A message from Dr. Sims about your insurance

Dear Patient,

Hello, Hello, Heller…as we approach the holiday season, there is much to think about and do in the Health Care and the Insurance Industry, we must think about:

Deductibles- the amount of money, our insurance companies requires us to pay towards our health care expenses every year.

Co-Insurance – is the additional amount of money that we must spend before the insurance will pay 90- 100% of the cost of our healthcare.

Co-Pay– The minimal amount we are expected to pay each time we go to the doctor’s office, emergency room, or urgent care facility.

Open Enrollment– The period each year you are allowed to change or modify your healthcare plan. Usually the month of November, but check with the Insurance companies.

HMO, PPO, POS, Supplement, Medicare…and on and on.

As a physician, I suggest you take the time to get familiar with these terms and for all of us with a health care insurance, please know that your deductible amount is reset every December 31.   I encourage you to get the most medical care for your money before that date if you have “met your deductible.”

Schedule now to ensure you are able to get a timely appointment before the end of the year. If you are changing health care insurance plans and you prefer to keep the doctors you currently have, me included, call the plan and ask them if Dr. Sims-Robertson is participating in that plan. Ask for a confirmation number for the conversation and keep it in your records.

There are so many changes in the health care industry that impact us all. Some are good, but some not so good. In order to keep doctors doing the best thing for the patient, it is imperative that we all examine our choices and engage our insurance companies.

A lot of pressure is on your doctor, not to spend reasonable amounts of time and money to diagnose illnesses. It is more intense each year.

Doctors are being warned/threatened by insurance companies that if they don’t limit the types of medications, tests, and treatments for every patient, they will be eliminated from a particular insurance plan.

For example: United Health Care eliminated over 300,000 doctors last year stating “they were trimming their Networks to better serve customers.” Imagine you were a cancer patient at Moffitt or John Hopkins, or just a lowly solo Practioner that provides the highest standard of care to every patient, and all of a sudden, you are told that in 60 days your or your patient’s insurance will no longer cover your treatment or services with your existing facility or doctor.

The doctor or facility has done nothing wrong but, spent too much money according to the Insurance Company on your care, money that is needed to be spent in the proper care and treatment of each patient, deserving the absolute best in medicine.

Think about why the pharmacy prices are unreasonably high for medications, and generics are being pushed so heavily.  Well, I will stop there and wish everyone the

Best in Health, Love and Joy.

As Always, I am,

Dr. Carol Sims-Robertson at your service

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