jmj11 Posted December 14, 2015 Share Posted December 14, 2015 I just had a patient, a registered pharmacist, tell me she is quitting. She is 44. She said that it has become impossible in retail pharmacy to enjoy her job. All day long she has found herself in the position of being the insurance companies' punching bag. "You are full of shit!" Shouts the patient to her. "I've gotten that prescription for five years and it has never cost me a dime and now you want $200!!! You greedy son of a bitch!!" and the older man throws his empty pill bottle at her. This is what she hears every day. The medication cost the pharmacy $180 and the insurance company used to cover it, but with a policy change, they dropped it from their formulary. So the pharmacists are are the bad guys who are greedy? But I've noticed that 90% of my confrontations with unhappy patients is due to insurance company policies. "I can't just do Botox today, we have to do a prior authorizations." I will say. To which they will respond, "This is a bunch of crap, my insurance company says I can have it when I want it!" "But I work with your insurance every day and they only pay for 75% of the Botox procedures I do and those are with a prior authorization. They pay for none without it." Then, like the pharmacist, how many times have you picked the perfect medication for that patient and it is rejected by the insurance company? I am trying my best to redirect that anger towards those responsible. I was just wondering, how often do you take the toil of patient unhappiness over decisions that insurance companies make? Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 15, 2015 Moderator Share Posted December 15, 2015 america needs to realize that insurance companies are just there to make profit - not to deliver health care... insurance companies are evil Link to comment Share on other sites More sharing options...
jdenning Posted December 15, 2015 Share Posted December 15, 2015 Every single day. Doesn't seem to matter what diagnosis/condition being treated either. Almost every day I find myself saying, "well, the best medication for your seizure type would be x sodium channel blocker, but your insurance won't cover it until you've tried and failed 2 other sodium channel blockers" which by the way have pretty intolerable side effects as well as a really unfavorable long term side effect profile... MS meds same thing. Sleep meds same thing. Headache meds same thing. And ICD10 is making all of this so much more time consuming. Link to comment Share on other sites More sharing options...
TWR Posted December 15, 2015 Share Posted December 15, 2015 I would say that ALL of us in primary care see this happen DAILY. Most people don't go ballistic like the old gentleman in the example above. Until you have to pay like our patients do, you can't appreciate the frustration from their perspective. We see the frustration for the other side and think about the CEO making more than 2 million dollars a year. I often think about that movie I think was called "Erin Brockovich" (sic) that took on a large insurance company that refused to pay for treatment for a cancer victim that died. They beat the insurance company (loved the ending)!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
swooshie1 Posted December 15, 2015 Share Posted December 15, 2015 I would say that ALL of us in primary care see this happen DAILY. Most people don't go ballistic like the old gentleman in the example above. Until you have to pay like our patients do, you can't appreciate the frustration from their perspective. We see the frustration for the other side and think about the CEO making more than 2 million dollars a year. I often think about that movie I think was called "Erin Brockovich" (sic) that took on a large insurance company that refused to pay for treatment for a cancer victim that died. They beat the insurance company (loved the ending)!!!!!!!!!!!! .... try 5 to 10 times that amount, accounting for salary plus benefits plus stock options..... Link to comment Share on other sites More sharing options...
TWR Posted December 15, 2015 Share Posted December 15, 2015 I know. I was being conservative!! Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 15, 2015 Share Posted December 15, 2015 As long as "health" insurance is a profit seeking "business" run by non medical folks with zero interest in actual health - we are all screwed. I get lambasted daily by patients - varying levels of angst, anger and hatred - about the premiums they pay, the deductibles they pay, the coinsurance they pay and the limitations they are facing. I have experienced it as the consumer. My husband is on an anti-arrhythmic. Failed 4 other meds - this is not a random choice of med. Insurance change and they said - "not on our formulary, we don't pay for it" PERIOD. No negotiation. It is generic but cash cost over $500 per month. Not realistic, not reasonable. It took a scalding, scathing, truly incredible letter from his cardiologist (he wouldn't even let me read it) and I got a single phone call from a very unemotional person who just said "it is now covered................". The cardiologist said he was as mad as he had ever been in his 30 year career. He was fed up with appropriate meds without flair or fanfare AND GENERIC being withheld from formularies because some bean counter made a decision. My diabetic patients get the same issue. Well, metformin has done as much as it can - or the diarrhea 6 times a day is simply unlivable. I would love to put you on one of the new generation meds that actually works with your pancreas but your insurance wants you to take a sulfonylurea first - yep, it can cause hypoglycemia - what? you drive a truck? Well now, hypoglycemia driving down the road isn't ok, now is it?.................... Ok, let's start the fight with your insurance about covering the meds that would actually work, not cause certain side effects and make your quality of life a bit better. Then, let's start the fight to get you more than one glucose meter test strip per day. Never mind that you are 73, starting insulin with an A1c of 11 and your insurance thinks that once a day testing is appropriate................................... Wouldn't it be lovely if HEALTH insurance actually did ANYTHING to promote health and allow for sound medical decision making? Never going to happen as long as insurance company CEOs walk away with 6-7 figure salaries AND monstrous bonuses and live in the 1% world. I will keep fighting the good fight - somedays it is so much harder than others..................... My very old 2 cents. P.S. if it is a penny for your thoughts but you have to put your 2 cents in - who is keeping the extra penny? Link to comment Share on other sites More sharing options...
BruceBanner Posted December 15, 2015 Share Posted December 15, 2015 Story of my working life, and I suspect everyone else's here. Insurance companies really have the MOST power in all of healthcare, and there is NOTHING to keep them in check. Not the patient, not you, not the ancillary supply and care companies. Insurance effectively controls who gets what, and when, and how much they have to pay for it. They are like a casino: sometimes the customer wins, but in the end the house always wins. Do you know how many patients I have who are on sub-optimal DM regimens because of coverage? Or how many patients cant get something as simple as a home oxygen refill because of a prior auth and a sleep study and 12 pages of bullsh!t?? Or how many patients wont get the care they need, whether it be imaging, a screening exam of some sort, a medication, diabetic classes, you name it---because they cant afford it?? And dont even get me started on "peer-to-peer reviews" for advanced imaging. You known, where you sit on hold for 30 minutes and then talk to some half-asleep robotic corporate doc just to tell them that yes, this patient really does need a CT. It's absurd, and I really believe our healthcare system is going to collapse upon itself. And the longer I practice the more I believe there is a special place in hell for insurers. Link to comment Share on other sites More sharing options...
CAAdmission Posted December 16, 2015 Share Posted December 16, 2015 Any time someone gets sh!tty with me over patient care, I put the patient on the phone with them. One of the hospitals I used to work in, the lab used to batch stat CBCs and run them all at once. After the second "another 10 minutes" response I would put the patient on the phone with them. It made them very uncomfortable. Call the insurance company from your office and have them explain directly to the patient why they are not approving something. Let the bad guy be the bad guy directly to their customer. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 16, 2015 Share Posted December 16, 2015 Next, can someone explain in understandable terms what an HSA is and why it is suddenly the future of insurance? How can a plan with a $3000 deductible be acceptable???? Insurance is so confusing that I completely understand how my patients don't know what to choose, can't afford most plans and then probably don't get the fullest benefit from the plan they chose due to its inane complexity and fine print. My patients ask me a lot of these questions and then I have to deal with it at home when choosing a health plan with my husband and trying to figure out who pays what, when and what goes under the deductible vs not. I think the idea is to keep the masses confused and working too much so they don't have time to ask real questions. Link to comment Share on other sites More sharing options...
BruceBanner Posted December 17, 2015 Share Posted December 17, 2015 Next, can someone explain in understandable terms what an HSA is and why it is suddenly the future of insurance? How can a plan with a $3000 deductible be acceptable???? Try a $6k individual/$10k family deductible. That's all most young people can afford. Link to comment Share on other sites More sharing options...
DogLovingPA Posted December 17, 2015 Share Posted December 17, 2015 Next, can someone explain in understandable terms what an HSA is and why it is suddenly the future of insurance? How can a plan with a $3000 deductible be acceptable???? I have an HSA and I'm still not fully sure what it is. From what I can tell, it is a pocket of tax free money to be used towards health care expenses. Mine is such that my employer puts $150/mon in it at no cost to me. As long as I use that money for healthcare, I never pay taxes on it. (Now, I pay approx that much out of my paycheck every month to cover part of the monthly cost of my insurance plan.... so there must be some tax advantage to the company as a whole to do it like this). From what I understand, I could have additional money taken out of my paycheck, pre tax, to be put in the HSA if I wanted. If I were to use any money out of my HSA for anything other than healthcare, I would have to pay taxes on it. Why this is the future of health insurance, I have no idea. We recently switched insurance companies at work and I was so confused trying to pick a plan (of only 3 choices) that I finally gave up and said "just give me the cheapest one". The "cheapest" being $358/mon for individual with a $2600 deductible ($698 if you want to add your spouse). Link to comment Share on other sites More sharing options...
Acebecker Posted December 17, 2015 Share Posted December 17, 2015 Try a $6k individual/$10k family deductible. That's all most young people can afford. This is almost all that *I* can afford and I make a crapload of money. So.... Y'know. Link to comment Share on other sites More sharing options...
probasestealer Posted December 18, 2015 Share Posted December 18, 2015 Any time someone gets sh!tty with me over patient care, I put the patient on the phone with them. One of the hospitals I used to work in, the lab used to batch stat CBCs and run them all at once. After the second "another 10 minutes" response I would put the patient on the phone with them. It made them very uncomfortable. Call the insurance company from your office and have them explain directly to the patient why they are not approving something. Let the bad guy be the bad guy directly to their customer. I agree with this. For most prior authorizations we will have the patient call the insurance company to request the appropriate paperwork. (Mostly medication) We've implimented the protocol of the patient calling insurance for any problems for the past 2-3 years, amazingly they are pissed at insurance 80+% of the time and not us. We do lose and anger a few patients, but in primary care it's nearly impossible to call the insurance company. Of course we still have to call for imaging. Interestingly I've found that if your staff or the patient will ask the name and credentials of everyone making the decision, you tend to get things "approved" quickly. Link to comment Share on other sites More sharing options...
UpRegulated Posted December 20, 2015 Share Posted December 20, 2015 As long as "health" insurance is a profit seeking "business" run by non medical folks with zero interest in actual health - we are all screwed. Speaking of a reality check, how much profit, in percentages, do insurance companies make? Do you even know, or are you just repeating what you have been told by CNN, NPR, and social-justice warrior co-workers? And speaking of CNN and "evil insurers," here is a recent report if you are curious. Last I checked, insurance companies are going belly-up all over the place after Obamacare regulations because they're hemorrhaging cash, losing money and can't keep their doors open. It was once said that the problem with socialism is that eventually you run out of OTHER people's money. Every drug, treatment, etc. has to be paid for by someone. As the old saying goes, there are no free lunches. That great new pill for x? Well, that drug company spent $10 billion in research and development (and to fight through FDA red tape) just to bring it to market and you want them to charge $10 for a month's supply? How does that work and scale economically, exactly? I look forward to your reply. Link to comment Share on other sites More sharing options...
UpRegulated Posted December 20, 2015 Share Posted December 20, 2015 Next, can someone explain in understandable terms what an HSA is and why it is suddenly the future of insurance? How can a plan with a $3000 deductible be acceptable???? Explain to your patient how voting works. Explain to them the consequences of voting for candidates that supported the "Affordable" Care Act. And Press Ganey. And HIPAA. All of which were liberal/progressive panaceas. And then explain how you, as a health care provider, supported none of them knowing how they would impede good care because you, as a provider, are (read: should be) well-versed in elementary health care economics. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 20, 2015 Share Posted December 20, 2015 https://www.thelundreport.org/content/regence-blueshield-loses-102-million-while-mark-ganz-takes-home-226-percent-salary-increase Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 20, 2015 Share Posted December 20, 2015 http://www.fiercehealthpayer.com/story/top-health-insurance-ceo-pay-exceeds-10-million-2014/2015-04-10 Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 20, 2015 Share Posted December 20, 2015 http://www.ibtimes.com/rising-costs-medical-care-health-insurance-median-pay-ceos-health-care-companies-1938699 Link to comment Share on other sites More sharing options...
Boatswain2PA Posted December 20, 2015 Share Posted December 20, 2015 I'm going to bring another perspective to this. Insurance used to be for the catastrophic. I remember my dad taking me to the minor emergency center several times as a kid to get stitches/splinted and he paid cash for the entire visit. HE was RESPONSIBLE for his family. He had catastrophic insurance in case there was some medical catastrophe (cancer, major trauma, etc).He was "connected" to the price because he paid cash, and that meant that when I had a fever, I got tylenol and chicken soup until I got better. When I had nausea/vomiting/diarrhea, I got chicken soup and loving until I got better. The one time I got REALLY sick as a kid he took me to the ED and I was admitted for appendicitis. I didn't have surgery, and he paid cash for the stay. Today health insurance is used for everything, and are even mandated to pay for birth control. With politicians using CMS as a promise to cover everything for (almost) everyone, people are no longer connected to the cost of their health care. Got a runny nose? No problem, go to the ED because insurance will pay for it. THIS is the foundational problem with our health care financing system in the US, and it's getting worse with the ever-growing CMS system. I absolutely hate Obamacare, but the ONE good thing with Obamacare is that it is, indeed, forcing SOME people actually pay for their healthcare. Your kid got a runny nose? Well, if you have a $6000 deductible, you might not run straight to the ED if you're going to be responsible for a $500 bill. Of course, the purpose of Obamacare wasn't to push the cost of healthcare back to the consumers, but rather to push as many consumers as possible onto CMS....the only goal that has been successful. Wanna get back at the insurance companies? Drop the requirements and lighten the regulatory burden so people can shop around and buy what they want. Oh, and HSA's are great. Put $6500 a year in it (pre-tax) and watch it grow. Start now when you're young and when you're old you'll have money to cover your knee replacements & such. Link to comment Share on other sites More sharing options...
UpRegulated Posted December 21, 2015 Share Posted December 21, 2015 http://www.ibtimes.com/rising-costs-medical-care-health-insurance-median-pay-ceos-health-care-companies-1938699 Your links to obscure websites from a google search of "wayyyy overpaid CEO'S of health insurance companies" notwithstanding, here's some basic math to contemplate. Let's say there are 1,000 health insurance companies in the U.S. I honestly don't know the number, but I assume it is FAR LESS than that. Let's say the CEO of each made $100 million annualy (which I am sure is wayyy more than they actually make on average). Now let's say they all decided to work for free, which, no doubt, a good progressive would say they should do, or something like it. So that's $100 billion dollars in CEO salary collectively - a $100 billion annualy in wealth that could be "spread around" to patients. So now, let's spread around that "outrageous wealth" to 350 million Americans to help them pay for their health insurance. That's $285 each per year. Yes, you read that correctly. $285 per year per person, IF every health insurance company CEO agreed to work for FREE. So what is your point regarding "outrageous" CEO salaries exactly???? I might add, the dude that pushes the cart into your local grocery store after you leave it in the cart corral probably thinks your near six-figure salary is outrageous too. Maybe you should work for free to help drive down the cost of healthcare. And you still didn't answer my question on the average profit margin, in percentages, of health insurance companies. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 21, 2015 Share Posted December 21, 2015 The data in the articles is sound and insurance shouldn't be for profit. I firmly believe that the insurance companies operate on the wrong principle - call that liberal or whatever you want. I am not here to engage in an argument with you. If the American is given insurance that is supposed to pay for things - then it should. Folks shouldn't be rewarded in their jobs for withholding services such as insurance does. I agree to disagree with you and really have no further desire to argue our different perspectives on this. I would be happy to see the US go to a medical system such as in Germany. Good Day Link to comment Share on other sites More sharing options...
Boatswain2PA Posted December 21, 2015 Share Posted December 21, 2015 RC - if insurance companies are not for profit, then there wouldn't be any insurance companies. I certainly am not going to run a business that doesn't turn a profit, would you??Well, except for CMS, and the government has a terrific track record of running not-for-profit businesses like CMS. Providers love dealing with CMS so much that in some places 1/3 of family practice providers don't accept them.American's shouldn't be "given insurance", nor should they be "given healthcare". These products should be purchased by the consumer. That is the only way to keep costs down (nationally) and continue to improve care. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 21, 2015 Administrator Share Posted December 21, 2015 RC - if insurance companies are not for profit, then there wouldn't be any insurance companies. Just like we have no credit unions, right? ;-) Link to comment Share on other sites More sharing options...
Boatswain2PA Posted December 21, 2015 Share Posted December 21, 2015 Good point. Then why are there no non-profit insurance companies competing against the evil for-profit companies?? Link to comment Share on other sites More sharing options...
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