Vent about healthcare

anotherone, BSN, RN · Feb 28, 2012

I don't go to a FP or any other OB/GYN because mine is the one who kept me from cancer.
What isn't understood is that PREVENTION is the key to lowering healthcare costs. The truth is, at a $50 copay, women may not take care of themselves the way they should. Would it stop me? No, but it may stop the other single mother out there who could not imagine spending her minimum wage on her $50 specialized copay because she doesn't have enough money or her kid will go without. The how heavy is it on the system when cancer is discovered.
I feel it is discriminatory to women. And my family practitioner and many I know will not do OB/GYN exams.
It's not a complaint, it's a valid concern.
And please. I did not imply or say I am not thankful I don't have cancer. I have been through a lot with preventing it and am very thankful. SO thankful, that which is why I am passionate about regular gynecological care for a woman to not be considered a "specialty"

That is life. Many people have illnesses that if they could afford to see their family doctor would not have spiraled out of control leading to horrible pain and suffering before death. If they could see a dentist they wouldnt have to deal with having no teeth at the age of 35.Prevention isn't the same as early diagnosis. Not everyone has access to this or even necessities and never will. I actually expect this to worsen in this century to the point where only the very wealthy and upper middle class can afford health care as they will be paying out of pocket for everything.

anotherone, BSN, RN · Feb 28, 2012

I don't go to a FP or any other OB/GYN because mine is the one who kept me from cancer.
SO thankful, that which is why I am passionate about regular gynecological care for a woman to not be considered a "specialty"

Yes, you went to a specialist in GYN, one who your insurance charges specialist prices to see.

allnurses Guide · Feb 28, 2012

I'm going to get "offended" on behalf of the many fine FP docs I've worked with over the years. There is nothing slipshod or sub-par about their ability to perform routine paps/breast exams. Most of the women requested that as part of their annual PE. They are perfectly capable of referring more complicated issues to a specialist, it is part of their board certification.

wooh, BSN, RN · Feb 28, 2012

GYN is considered PCP with my insurance. Very grateful for that.

Esme12, ASN, BSN, RN · Feb 28, 2012

I don't go to a FP or any other OB/GYN because mine is the one who kept me from cancer.
What isn't understood is that PREVENTION is the key to lowering healthcare costs. The truth is, at a $50 copay, women may not take care of themselves the way they should. Would it stop me? No, but it may stop the other single mother out there who could not imagine spending her minimum wage on her $50 specialized copay because she doesn't have enough money or her kid will go without. The how heavy is it on the system when cancer is discovered.
I feel it is discriminatory to women. And my family practitioner and many I know will not do OB/GYN exams.
It's not a complaint, it's a valid concern.
And please. I did not imply or say I am not thankful I don't have cancer. I have been through a lot with preventing it and am very thankful. SO thankful, that which is why I am passionate about regular gynecological care for a woman to not be considered a "specialty"

I hear your passion but the fact remains that a pap smear doesn't require an OB/GYN and an OB/GYN receives extra schooling to "specialize" in obstetrics. The system is broke. I don't know the cure. What I do know is that now that I have a chronic, progressive, neuromuscular disease and multiple "specialists" that I don't receive the medical care I deserve because being now disabled and $50.00 a pop plus medications.....I have to budget my visits so I can afford to feed my children and afford the gas to get to the appointment.

OCRN...:hug:

I hope you are now well.

I NEVER dreamt, in my scariest nightmares, that as an educated professional I would be in the position I find myself now. S#*ks doesn't it?

Esme12, ASN, BSN, RN · Feb 28, 2012

The 2011 implementation of the preventative care piece of the Affordable Care Act means that insurance plans can no longer charge copays for annual well visits and generally accepted screening diagnostics like mammograms, colonoscopies for those age 50 and older, etc.
Your insurance company may be attempting to circumvent this by (newly?) defining OB/GYNs as specialists. Ten states have enacted legislation which formally allows patients to designate certain specialists (including OB/GYNs) as their PCPs. Check this list:
Managed Care State Laws

From the queen of links.....thanks!

NPinWCH · Feb 28, 2012

I'm an FNP in family practice with another FNP and 2 MDs. I provide annual well visits for women on a regular basis and have found early, and not so early cervical cancers and breast cancers. Myself and one of the MDs both do colposcopy as well. This is well within our scope of practice and often the patients get diagnosed and treated much quicker since the waiting lists for the specialist OB/GYNs is quite long.

It does not take a specialist to do a pap and breast exam and it does not mean you are getting poor or substandard care if you get this done by someone in primary care. Preventing cancer comes down to getting screened, period...

MomRN0913 · Feb 28, 2012

Dude, I'm, glad you got the extra $20 It is a principal. My office is out of network with Horizon BC BS of NJ (there it is) and they explained that they give them much trouble with reimbursement and what they will cover.

SO, yes, while while a $50 copay is big for me, I am even willing to pay out of network benefits, because I am very grateful to the doctor who prevented my cancer and delivered my high risk pregnancy safely. I only trust him.

It's the principal, it's not me being cheap.

It is something that needs attention and reform in my opinion. Sorry if you don't agree.

everwonder_y · Feb 28, 2012

Come August 2012 no co-pays for preventive care via the PPACA! I believe, this includes, cancer screenings, immunizations, flu-shots, contraception, etc.

http://www.kff.org/healthreform/upload/8219.pdf

Hurray!

brandy1017, ASN, RN · Feb 28, 2012

If you have private insurance they have to go by federal and state laws, but if you are self-insured by the employer that has an outside company administering it they only have to follow federal laws. I would read the plan summary of your insurance to find out the fine details, ie the loopholes they come up with to stick you with the bill.

You might have to pay for it as a specialist with a higher co pay. It shouldn't be, but what can you do. If the plan summary says otherwise and look at the wellness benefit, than you can fight them. Otherwise you probably don't have a choice. This is just the latest trap to stick us with higher bills, there have been so many over the years, it makes a person weary.

To those of you with perfect health and no need to see a doctor, consider yourselves very lucky and richer than the next poor person who has some chronic health problem. If you are unfortunate with a chronic health problem, consider yourselves poorer thanks to the hospitals that have just stuck you with the bill and basically are giving you a pay cut! I really don't know how families make it with all the deductibles, copays, out of pockets, etc, etc. It's just insane!

typoagain · Mar 1, 2012

go ahead and post the name of the insurance company.
we'll look up their financials and see how much money they made denying care.
http://www.nytimes.com/2011/05/14/business/14health.html
"the nation's major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among americans who are postponing or forgoing medical care"

it makes me sick to see people fall for this crap. an people fall for it every single day.

"record profits" does not mean that they are actually making more money.

the facility i work at is making more profit than it did when it opened 35 years ago. but it opened it doors by only spending 2 million dollars. right now it is worth well over 50 times that.

the question is what is the profit compared to monies invested! you can have "record profits" and have a lousy return on your investment. oil companies today are having "record profits", put the return on their investments are half of what they were back in the 1960s.

heck, cnas are making record high salaries. but that does not mean that they making a lot of money. you need to take into consideration the amount of money invested and the effects of inflation. do you think that the average rn would be willing to work for these "record high" wages?

chevyv, BSN, RN · Mar 1, 2012

Op, I get exactly what your saying and I agree! What the one thing that will have a pt considering when to see the physician? The amount of copay. I find myself waiting and taking care of everyone else and then paying the higher copay. It peeves me that a woman should pay more for a health check. It's not so much the money, it's the point.

I would think the insurance company would encourage women to see their gyns yearly so they can catch something early rather than deal with the enormous claims that could have possibly (not always) been prevented. How to encourage people to be proactive with wellness care is to make the deductable the same and then sell it!

We are all worth the extra amount in the copay, but it seems like another way to sock it to you because you have female organs. I wonder if a male pays more for a prostrate screen.......