Just a short while ago, a patient was signing in for her childrens’ appointment. Apparently, when the receptionist verified her insurance coverage, she found that the patient has a different primary care provider listed on her plan. This is not all that unusual except for the fact that this same scenario happened with this patient 5 times over the past several months. She never changed to a different PCP but rather her insurance carrier did it on her behalf. The insurance company representative told her that she needs to re-verify her PCP every 30 days or the system will automatically assign her one. And she has many kids so she needs to do it for each of them. Each phone call took 30-45 minutes. Today, there are just too many roadblocks in the healthcare system.
This is just one example of one of the many roadblocks I am seeing. What other roadblocks exist for receiving appropriate medical care?
- Prior authorizations: many tests and medications are no longer covered unless reviewed by an agent of the patient’s insurance company. This often takes a few days but I have also seen it take several weeks to get approval. During this time, a patient may be without a diagnosis or even a much-needed medication.
- Denials: These days, diagnostic tests are being increasingly denied. These decisions are not based on medical history or even an examination of a patient. It is strictly enforced by insurance company guidelines. These guidelines were devised with the purpose of cutting healthcare costs. But, not all patients conform to a specific guideline. These denials also protract finding the right diagnoses for many patients.
- Lack of access: This is a growing problem in our present healthcare system. When I refer a patient to a specialist, there is often a wait of weeks to be seen. Additionally, many primary care practices are so overwhelmed that they are no longer accepting new patients. And some practices no longer contract with insurance companies and take payments directly from patients only. All of these factors are making it more and more difficult for patients to receive needed medical care.
- Deductibles: With the passage of the ACA and the insurance exchange programs, many patients now carry plans that have huge deductibles. Some deductibles are so high that insurance companies will never pay a cent unless in a catastrophic situation. This presents a huge barrier for many patients: they simply cannot afford. Patients are being deselected out of the healthcare system based on their insurance coverage.
Patients are facing many roadblocks to receiving proper medical care these days. Patients are frustrated and so are doctors. Patients are trying to gain access to the medical care they need and doctors are struggling to provide. Unfortunately, third parties disrupted the doctor-patient relationship. Much of the system is now driven to control costs and place more of the burden of healthcare spending onto patients. While we do indeed need to address ballooning costs of healthcare, it is unfair to expect patients to bail-out the system.
Copyright secured by Digiprove © 2015 Linda Girgis, MD, FAAFP
