Lately I’ve become increasingly frustrated with our health care system.
How about you?
For the most part, I hear sad, horror stories daily from my patients or would-be patients, about their experiences trying to receive the health care they deserve.
People call me completely confused and frustrated, attempting to schedule an appointment because they found me on their insurance website as a provider for their plan.
And then I start asking questions. My questions go something like this: Do you know for certain your policy covers acupuncture? Do you know if you have a deductible and if it’s been met yet? Do you know what your copay or coinsurance amount is? Do you know if your policy covers a consultation or just an acupuncture treatment?
A fairly high percentage of people get confused by my questions. Since I”m listed as a provider, they assume they can just call or email and schedule an appointment.
And while that use to be the case five or ten years ago, the insurance industry has become extremely complicated since then.
One of my patients overheard me on the phone with a prospective new patient the other day. Her comment after I got off the phone went something like this: “I bet you didn’t think when you got into this profession that so much of your time would be taken up with insurance issues.”
It was a very perceptive comment. Because yes, I got into this field to help people heal with holistic medicine, and to teach people how to heal themselves.
And now, probably 50% of my time is spent either answering questions from patients about their insurance, answering calls from insurance companies, billing insurance, or trying to collect money from insurance companies after they have refused to pay what’s owed.
It’s absolutely crazy what has become of our health care system.
I’ve recently seen a rise in the number of people who’s only insurance coverage is Medi-Cal, Medi-Care, or Worker’s Compensation.
In the case of these types of insurance, not only are the patients confused by what is or is not covered, but the people who work for the insurance companies who call me actually know far less than I do about how compensation for acupuncture works.
So I have to spend a great deal of time on the phone not only explaining it all to the perspective patient, but also I have to explain it to the person who works for the insurance company.
HMO’s for instance will now usually cover acupuncture, including LA Care, HealthCare LA, Kaiser, Facey, Lakeside, the Veteran’s Administration, and most others. This is absolutely great news, because a few years back, acupuncture wasn’t covered.
But problems arises because in most cases, there must be a pre-authorization sent to me before I can begin treatment. The prospective patient doesn’t understand this, because they are simply being told it’s covered.
Another confusing issue is that only acupuncture is covered. And most people would like a consultation and holistic approach, including homeopathy, herbs, and nutrition. But these are never covered by their insurance.
Explaining this is difficult, because most people see my name as a provider on their list, and assume they will receive a full range of services.
The number of treatments covered is also highly monitored by the insurance industry, as well as the type of problems that are covered.
Yesterday I had a patient call me and say their insurance company told them that their digestive problem would be covered. Then I received a call from the insurance company insisting digestive problems are covered.
This couldn’t be further from the truth. The only types of problems that are covered for acupuncture are what we call musculoskeletal. This includes, for example, headaches, neck pain, back pain, carpal tunnel syndrome, shoulder pain, knee pain, etc. Explaining this is difficult, and makes me feel like I’m operating with one hand tied behind my back.
The other most frustrating thing for me is that most of my recent patients are much different than my patients five, ten, or fifteen years ago. I’ve been in practice over 30 years, and for most of that time, the type of patient who came to see me, was very health conscious and wanted to work with me to achieve optimal health. They were interested in cleaning up their diet, working on taking the proper supplements and herbs, and possibly starting counseling and meditation to achieve more self awareness.
But over the last 5-10 years, as acupuncture has become more mainstream, most of my patients have no knowledge nor interest in their overall health. They are just wanting me to insert acupuncture needles into their painful areas, much in the same way as they would take pain medications.
The problem is that most of these patients are eating horrible diets, are overweight, don’t exercise, do not take supplements, have horrible digestion, nor are they interested in taking supplements, and have no awareness of the role the mind and emotions played in creating their illness in the first place, or in healing it.
And the most rewarding part of my practice used to be working with people to become more self aware, and take more control over their health care choices. Now most patients just want me to stick needles and have no interest or awareness in anything else.
This is the sad state of health care in our country. If you are eating foods which are inflammatory, and are not taking the supplements and herbs your body needs to regain balance and heal, and refuse to examine your diet and how it is contributing to your problem, then acupuncture only has a limited potential to help you.
Dont get me wrong. I’d still much prefer you to get acupuncture then to take more drugs or get surgery, and in many cases, the acupuncture will in fact help you to avoid taking drugs or getting surgery.
But holistic health has so much more to offer.
I just wish the health care system would acknowledge this, and that everyone had a higher level of awareness of how working as a team, we could create a comprehensive treatment program to regain health and equilibrium.
I”m here for each and every one of my patients in whatever way they would like to utilize me and my skills. So don’t get me wrong.
But I hope each of you reading this, will take a longer-term view at your lifestyle, diet, body/mind issues, and possibly consider stretching your mindset a little, to work on a teamwork level to manage your larger health picture, and not just expect that by doing acupuncture alone, you will see huge improvements.
In the long run, the deeper we all look at health, the more it will really pay off.
Optimal Health! It really can be achieved if you want it!.