Monday, October 12, 2009

Mayo Clinic Says, Sorry, Your Insurance Isn't Enough

What if the group of doctors you normally see suddenly say they aren't going to accept your insurance anymore for basic physician services? What if they say that to continue to receive primary care, you'll have to pay a $250 annual administration fee, plus "agree to make an appropriate number of visits each year, including physicals," ... and pay out of pocket for those visits, between $175-$400 ... for a total cost to you of about $1500/year?

Those costs would be in addition to your premiums, deductibles, and co-pays.

That just happened in Arizona, involving the much revered (even by Obama) Mayo Clinic, specifically its Family Medicine Practice in Glendale, AZ. The insurer in this case is the government's Medicare Program:
West Valley Mayo Clinic Nixes Medicare

According to Maggie Mahar, Mayo "is sending a message" ahead of the Senate Finance Committee's final vote on healthcare reform this Tuesday.

Mayo spokeswoman Shelly Plutowski:
"The message is that something has to change with the way we pay we pay for medical services in this country."
The something that has to change, from Mayo's perspective, is how little the government pays compared to what Mayo says it costs to provide care. It looks like Mayo's administrators don't like the idea of a government-run public option: they won't be able to negotiate with the government as they do right now with private insurers. Their message to the Senate: "Don't pass legislation with a public option."

It should be a scandal that 3000 people have to suffer (overnight find a doc who accepts Medicare) because Mayo wants to send a message.

This is basic primary care we're talking about, not specialty care. Mayo is saying they can't afford to provide basic care. They can only afford to provide expensive, high-tech specialty care.

Say your child has an earache, perhaps an ear infection. You plan to visit your primary doc. Your insurer says they will pay $x for that visit. Your doc says that isn't enough to cover his costs, he needs $z. So your doc decides not to treat your child unless you come up with $z.

If you can't afford $z, and your insurer says he can't afford $z, and the doc says he can't afford to treat without $z, then $z is too high. Or someone is not telling the truth.


ElDoubleVee said...

Oh the excuses they come up with to justify greed. Their plan is to go upscale and get rid of the riff-raff who have to rely on insurance.

Bix said...

The riff-raff. Most of America is riff-raff then.

Patients seems to have become cogs in a money wheel. And if they can't help turn the wheel, if they can't generate $, they're discarded.

Anrosh said...

saving the capitalism from the capitalist ?

Anonymous said...

I don't think this is a case of greed. Mayo Clinic has a long history of wrangling with the managed-care sector (private and public) to provide a higher standard of service, and that's why their name is synonymous with quality healthcare.

My issue with the public option is that it doesn't address the real problem in the healthcare industry: price competition. In no other market is there such an absurd variance in prices. The managed-care groups negotiate their own prices with doctors and hospitals, so to negotiate for the most money they can from the managed-care groups, doctors and hospitals set their retail prices exorbitantly high. Then the managed-care groups shoot back the invoice with a 50% cut and the deal is done.

If most routine care was cash-only, prices would drop significantly since there would be price competition, not to mention money saved on medical billing and correspondence with insurance companies. Managed-care inflates costs and creates a parasitic, bureaucratic nightmare.

Dennis said...

It didn't occur to me until I saw this article but perhaps that's why health care shouldn't be for profit.

We have purchased the world's most incredible Military to protect us.

Perhaps a fraction of those dollars could provide us with the world's most incredible "Medical Force" ...

Once we cut out ALL of the "Middlemen" (Like insurance companies), who each need their own 30+% Markup, we might be able to save lots of money.

And for those who say government is wasteful and always fails; I counter with the quality of our own Military.

If we spent 10% as much money trying to keep us alive as we spend trying to keep us from being attacked, we would be much further ahead as far as our "Quality of Life" is concerned.

But sadly, the corporations WILL prevail and you will Die if you don't comply ... because there's just no profit in you.

That is the attitude in 2009.

Let's change it in the next decade!

Bix said...

Those were some good points, Dennis. I liked the quality-of-life one. It seems to get short shrift in the healthcare discussions.

We are one of the wealthiest nations in the world. We can afford to provide basic health services to our citizens. What does it say that we choose not to?

"Let's change in the next decade!"

I second that.