Coverage isn’t care - The Highland County Press
It might shock you to learn that the “cash” price for many medications at your local pharmacy is less than the co-pay if you are using your “coverage” to buy these same medications.
In other words, you are better off claiming to be uninsured when you buy certain pharmaceuticals. Why is this? Your “coverage” represents an additional, contracted layer – a toll booth – through which the exchange between you and the pharmacist must take place. This toll to pharmacy benefit companies/wholesalers is removed from the purchase if you represent yourself as uninsured. The presence of this middleman/distributor can and does increase the price of pharmaceuticals dramatically, representing as much as 50 percent of the purchase price for a large number of medications.
Waiving deductibles or co-pays for those short on funds lowers the barrier upon which the insurance carriers rely to protect their own corporate wallets. After all, a patient who cannot muster their deductible represents little or no financial risk to those providing the “coverage,” and the higher the deductible – or barrier to care, the greater the likelihood the “insurance” companies will pay nothing at all.
The courts have been no friend to those well-intentioned physicians and facilities that have waived deductibles/co-pays in an attempt to help their patients. Once again, if you have “coverage” and are low on funds, you should always ask the “cash” price for a service before revealing that you actually have “coverage.”
Fans of “universal coverage” should keep in mind the countless “covered” Canadians who buy their care in the U.S. or overseas due to long access lines. Canadian provinces balance their budgets by stringing patients out on long time lines, extracting a painful and merciless “time tax” from their citizenry.
Fans of “Medicare for all” should know that while violating a private “insurance” contract can be a hassle for their physician, violating the terms of a contract with Medicare is a crime.
Unless a physician has opted out of Medicare he is not at liberty to waive deductibles or co-pays or charge less than the amount Medicare allows. In short, Medicare has criminalized charity, as demonstrated in a recent case of a Medicare beneficiary with a broken ankle who is stuck in a wheelchair because she can’t come up with her $2,000 deductible.
Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Okla., owned by over 90 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.
Hi Dr. Smith, Thank you for providing clarity on the very misunderstood 'modus operandi' of insurance companies and pharmacies, not to mention the big chain hospitals that welcomes and contributes to the opaque nature of layered, inflated costs. This comment has been hidden due to low approval.