I Like What You Are Doing, But I Have Good Insurance…

By Michael A. Ciampi, M.D.

 

I had an interesting conversation with an acquaintance the other day.  He is very much aware of the Direct Primary Care (DPC) model to which our practice has been transitioning.  He told me that he is very supportive of the concept of free market principles being introduced into medicine.  He even told me that he has been recommending our practice to his friends.  My question to him was when he was going to make an appointment for himself.  He hesitated a bit and said, “I’d really like to, but I have good insurance.”

Needless to say, I was taken aback.  I bit my tongue and asked him to tell me more about his healthcare so I could understand what he was thinking.  I know where he works and that they provide the equivalent to a gold plan on the federal exchange.  This means that he has low deductibles and copayments.  This means that he has to pay very little out of his own pocket for his healthcare, especially if he goes to doctors who are in his insurance’s network.  That is where it got interesting.

He went on to tell me where he went for his primary care.  It is a hospital owned clinic with many locations.  He often does not get answers to questions when he calls them.  He may or may not see the doctor who is identified as his primary care physician, if he sees a doctor at all.  He has to deal with a lot of red tape, and is often not satisfied with his interactions.

This gets to the crux of the problem with insurance based healthcare, especially primary care.  The gentleman with whom I spoke is a very intelligent person, but he has been conditioned, like so many of us, to the point that he could not see the truth.  When all is said and done, a person (or organization) works to satisfy who is paying them.  In his case, his clinic is paid by his insurance company, not him (except a nuisance copay).  This means that the clinic will do what the insurer wants above what he needs, lest they deny payments.  He is a prisoner of the system that the insurance companies have created to meet their needs, not his.  His doctors and their staff are probably good and caring people, but they are so wrapped up in doing paperwork and jumping through all the insurance company hoops in order to get paid, they have lost sight of what should be their primary mission, to take good care of their patients.

The Direct Primary Care model is radically different from the traditional model.  With DPC, the doctor contracts directly with the patient to provide high quality, accessible, and personalized care.  This is done at a reasonable price because so much of the unnecessary overhead mandated by the insurance company and government has been eliminated.

Don’t be a slave to your insurance company.  Get the healthcare you deserve.  Save insurance for what it supposed to be for: paying for major medical expenses, not routine care.  Work with a doctor whose first priority is helping you be healthy, not waiting for you to get sick so he can make money off your health insurance policy.  Go DPC!

 

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