Contributor
So $12000 per annum premium....but don't forget about that pesky out-of-pocket/deductible.Originally Posted by Stan Calow
A lot of folks/families won't see that $12000 "used" until they've paid out of pocket , oh, I'm guessing at least $10,000.
Meaning they have to [potentially] spend $22K before the insurance pays out especially if no expensive medical need arises until the last month or two of the calendar year.
"What you see and what you hear depends a great deal on where you are standing.
It also depends on what sort of person you are.”
Contributor
We have a new healthcare plan choice at work. It costs less than our other option, but has no deductible. The trick is that you pay a co-pay for every visit. The co-pay varies among providers. It is strange how the co-pays are set. There can be a dozen family practice doctors at a clinic, but there might be a half dozen different co-pays depending on who you see. I expect the clinic gets the same payment for a family practice visit from the insurance company no matter which doctor I see.
An interesting thing is the co-pay covers all services during a visit. If I see my family doctor and need lab tests and x-rays during that visit the x-rays and lab tests are covered by the one co-pay. The same thing for an ER visit. I also pay a single co-pay for an ER visit no matter how many procedures, tests, and imaging I need while in the ER. It isn't really clear what happens if you need emergency surgery.
Contributor
Good advice. And as a physician, my advice to old people ( like me ) is to be aware that overmedicalization is a major problem today. Prednisone dose packs and antibiotics are handed out like candy. CT scans and MRI scans for back pain don't cure the back pain but do generate revenue. We are experiencing the medicalization of aging. Be an educated consumer. There are several resources that are helpful
Contributor
Isn't the reason for an MRI or CT scan of the back to see if there are structural issues that might require surgery or other intervention versus a simple muscular issue? I have lower back issues, but my issues are definitely muscular from lack of physical activity and lack of exercise. I am currently doing daily exercises to strengthen my lower backer and hip muscles.
Contributor
Back pain is VERY common. Most of us will be afflicted with back pain at one time or another in our life. Usually we cope, and it passes. When it does not pass, see your doctor. If there are warning signals that something serious is going on, they may order imaging. If they do not think something serious is going on, they will not order tests. Do not push them into testing. It can be useless or even harmful. Most back pain will resolve without surgery and findings on MRI scan frequently have no relationship to your pain. The information must be carefully reviewed and a treatment plan developed. I believe 20 years ago they had 10 MRI scanners in Canada, and 2,000 here. And yet the Canadians have no more back disability than we did. The most famous back surgeon Gordon Waddell MD stated the most common cause of low back disability is physicians. Stay active, stay strong during tough times, look at books for lay people by brilliant physicians who are dedicated to serving their patients ( and not big bucks ) like Dr Nortin Hadler ( Harvard trained ) and Dr Gilbert Welch ( author of Overdiagnosed: Making People Sick in the Pursuit of Health )
Contributor
I appreciate this warning to be attentive to overmedicalization. I had a long conversation about this with a medical director in the hospital where I worked. His position was that defensive medicine was influencing a large % of medication orders. In other words, if a physician were sued, failure to meet standard of care is often failure to order a medication or test, rarely (if ever) ordering too much.
So when a physician is under time pressure to see as a large daily caseload of patients, the safest path of legal risk management is to err to the side of over medicating and over testing. Works out very well for drug and diagnostic companies that the legal system helps drive volume.
We brought in a consultant to help design the formulary for our P&T committee. He was a decorated research Pharm D who lectured all over the country. His position was that the extent of drug interactions was always a wild variable. It's simply not possible to run trials on every combination of drugs and underlying medical conditions, so with each additional medication, the potential for interaction problems went up too, and exponentially at that. Another argument for limiting medications to only those that are absolutely necessary.
Last edited by Edwin Santos; 03-09-2023 at 4:02 PM.
Moderator
The overmedication thing is very real, especially for, um...more mature...patients who tend to see more providers for their healthcare, especially when they are picking and choosing their providers a la carté rather than being in a local 'system' with a primary care doctor "directing traffic". Medicare patients, for example. I actually caught and issue around this with my mother when she was still alive. This kind of situation is ripe for both incompatibilities as well as larger doses of certain compounds that might be an ingredient in something else. That can be anything between uncomfortable all the way to deadly. Professor Dr. SWMBO and I are fortunate in this respect that we've been working with a primary practice that's associated with the local hospital system and most specialists we see are also associated. That means they all are looking at the same medical records, regardless of their particular practice and reduces the chance of issues with medication incompatibilities or amounts in excess of need. We intend to continue working with these same folks as The Professor transitions into retirement this year, regardless of our insurance coverage elections outside of not choosing anything that would preclude using the provider group, without going into details since they are not determined yet.
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The most expensive tool is the one you buy "cheaply" and often...
Contributor
The claim is that something like 25% of the medical employes are just involved with insurance. A doctors office will have one or two employees whose only job is figuring out how to bill the insurance companies and for what.
Years ago I read of one insurance company who decided to no longer require prior authorization for patients to see specialists or take special tests. They found the cost of multiple visits to get the pre authorizations cost more then the money saved by denying some few cases. I would suppose less costly treatments if diagnosed sooner.
Bill D.
Moderator
Bill, that's one reason so many smaller medical practices have sold out to large firms and became "employees" of the same...not having to deal with the insurance processing anymore and just taking a salary. This is not just individual physicians, but whole practices with multiple MDs, DOs, PAs, NPs, etc. The folks at the desk only handle appointments and insuring that the proper insurance information is in the computer. All the processing is dealt with by the larger multiple practice owner.
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The most expensive tool is the one you buy "cheaply" and often...
Contributor
On January 30, 2023 the Journal of the American Medical Association published an opinion piece titled "The Existential Threat of Greed in US Health Care" which makes the claim that financial self-interest in US health care is becoming a stranglehold, with "dangerous and pervasive consequences".
Contributor
Very true.
Contributor
Wow, the more I read the posts in this thread, the more I appreciate our Canadian universal health care system despite all its faults.
Member
And, if we were starting from scratch in designing a health care system that provides equal access to quality health care services in the US, is the current system what we would strive for? Not by a long shot.
Contributor
Exactly. Doctors and other medical professionals are so scared of getting sued for missing some illness/condition that they order all sorts of diagnostic tests just in case. Patients are not helping here either. Patients often want diagnostic tests because it feels like something is being done to help them. Patients with medical insurance don't care about the cost of the tests because it costs them little or nothing at the time of the tests. Never mind that it drives up the cost of their health insurance.
Contributor
If we could use money from a retirement account without penalty for medical expenses or dental would be nice.
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