"Do you take my Insurance?" The Truth About Insurance

If you are a doctor of any kind you have heard this question. If you are not a doctor but have been to one, you have probably asked this question. But what does it really mean? What does the answer that follows it mean? These days the meaning is a lot different than it was about 20 years ago.

Take the average insurance plan that comes through my office on a daily basis. Patients either have high copays of over thirty dollars, or they have a super high deductible (usually between $1,500 and $3,000) before the insurance company will pick up any of the expense. Doctors must be making millions of dollars with figures like this right?! Not even close.

Let's not forget, insurance companies are a business. In the state of New York, insurance "covers" chiropractic care. Usually they set a cap for reimbursement for a patient visit. Speaking candidly that fee max averages at about $35. That's thirty five dollars, when you spell it out. If your copay is $30, the insurance company will send a check for the balance of $5. That's five dollars. Good thing you are covered huh? If you didn't spend $400 dollars or more in many cases a month your insurance company wouldn't pick up those extra $5 associated with each visit. You would have to get treatments at a rate of 80 times a month to reach your $400 monthly premium (which is on the low end by the way). This example of course is in the absence of deductibles.

Deductibles are the patient's responsibility (your responsibility) for out of pocket expense BEFORE the insurance company will start absorbing payment to your treating doctor. Let's use the average deductible of $2,000 for this example. If you have a $400 premium with a $2000 deductible, you are accepting that you will need almost $7000 worth of health care each year! Don't believe it? Add it up. $400 x 12 months = $4800. A $2000 deductible that you have to pay before the insurance company will take responsibility for chipping in plus the set $4800 is $6800 per year. Do you need that much health care? Without insurance a physical with your primary care can cost about $200. Expensive services like getting eye glasses made can cost as much as $500. An endoscopy and colonoscopy would run you about $800 to $1000. Of course there are situations like surgery where one visit would run your bill over the $10,000 mark, but if that is your concern you should be speaking with your insurance broker about catastrophic care and relying on yourself to pay other health care fees as they will be significantly less than your insurance costs annually in many cases.

This is not meant to be a sob story. I want you to understand how the insurance industry works. Patients struggle to find quality doctors who take their insurance. Doctors struggle to give you the care you deserve because they need patient volume to survive. It's a viscious cycle.

So what are the alternatives?

If you carry health insurance, of course it makes sense to ask if a doctor takes it before deciding whether to use the doctor's services or not. The doctor's answer however should not be the deciding factor in your decision. Consider your insurance first. Do you have a high deductible? Do you have a high copay? If you do it is likely that you will essentially be paying cash for your services regardless of the doctor you go to. When I have a patient come in with a $40 copay we know very well that the insurance company isnt sending us a penny to supplement the payment. The copay is really the entire pay. The insurance books and the insurance provider websites just become referral sources for doctors in many cases to recruit new cash patients. Are you a cash patient? If you have a high deductible or a high copay you probably are.

So the answer is simple. Find the best doctor and allow them to give you the best care available. A common rebuttle to this suggestion is "but Dr. Sean, your fees are a a little higher than my copay and I can't afford that." It's a fair statement. However, it is important to know what your payment is getting you. If one doctor is more expensive than another but he gets you well in half the time, over the course of treatment the fees might actually be less.

Health care has become a confusing game of finance. Fortunately common sense still prevails. Find the best doctor, and let them get you well regardless of what insurance plans they take or don't.