Originally Posted by nrhareiner
So again lest do the math and I will use your ear as in this example.
I do under stand why you would want to go to the ENT but in reality it is hurting everyone. .
I agree with you in part. I made an assumption that I should not have made. I did not mean to say that some insurances require a referal from their primary to see a specialist in order for the insurance to "allow" any
of the charges. I assumed, incorrectly, that it would be taken for granted in a discussion about insurance that I meant a
referal is required by some
companies in order to ensure the charges would be fully covered to the extent allowable, I.e., not be penalized for "self refering". Lets do the math for the word "some", it is taken, universaly, to mean "not all", which means greater than 0%.
In your example you left out multiple variables. To begin with, there are 50 states and umpteen hundred counties,and not everyone has a general practitioner as their primary physician. It is not more expensive for me, for example, to go to an ENT than it is to go to my primary physician for the identical
treatment, it is LESS. So, I absolutely agree, a schedule of their charges should be posted - and it should be mandatory that they be posted.
Lost in all of this "cost savings" to go to a primary (which is not always a general practitioner) was my point...which was that a lot of people go to the doctor that do not need to be going, period. Cost? It does not seem to be one of those things they wish to quantify...but I would guess it is a high multiple of billions. Incentive not to go when not necessary - not much
that I know of for the insured. One rather widely discussed piece of evidence of this (people going to an md when unnecessary) is - resistant strains of bacteria.
If I have a tooth ache, I go to the dentist. The distinction between dentistry and medicine as they pertain to humans is an arbitrary one. If it were included as part of the medical world...the price of medical care would simply go up over all due to additional training and instrumentation costs, yet there would still
be "dental specialist". And, if I had a tooth ache in that "hypothetical" - I would go to the specialist, not my primary physician who is not a general practitioner.
BTW, most cities, not towns...and I said most, which does not mean all...have "urgent care centers" with what I assume to be general practitioners. Since most people live in cities...the availability of a general practitioner in cases where one needs immediate care, but not an ER, is already established.
Like I said, I almost never go to the doctor. If everyone went to the doctor as much as I do, insurance would not even be an issue. But, from that, should I then assume that all
those that go more frequently than I, do so b/c they simply don't understand something? I say this b/c you made the assumption that people such as myself drive up insurance costs by going to a specialist. I guess
I should have qualified what I said w "when necessary", but since my main point was the cost of the vast number of "unnecessary" visits people make, I mistakenly assumed that that was a given.