By Jonathan V. Wright, M.D.
From time to time, one of our health care team at Tahoma Clinic is asked “Why doesn’t Tahoma Clinic accept insurance re-imbursement? It would much easier for our family and many others to come here for health care if you did.” Briefly summarized, our answer is: “We work for you. If we accepted insurance payment, we’d be forced to work for the insurance company first, and you second.”
Although working for you and not any insurance company is of primary importance, another important reason for not accepting insurance payments was perfectly illustrated in a fax date-stamped “3/15/2013, 9:33:03 AM” from one of Washington State’s largest health insurance (a misnomer, of course, as all “health insurance” companies insure for disease treatment, not health promotion and maintenance) companies, “Regence Blue Shield”.
Below are a few low lights from that fax, along with my commentary…
“Regence Blue Shield is currently collecting information from our affiliated providers [another misnomer, but more about that later]…the data is collected from randomly selected medical records [can you guess where this is going yet?]….a list of needed medical records is attached…you must provide records free of charge…your provider [more about this later] agreement with Regence Blue Shield requires your participation…”
“…According to the HIPAA Privacy Rule [watch out, when los federales use the word “privacy,” you know what’s coming!] health care providers [there’s that word again] may disclose protected health information [so how exactly is it “protected”?] to health plans….as defined under the HIPAA Privacy Rule…”
[Now here’s the really “good” part, in bold face exactly as it was in the letter]: “Providers [again, that word] are permitted by HIPAA to disclose PHI [government-speak for “Personal Health Information”] to health plans…without an authorization from the patient…when both the provider [sigh!] and health plan have or have had a relationship with the patient…”
So much for privacy in your medical records! Let’s summarize: your physician is required to turn over your personal medical records on demand to your health insurance company without your authorization! In most cases, your physician won’t even tell you it’s happened.
Of course the letter mentions “strict confidentiality standards” and the “secure” way in which the data will be maintained. Let me guess…the data will be stored electronically on hard-drives or “in the cloud,” neither of which type of electronic storage has ever been “hacked,” right? And the work is done by humans, a species well-known to maintain absolute confidentiality whenever told to do so, of course!
Why “private” medical records are anything but private
However, the reality is one more potential violation of the privacy of your medical records doesn’t matter, as very few medical records are actually private, anyway. Thanks to that same Health Information Portability and Accountability Act (HIPPA), if your physician, clinic, or hospital maintains your medical records in electronic form (“electronic medical records,” which los federales are spending big bucks to promote) every bit of your medical record can be electronically accessed without your knowledge or consent by any person, institution, or agency “authorized” by los federales Secretary of Health and Human Services.
No, I’m not kidding. That’s been considered “privacy” under the HIPAA law, since 1996. It’s also the reason Tahoma Clinic does not and will not store your medical records electronically, but only on paper, where—except for you, your physician, and other members of the Tahoma health care team—they can only be accessed with a warrant signed by a judge. Yes, a warrant and a judge, as specified by the 4th Amendment to the Constitution of these United States, which is supposedly still the “law of the land,” but apparently is now obsolete in the opinion of los federales.
The rise of the health care “provider”
In health care, there are many “skill sets,” each requiring its own particular curriculum and length of time spent studying. There aren’t only physicians (medical, osteopathic, and naturopathic doctors) there are dentists, chiropractors, nurses (RN and LPN), acupuncturists, therapists (occupational, rehabilitation, respiratory, massage), technicians (dental, radiology), and many, many more.
Until los federales became a major third-party payer for nearly all—if not all—of these health services, each practitioner was described with the respect due his or her education—physician, dentist, nurse, chiropractor, therapist, technician, and so on.
But los federales, either from laziness or in an effort to level the playing field decided to start calling everyone by the generic term “provider.” So now, the term “health care provider” has worked its way into everyday language, and you and I can’t tell a nurse from a doctor from a technician from a…well, you get the picture.
There’s also a psychological aspect to the use of the word “provider.” There may or may not be much skill in being a “provider,” especially when what’s being provided—a hot dog or psychotherapy perhaps—isn’t specified. Providing sounds much simpler than diagnosing and treating, or knowing how to repair damaged teeth, or knowing how to do “pulse diagnosis,” and exactly where to put that acupuncture needle. (I could go on, but I’m sure you’ve gotten the point.) The bottom line is the word provider shows less respect for education and skill.
And it’s that same lack of respect that makes it a lot easier psychologically for los federales and the insurance companies to continually try to lower re-imbursement rates; after all these are just providers, not a variety of skilled health-care professionals with degrees and certifications, right?
Which is why I always cross out the word provider on any letters or forms sent to me, and (in my case) replace it with the word physician. I encourage my fellow health care practitioners of any and all educations and skill sets to consider doing your own version of the same—unless of course you don’t mind being demoted to “provider.” Doing this won’t change the world, but if enough of us do it, it’ll be noticed.
