I hear it quite often. In my dental practice and in the clinics where I teach, we usually write up a treatment plan (an estimate of the procedures needed), along with an estimate of the fees, broken down into patient portion and insurance portion.
Sometimes, I show the fee estimate to the parent of a child and the parent will look at the 20% they are responsible for rather than the 80% the insurance company is covering. And the parents sometimes protest, "Why do I have to pay?" "I'm sorry," I sometimes reply, "I didn't put the cavities there. I'm just trying to fix them." "Oh, not you", they return, "shouldn't insurance cover that? That's what insurance is for."
Sometimes, I make a treatment decision for a procedure that isn't covered by insurance. Most often, it's a small child who won't be able to sit for a filling done to the standard of care. Rather than torturing the child with a perfect filling, I'll opt for a temporary solution that will just buy time until the kid is old enough for a real filling. I don't know why the insurance companies don't cover them. Maybe because they don't last as long as definitive fillings. But we don't expect them to. We just need to buy time. I can see the insurance company's point. Sometimes they last only 6 months. Sometimes they last 6 years. They only cost about 1/3 of the cost of the final filling. But quite often, parents get upset. "Why won't the insurance company cover that procedure. That's what insurance is for."
Sometimes, I go a little above and beyond the first time I see a patient for a checkup. I ask what insurance they have and I explain that even though the American Academy of Pediatric Dentistry recommends two checkups a year, some insurance companies only cover one (because that's what's acceptable for adult care). The family is then responsible to cover the cost of the second exam. I don't mention that as long as their kids don't have cavities, the $66 for the second checkup may be the only cost to the family the entire year. I do mention that if the family does not want to pay the $66 for the second checkup, they are welcome to schedule a cleaning for their child (which is covered) and remind me not to come in the room for the checkup. Quite often they get a bit peeved, sometimes at me because I've insinuated something about their willingness to pay, and more often at the insurance companies. "That's what insurance is for," they often protest. Only sometimes do I explain that it may not be the insurance company that made that decision. It may have been the employer who chose to make the specific insurance plan available to the insured individual. Some families come in with insurance that covers both recommended examinations.
I think we need figure out what insurance is for. Is it supposed be similar to auto insurance, where coverage extends only to accidents and catastrophe and big ticket expenses that we didn't expect, and not to routine maintenance (like the oil change we don't expect our insurance companies to pay for). Or should it be extended to cover prevention, in which case it would have to cost more, like the additional sum I paid for the maintenance plan on my VW. I mean we can't expect to pay a little to receive a lot, can we? To pay for one thing and get another more expensive thing,right?
The reservation I have about the current movement is that insurance companies seem to be operating from the assumption that their purpose is to help us cover the costs of major unexpected events. But what I hear from the biggest advocates of the current health care bill, is that the purpose of insurance should include regular maintenance. But I don't hear much acknowledgement that the costs of such an increase in services will raise premiums. My impression of the supporters of the health care bill is that there really is an expectation that it will be possible to try to pay very little to receive a lot. And I don't think that's financially feasible.
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2 comments:
I think you're definitely on to something here. From the public perspective there is a huge spectrum of what people think insurance is for. There is definitely a need for the public to be educated on taking more personal responsibility for our health which ideally would lead to lowering the countless lifestyle related health problems. The question then is how do you get people to take more personal responsibility as opposed to being so quick to jump to the expectation that the Dr will take care of it and the insurance will pay for it? Placing an emphasis on preventative care could possibly address this but you're right, the costs would skyrocket in the years it would take to reeducate the whole population assuming the public is positively responsive. The other extreme I guess would be letting people experience the consequences of their actions but then you end up with all the "major illnesses"&"disease" from people doing what they are already doing--not taking enough personal responsibility--thus leading to major public health problem. At the end of the day insurance is a business and unfortunately there is a substantial number of health care providers who see it as just a business too. There is certainly blame to go all around. I kind of see government as mediators in this whole thing whatever side of the political spectrum you fall in. Yeah, it kind of sucks for all who are doing their part having to "pay" for those not doing theirs but I think that's part of being human, unfortunately we cannot survive in isolation.
BTW I think you are amongst the best in our medical world both in action and intent. My intention is to engage in this conversation with the utmost respect for you and what you do.
Lilia, thanks for your comments. I really do want to engage in dialogue. Since I lean conservative, much of my reading confirms what I already believe. So it's good to have exchanges with people I respect with different viewpoints from mine.
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