Over the past few months, there have been hearing increased conversations about the high cost of copays for office visits. It is not unusual to see co pays for office visits to be in the $40 – $50 range. This is certainly having an impact on patients seeking care. Patients are clearly not heeding the advice of their PCP and seeing specialists, having recommended screening done or otherwise spending money for their healthcare. There is a perception that these higher co pays are costing them too much money. They are, but not in the manner patients might think.
Let’s take a step back and review health care insurance. Every month an employer and the employee pay certain amount of money for an individuals healthcare – this is the premium that is paid for the insurance. Those monthly fees can be several hundred to several thousands dollars a month depending upon the policy ( single, family, deductibles, formulary etc). In general, one’s employer pays the bulk of the monthly premium as a benefit of employment and the employee parts the rest as a pre tax deduction on their paycheck. Based upon the plan chosen, the insured may have a deductible and /or copays for various covered services ( Doctors visits, labs, xrays, hospital stays etc). These deductibles / copays are generally some fraction of the total cost of the visit.
What is readily apparent is that health care premiums are increasing associated with increased copays for the service for which the health insurance is purchased. The result is the insurer is making your cost for your healthcare, which you and your employer already paid for, more expensive for you. All with the justification that the higher copays keep premiums keeper — yet every year the cost of premiums continue to increase. The result of which is, because these copays are so high, you choose not to seek the care you need, the insurer does not have to pay for services you did not seek and keeps more of the money that you and your employer already paid for insurance. In essence the insurers collected thousands if not tens of thousands dollars for premiums and because you can’t afford the copays your can’t seek medical care — which is exactly why you have purchased health care insurance. Think of it this way, you paid money to go to a gym but the gym charges you more money at the door to get in. What happens, you don’t go to the gym, the gym keeps your money and does not deliver the benefit of using the gym. Who wins… the gym they get all your money and don’t have to provide you a service. This is absolutely crazy but exactly what is happening in healthcare today. You purchase health insurance to help cover your health care cost but because the insurers demand higher copays you don’t seek medical so the insurers keep all your premiums dollars and you get no health care.
Can I fix this here and now? No. I have too many common sense ideas that the politicians and insurers would never consider. But I do have some ideas that you need to consider to keep your allergic disease under control and for you to be healthy.
- Keep your regular scheduled appointments – I can do a better job keeping your allergic symptoms under control when the are under control. I can devise plan that you can implement at home to deal with flares of your disease.
- Ask for samples. I can’t believe I just wrote that! I am generally not a big fan of the intense marketing that PHARMA utilizes. I am however a big fan of free. Think of samples as free money. If we can provide some samples of medication, you won’t have to buy the medicine, consequently you won’t have a copays for that medication.
- Use Coupons – Our website has a link for coupons that exist for various allergy medications. USE THEM!!!!!!! There is a show on tv called “Extreme Couponing” where individuals will go food shopping and almost pay nothing because of all the coupons they have. Do the same for your medications. If you are taking three medications a month and you can find coupons for $10-$20 off thats $120 – $240 or potentially more a year in savings. Once again, free money
- Tell us there is problem. If you are having problems paying your Doctors bills most physicians are more than will to help you out. But you have to talk to us so we know what is going on. Understand that federal laws and contractual obligations with your insurers may will limit what we can do.
The practice of Medicine is rapidly changing. It is not the same as it was 20, 15, 10, or 1 year ago. There are a myriad of forces that are working to forever alter the practice of medicine. The physician – patient relationship is in critical condition. In my mind, the physician – patient relationship is the most important part of your healthcare, without this there is no practice of medicine and no one to really care for you – the patient. Several weeks ago I was at a medical society meeting and a politician was speaking. This person had a family member who was very ill and close to death. It was only through the excellent physician care that the patient survived and is doing better. This politician, who has not been a friend of physicians in the political arena had an epiphany. They realized that at three o’clock in the morning the patient needed their Doctor. Not their lawyer. Not their insurance company. Not their pharmaceutical company. Their Doctor!
I am not going to solve this complex problem in a few paragraphs, but I hope the above offers you the insight that we care about you and your health and preserving the physician – patient relationship. If WE don’t do this, no one will!
