by Marcel Hernandez, ND
It’s been endlessly reported that the U.S. healthcare system is among the costliest and least efficient of all developed nations.
There are a number of reasons this is so.
For starters, we do not have a health care system. We have a system that attempts to prevent disease through vaccinations and by paying fleeting lip service to lifestyle change.
Otherwise, our healthcare system is about managing identifiable medical conditions. For the most part, it covers the pharmacologic, surgical, or radiologic management of conditions diagnosable by conventional imaging and laboratory testing.
The problem is that the standard ranges on conventional medical lab tests include the 5th to 95th percentile of “not necessarily well” patients.
If you fall within the range, you’re fine. But if you don’t, you’re out of luck. Never mind that you may be feeling extremely unwell – you’ll rarely be helped by this system, except with pain meds, if you aren’t diagnosable.
If you are diagnosed, the treatment will most likely involve pharmaceuticals that are aggressively promoted to physicians by the pharmaceutical companies. The drug companies offer incentives for physicians to use their products, giving them free samples for patients to try. When the patents on older products expire, new and more expensive products are offered.
For largely political reasons, exactly the same drugs may be purchased outside our borders for far lower prices.
Insurance plays a large role in medical costs and frustrations. Huge dollars are dedicated to coding medical conditions so the insurance company can determine whether you have a reimbursable condition, and whether they will cover a treatment deemed necessary by your physician, and whether you can fill your prescription for 30 or 90 days. It’s all computerized.
Off-label prescriptions and newer treatments, of course, often aren’t covered. With some exceptions, insurance only works with conventional physicians and conventional laboratories.
Lab costs are inflated to cover institutional needs. As an example, here at Pacific Naturopathic we’ve contracted with Quest Diagnostics for a rate of $172 on our comprehensive Wellness Panel. An unfortunate patient of ours didn’t listen closely to our admonition that she go only to Quest – with the result that El Camino Hospital drew her blood and charged her more than $3000 for the same panel!
If an insurance company contracts with a “complementary” provider lab, you may receive some reimbursement. Services with naturopathic doctors may also be reimbursed by certain insurance companies, but at the higher out-of-network rates. And some insurance companies may offer a few chiropractic or acupuncture treatments with their plans.
Make no mistake, it behooves you to have one foot in the door of a conventional medical system, whether you agree with its policies and treatments or not.
Should you need urgent care, a specialist, or hospital care, you will be able to access the service far more easily from within the system. For this reason, we advise our patients to make use of the yearly physical that’s usually offered by their insurance plans, and to get to know a primary care doctor who can help them if they need to be hospitalized, and who can refer them to specialists within the system.
For information about the services we offer at Pacific Naturopathic, please give us a call at 650-961-1660, or use the convenient Contact Form to get in touch. Thank you!