My name is Dr Arthur Axelbank. I am a family physician who has been in community practice in Orange County for 28 years. The President of the United States has made a mistake in his effort to restructure health care financing in this country. In making the case for change, he has not clearly pointed out the problems with the current system. They are too numerous to elaborate in detail, but I am here as someone on the front line to explain some of the difficulty we encounter daily in our patient care.
When patients walk in our door, we ask them to present their insurance card (if they have coverage). This scenario is familiar to anyone who has ever been in a doctor's office. The card can be from any one of more than 25 different insurers or "payers" we accept. Our staff has to verify that the patient's coverage is still in effect - that it has not expired. We then have to identify how much of a copayment we have to collect, what the deductible is, and whether the patient has met that deductible for the current calendar year, fiscal year, or other time period. Some of this information is featured on the insurance card, and some has to be searched on the internet. Our staff has to become expert in each different payer's unique set of rules and be able to apply them correctly. It is as if we have to be fluent in 25 different languages! The patient has to wait for all of this to occur before he or she can actually see the doctor.
When the individual finally gets to see me, I am faced with trying to figure out what services are covered by which payer, and by which type of policy. For example, is a general physical - a checkup - covered? (Checkups or well visits are covered differently from sick visits, and this varies for different policies, even with the same payer.) What about a surgical procedure? Is it covered or not? If so, what percent is covered? What portion does or does not apply to the deductible? Here again, we have to be fluent in 25 different languages!
Then there is the unending complicated saga of drug formularies. Is the drug covered? At what level or what percent? That depends upon what type of insurance you have! As clinicians, if we prescribe a costly drug, we often are faced with an array of extra paperwork that we must fill out to have medications "pre-authorized". As before, we have to be fluent in 25 different languages!
I am a primary care physician. If my patient needs to be referred to a specialist or even for an x-ray or other test, same thing - we have to choose the consultant based on each payer's unique list of so called "preferred providers". Not only this, but if a patient's employer changes insurance provider, or chooses a different level of coverage, or if a patient changes employers, the rules change. We encounter this every day in our office.
It is a fact that over 30% of our premium dollars go into administrative overhead of private insurers, not toward health care delivery. This compares with only 3-4% for public programs like Medicare. That's a big difference!
I could go on, but time is limited. The complexity, and our need to master the infinite number of different rules, increases our overhead greatly. The time and energy in staff training and maintaining skills is a huge burden. This, coupled with the profits and administrative overhead of the insurance companies themselves, adds up to one of the major causes of the rising cost of practicing medicine today, and it is getting worse. You and I are paying for this each time we visit the doctor! We as a nation cannot afford not to change the way we are doing business, and time is wasting!
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Last updated: 10/11/2009 by Vic