A Broken System: Part 2

As I’ve stated before, our current health care system is a Disease Management system. We manage symptoms and diseases. We don’t care for people. Patients are paying into insurance plans who deny coverage or require red tape and hoops upon hoops to get coverage for things which should be routine. You need to have symptoms to get a test. But sometimes those tests can pick up on issues BEFORE becoming symptoms and actually save money through preventative care. And, sometimes those tests will pick up on normal changes which are then treated as abnormal, but never resolve the patient’s issues.

This is where the clinician comes in— a provider who takes the time to discern what tests are (or aren’t) necessary, and which ones will likely result in distraction or static. Except currently, the clinician becomes hindered by someone states (or countries away) sitting at a computer, running an algorithm to determine what that provider should or should not recommend… and usually it’s someone with little to no clinical experience or education in medicine.

PT is often one of the specialties which take the biggest hit. You might be “allotted” 20 or 30 visits on your plan… but subject to approval. Although trust me- most of those plans will find any small reason possible to deny authorization before reaching the limit on your plan allotment. Sometimes the business will get a denial of services months after— this is when a choice is made to send you a bill (often the case) or write off the profits (no corporate wants to do this, trust me).

Out of the ashes of broken system comes a chance of rebirth and to start fresh— Like a Phoenix. Many providers like me are going BACK. Back to when the patient and the provider directly interacted. Before insurances. Before the government got involved. The provider takes care of the patient first. Payments used to be made either in cash, or sometimes via bartering. Maybe the patient didn’t have money, but they had a skill they could offer the provider in return.

It’s hard to run a business purely on bartering; but not going to lie, I have done some of this! However, I have tried hard to keep my rates as affordable as possible and still ensure I can make a living which covers my needs and allows me to look towards the future; Both in the growth of R&R, but also my personal/family future needs as well.

Lets go back to some of the data from last blog: The average personal insurance premium costs are over $8,000/year with a family of 4 costing just under $24,000/year (2023 data). This is a 47% increase in premiums since 2013 when the largest government subsidized program was launched. Remember, these premiums are costs BEFORE deductibles, co-pays, co-insurances, etc. How long do you have to wait for appointments? How many appointments with a provider (or office/specialty) does it take to get to a treatment? Is that treatment a solution for a cause, or a bandaid to cover symptoms? Does that treatment restore quality of life? How much does that treatment cost you (number of copays, amount of co-insurance, etc). Now, thinking bigger… How much does your insurance actually cost you???

Consider this: While the upfront costs may seem more per visit, what if in just 4 personalized visits you have superior outcomes than 12 at the mill clinic down the street? How much life has been restored and how much time saved? How much money have you saved in co-pays, time off work, gas, etc? What if your current wait of weeks or months for a Physical Therapy appointment could instead be one tomorrow, and you could contact your provider at any time between visits with no additional visit charge?

Did you know there are also alternatives that exist vs current “health” insurances (at least here in the US)? Health sharing programs have been around for over 30 years. They are often a fraction of the cost monthly, and come with added benefits such as negotiating rates or assisting in finding providers in your area who offer affordable out of network rates. Most have caps on how much you will pay for any event, so you know up front how much it might cost you should a medical need occur. There can also be reimbursement allotments to cover annual primary care visits/wellness checks. Many will also recognize you as a person— maybe with a birthday gift or other simple gestures! When was the last time your insurance sent you a gift — that wasn’t a bill? Health shares mean you can have medical coverage, but it’s not insurance. Trust me, there is a difference.  

Some images couretsey of JoinCrowdHealth via Instagram.com

While many insurances claim to be “non-profit”, this just means the the “business” doesn’t make money. Instead, the board members, corporate officers, etc may have lavish salaries, free care plans and dozens of other perks that the members do not receive. On the flip side, most health shares are “for-profit”. That doesn’t mean they are making money off you. In fact, that “profit” is often what helps to pay bills on your behalf.  While I can’t speak for all of them, I know that in many cases the CEO’s and executive team are members who pay into the pot at exactly the same rates as you and your family.  Additionally, most health shares will provide financial updates to members of how and where the money was spent in the prior month/quarter. Has your health insurance provider ever shared how they spend your money? I know none of mine ever did (before now)…

If you want to take control of your health and your wellness, start by finding providers who focus on HEALTH and truly CARE. Direct Primary Care (DPC), Lifestyle/Wellness Medicine, Functional Medicine are options which are often “out of network” for insurance, but usually include longer visits, easier accessibility to your provider and more thorough assessments of you as an individual. When you need PT, Restore & Reform (or others like me) can help you get moving at a fraction of the cost and time.

*Interested in learning more about HealthShare options? Just ask!