doc spelled backwards is cod not god

We really like our family doc. He's willing to offer homeopathic suggestions, for one. He's down to earth and friendly, for two., i.e., his ego is not the size of the heavenly firmaments.

So we've been going to our family doc for ten years now. A couple years ago he moved into a brand new building, a condomininum setup, so he now owns his office. Or the bank does. Within his office suite he has established a lab testing unit.

So my husband, Sam, takes an Rx that requires regular lab tests. Over the years, he's been going to one of those large, chain labs. No cost with his insurance card. Lab sends in results to the doc. Doc checks and notifies if there is a problem. All part of the regular check up.

Until recently.

Family doc's office staff instructed Sam to get his blood work done in the on site lab. Requires that Sam set an appointment, return to get blood drawn. Sam gets there, his weight and BP are taken (even though he was just there a few days ago), gets his blood drawn, does not see a physician, but is charged a copay for a "short office visit." In Sam's case, $35 copay. Ouch.

Sam protested to the office staff and the doc came out. Sam told him "I want to go to my usual lab." Doc insisted he get the lab work done on site.

Does this ring of a conflict of interest to anyone besides me? Might this be an ethical violation? We think he's funding his new office. Or has this "short office visit" become prevalent out there in family practice medicine?

vent-a-thong

Aaryn Belfer can rant like no other. And today's post was no exception with her 12 things she's really friggin sick and tired of. To include liars (yeah you, Rudy and Dana) and overly vain, surgically addicted fame-seekers (Heidi).

Me? I'd like to add my humble #13. Or make that #12, as I don't have a grudge against those cute, cuddly Pandas.

So here we go. Here's what I'm really friggin sick and tired of: so-called independent and swing voters who decide elections.

Because I have to ask: Who are you people, really?

That one year you can vote for the Bushie gang and the next election year Obama and now this year Scott "I posed naked for Cosmo" Brown?

I mean really, Massachusetts? You lose The Lion and you replace him with Beefcake Boy because he drives a fancy four door GMC Canyon pick up truck? I know this kind of down-home-boy fakery works in Texas elections, but you too?

And why is it that posing nude tends to work against women running for Miss America but works for men running for the U.S. Senate? WTF is that about?

I really do believe wonder if some people register as Independent so they can be the darling of the politico media. As in, I don't get enough attention in my real life so I'll call myself an Independent so exit pollsters will put a microphone and camera in front of my face so I can toyingly make them guess who I voted for.

This is not a game, people.

Did you not see what 8 years of Republicanisms did to America? To the stock market? To the banking industry? To people's homes? Jobs? Lives?

I guess you Massachusians are about as hard headed as your state is hard to spell.

You say you want to send a message to Democrats that you don't like how they're running things. Really?

Lesson 1. Brown's seat certainly means more Congressional stagnation, not less.

Lesson 2. Years of Republican regulation-ease led to financial near-collapse. Or have you forgotten already? I haven't. My husband lost a great deal of income. Our finances still have not recovered. And I am working longer hours to keep us afloat. I am not able to be the available mom that I was before Bush-face and Dick Vader took my country hostage.

Lesson 3. Recent economic indicators, thanks to Dem-lead initiatives, suggest we just might be out of the most troubled waters. I'd say the Dems are doing a pretty damned good job.

Lesson 4. A good thirty years we've endured a steady stream of steep health insurance premium increases and other assaults on our health care. Experts predict more of the same if we don't do something drastically different. But Republican leadership can only come up with tax-cuts and more tax-cuts and filibusters and no-votes and tort reform as supposed solutions.

Lesson 5. I got news for you tort-touters. I live in a state that passed tort-reform. My premiums have not come down at all. They continue to rise several hundred dollars every year. Some years, like this one, more than $1000. You can read more about how tort-reform "did not translate into lower health insurance premiums for consumers" here.

I can only hope Scott Brown makes good on his campaign promises cough! choke! snort! That he votes in the U.S. Senate like he voted in the Mass. State Senate. A moderate who worked with the Dems.

But it's hard to imagine the current Republican party letting Brown get away with anything short of the right wing red meat spewed out by the likes of Limpballs and Annthrax Coulter.

So we shall see, Mass-a-chew-on-this. We shall see.

health reform from a provider's perspective

Here's what I'm seeing in my practice. I've been doing this for ten years now. Long enough to declare a trend.

And no, stodgy research types, I don't need to conduct a double blind placebo trial in order to render opinions of substance. This is my peer reviewed blog.

Copays are going up. When I first started, the $15 copay was routine. Maybe the copay of highest frequency. I even saw a few $10 copays. Copays of $20 and $25 were the next most routine. But now? The most frequent copay has inched up (and by that I mean, nearly doubled) to $30 and $35. I have a few people who pay $50 per visit. And yes, that's a copay. And I haven't seen a $10 copay in years.

Deductables are higher. And I'm seeing them more often, too. When someone comes in for psychotherapy, especially for the first time, they mistakenly believe their mental health copays and deductables will be the same as a visit to the medical doctor. But the reality is that most of the time? As in, 90% of the time? The mental health benefit requires more cha-ching. (90% was derived from my unscientific, morning cup of coffee to jostle the memory, study).

Usually the most jarring shock is delivered in the form of the mental health deductable. It is not unusual, these days, for me to see $1500 and $2500 before their copay kicks in. Of course, for most, this is a no-getter. No getter therapy. No getter better.

Score one for the insurance industry. They got their premiums. Now you don't get your therapy.

Number of sessions authorized? Going down. It isn't at all unusual, these days, to see "20 visits per year" maximum. Or, lifetime maximum, 60 visits. That's lifetime, people. Which means, if you are diagnosed bipolar you can count on 20 visits per year for three years. Or it might be a dollar amount maximum. $3000 lifetime max. That doesn't cover very much therapy over the adult lifespan, which could be 60 years, easy.

Fees paid to providers? Not going up. Much. Or at all.

A couple days ago my daughter, TwinB, who is at a new school and meeting lots of new friends, approached me, wide eyed. That day she had told a new friend that her mom (me) is a psychologist. "Wow." The girl replied. "You must be rich." TwinB tilted her head at me, as if to say, "What the heck?!?"

This is the same daughter I took to the thrift store earlier in the week to shop for "new" jeans. She looked at me that way because she sees nothing of the rich lifestyle at our house.

We therapy shrinks, the ones paid by health insurance companies, are not making money hand over fist (what does that saying even mean?). Therapy shrinks as opposed to medical shrinks, that is. You know, those real doctors.

But, last I checked the business page, the insurance companies are making it hand over fist. How do we think they have become one of the most powerful lobbies in Washington? Their good looks?

One example. For ten years a certain health insurance company, whose name rhymes with poo-knighted wealth bear, has not increased my fee. Ten years. This lack of regard for inflation means many providers drop off the network. When a poo-knighted client of mine requires psychiatric care, I wince. Good luck finding a quality psychiatry doc who can see you before the next Perseid meteor shower arrives.

Which brings me my next point:

Provider networks are shrinking. No pun intended. I recall when my family doctor posted a sign that they no longer accepted, guess which one? Poo-knighted wealth bear. I knew why. But I asked anyway. The doc, looking none too comfortable discussing his bid-ness with a patient, said he was "having trouble getting payments." I wanted to ask, "Trouble getting a raise, you mean?" But didn't. I had a sick child before him. And I understood his decision. And endorse it even, from the hope that if enough doctors drop off the networks, people will see that insurance companies are dropping the ball.

It's common knowledge that when psychiatrists get a big enough clientele, or patientele, they drop off insurance networks. Private pay only. Those are some pretty discouraging words to hear when you're suffering from major depression because your husband has left you for a younger woman and you have no job because you've been raising his kids for the past twelve years and all you've really got left of your marriage is the fact that he still claims you as his dependent on his health insurance and that will only last until the divorce goes through so you need help now.

And there's more. There's HMO forms and authorization requests and stalled payments and denied payments and being on hold for fricking forever when you call the claims department. But that's about all I have time to go into right now because it's time to head into the office, and you know, be the provider.

But here's my end of the rant summation: The health insurance system, from my view, has tilted into the direction of the wealthy get healthy but the middle class get screwed. And dropped coverage. And depressed. And in need of mental health services but can't afford it.

Ok, after all of that, I'm depressed. I need to make an appointment with a shrink. Oh, but wait. That's right. I can't. I'm self-employed. I don't have mental health coverage. Can't afford it.

So I guess we providers on the networks are shrinking in more ways than one. Or we want to. But we can't afford the coverage.

Health Care Stories, Austin, Texas

This month Tome of the Unknown Writer is featuring a Health Care Stories Project "focusing on health care stories and opinions from the US and countries with universal health care all this month." Here is my story, fresh in my mind, as my young daughter required emergency surgery a few weeks ago.

The physician's assistant (PA) at the urgent care center diagnosed her with a kidney stone. She ordered a CT scan for later that afternoon, explaining that 90% of all stones are small enough to pass but a scan would alert us if the stone was too large to pass.

As the morning passed into the afternoon and the time of the scan approached, my daughter's pain moved from her back to the lower front of her abdomen and seemed more tolerable. We deduced she was passing the stone.

But let me back up so I can explain our health insurance situation. Husband and I are both self-employed. I'm a psychologist. He's a home builder. Husband is covered under a separate policy from the kids and me. Why? Because no individual underwriter will cover his chronic disease, AKA his pre-existing condition (diagnosed at 18 years old). He has special coverage under the Texas "high risk pool" (subsidized by the state). As a result, we pay two high premiums for two separate plans. We have high deductables ($4500 and $2500) and high copays ($45) so that we can keep our premiums to $1000/month. That makes for a combined total of $12,000 per year, math majors. And with copays that high, we see the doctor almost never only if we think it's absolutely necessary.

Given the high deductable, we knew the cost of the urgent care and the CT scan would be coming straight out of our pockets. Because we believed she was passing the stone, her dad and I considered skipping the CT scan because of the cost. I called the PA and ran it by her. She urged us to go, this time saying she wanted to rule out a few other conditions. We decided to play it safe and take her. But we still wondered if we weren't "wasting" a huge chunk of money.

The CT scan revealed that the source of her pain was not a kidney stone but, rather, a large cyst. At 4:45pm we were told to get her to a hospital emergency room (ER) immediately, that the cyst required removal.

Since then, my husband and I keep thinking, "What if we hadn't gotten that scan?" All because we can't afford a low deductable.

One last note on affordability. We're grateful we're able to maintain our current coverage. The recession has hit our family pretty hard. My biggest fear is that a harder hit will force us to join the nearly 50 million uninsured Americans. I don't even want to think about where we'd be, where my daughter would be, if we weren't able to flash that BCBS card at the medical centers.

But for now we're scraping by and paying our insurance premiums. To say I feel uneasy is a gross understatement. I think its unfair that small business owners have to pay so much more compared to someone working for a large corporation. Supposedly this country is all about supporting small businesses. Not where health insurance is concerned.

So I strongly support health care reform with a public option. Have been holding my breath for it, in fact, since we dropped husband's long held individual policy in hopes of the Clintons promised reform in the early 1990's. But the strong insurance lobby pushed back. And now here we are, more than fifteen years later, trying again.

To all of those congresspersons against reform legislation? Here's a challenge: Surrender your federally funded health insurance and join we hard working Americans who pay out the nose for our supposedly "best health care system in the world." I bet know if you were out here in our world you would pass something quick.

I do (so want your health insurance)

Marry him for his health insurance plan? BernThis posted about a couple who did just that. It's becoming almost commonplace these days.

My husband's first marriage? They tied the knot in his hospital room. A marriage destined for good times, right?

He needed emergency abdominal surgery for a chronic illness and her health insurance (group) had a much lower deductable than his (individual). So they moved their wedding date AND the location. Eventually both insurance plans kicked in and they made out like bandits. Nice wedding gift (unlike my wedding gift from hell).

I believe this double-coverage windfall has been nixed by the crafty (we make the money here, not you) health insurance industry but it worked for them.

And me? Wife number two? All I have to show for it is a husband with a scarred belly and a mediocre story for my blog.