Insurance

The Secret Back Door

Go to a typical primary care practice (like the one I was in for 18 years) and try to find out the cost of anything and you will only get shrugs and obfuscation.  It’s not only that they don’t know what things cost, but the design of the system on which care is built goes out of its way to hide those costs.  Why?  Because it would be infuriating to people to see that their insurance pays 100% more than someone else’s plan and it would be equally mortifying to some physicians to realize just how bad their pay is compared to the docs down the hall.

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Ask Dr. Rob: Medical Wreckords

Dr. Rob:  

Long-time reader, first time writer!  I want to know why it is that my doctor makes me pay to get my own medical records.  It seems like since they are my records, they should be free to me!  Can you explain this to me?

– Lucy in Texas

Thanks, Lucy, for asking such an astute question that is near and dear to my heart.

There is, in fact, a simple answer as to why doctors don\’t want you to lay hands on their medical records, Lucy.  It\’s the same reason you don\’t want your son\’s underwear after his first semester in college (known to have broken autoclaves):  they stink.

Why do they stink?  It\’s complicated.  The best way to see this answer is to look into the past.  Way back.

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Adventures in Caring and Acting Affordable

Some would think that since I no longer accept money from insurance companies, the Affordable Care Act would have less of an effect on me.  Those folks may be right in how it directly impacts my practice (since I don\’t know the actual impact on other doctors, it\’s not easy to compare), but there has been a significant impact.  I\’ve got plenty of ACA stories.

But that\’s not what I am going to discuss in this post. 

My personal adventures with this law are far more interesting from the other side of the insurance card: the health care consumer (AKA patient).  It has been quite a ride — one that has not yet reached its destination.

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Evidence

Is being in my practice something that saves money?  Some anecdotes from the recent past suggest the answer, giving evidence of significant savings, both financial and life quality, that my patients and their payors get.  This is an important case to be made to both the patients (who want to know if their $30-60/month is worth it) and payors (who could financially benefit from promoting this practice model).  I realize that this does not constitute a proof of concept, but it is not without meaning.

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