A Word of Thanks / Group Health Update

I wanted to come back and finish part II of the role of pharmacophobia (the irrational fear of medications) and the hope of getting well.  However, we are facing an unprecedented demand from patients and we are working as hard as we can to see as many as we can.  I haven’t had time to write.

First I want to share our appreciation for how well patients have understood our new policy of collecting deductibles up front. We realize that it is a hardship on many to have to pay at time of service.  However, as we learned the hard way last year, it is the only way we can survive.  With insurance companies now raising deductibles as high as $5,000, during our first months of the year, no one paid us.

This year things are much different thanks to our patients who are paying at time of service and we are grateful for that.  Our one mission for existence is to help as many patients as we can to get well. But to do that we have to find a way to continue existing and paying our own bills.

Group Health-HMO

We have patients calling us everyday who have Group Health HMO and want our help. Most of them have been referred by their HMO-contracted primary care provider. We try to explain that we can’t see them (unless they pay our discounted cash rate) and often they think they hear us saying that we have refused to contract with Group Health-HMO. However, nothing can be further from the truth.

In my old practice, 40% of my patients were Group Health-HMO.  Never, in a million years did I expect that when I created a patient-centered headache clinic that Group Health would refuse to do business with us, but they have.  They have such a strong political stance against us, that they willing to pay much more for inferior care.

Each time a Group Health provider sends us a patient referral, the referral is denied by Group Health. The person screening these at Group Health tells the referring provider  that the patient needs to see a non-headache specialist neurologists or a pain clinic within their system. The American Headache Society has been clear that non-headache specialist neurologists have little more to offer a headache sufferer than their own PCP and far less than a headache specialists. Pain clinics, while treating neck pain and back pain very well, do a poor job with treating headache patients. They also use very expensive and invasive procedures as their main method of treatment. But still GH prefers their headache patients go this route rather than to a board certified headache practice that has the highest patient satisfaction rate of any headache clinic in the US and who will cost GH much less.  I can’t get my head around it.

So, I am bringing this up again to set the record straight. We have fought with Group Health to become HMO-contracted providers for 4 years, taking this all the way to their corporate offices and even to the state insurance commissioner on the behalf of headache sufferers.  Group Health told the insurance commissioner that no one had ever requested our services. We have a file of almost 200 official requests by Group Health HMO providers for our services and we have had Group Health HMO patients calling daily since we opened our doors wanting to get an appointment.  I have no idea why they have taken this stance which is unfair to their subscribers who suffer from disabling headache disorders and who are not getting appropriate diagnosis or care.

We are once again applying to be HMO-providers. Things have changed that we are now board certified in headache medicine, one of only five practices with such credentials in the entire Pacific Northwest. If you are a Group Health HMO subscriber, contact your representative and request that they provide you the headache specialty care that you deserve at Pacific Rim Headache Center.  We will keep you posted if they come to their senses and listen to their subscribers this time.

J. Michael Jones, MPAS-C