Dealing With Doctors Who Take Only Cash
By PAUL SULLIVAN
A FEW weeks ago, my wife and I were at our wits’ end: our 4-month-old daughter wouldn’t sleep for more than an hour at a time at night. We had consulted books and seen our pediatrician, but nothing was working. So my wife called a pediatrician who specializes in babies who struggle with sleep problems.
The next day, he drove an hour from Brooklyn to our house. He then spent an hour and a half talking to us and examining our daughter in her nursery. He prescribed some medicine for her and suggested some changes to my wife’s diet. Within two days, our baby was sleeping through the night and we were all feeling better.
The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650.
A couple of weeks later, our insurance company said it wouldn’t pay anything. Here’s how the company figured it: First, it said a fair price for our doctor’s fee was $285, about 60 percent less, because that was the going rate for our town. Then, it said the lower fee was not enough to meet our out-of-network deductible.
While we were none too happy with the insurance company, we remained impressed by the doctor: he had made our baby better and was compensated for it, all the while avoiding the hassle of dealing with insurance.
Last year, I wrote about doctors who catered only to the richest of the rich and charged accordingly. But after my experience, I became interested in doctors for the average person who take only cash. What pushes a doctor to go this route, often called concierge medicine? And how hard is it to make a living?
As to why doctors decide to switch to a concierge practice, the answer is almost always frustration.
“About four years ago, one insurance company was driving me crazy saying I had to fax documents to show I had done a visit,” said Stanford Owen, an internal medical doctor in Gulfport, Miss. “At 2 a.m., I woke up and said, ‘This is it.’ ”
Dr. Owen stopped accepting all insurance and now charges his 1,000 patients $38 a month.
Can Maine Democrats, Republicans come together on insurance overhaul?
Posted Nov. 23, 2012, at 5:45 p.m.
AUGUSTA, Maine — They branded it the “rate hike law” on the campaign trail this fall. And now that Democrats have taken back control of both chambers of the Maine Legislature, one of their first targets is the health insurance overhaul package passed by House and Senate Republicans last year and signed into law by Gov. Paul LePage.
Rep. Sharon Treat, D-Hallowell, submitted legislation before this month’s elections to repeal or substantially alter one of the Republicans’ signature legislative achievements from the past two years. Now she’s working out the specifics.
“I’m not interested in just sort of rolling back the clock to the day before the Republicans took over two years ago,” Treat said. “I want to take a thoughtful approach to it.”
Ultimately, though, Treat and her Democratic colleagues could face a significant obstacle to making major changes to the law: LePage supports it and could veto any attempts to alter it. “The governor has no interest in repealing this health insurance reform,” spokeswoman Adrienne Bennett said.
The insurance overhaul bill — called Public Law, or PL, 90 — was an attempt to spur more competition in Maine’s health insurance market by making it easier for insurers to offer new plans for small groups and individuals and by allowing small businesses to band together and negotiate more favorable rates.
The bill also created a high-risk pool — or reinsurance program — to protect insurance companies from the high costs of covering patients who require the most medical care. The law funds the program in part through a $4 assessment on the monthly premium of anyone with private insurance.
In addition, the law allows insurers to charge different rates based on patients’ age, geography and health status. Proponents say that part of the bill is an attempt to woo more young, healthy patients into the marketplace by allowing insurers to charge them less.
Eventually, the law will allow insurers to market plans certified in other states to Maine consumers.
“It gives people choices of different products and creates competition among more than three insurance companies,” said Sen. Rodney Whittemore, R-Skowhegan, who chaired the Legislature’s Insurance and Financial Services Committee and co-sponsored the insurance reform bill. “If you had 12 companies all competing for that market, that’s definitely going to drive that cost down.”
But Treat said the law does away with important consumer protections and has disproportionately caused premium increases among small businesses in rural areas.
“We heard loud and clear during this election that this law was not working for people and small businesses,” she said.
Care at the End of Life
Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”
Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.
Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want.
Fifteen states, including New York, have already enacted laws or regulations to authorize use of these forms. Similar efforts are under development in another 28 states. The laws generally allow medical institutions to decide whether to offer the forms and always allow patients and families to decide voluntarily whether to use them.
With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care.
As drug industry’s influence over research grows, so does the potential for bias
By Peter Whoriskey,
For drugmaker GlaxoSmithKline, the 17-page article in the New England Journal of Medicine represented a coup.
The 2006 report described a trial that compared three diabetes drugs and concluded that Avandia, the company’s new drug, performed best.
“We now have clear evidence from a large international study that the initial use of [Avandia] is more effective than standard therapies,” a senior vice president of GlaxoSmithKline, Lawson Macartney, said in a news release.
What only careful readers of the article would have gleaned is the extent of the financial connections between the drugmaker and the research. The trial had been funded by GlaxoSmithKline, and each of the 11 authors had received money from the company. Four were employees and held company stock. The other seven were academic experts who had received grants or consultant fees from the firm.
Whether these ties altered the report on Avandia may be impossible for readers to know. But while sorting through the data from more than 4,000 patients, the investigators missed hints of a danger that, when fully realized four years later, would lead to Avandia’s virtual disappearance from the United States:
The drug raised the risk of heart attacks.
“If you looked closely at the data that was out there, you could see warning signs,” said Steven E. Nissen, a Cleveland Clinic cardiologist who issued one of the earliest warnings about the drug. “But they were overlooked.”
A Food and Drug Administration scientist later estimated that the drug had been associated with 83,000 heart attacks and deaths.
Many younger vets among the ranks of uninsured
By Chris Adams — McClatchy Newspapers
Belleville (Ill.) News Democrat - McClatchy, Nov. 19, 2012
WASHINGTON — More than quarter of all veterans who served in Iraq and Afghanistan don’t have health insurance and aren’t part of the Department of Veterans Affairs health system, according to an analysis of VA data.
The uninsured rate among these recent veterans is higher than for other war periods and for veterans as a whole, raising concerns that veterans recently back from the wars might not be taking advantage of care to which they are entitled.
Veterans advocates and some lawmakers have pushed to automatically enroll veterans in the VA health care system, which could fill in the gap for some of the veterans not now covered by the VA or the private market.
“It is critically important that we continue to reach out and inform veterans of the health care and benefits they have earned through their service to country,” said VA spokesman Josh Taylor. “We have made progress, but there is more work to do.”
The numbers are from the 2010 National Survey of Veterans, conducted by the VA periodically to determine the state of America’s veteran population.
Veterans who have left combat operations from the recent wars are eligible for VA health care for five years and after that must qualify based on the disability- or income-based standards. While some veterans can use the VA health system for life, most don’t; of 22 million veterans, 8.6 million are part of the VA’s system, 2011 numbers show.
That’s a surprise to many people, who assume all veterans qualify for the VA’s network of hospitals and clinics, said Steffie Woolhandler, a researcher who has tracked veteran health insurance status.
“I’m quite sure that most doctors believe that vets have health insurance, because they generally express surprise when I present my work on vets at meetings and in medical journals,” said Woolhandler, a professor of public health at City University of New York and a visiting professor at Harvard Medical School. “I’m pretty sure most of the lay public thinks so, too.”
http://www.pnhp.org/print/news/2012/november/many-younger-vets-among-the-ranks-of-uninsured
Belleville (Ill.) News Democrat - McClatchy, Nov. 19, 2012
WASHINGTON — More than quarter of all veterans who served in Iraq and Afghanistan don’t have health insurance and aren’t part of the Department of Veterans Affairs health system, according to an analysis of VA data.
The uninsured rate among these recent veterans is higher than for other war periods and for veterans as a whole, raising concerns that veterans recently back from the wars might not be taking advantage of care to which they are entitled.
Veterans advocates and some lawmakers have pushed to automatically enroll veterans in the VA health care system, which could fill in the gap for some of the veterans not now covered by the VA or the private market.
“It is critically important that we continue to reach out and inform veterans of the health care and benefits they have earned through their service to country,” said VA spokesman Josh Taylor. “We have made progress, but there is more work to do.”
The numbers are from the 2010 National Survey of Veterans, conducted by the VA periodically to determine the state of America’s veteran population.
Veterans who have left combat operations from the recent wars are eligible for VA health care for five years and after that must qualify based on the disability- or income-based standards. While some veterans can use the VA health system for life, most don’t; of 22 million veterans, 8.6 million are part of the VA’s system, 2011 numbers show.
That’s a surprise to many people, who assume all veterans qualify for the VA’s network of hospitals and clinics, said Steffie Woolhandler, a researcher who has tracked veteran health insurance status.
“I’m quite sure that most doctors believe that vets have health insurance, because they generally express surprise when I present my work on vets at meetings and in medical journals,” said Woolhandler, a professor of public health at City University of New York and a visiting professor at Harvard Medical School. “I’m pretty sure most of the lay public thinks so, too.”
http://www.pnhp.org/print/news/2012/november/many-younger-vets-among-the-ranks-of-uninsured
No comments:
Post a Comment