Tuesday, October 14, 2008

Open Enrollment Tip: Make Sure Your Doctor Can Still See You

A pair of articles in the Wall Street Journal and the Washington Post talk about and tips on saving money spent on health care and advice for open enrollment respectively.

I basically agree with all suggestions. WSJ's four tips include paying attention to open enrollment info at work (don't assume you will automatically keep your coverage by doing nothing), consider opting for higher co-pays and lower premiums if you don't see the doctor that often, signing up for a flexible spending account if offered, and inquiring about any company wellness incentives. The Post similarly suggests not to shop on premium alone and looking into wellness programs as well as figuring out your yearly out of pocket expenses, understanding your plan such as savings for in-network providers, and saving money by using mail order prescriptions.

However, one thing not mentioned in either story relates to changing insurances and still seeing your same doctor. The medical blogsphere (and even mainstream media) is filled with stories about how difficult it can be to find a primary care physician. One of the reasons is that many physicians, especially in metropolitan areas, have stopped taking some or all insurances. This is due to that fact that for some insurances the reimbursement rates are so low, physicians actually lose money by seeing patients in certain plans. As a physician in a university faculty practice that takes virtually all insurances, so many of my newer patients are from physicians just blocks away that simply stopped accepting these patients' insurances. Our division of General Internal Medicine has actually been closed to new patients for almost two years, simply because we don't have enough doctors to see all the patients we currently are responsible. (A closed university practice was once unthinkable and is a strong indicator of what a true primary crisis we currently have).

Before switching insurances, make sure your physician takes that insurance. Don't trust the information that the health insurance company hands out via your HR informational session. These paper copies are typically out of date. Call your physician's office business manager directly. Even if they currently accept the insurance, ask if they have any plans to drop it in the near future, as well as if they are currently accepting new patients on this insurance and if not, will they "grandfather" you in. When you sign up for a new insurance, you are considered a new patient. Though your doctor is legally obligated to continue your care, he or she is not legally obligated to accept your new insurance if they are closed to new patients. Though most physicians would unlikely "drop" current longstanding patients who switch to a cheaper insurance plan, it doesn't hurt to ask before you switch.

1 comment:

drivenwide said...

Set reasonable but strict limits of when you can be available and when you can’t. Never allow yourself to be manipulated. If you never give in to demands, your parent will learn that moaning and groaning doesn’t work and will eventually stop trying. If you give in to extreme begging, they will continue to push harder and harder, knowing that you will eventually cave in.