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Is Your Insurance Company Killing You?

This question might surprise a few people yet it has been documented that managed care has withheld treatment from patient's that has led to their early demise. Most of us don't think about the care we receive when we see a doctor of any type. We assume that the diagnostic procedures that he orders or doesn't order is appropriate for our presenting complaint.

The truth of the matter is, if you have some form of managed care as your insurance and you're seeing a doctor who is on the list and a provider for your plan, you're probably not getting the standard of care he gives other patients with similar complaints. I first became aware of this problem 20 years ago when HMOs first came about. HMOs were the first type of managed care to appear on the health scene. One of my patients had an HMO and hurt her back. The standard of care for this type of injury would include at least an x-ray. Since I wasn't part of her HMO she went to a doctor on the list. He simply looked at her and prescribed pain pills. She finally came to me because the pills weren't working. When I ask her what they did I was shocked that she had no diagnostics at all.

This type of limited care is great for the insurance company but can be lousy for the patient's health. Over the past 20 years this has just gotten worse. I have heard and read many news reports of patience being denied care or diagnostic procedures simply because the insurance company didn't want to pay for them. Insurance companies can put paperwork and red tape in front of a patient's right to care. Insurance companies also fund "research" into treatments and diagnostics so they can claim certain procedures as being ineffective, experimental or investigational. The millions of dollars that they have spent on junk science to muddy the waters have saved them billions of dollars in denied claims. And they can turn around and claim that their doing what's best for the patient based on research. While all the time patients die or suffer by lack of care. These same insurance companies come up with flashy commercials that tug at the heartstrings saying how compassionate they are for their insured. The truth is they could care less. Their accountants "bean counters" control health care more than the doctors do.

Let me explain the dirty little secret. When Congress allowed the insurance companies to take control of the healthcare industry they allowed non-doctors to control decision-making concerning a patient's health and care. And here's how it works: insurance companies take control of thousands of patients by insuring them. Then if doctors want access to these patients, and many of these patients have been patients of the doctors for years, the doctor has to join the insurance company as a provider. In order to do that the doctor has to agree to certain fee cuts as well as being told what is acceptable and non-acceptable care. If the doctor disagrees, he is bumped off the list as a provider. This in turn takes away a large chunk of the doctor's practice. What's even more outrageous is some insurance companies will write the patient and tell them that they don't have to pay for the procedure that the doctor did and can ask for a refund. If the doctor did some lab work on you he had to pay the lab for it and now the insurance company will tell you, you don't have to pay him. And for many doctors the choice is to play the game of the insurance company or find another profession. It would surprise you how many doctors, even surgeons, are now doing other jobs than what they were trained to do. I remember a news report about a surgeon who is now running a pet store because he couldn't take the stress that the insurance companies were causing. The cost of running the business in the healthcare field demands a patient flow that only happens when you're on a provider's list with several different companies. Most patients don't feel like they can afford to see a doctor unless the doctors on the list. Thus the squeeze.

To make this personal let me explain what has happened to me. In 2005 I received a letter from an insurance company, that I was a provider for, informing me that I was going to be removed from their list of approved providers in a few months. I was shocked since I've never received any type of correspondence with them that there was a problem. When I called I found out two things: (1) that there was a website I could have been visiting that rated me as far as my compliance with their program, a way to control the doctors. (2) I was being removed because I saw patients more than three visits. Since I was talking to a chiropractor who worked for the insurance company I asked him two simple question: How can I correct structural problems in three visits? His response was more shocking: we are not into correcting problems just symptom relief. You make the patient feel better and release them immediately. What about correcting the problem, 1-3 visits does not correct anything. His response was that if a patient took more than three visits then you'd have to see another patient less than three visits in order to keep your stats in compliance with us. Outrageous! Band-Aid care is not the same as health care. "Health" insurance companies don't care about your health. By just offering symptom relief they're trying to give you the illusion of health. But after my provider relationship ended some patients never came back. Because they are looking to their insurance company to help them pay for care. What they don't understand is they are going to run into the same problem no matter what provider, with this insurance company, that they see. They're just not going to understand why they're released from care so soon.

This is a malpractice. The insurance company is forcing doctors to commit malpractice and yet the doctors, not the insurance company, can and be responsible for any negative outcome. Fortunately this insurance company is being sued nationally by several chiropractic groups and patient groups for their outrageous, fraudulent business practices. But that could take years and years. For those of you who are lucky enough to have a regular major medical you don't have to worry about these issues. Because you can go to any doctor you choose and your doctor's free to make his own decisions about your health care. But for a large population of insured they are being funneled into inferior, substandard healthcare (Symptom relief care) and not even realizing it. When that first patient came to me that I talk to you about under the HMO, she didn't realize that she didn't get the standard of care at the time. Most patients don't. When you go to a doctor you assume that he is giving you the best care he knows how to give. But under today's system that's just not the case. Buyer beware, your insurance company could be leading you into substandard, dangerous health care and you might not even realize it. Be assured that will not happen at Keefe Clinic. When I see a patient I will give them the best care I know how to give. The insurance company might not pay for it but they don't have to live with the consequences of chronic health care problems, you do.

Sometimes the difference in reimbursement for a doctor on the list and a doctor off the list isn't great. The small difference that you pay in seeing a doctor not on the approved list could make a huge difference in your health and quality of care. Because the same doctor who gives you substandard care could give the very next patient he sees his normal standard of care because they have different insurance or they're paying cash. It's the managed care, the PPOs and HMOs that use this manipulation on the provider doctors so they can save money. HMOs are the worst, they have the highest death rate. What is more unbelievable though is that Congress has allowed HMOs to rename themselves "select PPOs" thus to be able to deceive the general public. Congress is not your friend either, but that's a different story. Don't think for a second that they care about you or your desperately sick child. Their bean counters are only concerned about their bottom line. And they have purposely, with their junk science research, muddied the waters as far as what is normal standard of care and what procedures are investigational or experimental. And their lobbyists in Congress have made it legal for them to deny procedures that are investigational or experimental. And every year there is more junk science downplaying the effectiveness of all types of therapeutic procedures. Which means in a few years from now what they will have to cover will be minimal. And you or your employer pay through the nose for the high cost of the insurance that goes primarily to the executives and bean counters that run the insurance company and not to you for health care.

In order to address some of these issues we offer different discount programs for those patients who want to maintain the highest level of health. With the way the insurance companies are going your best bet is just to stay healthy. It's a lot cheaper to stay healthy then risk needing to utilize your insurance to try to get better. Good luck out there.