Health care system makes me sick: negotiating bureaucracy through a haze of pain

In April, I wrote a post about my doctor’s departure from the American health insurance system.

In short, he now operates his practice as “direct primary medical care.” You sign up for his service, pay a set monthly cost, and come in, call, email, or text when you have a health issue. It’s so simple, and yet the experience feels revolutionary.

Urgent need? He’ll respond to your text right away.

Wondering if a symptoms requires an office visit (and time off work, fighting traffic across town, etc.)? You can spend as much time as you need explaining your concerns on the phone. There’s no push to make every question an office visit, unlike with providers who are only reimbursed by insurance for in person consultations that correspond to specific codes.

There’s also no bureaucracy, and no paperwork. Unless you have labs, there’s no need to take out your wallet. Remember, you’ve paid up front for whatever care you need. You pay cash for lab work done in the office, but, without insurance markups, these costs are reasonable—perhaps a few dollars.

I almost forget how wasteful, time consuming, and inefficient it is to get care elsewhere. I forget, that is, until I’m not feeling well, and I visit a specialist’s office or a local hospital. That’s what I did the other day, and it all came rushing back to me. Continue reading

My doctor won’t take my insurance, and I’m thrilled

I liked my doctor, but I never got to see him

I’ve had the same primary care physician—the health care professional we used to simply call “my doctor”—for about a decade. I’ve always liked him, both professionally and as a human being.

A few years ago, I started looking around for a new doctor. I didn’t like my physician any less, but I hadn’t seen him face-to-face in years. Instead, every time I made an appointment, I saw a different nurse practitioner or physician’s assistant. I liked some of them; others, I didn’t spend enough time with to form an opinion. Even when I made an appointment for a physical eighteen (18!) months in advance, I could only see random members of my chosen doctor’s group practice staff.

The final straw came when that physical with the nurse practitioner that I’d scheduled one and a half years ahead was canceled one week before it was due to happen. My kids were younger then, and I’m their primary caregiver. It’s a role I take seriously. Parenting is my job, so I organize my life in order to do that job well.

I had scheduled all of my own “routine maintenance” appointments for the same summer week: eye doctor, physical, well woman exam, teeth cleaning. If I had oil, that’s the week I would’ve changed it. I enrolled the children in summer day camp so all my “business hours” were free for one week. I wanted to take care of my health needs without distraction or discomfort from discussing sensitive topics in front of little ears.

Modern group medical practice didn’t prioritize patient needs

The disinterested office staffer who called and blithely informed me that I must reschedule my physical for a date a few weeks later—after the school year had started, after my full slate of mommy responsibilities had resumed, at a time that absolutely did not work for me—clearly did not understand my frustration with her message. She certainly had no power to fix my problem, and she didn’t seem to care. That’s when I resigned myself to finding another health care provider.

Considering the current shortage of plain old family doctors in the United States, none of this is surprising. Having “good” health insurance seems like an oxymoron. If I can’t see a doctor, how is my health “insured”?

I did some research on the Internet. I’d read an article about doctors foregoing insurance to simplify their finances by accepting only cash payments, and I looked for one of those. None appeared to be practicing in my physician rich corner of New England, though specialists who can take advantage of my “good insurance” abound.

There were no good alternatives for straightforward routine care

I had reached the uncomfortable position of interviewing “concierge doctors” by late 2013 as I tried to find a solution I’d be happy with. I’m okay with the idea that some people want to pay large sums to have a doctor available at their convenience, but my needs seemed much simpler and very… common.

I’m willing to make an appointment. I’m willing to wait my turn. I don’t care if the office is luxurious, or exclusive, or much more than conveniently located and hygienic. I just wanted to see my doctor when I had a scheduled appointment, and have at least a chance of seeing him or her when I had an urgent need. I wanted my doctor to be familiar with me and my health history.

I didn’t think I was asking for the moon, but alternatives were lacking.

After six weeks of frustration and having selected the concierge doctor I liked best after interviewing the few available candidates in my price range, I happened to Google my old doc’s name one more time. You see, when I’d called his old practice to inform them I wouldn’t be showing up to see the nurse practitioner I barely knew at the inconveniently rescheduled time, they told me Dr. So-and-so had left the practice. They “couldn’t” give me a forwarding address. (Later, Dr. So-and-so himself told me that the practice was well aware of his new office, but they appeared unwilling to lose patients by sharing that information.)

My doctor was as frustrated with the system as I was.

Guess what I discovered when I Googled Dr. So-and-so? He had left his old physicians group practice because he didn’t want to practice medicine that way anymore. He was sick of being rushed through 20 appointments every day during which he couldn’t take enough time to hear out a patient. He was tired of being an insurance-appeaser when he had set out to practice medicine. He was leaving the system. He was as frustrated with it as I was.

I knew I liked Dr. So-and-so for a reason!

I’d stumbled onto an article in the local paper about my good old primary care doctor’s foray into the everything-old-is-new-again “direct primary care” provision of medicine. I could pay cash directly to my preferred doctor to receive medical care when I needed it.

Revolutionary? It strikes me as obvious. And let me add cost effective, convenient, and finally!

The simple analogy used in the direct primary care model is that it’s like routine maintenance on your car vs. getting repairs after a major accident you couldn’t predict.

You know you need oil changes and the occasional new tires for the car, so you factor that into your budget and carry on. That’s the stuff my doctor handles. I see him for an annual physical, when I’ve caught a cold, or if I sprain my ankle. I have his cell phone number; he answers it himself. I can email him or send a text message and I hear right back. He can fit me in today. He has time to talk to me until I have said everything I have to say about my problem.

Monthly payments to the doctor cost half as much as a cable bill

I pay my doctor a monthly fee that covers as much medical care as I need. It costs less per month for me than my cable bill, or my husband’s data heavy cell phone bill. That’s or, not and. If you can afford to spend $4 per day at Starbucks buying coffee, you can afford this caliber of medical care for one adult and one child at my doctor’s practice. This is a manageable bill for a middle class family.

I still have health insurance. It’s that <cough> good kind. I use it to see my specialist care providers, or when I need an expensive test like an MRI or a bone scan. My doctor can still order tests for me at the same local hospitals, and he can still submit the forms for those big ticket tests to my insurance provider, but he also tells me what the cash price would be. Thousands of dollars out of pocket? Yes, let’s do paperwork.

Cash prices for simple tests can be just a few dollars ($3)

But many simple blood tests done in the doctor’s office cost just a few dollars, so I pay the bill and skip the forms. A cholesterol test costs less than a latté when it hasn’t been marked up for the rigmarole of insurance reimbursement. It becomes fairly obvious why insurance rates are so high when you compare these prices for yourself in the context of your own care. It turns out that there’s a huge cost created by the complexity of the insurance system itself.

When you use your insurance, you’re paying for extra billing staff in every medical office, the insurance company’s offices, the army of employees at said offices, and even profits distributed to investors in those private insurance companies. You aren’t just paying for your blood test, so the cost of your lab work goes up.

I’m still insured against a catastrophe

If the big stuff hits, that’s when my health insurance will kick in, like the major bodywork you’d seek after a car crash. God forbid I ever need it, but, of course, I will use my insurance if I require expensive hospitalization or ongoing care for a major illness or injury.

The insurance company keeps sending me letters encouraging me to find a PCP and get a physical. Their closed loop system doesn’t have any way to acknowledge that I’m receiving preventative care without asking their permission or sending them bills. It’s eerily hard to get the records at my specialist’s office updated with my doctor’s details because they can’t match him to an insurance provider ID in the computer system. It’s like he doesn’t exist. I think they literally put a sticky note in my paper file in case they need to reach Dr. So-and-so.

That’s a little frightening considering the push toward electronic record keeping. Is the insurance model so entrenched that it is inconceivable for a legitimate doctor to be working outside its bounds?

Frankly, it offends my sensibilities that something as personal as health care is becoming the exclusive territory of monolithic institutions that provide no additional expertise when it comes to medicine, instead introducing financial complexity and bureaucratic overhead to what was once a straightforward relationship between medical provider and patient/recipient.

Direct primary care works well for my family

My experience with direct primary care medicine has been wholly positive. It has removed obstacles to my receiving prompt care, and it has enhanced the care I get by providing the time and access necessary for excellent communication with my physician. The closest thing I’ve got to a complaint is how hard the insurance industry red tape makes it to integrate my direct care doctor with everything else.

Direct primary care won’t solve America’s health care crisis, but it is a sound model that could go a long way toward alleviating the pain of accessing routine medical care for many average families. That seems like a good solution to one pretty big problem to me.

Do you have convenient access to your preferred doctor? Are his or her costs reasonable? Do you get enough time with him/her at every visit?

Would you consider following a doctor you like to a fee-for-service or direct primary care practice if you were given a choice?