June 29, 2006, 7:23 pm

Begging For Health Care

figure

Boy, talk about “striking a pose”.

Unfortunately, I don’t find this funny at all.

Imagine a family.

Solid “middle-class” if there is such a thing.

Dual professional household.

Four members of the family.

All covered by a Blue Cross PPO.

Now, remember, I said BLUE CROSS. The insurance company that for all of my known life was the GOLD STANDARD when it came to health insurance.

I’ve taken job offers BECAUSE of Blue Cross insurance.

Only now the members of this family need medical care.

The wife has been covered for awhile. She had an internist agree to take her on as a patient many years ago and when he retired she was happily transferred to a wonderful internist in her area.

But the wife’s doctor would not take her husband on because of the impact the retired doctor’s patients had taken on his practice.

No problem. The name of a local physician was received and that doctor agreed to take the husband on as a private patient. But only because the husband’s diabetic labwork “passed” his entrance criteria. He specialized in endocrinology.

So, when the 22-year-old son needed medical clearance before going off to law school, the mom called her excellent physician for a referral.

Oh! The doctor would begin taking new patients on July 1st!!!! Great, the son would like an appointment!

“What insurance does he have?”

Same as his mother. Blue Cross PPO.

Nevermind.

The doctor is no longer taking patients with Blue Cross insurance.

WTF?

“Oh yes, their reimbursement rates are horrible now. They hardly pay for anything after the initial $15.00 co-pay by the patient.”

Okay, do you have the names of any other internists or general practitioners who are taking patients?

A name is given. The practice is closed to new patients.

So, the mother calls the pediatrician of the son. The son who is now 22-years-old.

Three referrals are given by the receptionist.

All three referrals are closed to new patients.

The 22-year-old son goes to see his pediatrician for his check up.

******************************

I’m sure you have figured out by now that I’m talking about my family. We aren’t poor. We aren’t on Medical. We have good jobs and while we have a few health issues, we are compliant with our medical regimens and are motivated to stay healthy.

Between the two of us, a six figure salary.

And we can’t get primary health care for our healthy son. My husband and I are “lucky”. My retired doctor took me on in spite of his office being totally impacted because I was a nurse. My husband got a doctor because he was “diabetic enough”.

But my healthy 22-year-old son can’t get anyone to take him on. So he sees his old pediatrician and stands in line with the five-year-olds to get weighed.

Why?

BECAUSE THE DOCTORS ARE NOT GETTING PAID!

You want an answer to 90% of the problems we have American health care?

PAY THE FREAKIN’ DOCTORS WHAT THEY ARE WORTH!

These men and women have dedicated more than a decade of their life to learning their art and it costs money for them to run their businesses.

PAY THE FRONT-LINE, PRIMARY CARE DOCTORS: THE GENERAL PRACTITIONERS, THE FAMILY PRACTITIONERS, THE PEDIATRICIANS, THE INTERNISTS AND THE OB/GYNS.

If you pay the front-line doctors they will take on the patients who will then have a place to go when they are sick, which will dis-impact the ERs of the country, encourage doctors to practice in rural areas, help stop disease processes before they get to the stage of needing intervention and decrease the number of hospitalizations.

The entrance into the health care system needs to be the local, personal, patient physician. Let them be the gatekeepers, but make then WANT the job by paying them.

Is there any other business where the owner says: “I charge $1.00″ but they are only paid 3 cents?

And don’t tell me the insurance companies don’t have the money. Blue Cross is NOT a poverty-stricken entity.

When doctors stop taking Blue Cross,

When families with a good income can’t find a doctor to take them when they are healthy but need a physician’s care,

Houston, we have a freakin’ problem here.

I can’t even imagine what it is like to be poor and to navigate the health care system. I am sure I have experienced only one iota of what they face trying to find primary health care. And I’m a nurse!

Pay the primary doctors and pay them well.

The other issues will take care of themselves.

Yes, I am passionate about this.

And no, I don’t want the NHS in the USA. Private insurance, affordable and paying the front-line doctors a larger piece of the health care pie.

Geeze, I better go take my blood pressure.

Good thing I have a doctor, just in case…….

Oh, and some day I’ll tell my son’s hilarious story about standing in line with those five-year-olds…..

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31 Comments

  • drcharles
    drcharles

    June 29, 2006 at 8:22 pm

    can i please write you in for president in 2008?

    seriously, if i were paid better i’d slow down, make about the same amount, and be able to take time with patients again. the system is horrendous


  • Aine
    Aine

    June 29, 2006 at 10:17 pm

    Kim -

    Nothing will change until we get the insurance companies out of the health care business.

    Consider. What do insurance companies add to the health care process? They do not provide care. They do not provide quality assurance or oversight, like accreditation committees. They do not advocate for patients’ rights or providers’ rights.

    They are parasites. Insurance companies are to health care what lampreys are to fish. The CEO of Blue Cross/Blue Shield, is paid $950,000/year plus $2.28 MILLION in bonuses, in part for “meeting financial targets” (translation: keeping profits up and costs down, by charging the insured a bundle and paying doctors bubkes). Compare and contrast with your doctor’s $0.03/1.00 compensation. And what, precisely, has Mr Serota contributed to the process between you and your doctor? Has he made your doctor better at his job? Has he contributed materially to your health?

    There are other problems, true (like pts who lead unhealthy and non-compliant lives, people who think medicine can cure death or at least prevent it forever, and pts who don’t care what it costs because they’re not paying, the insurance company is!) but here’s a good place to start.

    Aine

    PS Love the blog. Truly. You’ve made me consider going back to school for a third BS (BSN).

    PPS figures from Hoover’s (www.hoovers.com)


  • tscd
    tscd

    June 30, 2006 at 4:47 am

    The NHS needs money too! There’s no money to pay doctors or nurses here, so NHS isn’t hiring. Even the consultants are losing their jobs. Hundreds of unemployed doctors here in the UK! *waves*


  • Celie Thomas
    Celie Thomas

    June 30, 2006 at 6:21 am

    My husband has been a Family Physician for 24 years, and this is absolutely the most discouraging issue in his life. Nobody seems to know about how bad it is! Many of his colleagues are either retiring or going to “cash only” but he does not want to go that route and lose the families he has loved and treated continuously all these years because they wouldn’t be able to pay cash. Please continue your battle to educate the public about this! Everyone assumes that all doctors are “rich” — if the primary care docs take up this cause it will look greedy and self-serving. Thanks for your passion!


  • Kelly
    Kelly

    June 30, 2006 at 6:23 am

    This bothers me to no end. I’ve worked in medical billing (for a specialist), and one company would only reimburse, say, $15 bucks on a $75 charge. No Joke! That’s flat out ridiculous.

    What also bothers me about this is that I feel very comfortable with the primary physician and specialists that we see. They are excellent doctors and we love them. Are they getting clouded views of US because our Ins Co. isn’t paying them what they’re worth?? Are they getting disgruntled because when we walk through the door, they know we require a $100 office visit that they’ll only get paid $25 for?

    That’s just not fair for everyone involved. The doctor/patient relationship is one that should be open, positive, and lengthy (THAT doesn’t happen too much anymore! I’ve given up secondary ins just so that I didn’t have to give up my physician!).

    If there was any way I could pay our doctors out of my pocket, I would in a heartbeat. Their care is vital to our health and my daughter’s life.

    Since when is life only worth $25 bucks?


  • Dee
    Dee

    June 30, 2006 at 7:14 am

    Reimbursement amounts are horrible I agree. But, unfortunately, part of the cause is that we Americans drive up our own medical costs by insisting we deserve all kinds of treatments. New Jersey’s costs jump every time the legislature approves another health mandate. If we didn’t have to pay for all the special mandates, insurance could be a lot cheaper. And, if we didn’t insist that the 90+ old man in chronic renal failure needs a kidney transplant instead of letting him die peacefully (which is what HE wanted to do, except the docs all insisted that he was only depressed and really needed the treatment…) then we would save a lot more money and could reimburse doctors more. It’s a vicious cycle and everybody is losing, consumers, hospitals, doctors and insurance companies.
    But, I’d rather have insurance and pay the rates then have to deal with the rates I would pay as a non-insured person (been there, done that, STILL paying the bills from a 3 day hospital stay 6 years ago…)


  • ltaylor
    ltaylor

    June 30, 2006 at 8:40 am

    I agree w/Aine to a point. I think there should be high deductible catastrophic health insurance type of policy that would cover a major medical issue or hospitalization.

    All other routine visits would be on a cash pay basis. I have no problem with paying a reasonable amount to see my doctor when I am sick. Most doctors will offer a cash discount which is very reasonable.

    I know there are many doctors offices who bill for services not provided because the service they actually did provide was not covered and I am sure there are many other “billing tricks”. The insurance companies are so out of hand – they need to get out…now prescription drug coverage…that’s another story.


  • Peggy
    Peggy

    June 30, 2006 at 10:12 am

    Wow, I totally agree with Kim. We believe that we are doing the right thing by having insurance then when one of the top insurance companies is denied by a doctor there is a huge problem. Why can’t insurance companies be run as non profit organizations? Work the same way they do now. Customers pay their premiums, insurance companies pay their employees and operation costs and use the rest to pay the doctors! No need for million dollar bonuses…
    I agree Kim for president.
    P


  • Kelly
    Kelly

    June 30, 2006 at 11:23 am

    Well, my daughter has special needs, and thus, lots of medical bills. We’ve been on an HMO since we had kids, and its worth every penny for us because we actually “use” the medical care we are entitled to. But an HMO makes you jump through hoops. Its annoying, I hate it, I hate seeing how little they actually pay our doctors for Jenelle, but it is what I have to do to get by.

    Sad to see our health care system come to this!


  • Sid Schwab
    Sid Schwab

    June 30, 2006 at 1:29 pm

    It’s a mess. Not only do insurance companies suck lots of dollars out of the system — from overhead, from profits to investors (some companies) — but there are dozens of them, causing a chaotic bunch of rules, more overhead for those trying to get paid. My clinic — a large one — has a couple of floors of a building filled with people in cubicles doing nothing but insurance paperwork. Which is why a single-payor system makes sense. Small practices have about zero clout. They can refuse to take certain insurance because of low reimbursement, but the company is likely to say “who cares.” At least a large clinic, when it fires an insurance company, gets noticed and, in some cases, a change in the pay scale. It’s dysfunctional at every level. And it seems the only ones pretty much guaranteed to keep afloat are the insurers. Doctors, hospitals, and patients — especially patients — get the shaft. But Congress is right on the case: assuming you think preventing flag burning will help.


  • MotherJonesRN
    MotherJonesRN

    June 30, 2006 at 1:42 pm

    I hate insurance companies. Stinkin bastards. People with state medical assistance, at least where I live, have better access to health care than people with private health insurance. No joke. The state pays doctors what they are worth. The only reason I’ve been able to see doctors is because I’m a nurse. Thank God for professional courtesy.
    The problem is rooted in greed. To tell someone they have health care coverage and then not to pay for it is fraud.


  • Mark A. Rayner
    Mark A. Rayner

    June 30, 2006 at 1:56 pm

    I don’t think it’s fair to JUST blame the HMOs for this one. We have the same problem in Canada (where we have socialized medical system) and I think the blame has to be on the amount of time it takes to become a specialist. Blame it on capitalism. Supply and demand. Blame it on the medical schools lauding the specialist and not appreciating the GP.

    We need to value the GP and the preventative nature of their job as much as we value the incredible things that a specialist can do — that is the problem.

    Great post! m.


  • Nicole Daly
    Nicole Daly

    June 30, 2006 at 3:58 pm

    The whole insurance reimbursement thing is incredibly frustrating. I had uninsured labwork last year and spent several thousands of dollars. I have insurance this year, but my insurance company only has to pay 10% (literally, I get the explantion of benefits forms) of what I paid. How the heck is that fair!


  • Framboise
    Framboise

    June 30, 2006 at 6:04 pm

    “If there was any way I could pay our doctors out of my pocket, I would in a heartbeat.”

    “I had uninsured labwork last year and spent several thousands of dollars. I have insurance this year, but my insurance company only has to pay 10%”

    Yeah, it’s real hard to be uninsured and trying to honestly pay your way when your cash bill is underwriting the losses from the insured billing. Insured or not, the entire structure has totally lost touch with reality. It’s a massive financial industry and bears only the most remote relationship to actual health care delivery. But don’t forget that, in the US at least, big businesses are much more important than individual consumers, so we’re getting, right now, what the president things we should. Or more than he thinks we should. Doesn’t that make you feel better?


  • Celie Thomas
    Celie Thomas

    July 1, 2006 at 6:40 am

    Me again, with a note to Mark regarding “GP”s. Many people have no idea that there is a difference between a GP and an FP. A GP, or General Practitioner, does 4 years of medical school and a year of internship, and then goes into practice. An FP, or Family Physician, does 4 years of medical school, a year of internship and two years of residency — same as a General Surgeon — and then has to take national recertification boards every 6 years for the rest of the professional lifetime. These are the same boards that residents take, right out of training, and encompass all medical specialties! They have to earn all kinds of recertification “points” along the way to even be allowed take these boards. May FPs are just saying “Forget it!” now, because it means nothing. They don’t get reimbursed any more for the extra training and expertise. And, unfortunately, the AMA is primarily run by top-dollar specialists who aren’t particularly concerned about the primary care folks who are actually the ones who generate their patients! No one is going to care about this issue until they suddenly realize their are no family docs left.


  • Too Fat 4 Ponies
    Too Fat 4 Ponies

    July 1, 2006 at 12:11 pm

    I’m right there with you! BCBS of Tennessee regularly denies payment for our two sons’ pediatrician vists because we have to confirm, yet again, that they are NOT covered by other insurance plan.

    A friend of mine who programs software for health insurance companies has revealed to me that their industry software is designed to randomly deny payments to assist the insurance companies with “retention”. Meaning, retaining money so that it can gather a few more dollars in interest while the rest of us have to fill out ridiculous forms every 3 months stating… yes, my child is still my child!

    Sorry about the soapbox. This one hit a nerve!


  • kenju
    kenju

    July 1, 2006 at 2:50 pm

    Kim, we had the same problem with BC/BC of NC several years ago. What about a doctor who drops you as a patient after 3 years because you have turned 65 and have Medicare?? That happened to me.


  • bigmamadoc
    bigmamadoc

    July 2, 2006 at 5:42 am

    Sing it, sister!


  • Gimpy Mumpy
    Gimpy Mumpy

    July 2, 2006 at 6:42 pm

    I’m not sure whether to comment on the insurance crisis or the 22-year old son going to his old pediatrician!

    If it makes your son feel any better I clung to my pediatrician until I was forcibly booted from his practice for being “too old”. Damn, they were the only one’s that truly understood a needle-phobe like myself. When I next went to the new doc for labs I said “I’m not good with needles I need to lay down.” They laughed, had me sit instead and came back to find me laying face first in a pool of my own vomit. I hope it was a pain to clean up. I know I scared the bejeepers out of the nurse. hehehehe. :)


  • jen
    jen

    July 2, 2006 at 10:09 pm

    this is bad…….but what is worse is when a nurse has to wait 90 days for her insurance to kick in.

    excellent blog girl!


  • enrico
    enrico

    July 3, 2006 at 12:26 am

    Ciele: General surgery is NOT a 3 year residency like FP and medicine. It depends on the program, but it’s usu. a 6-7 year residency. “General” surgery is an unfortunate misnomer that implies non-expertise; in fact, general surgeons do just about everything under the sun that doesn’t involve the brain, bones/joints, or the heart.

    On to Kim’s post, insurance companies are bastards. As horrible, bottom-feeding creatures as career medmal attorneys can be, they are at least human and represent people. Insurance companies are financial enterprises that play billion-dollar odds games to ensure maximal profits at both the expense of physicians (by delaying/minimizing payment) and patients (by raising premiums and reducing coverage). Until proper legislation is passed to handcuff them (not likely considering their political contribution power), they will continue to prosper as we suffer.

    There is yet one more creature so vile, I am wretching as I type this: the whore physicians in their employ who review cases, picking at medical records to justify denying coverage.


  • Dee
    Dee

    July 3, 2006 at 5:56 am

    Enrico–come sit with me and see what our medical directors deny–

    The face lift in the 50 year old man that the plastic surgeon submitted as a blepheroplasty (with notes!), the breast reduction and lift (with only 150 grams of fat removed) in a 25 year old woman

    The 10th pain management injection for a patient in 5 months (yes, the MD calls the injection medically necessary, even though the patient is getting very little relief from them…did I mention he also owns the same-day surgery center where the injections are done, so gets thousands of dollars that way, too?)

    The extra day in the hospital because the family doesn’t want crazy grandma home on the holiday (yes, the nurse’s notes in the hospital documented the family’s refusal)

    The gastric banding on a 150 lb 15 year old who’s 5’6″ but wants to be model-thin (her BMI is 24); the MD notes that she wants to weigh 110 lbs or less, and has a history of anorexia

    Yes, they make mistakes, we all do. But, your insurance dollars go a lot further when we manage to avoid fraud and abuse.

    BTW–the company I work for is non-profit. The state wants the company to become a for-profit company so they can tax us even more.


  • unsinkablemb
    unsinkablemb

    July 3, 2006 at 7:29 am

    Amen, Kim! My mom has been a family practice doc for almost 30 years. I worked in her office during nursing school and did billing for her. She is a truly caring person and does as much as can for her patients. It was shocking to see how little she gets paid for what she does. No wonder more and more physicians are choosing to specialize.


  • hoosierstudentnurse
    hoosierstudentnurse

    July 3, 2006 at 10:11 am

    What’s crazy is that the patients are paying out the nose too. My husband and I now have $5000 out of pocket per year, and we are paying $268 per month for our share of the premiums, and this is for good old bc/bs. Also, my husband is a federal employee and the benefits are supposed to be the bomb! What really kills me, is that we paid our max due to my shoulder surgery and physical therapy, and my husbands rectal surgery in one year, yet my son, who is a college student, changed jobs and was a month away from being covered, had a medical problem that at the end, and a month in the hospital and having heart surgery and $75,000.00 in medical bills, got 100% coveragefrom indigent care offered by the state. Don’t get me wrong, I was grateful it was there, and he had to jump through hoops to get it not to mention spend 6 months filling out forms and exploring a 1000 options before it got done, but we spent over $8000.00 last year on premiums and out of pocket expenses for what is supposedly good insurance.


  • anonymouse
    anonymouse

    July 4, 2006 at 7:24 am

    If you think primary care is bad….try finding a psychiatrist who accepts BCBS (or any insurance)! Im a psychologist and often attempt to refer patients to providers who accept their insurance…can just about forget it…and generally, if you do find one with openings…its not one you’d send your dog to….. Ive pretty much given up..and refer them back to the primary care physician– this is generally ok if its a simple need for antidepressants but….for the more complicated situations…truly stinks….


  • shadowfax
    shadowfax

    July 4, 2006 at 4:33 pm

    Anyone who thinks that Blue Cross/Shield is any sort of “Gold Standard” for insurance is sadly misinformed. They are by far the worst of all the non-governmental payors. They pay the lowest rates and deny the mos claims and absolutely refuse to negotiate with physicians. I have negotiated with dozens of insurance companies to try to get sustainable levels of compensation for our physicians, and the Blues are by far and away the worst.

    So now our practice doesn’t take BC/BS. More and more across the country, the blues are getting dropped. I would take some pleasure in that fact, but the sad truth is that the patients then get stuck in the middle.

    We need to get rid of the insurance companies.


  • Evan
    Evan

    July 7, 2006 at 12:48 pm

    Kim, I think insurance is the biggest racket the US has created.

    As a healthcare worker I thought that insurance would be the least of my worries. I could not have been more wrong.

    My health insurance company raised my rates last year and the reason the gave: as healthcare workers we access healthcare more often than others. I was shocked! I access for primary care, preventative care and only rarely for ER. I haven’t had a hospitaliztion ever (knock on wood). I am left to pay for all the deadbeats that access the ER for a runny nose or backpain from sitting on the couch too much.

    Let me add my vote – let’s lose the insurance companies.

    Evan


  • Anonymous
    Anonymous

    July 7, 2006 at 10:30 pm

    This is positively scary. I currently have BCBS, paid for out of pocket, so I wouldn’t be at the mercy of whatever crappy insurance company my current employer picked. My previous employer’s last insurance company refused to pay for x-rays that were taken at the emergency room to determine if I’d broken my ankle after I fell down a flight of stairs. This was denied because my ankle turned out to not be broken (just a really bad sprain), so the insurance company said the x-ray wasn’t necessary. But the doctor didn’t *know* that it wasn’t broken until they did the x-ray! I had to pay for the whole business out of pocket, in addition to the outrageous premiums I was paying this company at the time. What a racket.

    My sister has also gone through the problem of no one on her insurance company’s “approved” doctor list accepting new patients. Kind of convenient for the insurance company, isn’t it? Want to reduce reimbursement costs? Only list doctors whose practices are full.

    I went to BCBS (and accepted higher premiums) to *avoid* this kind of nonsense. Now even they might be getting bad enough that doctors will start dropping them?

    Pay my doctor, dammit!


  • Insurance » Money Problems
    Insurance » Money Problems

    February 4, 2007 at 4:47 am

    [...] The doctor is no longer taking patients with Blue Cross insurance. [...]


  • [...] The doctor is no longer taking patients with Blue Cross insurance. [...]


  • Fleur
    Fleur

    September 1, 2010 at 12:37 pm

    I would never waste one cent on healthcare insurance. Its all a big giant fraud completely blinding the public to the real problem.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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