I’m running a fever, making this two years in a row where I may very well not see any live music during SXSW because of the common cold. Right now, my ability to write is running kind of low. But I have to share this story with you:
“During my recent annual visit with a new gynecologist, I was shocked by the doctor’s response to my request that she screen me for STIs along with my annual Pap test. Although my gynecologist didn’t exactly dissuade me from getting screened, she warned against having it done during my annual visit. In her experience, insurance companies often refuse to pay for STI screening done during an annual exam; insanely enough, she finds that insurance companies are more likely to cover STI screening when the patient returns for a second pelvic exam.”
Yes, they’d rather pay twice for some reason. Why, I couldn’t tell you.
41 Responses to “Insurance companies make a whole lot of sense”
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Even within the past five years I’ve been encouraged to get an HIV test apart from my regular physical, simply because of the use of records. I’m not terribly worried about my results, so it’s been a sort of “whatever,” but I’m sure there’s some internal insurance agency stuff going on that I should be but am not aware of. They are pretty much the lowest of the low, willing to suck the last possible penny of profit out of any and all human suffering.
Maybe I should go back to seeing if I can find anyone to test anonymously, just so I give the leeches less information. (Knowing that even requesting a test is information that could potentially used against me.)
who tests annonymously? planned parenthood?
i wouldnt bethe least suprised if ins co.s somehow even obtained those.
also: with all the outsourcing to india etc that hospitals & ins co.s do, how do any medical records stay HIPPA safe anymore? seriously. their laws are not the same.
obtained those PP records, i meant. illegally; of course.
This is yet another reason why the US healthcare situation is fucked from as many different angles as you care to look. Testing for free and as often as you need it is a net social good, without shadow of question. Putting bizarre profit-based in/discentives (and, seriously, there are some things so complex you can’t tell the difference sometimes) in place has the result that less people get tested. How can that possibly be a good thing?
MA Jeff, have you tried the fenway community health center?
My guess is that insurance companies have found (they have all the records, after all) that people are more likely to have “extra” tests if they have a chance to get them covered during an annual checkup, where “extra” means something like “no obvious reason to think that you have the condition in question”. So they cut down on their costs at (their statisticians believe) a reasonable cost in undiagnosed illnesses.
Oh, and remember, an undiagnosed illness only affects the insurance company’s bottom line if it a) costs more to treat when it finally is diagnosed, and the patient is still insured by them, or b) gets passed on to someone else insured under one of their policies, who then seeks treatment. So in general they get to pass the costs onto others while retaining the benefits for themselves. True in any multiple-payer market.
It also helps that insurance companies that operate HMOs or PPOs don’t generally pay a whole lot to doctors for multiple visits — they pay a fixed fee per patient per year, with a small (or sometimes zero) increment for additional visits depending on copay and other factors. So they don’t really care if you go for two visits and pay two copays.
And finally, there are some tests (most STI ones not among them) where it’s actually a fairly good idea not to have the test unless you have some reason (event, age, symptom, whatever) to think that you have the disease. Because there will always be false positives, and those can be damned expensive for everyone concerned, in both money and anxiety. So although the insurors are probably being money-grubbing threats to public health in this case, they might not always be.
MA Jeff, have you tried the fenway community health center?
For several years. Physical in two weeks. It’s some of the Fenway folks who were talking about insurance, anonymous, or no.
For those not in the know, Fenway is basically a gay health center. They’re in the process of a major fundraising/building drive, after which they’ll be the largest free-standing LGBT org in the country, with specialized units in trans health, lesbian reproduction, etc. They’ve also served as a primary site of HIV/AIDS research.
However, although it tries to provide a variety of services related to sexual minorities and HIV/AIDS issues, its primary clientelle is gay men with insurance. A good thing, but also points to problems of health care accessibility.
One of the hardest things about potentially leaving Boston (in terms of jobs) is leaving Fenway. I like having a queer health clinic.
Let me add that, as a student going to a Catholic university, having a local queer clinic has been particularly important. I quite simply don’t trust health services at an institution where mentioning the use of condoms is barred. That’s not health care; it’s sadistic irresponsibility.
Paul, I think the beancounter logic goes like this: If you get tested under insurance company A, then they have to pay for the early treatment, which costs them money. But if they pass you off to company B, and you show symptoms, then B has to pay for it. Luckily, B can claim that it was a pre-existing condition that you should have been tested for before, so they don’t have to pay for it either. In other words, it’s not just pass-the-cost-along. It’s use that as a cover story to create a system to minimize costs and maximize profits for everyone.
for folks who might be interested:
http://www.fenwayhealth.org/
I think the idea is that, if you come to the doctor for screening outside of your annual physical, it’s for a medical reason, rather than just having it done because, what the hell, you’re there anyway.
If they force people to come back, some folks won’t come back, and the insurance company saves money.
I’m sure that they have a less evil-sounding reason for this, if you ask them.
bluebonnet, PP and probably your local STD/AIDS health clinic do anonymous testing. Because it’s wholly anonymous (the clinic doesn’t have a record of your name) it would be very difficult for your insurance company to find out about it.
Never underestimate the evil of which insurance companies are capable.
My doc told me that an HIV test is now standard and that requesting one is no longer suspect. I still refused even though I had the whole battery of tests for other STIs. Some county health departments as well as LGBT/HIV-focused health centers will test anonymously and that is the only way I will get tested. I do get tested despite being in a low-risk group, but I’m only comfortable doing so in a place that never asks my name and only assigns me a number which they call once they have the results. Then again, I’ll never be able to get insurance on my own anyway considering all of the health conditions I’ve had, but there’s no reason to give anyone an extra reason to deny me treatment.
bluebonnet, PP and probably your local STD/AIDS health clinic do anonymous testing. Because it’s wholly anonymous (the clinic doesn’t have a record of your name) it would be very difficult for your insurance company to find out about it.
It’s actually a state-by-state issue. In some states, anonymous is quite simply not available. Indeed, and my recollection may be off, there’s a move away from allowing anonymous in federal policy lately as well, but I can’t remember the specifics.
Would our epidemiology goddess, Ms. Kate, have a better idea than i?
Ahhhh, I was gonna ask (since I remembered you were in academia) why your school didn’t offer free anonymous testing like even mine in the center of central Pennsyltucky does.
Forgot the religion bit. Le sigh.
My insurance company wouldn’t cover it as part of an annual exam - like paul said, they want to see evidence of the symptoms that prompted you to want the test. But don’t the most common STIs frequently have no symptoms? Interestingly, when I went to my first pre-natal appointment, they paid for a full battery of tests - HIV/STIs, bunch of other stuff I don’t remember. I guess they’re willing to take the risk when it comes to adults, but premature babies with birth defects from undiagnosed STIs, requiring extensive medical intervention, and the cost benefit-analysis starts to look different for them.
This idiocy is not limited to reproductive health. My doctor was telling me the last time I was in that most insurance companies won’t cover a tetanus vaccine at an annual physical, so she tells people to come in when they cut themselves (even if it doesn’t actually need medical attention) so she can bill it as in response to the cut.
But we can’t have a single payer system! That would be inefficient!
Wankers.
Is this that “mandatory reporting” thing?
onejewishdyke, requesting a test isn’t necessarily suspect, but a false positive might be. I’d stick with anonymous testing.
I’m so old, I remember the insurance paying for whatever was medically necessary. I’d like to retrun to that before I am eligible for Medicare.
Yes, they’d rather pay twice for some reason. Why, I couldn’t tell you.
See, a big part of the problem is, insurance companies are corporations. Decisions are made for insurance copmpanies by employees whose long-term interests are not necessarily aligned with those of the company. Particularly in recent years, insurance company employees improve their own standing in the company’s internal politics by posturing like tough guys, even though the company’s long-term bottom line is adversely affected by such decisions. You see this a lot in litigation, where insurers are now much more willing to spend huge sums iof money defending claims, when it would make more sense ecobnomically to settle. I suspect niot paying for STD exams is attributable to similar internal dynamics, even if it leads to more and bigger claims in the long run.
Would be nice, but not likely, Mold. (I remember it, too- first hospital job had everything paid for automatically. I was so dumb I went to the HR dept and tried to argue my way out of “this FICA thing I hadn’t signed up for”…)
One thing about being married to my insurance agent and handling my own claims- whenever I’ve gotten this kind of bull, I just say I’m self-insured, get an itemized bill for all tests etc and pay all of the bill immediately. I later file the claim myself directly to the company and husband can check the progress of the claim.
It took awhile for the office to understand that there WAS NOT a rigamaroll and that they were getting-money-immediately-for-the-procedures-they-had-just-performed. Took a supervisor in the billing dept to come out and oversee the first time; it just doesn’t happen any more. Now they know they get a check that day, I take copies of all paperwork, and that’s IT on their end. It’s an extremely unusual circumstance, for sure…
And… the coffee isn’t hitting yet… the point…
It’s a damn shame that for the sake of ease for the patient that one couldn’t get as much done per visit as they would like; this makes no logical sense whatsoever. Not only a nuisance for the patient, but double work for the medical professionals and increased difficulty trying to shove more people into the office daily than required.
Why, can you imagine the lessened wait times ALONE? What a screwed up system this currently is.
But if one could OFFER to pay for all of the testing at time of service, I wonder if that would change their success in making it so. Good ole “money talks” theory.
I’m not shocked. I agree with paul; they figure that a lot of people just won’t bother returning to get tested, because maybe they don’t have symptoms or the symptoms go away.
I use student health, and they use anything that could at all potentially be symptomatic of an STI as an excuse to get you tested, which is definitely for the best.
Me, I’m just angry at my insurance company and at the place I just went for an eye exam, because my insurance company claims to pay for one eye exam a year. But apparently this place is some super-luxury eye exam because after paying a good chunk of change at the time, I now owe still another $129. This is after being promised that they’d cover the diagnostics done. And $129 is a hell of a lot to me, especially this month (long story involving being screwed out of a large chunk of the fees my grad school fellowship is supposed to cover).
I hate the way insurance works in this country, and I hate how I feel like I’m arguing with aliens from another universe because no one in any position of power dares even admit the existence of single payer.
We all hope that you get better, and at least here’s some live music for you — or as close as YouTube can deliver!
But the answer to your question,
is simple: they’re hoping you simply skip the second appointment (as a lot of people do), and then it doesn’t have to be paid for at all.
Dana, I totally agree. And I’m personally freaking out not about potentially having cancer, but how being tested in April will affect my ability to obtain health insurance in the future (I have student health care, until August). I know that will show up on my records.
It’s the same principle as having to pay a nominal fee for something that’s otherwise “free” (in terms of immediate out of pocket expenses), even though the fee is worth far less than the service they are getting. It reduces the number of people who will do it overall.
Although not related to health care, I use the same principle with some things related to my job. A company that wants to make a deal with us has to put up a $500 application fee. Now, you have to be aware that for the companies I deal with, $500 is not only a piddling amount, it’s lost in the noise of the money they’ll eventually have to be spending if we do sign a contract. Yet having that nominal fee reduces the number of applicants we get to those that are actually serious about wanting a deal.
We know through experience that the people unwilling to pay the $500, or who complain about it, aren’t going to be the people we do a deal with anyway.
Actually the insurance company protocols probably don’t allow for paying for routine screening during an annual exam - unless there is evidence of the need (signs/symptoms) - maybe not even on the follow up. There must be a R/O (rule out) diagnosis to approve payment for services. It is more likely bookkeeping than anything else.
Besides the insurance companies have contracts with specific labs sometimes to preform certain testing rather than your treating physician.
And, they kinda hope you’ll skip it because it most likely means another visit and another co-pay.
If you do happen to be well enough to actually see live music at SXSW this year - well, tonight - go see Be Your Own Pet at Mohawk Patio. Trust me.
Of course absurdities and inefficiencies like this occur ONLY in the competition-free environment of government-run health care. The PRIVATE industry never promotes policies that cost more money for worse care. Capitalism and competition take care of that. Only CANADIANS suffer through bureaucratic red tape to get medical care. Uh uh.
Jesus on a stick. Why would I trust an industry that spends 15% of its budget trying to figure out how best to not provide the service its been paid to provide?
Rebecca C., what kind of a goddamned communist are you? Don’t you believe in the Invisible Hand Of The Marketplace?
[/snark]
Seriously, my wingnut father claims there are tens-of-thousands of Canadians going to Mexico for the critical healthcare their cruel and thoughtless government refuses to provide them. And this proves that all government healthcare solutions are bad.
And he really believes this, and will defend this belief to the death.
I don’t know how he’s smuggling that wingnut Koolaid in, but he’s obviously still drinking it…
and yet, when you SHOW THEM an article on how Americans are going to Mexico for dental care they can’t afford in the US (New York Times last fall, methinks), they just say, “oh, you know, the biased liberal media just makes these articles up because they hate the South.”
boggle…
Hold it: the Canadians are going to Mexico instead of that rather more conveniently located country with The Best Health Care In The World Damnit?
Maybe they figure it’s safer to go down there than take the chance of being shipped off somewhere to be tortured…
Sadly the Health Crisis in America is a perfect example of the Right Wingnuts devotion to the ‘primacy of the market’ - the absolute linkage of life saving medical treatment to profitability is what has mad the entire system reach this point of impending collapse.
My favorite screed coming from Big Pharma is their advertising campaign in which they - with a straight face - argue that ‘allowing Medicare to negotiate for better drug prices under Part D would hurt elders’
Under the current scheme, Medicare Part D is prohibited BY LAW from negotiating for any lower prices on behalf of their many many millions of participants. This is about as logical as saying that everyone should buy grapes one at a time - yet the Bush Admin was able to weasel this provision into law.
The biggest problem with single payer or a socialized healthcare system in America is how to compensate the best surgeons and specialists…under our current system, they are accustomed to making hundreds of thousands…
I for one do not want a Cardiologist who is disgruntled with their pay cracking my chest.
But for Health Insurance companies the number one goal is profit - not patient care.
Sadly, he very well might.
Though you know you could have some fun with him if he’s beyond hope. “Hey Dad, did you know in Canada, the government pays for boob jobs? Your tax dollars at work, eh?”
Caroline - often they will pay if you complain about it. Some insurance companies take the approach that they’ll deny services the first time, and then approve them if you complain, because a lot of people won’t bother to complain.
(Mr. Mythago, who is one of the world’s mellowest people, once lost his cool with an Aetna representative he was calling and snapped “You know, it took me an hour and a half to get through to a human being. I think your company does this on purpose to discourage people from calling.” To his great shock, there was an embarassed pause and the Aetna rep quietly said “Yes….they do.”)
You also don’t want to get one on their dime. You are marked forever.
I asked my doc back when I was still dating and he told me to go to the local health department, don’t dress up, wear ratty jeans and a t-shirt and nasty shoes and they’ll do it for a donation. (Bring small bills.)
I’ve also been advised by other physicians on what tests to ask for and what ones to not ask for. Heck, I wanted a PSA done when I was 35 and the doc talked me out of it based on the idea that if I asked for one and they paid for it I would be raising flags in their systems that I was worried about it and that might mean that either I hid something or that I some how thought that I was susceptible to getting PCA.
He said that the slippery finger was the best thing until I hit 40 if I was concerned. I wasn’t worried, just curious. The insurance companies are always looking for ways to cut their loses and loses to them is having to pay for anything for us, the insured.
That is way any attempt to ‘fix’ the nations health care system that includes them in any way is not going to fix anything. Get them the hell out of the health care business and things will be a whole hell of a lot better! We need universal single payer health care in this country. Period!
There will be changes under universal health care.
No more 90 year olds getting cataract surgery and pacemakers.
No more drunks getting multiple livers.
No more ‘children’ the size of new born panda’s being kept alive.
There will be a second tier for getting what the universal system won’t supply but you will have to pay for it.
Is America ready for universal health care? I guess we’ll find out now that the insurance companies, drug companies and politicians have ruined what we currently have.
That’s kind of like how the wingnuts around here blame the “teacher’s unions” for the sorry state of education in South Carolina, despite the fact that state employees do not have the right to bargain collectively in SC.
If the facts don’t fit the ideology, change the facts.
The problem is that they have a tremendous amount of clout and can bury any type of reform by buying the airtime and lying to the American people.
That is what is so disappointing about both Obama’s and Clinton’s proposals. Their “universal health coverage” plans both are an attempt to use taxpayer money to buy the silence of the insurance companies while they try to make sure that everyone can see a doctor when they are sick. It’s reverse bribery.
It’s wasteful and inefficient and they both know it. However, they have all but admitted that the insurance lobby is too powerful for them to take on directly. It says a lot about the state of politics in this country how few people are even remotely outraged that a small number of people can make public policy dependent on their corporate profits.
However, this is ten times better than the Republican proposal. The Republicans want to open up healthcare to the free market. The problem is that for many people, the free market dictates that they are unprofitable and should not be covered. If you are young and healthy, the Republican plan is great. But if you have any sort of health problem, you will not be able to get coverage that you can afford.
Republicans talk about medical malpractice driving up the cost of health care, but this is simply not true. First of all, it is not easy to prove medical malpractice in court. Second, biliing/insurance overhead is a much larger part of the cost of health care than malpractice costs. Finally, in states where “malpractice reforms” have gone through, the savings have NOT been passed on to the doctors. The insurance companies have simply pocketed the difference.
If you really want to driver down the cost of health care, the first policy change would be to make it easier for health care professionals to pay off their education bills. Student loan forgiveness for doctors and nurses would mean that it would be easier for people to enter these professions. Along with this, we should also look at investing in building more medical schools. We should also increase government funding for medical research. Yes, drug companies do a lot of valuable research, but there is an inherent conflict of interest between the drug companies’ obligation to its shareholders to provide a profit and the public’s need for lifesaving medicine. (Would you look for a cure for cancer when your company made millions on a very profitable treatment?)
However, the most important thing for the American people to stop electing people to run the government that don’t believe that government can do anything right. The Republican meme of government incompetence becomes a self-fulfilling prophecy when Republicans are in charge of the government. Democratic administrations put a man on the moon in 9 years in the 1960’s. George W. Bush recently proposed to put a man on the moon in 13 years in the 21st century. Americans simply have lowered expectations.
Republicans like to talk about “personal responsibility.” Democrats have found little to counter this other than pointing out the hypocrisy of certain Republicans. What needs to happen is that we need to talk about a new era of “civic responsibility.” Conservatives understand “civic responsibility,” but only in the context of the military. Democrats need to challenge Americans to serve their country in all areas, not just in the armed services. JFK was right, we should “Ask not what your country can do for you, ask what you can do for your country.”
Ya know, MikeEss, I think your father may be onto something! Instead of making a huge wooden bunny and shoving it from Canada to Mexico, I think those sneaky neighbors to the north have figured out how to fit inside of big honking Canadian geese and fly south every fall…
I’ll throw rocks and take one down this spring, cut it open, and confirm my theory.
Those Canucks might be hiding inside giant geese, but the idea of a giant wooden rabbit sounds really interesting…
From ‘Monty Python and the Holy Grail”, of which the missus and I are fans:
http://www.intriguing.com/mp/_pictures/grail/large/HolyGrail066.jpg
The large wooden Trojan Rabbit!! To be followed by a large wooden badger…