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“Coverage” Isn’t “Care”

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Contributor & author: Dr. Keith Smith, medical director, CEO and managing partner of The Surgery Center of Oklahoma and Member of the AAPS. See Dr. Smith’s bio at the bottom of this page.

Interview – Contact:  g.keithsmithmd@gmail.com or phone Dr. Smith directly at 405-627-0274

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Preview: 

  • if you have “coverage” and are low on funds, you should always ask the “cash” price for a service before revealing that you actually have “coverage.”
  • Perhaps the only gift of Obamacare was that the deductibles were very high and very few physicians or facilities actually signed contracts with these plans. This created a vigorous cash market, where patients who are “covered” but without benefit, could negotiate cash prices with physicians and facilities for the care they needed.
  • Medicare has criminalized charity, as demonstrated in a recent case of a Medicare beneficiary with a broken ankle who is stuck in a wheelchair because she can’t come up with her $2,000 deductible.
  • Leave it to government to force the purchase of this “coverage.” All who have been victimized by this cronyism have earned a seat on the #metoo bandwagon.

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January 16th, 2018

“Coverage” Isn’t “Care”

by G. Keith Smith, M.D.

If you are following health-related topics on social media you have likely encountered “coverage is not care,” as a theme or #hashtag. This phrase/quip should be viewed as an opportunity and lens through which the dysfunction of the crony-dominated “healthcare system” in this country can be viewed.

Not only is “coverage” not equivalent to “care,” “coverage” can and many times does create a barrier to care.

It might shock you to learn that the “cash” price for many medications at your local pharmacy is less than the co-pay if you are using your “coverage” to buy these same medications. In other words, you are better off claiming to be uninsured when you buy certain pharmaceuticals! Why is this? Your “coverage” represents an additional, contracted layer—a toll booth—through which the exchange between you and the pharmacist must take place. This toll to pharmacy benefit companies/wholesalers is removed from the purchase if you represent yourself as uninsured. The presence of this middleman/distributor can and does increase the price of pharmaceuticals dramatically, representing as much as 50% of the purchase price for a large number of medications.

The same goes for the care at many physician offices. Any physician who is contracted with insurance companies labors under their fee schedules, any departure from which risks expulsion from the “network.” Physicians who waive all or part of deductibles for patients or treat cash-strapped patients free of charge run the risk of running afoul of these same “network” contracts and may also face legal action. What gives? More

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Disruption of the Healthcare Syndicate

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new-logo25 G. Keith Smith, M.D.,

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The hospital charges $100 for an aspirin, collects $5, and claims to have “lost” $95. Such false losses maintain the fiction of the hospitals’ “not for profit” status. Often, insurance companies sell their “discounting” services. For example, they may reduce a bill from $100,000 to $20,000 and collect a percentage of the false “savings.” This is the “repricing” scam. This setup perversely inclines the insurance carriers to seek out the highest bills they can find, assiduously avoiding better priced alternatives.  A great disruption of the syndicate has arrived, beginning Jan 1, 2014, as several self-funded companies have formed relationships with facilities like ours. ______________________________________

My introduction to the practice of medicine began before I went to medical school. Dr. Don Garrett and Dr. Richard Allgood, both thoracic surgeons, allowed me to spend enough time with them to absorb countless lessons, many of which remain with me to this day. While both of these talented surgeons are now retired, their dedication to their patients and the precision and intensity with which they approached patient care are legendary even now.

Their surgical practices were huge, by any measure. They performed more surgical procedures in a week than most surgeons did in a month. The hospital in which they worked owed its success largely to these two men. They let the hospital administration know what they wanted and what they needed. And they got it. The administration could hardly afford to consider the alternative. But the administrators’ resentment grew, and they bided their time, eager for the day when they could turn the tables and call the shots. More

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