Missing the Point

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There was a message on my desktop to call a patient. This woman had been seeing me exactly once a year to renew her migraine meds for a while.

She had not had insurance because she worked construction, part time. Part time was all she could handle physically and she did not want to go on disability.

I dialed her number….

“Doc! I have insurance!”

“Yay for you! Off the exchange?

“Yep!”

“So when are we going to be scheduling that PAP and mammo and bloodwork that you are so overdue for?”

“You don’t take my insurance.”

“Oh.”

“But, Doc, I’m not switching. I am just going to cancel it.”

“No! Don’t do that. It is OK to switch doctors. We have been waiting years for you to get some coverage so you could get caught up on your preventive care. If you are worried about hurting my feelings, I completely understand, I promise. I won’t hold it against you, ever!”

“You don’t understand. I have seen these other doctors. I like YOU. I am not going back to them. But you did ask me to tell you about how it went getting signed up. It was easy!”

She went on to tell me the process and about her costs and coverage.

She was back in my office without insurance for her yearly refill appointment right on time.

Why don’t you just sign up to accept all plans?

I can’t. I am subject to whatever contracts the system that I work for has in place.

Why don’t they sign up then?

I don’t know. Perhaps these are payors with a bad historical track record? Perhaps the negotiated rates were not considered feasible for a practice? Bottom line, it is out of my hands.

So where do patients go? There are only a limited number of physicians taking some of these plans and access to care, particularly specialty care, is a problem.

What is the point of having insurance if you cannot see a physician? Good question.

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87 thoughts on “Missing the Point

  1. Yup, chances are the low-end plans don’t pay diddly to the providers and also are probably a pain in the pattootie to work with. (That’s a medical term, btw, pattootie.) The podiatrist I worked for often paid me more money to process a claim than he got reimbursed for, and I was grossly underpaid. He accepted most insurance, including Medicaid and Medicaid-like plans. He finally, toward the end of his practice got so fed up with the bureaucratic red tape hassle and low pay that he stopped taking a few of them. I would think it is worse now, but I haven’t processed claims since the ACA.

    Liked by 3 people

      • I’m in the same boat as your patients (or worse). I didn’t have insurance for years. Then with the job for Healthcare.gov (which ironically, we didn’t get to use), the company provided insurance but the deductible was $2000 and started in September, so I basically had no insurance. With the move to NH I just got signed up with Medicaid, for the first time ever. So on the one hand, woo-hoo, insurance. On the other hand… so many doctors can’t/won’t accept it, as a patient my hands are tied, and I’m really concerned that I’ll be in the same situation as the patient you mentioned previouslyβ€”get the diagnostics done and then find out I have zero options if there is a problem. sigh

        Liked by 2 people

  2. Private insurance is that way, too. For several years I paid a whole lot extra for a more expensive plan that took all of my doctors. This year, my doctors changed and accept all the plans. So maybe things will change for your patient and your practice. Fingers crossed.

    Liked by 2 people

    • We will see. I am not holding my breath, though. I never thought I would ever suggest that a single payer would be a good idea, but… It would just scare me that it would be further expansion of Medicare or Medicaid and those are failed programs in my opinion. I wish I had good answers. I don’t.

      Like

      • Nobody really does.

        Private insurance sucks, too. I literally spend more than half of my salary on it for a family of three. They don’t even cover the damn dog.

        And th thing I hate most is that the only ones who are benefiting from insurance are the insurance companies.

        Liked by 6 people

      • Maybe we are considered a single payer system – since the “payer” is technically the provincial health care budget. We have all essential medical services covered (and preventative health and GP visits are also considered essential), there is no middle man, all doctors get paid and all citizens are taken care of. We spend less money per capita for health care than the US and even the homeless and jobless people have the same right to care as everyone else.

        Liked by 3 people

      • And do we REALLY want the United States government to manage our healthcare? Can you name a single U.S. government-run entity that runs efficiently and that hasn’t morphed into an out-of-control leviathan that hemorrhages money?

        Liked by 3 people

  3. “What is the point of having insurance if you cannot see a physician?”

    This is exactly the type of question that would never occur to a bureaucrat. The masses are simply to be measured, counted, controlled, organized and taxed. The particularity of a situation is not the concern of those at the top.

    Liked by 6 people

  4. I didn’t realize that was a problem in the US. Here in Canada any insurance that is sold is taken by all medical establishments. Whether it is prescription, dental, hospital upgrade (say a single room). The only issues I have ever had has been with dental insurance where services are limited – so they will not pay for white fillings in the back (front is OK), cleaning is only every 6 months and there are limits per tooth and per year.

    Liked by 3 people

  5. Some of these posts make me realize how much I’ve been taking my insurance, which we rarely have to check in advance to see whether a provider accepts it, for granted.

    Liked by 1 person

  6. I never realized that doctors could not accept any insurance they wished to accept. Guess there are drawbacks to being part of a group.

    We have a number of hospitals in our area, forming two separate hospital systems, and one of our local insurance companies recently decided that it would not cover patients in a particular hospital system. That really sucks for patients who now have to go to the hospital furthest away from their homes. It also sucks for the rest of us who are now finding our closest hospitals overwhelmed with new patients. Both hospital systems are equally good, so it wasn’t a decision based on quality of care. Makes no sense to me.

    Liked by 1 person

  7. Thankfully I work for a major law firm and I have what I consider decent insurance for the most part. Plus I can set aside funds from each paycheck pre-tax to use for co-pays, etc. The only hiccup recently is that the firm changed providers and we had to change our doctor because she wouldn’t accept the new insurance. However, one of her partners does so the switch was relatively painless for us. I count my blessings for my job and its benefits all the time but your stories of late make me realize just how blessed I am.

    Liked by 1 person

  8. We are betwix and between with government run insurance- ACA, Medicaid, Medicare and, private insurance. I am very grateful to have been with the same insurance company for at least 25 years that I signed up with as a civil service employee. My government retirement annunity pays for about 1/3 or 1/2 of my medical insurance and then I also have Medicare which is the primary payer. I complain about the government and how it is run but if one can stick it as their employee then you are well taken care of .

    None the less, I feel terribly bad for those who do not have insurance. My son is self- employed and has no insurance. He has to call around to find a MD who will take cash. I don’t know what that is about except the fact that they can not stick it to a cash paying patient in the same way as an insurance company. I so hope that my assumptions are wrong but I’ve asked for explanations and can not get an answer.

    Liked by 1 person

    • The issue with self pay is getting people to pay. Believe it or not, insurance companies are more reliable than patients themselves. That being said, I charge cash pay patients 30% less than I bill insurance because they never pay me what I bill anyway and in my opinion, neither should cash pay patients.

      Liked by 2 people

      • I’m glad that you take cash. I do not understand what is the problem when one offers to pay up front and waves a debit card/or cash at the money taker. The debit can be scanned immediately to see if there is money in the bank to cover the payment. Also money can be counted. I suppose that is considered too much trouble but maybe they just do not want to offer a deductible when cash is the payment.

        At least you have scruples doctor. I pray that you never lose them. You come across in your blog as caring and compassionate. That is rare.

        Liked by 2 people

  9. Reading the comments, it seems Canada has it right in regards to universal coverage. There has to be a catch. How is it financed ? Are they paying so much more in taxes for the privilege? Just curious, especially if that’s where we’re headed. Thanks for the post, Doc.

    Liked by 1 person

  10. Michigan has 80% physicians taking new patients and 70% are accepting Medicaid. So those elugibk eligible for the Medicaid expansion Michigan should strike while the iron is hot. And while I understand some folks are having trouble finding the right primary care at least a hospital stay is less likely to lead to bankruptcy. I hope. It’s time to get into the single payer arena. Unknowns are scary but not as scary as the crap going on now.

    Liked by 1 person

  11. Our system up here is really different from that. It seems far less stressful in our world, but we do pay for it big time. Our tax rates are the highest in the G7, and the quality of care can be questionable… but I feel good that it’s generally accessible.

    Liked by 1 person

  12. Another one slips through the cracks and yet again we end up paying cash for what we really want and need. That’s exactly how dentists make money, who actually uses a 1-800 dentist anyways?? *rolls eyes*

    Liked by 1 person

  13. I have a dr. He receives $15.00 per visit. I pay $30.00 copay. But I pay him $100,
    I like him , I cut out something less to purchase in three months and see him 4 times a year. My insurance likes to recruit drs that have regular patients like an assebly line. I refuse to be part of it!

    Liked by 1 person

  14. I have only been “training” in this small rural town for 2 years , 7 months and 3 days. I’m assuming you get the picture. Of 183 high school students, 21 see regular doctor when they are sick. They go to the one and only hospital. Seriously? Insurance? They don’t need it because they just go to the hospital and then don’t pay the bill. Really? And I’m supposed to be training healthcare workers to be viable, productive citizens? Not stupid, just not educated BUT when you are the only one they know who starts to break a family cycle of “running to the hospital” and speaking of yearly Preventative care check ups YOU are perceived as the uneducated one. Now I’m even more depressed because it does look as overwhelming in typing as it does in my head. 😞God bless

    Liked by 1 person

  15. I am sure this is a mute point but with ALL insurance now being mandated through .gov and the IRS who are the only private company with permission to cease personal assets and funds of individuals without permission, how many people who “wouldn’t ” pay a large surgery bill at one time will have their accounts debited equal to what the IRS does with “deadbeat” dads? My physician isn’t the high cost, it’s the hospital. Our physician adjusts for cash pay. For me only through work I have a monthly 660.00 insurance bill with a 5,000.00 dollar deductible. And that is the best PPO plan the district offers.

    Liked by 1 person

  16. I am pretty sure that I would be dead if I lived in USA. That sounds pretty melodramatic but I live in Australia and most of my intensive treatment for a severe systemic auto-immune disease is free. Some of this is because my doctors and even specialists bulk bill me but I have had infusions of IVIG for 5 years and didn’t pay a cent. It was all covered. I’ve heard of people in the US having trouble getting insurance to cover it. Australia is also introducing the National Disability Insurance Scheme to help offset the costs of disability. They’ve always said that we’re the lucky country!!

    Liked by 2 people

  17. Bureaucracy plays a major role in this arena. The practice becomes so tangled in red tape, the financial incentive to accept certain carriers disappears into oblivion. Eventually, the list of accepted carriers seems like a private after party guest list. In the midst of all this red tape tangling, it’s the consumer who suffers.

    Liked by 1 person

  18. Reading your posts and comments I feel very much for ill people having the extra stress of what comes across as a totally unfair system. I am in England and am shocked at what I read. If I phoned my Dr surgery right now they would guarantee to see me today. The NHS service, from my personal experience, has always been excellent. We have fantastic private medical insurance and are given a huge choice of which hospital and consultant to see. Also as you say the prevenative care is so important, again we get all the screenings you mention on our National Health Service. Kindest regards x

    Liked by 1 person

  19. I know it’s not perfect, no system is, and if a person wants to find flaws in it, they will, but for now, as long as our population stays under 40,000,000 (a very important fact when talking about Universal Health Care) I’ll stick with our Canadian Health Care System. I just wish there was more my southern neighbors could do because I hate seeing so many people in such an amazing country having so much difficulty getting their basic medical needs met. And aside from the nameless bureaucrats, there doesn’t even seem to be a real villain here. The patients, and the doctors, are both getting worked over on a daily basis, with no relief in sight. Maybe you should all move north of the border, we could probably make room. πŸ™‚

    Liked by 1 person

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