Imagine your car insurance is run like your health insurance, and you take the car in for an oil change. You use a particular service center because they accept your insurance. Before getting started, the service clerk requires a copy of your auto insurance card. You’d really like that new synthetic oil you’ve been studying, the one that helps your engine last longer. But it’s not approved by your insurance without prior authorization. So you insist and wait while the clerk makes a phone call, only to promptly be put on hold for 30 minutes.
You figure that maybe the old generic oil might be OK, but you know better and decide to wait for approval on the good stuff. Your technician agrees; yes, this new synthetic oil is the stuff you want. He is willing to fill out the paperwork to get the oil. Finally, after an hour and several faxes back and forth with forms completed that justify your request, you get approval for the oil you and your technician requested.
At this point, you wonder what this oil change is going to cost, so you ask the friendly clerk. He can’t tell you because “it depends on what your insurance reimburses.” A little confused, you ask, “What is your standard charge?” Again, the clerk explains they don’t have a standard charge, and only after submitting a claim do they really know what it will cost. However, your co-pay on any service is a flat $10. OK, so you will pay $10, but don’t really know what the oil change will cost.
Later, you get a statement from the insurance company. The fee for the oil change was $50, but then it was “adjusted” to $40, and the insurance withheld $10, whatever that means. The service clerk had mentioned it costs them $5 to pay a professional billing agency to submit your claim, as it is way too complex for them to do directly. So you figure the service center got paid $25 from your insurance company. You recall that the service center spent over an hour of their time getting the oil authorized, before even spending time actually changing the oil.
It’s then you realize that the service center down the road only charges $20 for an oil change – less expensive because they don’t take insurance. You could have simply paid $20 for the oil change, got what you requested right away, and been on your merry way. But, since you pay a ridiculously high premium on your car insurance, you feel like you really should use it …
WHAT IS INSURANCE?
Insurance is designed to mitigate catastrophic risk. It allows one security against the rare calamity. Without insurance it would be difficult to take risk, such as owning a building or a car. Without insurance there would be no way to guarantee your welfare should you become injured or to provide for your family should you die prematurely.
Health insurance today is a misnomer. The term “high deductible” is redundant. It’s not insurance, it’s health management; and you are not only paying super high premiums to support the insurance industry, you and your doctor are losing control of your time and your healthcare.
Another issue with insurance playing the role of health managers is we have “invited them into the bedroom” so to speak. They increasingly dictate what procedures and medications are best for patients. Suddenly doctor and patient have less say in what methods they would choose to treat or more importantly prevent disease. Only the conventional path is allowed, thus limiting treatment options and stifling the individual creativity that leads to innovation and advancement of practice.
We are under the delusion that the current healthcare system deals with health, and physicians have control of how healthcare is dispensed. In the current paradigm physicians are simply puppets of the insurance, government, and pharmaceutical industries. Physicians have become experts in “sickcare,” not healthcare. Insurance dictates what drugs and what therapies are approved. If you want to step outside that system, good luck.
A HEALTHCARE SOLUTION
Step one toward a solution to our healthcare crisis is restoring insurance to what insurance is meant to be, a means to take care of catastrophe. Car insurance doesn’t pay for an oil change or a flat tire — they pay when the car is totaled. Homeowners insurance doesn’t pay for a new coat of paint or fixing a leaky faucet — they pay when the house burns down.
The health insurance industry is a multi-trillion dollar industry that contributes nothing to direct patient health. If every U.S. citizen converted to a high-deductible catastrophic health insurance plan, it is estimated 90 percent of them would not reach their deductible in a given year. That means the majority of insurance system costs would disappear.
With real health insurance, that is high-deductible plans, we’d see premiums drop, healthcare costs drop, patient freedom of choice and responsibility increase, while physician reimbursement returned to the free market based on our success at actually treating and preventing disease. Insurance companies could be less discriminatory with pre-existing health conditions and exclusions as the actuarial numbers would get much simpler to predict and afford.
At the Integrative Medicine Center, I don’t bill insurance and I set the fee schedule. This allows the time and resources to do what I think is in the best interest of my patient. I order the tests and treatments necessary to get my patients results, not just the ones approved by the insurance industry. My patients and I can address health issues at a much deeper fundamental level without the yoke of the insurance paradigm weighing us down. Instead of simply starting medications I can actually take a holistic, time-consuming approach to patient care, integrating a team of professionals to help me reverse and prevent disease.
With the cost of health insurance skyrocketing, I encourage you to consider a high-deductible plan. Also, look into an accompanying “health savings account” as a tax deferred method for building up savings to use for health-related costs. If you need an expensive hospitalization or a high dollar surgery, then, and only then, let the insurance kick in … That’s what insurance is for.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.