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Maine Voices: The problem isn’t Obamacare; it’s the insurance companies

MILBRIDGE — With the current news approximately will increase in premiums for fitness plans bought via the lower priced Care Act marketplace, all of us wants to vilify the ACA. The ACA is but a symptom of the difficulty. wherein are our policy dollars going?
As a number one care medical doctor, i am on the front traces. Milbridge is far flung. In properly weather, we’re 30 to forty mins from the nearest emergency room, so my office operates as an urgent care facility in addition to a familyclinical exercise.
approximately the author
Cathleen London, M.D., is a primary care physician training in Milbridge.
it could take 20 mins for an ambulance to get right here (as it did one time when I had a patient in ventricular tachycardia — a fatal rhythm). I need to be stocked to stabilize and deal with.
We are also approximately hours from professional care. happily, i am skilled to handle about ninety percentage of scientific problems, as my sufferers frequently do now not want or do now not have the resources to travel. I ought to be organized for much greater than I did in Boston or big apple metropolis, where I had colleagues and different substancesdown the hall or nearby. now not do i’ve a sanatorium blocks away.
One nighttime i used to be nearly home after a complete day’s paintings. around 7:30, I got a name at the emergency line concerning an 82-12 months-old guy who had fallen and split his head open. His wife wanted to know if I may want to see him, despite the fact that he became no longer a affected person of mine.
rather than sending them to the ER, I went back to the workplace. I spent 90 mins evaluating him, suturing his wound and making sure that not anything extra sinister had came about than a lack of footing via a man who has moderatedementia. while i was certain that the person could be secure, I allow them to go.
I billed a complete of $789 for the visit, restore, after-hours and emergency care costs. mentioning that the after-hours and emergency offerings were billed incorrectly, Martin’s point fitness Care threw out the claims and reimbursed me $a hundred and five, which does now not even cowl the suture and different substances I used.
I referred to as them about their choice, stated that it became no longer right and let them recognise they’d lose me if they reimbursed this as a recurring patient visit. They replied, “pass ahead and ship your termination letter” – which I did.
The equal day, Anthem Blue cross stored me on the phone for 45 minutes concerning a breast MRI advocated by usingradiologists on a girl whose mom and sister had died of breast cancer. She’d had five months of breast discharge that wasn’t traceable to something benign (and it turns out the MRI is highly suspicious for cancer).
Anthem did now not want to approve the MRI unless it turned into to localize a lesion for biopsy, even though the mammogram have been inconclusive! This must were a slam-dunk fast track to approval; instead, coping with Anthem wasted a good a part of my day.
Then Aetna instructed me there’s no manner to negotiate fees in Maine. i used to be particularly flabbergasted. I do morehere than I did in either Brookline, Massachusetts, or the big apple. The fees have to be better given the extent of care i’mproviding. i have chosen now not to participate with them. This most effective hurts sufferers; however, I can’t holdlosing cash on visits.
I do lose money on MaineCare – their repayment is below what it prices me to see a affected person. For now, that may be a selection that i’m living with.

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