Your Insurance and Your Check-up

There is plenty of evidence supporting the need for regular healthy check-ups for children. The general health for your child and for the community is improved. There is also ample proof that getting your care with the same physician is much more beneficial than seeing many providers at diverse locations. 

But, as with many healthy suggestions, there is a catch. 
      
At our practices, we are finding that insurance companies are getting more and more restrictive about check-ups. Some companies only allow one check-up in a 365 day span. Other plans allow only one check-up in a calendar year. Co-pays are also changing a lot this year. Of course, these restrictions don’t apply to babies and toddlers, but the rules are becoming more and more confusing and restrictive. 

Sometimes issues come up during a visit that exceed the normal bounds of a check-up. If we spend significant time, have to prescribe medications, arrange referrals, etc there may be an extra charge with your check-up. These are also new rules imposed by your insurance company.

Please check with your insurance company to determine your individual coverage before a visit. Our staff will do our best to figure it out also; but we hope you understand that as the rules get more confusing and diverse, it takes us more time to help you with your child’s regular care. We’ll do as much as possible to help you understand the intricacies and rules governing your coverage.  

We all love seeing our patients as they grow and we hope you like seeing us too. 

MEDICATION COSTS AND WHAT CAN YOU DO

The cost of prescriptions is rapidly becoming the most expensive part of our health care. Presently there is very little control over the price that manufacturers are charging and it’s costing us and our country dearly.

You’ve probably heard about companies like Valeant who successfully increased the cost of medications and are not being held responsible for this change. You’ve probably heard about the ridiculous price of Epipens, the price increases for AIDS medications propagated by everyone’s favorite drug villain Martin Shkreli, and essential medications for patients with Wilson’s Disease that used to cost 100’s of dollars a year now costing them $300,000 a year.

Generic medications are no longer the cheapest option because drug manufacturers have unique contracts with certain insurance companies that allow their branded products to be “cheaper” than the generics. If you have a high deductible or HSA health plan, you’re the one paying these vastly inflated prices. Pharmacy and insurance company shareholders and stocks are loving it, but your wallet is paying for it.

Pharmacists are not allowed to tell you about cheaper options. Most pharmaceutical and insurance companies have enacted gag orders for pharmacists so they are legally not allowed to help you. This is frustrating, confusing, and expensive for doctors, for the country, and for you.

There are a few things that you can do to try and combat this change.

First of all, be your own advocate. Do not automatically pay for a medication if it seems ridiculously expensive. Doctors really can’t effectively keep up with the changing prices of the medications we prescribe. Deals and contracts are changing faster than even our electronic medical records can keep up. So ask before you swipe that credit card. Ask if there are any cheaper options. If you do ask, the pharmacist can help you; if you don’t, they can’t. Ask your pharmacist about coupons. Once again, if you ask, they can help you; if you don’t, they can’t.

It’s a mad, mad world where a few people are making a lot of money and you and I are paying for it. Until there is some action taken by the powers that have influence, these prices will continue to rise. Until then, be careful, be wise, ask questions, and make sure you’re getting the best deal possible before you swipe that card.