Abstinence from Alcohol Rebuilds Bone Strength

Matching Medicaid payments to Medicare: From pitiful to pathetic

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“The specialist rescheduled me again,” the patient told me, looking embarrassed.  ”I think he doesn’t want to see me any more.”

“I’m sure that it isn’t that he doesn’t want to see you,” I replied.  ”This has to be a miscommunication with the front desk.  It happens all the time; it drives doctors crazy.”

“I don’t know,” he continued.  ”I just got on Medicare, and I wonder if maybe he doesn’t want me any more because of that.”

Whether it is Medicare, Medicaid, or a commercial insurance (or no insurance at all), patients are paranoid about their coverage.  They feel vulnerable – that they somehow came to the ball wearing an ugly gown and nobody wants to dance with them.  Insurance has become like the smell of the bathroom or like feminine hygiene – you know people do it, but nobody wants any details.

There are several reasons, I can guess, for this universal discomfort:

  • People hate to appear cheap. Insurance is how people pay their doctors, and (at least for primary care) they don’t want doctors disliking them because their insurance doesn’t pay well.
  • People don’t have any idea how much their insurance pays. Obviously this is impossible for patients, since each doctor has negotiated a different contract with each insurance company.  One doctor may have negotiated well (perhaps as part of a large group) and is paid $80 for an office visit, while another is paid only $50 for the same work.  If a specialist bills for an office visit (99213), they are paid substantially more than the primary care physician billing the exact same code (for the same reason).  Most patients have no idea about this variability, but they do know that whatever the card does is a mystery.
  • Most people don’t get to choose their insurance coverage. Employers usually give only a single plan, although some will give a choice of plans.  Regardless, the plan most people have is not what they would choose if they had a choice.
  • Insurance changes so often that even if someone learned about a plan it would become obsolete in a very short time.
  • Most doctors don’t know what each insurance pays, so they tend to complain about them all, making patients feel uncomfortable.

We’ve dropped two insurance plans in the past 12 months, picking one of them back when they renegotiated.  Each time we dropped a plan, patients were rarely angry with us.  They assumed that we were getting screwed by the insurance company (which we were in both cases), and felt sad that their inability to choose a different insurance plan made it impossible for them to come to our practice.  When we came back to the one plan, patients were grateful to us, still having terrible things to say about the insurance company for putting them through the exile from their doctors.

Click here to read the entire article by Rob Lamberts, MD.