Does this sound familiar? You’re looking for a new doctor or specialist. Before you read the reviews, before you check if they are the best in their field, or even have availability, you make sure they are in network with your insurance. It’s like you must ask permission to find the best care possible for yourself. When it comes to our health, are we even in the driver’s seat or are we the passenger? Sometimes it can feel like we're not even in the vehicle at all. Many things are wrong with this process, but the problems stem from the same source... insurance companies are driving the car!
Do Insurance Companies Control Healthcare?
Traditional healthcare is broken. Medical offices are forced to prioritize quantity at the expense of quality. This often looks like booking four patients every fifteen minutes in primary care settings. Stretching physicians super thin, maximizing patient load, and limiting walk-in hours are the only ways some doctor’s offices can keep enough revenue to stay open.
Many factors have contributed to the loss of doctor’s financial relationship with patients in the last fifteen years. This loss meant the end of house calls, the need to add more patients, limited face-to-face time, and the end of physician-owned hospitals. Healthcare shifted from prevention of illness and injury to the business of managing the sick. This model of business is only good for insurance companies.
Legislature Supports Insurance Companies in Controlling Healthcare.
In 2021, the top five healthcare spenders on lobbying included Blue Cross Blue Shield and were among others in pharmaceutical research, like Pfizer. Politicians write legislation and vote medical governance into practice with no clinical expertise.
In an opinion piece published by The WallStreet Journal, Dr. Ronald Frank wrote, “Facing the pandemic, the medical profession took a back seat to the government task forces, which have made flagrant missteps. While physicians treated patients, the directions of care were outlined largely by the government. How can we possibly think government agencies would be more adept than the clinicians, the ‘foot soldiers’ in the field? Physicians have been disrespected—taken out of the equation and largely ignored or silenced in policy making.”
Healthcare mandates and CMS (government subsidized healthcare initiatives) have all but smothered private practice primary care.Individual doctors cannot provide the comprehensive, quality healthcare to the patients in their community because doing so, while accepting insurance as a primary payer, would create a financial strain.
Patients Learned to Accept the Unacceptable
The changes to healthcare, brought on by insurance companies, include:
· Herding patients in and out of appointments at record speed. Insurance determines how much a provider can receive per type of patient (preventative visits being the least amount). The low return means the doctor must see as many patients as humanly possible to maintain enough revenue just to keep the lights on.
· Referring individuals to specialists within the hospital system so the money stays “in-house.” Specialist, like dermatologists and podiatrists, make more money than primary care providers.Since primary care dollars are almost as limited as their time, PCPs are more likely to refer a patient to a specialist because of the lack of time available to dedicate to helping a patient themselves. Often, the doctor has the knowledge and experience to assist a patient with their problem, but hospital protocol and regulation keep them from treating the simple ailment themselves.This could mean higher copays for the individual, but absolutely means more money to the hospital system.
· Using express clinics housed in strip malls instead of seeing primary care. Family practice and internal medicine doctors are absolutely qualified to manage acute illness and injury. However, their daily patient load limits the number of walk-in hours an office can offer. Urgent cares also receive more money from insurance companies than normal primary care sick visits. Even though sick visits to primary care may yield more than well visits, long-standing scheduled visits for chronic conditions are more likely to result in referrals than a onetime visit for an ear infection.
· Long wait times in the office. If one patient takes even a little more time than the schedule allotted, all subsequent appointments for the day run late. Most offices require a patient to check in fifteen minutes prior to their appointment time, but they do not return this same courtesy. Waiting room times are often in excess of fifteen to twenty minutes past the original appointment time. This is more than an inconvenience.
· Longer wait times for non-urgent and specialist appointments. It can take months to see your doctor for something as simple as weight loss or chronic back pain. Delays in care because of referrals, insurance authorizations, and limited pool of providers to choose from can be catastrophic for a patient waiting for treatment.
The list goes on, and the umbrella of medical insurance has conditioned us to tolerate a complete lack of individualized and empathetic care. If only there was a solution to how insurance companies are controlling healthcare. Well, guess what.
There is an Alternative to Insurance Controlled Healthcare
Many primary care, family medicine and internal medicine, doctors are leaving the traditional healthcare setting to join their peers in membership-based, direct primary care offices. By removing insurance as the primary payment method, doctors can determine their own, much more focused, patient load. They can determine their own schedules, ensuring patients aren’t waiting a minute past their appointment time. They can even make house calls.If a treatment is honestly better managed by a specialist, they can provide a referral and it’s more than a piece of paper. The doctor can help identify, contact, and even schedule the appointment on behalf of the patient. This concierge approach to direct health management puts CARE back into healthcare.
Connected Health Believes You Deserve Better than the Traditional Insurance-Controlling Healthcare
Health insurance still plays a part in managing out-of-pocket costs of needed specialty providers, surgeries, emergencies, and hospital stays. However, it no longer needs to determine the quality of primary care you receive. Connected Health is Pittsburgh’s leading provider in direct concierge primary care. We believe in providing the extra care that goes into healthcare. Our doctors maintain a few hundred patients instead of a few thousand traditional primary care physicians mandated by insurance. They spend most of their time getting to know every patient, their personal health journey, and setting up a comprehensive, proactive plan for achieving those health goals.
There are almost no wait times, with many appointments scheduled within a week. Our medical team is available 24/7 via an internal communication system accessible to all patients. This means you can message your provider at 8pm on a Tuesday night or noon on Sunday and receive a response from someone you actually know (and knows you).
Direct Care is better care. Messaging, sick visits, regular visits, and checkups are all included in a monthly membership fee, no matter how often you use them. No more separate facility and doctor bills. No more surprise bills months after the visit.
If you are ready to leave the unacceptable, contact Connected Health today for a consultation.