Flat rate, no insurance care----

One of the biggest complaints I hear from women (and a few men) wanting to go see a doctor who specializes in bioidentical hormone replacement therapy is that most of the practices do not accept insurance, so the cost of the visits are out of pocket. I get it, in this lousy economy one more expense is a terrible burden.

However --- and I have had more than one discussion with physicians about this ---- the real culprit is the insurance companies themselves, who flatly refuse to pay for office visits for hormonal balance (and in many cases it doesn't matter if the hormonal therapy is synthetic or bioidentical). In other cases, the insurance companies make it so difficult for the doctor's office to collect reimbursement (which is usually dismally low) the doctor has to hire one full time staff member just to deal with the insurance companies, and so he ends up losing money on every transaction. It is simply a fact of life in health care today.

Additionally, balancing hormones is not something that can be done in a 6-10 minute office visit. I know my own hormone doctor generally spends at least an hour with a patient at the first visit, and follow ups are usually at least 30 minutes. He needs that sort of time to get a detailed history, exam, and listen to what symptoms the patient is experiencing in order to bring the hormones back into balance.

I ran across this article today on Yahoo News and the idea is intriguing. I suspect that no matter what form our health care reform takes, a lot more doctors are going to get fed up with the beaurocracy of it all and set up their practices to be on a cash only basis. It's something we all need to think about and start paying attention to, because even if you are one of the lucky folks who is in good health and has health insurance through an employer, you are going to be affected by the changes that are coming in our health care system.