Hi! This is Dr. Pamela Wible and welcome to “Insurance 101” where I’m going to explain my philosophy about health insurance. So let’s just use the rubber duckies as kind of a teaching tool here. So this is you, the doctor, and here’s the patient. And so you all are sitting in the room doing your office visit. Maybe the patient came in with an ingrown toenail or bronchitis or something. And so you’re having your little session and everything’s hunky-dory.
But you might kind of wonder why you feel like there’s so many other people in the room—other little ducks quacking at you. And here’s a group of little quacking ducks that might be passing by because in the average assembly-line medical clinic there’s five FTE staff per physician so, you know, here’s the coder, the biller, and all the people that you need to run that big assembly-line office. And you might feel like they’re kind of like traveling into your exam room with you. So now it’s no longer you and the patient. You’ve got like a bunch of quacking ducks in here.
And then you’ve got insurance companies, like these guys here are basically, look at this, like spitting on you, ya know. This one is spitting on your patient. And so the thing is if you feel like somebody is spitting and shitting on you it could be that you’ve got people in the room that really shouldn’t be there like maybe possibly insurance companies. Here’s another—maybe this is workers’ comp or something. There are some pretty massive insurance companies that could come right on through and disrupt what’s going on between you and your patient and have you filling out all sorts of the extra forms and paperwork that take like two, three, four times the amount of time that your office visit took.
And so I just want to encourage you to think clearly about what is best for you and for the patient. Is insurance serving you? I think for catastrophes, ya know, like lung transplants or things that are high ticket items obviously insurance may be necessary. But, ya know, for little ducky toenails and little ducky bronchitis is insurance necessary? So just give that some thought and in the next few videos I’ll share more about my philosophy on medical insurance.
Want to see more videos? Contact Dr. Wible here.
Pamela Wible, M.D., is a family physician and founder of the Ideal Medical Care Movement. She hosts physician retreats where she helps doctors and patients design ideal clinics and get back to healing. She is the author of Amazon’s #1 best selling Physician Suicide Letters—Answered and Pet Goats & Pap Smears. Please Contact Dr. Wible anytime. She returns calls from her bathtub perch above the Pacific Ocean. 🙂
I loved your Insurance 101-Bubble Bath video. Hilarious but SO ON TARGET! Keep up the good work you are doing ( especially with physician suicide, etc)
Thanks Robert! Just being real! Thank you for sharing & caring . . . means a lot. Really.
Delightful, Pamela. Who doesn’t like rubber duckies? Presenting from the bubble bath is a marvelous touch!
So right on!
(Love the bubble bath!)
That was so great. Looooove the scenery.
Very creative- keep up the tough conversations from the bathtub. I enjoy the humor.
Will do! Promise . . . more to come . ..
So cute and accurate. Thanks for being you and sharing. Love it.
Hi, Pamela I applaud you for breaking barriers in medicine.
Pamela, you know there are no simple things in medicine any more ! Now when businessman leads medicine everyone has to have a CT or MRI for broken nail, ha ha. What if something terrible is inside the nail ? Don’t want to take any chances. That is why we need INSURANCE. You do not actually expect people to be responsible and pay ? Oh no, everything needs to be approved, double checked and scrutinized. It does not matter that you the doctor just passed board exam for the 3rd time in your career. No, no. You the doctor must have your actions approved by a medical assistant. They need a job too.
You do not actually think that it is a good idea to pay few dollars for medication invented 60 yrs ago, cash. Oh no who needs cash anyway. We need credit. What if we loose the money on the way to the pharmacy. Who can save us then ? Nobody is going to be able to track our moves and “save us from ourselves.
With a stroke of a pen, medicine became “Animal Farm”.
I feel that boa constrictor of bureaucracy is squeezing us tighter and tighter every year.
Keep up your great work.
That is the plan. I’ve got 30 more videos coming your way!
Interesting backdrop does this place have a name?
Room 205 in my favorite hotel 🙂
Hilarious analogy, and also to-the-point. It is important to consider the cost and impact the insurance can have on patients, so definitely food for thought! 🙂
Increases cost of care by 40% for patients and drives docs out of practice in primary care. Unsustainable. Read this –> https://www.idealmedicalcare.org/blog/when-your-health-insurer-pays-for-breakfast-heres-what-happens/
Hilarious! You cut through the foam. Well, not too much!!
I enjoy reading you emails and posts. You are a true inspiration. Now I can look forward to your videos! You are right on target. Thank you for speaking out on behalf of health care providers.
Pamela, beautiful sea view!
I’m afraid these ducks you won’t be able to get in a row anymore.
In most “managed” healthcare systems, think US, Canada and NHS, the time has long past that it’s about the relationship between doctor and patient and what’s best for the patient.
They will claim that to be the case, but it’s not.
Medicine is now a business. Different models, but still just that.
Sad. Biological assembly line.
It’s been brutalized and dehumanized.
Can we put its soul back? Absolutely!
But, very few MDs are up for that struggle.
They battle from day to day to stay “alive.”
Thanks for the “ducky” lesson!
Pamela thank you for being the voice that we physicians are desperate for right now!! Keep up the good work.
p.s. what is keeping doctors from unionizing?
Divide-and-conquer tactics and fear.
A comment I received to post:
Didn’t have the courage to respond publicly to your great video.
I think the title that came to my mind was “Medicine is ‘ducked up’!” 😉
Some other ducks that were missing from your party:
The IT department
The office manager and the stop watches
The newly appointed and undertrained, freshly created job title person who has the unpleasant job of ‘bringing all the doctors into line’
The vendors selling your employer or your office staff improved mobile apps to bring action to the following buzzwords:
“network transition issues” (preventing patient leak outside of your network)
“Improving your static info” (designing better web pages and featured applications for your patients to interact on their phones with you)
“guarding your ‘brand’”
“protecting your revenue stream”
Also, there were no additional ducks present that should be in the room with the patient. The medical students who can learn from an engaged, well-trained colleague.
Most of the leaders in the industry state that they acknowledge the need to change. They also report that they are leading the changes in healthcare. However, most of the actual actions around patient change seem to revolve around protecting the status quo.
The industry is truly in disruptive chaos. While everyone is driving their wagons westward to take part in the next gold rush, there are some who remain focused on what we were called to do. Keep doing what you are doing. You are not alone, and your voice and the voices that you inspire continue to grow as well.
Are you familiar with the butterfly/patient analogy?
Health care companies, insurers, large health care organizations have been in the business of providing care to butterflies for some time. Initially, they erected large buildings to provide all of the care that the butterflies would need in one spot, so that they would not have to travel to multiple places to get their care. This worked well enough until fierce competition broke out and then then big medicine began outfitting their offices with ‘nets’ to capture more butterflies, so that they could control the market share. In my opinion, our healthcare dollars have been spent by big medicine developing bigger and better nets to collect more butterflies. Population health is another highly hyped net, tasked with the difficult expectation to ‘save medicine’. IBM just bought Truven Analytics for 2.6 billion dollars. Epic purchased Mayo Clinics patient data and then leases it back to them in a 46 million dollar deal.
My point is—there are only a finite number of butterflies in any given region. Instead of spending more money to keep all of our butterflies in our nets, why not create a better garden? Better gardens attract more butterflies. How much true population health could be accomplished with 2.6 billion dollars? Prevention, education, behavioral health services—services that are much needed, under or unreimbursed, but make for much happier, healthier butterflies?
I know that I could build a heck of a butterfly garden for $2.6 billion dollars. AND…..I’d even throw in a duck pond!!!
Take care, and continue your good work.
I’m a physician (a child/adolescent/adult psychiatrist) in Austin, TX. I’ve been following your blog (admittedly, lurking) & writing for awhile, now. I really appreciate your boldness in confronting all that is ill with managed care & defiling the doctor-patient relationship (& thus , health of doctor & patient alike!)
I know some may find your approach too challenging or “too bold”, but you have my full support. We must advocate for our patients and for ourselves, in the truest way. Sometimes that takes a bubble bath and some fightin words! 😉
Jacob Mays, DO
Thanks Jacob!! Appreciate your support. Maybe authenticity starts when we no longer fear being vulnerable and true to ourselves. You might like my response to this med student’s letter: https://www.idealmedicalcare.org/blog/what-do-modern-day-shamans-do/
Outstanding. I have eliminated all the quacking in my practice. I practice like you do. My patients love it. Thanks for sharing.
Also, single payer won’t solve everything…imagine no cost medical schools and no debts…imagine enough docs that no one had to work long insane hours to make a great living.
Imagine medicine as if human lives mattered!
Education should be free or subsidized (not with life-threatening debt).
Hate Insurance! Love You Pamela! Feel the same way. Just have to convince patients that insurance transparency is in their best interest. Especially with people with high deductibles who have to pay out of pocket until they meet the deductible. They really don’t understand. And there is an insidious nature on the back end with doctors and medical groups. They want to squeeze whatever they can get too! Happened to me. I experienced insurance and gouging at it’s worst. Because I know how coding and discounts work, I challenged the medical group when they charged me a level 4 visit for a medication refill. During the challenge, they told me they would not send another bill until it got resolved. In January, I get a collections notice from them. Bastards!Didn’t even try to resolve my concern.
Love your video!
Insurance is not all its “quacked” up to be!
Indeed a very clever demonstration of how “inappropriate” it is for insurance companies to be “peeping” ducks, to shit and spit on us.
good to see you happy and well, lecturing from your hot tub 🙂 wish I could beam over
whoa, this whole new chapter into I am not a robot is scary. I am not a robot. but who is?
You are hilarious!! You went through so much effort to get your point across
Yes. I went to several different toy stores looking for rubber ducks that would actually float well. I tried a bunch of bubble bath combos to get enough bubbles to cover my breasts. I have an entire series of these bathtub videos. Really fun.
When you’re up to your neck in Ducks,
And they don’t seem to give a…darn,
Persevere you must do,
The Patient’s counting on you,
Be a Doctor,
I love the article and spending over 30 years in the medical field find it is so true that the exam room, hospital room, procedure room or OR have become rather overcrowded with non-clinical people wanting to control healthcare. What many healthcare providers do not realize is there are relevant state and federal laws that protect the rights of patients and healthcare providers. Laws that continue to be disregarded by payers and some governmental agencies providing oversight. Laws that are shoveled under the rug, until the payers are addressed and held accountable. Payer compliance concerns related to claims handling processes that leave healthcare providers and patients financially distraught, while revenues and insurance CEO salaries continue to increase at astronomical rates.
As an appeal specialist (ie provider and patient advocate), and I deal with payor non-compliant claims handling issues on a daily basis. I started out many years ago as a medical assistant (a childhood dream) and in a short period of time moved into assisting with insurance claims. I was actually in the position of management when we experienced the implementation of “managed care”. In a short time the payer strategies moved from “managed care” to “cost containment” schemes to enhance their profitability. At a large medical conference where I presented laws that protect healthcare providers and their revenue, I explained that healthcare providers have strong rights that when exercised will protect against the abuse they are receiving from insurance companies. An anesthesiologist who was there said it best – “so we actually created our own monster by not standing up for the rights we have while the insurance companies continue to take full advantage of the fact that most healthcare providers are unaware of the laws that protect us.” Addressing the non-compliance of claims handling head-on for healthcare providers nationwide, I have found that once healthcare providers utilize their rights and take a stand against the swarm of surreptitious ducks, they swim to another destination. It merely takes educating yourself and your billing or revenue cycle staff about the relevant state and federal laws and protected rights that are in place to protect you and your revenue, and then take action and a stand to exercise those rights, strengthen your appeal process, and then you will see a difference as you watch the big ducks turn and swim to another destination leaving you with what you do best.
Yep. Docs gave their rights away and have been victims for too long. Please share any relevant links. Love to learn more.
I was so happy to just read this statement by you Dr. Dittrich. For years and years I wondered why the Physicians just kept laying down, basically and letting these bureaucrats run over them. Every year they pile it on the Physicians higher and deeper till there’s hardly time left to see a patient. As a patient you go into the physician’s office and they’re always so rushed, you feel like you’re in a restaurant where they grab your plate away from you before you finished eating. I think all Physicians need the band together stand up and tell these bureaucratic paper creating, rule making, money-hungry entities to go to hell.
Keep sticking up for patient rights.
Dr Wible, you’re a hoot. I love your simple down-to-earth style of talking and teaching and expressing your thoughts I think you’re amazing! As I said in another post I think doctors all need to band together and stand up for their rights and stop letting them keep pushing them in the corner by them I mean all of the bureaucratic people that have nothing else to do but create rules to make it harder to effectively serve a patient without pushing Physicians to the brink.
Keep up your excellent work!
Dr Wible I just had to tell you I absolutely LOVED your Insurance 101 from the Bubble Bath! Totally hilarious delivery, but soooooo true. People expect their insurance to cover every single thing they need medically, but that concept is a complete waste of money.
I tell people all the time, “You should insure the things you can’t afford to pay for.” Many of us will blow $100 on any given night going to dinner or hanging with friends. Why should we buy insurance to pay for day-to-day needs like office visits or prescriptions!? It’s like buying auto insurance to cover oil changes and tire rotations! It just doesn’t make good sense (or dollars) 😉
Great video. 🙂 Happy holidays to you.
Omg. Hilarious. Fuck yeah, Pamela.
Glad someone has my sense of humor 🙂
Pamela! This is so classic! No wonder if feels so mind-blowingly complicated to treat bronchitis. Hurry to bubble bath Duckie demonstrations!!