INSURANCE

I loved being a doctor.  Realistically, I loved it when I was in an exam room with my patient, liked it when I was rounding at the hospital, and hated it when I had to deal with insurance companies and Medicare.  Early on, I learned that insurance companies were in the business of making money and they made their livings by denying patient access to medical care.  As time went on, insurance companies got better at restricting care; and, by the time I retired, the insurance industry had decimated my profession, becoming a de facto government.

Of course, the insurance companies would disagree with my assessment of their role in medicine. As a matter of fact, they flood the airways with commercials portraying them as kindly neighbors, there to take care of your every need 24 hours a day.  Current commercials promise to give you more benefits than ever, with dental care and eye care coverage, while depositing an extra $100 dollars a month in your savings account; and you get it all for free.  Even the plans’ name, “Medicare Advantage,” is designed to give you a sense of being special.

You should ask yourselves how the profit-focused insurance companies manage to pay you $1200 a year while giving you more services?  The answer is that they can’t!  While promising the moon, they take away your right to see the doctor of your choice and make some medical choices you feel you need.  Sure, they tell you that you can see any doc you want.  What they don’t tell you is that many generalists and specialists refuse to accept the limitations the “Advantage” contracts impose on them.  Their reimbursement for services is pitiful.

One of the last patients to join my practice was in an Advantage plan.  Unfortunately, he was sick, having not seen a doc in years.  He had multiple problems requiring specialty care ASAP.  It took 4 months to get his referrals done and appointments scheduled. Had he been on Medicare, he would not have had to get referrals approved by his plan and he could have been seen quickly.  On Medicare, he would have seen a specialist in Barrington.  On his Advantage Plan, he had to travel 40 minutes away to find a doc who accepted his plan.

The long and short of it is that Medicare Advantage saves you money and gives you additional benefits if you stay well.  Medicare Advantage becomes a disadvantage if you get sick.  We are being brainwashed by TV commercials and the internet into believing that we will be in the good hands of our neighbor, Jake, while we are sold inferior products.  If a car salesman told you he could give you an upgraded model, pay you $100 a month, and do it for free, you’d run, not walk, away. 

I could never admit to any of this when I was a practicing physician as many insurance contracts have built-in gag orders.  Years ago, I had a well-read medical blog and kept my patients informed about the transgressions of the insurance companies despite the gag orders.  I was visited by a representative of one of the larger insurers who informed me that, if I didn’t take down my blog, his company would cancel my contracts.  Losing their contracts would have put me out of business.  I took down the blog.

Recently, I’ve learned that my home and auto insurance companies are just as bad, if not worse, than medical insurers I grew to hate.  More about that later.

Here’s today joke:

Larry’s barn burned down and his wife, Susan, called the insurance company. Susan told the insurance company, “We had that barn insured for fifty thousand and I want my money.”

The agent replied, “Whoah there, just a minute, Susan. Insurance doesn’t work quite like that. We will ascertain the value (using our formula) of what was insured and provide you with a new one of comparable worth.”

There was a long pause before Susan replied, “Then I’d like to cancel the policy on my husband.”

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