When your health insurer pays for breakfast, here’s what happens . . .

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Health insurance is complex. Eating out is easy—unless you were to involve your health insurance company.

If you hired a third party to pay your restaurant bill, you’d pay twice as much, wait 2 weeks for a table, and have 7 minutes to eat.

I shared my restaurant analogy on a LinkedIn discussion with health care executives, and got this response: “I’d like to ask the Doc if she pays cash for dining out or does she use a third party like MasterCard or Visa to pay the bill?”

I may use plastic, but a credit card is not an insurance plan that requires prior authorization for my burrito, checking a formulary to see if I can get a side of noodles, and—worst case scenario: a policy may have an exclusion for desserts in excess of 200 calories.

Don’t like the restaurant analogy? Here’s what happens when you use health insurance to cover your automobile.

Need an oil change? Jiffy Lube has a 10-day backlog until their administrative office can fax State Farm for approval. Flat tire? Soonest appointment at your in-network tire facility is next month. Out of fuel? You can’t stop at Shell or Exxon because Chevron is your preferred provider.

If this seems ludicrous, it is.

Insurance is for catastrophes, not daily care and maintenance. Car totaled? Call Geico. Fractured femur? Call Aetna. Or maybe Kaiser has the best deal. In the meantime, want to save 40% on routine care? Stop using health insurance for your hangnail.

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Pamela Wible, M.D., is a family physician who pioneered the first medical clinic designed by patients. Watch her TEDx talk on ideal medical care. Photos by Dr. Wible.

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8 comments on “When your health insurer pays for breakfast, here’s what happens . . .
  1. Hello sir,
    Thank you for your nice posting.Soonest appointment at your in-network tire facility is next month. Out of fuel? You can’t stop at Shell or Exxon because Chevron is your preferred provider.
    Thanks……

  2. Ann says:

    With the huge deductibles, if you don’t file everything with insurance they won’t accept that you spent that on your health and you end up paying it twice if something does go wrong. Damned if you do, damned if you don’t.

  3. Lisa says:

    I get gas at one gas station, the cheapest in town so I have a preferred provider for gasoline. A flat tire would be considered an emergency. Have the care towed to an ugent flat tire clinic. And an oil change would probably be considered preventative and covered at 100%.

    Seriously, while I don’t go to the doctor for minor things (daily care and maintenance) when I do go to the doctor I want the charges to apply to my deductible.

  4. Solo Specialty Practice Girl says:

    Who covers oil changes at 100%? No one really does! Though you may think you are “covered,” you are really paying several times what you ordinarily would pay for an oil change, because that cost is covered by inflating the cost of your car. That’s just business 101. I’mean shocked that you didn’t know that! When you are traveling you might gas up at your favorite station before you left, but what happens when you need gas while you are on the road? Thankfully, you’re not limited to in network gas stations, or you’don’t either be very limited in your travel destinations, or ‘don’t be in trouble! The same goes for emergency maintenance needs.
    Do you ever actually read your EOB’s, or are you one of these geniuses who tosses them unopened in the trash can? If you read them once and a while, and you have an average insurance plan, you might be surprised to discover that your co-payments can sometimes be higher than your actual charges. If you have a so called Cadillac plan you are still paying higher costs for “health care” than you would pay, if insurance was out of the picture entirely. Most doctors and hospitals will discount costs considerably to patients who don’t force them to use their staff members to jump through hoops for a pimple faced 19 year old claims processor who sits at a cubicle armed with a shiny new GED and a “cookbook” on the practice of medicine willing and able to argue with the doctor, him or herself that he knows more about a subspecialty that the doctor spent many long years studio and practicing. Think I’m exaggerating about the class processer? Stop by our office anytime for a hands on education! These people are starting to believe they’re demi gods and godesses. After all, wouldn’t you, if you had all of that power without having to complete an appropriate education or even have an appropriate level of motivation to do anything positive to help patients? Now, think about who benefits most from your hard earned health care devoted dollars. That would be third-party payer CEO who average several times higher salaries than the most talented cosmetic surgeons you can mention, and not one of them could successfully clean and dress a minor wound or treat a case of the flu, let alone perform life saving complicated procedures that you trust your doctor to either perform or know another doctor to whom he or she can successfully refer you. About that physician referral … your insurance company may not deem the best doctor to be qualified to perform your procedure, because they prefer the one who is willing to allow them to cut the cheapest deal for them. Keep drinking the Kool Aid, if you think these companies or even the Government cares about you and your loved ones. Very recently an obscenely paid health insurance executive was quoted on the record as saying “We’really not in the business of providing health care, but, rather of making money.” Yep! There you have it in a nutshell, folks! They’re not altruistic demi gods and godesses at all! They’re just way over paid, glorified bookies betting they can get more money from you than you would ordinarily need to spend on your care, and, now, thanks to recent legislation, they’really holding all of the marbles. May God have mercy on us all.

  5. Rab says:

    This is not exactly on topic, but years ago I spent 20-30 minutes trying to get authorization to see my schizophrenic patient again after about 5 appointments over some months. The insurance employee asked me why my patient wasn’t cured and why do I need to see her more than 5 times..? I was dumbfounded, but obviously the individual had no clue what schizophrenia is, which was perplexing considering she was responsible for authorizations … sigh. Try teaching a (possible) highschool graduate the intricacies of mental illness over the phone in a couple of minutes… Soon after I gave up private practise…

    • Pamela Wible MD says:

      That is the definition of insanity. Wow.Too bad you gave up private practice.

    • This implies that doctors are incompetent and wasteful of resources if they don’t cure the patient in a few sessions — singlehandedly, of course. And it’s what our culture has come to expect, supported by insurance codes that these claims processors go by. So ignorant, so arrogant, and so sad.

  6. Janice Michaud says:

    Dr. Wible,
    Thank you so much for your work!
    I have often thought that restaurants are such happy places because they lack the very things that medicine and insurance are saturated with.
    The workers have a shared interest that isn’t denied or subverted, while the customers fully know what they will get for their money.
    It has been increasingly true that as government becomes more and more the payer, we have more and more dehumanizing bureauCRAZY and less and less patient/doctor power.
    I loved your duck video, but you need the CMS duck a couple of GAGgles of government agencies.
    I am a former nurse, restaurant owner and now insurance broker.
    I am not a fan of centralized planning or control over the lives of others and I see a huge threat to our American culture that the stupidest people (politicians) have control over the smartest people (doctors). Too scary!
    Thanks for all you do…

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