Exiting the healthcare superhighway

Image by scootiepye. All rights reserved. Check out her Flickr photostream; it’s awesome. Even though it’s gotten awfully full of feathers lately.

I am very appreciative of the number of readers I have from the UK. I apologize that this post might make no sense to you. In the US, national health care is pretty bare-bones. Most people get their primary care from their employer, who contracts with one or more private health insurance companies. You select a plan, and contribute a small amount per month for the level of care you choose for yourself and your family.

My parents still have intellectual heart palpitations when I talk about walking away from this system. It goes against everything they think about work, the long-term security of a decent job and the jewel in the middle-class crown: a good healthcare package provided by an employer.

I go to doctors who, for the most part, have severed their ties with health insurance companies.

At first, it’s a bit scary doing this. Your co-pay is not going to be $20 for the visit. You’re going to pay the whole amount up-front. It might be a few hundred dollars.

You will, in return, not get a rushed visit in a system that expects a doctor to see 6-8 patients per hour, nor will you get a fistful of pharmacy scripts on the way out, attempting to fix the  ailments you might have mentioned during your visit. The doctors in the “system” aren’t trying to give you bad service. They simply have to deliver a certain level of income to the insurer.

Of those doctors who’ve left the insurance super-highway, they are  putting their livelihood on the line in the belief that there is something wrong with the insurance-driven healthcare system. Going to such a doctor is a revelation. You get the better part of an hour with someone listening to you, who knows almost everything going on with you, and who is not worried about the over-booked patients (patience required) waiting in the reception room.

My primary-care physician calls herself an I.M.P.

this means:

• Innovative medical practice
• Ideal medical practice
• Ideal micro-practice

In short, it’s high-quality care with a minimum of overhead.

Here’s an article from the Wall Street Journal, describing this phenomenon.

If you want to see an off-grid doctor, you need to be sure of the following:

1. Your plan allows for “out-of-network” doctor visits
2. You can afford to cover the deductible until partial reimbursements for your visits begin
3. You can afford to pay up-front, and wait for the reimbursements when they come
4. You are able to keep track of the forms and, sometimes, submit them yourself. You must reach the amount of your deductible before you will see any money back, so you need to watch carefully, and submit everything  to your insurer to add to the total
5. You are able to get over the fact that a doctor’s visit isn’t worth the cost of two fancy coffees. Because of this ingrained belief, the U.S. is ranked 37th in the world regarding health care.

At the end of the visit to an out-of-network provider, the doctor will give you a sheet, checking off the correct diagnostic codes. If you do need to submit the claim yourself, this form is the key for getting credit from your insurance company. You will find a form for a manual claim-submission on their site.

So, just because a doctor says they don’t accept insurance, it doesn’t mean your insurance company won’t cover some part of your visit as an “out-of-network” provider. These practitioners just aren’t agreeing with the rules placed upon them by insurance companies, with their required number of patients seen per day, resulting in minimum visit times.

My holistic dentist does take insurance. I pay for the whole thing and get some it it back, on average, in three business days.

After I meet my deductible, this is what happens to my other two physicians:

My holistic osteopath only takes Medicare in office. For people who aren’t on Medicare, she will fill out the diagnostic sheet. I have to mail it in myself. I get back about 75% of what I paid after about a month.

My holistic primary care doctor takes no insurance at all, fills out the diagnostic sheet and submits the paperwork for me. Again, I pay the whole bill, and get about 75% back in a month.

Some practitioners now even allow you to subscribe to their practice, accepting an annual fee for your family. I’m not sure how that works for reimbursements. The one doctor I have who does this, does it only for families with young children. She’s a specialist in children on the autism spectrum. I admire her for that.

So, if I have a traumatic injury, I’m covered. I get prescription coverage. I have a flat rate for the emergency room. I get to go to the doctors I want to see. In fact, this unfamiliar and scary way of doing things allows me to build a medical team. My doctors not only know each other, they GO to each other.

This is not a path for everyone. You, unfortunately, need some spare cash. You have to set a budget. You have to be organized enough to submit the forms. You need to keep records of everything — many things I don’t get back give me some deductions on my income tax.

It’s the path untaken for most people. For me, it was worth it, even though I’d be financially better-off if I did not.