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Dr. Melissa Young shares with us why January is her least favorite time of the year - from cold weather to unmet deductibles.
I hate this time of year. It's cold, it's dark, the holidays are over, and the holiday bills are coming. And for physicians and for patients, it's really the darkest time of year. Fair warning, a whole lot of whining is about to follow.
Where to even begin. Let's start with the weather, I suppose. Just this week, we were struck by the "bomb cyclone." Patients had called a day or two before the storm was supposed to arrive to cancel their appointments. Since, in the past, the weathermen had been significantly wrong about their forecast (the only job, by the way, where you can be so wrong so often and still keep your job), we told patients to keep their appointments where they were, in case the storm wasn't too bad. Well, not only was it bad, it was much worse than we anticipated. So early in the morning, I texted my staff and said "stay home if you don't think you can drive to work safely."
They all did the smart thing and stayed home. My associate and I, on the other hand, went to the office, and called everyone on the schedule to make sure they stayed home. Most of them had already planned on not coming, but the mom of one patient started to say, "I know the weather is bad, but she's been waiting so long for this appointment…" I didn't let her finish. I wasn't about to have them risk getting in an accident and I didn't want to stay in the office and get stuck in an additional six inches of snow. I told her that we would try to get everyone who was supposed to come in accommodated in the next two weeks even if that means staying late a couple of nights. So, we are having to stay late a couple of days this week.
Then there's the issue with formulary changes. Arrggg! I hate when insurance companies insist that patients who are doing perfectly fine on one medication have to switch to something else. I've said it before - I get it. I understand why they would want me to justify an expensive drug. I don't like it, but I understand it. But once I have gone through the hoops of getting it approved, and if the patient is both tolerating the drug and benefiting from it, why do we have to change it? Oh, I know why. Money. When patients ask me why, I tell them "because it's not about you. It's not about how well you are doing. It's about the bottom line. It's about how much money the insurance company will save." It's a horrible system, and I hate it.
And then there's the new plan for the New Year. Employers have patients change plans and usually the effective date is January 1. Unfortunately, come January 2nd, not everyone has their new cards. And many of them are completely surprised that their co-pay is different. Some of them are completely caught off guard and don't realize that their doctors aren't in their new plan. Some aren't even aware that their plan is different or that their new card has slightly different numbers and whip out the old card when the staff asks to check which leads to denial of payment.
For many patients, including those on Medicare, there's the dreaded deductible. Somehow, even people who have had Medicare for years fail to understand the concept of the deductible. "Why was it only $10 last time?" Because last time was August and you had met your deductible. "Last week, I saw my cardiologist and it only cost $15." Well, last week was still December.
And again for Medicare patients, I get the call that their meds "aren't covered." Yes, they are covered, but you have a deductible, and after the deductible, Medicare pays for 80 percent and you are responsible for 20 percent, which means that if you are on a $300 drug, you are going to need to pay $60. "But last month it was only $9!" That's because you miraculously dug your way out of the "donut hole" and were in the catastrophic phase when Medicare paid 97 percent of the cost; but now it's January and the whole joyous thing starts all over again.
Yes, I hate this time of year. I cannot wait until the weather is warmer, the days are longer, the meds have been switched, and the deductibles are met!