I have mentioned before how staff working for our healthcare corporation or affiliated hospital system now are on highly restricted insurance that only allows them to see physicians that are part of that system.
In fact the system is putting tremendous pressure on primary care physicians to refer ALL of our patents, regardless of insurance, only to system affiliated specialists.
There are gaps, however, in approved specialist coverage. For instance, psychiatry has only one physician supposedly servicing the thousands of employees. A psychiatrist that quite frankly sucks.
Or sometimes the best doctors are not part of this approved group…
So the other day I had a patient, an employee of the system, who told me that the corporate approved neurologists refused to treat her. She now has to go outside the system, at a significantly higher cost, to a subspecialist in that field but was told by the insurance company that they would not approve an in network rate despite the fact that she has no choice in the matter.
Her portion of the cost is significant, almost prohibitive, particularly given her meager salary.
Patients with Medicaid and Medicare can see this doctor. And yet this woman, gainfully employed and who wants to keep working, has to pay through the nose.
How is that ethical or right?