Why should I pay my full copay if I don't see my doctor?!

[RedSox143]

Okay guys going to keep this short, hear me out on this, looking for some takes on this.

Sometimes (most of the time now) when you go to your primary care for a somewhat minor acute concern you usually see an NP, PA etc. not your doctor. Now this is fine, don't want to take up he or she's time with a strep test or something BUT why do I pay a full copay. Why does a visit with them cost the same amount as a good sit down visit with my doctor.

For specialist care the follow up is almost never with my doctor yet I still pay full price...

Maybe I'm crazy cuz it is a service provided etc but is a short visit with an NP or PA who knew you for maybe 2 min worth as much than one with my doc who's known me for years? Not a chance in my eyes.

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[VA Hopeful Dr]

Find a doctor who doesn't use midlevels, problem solved.

 

[ProfMD]

Actually, you don't pay full price. You pay a co-pay. The rest is paid by insurance. And even that is not full price - it is the discount price negotiated between the insurance company and the physician's office. And if you do see an APN, then the insurance company pays less.

 

[RedSox143]

Actually, you don't pay full price. You pay a co-pay. The rest is paid by insurance. And even that is not full price - it is the discount price negotiated between the insurance company and the physician's office. And if you do see an APN, then the insurance company pays less.

So the insurance company is the one who pays less if I don't see my physician? Why doesn't that trickle down to dilute my copay? Costs go up if certain tests are ordered etc why can't costs go down if I don't see my physician? These are all hypothetical

 

[ProfMD]

That's a good question. Here is my cynical, but I think largely true, response:

Insurance companies are not interested in saving you money. They are interested in saving themselves money. Co-pays exist to give the patient skin in the game. If you could go to the doctor (or APN) at any time, paying nothing, you would be more likely to go for every little ailment. With a co-pay, you are more likely to consider the necessity of that trip. Reduce the co-pay, increase your likelihood of seeking care, increase the insurance company's payout. While they may pay the APN less than the doctor, they still pay him or her more than the zero it would cost for you to stay home.

 

[goodoldalky]

So the insurance company is the one who pays less if I don't see my physician? Why doesn't that trickle down to dilute my copay? Costs go up if certain tests are ordered etc why can't costs go down if I don't see my physician? These are all hypothetical

This is all because health insurance companies exist for one reason: to make as much profit as possible. In this case, you pay more, the practice you go to gets paid less, and the insurance company comes out ahead. If you haven't met your deductible, they don't even pay anything, you pay it all. $$$$$$$$

 

[Perrotfish]

So the insurance company is the one who pays less if I don't see my physician? Why doesn't that trickle down to dilute my copay? Costs go up if certain tests are ordered etc why can't costs go down if I don't see my physician? These are all hypothetical

It trickles down to dilute you PREMIUM. If everyone saw a doctor rather than a midlevel everyone would need to pay an extra $50/month (or whatever) to make up for the increased cost of care.

The copay doesn't go down because the copay isn't there to pay for your healthcare. The visit itself costs at least 5 times the copay, paying for it is what your monthly premium is for. The copay is there to give you an incentive not to over utilize physician visits. The idea is that if you have to pay $20 (or whatever) for each visit then you will only come in when you actually need to and not just because you're bored, fishing for medications, or need reassurance.

Those of us who work in enviornments where most of the patients are seen without copays (military medicine, ERs that serve mostly uninsured patients) get to see that people really will do things like come in 5 days in a row for bronchitis ('but I'm still coughing') or lower back pain ('I really think some Vicodin would help, doctor). One patient like that can cost the insurance company thousands of unnecessary dollars a week, and that extra cost then gets split between all of the more responsible customers. The goal of the copay is to make the over utilizers think twice about coming in.

This is all because health insurance companies exist for one reason: to make as much profit as possible. In this case, you pay more, the practice you go to gets paid less, and the insurance company comes out ahead. If you haven't met your deductible, they don't even pay anything, you pay it all. $$$$$$$$

Insurance companies in the US mostly run on razor thin profit margins and have relatively poor administrative and executive compensation. Unlike big pharma, large hospital systems, medical education, and (yes) physicians there really is no evidence that they could do the job we need them to do for less money than we're paying them. This is a good article on the subject that I think everyone in healthcare should read: http://money.usnews.com/money/blogs/flowchart/2009/08/25/why-health-insurers-make-lousy-villains

 

[goodoldalky]

Usual nonsense biased article, show me a healthcare insura

Insurance companies in the US mostly run on razor thin profit margins and have relatively poor administrative and executive compensation. Unlike big pharma, large hospital systems, medical education, and (yes) physicians there really is no evidence that they could do the job we need them to do for less money than we're paying them. This is a good article on the subject that I think everyone in healthcare should read: http://money.usnews.com/money/blogs/flowchart/2009/08/25/why-health-insurers-make-lousy-villains

1. Razor thin profit margins. Show me a health insurance company stock that has not doubled or tripled in the last 5 years. Hint: there is not one.
2. Poor executive compensation? Every one of the major executives were compensated more than $10 million in 2015. Most of this compensation is manipulated into stock grants in order to minimize tax bills on top of that. So you can take the cash number of a CEO's pay, it's going to look like one number, but the reality is they are walking away with double digit millions per year. http://www.fiercehealthpayer.com/st...ce-ceo-pay-exceeds-10-million-2014/2015-04-10
3. With regard to your article, it's from 2009. It's outdated, and the facts since then have proven that it is also wrong. Since 2009, Humana's stock is up 1,010%, Cigna, 1,113%, Anthem 469%, Aetna 628%, United Health 814%, and WellCare 1410%.

I do not blame you for being mislead and incorrect on this issue.. there is a lot of misinformation floating around.

 

[Perrotfish]

Usual nonsense biased article, show me a healthcare insura


1. Razor thin profit margins. Show me a health insurance company stock that has not doubled or tripled in the last 5 years. Hint: there is not one.
2. Poor executive compensation? Every one of the major executives were compensated more than $10 million in 2015. Most of this compensation is manipulated into stock grants in order to minimize tax bills on top of that. So you can take the cash number of a CEO's pay, it's going to look like one number, but the reality is they are walking away with double digit millions per year. http://www.fiercehealthpayer.com/st...ce-ceo-pay-exceeds-10-million-2014/2015-04-10
3. With regard to your article, it's from 2009. It's outdated, and the facts since then have proven that it is also wrong. Since 2009, Humana's stock is up 1,010%, Cigna, 1,113%, Anthem 469%, Aetna 628%, United Health 814%, and WellCare 1410%.

I do not blame you for being mislead and incorrect on this issue.. there is a lot of misinformation floating around.

Your numbers aren't exactly wrong, but they're insanely misleading. You're right that most health insurance companies have almost doubled in value the last 5 years... but so has the dow. In fact all the stock prices you're citing almost exactly parallel the growth and contraction of the US stock market. The truly insane numbers (1000+% growth) is just counting from each stock's individual nadir during the great recession. These stocks didn't got way up, they went way DOWN, then recovered, and then grew with the rest of the boom economy.

That is as opposed to companies in big pharma, or heathcare education, who have been seeing their revenues rise way out of proportion to the economy for years.

 

[futuredo32]

I only see Drs no PAs or NPs, problem solved.