The Health Care Insurance Crisis Hits Home

©2004, Elizabeth Fuller


When our son was born last year, we found a pediatric practice that we absolutely love -- they have a staff of great doctors (turns out Dr. Harvey Karp, author of "The Happiest Baby on the Block" and "The Happiest Toddler on the Block" books is one of them, though we didn't even know that for months after we started going there), they have wonderfully flexible appointment hours - including evenings and Saturdays, and they have the most incredible lactation consultant imaginable -- she literally saved our lives (or at least the life of our son) more than once in the first few months when we were having a string of major difficulties with breastfeeding.

I had fully intended on taking our son to this practice until he was way too old for a pediatrician and they had to kick him out.

But then yesterday, we got a letter from the doctors' office. It said that as of January 1, the practice will no longer accept health insurance of any kind - not HMOs, not PPOs, not anything - and that they are going back to a "traditional" payment system: all patients must pay them their full rates, in full, at the time services are rendered.

The letter went on to say that we could still choose to submit claims after the fact to our insurance company, and the insurance company would probably cover their services as an "out of network" provider. But that's hardly the same. First of all, insurance companies don't usually pay as much for the services of non-network providers as they do for doctors who are members of their network, so the reimbursements would be at a lower percentage of the total costs than they are now. Also, when doctors work through insurance companies, they must adhere to lower rates and rate caps that they negotiate specifically with each insurance carrier...which means they usually must accept less than their normal rate as payment in full. This does put a huge burden on the doctors/providers (which is why many, like ours, are now starting to opt out of the insurance game altogether), but it also helps patients by keeping costs down for them to some degree.

Under the new system, however, I'll have to pay the pediatricians' office their full rate, not a negotiated discount rate...and if my insurance company will reimburse for the services at all, it will be at a lower percentage rate than before. (And of course we'll still be paying the same insurance premiums as before, even though our share of the doctor bills goes way up and we'll have to pay them in full out of our own pockets). Which means that the cost burden for rapidly escalating health care services has just been shifted from the doctors (who were understandably upset about being forced to bear an unwieldy share of that burden) onto me and other parents who have chosen this practice for their kids. And this means that many of us - and probably my family - might have to switch from a fabulous care system to one we might not be so happy about.

Suffice it to say that today I'm furious. Not at the doctors -- I'm disappointed with their news, and very upset at what it means for our family, but I can certainly understand why they've decided to wash their hands of a system that frequently pays them only pennies on the dollars they need to make ends meet and make a living -- but at a nation and national government that has let our health care system get into such a mess.

One of the major arguments against national health insurance is that it would stifle freedom of choice...but if the current trend continues, and more and more doctors start opting out of the private insurance system, as ours have now done, it's quite obvious that health care choices will become increasingly limited for all but the wealthiest individuals. My husband and I chose these doctors and this medical practice to care for our son...but now we may be forced to move to providers that we consider to be of lesser quality, simply because we can't afford to pay for the doctors we've come to love and trust.

In the end, all I can say is this: whatever your feelings on this issue (and I haven't even mentioned spiraling insurance premiums, which are also squeezing consumers), be aware that the crisis in health care costs is very, very real...and if you haven't yet discovered just how real, you probably will soon, in a manner very similar to the rude awakening our family got yesterday.

For me, the time has finally come to start making a ruckus -- at the very least, to take a look at the positions this year's candidates for elective office hold on health care, and to be sure I vote for those I support. I also plan to hold the winners accountable for tackling the problem once they take office. The health of my family - and probably yours - depends on it.