Suddenly Uncovered: The Horror

11 Sep Suddenly Uncovered: The Horror

By Sheila Tillman

For about twenty years, I had been covered by my husband’s insurance. Every now and again we’d have to prove eligibility by submitting documents such as birth certificates, marriage licenses, etc.  This past year was no different. This time around, I couldn’t find my marriage license anywhere. I thought that it was no big deal; I’ll just get another copy from the county clerk’s office. Simple enough, right? Wrong! Things slowly began unraveling when the county clerk’s office had no record of our marriage certificate nor did they have the application we filed. I know we are legally married because number one, I was there, number two, I had to submit my marriage license to the military, IRS, Driver Services and the Social Security Administration. So why was it that Fulton County suddenly could not locate my marriage license? This is a battle I am still fighting. Still, I didn’t hit the panic button. So, instead I submitted copies of our tax returns, proof of co-habitation, bills etc.; all, for naught.   During the midst of this chaos I had to go out of town on business. It was a lengthy project so I needed to refill my medication. But before I could request a refill, I needed to make sure my INR was still in range. I found a local physician who accepted my insurance. Upon check-in at the doctor’s office, I was promptly notified that my insurance coverage was terminated.  Just as I was about to argue with the front desk representative, it dawned on me that maybe they had terminated my coverage. Yes, I was terminated from my husband’s policy. I had no idea the insurance company would terminate my coverage so quickly. There was no communication at all, written nor verbal. The great thing was that I was contracting at a large healthcare system and was able to get my INR checked without incidence. I notified my physician via my patient portal. She called in the prescription to the local pharmacy which happens to be Warfarin. Luckily, Warfarin is on the $4 dollar list of prescriptions. I was able to pay for my prescription, crisis avoided.

Now for the horror, imagine if I was unemployed, no money, and symptomatic. What would be my recourse? What would be my next step? There are so many scenarios that strikes fear in my heart.  Understanding that there are some flaws with the Affordable Care Act, complete repeal without a replacement would be devastating to those in the same predicament. But instead of preaching doom and gloom, I have decided to try to shift the paradigm. There is accountability we, the patient consumer must acknowledge. We have become wimpy and passive when it comes to our own care. We complain about the having to pay a copay for care provided by physicians. We complain about high premiums. We complain about prescription copays and the overall cost of healthcare. Change is inevitable and at the risk of sounding like my childhood hero He-Man, we have the power.   The consumer patient can drive healthcare’s direction more effectively than any act of legislation. The old adage states, “He who holds the purse strings controls the world.” This is evident through witnessing the record breaking profits of health insurance companies. Unfortunately, because we view health insurance as our rich uncle as opposed to being crisis management, we are faced with financing our own risk. Think for a moment if we had car insurance that covered the maintenance of the car. Suppose they covered oil changes, air filters spark plugs etc. What do you think the risk would be? Can you imagine paying  a copay every time you received service on your car? As a consumer, you’re thinking yes! But this would jack up auto insurance premiums to ridiculous levels. We, as the patient consumer have to be accountable. We have to pay physicians what we owe them. The amount we pay in cell phones, cable bills and eating out could more than cover maintenance services. According to most primary care physicians, spending roughly $250 quarterly on routine check-ups, blood tests, x-rays, immunizations, eating healthy, and remaining compliant would significantly reduce chances of serious illness and reduce long term effects. Since we have chosen to allow Uncle Blue to cover our maintenance services, he can now tell you what kind of care you can receive and how often you can receive it under the guise of “Managed Care” and “Cost Containment.” It doesn’t matter that you’ve been going to Dr. Smith for twenty years and he knows all aspects of your life and health socially and emotionally, Uncle Blue calls the shots. Now, the relationship between the physician and patient is secondary, because both are at the mercy of the insurance company. Physicians are suffering because of the risk we’ve passed on to the insurance company. These are for profit companies with shareholders; of course profits are the goal. But until we accept some responsibility in the care we received and are willing to be financially responsible for the care we can reasonably be responsible for, things will not change. We have all heard the renderings of the power of consumer driven healthcare, now we need to change our thinking surrounding it. Regina Herzlinger, a Harvard Professor and Consumer Driven Healthcare advocate, wrote a very thought provoking book called, Who Killed Healthcare? She names four culprits, health insurers, hospitals, physicians and patients. We all have a hand in it and since we have the most at stake, we should be the most vocal and vigilant about making substantial and sustainable change. I suggest reading this book to get a strategic view on combating healthcare costs from the consumer standpoint.

I am not ignorant of the fact that there are far more serious and chronic conditions that require the government’s financial intervention, but for those of us, who can reasonably afford maintenance care, let’s take up the slack and pay our physicians. This would slow the rate of Physician office closures, and give physicians more bargaining power as it relates to Managed Care participation and Hospital affiliation. If we set aside few bucks per month in either a Health Care Spending account or basic savings account, before we know it, we are now in control of care and how often we received it. We, the patient consumer are the better authority for quality healthcare because the Key Performance Indicator is our own health and ability to thrive. When your back is up against the wall, you are more inclined to look to alternative but effective measures. Patients who are engaged and are co-facilitators of their care more likely to beat the odds and yield the best results. PreMed Medical is a company created to allow the patient consumer and the healthcare provider coordinate care on their own terms. By allowing patients to prepay for services and save up for more major services, patients are more empowered to spend their money how they see fit. It is a subscription based self-pay network that allows patients to select physicians based on the budget there have allotted for their care. Physicians can offer services knowing they have the guarantee of payment so the patient is the focus. Clinical trials are available for enrollment to further aid in cost absorption. While PreMed Medical is not solving all problems, it’s mission is to solve one, that is to put the intimacy of patient care back between the patient and physician. In conclusion, to avoid the horror of being uncovered, begin to institute a backup plan while you can so when you find yourself suddenly uncovered, the blow won’t be as bad.



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