Conscious Choice: Managed Scare and Mangled Care

March 2001 | Health Conscious

Managed Scare and Mangled Care

by Rebecca Ephraim, RD, CCN

Healers in complementary and alternative medicine (CAM) traditionally work in harmony with the mind and/or body’s natural healing forces. Unfortunately, approaches like acupuncture, homeopathy, naturopathy, massage, nutrition, and colonic therapies that yield results (whether or not Western science has said so) are mostly not covered by conventional-minded health insurance companies. For better or worse, practitioners of these and many other disciplines rely on the fact that patients wanting their help will pay out of their own pockets.

Surprisingly, at least a handful of allopathic physicians — you know, the ones with M.D. behind their names — are voluntarily joining the ranks of those who work without health insurance reimbursements for themselves and their patients. These M.D.s, most of whom are practicing integrative medicine (the combining of conventional and alternative health care) are fed up with what one doctor calls the "crippling" rules and regulations of health insurance companies. They’ve moved to a system of treating patients on their own terms and requesting cash payments. They’ve scaled-back their fees, eliminating the markup physicians build into their bills to collect for insurance.

Robert Rountree, M.D., a general practitioner in Boulder, Colorado, was an herbalist before he attended medical school. He combines conventional medicine with nutritional and herbal approaches. But under the rigors of health insurance plans, Dr. Rountree, like most doctors accepting insurance reimbursements, was restricted to seeing patients for a ten- to fifteen- minute visit and forced to follow a narrow set of treatment options. "The coverage is not based on what works," he says. "[Insurance] coverage is based on arbitrary decisions on what will be covered. I had a cancer patient, a guy with lymphoma. I found a nutritional substance that I gave to him intravenously and it helped. His lymphoma got better! Then I got a letter from his insurance agency that said‘we’ve decided this is not legitimate medical care so we’re denying medical coverage.’...So your coverage is not based on whether it works...because we already knew he responded to [the treatment.]"

Regularly stymied by such insurance "no-wins," Dr. Rountree decided about five years ago to abandon the traditional health insurance/HMO environment altogether. Two things have happened, he says. He uses whatever complementary approach he and his patients decide would be most effective and, in turn, his patients have taken more responsibility for their own health. "One of the most discouraging things about working with people in managed care was the sense that they would spend more money fixing their car than fixing their body. And I think we’ve gotten into this place where we’ve abdicated responsibility...saying,‘I’ll only do this if my insurance pays.’ Somehow that divorces [one] from being responsible for what happens to [his] health."

The immediate effect of Dr. Rountree’s move was that many of his older patients — the ones on Medicare, the federal health program for the elderly — stopped seeing him. The make-up of his integrative medicine practice changed as word got around that he doesn’t take insurance but specializes in complex cases of fibromyalgia, rheumatoid arthritis, chemical sensitivities, irritable mood syndromes (his term for manic-depressive disorder) — all of them illnesses with which conventional medicine (and insurance) has little success. He now spends forty-five to ninety minutes with each patient unraveling problems that took years to develop. "There’s no way you can deal with these [kinds of problems] in ten minutes."

Dr. Rountree charges $200 an hour (that’s $50 for fifteen minutes) which he says is about a third less than the fees of a typical family doctor in the Boulder area who sees insured patients. For many of us $200 is a big hit but he says that it’s the fairest fee he can muster when he factors in his malpractice insurance, medical supplies, and employee salaries.

Vern Cherewatenko, M.D., a family practitioner outside Seattle, has also dumped his contracts with the insurance companies that create "paperwork nightmares" and now charges his patients $190 an hour when they pay cash. He refers to the health insurance programs of managed care as "managed scare" and "mangled care." "Both the providers and the patients have been scared into the current system," he says. "The doctors feel if they don’t sign up with the insurance companies they’re not going to have a waiting room full of patients...and the patients are fearful that if they don’t have insurance...[they won’t be able] to take care of themselves if something major happens."

Dr. Cherewatenko, who practices integrative medicine, assures both patients and doctors that won’t happen. "In our own practice we were able to attract patients out of the woodwork who said‘I don’t mind paying cash today for my services as long as the services are reasonable and the charge is reasonable.’"

Based on that idea, Dr. Cherewatenko, has introduced a nationwide program called SimpleCare that lets patients, willing to pay cash, access health providers who are willing to reduce their rates by 30 to 50 percent for not having to deal with insurance reimbursements. This saves valuable time for health-care providers — time they can now spend with patients instead of doing paperwork. It saves money too — money that was once wasted on billing, coding, and administrative costs.

Both Cherewatenko and Rountree want us to reconsider our health insurance needs. Both believe that for most of us, the money we spend on health insurance should be put toward other ways of covering our medical expenses. They recommend purchasing catastrophic health insurance policies with high deductibles for those rare and expensive health crises (these policies have low premiums). The money we save on regular health insurance, they say, can be put in a medical savings account or a regular savings account for when we have to pay for the more ordinary expenses associated with our health.

This approach is a very workable one according to a 1996 study by the National Bureau of Economic Research which looked at 300,000 employees and their families who basically did just what the doctors are suggesting. In the final analysis, it turned out that about 90 percent of the group actually spent very little of the money that was specifically set aside to pay cash for medical treatment.

This is good news for those of us who want to pursue the services of health-care providers who specialize in the practice of true preventative medicine. We can see that we don’t have to necessarily settle for less. Take the money we usually spend on health insurance and put it toward not only the routine visits to the doctor but also the nutritional supplements and exercise and stress-management programs that support an optimal immune system. This approach would certainly make it easier for the estimated one-fifth of the U.S. population (mostly working class) that doesn’t carry health insurance to seek medical treatment.

If this is an idea you’d like to pursue, Dr. Rountree suggests pitching doctors with "I’ll pay cash if you give me a discount." Otherwise check out SimpleCare (www.simplecare.com) for the names of practitioners who have already committed to reduced rates for their patients making cash payments.

The doctors are the first to acknowledge that the fee-for-service movement they’re recommending is out of reach for the financially destitute. In light of this, Dr. Cherewatenko is working with other health providers to develop a partner program to SimpleCare that enables the poor to cover the cost of their health care by volunteering their own time to help others. Obviously, the health-care practitioners would be donating portions of their time as well. The plans are still coming together, but such thoughts of generosity and goodwill gush with positive energy. Let the healing begin!

Disclaimer: This column is for information only and no part of its contents should be construed as medical advice, diagnosis, recommendation or endorsement by Ms. Ephraim.

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