Barriers to Care - It Shouldn’t Be This Hard

In the past couple months, a large healthcare system in my area went out of network with one of the largest insurance providers in my area. This means that thousands of patients are now being forced to find new care providers (even if they’ve been seeing their current ones for years) or pay astronomical out of pocket expenses (because our healthcare system isn’t set up to be affordable without insurance). This means that there are also many pregnant families that now have to find new pregnancy care providers, which could mean they have to travel farther from home, give up relationships that they’ve already established with trusted physicians, navigate the complexity of paying higher out of pocket expenses, and let’s not forget how much more complex all of this is if a NICU stay is involved. It shouldn’t be this way.

For me personally, I was approved for continuity of care since I am so close to my estimated due date, and transferring care would have a negative impact. However, I can tell you that I am still worried about all of my claims processing correctly on the backend (the healthcare system billing them correctly and my insurance processing them correctly). I am trying to prepare myself to fight an administrative battle all while being only a few weeks postpartum so that we don’t receive a crazy bill at the end of all of this. Even with an approval for continuity of care, I am still worried that it will be a financial battle. Again, it shouldn’t be this way.

This large insurance provider going out of network with this large healthcare system is just one example of the many ways that patients are forced to carry administrative, financial, and logistical burdens when trying to access quality care. However, through this scenario, one positive outcome could be the migration of care to a system that does not rely solely on health insurance to be affordable (and is it really even affordable if someone’s deductible is $8,000?). There are more and more providers in the mid-Missouri area that are starting to offer services on a self-pay basis, and this often speeds up the patients’ access to care, reduces administrative burdens (for the patients and providers), and lets the patients and providers decide what is truly medically necessary (not insurance companies). The main downside to this is that many are still doing “the right thing” and paying for health insurance since the cost for healthcare is so elevated. So, it’s often not easy for many to forgo using their insurance because then they don’t get closer to meeting their out-of-pocket maxes, and they are paying monthly premiums for insurance that they don’t end up using.

As I mentioned earlier, logistical burdens are often very real within the healthcare industry. It can be hard to find providers that fit with your values, specialize in the care you need, and are close to home. A great resource for pregnant families was just published this week - it’s a resource guide with a list of a variety of providers that you may need in mid-Missouri. Here is the link. This resource guide is just one small tool that families can use to find the care they need, but it can make all of the difference when you need to find care quickly.

This blog post hasn’t even begun to scratch the surface of all of the barriers that exist within our healthcare industry. However, I wanted to share to encourage all of us to start thinking about how we can contribute to making a positive impact. This will often just be at an individual level, but this is where we can likely make the most difference.