device or prescription drug. Such materials could become even more important if you later find that they contain errors that do not match your recollection of your care.

Safety advocates also urge patients who are seriously ill or injured to get a loved one or friend to be with them during key medical consultations and to take notes and, if appropriate, to ask questions and seek answers about procedures and treatments.

For too many of us, however, health insurance continues to be a wobbly, evolving fundamental — affecting the affordability, access, and even the safety and quality of our care.

The long battle over the federal push to provide tens of millions of people with affordable coverage via Obamacare seems mostly over.

Still, critics say, Republicans’ almost theological opposition to any role for the federal government in health care will lead to millions of poor and lower-middle-class Americans losing their coverage under Medicaid.

During the coronavirus pandemic, the Biden Administration and Democrats in Congress pushed through legislation to protect as many people as possible, especially those who can least afford medical care, by enhancing Medicaid funding and keeping patients continuously enrolled.

But these pandemic-related efforts are coming to an end, and states now must “unwind” the benefits that have led to major increases in Medicaid enrollment and a reduction in the number of Americans lacking even basic health coverage. As the Washington Post described this situation:

“This Medicaid ‘unwinding,’ as it is called, is a reprise of a pre-pandemic practice of requiring low-income people to demonstrate each year that they qualified for the coverage. But federal and state health officials and grass-roots advocates are bracing for what they say looms as the nation’s biggest health-insurance disruption since the Affordable Care Act came into existence more than a decade ago. That disruption is among the most profound ways the government is gravitating away from a pandemic footing, retreating from generous policies it adopted to help Americans in an emergency.

“The scale of the undertaking has no precedent. The number of Americans relying on Medicaid has soared by about one-third — to 85 million as of late last year — since just before the coronavirus pandemic took hold in early 2020. Those who joined during that time did not need to pay attention to renewal notices from their states — which now could cost them their insurance. And within state governments, many Medicaid agencies are strained by shortages of eligibility workers and call-center staffers to advise beneficiaries, while employees hired in the past three years have not until now needed to learn how to conduct renewals.”

The states, of course, have differed sharply in how they have regarded Medicaid and its benefits to lower-income people and children in need. Where patients live will become significant in whether their states make vigorous or lax efforts to keep them covered. Some recipients, for example, could afford to move to coverage under the Affordable Care Act. Others could keep their Medicaid if they properly re-enroll.

It is up to states, though, to ensure that they do not create coverage roadblocks, as some have in the past, for example, by making Medicaid eligibility confusing or requiring poor individuals to sign up only via computers they don’t have or lack access to.

The Medicaid travails are occurring even as Republicans in the House are howling about the federal budget and the program, notably by advocating for work requirements for recipients. (Research and experience have shown such requirements don’t work.)

Life changes, coverage shifts

In the meantime, millions of heretofore better-off Americans will be racing to check their health coverage as companies across many different sectors (including tech, banking and finance, and entertainment) announce waves of layoffs. With inflation a persistent problem and interest rates increasing, economists are fretting about the possibility of a recession and even greater job losses. The unemployment rate, however, is staying low and steady.

Employers may try to cushion the blow for their laid-off workers by providing them with varying periods of health coverage. The jobless can qualify for “COBRA” coverage, which can be pricey. Obamacare, especially with changes pushed by the current administration, can be an option for many (click here to see a federal website that outlines options for health coverage for the newly jobless).

Losing a position is painful and dealing with vanished benefits can be disheartening. But those who have gone through the nightmare also can testify that they listen more carefully and collect documents more robustly from their subsequent employers about health coverage and other work-related offerings.

An argument once could have been made that insurers were acting in a good way to contain the soaring costs of medical care by raising at least some questions about doctors almost reflexively ordering the most expensive therapies and prescription drugs.

Insurers struck back by requiring doctors — and patients — to seek approval in advance for the priciest of these, such as major surgeries and advanced medications, notably in cancer care.

But the profit-mongering in this process, critics say, has gotten out of hand, with insurers requiring pre-authorization for a widening array of medical care, including routine prescription refills and imaging studies.

The delays in care that this has caused, as well as the dubious reasons (or lack of explanations) and rates at which insurers rejected claims, has incensed doctors and patients.

For doctors, the pre-authorization process has become a major drain on their time and resources, too often pitting them — and their education, training, experience, and expertise — against clerical billing staff at health insurers in long calls and email exchanges.

Patients, as always, find themselves stuck as pawns in a maddening, bureaucratic, and risky mess, as CNN reported:

“Waiting for health insurers to authorize care comes with consequences for patients, various studies show. It has led to delays in cancer care in Pennsylvania, meant sick children in Colorado were more likely to be hospitalized, and blocked low-income patients across the country from getting treatment for opioid addiction. In some cases, care has been denied and never obtained. In others, prior authorization proved a potent but indirect deterrent, as few patients have the fortitude, time, or resources to navigate what can be a labyrinthine process of denials and appeals. They simply gave up, because fighting denials often requires patients to spend hours on the phone and computer to submit multiple forms.”

The Biden Administration — through the Centers for Medicare and Medicaid Services (CMS), the regulators of hospitals, nursing homes, and other care facilities via the giant federal programs — has taken note of the rising fury about this consumer horror.

Federal officials say they are especially concerned about sketchy data surfacing about Medicare Advantage plans and their eyebrow-raising rates of rejecting claims and pre-authorization requests.

Even as federal regulators rumble ahead with proposals on ways to reduce and streamline the pre-approval process, several major insurers apparently are seeing the writing on the wall and promising to make changes on their own, the Wall Street Journal reported:

“The paperwork required by health insurers to get many medical procedures or tests — one of the biggest gripes of doctors and patients — is getting rolled back.

“UnitedHealth Group Inc.’s UnitedHealthcare, the largest health insurer in the U.S., said … it would cut its use of the prior authorization process. Starting in the third quarter, it will remove many procedures and medical devices from its list of services requiring the signoff. The insurer also said it would eliminate, starting next year, many prior-authorization requirements for so-called gold-card doctors and hospitals whose requests it nearly always approves. And it aims to automate and speed up prior authorization, though that will likely take a few years … [As] complaints have increased, health insurers have been making tweaks. Cigna Group, another large insurer, said it was reducing prior authorization, including removing the requirement for about 500 services and devices since 2020. Meantime, CVS Health Corp.’s Aetna health insurance arm said it was working to automate and simplify prior authorization.”

While some of the insurer concessions sound promising, let’s see how and if this paperwork menace really recedes.