I think that Josh Estelle, of the Pfenninger insurance agency, and Kim Cronk, of the County council, should be congratulated. They came up with an idea to increase the health care options for city and county employees while decreasing total health care costs.
The city and county are self-insured. In simplified terms, this means that the more health care expenses the employees incur, the more the city and county (i.e. the taxpayers) must pay. As the eighth and fifth largest employers respectively, this amounts to a large sum of money.
A significant expense involves emergency room visits. Unfortunately, after 5 p.m. (or earlier depending on the doctor) during the week and not at all on weekends, the employees' physicians are not available to see patients. So, while a medical problem may not be a life or limb threatening emergency, it may be a condition that could become one if not appropriately treated for 2 or 3 days.
After-hours or on weekends, phone advise from your doctor may be helpful, but it does not take the place of a hands-on evaluation from a physician. Previously, the employee's only option locally was to go the emergency room and have the city or county (i.e. taxpayer) pay a large bill or to come to the Spiceland Pike Medical Center.
The problem with the latter choice was the requirement to pay up front and the patient might not get reimbursed from their insurance company. Many people would rather wait for long periods in the emergency room for care that can be provided more efficiently and inexpensively in a doctor's office if it means no immediate expense and the co-pay for the E.R. visit will be about the same as the cost of an office visit. The taxpayer's cost however will be vastly different.
Mr. Estelle and Mr. Cronk were both aware, as are the regular readers of my compositions, that for a variety of reasons, I am loathe to join any health insurance plan. But, their idea addressed my concerns about charging different people different amounts for the same service, loss of autonomy in medical decision making and administrative hassles.
As of 4-15-07 the Spiceland Pike Medical Center now will see patients with city and county health insurance and charge only the co-pay at the time of service. My understanding is that the co-pay will be less than the employees have to pay at any other doctor's office.
This was made possible because I am allowed to keep my already low fee schedule intact and not have to arbitrarily provide a percent discount. My charges sans discount are lower than those "discounted" prices of other providers so the city and county save money.
Another key component was the elimination of my loss of medical decision making autonomy. I refer to specialists and for additional testing as I, and not some insurance pencil pusher, sees fit.
The last selling point to me was the lack of administrative hassles. I can bill the insurance company and receive reimbursement quickly and efficiently and can therefore keep my prices the same due to not incurring any additional overhead expense. My contract with the insurance company is one page. For comparison the one I was offered from another insurance company recently was over 40 pages and did not even include a fee schedule, as per the norm.
This agreement benefits all those involved. Patients have more options, the county and city (taxpayers) save money, the emergency department can devote its resources to true emergencies, and I have the opportunity to help more people while maintaining my ability to practice medicine without compromising my autonomy.
Of note, I do not know why other insurance companies do not do likewise. I suppose it's because they do not want the hassle of changing the status quo for a single doctor. It would be nice if those purchasing the policies were thought of first and provided with more choices as it would not cost the insurance companies any extra money.
I did offer this same proposition to the local hospital when I first opened. The administration at that time would not discuss this unless I joined their health network which I was not about to do. There is no good reason that the self-insured local county owned hospital, as the third largest employer in Henry County, shouldn't try and save taxpayer dollars by entering into a similar agreement with myself for the benefit of its employees and the taxpayers.
