Dining out insurance-no guidelines

Not from my wallet

Here’s the deal, I am now offering dining out insurance.  That’s right, you buy my insurance and you will be reimbursed for eating in a restaurant.  Here is how it works.  You can go to any restaurant you like, no one will interfere with your choice or what you and the chef decide to have for dinner.  Appetizers are covered 100%,  no deductible so chow down.  Pick what you like for an entree and we reimburse 80% of the cost.  Desserts cost a bit more, because they are really quite elective there is a 5% surcharge if you have dessert.  But hey this is a pretty good deal, you pay your premium each month and after that there are no questions asked, not even any guidelines to worry about, it is entirely up to you and your waiter and chef what you eat and how much.  Are you interested in a policy?

I want a free piece of pumpkin pie

I’m mad as hell and I can’t take it any more.

Medical guidelines are an interesting thing, we soon forget they are guidelines and we quickly assume that they are only valid when covered by insurance.  We also assume that insurance companies following guidelines  means that we may be denied the test “we need.”  Today it is PAP tests, yesterday mammograms, the week before PSAs and prostate exams.

Republicans see this as an example of bureaucratic interference in our health care, people affected see it as a slap at their quality health care, I say hooray!

Make a list of all the things you cannot afford. Let’s see on that list will be:

  1. Annual flu shot
  2. Mammography
  3. Routine office visit
  4. PSA test
  5. PAP test

What is not likely to be on the list is:

  1. Dinner at Olive Garden
  2. A trip to the nearest casino
  3. A carton of cigarettes
  4. Premium cable TV
  5. Coffee at Starbucks
  6. An oil change for the car or new tires

All that medical stuff is sooooo expensive, well perhaps it would not be if we paid for the basic stuff ourselves and we complained about the cost of the $200 mammogram.  Did you ever stop to think that the medical stuff costs what is does in part because nobody cares what it costs or asks about it?  Have you considered that health insurance premiums are so high because the plans cover so much stuff that should not be insurable?  Well, think about it, we surely cannot count on Congress to do the thinking.

I have been perusing a number of blogs where the debate rages on about the mammogram controversy and in many cases the tone of the comments is that now insurance companies will deny the mammogram and people will have to go without.

Flash, insurance companies do not deny coverage they deny paying for it.  You can spend your own $200 each year for a screening, go to it if it is important to you. Why wouldn’t you spend the $200 and skip a night or two out if you have to?  Why, because we don’t want to spend $200 of our hard earned money on something that does not give us pleasure and a prostate exam or mammogram sure come under that heading, but it is still the same $200 no matter how we spend it.

We have this discussion of health care costs backwards and we keep reinforcing the wrong attitudes.  Pending legislation makes it even worse by mandating that more and more services be reimbursed at 100% and by diluting the value of flexible spending accounts and health savings accounts that help people manage health care spending with their own money.  For Pete’s sake how dumb can we be (I suspect we have a ways to go)?

A few years ago, the wife of an employee called me and wanted to know why Lyme disease vaccinations were not a covered benefit.  I explained they were routine preventative and not covered thus the employee’s responsibility.  She then told me flat out that if one of her children died from the disease she was going to hold me responsible.  I said she was free to have the shots on her own.  “You expect me to pay for the shots, they cost $60.”   I have never forgotten those words because they sum up the general American attitude about health care costs.

PS  Her children were under age 13 and not eligible for the vaccination in any case, but that didn’t seem to matter…damn those guidelines.

You have heard NIMBY, now you have heard of NFMW (not from my wallet).

Not only do each of us approach the purchase of health care wrong, now our government is making one of the biggest mistakes in history and all we seem to do is couch the debate in political terms.  Federal, state and local government spend more on health care for the older population than on education for children and that is today before the baby boomers are well into Medicare.  Shifting some of those costs to the private sector and raising taxes as proposed legislation is doing does not solve the problem, but most of our politicians are more worried about the 2010 elections than truly addressing the issues.

By the way, after a year or so, I suspect my new insurnace company will need some TARP money to get us by.



  1. This is part of the entitlement mentality that somehow has imbedded itself into America’s psyche. It is also fed by politicans commenting about health care reform promising to cover virtually any condition. I do not know how this thinking can be cured except for the system to blow up.


  2. Sadly, over the past fews years I’ve fallen into the trap of telling (implying) that a patient can’t have a particular product because the insurance plan “won’t allow” it. I used to explain that they just won’t pay for it but the patient interperts it in the latter manner, so I guess I’ve given up. You are right about our priorty lists. On the other hand the insurance plans must share alot of the blame. They have educated (advertised) the your heathcare “will not cost you a dime”
    An amusing real story. I had a patient come into my pharmacy with a prescription for a pain reliever. When I submitted the online claim, it was rejected because for some reason his eligibilty expired. I offered him the medication for $5.95 (his copay should have been $4.00) but he refused because the “damn insurance company” must have made a mistake with his payment and he was going to MAKE them pay…..tommorrow. I guess he was so mad that he forgot his tooth was extracted today. On his way out he went to another area in the store an bought a pack of cigarettes, at the time they cost about $6.00…go figure


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