Medical insurance company RANT

[disneysteve]

I have to agree with Steve here. This could lead to more cost in the long run for the insurance companies because if a disease goes undiagnosed.

The bottom line, though, is that the insurance companies are willing to take that risk because they know that statistically, most patients change insurance every couple of years, so when that more serious condition crops up down the line, odds are good that the patient will be with a different company and somebody else will get hit with those bills.

[PetMom]

The bread and butter type ailments you mentioned also could be lost to a new internet thing where people can find remedies easily available to them without a Dr. Eg...pink eye has a host of 'no Dr. needed' remedies that they claim are just as effective (this is a forum I refer to not an advertising website).

Think of the people not insured, think of those who do not trust Dr. (a whole generation of people - Tuskegee), illegals who are afraid of being caught, people who do not want to make a Dr. visit because of fear of their rates being raised higher by the insurance co., or just the flat out inconvenience and high cost due to the taking a vacation day off (as one poster iterated here).

On a similar note there are midwife practictioners who take over the
birthing now.

Further, some news segments stated that we will be paying even more for health care in a few years, if that is even feasible.

[aida2003]

This thread is interesting to read though I'm still on the 2nd page.

But I am curious about one thing.
Don't the nurses at the CVS clinics have a list of what illnesses they are OK to diagnose and when they're supposed to tell a patient to go see a doctor? Or e.g. advising the same patient that after using this or that treatment to go see a doctor if it doesn't get better?

I think right now I agree with someone's analogy who said "why would I go to a CPA if I have to file a 1040EZ." Or why to use a CPA when a TurboTax can do the same job for much less (unless it's a very complicated return).

Just my 2 cents.

[disneysteve]

But I am curious about one thing.
Don't the nurses at the CVS clinics have a list of what illnesses they are OK to diagnose and when they're supposed to tell a patient to go see a doctor? Or e.g. advising the same patient that after using this or that treatment to go see a doctor if it doesn't get better?

Absolutely. They have a specific list of conditions they treat and services they provide. Anything outside of that list, they tell the patient to see their family doctor.

I totally understand why some patients would choose to go to a clinic. That isn't my issue. My issue is the insurance companies incentivizing patients to use the clinics instead of their family doctors. I think that is short-sighted from a medical standpoint and will result in a lower overall quality of care.

[sweeps]

Steve, would you be okay if the insurance company made the co-pay a percentage of the bill? 20% let's say.

So at Minute Clinic I would owe $15 for a $75 bill. At my doctor I would owe $40 for a $200 bill.

[disneysteve]

Steve, would you be okay if the insurance company made the co-pay a percentage of the bill? 20% let's say.

So at Minute Clinic I would owe $15 for a $75 bill. At my doctor I would owe $40 for a $200 bill.

That's actually the way some insurance companies work already. Traditional indemnity plans are often 80-20, meaning the plan covers 80% and the patient is responsible for 20%. I'm fine with that. In this case, however, it is the equivalent of the plan saying at the doctor's office, you pay 20% and at the retail clinic you pay 0%. That's where my issue lies.

[LivingAlmostLarge]

I've lived in 3 major cities during my adult life and I've never been able to see a doctor that day or within a day.

I've had kidney stones/infection, I went to the student health. Sent me home to take tylenol. I nearly passed out from the pain, my DH drove me to the ER. Sorry, but I couldn't get into my GP too busy.

So instead I sat in the ER and waited and was in terrible pain. It was awful.

I broke my foot and went to the ER. Went to see my GP, he said it was a spain. 1 week later, I still couldn't walk and my foot was horribly swollen. I called and orthopedic surgeon and went to the ER in an emergency. The Ortho saw me that day and my foot was broken. Dumb ass. The orthopedic didn't know why the GP couldn't read the film, and by the way, I had a radiology tech take the picture at night.

Sorry but I'm still pissy about the medical community and I gotta wonder about some of these doctors.

And so sorry steve, but I'd go to a clinic. GP/family doctors are not exactly my cup of tea, and I'm not going to sit there for 2-3 hours or not be seen for weeks.

And I'm calling my insurance tomorrow to report the doctor isn't taking new patients. The DOCTOR'S office said it's the insurance companies fault because they don't update their website.

So whose to blame? By the way I'm sure I'm costing an arm and a leg constantly going to the ER, but what else can I do? I am pretty much dying and in horrible pain before I go, but a GP won't see me and when they do, they misdiagnose me anyway.

[Scanner]

DisneySteve,

I don't want a philosophical war to erupt (because I hope you don't think I am like that) but I don't think you have to accept the drug reps supplies and be indebted to them.

97% of doctor's visits end in a prescription. And prescriptions are the fastest rising expense on health ins. plans.

I don't think it has to be that way.

You could diagnose a viral infection, say you'll watch it, come back in 7 days (thereby increasing the lost volume you are worried about), if it's still there, then I'll give you an antibiotic. Or. . .let's try fish oil for 3 months and check your cholesterol again. There are probably other examples I am not thinking of.

Of course, the NP at the CVS isn't going to do that, are they? CVS is putting them in there for very, very astute business reasons.

You get a diagnosis, a prescription, walk 20 feet and CVS sells you their pills.

I don't like it at all.

I think it bodes bad for America, just for different reasons than you think.

I don't like it any more than I would like it if you had a pharmacy at your front desk and you made $20 profit off of every prescription.

It's too much a conflict of interest.

I want my doctors and pharmacies seperate, distinct, and no kick-backs.

[gladtobeamommy]

97% of doctor's visits end in a prescription. And prescriptions are the fastest rising expense on health ins. plans.

I don't think it has to be that way.




There are plenty of dr's that are not script writing happy. I should know I work for one he actually gets upset when the patient ask for a script His logic is they are self treating with what they think they need.

I hope this quote thing works I always have a problem with it

[disneysteve]

I don't think you have to accept the drug reps supplies and be indebted to them.

There is a big difference between accepting token items, like pens and note pads, and being in any way indebted to the drug companies. And I don't believe one causes the other.

I have reps who come to my office every 2-3 weeks promoting products that I don't prescribe and have no intention of ever prescribing. The reps still come. They still leave pens and pads and tissue boxes. I have other reps who come and promote products I do use, sometimes periodically, sometimes quite regularly. They also leave pens and pads and tissue boxes.

What medications I prescribe for my patients has little to do with the drug reps presence in my office. The big exception to that would be my uninsured patients. They are the beneficiaries of the drug rep visits because whenever possible, I will give them medication for which I have a steady supply of free samples. If and when they need medication and I don't have samples, I either change them to something similar that I do have samples of or I prescribe the cheapest option, generally something off of the $4 generic list at Wal-Mart.

That Wal-Mart list gets used almost every day in my office. There is a copy in each exam room and I refer to it frequently. Just this week, I switched all of a patient's meds to products on that list because he told me he's been having trouble paying for his prescriptions.

Am I ever influenced by drug reps? Sure. I'm not going to lie about that. If I have to choose between 2 or 3 similar drugs for the same condition, all with a similar cost, I'll lean toward the one from the company that provides better support to our office. But for most conditions, there is a cheaper option, a generic option or even an over the counter option that I will go with when possible.

[disneysteve]

the NP at the CVS isn't going to do that, are they? CVS is putting them in there for very, very astute business reasons.

You get a diagnosis, a prescription, walk 20 feet and CVS sells you their pills.

I don't like it at all.


It's too much a conflict of interest.

I want my doctors and pharmacies seperate, distinct, and no kick-backs.

I agree with this. I think having a clinic in the pharmacy is a conflict of interest. They say it isn't because they say the patient isn't obligated to fill the prescription at CVS, but come on, if the whole point of the clinic is convenience, why would a patient leave there and then go somewhere else to get the medicine filled?

[maat55]

The concerns you raise about follow-up and prevention are valid. However you are not competing against a co-pay but convenience. If you could find some way to make a visit to your office less time-consuming and less frustrating, then the Minute Clinics would not stand a chance. Physicians' offices tend to be very rigid; they open at 9:00, close for an hour at lunch(or longer) and close at 4:30. If you don't like it, go to the ER. You get there, you wait in the waiting room, you wait again in the exam room to see the doc and you wait again to check out. Going to the doctor can take a significant portion of your day which is not really acceptable to people who work. It's all the more frustrating if it's for something relatively simple like an UTI or conjuctivitis.

I have to agree with this. Convienence stores are big because you can get in and get out with what you need. Going to the grocery store is a pain. Same with Doc offices. I prefer being at the Doc's office, but it's easier to go to the clinic.

[Spud]

But GD, health care premiums are going through the roof. I seriously cannot continue to pay these premiums if they continue on this path. Some serious changes have to be done to the health care system. And this is one place to start.

If insurance companies pay more, ultimately that means I pay more. So not only am I interested in lowering my direct health care costs, but also my indirect health care costs (i.e. what my insurance company pays on my behalf).

This thread is kind of interesting timing. We were downstairs cleaning out the basement this weekend and I was going through some old files making keep/recycle/shred piles. In doing so I came across some old memos (hand-written on graph paper! My, how the company has grown/matured since then!) that talked about health insurance rates. My husband has worked at the same company for 15+ years now, and they have kept comparable coverage since then. Prices were this:

1990: Spouse: $125.23 Children: $94.68
1991: Spouse: $131.40 Children: $99.34
1992: Spouse: $138.50 Children: $104.72
1993: Spouse: $131.41 Children: $99.29

Compare those figures to 2007, when we paid $399.18 for me, and an additional $486.67 once we had our baby. $886/month went to health insurance. And that does not include lab fees, deductibles, or any other medical costs -- just insurance. My husband works in a company with people who have professional degrees, and people in their company could not afford to have their children insured. I can certainly understand where they are coming from -- If we had any debt at all, I'd certainly be working, if only for the health coverage.

For 2008, the company went with a plan that had a higher deductible and some other concessions in exchange for our monthly rates going down to $675.04.

Even considering inflation, that is an incredible increase in costs. I just don't understand what has happened. "Medical Costs Have Skyrocketed" isn't enough information. But it *is* enough to demand changes in the system.

[Snave]

Tough discussion with no real answer that will be liked by all. I don't know the answer either. This thread has commented that doctors charge too much, drug companies charge too much, and insurance companies pay too little. All I know is that if I do get seriously ill someday that I hope there will be some physician that can diagnose my problem, potentially refer me to another physician that can perform a surgery and then I can be helped along in that process by medicines that to also heal me. I'll be thankful that I am alive and didn't have to foot the entire bill. As for the insurance companies - at least I am not paying 100% out of pocket b/c I am lucky enough to have some coverage. As for the physicians - thank goodness someone still wants to go to medical school - I wouldn't these days. As for the drug companies - thanks for sinking a billion dollars into a new drug that makes it to market, let alone the billions for those that don't. I understand the risk of trying to bring a new product to the market. It's not like you are Coke or Pepsi where you throw a little cherry flavor in and bring it to market, call it a new product, and make millions.

[Exile]

To sum it up, this is why America needs a nationalized health plan like the other industrialized countries and even non-civilized societies like the U.S. Congress have.