Shopping Around

Macy's in New York City

“She doesn’t have physical exam coverage and her insurance only allows three office visits per year. No lab coverage. No preventive care coverage. She needs her blood pressure and diabetes meds refilled but she cannot come in for a physical.”

I’ve seen this a lot lately.

“No problem. Tell her to come in for a regular office visit so we can at least check her blood pressure. I will code a 99214 and she may get a 30% discount off that as a cash pay patient. I can send her to a discount laboratory for labs that will save her hundreds of dollars. In October she can get a $99 mammogram at one of the local imaging centers. Her flu vaccination she can get cheap at the health department. We will just have to postpone her PAP another year.”

So she came in….

Crying.

“I pay over $700 a month for this insurance.  I work for myself and with my diabetes no one will cover me otherwise. I can’t afford anything else. They told me that all of my doctors were covered and my meds were covered. They lied.”

She did not read the fine print. Not that she really had any other options available to her… 

It used to be like this ten years ago. People with expensive but essentially useless policies. Here we go again. Now, at least, I have access to a discount laboratory. 

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110 thoughts on “Shopping Around

  1. It doesn’t have to be like this. Here in Germany the health insurance isn’t perfect (it has been developing in random ways since 1880, so there are a number of quirks), but we all have the coverage we need and never think twice before going to see a doctor.

    Liked by 1 person

  2. I find the ‘healthcare ‘ situation in the US mind boggleing. We don’t have ‘free’ healthcare up here (contrary to popular belief) – everybody pays a monthly premium based on their income level – but it’s still very affordable. Many people carry extra health insurance to cover some of what isn’t covered (eye exams/dental/prescriptions/physicals required for work and so on) and one province (Alberta) has abolished the premiums altogether. But as much as I bitch about premiums, I really shouldn’t. Mammograms are covered (and if you miss your yearly they will send you a reminder), lab work is covered, hospital procedures, child birth, you name it – you’re taken care of. It’s incomprehensible to me that I’m a first world country such as yours – basic healthcare is so expensive. On the flip side – we have a shortage of doctors away from large centers. When I moved here 13 years ago – it took four years to get a general physician. If one got sick – off to waste space in emerg. Fortunate for me – I’m healthy.

    Liked by 2 people

      • Yes and no…..as a city of 60,000 – we still have a bit of a shortage. In small communities – there sometimes isn’t an available doctor at all. The provincial government has set about trying to correct the problem by offering financial incentives to attract and retain physicians for these places. We do have two ‘walk in clinics’ here now….all doctors are required to put some hours in at these clinics. They serve their purpose tough – excepting for the fact one feels rather like cattle in a chute as they try to jam through everybody in the lineup – the wait is sometimes a couple hours. Mind you – emerg here is a gong show – the standard rule for those in the know ‘if you’re not showing up with your severed leg in a baggie’ – don’t go at all. My boss, just two weeks after a quadruple bypass, went in last week because he felt something had run amok. It was over six hours before they got to him.

        Liked by 1 person

  3. They all screw you over. Every single policy. And no matter how many questions you ask, they don’t give the correct answer. Is it because they don’t know? Maybe. Probably. Because who wants to read those policies anyway? I don’t.

    With my employer-provided insurance (at 1/3 of my salary) I asked a lot of questions at time of enrollment. How much, if any will my co-pays go up. What about this infusion that I currently pay $50 for. What is applied to my deductible? All the answers I got were wrong, leaving me with about $4 K to pay that I hadn’t planned on.

    Universal health insurance. Please god.

    Liked by 2 people

  4. I have medicare but for a 1000 dollar cardio-version they might pay 200 dollars. I don’t pay anything but a 175 dollar copay for the hospital.So who pays the ds and hospital. No wonder i see drs cramming more patients into their day and double booking, and giving 5 minute visits. Same with pharmacy. My insurance pays little or none, I pay 3-10 dollars and after paying a huge initial copay, Epic kicks in an pays a little. I don’t see anyone making any money with this. I have medicare.

    Liked by 1 person

    • Medicare is what we are talking about moving into when people want universal healthcare coverage. It has its drawbacks, mainly that physicians have a hard time jumping through all of the hoops and still making ends meet. The real money in healthcare is in the CEOs, insurance companies, and pharmaceutical industries.

      Liked by 1 person

  5. An IT guy in Chicago, working for a huge, prominent law firm, after shopping carefully, pays $1700/month in premiums for his family of 3. The co-pays are ridiculous; every time he walks into a health care facility for routine check ups it costs him several hundreds, and he pays full list price for prescriptions. He has familial combined hyperlipidemia, and type 2 diabetes, so you can imagine what his labs cost each quarter. “…This town needs an enema!” How I wish he at least finds a doctor like you, Victo.

    Liked by 1 person

  6. I don’t know, I’ve said this before government sponsored healthcare is so much better in India, even with the limited facilities in rural centres. There’s a doctor every few villages (in most places less than an hour away on foot), there are basic emergency and radiology facilities, a minor OT, medicines… And it’s cheap, almost free. Obviously there’s no MRI and no vascular surgeon everywhere but for most common issues you don’t have to pay much. Medicines can get expensive, esp if what you need isn’t in govt supply, but I was surprised at a hundred dollars for a mammogram and saving hundreds of dollars for lab work. You can walk into any govt health facility here and get your blood sugar tests for free, you don’t even have to be poor, it’s just a test they decided was too basic to charge people for; I’m getting mine done today (reasons to follow).
    I don’t mean to say India is a health haven (not by a long, long shot), but basic health access ought to be accessible, geographically and monetarily.

    Liked by 2 people

  7. I guess if a country prides itself on being the bastion of free enterprise and minimalist government interference you have to expect that the free entrepreneur will do whatever it takes to make money even at the expense of his fellows. It’s a shame you can’t have a system that recognises the concept of balance between liberty and care for others less fortunate. I think the idea is that the more you get the more selfish you are allowed to be.

    Liked by 2 people

    • There are many generous, selfless people here. Greed does not belong in medicine. Humans are flawed. It will never be possible to eradicate greed completely. But dang if the US has not set itself up for this over the past decades.

      Liked by 1 person

  8. We can go to the doctor as often as we liked. The doctors order lab tests left right and centre. It’s all under Medicare. I get my annual check up once a year. If I need lab tests they are covered. They only start charging if you’re going as a private patient.

    Liked by 1 person

  9. Damn, Victo. I can’t bring myself to *like* a post like this one. The human face of the health care crisis in the US breaks my heart … and I’m merely a casual observer at great distance. I can’t imagine the toll it takes on you trying to help your patients navigate this horrific mess 😦

    Liked by 1 person

  10. It’s better than it used to be, but still a mass of confusion, even the best coverage. Getting a referral is like navigating a minefield too. It takes so much energy, it’s often just easier to put up with whatever’s bothering you. And to figure out what exactly is covered and how much it will cost…impossible. (K)

    Liked by 1 person

  11. For the first time in my life, at age 62, I find myself without any medical insurance. My husband is waiting on a ruling from his former job and all of our insurances have been dropped. Thankfully my monthly meds are super affordable or I would really be up the proverbial creek. I can only pray that we both stay healthy until his ruling as we do not have the means at this time to afford any kind of private insurance. I thought our new President was going to “fix” our healthcare system but from what I read, it may get worse. Just takin’ it day by day……

    Liked by 1 person

  12. I’m on the side of the coin that believes healthcare is a right. Life should not be disposable, for heaven’s sake. Each of us only gets one. We shouldn’t treat it like tickets to the game or a pair of new shoes. The “let them die” faction would sing a different tune if they were suddenly without care. This makes me so mad!!!!

    Liked by 1 person

  13. While this post makes me want to scream because of all the horrifying, damaging systemic wrongs it reveals, it also makes me grateful on a personal level. I’m glad you take these extra steps to try easing other people’s pain. It’s a beautiful thing that I wish could be a given for everyone, everywhere.

    Liked by 1 person

  14. The Republicans are complaining that we have to control costs and they want to do this by cutting off health insurance to millions of people. It would take more time to figure out how to control rising costs of healthcare and maybe they are just not capable of figuring it out. So they just want to cut everything. I just wish and hope that congress will do a much better job to provide affordable access to healthcare for all our citizens. It is great you are trying to help your patients to get the care they need. πŸ™‚

    Liked by 2 people

  15. I’ve been living in Europe and now I am in Canada. Although, I never was considering the Latvian health care perfect, I’m starting to believe it is way better. While lots of things are free in Canada with Ontario Health Insurance Plan (that’s where I am), the health care itself is far from good. I have to go frequently to Europe and try to fix issues what were totally mismanaged by Canadian doctors. That costs a lot. I find many of doctors here way below the average. We have a huge shortage of doctors. I haven’t had a family doctor for 4 years, and that’s how long I haven’t had a decent examination. Although, I’m invited to do tests, I cannot get them done because I have no GP who refers me. I had a surgery which resulted in more than year long nightmare just because the doctor didn’t think it was serious enough, so I’ve been on antibiotics for more than a year. Type I diabetic, need screening for pancreatic issues, basically I do not get any tests and their results because I don’t have a GP. Medications are extremely expensive. Although, I haven’t been working for as long as my recent issues (3 years) I have to pay $500 a month since I need 2 types of insulin, lots of strips, digestive enzymes (8 bucks a day these only), dressings for wound, antibiotics, etc. and etc. I find the drug prices in North America and Canada are minimum 5 times higher for the same thing than in Europe. Quite frequently these prices are 10 times higher for exactly the same drug. I’ve been working for 35 years for major drug companies writing their instructions for doctors and patients and also analyzing clinical trials. I know how they want just profits and profits, and patient is the last concern.

    Liked by 1 person

  16. I find this heart breaking.

    I live in a country we healthcare is a right and mostly covered by your taxes. Our children get free care until they are 6 including immunisations. Once they are at school, low/no income people, retired folk and high users or costs $20ish per visit and working adults are $45ish per visit. If you need a specialist you go on a waiting list. If you need an op you go on to a waiting list. If you need a scan you go on a waiting list. If you need bloods you pop over to the path lab. All of these are covered by the initial visit. If you have an accident its covered by ACC and you get paid 80% of your usual income until you can return to work. Physio and rehabilitation, covered. You have a baby, its covered. Yes, sometimes when the requirement is not classed as dire you have to wait a bit but hey, its still covered. I had major knee surgery 2 years ago and yea, because I could still walk (read hobble) I had to wait 7 months between injury and surgery but although I couldn’t run it wasn’t the end of the world for me so I was happy to wait. We have the option of getting insurance if we desire but the cost is ridiculous so most people don’t bother and use the public health system.

    I really do find it rather unfathomable that in a country the size of America doesn’t have affordable healthcare for everyone. It should be a god given (no matter what god or no god you believe in) right for all regardless of circumstances not just a privilege for the more affluent and/or already healthy. A country moves forward on its workforce so keeping it healthy should be a priority.

    Liked by 3 people

  17. Pingback: Writing Links…7/24/17 – Where Genres Collide

  18. Yep. It’s like that now. Good thing I personally have “good, old-fashioned” insurance that still covers stuff. My husband, on the other hand, has some redonkulous co-pay ($140) and equally cray deductible, it’s like thousands of dollars. We used to visit the doctor freely, now…it has to be an emergency.

    Liked by 1 person

    • It has really changed how people use doctor’s offices and ERs for sure! Some of that is good. I don’t get people demanding the newest most expensive drugs anymore, they are more cost conscious, but then there are people also forgoing needed care because they cannot afford it.

      Liked by 1 person

  19. 700 bucks a month for 3 office visits and no labs. Hello… welcome to Death Insurance! The only insurance that guarantees you will die. If you don’t you get your money back.
    I’m getting pissed.
    (Oh, here, 700$ a month would be a senior clerk or a junior exec salary…)

    Liked by 1 person

  20. Yeah. She and I are like the same person. All this money for insurance and you go in and the good ole doc has your best interests at heart and prescribes what you need and then you get screwed by insurance one way or another. Still no pain patches for my muscle disease that are only lidocaine. They’d rather me get hooked on oxy. No way! So i sit here in pain because the pain patches are 800 dollars to pay out of pocket.
    And to get refills on our meds we have to go in to the doctor every few months. More money for everyone. The sick are not catered to. The sick are screwed over by so many people that it is no wonder that we just don’t make it

    Liked by 1 person

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