American Patient
In a comment on my previous post, BrooklynGirl asked the following:
What sorts of ways do you think patients can help make a change?
In NYC, the current trend seems to be that fewer and fewer doctors are taking any form of insurance at all, leaving patients the choice of finding a (potentially) less skilled doctor who does accept insurance or sucking it up and finding other ways to pay the bill. I’m at a loss about what I can do to change this, though clearly I would like to.
This highlights the seriousness of the problem from a patient’s perspective. Physicians are currently talking a lot about having practices that do not accept any insurance, but charge a straight fee-for-service rate for all visits. From the physician’s standpoint this is a good business decision. The amount of overhead (and friction) dedicated to dealing with insurance-related problems is huge. Having no insurance to deal with would reduce my staff substantially and greatly decrease the day-to-day problems in dealing with the structure thrust upon me by the insurance companies. In short, it would allow me to either make more money or see patients for less cost and much less hassle.
This sounds ideal, until you look from BrooklynGirl’s perspective. What can work for individual physicians simply cannot work for the whole system and would cause a system-wide collapse if a significant number of providers adopted this type of practice. This may be the catalyst needed to effect real change, but it is by no means a long-term solution. In effect, this type of practice limits care to those with the resources to pay for it and prohibits that same care to the economically disadvantaged. If this does not cause collapse of the system, it will cause a multi-tiered system (or more accurately, worsen the multi-tiered system).
This is why the solution can never rest in the hands of a single group. The physicians may come up with solutions that will harm patients. The insurance companies are clearly in it for themselves and have harmed (and occasionally helped) all other parties involved (more on this later). This is why there needs to be leadership from all concerned parties.
I agree with the call to state that the king is wearing no clothes. The real question is, however: who is going to make him some clothes before he dies of hypothermia?
January 8th, 2007 at 6:10 pm
Sometimes, when I look at the EOB statments my insurance company sends me, I’m flabbergasted at the ridiculously low reimbursement rates to the providers. They definatly deserve more, yet, at the same time, I personally would not be able to seek all the care I need in a fee-for-service system.
I think it’s possible to have some of the problems related to insurance reduced by letting the well-informed, self-advocating patients full access to their records so they themselves can do some of the insurance stuff. I know if I could, I’d have been able to cut down on waiting time. Even when I tried solving whatever the problem was, I couldn’t because I didn’t all the info at hand and none of the office staff were giving me a stright answer.
I live close to NYC and know of a few physcians that do not take any insurance. They offer the best of care, if you can afford it. I prob won’t see anyone that doesn’t take any insurance even if I could afford the fees. I understand why a physican would not want to deal with insurance, but at the same time, I can’t understand just how they end up limiting their practice to those who can pay the $600 consultation fee. I read about a surgeon who wanted to ‘give back to the community’ and help the less fortunate yet he doesn’t take any insurance… that just confused me.
January 8th, 2007 at 7:37 pm
Thanks for addressing this, Rob.
I have see three doctors fairly regularly: a hematologist (who accepts no insurance), an OB (who will stop accepting insurance this month, but is attempting to file “continuation of care” paperwork with my insurance company for the duration of my current pregnancy), and a reproductive endocrinologist (who accepts some insurance but who is out of network for me).
Pursuing reimbursement for out of network medical treatment did, at times, feel like a job–especially since there was so little visibility into what my insurance would and would not cover. And I’m just one patient. It’s no wonder to me that doctors would want to escape that paperwork vortex if they could.
January 8th, 2007 at 7:52 pm
Oh, and in terms of cost: I’ve never paid more than $250 for an appointment and that was an initial workup, with $150 for follow up appointments (the IVF cycle with the RE was a totally different level of expense, but that treatment wasn’t covered by my insurance company even if it had been in network).
I get reimbursed 70% of “reasonable and customary” which is usually between $100 and $120 per appointment.
January 10th, 2007 at 11:56 pm
I really worry about this issue. I became Social Security disabled at age 45 and widowed shortly thereafter. I stayed with Original Medicare plus a category A Medigap and now BCBS Part D. I see six doctors at least quarterly plus the occasional specialist and take nine long-term drugs. In 2006 I reached my deductible January 2! And yet I am much luckier than some other disabled people I know.
My doctors are wonderful (two even make emergency house calls) but I know they cannot do the same for everyone, and several no longer accept new Medicare patients. What will happen when they leave practice?
I wish for a system where neither the doctor nor the patient has to be a charity case.
February 28th, 2007 at 12:21 pm
[…] has caused there to be a growing trend of physicians to stop accepting insurance at all. In a previous post on the state of healthcare in America, I responded to a comment by someone stung by the fact that […]
April 21st, 2007 at 10:12 pm
Health care is the only place where the insurance companies can decide how much you will receive for services rendered. How arrogant is that! If one wants to charge 75.00 for a visit, the insurance company says Hmmm… we think you should only get 35.00. Not very fair. Overhead is huge and the paperwork battles with insurance companies takes up lots of time. The system is broken but who knows how to fix it.
September 20th, 2007 at 2:19 pm
[…] this has caused there to be a growing trend of physicians to stop accepting insurance at all. In a previous post on the state of healthcare in America, I responded to a comment by someone stung by the fact that […]