Health Plan Reality: Clinics Firing Patients

[Lydia Leftcoast]

Once a month, doctors and staff at Edina Sports Health & Wellness stay late to talk business. Munching on take-out, they set call schedules and review patient complaints and insurance issues. Then there's the topic nobody likes: which patients to drop because they aren't paying their bills.

The clinic has been terminating an average of 16 patients a month. Most have high-deductible health plans and haven't paid their bills for more than nine months.

"For the most part, these are college-educated and middle-class folks," said Dr. Rochelle Taube, one of four doctors in the practice. "We send them a letter and say unfortunately, we're not able to care for you."

Break-up letters from doctors are just one unintended consequence in the roll-out of high-deductible plans, the fastest-growing segment of the medical insurance market as traditional plans become ever more unaffordable.

http://www.startribune.com/business/27701694.html?elr=KArks:DCiU1OiP:DiiUiD3aPc:_Yyc:aUU

[Turbineguy]

1. High deductible means low premiums

That's the deal. It's up to the patient to economize. The high deductible encourages a healthier low-medical cost life style.

[Lydia Leftcoast]

2. That's the propaganda in the colorful insurance company brochures

In real life, it means that people who couldn't otherwise afford ANY insurance take a high-deductible policy. However, these policies pay for NOTHING, and both doctor's visits and tests cost triple digits each, no matter what.

Part of a healthy lifestyle includes getting regular checkups so that you know if you have a looming problem, whether due to bad habits or unfortunate genes. Most cancers are quite treatable if caught early enough, but if you're afraid to go to the doctor because you don't have over $200 for each doctor's appointment and $300 to $1100 for each test, you might not go to in until the cancer is too far gone to ignore.

Almost every condition is more treatable if you catch it early. The insurance companies are penny wise and pound foolish for not giving 100% coverage to the screening tests that everyone is supposed to have at various ages.

[Gormy Cuss]

14. Here's one link discussing the consequences of high deductible plans

I've read others and repeatedly the conclusions are that high deductibles don't work the way those colorful brochures describe.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=274007

The major purported advantages of HDHPs are that they will a) lower health care costs by causing patients to be more cost-conscious in their health care decisions, and b) make health insurance premiums more affordable for the uninsured. The authors find, however, that such plans are unlikely to have a substantial effect on either costs or coverage.

* Only 4 percent of health care expenses are accounted for by households with spending below the minimum deductibles required for participation in a health savings account (HSA). Altering the financial incentives for patients with health care spending under the deductible is unlikely to affect health care outlays significantly.
* The major effect of high deductibles is not lower total health care costs, but rather a one-time shift in spending from insurance premiums to patient out-of-pocket outlays. In future years, premiums are likely to continue to rise.
* High-deductible plans in the individual health insurance market are unlikely to be affordable for those Americans who are currently uninsured. Two–thirds of the uninsured have incomes that are less than twice the federal poverty level. Premiums for HDHPs equal about 6 percent of income for a 25-year-old man living at twice the poverty level and about 20 percent of income for a 60-year-old woman at that same income level. Researchers have found that few low-income individuals can afford to purchase coverage if premiums exceed 5 percent of income....

[Tangerine LaBamba]

3. I know you didn't mean it,

but your post suggests that we all, somehow, would never get sick or have accidents if we simply followed a "healthier, low-medical cost life style."

I am sure you didn't mean it the way it came out.

[Lydia Leftcoast]

4. Some people do; that's the scary part

Look at any discussion of health care, and inevitably, "blame the victim" types pop up.

[Tangerine LaBamba]

5. I know,

and they're idiots. I knew you were better than that.

Shit happens. I am wishing nothing on anyone, but the first time a serious illness hits someone close to them, perhaps they'll change their outlook.

[SheilaT]

6. It is far too easy to

blame people completely for their health or lack thereof.

I'm one of those annoying people who never gets sick, doesn't get flu shots, never comes down with whatever may be going around. I'm 60 years old and I'm the healthiest person I know. But I try very hard to keep in mind that it's partly some lifestyle choices (I don't smoke) and a probably mostly lucky DNA. I also try very hard to remember that something terrible could happen completely without warning, either some kind of accident or some terrible disease just strike from nowhere.

We all should have access to whatever medical care is needed, without worrying about what it's going to cost. No one should ever delay seeking medical care because it's "too expensive". We need to focus on prevention first, and then treat everyone (including those whose lifestyles are less than perfect) and not blame them for their illness.

[roseBudd]

7. Me too, I virtually never catch anything anyone has at work, only sneeze from allergies...

I tell people I think I get my immunity from sticking my dirty fingers in my mouth.

Seriously when I cut myself I am usually too busy to use peroxide or anything like that, I usually if it's bleeding bad rinse with tap water, & wrap a paper towel around my finger secured with a rubberband.

[Tangerine LaBamba]

9. Famous last words

I have a friend, she was in her early sixties, so healthy she didn't even have a regular doctor. She didn't get flu shots, caught a cold maybe once every couple of years, and was really blessed with great health.

Then, one day, she had a backache. It persisted, and she, a yoga practitioner since she'd been 22 years old, figured she'd done an improper asana and would just stretch it out. But, that didn't work, and the ache persisted. Not so much that her life was changed, but enough for her to start taking ibuprofen. Tylenol. OTC stuff.

Imagine her surprise when, about a month after this backache began, she found that she couldn't stand up. Couldn't get out of her chair. She was at home, lived alone, and so had to call 911. Taken to the hospital,she began a nightmarish round of tests and diagnoses, none of which helped her to walk or relieved the now-excruciating pain she was experiencing. She kept telling them where it hurt, but they treated her for cardiac problems, which she didn't have; they treated her as a malingerer, a liar, a psychotic, tried to put her on psychotropic meds, and finally just discharged her.

She couldn't walk. Couldn't even stand up. Couldn't move her right leg, but they claimed she was faking it.

Through a series of horrific events, her luck finally changed, and a radiologist who was reading an x-ray of her stomach - she was now throwing up 8-10 times a day - noted on the x-ray, "Did you realize your patient has a broken hip?"

The upshot of this story was that she finally had surgery to rebuild her femur and pelvis three months later, after she had to spend three months in bed because those bones had already started to knit, and they couldn't do surgery until they saw how the healing took place. It took place wrong, and when she finally had a seven-hour surgery (the first of her life), the surgeon had to break her femur again in order to repair it and make it right.

Her recovery took six months, and now she's facing more surgery because she hurt the knee on her good leg during rehab, and she needs a knee replacement. She's also been found to have an auto-immune disorder, which has to be brought under control before the orthopedic surgery can take place.

She was always healthy as a horse. And now, no one knows why her leg and pelvis broke - no osteoporosis, no fall, no trauma. And that's when she found out about "pathological fractures." Sometimes bones just break, and no one knows why.

So, count your blessings and enjoy your good health, but be aware that it can all change in an instant.

[roseBudd]

10. I realize that, just my anecdotal opinion regarding immunity & dirty fingers in mouth

I don't fear germs, so the idea of germy fingers or dirty money doesn't deter me from sticking them in my mouth.

But I do respect raw chicken and have a realistic fear of ecoli or salmonella

[Seldona]

11. My father said virtually the same thing,

until a month or so before he died of stage 4 lung cancer. In the few times we were together that he mentioned it, he seemed SURPRISED. He was in 'perfect' health according to his doctors. Minus the cancer that is...

[eridani]

13. Wonder how they'd like it if they called 911 for a house fire--

--and they had to take a little quiz before the fire department sent a truck out

1. Do you let your kids play with matches?
2. Is your wiring currently up to code?
3. Do you store oily rags in the basement?

etc.

[Turbineguy]

8. I probably did not put it correctly

In the last two years I spent about $35,000 on healthcare including insurance. I have the high deductible type policy. It was a lot of money. But I knew what the policy said. I read it. I expect to pay for the part the policy does not. This year, will likely be less, about $6000.



I'm not blaming the victim, but the OP said these people were educated and so presumably better off than average.

Quite frankly, our health care system sucks. We are based on profiting from misery and tied up in paperwork and processing costs.

I only see this arrangement as a temporary transition because the current health care model is financially unsustainable.

We need to establish a non-profit system for healthcare, at least for the parts of it that deal with administration. Health care professionals can and should be well paid. But ultimately everything should go through non-profit organizations. That can be private or government.

There's no place for multi-million dollar executive bonuses and Wall street money men.

[raccoon]

12. I'd rec this if it wasn't past the rec time. nt