Who Really Makes Your Health Care Decisions?

If you think that you and your doctor make all of the impact on your healthcare decisions you may be surprised! The doctor-patient relationship is not as simple as it used once was. Today, several other parties including insurance companies, pharmaceutical companies and hospitals have a say when doctors in Sonoma make a healthcare decision about their patient’s health.

Let’s take a look at some examples of how outside parties can influence the healthcare decisions made for you by your doctor.

  • Let’s suppose your doctor is employed by a local medical group ABC Corp and your insurer is XYZ Ltd. You see your doctor and they want to prescribe a medication, which XYZ ltd. refuses to cover and will only cover an alternative prescription medicine, which is an older version of the medicine your doctor wanted to prescribe. Your insurance company just made an important healthcare decision for you

 

  • Your doctor wants to order a specific imaging test in order to gain a better understanding of your condition. However, yet again your insurance company refuses to cover it. Another important decision has been made for you, unless you plan to pay for the imaging test out-of-pocket.

 

  • You are experiencing an increase in the intensity and frequency of migraine episodes. Your doctor wants you to see a neurologist. However, their employer, ABC Corp or your insurer, XYZ Ltd. wants them to reverse their decision as the neurologist works for a competing medical group or is not in your insurer’s network. Your doctor’s employer or your insurer insists that they refer within their group. This may include doctors who have little or no experience handling cases similar to yours. Your doctor’s employer or your insurer just made a healthcare decision for you.

 

  • You visit your doctor for abdominal pain. They want to spend more time with you in order to delve into the problem, but are unable to do so as their employer ABC Corp. wants them to see 20 patients per day. Your doctor’s employer also wants them to check boxes against questions included in the form provided to them so your insurer XYZ Ltd. reimburses the medical group at a higher rate. As a result, your doctor is unable to spend the time with you that they need to in order to make an accurate diagnosis and refers you to an empaneled gastroenterologist. Family doctors are trained to diagnose and treat various health problems when they are able to spend time with their patients. However, in your case your doctor does not have enough time and has to refer you to a specialist

What Can You Do?

Instead of seeing a doctor that works in a traditional setting, look for a concierge doctor near you. Concierge doctors see less patients on an average day than doctors who work in traditional settings, which means they can spend ample time with you. They also offer telehealth services, can be contacted after office hours, and even make house calls. In addition, they’re much less likely to have the same restrictions placed upon them when it comes to making decisions that can impact your overall wellbeing.

Dr. Guy is a renowned internist in Sonoma. His professionalism, specialized knowhow, and experience set him apart from your run-of-the-mill doctor. To discuss your health issues with him, call (707) 938-1255.

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