Yesterday, I saw yet another example of stupid insurance company tricks. This time, it was Tufts Health Plan. I used to think they were decent. Apparently, they will only pay for one routine visit per year. This is all fine and good if you're healthy.
In this case, my patient has diabetes. The guidelines for diabetes is that the patient should have quarterly visits with the primary care doctor. This allows me to adjust his medications appropriately and encourage him to double down on diet and exercise if his blood sugar is rising. Diabetic patients who attend their quarterly doctors' appointments tend to have fewer complications and ultimately cost the system less. So why would an insurance company want to discourage this behavior?
Because the current healthcare system (regarding this sort of issue, Robamney care is the same as our system has been for 60 years) is a game of musical chairs. Tufts Health Plan is gambling that by the time he has complications his employer will be contracted with a different insurance company, and that company will have to swallow the costs. Meanwhile, the patient swallows the costs of standard of care treatment. Just another example of how insurance companies don't save money for anyone but themselves.
Thanks, Demopublicans for locking this system more firmly into place! (And don't let Republican politicians off the hook. Despite their howling, Robamney care was conceived by the conservative Heritage Foundation and originally pushed by Republicans.) Incidentally, thanks also, AFL-CIO for coming up with employer-based health insurance 60 years ago. Other countries' labor movements had the foresight to hold out for better, more economical systems.