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.
{ 4 comments… read them below or add one }
Joe, I like your thinking regarding healthcare. I was perusing the financial records of a couple publicly traded insurance companies one day. With the bigger ones reporting nearly ten million dollars in earnings per quarter (not to mention the millions the executives are raking in each quarter), I wondered if insurance should be non-profit… which I guess is really just a for-profit i\organization that pays out all the profits to the executives’ payrolls.
But I love your solution of a doctor run insurance company.
Thanks, Stu. I really don’t understand why the AMA doesn’t spearhead something. I hear doctors constantly complain about insurance, and whenever I spend any time in a doctor’s (or dentist’s) office, I hear and watch constant insurance “transactions” – desk help asking for insurance cards, copying cards, having patients update their insurance info, calling insurance companies for pre-authorization, and on and on.
I’m not a proponent of monopolies, but it seems like it’d be a lot easier and require less work (and the associated cost) to have everything standardized. You’d still need some sort of checks and balances to keep doctors and patients from taking undue advantage of the system, but I bet a lot of what we pay in health insurance is going toward paying for inefficiency.
In addition, I think if the system were standardized, it would take this huge hassle off the doctors’ plate, so they could focus on treating patients.
I KNOW SOMEONE WHO HAS TO DRIVE ALMOST ONE HUNDRED
MILES FOR CLINIC AND ALMOST SIXTY MILES FOR HOSPITAL. HE GETS HIS INSURANCE THROUGH HIS EMPLOYMENT AT A NATIONAL CHAIN RESTAURANT. THE INSURANCE COMPANY IS WELL KNOWN.
My insurance for mental health services is so bad about paying claims that the large mental health group where my therapist is located pulled out even before their renewal time was due. When I spoke to the billing dept., the lady said that my ins. co.’s service was so poor & they just didn’t want to have to waste so much time trying to deal w/them.
Tell me about it! I’ve spent hours every month on the phone telling them why they should be covering claims that they have denied. This has been going on for years so when this happened & I would now have to pay “out-of-network” fees for my therapist, it was the last straw. I was going to be punished for the substandard service of this ins.co.
I wrote up a letter describing all the difficulties I’d been having w/this co. over the years (not only being denied claims that should have been covered but treated rudely on the phone when I tried to get the claims paid for that were allowed in my policy). I also had documented all my phone calls w/dates & who I had spoken to (some of these bozos were so-called “supervisors” who didn’t seem to understand the policies from their own company. I was continually having to explain my coverage to them).
I had my husband email this letter to the H.R. dept. of his company through which we get our insurance. It is a very large company & within a few hours, my husband had heard back from some bigwig apologizing & saying that he would be addressing these issues w/the ins. co.
I got a call from the ins. co. soon after & SUDDENLY I was their top priority & now have my very own personal representative w/a direct phone line to call every time I file a claim. And they are going to continue to consider my therapist “in network” so I won’t have to pay out-of-network prices. I think the ins. co. thought I would be very pleased w/this “special” treatment, but actually I still expressed that while my “situation” seemed to be resolved it was too bad that all the other employees of my husband’s company could not have the same “deal” as I did & that they had to be treated w/the scorn & rudeness that I had had to endure so long as they didn’t have their own private representative simply because they had not YET complained about the poor service & unprofessionalism of this company. (Yeah, by this time I was pretty riled up & it is hard to get my unriled!) They would be paying out-of-network prices or have to find another mental health care provider. It irks me that an ins. co. can basically dictate whether you can go to the provider who gives you the care that most fits your needs. I have no doubt there are many people from my husband’s company or family members that this will affect as this is a very large corporation w/many mental health services providing care for the very low-functioning to the rather high-functioning (which I am some days!).
By the way, I am a big fan of your Bipolar Beat/Blog & Bipolar Disorder for Dummies book & live near you in Indiana! I just realized that after reading this article.