Insurance Hell

Okay.  Here it is.  This may be one of my most important posts yet.  Why?  you ask, (all three of you).  Because I am sick and tired of it and I am biding my time.  I will speak  the truth because I am fed up.  Done.  Then in a couple of  months I will feel the pressure to take this post and delete it.   So, share it with your friends and pass the link around because it will not last long…I will share with you the low down and dirty…

Sorry, I need to get political for just a little bit.  When President Obama insisted on the need for healthcare reform he showed himself to be hostile to doctors.  We are the enemy.  We put ourselves through minimum 11 years of education (4 years college, 4 years med school and minimum 3years training) at a heavy financial cost.  He wants to subjugate us and enslave us to his idea of what he thinks is right.  After all that debt and schooling, he wants us to do less for patients and see more patients (increase our volume) and decrease our charges; a consequence that would put us at increasing risk for lawsuits so that his buddies can sue us. Great.  Common sense tells you the quality will decline, to the quality of government cheese.  Then, when he stated as a fact that pediatricians make money taking children’s tonsils out, I was personally offended.  Why didn’t anyone stand up to him and defend us?  (I have to say only Rush Limbaugh did). He showed himself to be just another ignorant politician.   First, we are not surgeons.  We do not actually take a scapel and cut out the tissue.  This is a procedure.  You have to be trained to do this kind of thing.  Then you have be licensed for it.  Then you have to be insured for it.  If you are a renegade, you might just do it without all these pesky in between steps but that would put those 11 years and a quarter million in education at risk.  Doctors aren’t known to be risk takers.  Second, the government is all up in our business.  If I accepted money for referring my patients to a surgeon, that is illegal, that is called a kickback.  So, the nitwit lawyer does not even know what he is talking about (didn’t all his aides warn him?) In my area, all the ENTs are good decent people.  They are not friends.  I do not socialize with them.  We are not buddies.  I like that the relationships are professional.  They are easily severed if there is any hint of nonsense.  I refer and when I get feedback I then change my referral pattern or not.  Most often we refer, at least I do, to other doctors who are philosophically similar. 

The government sets rules for payments, after all it is the biggest of all payors.  MediCare.  How does this affect pediatricians?  The bean counters crunch their numbers and figure out what a disease is worth, essentially.  How difficult is a visit?  How much time was spent?  How much was done?  They set the payment for visits.  Insurance companies follow suit.  If the government pays 1 dollar, some insurances set their rate at between 70 -80 cents on the dollar.  The government is a big fat teat.  Many take succor from it.  There is fraud.  The government can audit.  If the i is not dotted or t’s cross, the documentation weak, then there is fraud.  Prosecution can lead to fines and imprisonment.  Insurances do the same – with the exception of the jail part.  I chose to not have the government involved in my business, I do not wish to suckle on the government teat.

Because they (govmt and insurance) generate volume and numbers, doctors offices should generate  patterns.  If you deviate from that pattern then something is fishy.  Everything is standardized and people are herded like cattle in numbers.  The problem is that is statistics.  Remember the bell curve?  Most of us fall smack dab in the middle.  We can take pills and injections, no problems.  The ones who get screwed up are the outliers.  Sorry guys, your bodies don’t act like everyone elses, but you are subjected to the same rules.  You know who you are.   You too are fed up with the system.  You are the ones who need the tailored medicine services of the traditional osteopath.

For pediatricians, those suckling on the govmt teat, to pass inspection you  need a $20K crash cart.  Once you pass inspection, then they will ship you vaccines for free (because they purchase it).  You hard working middle class people need to hear this.  Federal mandate states that all children regardless of economics should get vaccines for free.  So children walking into any free health clinic, no charge.  For insurers, they are mandated to cover vaccines in part.  So you might have a coinsurance.  If it doesn’t bother you because can afford it, no problem.  If finances are tight, you still have your share, tough luck.  Those whose offices, like mine, are private, we have to pay out of pocket for our vaccines first.  Yes, buy the vaccines first and store them in our refrigerator.   Then when we administer them, then we get to bill for them, to recoup the loss.  But the law allows the insurers 90 days to pay.  How do you like that?  You go to McDonald’s to buy a hamburger.  They make you pay right then and there.  Imagine that!  There are other issues and incentives that I should probably talk about, but it is too much for now…

Those of you who choose to use insurance, you get what you pay for.  Insurance pays for the orwellian double plus ungood CMS misthink.  It is okay if you fall within the statistical norm.  The Conventional Medical System is a biostatistical model.  To get that bell curve, you have to treat the population in mass numbers, like cattle.  Again, it is okay to think this way to cover the mass immigrant influx, to protect for the greater good and if it is all you can afford.  It is only when you fall outside of the norm, and I am beginning to suspect that those of you who do, number in the 20% of the population range; that is, of 300 million Americans, 240 million of you people can go to any board certified doctor in any area and can pretty much ignore us DOs.  That leaves 60 million who need us.  With only (high gross estimate) 5,000 DOs doing traditional osteopathic manipulative treatments, well, your odds of finding one of us is pretty slim…

What am I going to do about this insurance hell?  Ha.  I will be teaching soon.  Clinically.  I am going to teach new young doctors to be good DOs.  I will teach them not to bother with insurance.  I am getting good enough now that in this last month, patients who come to me, I have already figured out their mechanical strain and am able to deliver 90% results in less time.  I am excited for the next 30 years.  When I get busy, I will start to cut off insurances.  Ha.  The truth is those of us who are good enough to work hard to deliver results should not be constrained by nonsense.  I have heard of DOs who are so good, they just work out of their homes, treat for 15-20 minutes and charge $50.   That will be my longer term goal.  Go under the radar. Go underground.  Drop insurances.  Drop malpractice.  Just word of mouth.  Line up first come, first served.  Yahoo!  I look forward to my future liberation.

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