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Finding a Good Doctor, Medical Care & Affordable Health Insurance: Is It Even Possible?

  • Written by  Jared Mayer
Bad Rx: Doctors with attitudes! Bad Rx: Doctors with attitudes!


So did you hear the joke about the guy who went to a doctor and ended up sicker than before? Well, it’s not really much of a joke, because finding good health insurance and getting quality care from doctors is harder than ever, especially if you live in America where there’s so much confusion about health care, insurance and medical treatment.

With health care reform and health insurance such a contentious part of the 2012 presidential campaign, it’s easy to forget that this is a very personal matter.

Here’s what happened when our health care system harmed me. And it isn’t just my story--it’s an example of what happens to thousands of other people too…

My health problems started with a serious injury that messed up my spinal cord.

Before you trust your doctor, read this…

MRIs and x-rays showed I needed specialist help, but my health insurance required me to go to a primary care/family practice doctor to get specialist referrals.

I finally found a primary care physician who was “in-network” for my health insurance. In-network means all I have to do is pay a $25 co-pay. I thought it would be easy to go there and get the doctor to write the referrals. I was wrong…

Health Care Scam #1:
Family Practice/Primary Care Physicians Act as Gatekeepers

What I hadn’t yet figured out is that a primary care/family practice physician is often a gatekeeper who blocks specialist referrals.

Health insurance companies encourage primary care physicians to ration specialist referrals, because specialists cost more.

It’s a way for the health insurance companies to make more profits, at your expense.

Some primary care/family practice doctors claim they can do the work of specialists, so they can bill you for services that only a specialist should perform.

 When I made the appointment, I told the doctor’s staff all I wanted was specialist referrals. They said no problem.

Health Care Scam #2: Primary Care Doctors Pretend to Be Specialists

During my appointment, the primary care doctor looked at the comprehensive medical reports I brought with me.

Anybody with a brain could see I needed specialist care, and every few minutes during the appointment I told the doctor that the only reason I was there was to get the referrals.

The doctor said he’d give them to me, but only if I took a “respiratory test.”

I told him nothing was wrong with my lungs. He said the test only took a few minutes and my insurance would pay for it. I didn’t agree to take the test, but at that moment, a tough-looking Russian woman came into the room with a machine, and told me I had to blow into a tube and then inhale some asthma medicine.

I’ve never had asthma in my life. I didn’t want asthma medicine.

The doctor came back in and said my lungs were fine.

“Sure they are, Doc” I replied, “and we both know there was no reason for that test; please just give me the specialist referrals I came for.”

Health Care Scam #3: Doctors Do Tests You Don’t Need

But the doctor said I had to come back for another appointment before he’d give the referrals.

When I asked why, he said my “skeptical, angry, non-obedient attitude” indicated I had a “mental illness” called “oppositional defiance disorder.”

I looked it up in the official manual of psychiatric disorders and found that psychiatrists believe that somebody who rebels against the system, especially if they’re young, has oppositional defiance disorder.

The alleged cure consists of psychiatric drugs that chemically lobotomize you.

The doctor said he was prescribing me three psychiatric drugs. I’ve never had any mental illness. I told him that I wouldn’t take the drugs, and I got up and left the room.

 On the way out of his office, I tried to pay my $25 co-pay.

The staffer refused to take it, saying there might be “extra billing.” I reminded her that the doctor was “in-network,” so there is no extra billing. She still refused to take my payment.

Two weeks later, I got an update from my insurance company. The doctor had billed them $675 for an appointment that took less than half an hour. Much of the bill was for the so-called “respiratory therapy.”

Two days later I got a bill from the doctor asking me for $289, the amount my health insurance company refused to pay him.

Health Care Scam #4:
Doctors Overbill Insurance & Try to Make You Pay the Difference

I called the health insurance company. They said the doctor billed for the same services twice, and that all I owed the doctor was my $25 co-pay, regardless.

I talked to the doctor’s staffer again; she insisted I had to pay whatever the insurance company didn’t pay.

“You signed financial paperwork at the time of your appointment,” she said. “You agreed to pay us for anything not covered by insurance.”

Then I got a call from a local pharmacy. They were charging me for the three psychiatric drug prescriptions I’d never picked up.

Turns out as soon as I’d left the doctor’s office he’d phoned the prescriptions in. My insurance had been charged for the drugs, they’d paid the pharmacy, and now the pharmacy wanted me to pay my prescription co-pay.

I remembered that as I sat in the primary care office waiting 45 minutes later than the appointment was scheduled for, I saw pharmaceutical salesman going in and out of his back office like they owned the place.

Turns out they did.


Health Care Scam #5:
Doctors, Pharmacists & Pharmaceutical Companies Want You Drugged

I called the pharmacist to complain about his store billing my insurance for pills I never picked up and never wanted. I was being asked to pay prescription co-pays for each set of pills, even though I’d never wanted the pills and had never picked them up from the drug store.

The pharmacist admitted the three psychiatric drugs had terrible side-effects.

But he also said: “If your doctor prescribes something, you better take it, or else.”

Or else what? I asked. He didn’t answer.

I called the corporate headquarters of the drug store where the pharmacist worked and asked why the pharmacist was charging me for drugs I did not want and had not picked up.

The corporate officer said that’s how it’s done nowadays, but since I didn’t pick up the drugs, eventually I would not be billed for them.

Today it’s three months since I went to that primary care visit and the doctor’s office is still trying to bill me for money I don’t owe.

Last time I talked to the office staffer, she said if I wanted to argue about the bill, I had to make an appointment to come in and see the doctor!

A week ago I went to another primary care doctor who looked at my medical records and immediately gave me the specialist referrals I asked for.

I told him what had happened with the previous doctor. He shook his head knowingly.

“Some doctors think of you as a cash cow, not a patient. They work for the pharmaceutical companies, not for your health,” he explained. “The whole system—from medical school to health insurance to the doctor’s office—is built around money, not patient care.”

How do you fight back?

  • • Don’t sign any contract or financial obligation form until you know exactly what you’re getting yourself into.
  • • Do things in writing. When you go to a doctor’s appointment, have a printed memo telling the doctor exactly why you came, and what you expect from the visit.
  • • Don’t rely on phone calls. Get it in writing. Correspond via email, or certified letter.
  • • Don’t let doctors talk you into taking pharmaceuticals unless you are fully informed about the risks and rewards, and have done your own research. Many doctors are pimps for pharmaceutical medicines.
  • • File complaints with regulatory agencies.
  • • Use online resources such as vitals.com to research doctor’s histories and comment on what they do.
  • • If a doctor is padding bills, overbilling and otherwise scamming, report it to the health insurance company, and to anybody else who can do something about it.

It’s sad that when we’re feeling sick, we may have to deal with health care insurers, pharmaceutical companies, and doctors are often more interested in money and power than they’re interested in healing us.

Obama and Romney talk about health care and health insurance, but they aren’t focused enough on ending doctor fraud, health insurance fraud and pharmaceutical industry control that corrupts our medical system and hurts people who are already hurting.

But now that you’ve read this article, you’ve got the tools to stand up for your rights as a patient, and at least have a chance of getting the medical care you need.

 Copyright © RosebudMag.com , 2012

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Last modified on Monday, 08 October 2012 20:26

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