Wednesday, March 25, 2015

Pawns

Book Ends
I have written before about my life as bookends.  Before I was commenting about growing up in the 1930s and 1940s, and now seeing some similarities here in the US to those troubled times.  But now, my bookends relate to health care.

We are on Medicare, thankfully, and have been for 15 years. We have also lived in Concord for the same 15 years.  During that time, thanks to our daughter, Erika, who is one of the doctors in a leadership position at Cabarrus Family Medicine, we have gathered around us a supportive network of high quality physicians to care for us as we age into our final life stage.   And we feel very well cared for indeed.

Now, one of the things you discover as you age a bit (I have now entered my 42nd 39th year of life—you do the math) is that you require increasing amounts of medical care—both from the docs, and from Big Pharma, as well, occasionally, from the local hospitals. Yes, aging in place is a lot of fun, but as has been noted by others, aging is not for sissies.  And in discovering that one needs a lot of care, one also discovers that the trusty old Medicare doesn't quite pay all the bills. Congress has seen to it that Medicare hasn't quite kept pace with inflation and there are increasing gaps between what our Medicare pays and what the actual bills are. So, guess what, one needs what they call Medigap policies.  The gaps exist in regular Medicare payments for physician visits, tests, and the pharmaceuticals that keep one upright (most of the time).  So, in addition to the regular Medicare insurance, one now needs to purchase some added insurance.  So we do exactly that.

Now, for those folks currently whining about the complexities of Obamacare, or the bad old IRS, it is useful to note that those complexities do not begin to compare with the complexities introduced by the much beloved private insurance companies.  Yes, we understand that republicans do so love private insurance companies. They’re private after all.  They’re not big bad GOVERNMENT.

So, we have been dealing with these beloved private insurance companies for many years now. We have occasionally changed carriers, mainly because the companies keep changing how they cover, what they cover, and how much one has to pay for the various services one needs. They do keep you on your toes.
In a recent open season (what a charming name, huh?) we again switched from one carrier to United Health Care, mainly to gain some pricing advantage.  They were somewhat less expensive than our previous carrier.  We attended an open meeting sponsored by United, listened to their sales pitch. We checked their materials to be certain that our entire panel of both primary care and specialist care physicians were on their list of “in-network” physicians, and that our drug regimen was within their formulary.  All were included, so we decided to change.

That was last November.
What United Health Care neglected to tell us was that they were currently in process of negotiating a new agreement with the vast Carolina's Health System, which includes the hospital we use, and the entire panel of doctors we visit.  Had we known about their “negotiations”, we almost assuredly would have foregone the pleasure of changing to their coverage.  A bit risky.

But we didn’t know and they didn’t bother to tell us.

So, the changeover occurs, and now we are using United Health Care. Lots of changes, but the complexities are all manageable. But then . . . the “negotiations” drag on—December . . . January . . . February.  Then we start getting notices from United that we may have to obtain a different primary care provider, one who is “in-network”, since they seem not to be able to conclude their “negotiations” with CHS yet. The shocking piece of news from United is that Cabarrus Family Medicine—our PC provider network system, will soon be “out-of-network”.  But, ever helpful, United offers to sign us up with a new primary care doc. They suggest a doctor by name.  We check the doctor. Turns out he is a resident in training at, guess where . . . Cabarrus Family Medicine.  So, it seems they don’t have a clue what they are doing.

The “negotiations” drag on. It is now nearing the end of March. Still no progress. The rhetorical war heats up, with the equivalent of name calling.  I begin to think about the Arab-Israeli “negotiations”. The reason they always fail to reach an agreement is that both sides think they will/must “Win”, ergo they never really put anything worthwhile on the table. As a result, no settlement is ever reached. I imagine the same thing occurring with United and CHS.   Neither side wishes to give in, lest they “lose” something of value (money). And then, while checking something on-line, my wife notes something interesting. United has already ‘assigned” us to a new primary care physician.  Note, not only did they not ask our permission to assign us, they did not even have the courtesy to inform us.  Oh, and it turns out the doctor to whom we were assigned is a staff physician on a local indigent care clinic in our town. Wow, that really fills us with enthusiasm.

Well, it’s really all about the money. And, as I noted in my last blog posting, when money becomes the sole criterion, then nothing else matters, including especially the wishes/interests  of the people within the system-the customers/patients. No we really don’t matter at all. Money is all that matters. Oh and forget about that "continuity of care" thing.  Our insurance company either doesn't understand that concept, or it has been lost in the money chase.

So, one option is for us to have the equivalent of no insurance, i.e., we would be paying United, but be unable to access any of our regular physicians or hospital.  And that brings me back to the bookends concept. See, when I was little, growing up in New York City, we didn't have regular physician or dentist visits. We simply didn't go, except when an emergency occurred (like me breaking an arm, or requiring a dozen stitches. Dental care? Nope. Regular "well-child” visits?? Nope.  Dental care occurred once in a while, when I needed something done, and then I went to a dental school, where they practiced on me.
So, now, we understand that we—the insured—are the pawns in this chess game being played between United and CHS. They are quite willing to use us in any way they choose, as bargaining chips (remember that old saw about taking your football and going home?). Yep, that’s United Health Care.

So, instead, we are taking our business elsewhere. Turns out, we can switch back to our original plan, if we don’t like our new coverage, anytime within the first year.  So, yeah, that’s what we will do.  And our suggestion to United?? Perhaps they should go into some business they might better understand—like maybe auto insurance. Yeah, they could start a motor maintenance organization (MMO). That way, they might still screw things up, but, hey, it’s only your car, right???

Anyone for a single-payer system???? I'm in.
Post a Comment