The Medical Insurance Trap

31 Jul The Medical Insurance Trap

Posted at 17:18h in Blog by David Tener 0 Comments

Paul A. Goldberg MPH, DC, DACBN, DCBCN
Founder and Consultant to The Goldberg Tener Clinic
Chronic Disease Reversal

You have a “chronic” disease. Rheumatoid Arthritis, Ankylosing Spondylitis, Ulcerative Colitis, Crohn’s Disease, Chronic Fatigue, Obesity, Diabetes, Eosinophilic Esophagitis (EOE), Psoriatic Arthritis, Hypertension, Eczema, or any other of hundreds of chronic disease titles given to patients. You’ve gone from physician to physician chasing a “cure”. You’ve seen conventional/alternative / functional medicine doctors and undergone a myriad of treatments. Time has moved onwards; the quality of your life is declining. Your physicians have you taking multiple drugs and you are experiencing side effects… steroids, immunosuppressants, antibiotics, anti-depressants, antacids/PPI’s/H2 blockers, Enbrel, Humira, Remicade and other pharmaceuticals. You are in an endless routine of treatments with no escape from your misery in sight. Months and years go by…the prescription and supplement list becomes longer. You watch the world go by and miss being active in work and recreation.

Your insurance covers the cost of most of your treatments… but despite the thousands of dollars insurance pays, your health continues to decline. Your enjoyment of life has come to a standstill.

If you are utilizing insurance-based physician care for a chronic disease, you are, knowingly or not, allowing your insurance carrier to determine the type of care you receive. This care generally consists of symptom suppressing drugs that often destroy the potential for recovering your health.

We frequently receive the question… will you take my insurance? We politely answer no. We will provide the paperwork for patients to file, but we won’t have the insurance industry dictate how we care for our patients. If we were to do so, most of our patients who have, under our care, reversed chronic diseases and attained excellent health, would still be suffering. We, along with each patient, determine the right course of action to restore the chronically ill person to health and reverse their chronic disease not simply treat their symptoms.

After my first three years of practice, I left the insurance game so I could help my patients overcome chronic illnesses, spend ample time with them and employ a well thought out individualized plan for each one… not simply a protocol determined by their insurance carrier.

Did you ever wonder why so many disease conditions are labeled as “chronic” diseases? It is because they are regarded by the medical, pharmaceutical and insurance industries as being lifelong disorders… not reversible… to be managed indefinitely. A dismal prediction from the start. If you have a “chronic disease”, you are being set up by the insurance and medical industry to become a lifelong patient. By definition. The following cartoon illustrates this common scenario.

Your Insurance Card Please

No patient at our office is ever asked for their insurance card. We do not base patient programs on insurance protocols. We enact steps based on identifying and addressing the causes of each person’s illness, reversing their disease, restoring health and putting the patient in the driver’s seat of their health care. We are a practice where health restoration is not only the goal, but as our long history, testimonials and lab results demonstrate, is the reality our patients can look forward to.

(Scroll down to see over sixty before / after pictures of patients at our clinic illustrating the excellent outcomes that are possible.)

The Insurance Trap

Most patients do not recognize that an insurance-based office where you file medical insurance for payment, will not give patients the time and individualized care required to reverse chronic disease conditions. When a patient with a “chronic disease” utilizes an insurance-based practice, they paint themselves into a corner. They experience short, superficial visits, take pharmaceuticals to treat their disease and are set up for ongoing office visits. No health recovery… no renewal of vitality, only ongoing symptom management.

Is insurance-based treatment for chronic disease expensive? Think of a common drug such as Remicade, the brand name for a monoclonal biologic antibody (infliximab), used to treat Autoimmune Diseases, including Crohn’s Disease, Ulcerative Colitis, Rheumatoid Arthritis, Ankylosing Spondylitis and Psoriatic Arthritis. Typically, for example, the cost of Remicade is between $50k-150k per year on an ongoing basis just for the drug itself. This does not including Physician fees, lab tests and the dangers of developing cancer from the drug (read our article “The Dangers of Biological Drugs”). In contrast, in forty five years of clinical practice, no patient of ours, the majority of whom recover from their chronic disease, has ever spent even a tenth of that yearly amount for everything including labs, supplies, office visits, etc. In addition, not one of our patients in forty five years has ever had an adverse effect that placed them in the hospital unlike pharmaceutical based practices.

The Insurance Based Practice

The insurance-based office requires a larger staff as there must be workers to handle insurance matters. Physicians using insurance are generally found in group practices. Their procedures are governed by what insurance covers. Doctors in group practices are also expected to “process” a certain number of patients per day.

The Nature of the Insurance Based Practice

The insurance-based practice follows the treatments that insurance carriers mandate. This also becomes part of the protocol taught to medical students. Medical Physicians employing titles such as “functional” or “holistic” (neither requiring additional training) still must utilize insurance approved protocols and drugs in their practices to maintain a relationship with insurance carriers (read our article “The Facade of Functional and Alternative Medicine”).

Medical Insurance is an extension of the pharmaceutical/medical industries. From the moment you hand out your insurance card the course of care is predictable. The doctor runs into the room you are waiting in and a few minutes later flies out the door to see the next patient. The routine is standardized. The doctor needs to meet his quota each day. No time to know the patient, how the problem evolved or to set a course to restore health… only time to name the disease and “treat disease symptoms”.

Expect a short visit, lab tests / imaging studies, followed by drugs. If labeled with a “chronic disease”, expect staying on drugs to suppress your symptoms. Also expect ongoing visits to assess damages from the drugs or to change the drugs prescribed. It continues in this manner for the chronic disease patient for a lifetime.

The reason chronic diseases are referred to as chronic diseases is because physicians know that the “treatments” you will be given will not reverse the disease or restore your health. You will be a lifetime patient.

Over fifty years ago, as a young man with multiple Rheumatoid Disease diagnoses (click here read my story), I learned the futility of going to insurance-based practices… the impersonal nature, the limitation of time the doctor would spend with the patient, the standardized pharmaceutical protocols, and most disappointing, knowing that the care given was only to suppress symptoms. It was clear that regaining my health was not part of their plan nor training. Indeed, upon my questioning, I was told I would be ill for the rest of my life, but they would manage my symptoms with drugs.

Millions of Americans each year are labeled with chronic diseases and “treated” for symptoms while causes go untouched.

There is a better way I learned that enabled me to recover my health. It starts with understanding the etiological factors that lead to disease and addressing those issues directly. This is not part of a medical insurance-based practice.

The Treatment Trap

After an extensive battle to identify and address causes, I regained my health and set out to help others do the same. I took graduate and professional training in Public Health, Chronic Disease Epidemiology, Clinical Nutrition, Functional Gastroenterology, biologically based Rheumatology, Nutritional Biochemistry and worked for the Federal Government as an Epidemiologist. I later became a University Professor of Public Health and Clinical Nutrition, instructing Undergraduate, Graduate and Chiropractic Students and earned a Doctor of Chiropractic Degree.

When I started clinical practice over forty years ago, I accepted insurance for a short time. I found, however, that it severely limited how much help and time I could give patients. My practice profited monetarily but the results with chronically ill patients did not fully meet my expectations. I needed to spend more time and attention with each person. After discontinuing the acceptance of insurance, I began devoting one to two hours to each patient’s initial visit to more fully understand how they had developed their illness and how to assist them in evolving out of it.

Applying interview, examination and laboratory skills and giving patients all the time they required, I saw a dramatic difference in how patients responded. Health was restored, their lives made enjoyable again and they left behind the pharmaceutical nightmares they were trapped in. Using skills I learned from my own experience and education, I helped them unload their metabolic burden, addressed causes and watched patients emerge into renewed good health.

This approach limited the number of patients I could see but the satisfaction in seeing “chronically ill” patients recover their health made this manner of practicing the only way I chose to practice from then on.

There are patients, upon hearing we do not take insurance assignment, that continue going to insurance-based practices. That is shortsighted. In the long run they will spend much more money and, importantly, experience ongoing discomforts and dangers from the treatments received.

It is important that every person with chronic disease consider the real costs of remaining chronically ill. The loss of enjoyment of life. Drug complications. Facing pain each day. Being in a sour mood with families, children and friends. Unable to engage in vigorous labor, outdoor activities, sports, travel, playing with children, grandchildren and pets. Not looking forward to the next day as anything other than another day of suffering. These are the real costs of chronic illness.

As regards monetary costs, chronic disease limits a person’s ability to work. It can dramatically curtail one’s lifetime earnings. What of deductibles, co-insurance, pharmaceuticals, hospitalizations and surgical expenses of their ongoing health care costs that might have been avoided with the appropriate causal based approach.

Hospitalization Insurance

Should we have medical insurance? Yes. Having insurance for major medical expenses/ hospitalizations resulting from accidents/injuries and catastrophic illnesses where the costs can be overwhelming is important. Depending on insurance coverage for reversing chronic diseases is, however, highly problematic and often leads to a lifetime of misery that could have been avoided.

The Goldberg Tener Clinic: A Clinic for Chronic Disease Reversal

The Goldberg Tener Clinic is a modern facility yet takes an old-fashioned approach to patient care. Two doctors are involved with all patients. A generous amount of time is given to conduct a detailed analysis and answer questions. Each person’s care is individualized to that person not the name of their disease. We work to reverse chronic disease not simply treat symptoms or “manage” them.

Patients benefit from a causal directed analysis from a Chronic Disease Epidemiologist using detailed interviews, examinations and advanced clinical laboratory testing with the experience to interpret and apply the results to each patient’s case.

The value we bring is to give each patient the optimal opportunity to regain their health from “chronic” disease conditions. Working diligently with us, patients have the potential to return to a fuller life where they are captains of their health destiny. Shown below are over sixty before/after pictures of patients at our clinic illustrating the excellent outcomes that are possible.