Insurance Companies are NOT your Doctor

By Michelle Flaat, Executive Director of the Emerald Coast Medical Association.

It’s that time of year again…Open Enrollment for Individual Health Insurance plans. Confusing information and sometimes empty promises will be made by a multitude of insurance companies about their plans. Medicare-eligible patients will be inundated with marketing materials that promise you can have the best care with a $0 premium. Younger people will be enticed with calls, emails, and advertising that promise good health if only you purchase the right insurance plan with their insurance company.

I want to provide you with insight and information to help you make your decisions with a dose of reality.

1. Your insurance company is NOT your Doctor. And when I say Doctor, I mean your physician, an MD or DO. Other health care providers with the title of Doctor hold a Ph.D. in their field of study such as Nursing or Physical Therapy and are not to be confused with the rigor it takes to become an expert and hold a degree in Allopathic (M.D.) or Osteopathic Medicine (D.O.).

2. Look carefully, ask questions and talk to your physician’s office before changing plans, the insurance company may give you a list of providers that include your physician’s name, but the list could be outdated. Nothing is more important than having a say in who your physician is and having the ability to see the specialists you need.

3. Understand that your physician will at times have to fight your insurance company on your behalf to get approval for the right medication or procedure to treat you. If your physician is employed by the insurance company do you think they will fight their employer on your behalf? There is a trend of clinics opening that are owned and operated by insurance companies, be aware and do your research. Nothing can compare to the relationship you have with your physician and their staff.

4. For Medicare patients specifically: It is always enticing to hear that you could get a supplement plan at no cost to you. Ask questions and understand the limitations of that coverage. These Medicare Advantage plans can be very restrictive and are based on cost you more out of pocket to utilize it. Many times, if you see a specialist for your condition, they will not be covered in that plan and your out of pocket costs for treatment will far outweigh the premiums you would have paid. The contract physician, in-network for your plan, may be 2 hours away.

5. Be realistic about your health status. Prevention is far more affordable than treatment. Again, you need to see an expert, a Physician, on a regular basis to stay on top of your health and prevent disease. As the mug in one of our member physician’s office says: “please don’t confuse my medical degree with your google search.”

6. Pharmacy benefits: If you know you need a specific drug look carefully at what the plan covers. You can never predict when you will need medication so again understand what your options are. I personally know stories of physicians calling and fighting the insurer on their patient’s behalf. The insurance companies hire physicians (not necessarily from Florida) to approve/deny exception requests for medications outside the approved drug list. You want your personal physician to be free to work on YOUR behalf in this process. Your insurance is a financial agreement and the physicians working for your insurance company to review claims and authorizations do not even have to be of the same specialty as your physician. Example: your Dermatologist is trying to get approval for a drug to treat your skin condition and the specialist they need to get approval from with your insurance company is an ophthalmologist. ECMA also partners with Florida RX card to offer medications at a discount. Go to our website to download the card and find out which pharmacies offer the best price on specific drugs.

7. Remember that an insurance company provides financial aid for the costs incurred for your health care. They may deny coverage, no matter the consequences, as it is not their responsibility to take care of you, just help pay the bills. Only you and your doctor are responsible for your health. An insurance company has a contractual responsibility to cover some health care items incurred and no more.

With all of that said I hope each of you are able to find a plan you can afford. If you don’t already have an established physician, I strongly recommend you choose a member of the Emerald Coast Medical Association. They are a strong group of physician leaders who spend countless hours outside of their own practice planning, advocating and learning to take the best possible care of you! Go to to access our Doctor Directory or call and I’ll be happy to guide you to the best physician for your needs.

Give yourself the gift of good health in 2020 by choosing a physician and an insurance plan that will allow that physician to make the best medical decisions for you.