Being Pushed Around the American Healthcare System

I’ve recently decided to look into accepting insurance patients at my office.  The reason behind doing so was not due to financial gain, as you will soon find out.  My main reason for signing up with an insurance company as a provider was to be able to share acupuncture and Traditional Chinese Medicine (TCM) with more individuals. My goal is to allow more patient access to the benefits of Eastern medicine and widen the acupuncture demographic profile.  But, my foray into being an “in-network” provider may be short-lived.  Please, read on.

There are still many people in the United States that don’t know about alternative healthcare and are completely in the dark when it comes to anything outside of Western medicine – “American style”.  I’m not trying to make a blanket statement for this country, but much of the general American populous wants a quick fix for their aches and troubles, and are willing to invest little more than waiting in line at the pharmacy to fill a drug prescription.  But, the main reason acupuncture hasn’t hit mainstream, is due to the fact that it isn’t yet part of the mainstream American medical model.  Most people will visit the doctors on their health insurance plan.  Even though some plans will cover acupuncture, quite a few acupuncturists will not participate as medical providers.  At the same time, insurance plans are eager to tout that they cover complementary care, yet the fine print reads that coverage is available only for a select few medical techniques and procedures. Lastly, the insurance plans are usually written to be so confusing, that many of the covered persons do not even begin to understand what medical coverage they currently pay for.

All of the HMO (Health Maintenance Organization) patients that have walked into my clinic are “last resorters”.  These are patients that have gone from physician to physician (for years) and have seen no positive results, and sometimes negative results from their healthcare.  All of the HMO patients that I’ve talked with were on some form of medication.  All of them were on at least 3 medications per day.  One patient was on 10 daily medications to help manage her condition.  (And yet, there was still no relief from her pain…which is why she was sitting in my office.)  These last resorters have been essentially circulated through the system, paying their co-pays, filling out mounds of paperwork, and spending time with their physician(s) and specialist(s).  Finally, one of the physicians or specialists waves the white flag at the patient’s confounding problem and passes said patient to “alternative” medicine, such as acupuncture.  Voila!  That very disappointed, extremely frustrated patient walks in my door.  Many times, this patient, distraught that the Western medical community couldn’t help them, is now looking for an Eastern medical miracle.

So, in front of me is today’s prospective HMO patient.  I inform them that there is a boatload of paperwork that they need to fill out.  I also tell the patient that I am only allowed to treat certain conditions under their insurance plan.  I am limited by the insurance company as to what conditions I will get reimbursed for.  (To sum up, the conditions generally accepted by insurance companies are pain, pain, and pain.) Then, I get to tell the patient that their insurance company also dictates how I can treat them.  Meaning, the insurance company decides what treatments I, the medical practitioner, can perform.  (I still don’t understand how the insurance company can possibly know what medical treatments are best for the patient.)  Lastly, if I haven’t yet scared off my possible new HMO patient, I get to tell them that the insurance company will only pay for a few minutes of my time.  My fee is capped by the insurance company and I won’t be reimbursed for anything more than approximately 30 minutes of time.  Any time spent with the patient after that WILL NOT BE PAID.

From my perspective, becoming an in-network healthcare provider, I can expect to severely discount my going rate for insurance patients.  I get to be limited in the types of treatments I can do.  This can lessen the overall effectiveness of the treatments, which can make my acupuncture and all of Chinese medicine look ineffective.  (We all know that humans have a tendency to relay a bad experience to more people than a good experience.)  Lastly, I have to keep tons of paperwork on each patient, and have to play phone tag with the insurance company to get paid if my paperwork is incorrectly filled out.

HMO’s are still available, but as you probably already know, there are a lot of healthcare providers that won’t accept HMO’s.  Why?  Because, for them, it isn’t worth their time.  Why would anyone fill their clinic with patients paying a severely discounted rate rather than their full-price counterparts?  Also, you may see a lot of new practitioners in their respective medical field accepting HMO patients.  Why?  Because these doctors are trying to build a medical practice and there are a lot of people with HMO’s that need medical care.  For the rookie doctor, seeing that HMO patient will pay off at least a tiny amount of their looming student loan.  Here’s yet another thing to think about.  And this one should really be chewed on for some time.  If a medical doctor sees an HMO patient and knows that 30 minutes is all that the insurance company will reimburse them, the doctor may only have time to diagnose a problem and give the patient a prescription.  (Pharmaceutical companies have drugs for just about every disease known.  Heck, they’ve even created some disease conditions so that they could develop drugs to treat them!)  Now, the doctor becomes nothing more than a drug pusher.  They know that too much time spent with the patient can cause them to lose money and business.  The doctor becomes bound by the hands of his insurance company.

To make a long story short, insurance companies have ruined the healthcare system.  Taking large profits, charging exorbitant amounts for insurance coverage, the insurance company giants have the financial clout to control the medical industry.  So much so, that medical providers are forced to change the way they provide medical treatments in order to make a decent living.  Patients are required to jump through hoops just to get the proper care they need.  As a healthcare provider, I’m torn between making acupuncture accessible to more people by way of insurance, and restricting my acupuncture care to those that can afford the out-of-pocket expense.  (I have bills to pay too!)  It’s still a tough decision for my clinic to make, since becoming an insurance provider indirectly feeds fuel to the already out-of-control health system fire.  There’s no easy answer to our healthcare mess. But one thing is for sure.  In the current American healthcare system, it seems that insurance companies are winning, and the care providers and patients are losing.