Once again, I think we have to continue to educate our PATIENTS as to how their insurance company stacks up. As I mentioned earlier, we have a big Humana base here in "Kentuckiana". For years they refused to pay an additional fee for Paps done at the time of general exams. Because of this I quit doing them and made my patients come back 6 months later to have their GYN exam done. I figured, if the patient went to a Gynecologist, the insurance company would have to pay them and the patient would have to pay another Co-Pay so, what's the difference? I was willing to do the procedure the same day (which would save the patient another Co-Pay) but THEIR insurance company would not allow this. I told the patient other insurance companies (most anyway)paid for the added procedure. When the largest school system in the area changed to Humana, my policy stood and I had a bunch of unhappy patients. I directed this swarm of teachers to contact their insurance carrier, their HR person (who by the way was/is a patient of mine) and their school board and complain. They did and they told their co-workers who were having similar problems in other offices to do the same. Now, I cannot really say if this was the straw that broke the camel's back but, as of this year, Humana will now pay for the Pap as the separate procedure that it is.
The medical community here is now ignoring United Health Care. Many have stopped taking it completely, many will take no new patients and many of us simply refuse to do routine, in-office things if they have this insurance. And, every patient I see who has UHC is sternly reminded that, because of THEIR insurance, we will not give injections, do EKG's, Bone Density scans, clean ears, do urines, take cultures, or any other convient-for-them procedure because their insurance reimburses below our cost. "So sorry, you will have to go to the lab or to the hospital or to the ENT specialist or to anywhere but here because your insurance company will not pay me to do it." I make a very special point of telling them they are getting service below even which Medicare gives. The usual response is, "But I have no choice...it is what my employer offers". I then tell them they do have a choice and their first step is to en mass, complain to their union or to the employer and fight for their right to at least be offered a CHOICE of health care coverage and level of care.
Until we put the burden of poor coverage on the consumer and, bring to their attention and pocketbook the carpet-bagging which is going on, the insurance companies will continue to suck us and them dry. I am beginning to see some heads come up. I am beginning to see patients fighting more for their medical care. Previously they would argue with me and get mad with me when, for example, I refused to put a diabetic, who for several years now has been very stable on an ARB, on a different GENERIC one. Even after I explained there IS NO GENERIC and they coughed on the ACEIs they continued to picture me as the bad guy. More and more I see them turning now to the insurance company and writing letters and complaining to their employers. Will this make a difference? Who the heck knows. But we simply HAVE to involve our patients in this battle. IMO, the first thing we need to do to fix our health care crisis is to completely remove the burden of health care insurance from the hands of our employers who don't really give a hoot about our health unless it affects their bottom line. Let's give the decision-making back to the people who use it. Let them decide what level of care they desire and what risks they are willing to take. Our employers do not choose our auto insurance, make our grocery choices for us or pick out who we will marry. Why in the heck do we allow them to make our health care decisions for us?
Sorry for the rant...having turkey withdrawals
Leslie
