By Megan Anderson, APN

Whether you’re a health care provider or a consumer, we’re all familiar with this question.  As the health care landscape changes over time, I think we’re becoming more familiar with a negative answer.  The thing is that insurance was never really designed for prevention; it was designed to account for the unexpected.  

To put it in perspective, we are required to have car insurance in case we get into an accident (the unexpected).  Our car insurance doesn’t cover the cost of our oil changes, car washes, or even engine repair. We also all have homeowner’s or renter’s insurance, but this is designed for fires or floods or break-ins (again, the unexpected).  How amazing would it be if our homeowner’s insurance paid for new countertops or landscape design? It sounds absurd, but that is only because we’ve come to accept that if we want to make our homes or cars look nicer, that is an out-of-pocket expense.   

Sadly, insurance was not designed to provide the best options for patients in all situations, and while it may sometimes pay for “preventive/wellness” visits, I think we really need to change the way we make decisions around our health.  Instead of deciding on a medication or even a provider because of whether or not insurance covers the cost, we need to start asking ourselves “what is the best option for me with the least amount of side effects and risks?”

I can tell you that as a clinician, it is liberating to not have insurance guide my decision-making.  It is liberating to not be thinking about what diagnostic codes I need to use in order to justify my treatment plan.  Caring for a patient involves really getting to know them, and unfortunately “time spent” with a patient is not a high value for insurance reimbursement (and yes, “time spent” is actual diagnostic criteria).

I can appreciate that we all spend a lot of money for our insurance plans (I’m right there with you), but I would also encourage you to start treating your health with the same value with which you treat your other possessions.  I think it’s worth paying more money on the front end to eat clean, belong to a gym we LOVE, and do annual testing that might not be covered by insurance than it is to pay for exorbitant disease care costs on the back end.

I’ll get off my soap box now, but I’d love to hear what you think about this topic…