Do you have health insurance? The vast majority of my patients do so it is an important part of my practice and has been over the past 15 years. Many of us think “Well I have insurance, so I am covered if I am injured”. This is usually the case but there can be vast differences in what you will pay for that injury depending on what decisions you make.
I have been treating patients for 20 years now and I have seen a lot of changes in what we call “Out fo Pocket Cost”. After you and your employer pay the insurance premiums, you will still likely have to pay something for your health care. This comes in the form of Deductibles, co-insurance, and copays. If you dont know what these are, check out my previous blog post that explains them HERE (Link to Deductibles, co-insurance and copays)
I can remember a time when a patient was upset that they had to pay a $5 copay.
”I have to pay every time I come in? I all ready have insurance!”
The days of $5 copays are long behind us. I recently had a patient with an $85 copay who would have been happy to pay the $5 my patients 20 years ago had to pay. Times have changed and my patients are paying more and more out of pocket costs on top of their insurance premiums.
What does this mean for you as a consumer of health care? You have important decisions on how to treat the issue you are having. I want to help you navigate our healthcare system and save you time and money while doing it. Let me give you two different paths you can take when dealing with an orthopedic injury. I like stories so we will look at the story of Mike and Jen.
Mike was walking out of his house carrying boxes and when he stepped off his front porch he twisted his ankle and heard a pop. He had some pretty good pain initially but was able to get up and walk to his car. The pain got better but there was a lot of swelling and bruising in his foot.
He decided he needed to get it checked out so he went to his primary care doctor. He paid his 20% co-insurance which was about $25. His doctor prescribed him some medication and told him to rest it for a month and come back. Mike paid $10 for his meds and felt a little better but still had pain after a month. He went back to his doctor and paid his $25 co-insurance for the visit. His doctor thought that there may be more damage so he ordered an MRI and told Mike to see an orthopedic specialist. Mike went to get his MRI and this is an expensive test. His insurance covered 80% of the bill but he had to pay $500. He took the test to the specialist, paid his $25 co-insurance and the specialist told him he had sprained his ankle but there was no fracture. Mike was handed some exercises to try at home and told to go follow up with his primary care physician in a month. Mike did some of the exercises and felt a little bit better. He went back to his doctor, paid his $25 and reported he was better but still didnt feel confident walking on grass and couldn’t really jog for exercise like he did before the injury. His doctor told him to do some of the exercises at home and it should heal up.
Jen had a similar problem. She was doing some trail running and tripped on a log. She fell and heard a pop in her ankle that was followed by a good amount of pain and swelling. She limped back to her car and knew that something wasn’t right. She iced her ankle for a day and still had pain. Jen has had injuries in the past had had success with physical therapy . She called her physical therapist and made an appointment for an evaluation the next day (If you thought Jen needed a script from her doctor for physical therapy, read my blog HERE.) Jen went in and paid her co-insurance which was $20. She got evaluated and was quickly diagnosed with an ankle sprain. There was no fracture so she was able to start treatment on her injury that day. Because she was proactive and got immediate treatment she only needed 6 visits of physical therapy and was back to running on the trail in 3 weeks. Actually she was even stronger than before the injury because the physical therapist discovered her hips needed a little work so she got treatment to strengthen them as well.
Here is the difference between Mike and Jen who had the same exact injury and have the same exact insurance coverage:
Mike paid $610 out of his own pocket, spent 3 months trying to get better, and is still not 100% recovered and back to his normal life.
Jen paid $120 out of her own pocket, spent 3 weeks in therapy, and is stronger than she was before the injury.
Who would you rather be?