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> If the healthcare I receive includes GP visits needed to get a referral to a specialist to satisfy my insurance co, or extra tests to convince them that a pro

by jmye 3y ago

> If the healthcare I receive includes GP visits needed to get a referral to a specialist to satisfy my insurance co, or extra tests to convince them that a procedure is necessary, is that "value" that I received? Do you think all of those tests are irrelevant? Who sent you to the specialist, if not your primary care provider? What do you think health care value actually is? It appears you don’t think it includes actual care or diagnosis.

buffington 3y ago
My primary care doctor has to consider what my insurance allows when providing me care, and that includes knowing what my insurance will allow for procedures that require a specialist. We talk about it all the time, and he hates it, because he knows I need to see the specialist for a specific procedure, but knows that without the test, I'll end up with the bill instead of the insurance company. Who should I trust more with my health? My doctor, or my insurance? In October of 2019 I needed a hip replacement. I had bone grinding into bone. You could literally hear it if you walked beside me. Imaging showed it clearly. My doctor, being a doctor, knew that the best course of treatment was to replace it with a prosthetic ball and socket, despite the risks (I will need two more in my life, if I live to average age). My insurance refused to pay for it, saying my age alone disqualified me (too young). It's 2024. I'm still fighting that insurance company. I'm totally healed, feel no pain, and can actually run as a hobby. My health as a result has drastically improved. Do you believe that health insurance companies provide value?
abeppu 3y ago
Given your particular medical history, preexisting conditions, including past GPs and specialists which your current insurance company may know nothing about, you may already know who you need to see. Re-convincing an insurer can be a waste of everyone's time, and can in some cases create greater net expense and delayed care. And GPs and other medical professionals have complained to me in the past that some test is not actually necessary, that they are confident in a diagnosis, but some additional test is necessary purely to convince the insurance company that they do in fact know what they know. I value diagnosis by the appropriate trusted medical professional. I do not value the opinion of my insurance company.

by jmye 3y ago

buffington 3y ago

My primary care doctor has to consider what my insurance allows when providing me care, and that includes knowing what my insurance will allow for procedures that require a specialist. We talk about it all the time, and he hates it, because he knows I need to see the specialist for a specific procedure, but knows that without the test, I'll end up with the bill instead of the insurance company. Who should I trust more with my health? My doctor, or my insurance? In October of 2019 I needed a hip replacement. I had bone grinding into bone. You could literally hear it if you walked beside me. Imaging showed it clearly. My doctor, being a doctor, knew that the best course of treatment was to replace it with a prosthetic ball and socket, despite the risks (I will need two more in my life, if I live to average age). My insurance refused to pay for it, saying my age alone disqualified me (too young). It's 2024. I'm still fighting that insurance company. I'm totally healed, feel no pain, and can actually run as a hobby. My health as a result has drastically improved. Do you believe that health insurance companies provide value?

abeppu 3y ago

Given your particular medical history, preexisting conditions, including past GPs and specialists which your current insurance company may know nothing about, you may already know who you need to see. Re-convincing an insurer can be a waste of everyone's time, and can in some cases create greater net expense and delayed care. And GPs and other medical professionals have complained to me in the past that some test is not actually necessary, that they are confident in a diagnosis, but some additional test is necessary purely to convince the insurance company that they do in fact know what they know. I value diagnosis by the appropriate trusted medical professional. I do not value the opinion of my insurance company.