For higher or for worse, the evolution of preventive care has progressed to the purpose of “direct-to-consumer” promoting and screening companies that don’t require a clinician’s orders. Since about age 40, my major care physician has ordered a set of “screening laboratory assessments” yearly with my routine bodily. They’re saved within the firm’s “app,” facilitating the comparability of earlier outcomes and recognizing developments.
As time handed, insurance coverage practices have modified. This annual preventive care has turn into more durable to get with out out-of-pocket bills for copays and deductibles—and even the ever-present “prior authorization” or analysis as to “in-network” standing. As I write this, my “PCP” is a nurse practitioner for the primary time in my life. We moved to a brand new state, and she or he had the primary opening after I known as for my routine checkup appointment. The ready instances for routine appointments in our space may be 4-6 weeks for a PCP and as much as six months for a specialist. To get an appointment for yearly labs and a checkup has, at instances, been a hassle, and it’s now at all times an expense.
In 2024, I noticed a Fb commercial for a direct-to-consumer service that supplied entry to a battery of blood assessments, a U/A, an prolonged lipid panel, and different screening labs for a yearly payment. After all, this “greater than 100 biomarkers” was described as extra complete than most individuals often get at their PCP. No physician’s order or go to was required, and the payment was lower than different bundles of labs I had seen. The payment for the service and their report interpretation was $499 yearly, and it’s HSA-approved. I believed I might strive it. There isn’t a obligation to proceed until you see worth.
Right here’s what I realized.
Attempting One thing New
My present HDHP PPO suggests most well-liked suppliers to cut back copays and deductibles, nevertheless it nonetheless includes paying notable quantities for each. The “most well-liked suppliers” close to us are largely on the native metropolis well being clinic. My part-time employer is in Michigan, and the out-of-state protection defaults to Aetna. Woe be to your pockets for any “out-of-network companies.” I’ve additionally been billed for lab research that have been “not lined.” We are all wholesome, and we’ve got minimal care wants. In truth, none of us (besides me) have sought therapy for signs within the two years since I dropped to half-time work. For a lot of, getting yearly labs performed includes a PCP appointment with a most well-liked supplier after which paying plan deductibles. Despite the fact that most insurance coverage covers a “wellness go to,” this will likely not embrace complete labs, and it not often features a preventative care method.
The same old “routine or preventive” labs {that a} PCP orders can fluctuate broadly, as can the authorised insurance coverage funds for these labs. In my present psychiatry place, we order a yearly CBC, Chem 20, Lipid profile, HbA1C, TFTs, Vitamin D stage, and different labs individually based mostly on remedy regimens or comorbid situations. These are the fundamental labs on the yearly profiles that my PCP has ordered previously, together with a screening PSA check.
There are CEOs and VIPs who’ve yearly blood check screens that search for DNA markers for over 50 most cancers varieties. If you wish to add this Galleri most cancers screening, you may for a further $899. In order for you different add-on labs, you may pay for them based mostly in your particular person or household historical past. For instance, I paid for a genetic assay of my ApoE allele standing as a consequence of a notable household historical past of Alzheimer’s illness (an additional $129). This sort of “preventative screening” is changing into extra generally accessible. There are longevity facilities and concierge clinics that supply many sorts of assessments with testing that embrace labs, a bodily examination, a dietary analysis, a cognitive screening check, entire physique imaging exams, cardiac stress assessments, and coronary artery calcium scoring. I examine one just lately that a wellness journalist selected, and the appointment and assessments have been all performed in 5 hours at one go to.
The service I selected for $499 (plus the additional bit for my ApoE allele standing) used a nationwide laboratory service (Quest Diagnostics), and the appointment was set within the app for the service with two appointments every week aside. The lab was inside a half hour of my home, and I used to be accustomed to the lab firm. I used to be given detailed directions to observe within the days earlier than the blood draw for stopping dietary supplements, fasting for eight hours, and hydrating adequately.
I’m not saying that these companies exchange routine follow-up care or persistent illness administration. I’ve no new signs and only a few persistent medical points. I are inclined to get all of the advisable screening labs or research to maximise my probabilities of dwelling a protracted, wholesome life. I eat a nutritious diet. I had a coronary artery calcium scan that was ordered by my PCP in 2020 after I was 56. Like many retirees seeking to stay lengthy sufficient to spend a few of their financial savings, we hike to remain match. I swim two or three days every week and do physique weight energy coaching two days every week. My weight is inside 10% of my weight at age 35, and I don’t smoke.
Luckily, I would not have HTN, DM, or a recognized familial lipid dysfunction. I’m merely attempting to stop or detect what I can on the checklist of well being points that may wreck my high quality of life or kill a lucky, wholesome retiree like me.
Extra info right here:
Don’t Push Your Luck (Bodily or Financially)
Practical Longevity: What Use Is Retirement If You Can’t Transfer and Suppose?
Was It Value It?
Is an oz. of prevention value a pound of remedy? Are any of those companies efficient in stopping or decreasing sickness sequelae, detecting most cancers, or discovering coronary points earlier than the widow maker MI, like one among my coworkers had? Are these companies “value it” for a wholesome particular person, or are they higher for somebody with extra well being points? Do they supply actionable information? If not, why are CEOs lining up for them? Do they trigger extra hurt than good with “false positives” that require follow-up testing? Do they supply any peace of thoughts? Does one actually need LDL fractionation, or is that this largely a technique to get your hard-earned {dollars}?
These are good questions with few data-driven solutions.
In my case, I averted one or two PCP appointments the place I might attempt to persuade the clinician to do extra intensive testing than the norm. Going to the physician takes time, and I at all times have copays. The labs usually are not at all times lined. It may possibly simply add as much as $500 until I decide the “in-network supplier,” acquire “lined lab companies,” and take a number of journeys and hours of time. There could also be little dialogue of labs past “they have been typically regular.” Some clinicians don’t at all times cowl diet or talk about helpful dietary supplements. In truth, based mostly on the resident boards I learn, it appears the “wealthy sufferers consuming Chia seeds, consuming inexperienced smoothies, and taking a handful of dietary supplements” are routinely mocked.
Asking for particular assessments can step on the clinician’s toes a bit and brings up the adage: “The physician who has him or herself as a physician has a idiot for a physician.” I’ve by no means been supplied all these labs directly. I used to be by no means informed to get an ApoE phenotype check regardless of my household historical past. I’ve additionally had clinicians discover it humorous or off-putting after I inform them I really like my life and easily don’t need to die prematurely and go away my household, retirement financial savings, and most Social Safety advantages on the desk.
The “biomarker” outcomes have been accessible in about two weeks, they usually got here with an in depth, pretty cookie-cutter dialogue of suggestions and actions to take based mostly on the out-of-range values. Previous to the assessments, I predicted my ApoE allele standing as E3/E4 based mostly on allele prevalence and household historical past. Mine turned out to be E2/E3. That is within the decrease danger quartile the place the uncommon E2/E2 phenotype sits. In truth, E2/E3 is the following greatest at ~11% of the inhabitants. The worst phenotype is E4/E4, and it is current in about 2% of the inhabitants.
The six doable APOE genotypes are: E2/E2 (1%), E2/E3 (11%) (this was my outcome), E2/E4 (2%), E3/E3 (61%), E3/E4 (23%), and E4/E4 (2%) (the worst).
ApoE4 will increase Alzheimer’s danger. Having at the very least one ApoE4 gene doubles or triples the chance of creating Alzheimer’s illness. A uncommon group has two ApoE4 alleles. Having two copies of ApoE4 will increase the chance of getting Alzheimer’s illness much more—about eight- to twelve-fold.
In one meta-analysis of pre-clinical amyloid deposition, the ApoE phenotype was correlated with age of accumulation: “The age at which 15% of the individuals with regular cognition have been amyloid optimistic was roughly 40 years for APOE ε4ε4 carriers, 50 years for ε2ε4 carriers, 55 years for ε3ε4 carriers, 65 years for ε3ε3 carriers, and 95 years for ε2ε3 carriers.”
My normal lipid profile outcomes (Whole Ldl cholesterol, HDL, LDL, and Triglycerides) have been about the identical as at all times. This service included an LDL fractionation to take a look at particle dimension, ApoB, and LP(a). The brand new information right here was that my “LDL small particle” quantity was excessive, and different LDL fractionation ranges have been irregular. I had 90/106 markers “in vary.” My Hb and Hct have been barely elevated, a consequence of at present dwelling at 2,900 ft elevation. I had regular HDL, Lipoprotein (a), Excessive Sensitivity CRP, and Triglycerides, and I would not have a household historical past of CAD or early MI. One new discovering was that I’ve notable ranges of anti-thyroid antibodies. This had by no means been checked earlier than.
Extra info right here:
Well being Insurance coverage in Early Retirement
The way to Save On Healthcare Prices
My Response to the Lab Outcomes
General, the added peace of thoughts from the ApoE allele and the general evaluation have been well worth the cash spent. I feel I’ll have spent the same quantity on copays and deductibles had I gone the same old PCP route.
What did this transformation for me? Properly, I now know to watch T4 and TSH throughout time for indicators of scientific Hashimoto’s. I do know that my Alzheimer’s danger is low with my phenotype (E2/E3), particularly given my way of life, weight loss program, and train ranges. I do know that, regardless of wholesome HDL and regular LDL and Triglycerides, I’ll have unquantifiable cardiovascular danger from LDL small particles, elevated ApoB, and elevated homocysteine ranges. I regarded again on previous labs, and I observed an elevated homocysteine stage from 5 years in the past. However I acquired no suggestions from my PCP on this. I learn that reducing this by 20% (with B Nutritional vitamins) has not confirmed to correspond to any decrease cardiac or stroke danger, one other “fascinoma” like LDL fractionation. It isn’t solely clear that “managing” these will do something spectacular.
Nonetheless, I made a decision to additional cut back my crimson meat consumption, enhance my consumption of non-peanut nuts, and eat much more greens. I additionally determined to strive the “high dietary supplements” advised by the service based mostly on my outcomes. I regarded them up and examine every of them. A two-month provide of all of them was about $125. One can search for every complement and skim any accessible analysis on its effectiveness. In my expertise, it’s uncommon to get particular suggestions based mostly in your “biomarkers” after which have follow-up labs to find out if goal values change. My labs shall be checked once more in six months. At least, it’s fascinating, even when it’s a bit neurotic. For the following six months, I’m a type of “wealthy individuals who need to stay perpetually,” however at the very least it isn’t “by dietary supplements alone.”
After all, I’ll hold swimming, climbing, doing physique weight workout routines, studying, fixing the New York Occasions every day phrase puzzles, and writing for an viewers. My spouse and I additionally signed up for a “trip half marathon” within the Nice Smoky Mountains in September 2025. We’ll proceed to hike all our native favourite trails that weren’t broken or closed by Hurricane Helene’s rampage. We took holidays to hike Sedona, Arizona, and we hiked 80 kilometers of the Amalfi Coast of Italy in 2024. Climbing journeys are extra enjoyable than nutritional vitamins and dietary supplements.
Good luck to me and my LDL fractionation and homocysteine ranges. I’ll nonetheless see a PCP yearly, however I’m nonetheless on the lookout for one like my prior PCP in Michigan. She was glorious, and I miss her.
Would you or have you ever ever tried a service that provides expanded labs? What conclusions did you attain? Did something in your life change?
