Joe Kraynak

Doctors vs Health Insurance: Athens vs. Anthem

August 31, 2008 on 1:41 pm | In Consumer Protection, Health, Health Insurance |

People who’ve grown up in Crawfordsville, Indiana like to refer to this small town in Central Indiana as “The Athens of the Midwest.” Perhaps it is, and from what’s been going on lately, this might just be the place where the battle lines are drawn between physicians and the health insurance companies, where debate over national health insurance finally gains enough momentum to make a difference.

Over the past couple months, I’ve heard some discussion about Anthem Health Insurance not covering treatment provided by St. Clare Medical Center - the only hospital in Crawfordsville. Apparently, the two parties settled whatever dispute they were having, and the issue kind of faded as a topic in the local gossip chains.

The other day, however, my wife received a letter from Athens Medical Group, where her primary care physician practices. (You can view a PDF version of the letter - 1 meg.) In his letter, CEO of Athens Medical Group, Brett Spencer, MD informs patients that Anthem Insurance Companies are dropping Athens as an “in network” provider. For anyone who’s dealt with health insurance, this is a biggie, because you pay a premium for “out of network” care.

The conflict could affect my family through my wife - forcing her to pay out-of-network if she wants to continue seeing her current providers or to drive a half hour or more out of town to obtain in-network care. My health insurance is even worse. I pay over $2,000 per year for a $10,000 deductible policy to a company (American Medical “Security”) that simply sends me statements explaining why it’s not paying any claims.

What I’m waiting for is the doctors to get totally fed up with the status quo and launch their own national health insurance company through the AMA (American Medical Association). Get rid of the middleman! They could standardize all the forms, so they wouldn’t have to deal with multiple insurance companies and forms, streamline operations, and increase efficiency. Who better to oversee what insurance companies should and should not pay for than the doctors themselves?

And if that doesn’t work, why don’t we just go back to paying cash - out of pocket? Require each doctor to do a set amount of pro-bono work, and get rid of health insurance altogether? What we have now just isn’t working.

Until this gets fixed, I’ve left strict orders with my family. If I have a serious illness and can’t get myself to the hospital, they’re to take the wallet out of my pocket, drive me up in front of the hospital emergency room, and roll me gently out onto the pavement. This is the only way I’ll be able to get the treatment I need without going bankrupt.

If anyone has any detailed information about what’s going on between Athens Medical Group and Anthem Health Insurance Companies or any other similar dispute, please leave a comment. Or just weigh in on the current state of health insurance in the United States.