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justme

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  1. This is Beth, justme's partner. I'm very concerned about this merger between health care and health insurance. I'm a psychologist, so I see this from both our end as consumers and my end as a provider. We also live near Pittsburgh, where Highmark BC/BS is starting to compete with the University of Pgh Medical system, joining them in merging health care and health insurance. I am very concerned that those two systems are starting to divvy up the Pittsburgh population for who can provide medical treatment to whom. If the best place to get a particular surgery is at West Penn Hospital, I want us to be able to go there for it. If the best Cushings doc is through the UPMC system, all Pittsburghers with Cushings should be able to get to him/her. There are increasingly physician offices that I can only send some of my clients to, because they are so in bed with one insurance system that they aren't allowed to take the competing insurance system. In return, one practice has just gotten to greatly expand their building, equipment, and scope of practice, and they have now become the primary primary care physicians for a particular nearby hospital. We tried this before. In the 1980's the health insurance systems invented "capitaton," a system by which physicians got a certain amount of reimbursement for treating a person, regardless of how much treatment that person needed -- this "incentivized" them to undertreat -- my primary care physician in the late 80s once refused to treat the chronic pain I had in my navel on the basis that "such pain couldn't physiologically exist." I had to quit another PCP who got "managedcaritis" after having been a very good doctor for years. I was kicked off a managed care company's provider list at one point because my average length of treatment was longer than they wanted -- they said so directly, first telling me I would be kicked off if my average did not fall to about 6 sessions per client, then kicking me off after I got it to that point because it should have been three sessions per client. The fact that I bowed to pressure to reduce the length of treatment at all means that they were impacting my judgement in giving clients what they needed. At about the same time, my mother was one of several people being treated in the hospital for a deadly disease -- she was the only one offered a particular experimental treatment, probably because of decisions made by each insurance company about what they would and wouldn't cover (Mom had a "cadillac" policy at the time) -- as she got better, she was asked to spread hope by visiting one of the other patients with the same disease, but to not discuss the experimental treatment -- Mom lived, the other lady didn't, and Mom felt horrible survivor guilt about how she was offered a treatment not available to all patients with the same disease. This trend is especially important to people with little-known medical problems like Cushings, which is already underdiagnosed, repeatedly blown off, and requires a doc to fish around doing testing to find. Mangedcaritis will mean an even longer time between symptom onset and treatment for Cushings folks, more folks who get no treatment because they give up trying to get help after repeated attempts. We all need to be aware of what it means when insurance companies dictate our medical care, and we need to scream bloody murder when they try to get more power -- because that's what it will become, murder via conspiracy to save $, when more people don't get necessary treatment because the physicians are trying to hard to do the insurance company's will. Please consider contacting your legislators and doing whatever else you can to stop this trend. Thanks for letting me rant.
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