Straight Talk Tuesday

It’s time for some straight talk on patient insurance since the Affordable Care Act.

Am I the only one who has noticed that things have changed? I’m practicing in an affluent community but more and more patients with private insurance walk into the clinic and say, “I can’t afford any procedures.” They don’t want dressing supplies sent to them because they can’t afford their $3,000 deductible. The ones with Medicare “replacement” plans need authorization for everything and the answer is most often “no.” I can’t get authorization for things like new off-loading devices. I’ve been waiting 6 months for one patient with a severe Charcot deformity and a foot ulcer to work through the red tape of her Medicare HMO for a new CROW walker. The medical director of the insurance plan told me that off-loading was not part of wound care. She’s had to go back to her PCP for a referral to an orthopedic surgeon to get a referral to an orthotist. I figure that their unwillingness to allow me to make that referral in a timely way has cost them about $3,000 in futile care.

And I have more patients using diapers for dressings than any time since the 1990’s.