Beating The System

Open Enrollment season is coming to a close. The big challenge in Ohio is to pick the health insurance plan that will give you access to the doctors and hospitals you would want to utilize if you get sick or injured in 2019. If you are under age 65 in Greater Cleveland and paying for your own coverage, you only have one option to access the Cleveland Clinic, the Cleveland Clinic + Oscar plan. If you would like to get into the University Hospital system or Lake Health, you will choose Medical Mutual of Ohio. These policies are HMO contracts. Unless it is an emergency, you must use the doctors and hospitals in the system. Many of us have doctors in both systems. That doesn’t work. You must choose one system or the other.

This has put more than a few of us in a bind. Do you retain your cardiologist and find a new pediatrician for your kids? Which relationship is more important, the long held one with your psychiatrist or your comfort with your gynecologist? My advice to my clients is to choose the system, not the doctor. You can’t chase doctors. Not in Ohio.

As I’ve mentioned previously, I had a little health adventure in 2016. I took control of my care in early 2017 and put together a new team. A key member of this team is my oncologist. Great guy. He’s the one who orders the twice a year tests, including CT Scans, and then reviews them with me a week later. He always answers all of my questions. The last time we met I had one last question for him, a personal one. I wanted to know how he was doing since he seemed to be more focused on research than billable patient appointments. He assured me that he looked forward to our next visit in May 2019. I got a letter in the mail today from University Hospital that my oncologist had moved on and that the system would help me find a new doctor!

You can’t make a health insurance decision based on doctors. If you base your choice on doctors, you lose. You choose the system and find a doctor within it.

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I had a pain my chest. It had bothered me for about a week. It might have been just indigestion, but I wasn’t sure. I could go to the doctor. I didn’t want to blow $50 or $100. I found out that my friend, Frank, had the same pain. I talked him into going to having it checked out. If it was nothing I beat the system and saved some money. The next day I heard that Frank had died. I rushed over to the Cleveland Clinic and got an executive physical. $2,000! They poked and prodded me and then told me that I was suffering from indigestion. I went to Frank’s house and asked his wife if he had suffered. She said, “No. He died the moment the bus hit him.”  A Woody Allen classic updated slightly.


Picture – David L Cunix – A Different Bus

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