Which one are you?
EDIT: This was a sincere question, and no judgements of any kind were intended.
Does it matter?
A fat doctor smoking a cigarettes is still right when he tells you to lose weight and quit smoking
But for the record I make about 50-60k a year and have high deductible insurance. I could potentially make substantially more but I don’t because I have a large number of sliding scale slots to subsidize the care of people who have financial need, at my expense, because the system is bullshit
I have colleagues who do not do this and work the same amount of hours as me and easily clear 70-80k thanks to a combination of no sliding scale and much more draconian no show penalties assuring they always get paid even when someone doesn’t attend (some charge as much as $100 for missed appointments)
Some colleagues curate the insurance panels they’re on so they maximize payment amounts. Some eschew insurance altogether and only take out of pocket payments, usually far more than what any insurance would pay (over $150 an hour). These tend to make over six figures
But even if I was in the latter categories that wouldn’t change that it was correct (although it would make a hypocrite tbf ig). Insurance is a collectivist concept for the greater good and cannot work without someone subsidizing someone else, typically the young subsidizing the old. The only way you escape the need is being healthy forever (unlikely) or being obscenely wealthy (far more unlikely)
No judgements whatsoever, I was just curious. And TBH your situation is very interesting and illustrative of the problem, whilst also being clearly awful and kind of confusing. I would bet any non-americas reading it would be completely lost. I actually had to explain our insurance system to a new co-worker in India because I suddenly work in the fucking insurance industry due to a recent merger. I pulled zero punches, and fully let loose with how completely bonkers this system is. The dude is super cool though. We do have the high-deductible options, but I just could not math those out to make any sense whatsoever.
Often the high deductible options do financially make sense if you are in a place where spending the deductible each year isn’t a burden. They can even be advantageous if you are healthy; in that scenario they are essentially “hedging your bets”. You can save a substantial amount over a ppo if your utilization is low and typically if you just spend to the deductible the cost is about the same.
It’s the coinsurance afterward that can be a killer, especially if you have a chronic illness that requires a lot of expensive stuff. A PPO caps everything at a copay amount (which, tbf, can sometimes be quite high), but coinsurance can be 10-30% sometimes (maybe higher but that’s the highest I’ve seen). And if you have cancer, or some other nasty thing that requires expensive scans, medications, bloodwork, etc, paying 10-30% of the bill is still a shitload of cash. Thankfully there’s still an out of pocket max but that’s often quite high
And tbh I took your statement as judgey. I’m glad it wasn’t, thanks for clarifying. But that’s one of the issues with such a system. My colleagues who don’t do what I do are absolutely judged. But at the same time I do not judge them (usually, lol). This is not a sustainable setup. It is not sustainable to ask individual practitioners to take on the financial burden. It harms the relationship between practitioner and client, it’s destructive and can breed resentment. It results in quality of life issues for practitioners like wildly unpredictable pay. I could go on.
Ideally we would just be paid an actual salary, an actual living wage, with benefits, to work with a set number of clients, but with the current system this is functionally impossible. If we had a single payer system this would be easily feasible, all healthcare staff could be government employees basically. Good luck getting most doctors to support this though. They love padding billing under the current system
