Caution: When choosing your health insurance remember to look to the future!

The country is in the midst of a monumental healthcare debate. Physicians like me treat individual patients, not populations. Thus this note of caution is meant for you, the individual who now must determine what health insurance plan best suits you and your loved ones. This blog in no way addresses the merits or lack thereof of the Affordable Care Act (ACA). I have been a practicing Cardiologist for over twenty years. During that time, my practice has run the gamut from intervention to prevention. Although it would be hyperbole to say “I have seen it all”, my varied experience has afforded me the opportunity to participate in the most intimate and meaningful aspects of a great many patients’ lives during so many different types of medical trouble. I have also myself unfortunately been a patient with life-threatening ailments on more than one occasion. To say I am an expert in the medical arena is therefore not hyperbole.

Now that many Americans must examine their health insurance with a new perspective I want to raise a single note of caution: When choosing your plan, always look to the future. It is one thing to keep your current doctor; that is indisputably important. Possibly even more consequential though is the fact that many of us ultimately develop complex, serious, and even rare medical disorders. We do this “in the future”, and to make matters worse, we never know when the axe will fall. Sadly but irrefutably we are all vulnerable to this fate. When this occurs, patients invariably and appropriately want to “see the best”. To do so often requires long trips to a variety of places in America (as an aside, it is ALWAYS in America where you will find “the best”). I have patients and loved ones who have traveled to Nebraska and Texas for the treatment of Lymphoma; Sloan Kettering for Neuroblastoma and other cancers; the Brigham and Women’s, Massachusetts General Hospital, Columbia Presbyterian, the Mayo Clinic and Cleveland Clinic for Cardiovascular issues; and many other centers of excellence for a host of other ailments as well. Every time patients travel afar to see the experts they do coordinated research with their physicians in order to identify the doctor and institution best suited to manage a particular condition. This is always a difficult and emotionally challenging task. Now consider this. The majority of plans under the ACA do not have contracts with most of the aforementioned hospitals. In fact, it is my understanding that perhaps the finest cancer center in America is not on ANY of the ACA plans. So, when choosing your health insurance, please focus on what you don’t know. Give the future as much attention as the present. Being unable to see a true expert to treat the disease you have not yet developed (but sadly will most likely afflict you or your loved ones at some point in your life) would be a catastrophic event. Buy your plan with your eyes wide open. Know what you’re getting for now, as well as for the days that lie ahead.

Please read more about preventive cardiology at www.preventivecardiologyinc.com.

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2 Comments

  1. Brian Edwards December 10, 2013 at 8:55 pm #

    I recently purchased Platinum level care for 2014 on Florida Blue Cross Blue Shield. I found out via ACA exchange that the Blues were the only company offering Platinum plans in Florida. Since I am a snowbird between KS and FL I wanted coverage in Topeka. I was told my PPO would be covered by the Blue in KS. My total out of pocket expense is $2,800. However if I go outside of my PPO network my out of pocket expense is $12,500.
    Wealthy people can get Cadillac policies which will cover them anywhere? but for which they will pay a tax. I guess your warning is for the wealthy who can afford to cover any future possibility. They can still find these Cadillac policies.
    Lets return to 40 million people who have no insurance.
    ACA is concerned with getting these folks good insurance, even Bronze level with high deductibles allows three free office visits and many free preventive care measures. These folks will probably choose HMO policies to save $100 a year. They will not be able to go outside outside of their local network. Yet this is a tremendous advance for them.

    As to getting the best care possible, I respectfully would like to challenge this concept.

    I did my Internal Medicine training in Brooklyn, NY. I did my fellowship in Infectious Disease at Kansas University Medical Center. I will speak from experience rather than RTC’s?

    I found in my 30 plus years of experience that 95% of medical care can be delivered by local care.

    I have seen many “Executive Physicals” done by the mill of Mayo Clinic and found the long medical record very unhelpful. The patient however thought they were now in great health. Was a Framingham Risk Score documented? No. Was a CAC or CIMT done in patients with one risk factor? No. Did Tim Russert die of sudden death after getting a nuclear stress test for asymptomatic Coronary artery disease? Yes. Is a patient more likely to get Methicillin resistant Staph Aureus infection after surgery in the local hospital or in a major urban medical center? No.

    The question can best be answer by rural Oncologists. When I have asked them If a patient should go to a major Cancer center, the answer was they can get into a research protocol. I believe patients don’t pay for those.

    No doubt, Mayo have seen and treated pheochromocytomas while in Topeka they rarely see it. I know of a case where Topeka botched it years ago. Perhaps that is a case where the local oncologist should have sent it to Anderson as the family could afford it. However, the Oncologist thought he was delivering the most up to date care, he saw no reason to refer. If surgeons make more money by doing more procedures there is less incentive to send the case out. In the end the patient usually trusts their physician. We find that patients use a different criteria for best care than more objective professional organizations use. Do the cardiovascular surgeons embrace BARI or COURAGE trials at the major centers?

    As a country we need to get coverage for 98% of people as Massachusetts did.

    I believe we have that now with ACA.

    As for those who can afford the $12,500 out of pocket expense that I have to pay to get to go to Anderson for a very rare cancer, that pathway is available with the new 2014 policies and I don’t have to pay a Cadillac tax on a deluxe policy.

  2. Steve December 19, 2013 at 8:42 pm #

    Sloan-Kettering is now listed on several ACA plans. They say so on their own website:

    http://www.mskcc.org/cancer-care/hospital-information/health-insurance-exchanges-marketplace

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