I wasn’t going to start this until next week, but this story is so important I’m jumping the gun. Today I begin 30 days of Gotchas, to show just how widespread and menacing this problem is. The series corresponds to the launch of the new edition of my book Gotcha Capitalism: How Hidden Fees Rip You Off Every Day and What You Can Do About It. (It’s only $4.99 at Amazon)
Today’s Gotcha is life threatening. What good is health insurance if there are no doctors to treat you?
And it’s from the file of: however messed up you think America’s health care system is, it’s much worse than that. Unless you know someone with this issue, you probably don’t even know that it exists, and might not believe it. But I’m here to share it is indeed real.
Even in large Eastern cities like Washington D.C. You buy insurance, you visit your carrier’s website to pick an in-network doctor, you call the doctor to make an appointment, and you’re told “We’re not accepting new patients.” Rinse, repeat.
In other words, you pay $500-$2,000 to buy insurance, the carrier’s site says you can visit X doctor, but the doctor says you can’t. Repeatedly. So often that you begin to think, “There are literally no primary care doctors available to me.”
The only hint you have that there might be some kind of trouble is a small note on the physician directory inviting frustrated doctor-shoppers to fill out a form to report inaccuracies in the list. Inaccuracies like “the doctor doesn’t belong on the list.”
Somehow, the health insurance carrier isn’t obligated to keep their directory up to date.
Finally, there’s a major lawsuit that touches on this this issue. According to The New York Times, a lawsuit filed in federal court in Washington State claims Centene, a large for-profit health insurance company, intentionally kept doctors in its list after they had requested to be removed. Plaintiffs in 15 states now allege the insurance they purchased was useless. From the story:
“Members have difficulty finding — and in many cases cannot find — medical providers,” who will accept patients covered under policies sold by Centene, according to the lawsuit filed in federal court in Washington State.
“Centene misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers — some of whom have specifically asked to be removed — as participants in their networks and by listing nurses and other non-physicians as primary care providers,” the lawsuit claims.
People signed up for insurance and they “ discovered there were no doctors,” said Seth Lesser, a partner at the law firm of Klafter Olsen & Lesser who is representing some of the policyholders.
Centene denies the allegations.
The lawsuit suggests that Centene intentionally entices consumers to sign up by keeping its directory full of doctors who don’t accepts its insurance. In December, Centene agreed to a $1.5 million fine and consent order after Washington State officials accused it of failing to maintain an adequate network of doctors there.
“We are committed to address known issues in our network in select regions of the state, and we have taken actions to ensure our members have access to these services,” Centene said in a statement.
Intentional or not, Centene’s consumers are hardly alone. Plenty of patients have trouble finding in-network doctors in America. This issue touches on many problems with America’s health care systems: There aren’t enough primary care doctors to begin with, because being a primary care doctor stinks right now; there aren’t enough regulators to keep health insurance companies honest; we don’t have an effective way to keep health providers from overcharging for simple services like aspirin; we allow a cabal of hospital drug purchasers to keep prices artificially, insanely high; but most of all, it’s impossible for consumers to make intelligent decisions about health care.
Let’s step back for one moment and consider this situation. It’s December, and you have to decide how you’ll buy health insurance. Your only choice is to visit the websites of providers you have have access to — you’re lucky if you have two or three — and you see what those insurance plans will cover. Using your magic 8-ball, you guess you’ll have X and Y health problems during the year, and pick a plan that includes doctors well-suited to those conditions. You’re already in la-la land. But today’s Gotcha trips up even this kind of clairvoyant consumer. Because six months later when you pick a doctor you saw on the website, and — GOTCHA! — you’re told you can’t see that doctor after all.
It’s insanity. But here we are.