Tag: health insurance

cold snow wood light

Honest to goodness

Joanne Dragun, M.D.

It’s not just a phrase it’s a means to an end. I have a very simple, straight- forward message today that can actually mean the difference between (not to overstate) devastation and healing.

The nurse is amazed that three new consults in a row on Friday all hail from the same Midwest state. A common regional trait is candor. Unfortunately the heat and humidity of Florida must have influenced the chemistry of this “natural state”. Known to be straight shooters I was surprised how circumspect each of them were. Xavier, Marsha and Terry push back on the offer for therapy. It is highly recommended and standard of care for their three types of cancer to be controlled. All sorts of ‘reasoning’ is in evidence: fear, friend told me radiation burns and will make me sick, don’t have time, it’s inconvenient (not like cancer is)! I am patient and in each encounter, after all the information is shared, I ask the same question: “What is the real issue”? They each seem to visibly breathe a sigh of relief. Their real desire is to be honest. They are stopped however, by embarrassment. They don’t want to bring money into the equation however, it is central to each issue.

Xavier has no insurance so has to pay out of pocket for extremely expensive care while not even working. Terry admits the gas to travel a distance is an issue and the 20% she will owe, not having a Medicare supplement, is prohibitive and Marsha works 12 hour days for the minimal insurance she has and will have to shorten hours and still have co pays.

Once I get to the bottom of this, for each one, we can set up financial counseling and even assistance. I can work around their schedules for timing and even limit the number of visits to cut cost.

Will other offices do this for you if you don’t speak up? No. Economics are everyone’s concern , but your health and well being is ours. Allow your docs and their practices to help when and however they can. Last week a friend’s daughter called. She has been turned down by hospitals and other offices because of her “poor” insurance. At least she has some. Her family intervened to get care but only after she has suffered and gone to the ER several times. The mental anguish is worse then the physical now. Hospitals receive substantial government subsidies and should accept all comers as we do in private practice. It is so difficult to hear, “No we don’t take your insurance!” Since I cannot change that dynamic I can at least provide guidance and support when possible.

Please be brave when faced with your own need for help. Be assured that you can receive the care and treatment you need, but it will take patience and effort. Be sure someone is on your team to help you navigate- they can work to set up the right appointments, sit on long insufferable holds and also demand help or at least the first available appointment. You need a champion or even a few.

What a tough time it is. You will soon be asked to consider your health insurance during enrollment period. I have written about this before. It is great that preexisting conditions cannot limit your choices, now as it did in the past. (If you have cancer you can still change insurers). We do not need free lunches. We need expensive chemo, surgery, radiation, scans and even hospitalization. That is what insurance is for. It’s not for the fender bender. It is the devastating crash and that is what cancer is. Get the best policy you can because the restraints are getting tighter and FOMO is real, even in cancer care.

Honesty requires the best policy for you to enjoy the benefits others are receiving. It is not for the rich it is for the wise, so don’t take this part of your budget for granted. You will be rewarded with calm assurance that you made good decisions for yourself and your family – even if they need to assist you with the cost. I tell you they would rather be part of your decisions then find you adrift and everyone heart sick due to poor coverage. Always be honest with those trying to help you. It is the best way to be armed for battle. It will in turn be a gift to your whole family that they can rest assured you did all that you could.

Shop wisely

Joanne Dragun, M.D.

Black Friday, Cyber everyday now. You are surely spending some time and money shopping this weekend. I am compelled to weigh in on the most important purchase you will make now for next year (my perspective) and its not a 72″ TV. You are being bombarded by advertising in mail and TV regarding open enrollment choices (yawn). We all need healthcare so this matters, please don’t ignore your most precious property.

 I refuse to subscribe to the Zeke-kill everyone over 75-Emmanuel concept that no one deserves healthcare over 75 (See The Atlantic, 2014). The “good doctor” is now on the Biden team and still subscribes to the concept and has written just recently, “Why I hope to die at 75”. Wonder what Nancy and Joe think- oh that’s right, they have fabulous coverage not available to us masses, so no need for them to regulate.

While the advertisments claim “you should get all you deserve”, trust me free rides is the least – you need mri’s, the most up to date chemo and radiation and surgical procedures and more! When I have to argue with an industry paid doc to allow for my state of the art radiation instead of using treatment machines that I literally threw away 12 years ago,  I just want to say, “YOU SELL OUT!!” While working, you contributed to medicare probably since you started at 16 and deserve care, not to have the drug and insurance stocks skyrocket by refusing that care. We are probably headed toward a British model: they have a two tier system: NHS delivers a basic level that the government  can afford to the masses, everything  else is self pay. With the cost of chemo, radiation and hospitalization, all that you saved in a few years by getting a bargain plan, is wiped out in one event- so shop wisely. Younger people with good genes may be served by the cheaper options. When you turn 65, your risk of major disease increases dramatically so then is not the time to opt for less.

Here is the inside scoop: primary care “gatekeepers” for these plans  are penalized by approving high cost treatments and insurers and medicare have hired third party companies to “triage” treatments- making docs like me defend our choices when we all know its about the money.

Try for a full service plan, or a PPO, and shop around. Check that your current medications are covered, but also look for plans that do not require a lot of “preauthorization”. Yes they cost more. Don’t let them fool you- you didn’t buy health insurance for an uber ride or exercise classes. You bought it to save your life.  You can live a long, productive and amazing life with access to the best healthcare in the world. Don’t cheat yourself. The cost of a good plan is never a luxury.

Many of you reading this perhaps do not realize the person next to you may get care that your plan doesn’t approve. Every week the medical oncologist will inform me that they can’t get a new drug approved so they will use something else instead. Medicare supplements are not uniform either. The “advantage” is to the government, not you. Government needs to provide some basic level of service to people- not the Cadillac version which can make a difference in your life and wellbeing.

We all know that without health, life is hard, so be good to yourself.  You and your family deserve it more than any other luxury- it is a necessity. I will always fight for you but I need you to have awareness and choose wisely too. Please take the time this week to do your homework with renewed insight so that you and your family can a happy and healthy new year. Thank you.