Whew. It's been pretty busy - please excuse the anemic posting. I hope to have something good for you later this week. In the meantime, I can report that all my Christmas shopping is done (hallelujah) and nearly all my wrapping. I still haven't gotten lights on the tree though - it's sitting there naked.
The end-of-year surgical crush is upon us, so I am doing pre-operative physicals like crazy. Patients have met their deductibles and now want to get their surgeries done before the end of the year, when the clock resets and they have to pay all over again. Now that we have more managed care we don't see so much of that, but some patients' insurance plans still have deductibles, where you have to pay out a certain amount of money ($250 or $500) before the insurance coverage kicks in.
Managed care, meantime, is not without its issues; my elderly patients, many of them, have met their drug capitation for the year and are now subsisting either on samples, paying cash, or doing without their expensive but necessary meds until January. It never fails to amaze me how we manage to cobble together some sort of support for these people, at least most of them. Their generic drugs are covered, but brand-name drugs have a $2000 limit. (This is
Secure Horizons we're talking about, the only senior plan we take.) Next year it will get worse.
Pacificare (the parent company of Secure Horizons) thinks we're too expensive, due to the fact that our hospital contracts are with Cedars and Midway (a Tenet-owned hospital). They're right, we are too expensive. I will omit the long backstory and merely state that at Cedars, the cost for an outpatient surgery averages nearly twice the cost of an outpatient surgery anywhere else in town. So, to put the squeeze on the helpless elderly patients, they now will have to pay a $25 premium every month if they want to stay with us, plus
no brand name drugs will be covered - just generics. I think we're going to lose a lot of patients, some of whom have been with the group for ten years.
I will keep you updated on this situation as it develops. We have begun to refer to this particular company as "Insecure Horizons."
posted by Dr. Alice at #
