Medical insurance company RANT

[disneysteve]

OMG. My partner and I just found out that one of the big medical insurance companies, Blue Cross Blue Shield, is waiving copays for patients when they visit a retail clinic, like the Minute Clinics in the CVS stores.

This means that if a patient is sick, rather than coming to see their family doctor where they have to pay their copay, they are being encouraged to go to a clinic instead where they see a nurse practitioner and pay nothing.

This is so short-sighted on the part of the insurance company (big surprise there). They run all these commercials saying they care about the patient and want people to get preventative care and then they go and do this nonsense. I can't tell you how many times a patient has come to see me for something acute, like strep throat, and that was the opportunity for me to remind them that they were due for bloodwork or a mammogram or a Pap smear. Or that they never followed up after the abnormal test they had a few months back. That reminder got them back on track and back under treatment. If they go to the clinic instead, that won't happen and more serious problems will be missed or allowed to worsen which will end up costing the insurance company a lot more money in the long run.

Doctors are struggling enough with higher overhead, malpractice premiums and lower insurance company reimbursement. Now, not only are the insurers paying us less, they are actually encouraging the patients to go elsewhere for their care.

I think we will be contacting our state medical society and professional board about this issue. It is actually illegal for me to waive a patient's copay. It is considered insurance fraud. But for some reason, it is perfectly okay for the insurance company to do it.

Ok. End of rant for now.

[Scanner]

Steve,

I appreciate a good medical ins. co. rant. . .and I am no apologist. . .but isn't this economics working?

At a "Medistop" clinic, they have published prices for conditions (Sinus infection $65.00, Ear infection $49.00).

That's not only great from their perspective but great from a consumer cash-and-go perspective if you don't have insurance.

I just don't know how much it's going to cost to visit the family doctor. It's a huge unknown. It could be $70 dollars. It could be a lot more. I went to the one next door to my practice and the next thing I knew, I was hooked up to an EKG monitor for 24 hours for a partial bundle branch block. Count in the ultrasound of my heart. . .and the ins. co. was out a few thousand for a sinus infection visit (originally).

Good luck on the medical society thing. . .for years DC's have had to put up with the fact that it often costs one copay to go to the PT and a $10-30 copay for each chiropractic visit. Ins. co.'s are allowed to incentivize and dis-incentivize how they see fit. And my field is constantly disincentivized in the name of cost-cutting.

Think about it - it's $20 for a back surgery. Or for 12 visits to a DC - $240.

To the simpleton patient, the surgery is the better deal.

You just have to compete on value vs. price.

I know I won't go to these clinics. . .even if the copay is zero. I'll continue to go to the family doctor.

You are only losing the "frugal" market, not necessarily the value market. And do you really want someone who whines about the $10.00 copay?

Really. . .they are better off elsewhere if they value you that little. Let the Nurse-in-a-box deal with them.

One more piece of advice. . .think outside the system. Nearly every medical or other physician who is doing good (I'll except big name specialities) are doing something "cash-related." Dermatologists doing bo-tox, family docs doing vitamins, etc. . .think outside the box.

That Aetna or Blue Cross card is no longer profitable.

It is no longer profitable to be in the system delivering quality, evidence-based healthcare. In fact, I submit ins. co.'s are making sure that it's unprofitable for you and profitable for them.

Good luck.

[disneysteve]

At a "Medistop" clinic, they have published prices for conditions (Sinus infection $65.00, Ear infection $49.00).

That's not only great from their perspective but great from a consumer cash-and-go perspective if you don't have insurance.

I just don't know how much it's going to cost to visit the family doctor.

for years DC's have had to put up with the fact that it often costs one copay to go to the PT and a $10-30 copay for each chiropractic visit.

You are only losing the "frugal" market, not necessarily the value market. And do you really want someone who whines about the $10.00 copay?

One more piece of advice. . .think outside the system. Nearly every medical or other physician who is doing good (I'll except big name specialities) are doing something "cash-related."

I'm only talking about the insured - not the uninsured patients. I understand the appeal for them of going to these clinics. But if someone has insurance, they know exactly how much a visit with me will cost - their copay, whatever that happens to be, typically about $20.

I wish PT didn't have a copay for each visit. When I got PT for my shoulder, it was $30 every visit and I was supposed to go 3 times/week. That got really expensive really quickly.

As for only losing the frugal market, I work in a very poor area. If these folks can save $20, they will do it, no matter what. While I understand and respect that $20 is a lot of money to many people, I don't think the insurance company should be encouraging patients to not see their doctor when they are sick.

As for thinking outside the system, we already do that in a couple of different areas, so we've got that covered.

[sweeps]

No offense, Steve, but I have to agree with Scanner. The only way to reliably solve the skyrocketing cost of healthcare is for health care providers to compete. And there is no competition until consumers have full awareness of prices AND consumers have an incentive to choose less expensive options.

The insurance companies aren't stupid. If a patient has an ear infection, they'd rather pay $75 for a Minute Clinic visit, than $175 for a traditional doctor visit (even after co-pay) for arguably the same result. And for the patient it's a lot more convenient to drop in at CVS than calling the doctors office where (a) you'll sit on hold for 20 minutes, (b) argue with the receptionist for another 20 minutes that you should get an earlier appointment than a week from now, and (c) have to take a vacation day from work because 1pm is the only time the doctor is available.

[m3racer]

Unfortunately, one can't be entirely surprised with this move. I'd stop being a contracted provider for them. I also have to agree with scanner about catering to patients that bitch about $10 copays. Good luck.

[m3racer]

Sweeps, the bottom line is a nurse practitioner is not a physician. You're comparing apples to oranges.

[sweeps]

Sweeps, the bottom line is a nurse practitioner is not a physician. You're comparing apples to oranges.

For low level services, I would argue there is no difference. Sorry -- I know that may be a controversial view.

But an analogy...
I don't need a $400/hr CPA if I file a 1040 EZ.
I don't need an electrician if I'm changing a light bulb or replacing an outlet.
I don't need the Geek Squad if I'm removing a virus from my computer.
I don't need a doctor to check my temperature and blood pressure or look in my ear and see that I have an infection.

Regardless of all this, my point still remains... there MUST be clarity in pricing AND there needs to be an incentive for the patient to choose lower cost options. If a patient doesn't know how much things cost, or they don't care because they always pay $25 regardless, this health care crisis will never get solved.

[disneysteve]

The only way to reliably solve the skyrocketing cost of healthcare is for health care providers to compete. And there is no competition until consumers have full awareness of prices AND consumers have an incentive to choose less expensive options.

I understand competition, but it doesn't work if the playing field is unlevel. It is illegal for me to waive a patient's copay. It is considered insurance fraud. But now it is okay for the insurance company to say you don't have to pay your copay if you go to the clinic. How can I compete with that? Plus, if you come to my office, you are seen by a physician board-certified in family practice. If you go to the clinic, you are seen by a nurse practitioner. I have no problem with nurse practitioners. I've worked with some very talented ones. But they don't go through the same training and, subsequently, don't command the same reimbursement.

[Scanner]

DisneySteve,

But if someone has insurance, they know exactly how much a visit with me will cost - their copay, whatever that happens to be, typically about $20.

Right. . .it's $20.00 but maybe it's more to their insurance.

And there's the problem. . .the "risk" to the ins. co. . .at the Minute Clinic. . .they are assured the bill will never be above $x (cash or insurance). . .at a family dr. . .it could run into the thousands (but not as much if you are cash thus the dual fee schedule).

If you are in a poor area (and yes, I think you are), I'd make plans for an exit. It seems NP's and PA's are positioned to serve the poor and indigent better and really, in a way. . .as a tax payor, why should they get the best (you) when adequate (NP) is what they should get?

I realize that subject is a bit different. . .since we are talking private pay at this point (Blue Cross).

If you want to serve the poor, I'd volunteer. . .not make a business of it.

Really, I don't understand it. . .yes, they are poor. . .but they have health ins. so that means they have a job. Are they really going to switch providers/go elsewhere for $20?

Or is this the Blue Cross Medicaid program you speak of (NJ Family Care?)?

[disneysteve]

I don't need a $400/hr CPA if I file a 1040 EZ.
I don't need an electrician if I'm changing a light bulb or replacing an outlet.
I don't need the Geek Squad if I'm removing a virus from my computer.
I don't need a doctor to check my temperature and blood pressure or look in my ear and see that I have an infection.

Regardless of all this, my point still remains... there MUST be clarity in pricing AND there needs to be an incentive for the patient to choose lower cost options. If a patient doesn't know how much things cost, or they don't care because they always pay $25 regardless, this health care crisis will never get solved.

You make a very valid point, but at the same time, if you make it harder and harder for doctors to stay in business, what effect will that have on the healthcare crisis? I have a friend who was forced to close his office and retire a few months ago because he simply could no longer afford to operate his practice. He didn't want to retire but he had no choice. He wasn't making enough to keep the place open. Just today, I had lunch with a sales rep from a medical supply company. That rep is a licensed, certified chiropractor who gave up his practice because he couldn't survive financially. I know a pharmaceutical rep who was a podiatrist for several years before folding her practice for the same reason.

Doctors are being forced out of practice while healthcare costs continue to rise and insurance companies rake in record profits. As easy as it seems to blame the doctors, it isn't our fault.

[Scanner]

I don't know. . .I'm conflicted on this. . .I really don't want to see DisneySteve hurt economically so don't feel "ganged up" upon. I feel family docs bear too much pressure and risk and not enough reimbursement.

I'd like the advice of just slowly exiting the plans. Pick your crappiest one every year and just say "No more."

I just did that with NJ Family Care. . .they were paying me $8.25 (after pre-certs). The director said, "I think that's fair and equitable." I wrote back and said, "IF you really think that fair and equitable, go offer to pay that cash to a physician near you and see what he says."

They have too much power because we give it to them.

Roll some heads. . .fire some medical assistants and nurses who work for you. . .and exit the plans so they have no doctors on it.

Maybe then they'll realize, without doctors on the panels, there will be no plan.

[disneysteve]

If you want to serve the poor, I'd volunteer. . .not make a business of it.

That is not feasible due to the malpractice insurance. My friend who closed his office would love to volunteer at a homeless shelter or some other place in need of care, but he can't because he needs to have malpractice insurance to do that.

Really, I don't understand it. . .yes, they are poor. . .but they have health ins. so that means they have a job. Are they really going to switch providers/go elsewhere for $20?

Or is this the Blue Cross Medicaid program you speak of (NJ Family Care?)?

Nope. I'm talking about private BCBS PPO of NJ. I work in a poor area but that doesn't mean all of my patients are on Medicaid. I have a large working class patient population. Will they go elsewhere to save $20? Some will. Just the same as they will happily transfer all their prescriptions to WalMart to get them for $4 instead of $10 or $15 at the pharmacy they've used for the past 20 years. And I can't say that I blame them.

[Scanner]

DisneySteve,

I hear ya. The family doc next to me has almost said to me that he does family practice as his "hobby" (nice to know, huh?) and instead invests his time and energy in multi-level marketing (which some of his patients attend the weekly meeting).

I don't think people realize how bad it's gotten.

If all this is too much to swallow. . .there's no shame in thinking about a career switch sooner or later. I do it all the time.

We need to let our students/young ones know that being a doctor isn't rewarding any longer and we need to tell our brightest and best to pursue something better, like politics

We should just import doctors in the future.

[Scanner]

And frankly, I think it's a real pisser that sometimes the drug reps are making more than you so I'm going to give you some free advice from a drugless provider, Steve.

Throw them the hell out of your office, I don't care if they look like a hot model.

I'd come up to the front, ranting and yelling like a banshee and throw them out on their asses.

Embarass them so they don't come back.

Tell the drug co.'s to spend their money on securing you better reimbursement and throw out the tissue boxes, pens, scratch pads, and buy your lunches from the deli.

If a bunch of you in a region did this, I bet they would take notice.

When DC's provide this sort of rhetoric, we look like nuts (because we are ). You do it and you'll look like reformers.

Really, as much as DC's and MD's have collided/butted heads in the past, I submit we are often in the same boat.

[disneysteve]

I don't think people realize how bad it's gotten.

We need to let our students/young ones know that being a doctor isn't rewarding any longer

I think that's the key point. The public simply doesn't realize that all the talk you hear about rising healthcare costs isn't benefitting physicians at all. In fact, physician income has been steadily falling for years. All those rising costs are not going to the doctors providing the care. They are going to the bureacracy controlling the care. Add to that the huge cost of medical education and the debt load students graduate with and you've got a recipe for disaster. You can't spend $200,000 and above for an education if your career won't provide the means for you to repay that debt.