I would like to respond to Dr. Jacob's
statement, "Will people postpone necessary
medical care because of high deductibles? The
answer is no; for the most part, people will
continue to see real doctors for real problems.
Will they postpone paying for you to cut their
toenails, trim calluses, do laser fungus
treatment, pay $600-$800 for an orthotic, buy in-
office dispensed lotions and potions, or pursue
other unproven therapies like low intensity
laser, US-guided injections, FAST heel pain
treatment? You betcha.
The purposes of deductibles and co-pays are two
fold. First as anyone who has PPO health
insurance coverage is aware and any doctor in
private practice has learned, these higher
deductibles act as a strong financial barrier
and disincentive for the paying patient to seek
the "necessary" medical care sooner. Second, the
higher co-pays and co-insurance cost shifting to
the patient not only puts added financial
pressure on the patient and should make them
more involved in the finances of their own
health care (as it is intended) but also
interferes with the doctor patient relationship
by placing the pressures of reducing then the
out-of- pocket costs ahead of acceptable
treatment plans and protocols.
As an example, acceptable heel pain or plantar
wart treatment options are many. I contend that
the treatment decision should be made not based
on a patients high deductible and high co-pay or
what is or isn't covered, but rather it should
be decided on what is best for each individual
patient regardless of their insurance.
I often see patients who have been postponing
their care due to financial reasons. When they
finally come in, they have expectations that
often are not realistic. As an example, patients
with chronic heel pain and other like conditions
that we treat often hope for a miracle on 1
visit, thinking something like a single
treatment approach, such as a cortisone shot
will cure their condition. It becomes incumbent
on the doctor to explain to the patient that
there likely is no quick cure or single
treatment approach. The same is often true for
another condition we all see and treat, warts.
Interestingly, I have found, unlike Dr. Jacobs'
second statement, that pateints will pay out of
their own pockets for nail care and callus
trimming, when you explain to them that it does
not fall under medicare or some other insurance
guidelines, and they will pay for non-insurance
covered orthotics when the doctor takes the time
to explain why the custom orthotics are not
only "indicated", but necessary and not covered
by their insurance.
People will pay for what they need or want. It
is called prioritizing and we all do it every
day. If you are in private practice, you better
get used to this and learn how to educate your
patients or you will not survive.
Keith L. Gurnick, DPM, Los Angeles, CA,
keithgrnk@aol.com
