I have always been a therapist who accepts insurance. This means I can't charge as much as providers who don't take insurance, who can charge two or three times as much as I do. This is a choice providers make, whether or not to apply to be part of an insurance network and accept their low fees. I have mostly worked at salaried jobs in institutions that accept all insurances. But even when in private practice, I applied to lots of networks so I could accept most insurances. Most of my colleagues in private practice, on the other hand, did not accept insurance and expected their patients to pay their exorbitantly high fees. Many were affiliated with prestigious hospitals who sent the referrals to their private practices. Insurance companies love providers who make patients pay out of pocket. It is that much money saved for them. I consider providers who don't take insurance totally unethical. There is a general belief that if they aren't covered by insurance they are somehow superior and more prestigious, which is what draws people to see them anyway with money they don't have. Only the best.
The premise of the TV series Breaking Bad is that of a science teacher with lung cancer who decides to make crystal-meth so he can leave his family with money after he dies. Despite the fact that they live on a teacher's salary, his idiot wife decides he should get his care from "the best" doctor in the country, who of course doesn't take their insurance and charges a fortune. This ties the science teacher, Walt, all the more to his illegal drug work. Much later in the story, his DEA cop brother-in-law is injured and his wife, too, wants to go outside her insurance network for the "best," so ironically her sister uses her husband's drug money to pay for it. It is no accident that so much of the drug money spent on this show is for medical care outside of insurance networks for people who have insurance and would not be able to afford it without drug money. It is totally ironic and infers that doctors who don't take insurance are corrupt drug lords. There is a message here about medical ethics. People who have insurance are lucky and should use it. The truth is, there are good and bad doctors both in and out of the networks, and you can shop around. The worst therapists I ever had didn't take insurance. Once a provider is part of a network, they have the power to advocate for more services for their patient if necessary. Diagnoses are highly malleable and if one doesn't work, you can try another or two or three. As the expert, you have the upper hand with the insurance company. And on the other hand the insurance company regularly recertifies you to make sure you aren't a quack. That is a safety check for patients.
I used to work in a staff model HMO, a medical practice owned by Blue Cross. Anyone who chose their primary care physician at the health center had to get all their health care there and use our affiliated hospitals. I worked there for fourteen years and patients got the best mental health care I've ever seen anywhere. I get my own health care in a similar practice. Still, many patients resented "having" to see me instead of a therapist of their random choice outside our center. I was frequently insulted by ungrateful patients calling me "just an HMO doctor who I'm only seeing because I have to see you." They were medical snobs who wanted "only the best" and had no idea that I was, in fact, one of the best, as were my colleagues. With medical care, people seem to be stupid enough to think that if it costs a fortune it must be worth a fortune, and then end up wasting what little money they have and going into unnecessary debt. People who have insurance are extremely lucky. Too bad so many don't appreciate it and go out of network for "the best care." They are fools to waste their money like that. They are much more likely to be treated by a charlatan outside of a network than in.
5 comments:
i think this is good thing that one do not charge much from one who don't have insurance-Ca Contractors Bond
I have a good medical plan through my employer, and very few providers are outside of their network here. I suppose that's what comes of living in a rural state. I stay within network at least 99% of the time. The deductible and out of pocket is difficult enough for me to make annually (although they're not that terribly high) it just seems silly to insist on stepping out of my network and incurring the extra expense. What's the point of having insurance at all if that's the way you want to seek treatment?
Some people think if it costs more, it must be more valuable. Providers who don't take insurance encourage this perception.
To me that only encourages the same concept of the old snake oil salesman. It's expensive so therefor it must work! That's not to say that all expensive providers are schuysters. It's almost like an economic reverse marketing, instead of providing quality care for less, they are providing the same or less than the level of care and using the price tag as the selling point. It makes no logical sense to me. I guess I find myself looking at those charging exorbitant rates, for a comparable amount of service out of fear that they will have to eventually contend with a malpractice suit. High rate scream of mismanaged overhead or a lack of confidence in the service provided, hence a need to pad the patient's bill.
Medical illness is mysterious to most people. They will pay more for the peace of mind that maybe this doctor will cure their cancer. I don't think the doctors are thinking of malpractice. They're just charging as much as the market will bear. There are no standards for physician costs outside of the lowballs that insurance companies set. Outside the insurance networks, the sky's the limit. If they can get patients to pay it, they'll charge it.
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