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Ask the Dr . . . what if a practitioner doesn't accept my insurance?

Ask the Dr . . . what if a practitioner doesn't accept my insurance?

Dr. Lou Pack

ASK THE DOC……..

I was referred to a really good physician but he doesn’t take my insurance.  What are your thoughts?

The number one question any physician’s office hears today is, “do you accept my insurance?”  I have been in medicine nearly fifty years and can remember when physicians used to be interviewed by patients as to what their credentials were and where they were trained.  Now that’s the last thing we are asked……if asked at all.

We purchase insurance so that it’s there to cover our expenses when needed, so itcertainly makes sense to try to use it.  I do that as well.  If nothing else, it is a way to get our “monies worth”.  But understand this……   it is impossible for most physicians to offer the quality of care you want when bound by insurance constraints.  You may not be getting the necessary tests, medications or even referrals that you need either….and not even realize it.   Yes…there are exceptions, but remember insurance companies make money by leading you to believe they cover more and actually paying out less.

A family member recently had cataract surgery.  She went to a physician that was in her covered network.  The surgeon that actually did the case saw her for only a very brief moment before the case and then for less than fifteen seconds afterward.  I was with her so I know.  He never, ever saw her again.  She was sent to an optometrist for all follow up evaluations and problems.  Note that this is someone who has never even seen such surgery and yet is responsible for follow up problems!  She developed complications and had to go to another group.  In busy practices, many patients are not seen by the physician they contracted to see but by a physician’s assistant, nurse practitioner or other allied personnel.  Now these professionals may be very well qualified but that is not the point.  If I hire you to teach me music and when I make an appointment someone else shows up that I did not chose, I would not be a very happy camper. You should not have this choice decided for you.

You may also be surprised to know that physicians who are in HMO’s and PPO’s have an insurance “profile;” i.e., they are monitored as to their expenditures on patients.  If they spend too much on your care, they can be eliminated as a provider.  Again, there are exceptions, but there is a lot more here than you may be aware of. Physicians who accept Medicare are bound to charge a “Medicare Fee” and at times cannot afford to provide top quality care.  And in some instances it is a federal law that they cannot accept the additional money you may be willing to pay for the care you want.   Suppose you got a free coupon to eat at a restaurant.  Initially, that would be enticing…..I agree.  But would the fact that it was free be the only thing that mattered?  Perhaps the quality of the food, cleanliness of the facility, and service might be more important.   Did you ever buy a better piece of clothing for a higher price because you were interested in something with greater quality?  Should you not use the same thinking for your health care?

These are tough economic times.  There are a few physicians still managing to some degree to provide a high quality of care despite the changes in medicine.   If you simply can’t afford it, you may have no choice.  But many times you may very well end up spending more on co-payments and deductibles, than you would have if you had gone to a doctor your insurance didn’t cover to begin with.  What is any coverage really worth if you don’t get better or continue to get worse?  I frequently have patients who come to me with a whole shopping bag full of so called custom foot orthotics that they got because their insurance covered them, but not only can’t they use any of them, but their knee arthritis has gotten much worse because of it. Was having them covered in their best interest?  

We all want a bargain and sometimes you can find one.  But for the most part you still get what you pay for.  So “buyers beware”!  A free restaurant coupon may just bring you indigestion!

A former reconstructive foot and ankle surgeon, past Clinical Instructor of Medicine at Emory, and Fellow of the American College of Rheumatology, Dr. Pack practices in Greensboro and Atlanta.  He treats athletes at all levels and works with patients who have arthritis and want to remain active.  In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCCA National Champions).  For further information please contact him directly at 770-335-9201, via email at dr.loupack@mindspring.com, or see his website at www.drloupack.com.   His new book, The Arthritis Revolution, Latest Research on Staying Active Without Pain Medication or Surgery, is available on LuLu.com or Amazon.com.