Uninsured Become De-doctored, Too

A friend and business associate who lives in Florida shared this story with me. It's eye-opening, frustrating, and raises bigger pictures about the value of one's life in America.

You may be in this position someday -- so please pay attention. And think about this as you hear discussions of healthcare reform and the presidential election.

Maryann owns a technology consulting business, and last year due to some severe family health problems, and some major travel, including a trip to China, Maryann's income was low enough that her family could no longer afford the health insurance she has carried for many years.

Since Maryann has young children, she looked into Florida's healthcare plan for children who are uninsured, called Florida KidCare -- and yes -- her family qualified.

She was very happy to find that the pediatrician who had cared for her kids to for 10 years was one of the doctors who accepted KidCare insurance. She found peace of mind knowing that her children would continue to get the excellent care they had been getting, even though she and her husband would go without coverage.

Earlier this year, her son got sick, so she made an appointment with the pediatrician. At the doctor's office, she was asked for confirmation that she still had the insurance she had in previous years, and no -- Maryann told the receptionist they had changed to KidCare -- and handed over her new insurance card.

"I'm sorry," the receptionist told her as she realized the new insurance was Florida KidCare. "We won't be able to accept your children as our patients."

What???

For 10 years Maryann has been taking her children to this same pediatrician, but now, since they are using the state program -- her children can no longer be seen by their lifelong doctor?

So where's the disconnect here? Let's take a look....

First, state-sponsored health insurance programs provide access, but not necessarily to the doctors you think they will. Most doctors will say they participate, but they often limit their participation. They simply can't afford to accept too many state program patients because the reimbursements are so low.

Explained another way -- doctors accept the insurance programs they know will reimburse them best for the work they do. In general, private insurance reimburses them at one, higher rate, while state and government programs reimburse them at lower rates. It would be like if your boss tells you that your paycheck for one hour will be more, or less, than your paycheck for another hour. It's not based on the work you do or how well you do it. It's arbitrary.

Then, in general, state-run programs reimburse at the lowest rates. Medicaid programs and SCHIP programs (like Florida KidCare) reimburse doctors at very low rates. If they were to accept too many patients at those lowest rates, they would not be able to keep their doors open and the lights on, much less provide the care patients need. It's not that doctors are being snobby or elitist. It's that they want to stay in business.

The bottom line is that participation in these programs guarantees access, but not necessarily access to your first choice of doctors or care. Access in general is absolutely necessary. Access to THE right doctor of your choosing is an extra -- and not necessarily funded by state programs.

And of course, that raises bigger questions -- why should a doctor get reimbursed at different rates? If a doctor cures a child on a state program, should she be paid any less than if she cures a child who is insured privately? That's exactly what happens now.

Is one life more valuable than the other? A system that reimburses at different rates -- the American healthcare system says yes -- one life IS more valuable than another. The better your insurance reimburses the doctor, the more valuable your life is.

What do you think? I invite you to share your comments about this in the Patient Empowerment Forum.
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