• Dr. Saru Bala

The Insurance Model

Updated: 5 days ago



The short answer: because I want to spend more than 5 minutes with YOU.

There are SO many flaws in our healthcare system, and this can turn into a pretty long rabbit hole, so if you want to see more of the details, see these articles from Medscape:

All doctors went to medical school for the same reason- to help their community. Sadly, the conventional model of healthcare doesn't always allow for the best care to happen.

For our $350k+ degree and years of education to be worth it, we need to be compensated for our time and our worth.

The insurance model is set up so that doctors only get paid a fraction of what they bill. For example, on average, a primary care doctor gets about $20-30 per visit from insurance companies (and an ND will only get back about 75% of what an MD would). On top of this, some scenarios require “pre-authorizations” from insurance companies. This is where your doctor essentially has to plead to provide adequate care, while the insurance company denies or approves a certain number of treatments (and mind you, the insurance people have less than zero medical training and are looking to save their money).


So, to make sure they can bill for the highest amount, doctors try to check off every box possible so they can bill a higher code. Which makes sense- if insurance reimburses sh*t, of course they're going to do whatever they can to bill higher.


If you're only getting a portion of what you're billing per visit, of course you're going to want to fit more people in your working hours, to make sure you can get paid enough (just to even pay off those student loans), right?


Where does that lead us? To an hour long visit at the doctors office, where you spend most of it with the nurse and the waiting room chair, and only 5-7 minutes with the actual doctor. Most of which is spent not getting any questions answered, and being handed a prescription, with no time spent on why you came in or why they’re choosing that treatment.


This is NOT the fault of the doctors. It's our healthcare system. So, many ND's have chosen to remove themselves from this horrible model of medicine, so that you, the patient, can get more attention, better care, and at the end of the day, we can still eat.


“But It’s Too Expensive to Pay Out of Pocket”

Is it though? How much are you paying to have your insurance, to get healthcare you're unhappy with? At least a few hundred dollars every month.


The average cost of health insurance for single coverage in America is $450, and for families, the average is about $1,200/month. Sure, some insurance plans give you an HSA and make it seem like you "get more," but you're paying to have the insurance that's giving you an HSA. Wouldn't you rather just use your money where you want it?


So here you are, paying hundreds every month to have insurance, that you're not getting great care with, and you're probably not using very often. When was the last time you went to your doctor? And the time before that? It's probably less than 2-3x/month, I can almost guarantee it. Unless you’re having an acute issue. OR, you are 60+ and have chronic health issues that diet/lifestyle just can’t fix at this point. If that's the case, then this post isn't for you.

A lot of the patients I get are women who were just put on birth control and didn't really want to be on it in the first place, but know that if they go back to their doctor, they'll just switch them to another one. So they're stuck in birth control limbo and just continue taking what they were given, since they don't have a better option.


Instead of paying those hundreds for your insurance, you can put it towards visits with an uninsured practitioner. Generally, follow-up visits with NDs cost anywhere from $150-250, depending on your doctor and the area you're in. That means you can see your ND every 2 weeks (maybe more) for the cost of your insurance, every month. And chances are, you most likely won't be seeing them that often, at least not on a regular basis.


If doctors do their jobs right, they'll never see their patients for too long. And that's our goal. As much as I love my patients, I don't want to see them forever!

Things You Pay a Lot of Money For and Don’t Think Twice About


Beauty services

Ladies, this one’s for you. How much do you spend on that haircut every few months? Unless you're going to great clips, you're probably spending close to $100, if not more! And what about a facial? Those usually start at around $100, so I know you're spending at least that. Whether it’s your eyelashes, your nails, or whatever, these things add up, and if they're a regular routine, just make note of exactly how much you spend on these things. Doctors go to school and into debt for a LONG time to be getting almost as much as an esthetician or hair dresser makes in the same time per person (in the insurance model).


Eating out

I know this one is annoying because it's on every business blog and post. And I'm definitely not saying you should give up date nights or friends nights to see your doctor. Community and having a social life are important. But just make note of how much you spend on one night out- easily close to $100, if you're having a couple cocktails with dinner and do something afterwards.


Amazon/Online Purchases

As much as I'd love to say I'm above shopping on Amazon, I'm not. Though, I will say the amount has drastically decreased since watching that episode of The Patriot Act. But seriously.. We all know that you get a package on your doorstep every too often with a purchase that wasn't totally necessary. But it was so easy to just browse, and click, so you bought it, and now you have 50 cardboard boxes stacked up next to your recycle bin. I may or may not be speaking from experience…


Therapists

We’re all fine with spending around $200 on a therapy session. It’s therapy, that’s just how it is! No one questions it, no one gets upset that their therapist isn’t taking insurance. It’s accepted and expected to spend that at a therapist’s office. We all feel it’s so worth addressing mental health, staying on top of anxiety, depression, or just having a therapist for general maintenance and well being. And it absolutely IS!

And don’t you just love the attention and care you feel from a therapist? You know why? Because they aren’t bound to the insurance model of care. When we remove the middle man who dictates how we practice, the care we receive (not so) surprisingly gets better!

Low Income Populations


You might be thinking, well what about those people who really can’t afford to pay doctors fees? This post is not regarding the low income population. Those individuals living in a food desert, living paycheck to paycheck, or trying to just pay rent are not the individuals targeted by this post.


Theoretically, the free cost of government healthcare is helping this population get access to medical care. But in reality, this group of individuals is mistreated in the healthcare system, disregarded, and marginalized. The quality of care they’re getting is very minimal, and the lack of resources for their care, the lack of patient education, and the lack of trust for providers, all play a large role in the system being against this population. This is a whole other issue that I will save for a later time.


Oftentimes, providers who don’t take insurance will usually offer a sliding scale, discounted, or even free visits for individuals of this population.


Long story short


In short, the American healthcare system sucks, to put it lightly. The doctors that are in it are doing the best they can, but for you as a patient, that's not always enough.


However, you can afford to do something about your health! You don't have to keep taking that prescription you never wanted, or keep feeling the way you feel. Your health should be something YOU ARE in charge of. Don't let the healthcare system speak for your body, your health, or your decisions!


Putting money into the insurance system only puts money back into the pockets of large corporations and the broken healthcare system.


Unless you’re having a major surgery or need hospitalization, insurance is not helping you get good medical care.


Put your money where you want it to go. Helping out a local business (aka your neighborhood ND), not only helps you get better care, but it helps them to help more people, like you. The money you give to your healthcare practitioner goes towards their overhead, supplies, conferences to learn more information, and resources to better help YOU. It ends up coming right back to you!


So what are you waiting for?



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