I was stunned into silence at a recent doctor appointment, one not related to my multiple sclerosis (MS). The doctor was describing a possible treatment for a medical issue when she said, “oh, and Medicare will cover it.”

The shock was not about whether or not the procedure is covered by insurance, it was stunning because of the person who said it. Whenever the question of insurance came up, it would be answered by administrative personnel, and not the physician. In my experience, insurance was the purview of the office staff.

On one hand, I was happy my treatment was covered. On the other hand, it disturbed me because insurance specifics ultimately dictate the treatment option or care.

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What struck me at that moment is that there was a possibility that my previous healthcare options could have been predetermined at the time of diagnosis. What if a needed procedure was not covered? Would that have even be presented to me as an option? On the flip side, was I offered a procedure solely because it was covered. 

The rules of medical coverage are so byzantine there is an entire profession dedicated to figuring out the various codes and minutiae from the plethora of medical insurance plans available, both private and public. What we do know is that private insurance is routinely preferred because of the higher payout and faster turnaround. Many practices will not take government insurance programs like Medicaid and Medicare precisely for this reason. 

Insurance bias does exist. A study published by the American Public Health Association reported healthcare professionals said they omit potential treatment because their patient’s insurance would not cover the procedure.

The popular thinking is why offer an option that was not feasible. This, in my mind, goes along the same lines of offering false hope. While there is always the risk of disappointment, healthcare professionals should consider airing on the side of disappointment to ensure the patient understands the full scope of treatment options. 

In an MS social group, we regularly discussed insurance. Most of the discussion revolved around how to get our preferred treatment covered by insurance. One of the most irritating tales was experienced by a woman who had to deal with TRICARE, the medical insurance for our military members and their families that is known as notoriously difficult. Whether it was public or private insurance there were often barriers to be overcome.

We may have had different stories, but one thing was the same. We all wanted to know what our healthcare options were. It did not matter if it was covered by our insurance or not, we still wanted to be informed. If you are in a position to recommend a procedure or treatment, please keep in mind that we are not our insurance. Let us know what options are on the table and we can decide from there.