So, what am I talking about here? Well folks, I am doing today’s blog to talk about insurance companies and how they promote the lowest cost options available, and the reason why they would do this. You see, it turns out that most patients dump their insurance and change carriers after just a few years, so from the insurance company’s point of view, it really is not a good idea to pay a lot of money and cover that patient for high quality treatment since they will not likely recuperate that expenditure as the patient will not stay with them long enough and pay enough in premiums to make high quality/higher cost treatment practical.
This is where we talk about LEAST: Least Expensive Acceptable Standard of Treatment. This is a really good acronym that explains how insurance companies operate. You as the patient would like to have high quality care, of course, yet the insurance company just wants to minimize their own out of pocket costs. The two goals are not in synch with each other, quite obviously. Therefore, when a patient comes to my office they are sometimes in a conundrum. They want the best care possible. They want to actually FIX the problem, not just put a band aid on it. And then when they find out that it will cost a lot of money out of pocket to work with us, they tend to have second thoughts.
And this is where the concept of ‘in network’ kicks in. A ‘participating provider’ is simply a doctor who is willing to work for a lot less money in most cases. And to do this, they make up the difference in volume. They do what I call the Costco approach – pack in as many customers as possible because profits are so low that the only way to make any money is to jam in as many patients as possible. You see this routinely at the dermatology office. A few years ago, I sat in my daughter’s dermatology office for an hour and a half waiting to be seen. When I told the receptionist, we did not have all day, she told me she would still charge for the appointment when I told her we were leaving. I told her the doctor would have to pay me for my down time as well. It was a stand off and I never went back again.
So here I am comparing the concept of selling a product, Costco that is, to the concept of selling a service, and that is where the problem comes in. Insurance companies are trying to commoditize health care and make you think it’s basically all the same, so it does not matter who you go to. Well, dear readers, there is something truly wrong in the state of Denmark if you believe them. This is what my blog is all about. I CHOOSE not to do the lowest standard of care for my patients. I CHOOSE to provide a high-quality service at a reasonable cost. I could easily just write prescriptions all day long for pain killers and drugs that reduce dizziness or drugs that make you sleep better or drugs that do whatever you want done. But I do not do this because drugs do not actually fix anything. They simply mask the problem.
In my practice I have chosen to actually fix problems, not to cover them up. And this costs money. And this is often not well covered by the insurance carriers because it is simply not the LEAST available. This morning alone, I have been told by ALL my patients that their head pain is less, the tinnitus is better, the shoulder pain is gone, the neck pain has lessened, and the dizziness has reduced. Those who were taking drugs are now taking less drugs. This is how it should be. And let’s talk cost. Yes, it is somewhat expensive to have me make these devices, however, it is far less than the cost of not wearing them over the long term. When a patient chooses the insurance company over me, they end up on drugs that they will eventually become intolerant to or they end up with liver and kidney problems from the medications. There are other more numerous side effects to drugs, but we all know that. So, let’s also look at a little thing that I call opportunity cost- the cost of what you missed out on.
For this discussion on opportunity cost I am going to recall a wonderful lady from Florida who I treated for dystonia a while back. She had literally spent over 20 years in bed she told me, due to pain from having her neck pulling all the time. She lost out on life basically. Well, when she met me, she was understandably skeptical that a little device in her mouth would fix most of the dystonia. She took the plunge, paid the cost, and now let me tell you about her. She has two wonderful daughters who she spends every evening and weekend with now, instead of curling up in bed and in pain. She has created priceless memories with her girls. I was able to give her back her life, instead of taking pain meds that were the only things ‘authorized’ by her insurance company. So, she lost a lot of years from being in pain with dystonia, but today she feels great and is living her life to the fullest. There is no price you can put on this.
So here we are folks, the year is 2019, and I get emails almost daily from patients asking me to participate in their so-called network. My response is basically what you have read above but I also add this in as well: How would you like it if next year your employer told you that you are going to work for 40% less pay, take it or leave it? This is the kind of doctor you are dealing with when they participate. You are now going to an office where they need to see you quickly and get you out the door so they can make their money and move on to the next patient. Dear, dear people- that’s just the way it has to be. You are now a participant in the commoditization of health care! All doctors are the same and all treatments are the same!
In reality, that simply is not the case. Like I said, it’s 2019, and it’s also June 19 today. Because I do not believe in the principle of LEAST, I spent last weekend at the ALF Academy/Interface meetings in the exciting town of Columbia, Illinois (let’s just say the most exciting thing I saw there was the local carwash). That weekend was both my birthday and Father’s Day and I spent those days training at the Academy meetings. It was a choice and a choice that I would do again and again. It was all about becoming the best that I can be. And Monday morning when I returned to the office, that training came in very handy once again. It seemed that most of the new patients early this week had already been to many doctors and simply found no relief. It literally took but a moment or so to figure out that they had cranial bone distortions and/or slipped discs in the TM joints. But, in addition to all that, it was painfully obvious that they were not sleeping well and that was highly contributory to their reported symptoms. Because of last weekend, I am now working with an MD who is checking blood panels for Vitamin D-3 discrepancies which we now know are highly contributory to clenching/grinding and sleep disordered breathing. Because we now have neurologist attending the Academy meetings, those of us who train there are now able to help our patients even more. But that is another blog for another day.
To wrap things up, now you all know that I am not a ‘LEAST’ doctor, and now you know why. I sleep well at night because of this, and hopefully this blog will help you sleep better too. Thank you.