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Health Insurance And Doctor Visits
One of the great myths about the health care in America is that access to the system depends on getting health insurance. Sure, insurance gives people peace of mind, but the cost of insurance currently far outweighs the returns. The average income in America is $48,000 per year. The average cost of health insurance for a family of four runs about $12,000 per year, or ¼ of a years. income. Instead of health insurance, what most people need is what used to be called "major medical", or insurance to cover the big items (eg hospitalization, surgeries, emergency room visits). Having insurance for an internist or personal doctor is wrong and completely unnecessary, since it is far more expensive than it needs to be. Furthermore, most people select their doctor from a list provided by the insurance company. Little forethought goes into that decision. And what people notice is that access to that personal doctor is limited. They have to wait for an appointment, they get to spend 10-15 minutes with an obviously rushed doctor who discourages questions and gives short shrift to effective teaching, and they don't always get their phone calls returned on time.
How did it get to be this way? One of the factors is that advanced technologies brought various health testing machines to doctors offices. Instead of just blood tests, EKGs, and Chest X-Rays, various ultrasounds for every part of the body, bone density machines, treadmills, and now CAT scans and nuclear medicine equipment are routinely being performed in doctors. offices. The real question that nobody wants to ask is how often these tests are really necessary and indicated or how often are they just done because the modern medical practice more closely resembles a for-profit business model instead of the once privileged profession that was our ideal. But, it's really not that doctors are greedy. Their decisions followed logically from the progressive decline in reimbursement rates that insurance companies were willing to pay for services. With declining reimbursements for cognitive and diagnostic skills, doctors considered their options and started adding new testing machines to their offices as well as seeing more patients. See more patients and/or get more toys to add to your store.
If doctors were savvy, insurance companies were always one step ahead of them, and usually 5-10 steps ahead. Once reimbursements increased for added testing, health insurance premiums went up. Most patients have no problem agreeing to more testing in a doctor's office if it's suggested, because the cost is transparent to them. "The insurance will cover it". But, in reality, we all pay for those costs, because they are redirected into premiums. Over the last decade, health insurance premiums have inflated by double digit numbers almost every year. And yet, most of that premium increase goes into maintaining the profit levels of the insurance companies themselves who had become beholden to investors as well. These insurance companies, who do not provide health care, are the most profitable industries on earth. Several years ago, the CEO for United Health Care was paid an annual salary of 1.6 billion dollars.
Over the past 4-5 years, our office stopped accepting insurance and required payment up front at a discounted rate. We discounted our fees by 25-30%. This is important to know, since most doctors who do take insurance will submit charges far greater than what the insurance company reimburses. If someone has a high deductible and the insurance company pays nothing, these doctors redirect that "retail" bill back to the patient who is expected to pay it all. Our office does bill the insurance company and anything that is paid is either sent directly to our patients or reimbursed by our office to them.
The effect of this change in office policy has offered dramatic benefits. It has freed me up to spend time with my patients and genuinely listen to them at each and every visit. I enjoy teaching and can do so in plain English in an effective manner. I am available to schedule appointments the same day and always return phone calls and e-mails promptly.
I have served as a medical expert frequently through the years for medical malpractice attorneys. This has provided me with a unique insight into mistakes by doctors. Most mistakes are not made by misreading X-rays or writing the wrong dose on a prescription. Rather, most mistakes involve errors in thinking. Symptoms and signs are noted, a pattern is recognized, and a diagnosis is made. Information that does not match the pattern is largely ignored. The question, "What else could this be?", is not asked. Ultimately, an inflated confidence by doctors in a given diagnosis without consideration for alternative options is the usual pathway to errors.
It takes passion, experience, and sufficient time to practice quality medicine. The forces behind most doctors in private practice work against themselves. Our office policy, with respect to health insurance, allows me to provide consistent and optimal health to my patients. It would be a privilege to earn your trust and prove how my 23 years in practice as an internist will help you feel better and gain the confidence and clarity that you need to make the best decisions for your health.
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