On March 12, a popular Pacific Grove medical office sent letters to more than 4,000 patients notifying them that 1,100 of them could convert to a membership option. The others would need to find new doctors. The membership fee would be $840 a year and payments would be required before appointments could be scheduled after April 1.
That didn’t leave much time for nearly 10 percent of the population of Monterey and Pacific Grove who see doctors in this office. This new “Club Med” practice warned that patients who don’t sign up may miss the boat on health care in Monterey County.
I am a small business owner who offers health insurance to employees. Our plan’s premium has increased more than 20 percent over the last two years. If we were to pay the additional membership fee, our payout to access a general physician would increase another 13 percent. What’s next? Will there be a membership fee to access the gynecologist, dermatologist, or urgent care facilities?
So what is offered through the membership model at this medical facility? Access to a physician 24/7 is promised. Consultations for acute medical problems will be scheduled within 24 hours. Patients need never wait longer than 45 minutes or they will pay you! Treatment plans for chronic diseases will be personalized, and acute medical issues will receive personal communication with a hospital-based treatment team, or possibly a home visit by the doctor.
It appears as though their membership package is built to support those with chronic or catastrophic issues, and doesn’t offer me much more than the standard services I expect from my physician.
Monterey County health insurance premiums continue to be among the the most expensive in California. Although premiums through Covered California may be more affordable, few local doctors accept Covered California plans. In an acute situation, out of network expenses may seriously affect a patient’s total financial liability.
I was relieved to learn that Community Hospital (CHOMP) accepts all Anthem policies (including Covered California), and was then discouraged to learn that CHOMP’s contracted physicians might not accept these plans and may bill separately for out of network services.
A recent Harvard study found that medical expenses are the biggest cause of bankruptcy, representing 62% of all personal bankruptcies, according to an article in Investopedia. It also said, “One of the interesting caveats of the study shows that 78% of filers had some form of health insurance, thus bucking the myth that medical bills affect only the uninsured.”
Although health insurance is more accessible, health care on the Monterey Peninsula is increasingly unobtainable. We all share responsibility for finding a solution. Our elected officials have a responsibility to be hard-fisted and demand that insurance carriers provide consumers with affordable premiums and physicians with fair compensation. Our doctors have a responsibility to service the needs of the community and to strong-arm insurance carriers for payments rather than their patients.
As residents, we have a responsibility to keep health care accessible to the community. For most residents of the Monterey Peninsula, membership medicine isn’t an option.
Donna Kaufman is a social entrepreneur, business strategist, and environmental planner. She is co-founder and chief strategy officer of NatureFootage.