Doctors fees

[VegasBella]

We've had a lot of difficulty with insurance recently. Our old insurance couldn't keep up with the legal changes so we opted for a new company which is going bankrupt apparently so we are getting new coverage with yet another company starting soon. Each time we change I have find new doctors and even change pharmacies. I have asthma that requires daily medication to keep it controlled. These constant changes are very stressful and time consuming. I wish it were all just one system.

 

[WinniWoman]

We've had a lot of difficulty with insurance recently. Our old insurance couldn't keep up with the legal changes so we opted for a new company which is going bankrupt apparently so we are getting new coverage with yet another company starting soon. Each time we change I have find new doctors and even change pharmacies. I have asthma that requires daily medication to keep it controlled. These constant changes are very stressful and time consuming. I wish it were all just one system.

It's crazy and, although I tend to lean on the conservative side politically, I honestly think we need a single payer system- like Medicare- for everyone- with optional supplemental insurance like the elderly have.

Just all way out of hand.....Obama care hasn't helped any of it...

 

[myoakley]

$1650. is a bargain compared to what my doctor charges. (Of course, this is Fairfield County CT.) I was shocked and horrified when I received a letter last year explaining that she was moving to the concierge plan, and that patients would have to pay $4000. per year (per family member) to continue to receive care. Needless to say, I am shopping for a new doctor. However, I am thinking that people who accept to pay this much are going to be very demanding patients and will expect the doctor to be at their beck and call 24/7. It remains to be seen whether doctors will rethink this arrangement a few years down the road.

 

[bogey21]

This would be ideal, but I bet there is no guarantee. I really don't see how this type of medical service would be more beneficial to the patient financially. Hopefully, enough physicians stick with the traditional practices.

I don't think anyone thinks that this is more beneficial to the patient financially. It is simply a way for those who can afford it to pay for more timely access and more personal service.

George

 

[SMHarman]

I'm generally a fan of self insuring, but not where medical care is concerned. I often see physicians & hospitals billing as much as 10 times the rates that they agree to accept from insurers or Medicare. This seems to be one area where it really can pay you to pay someone with power represent you.

Buying catastrophic cover achieves this and is a good add to self insured.

With a cat cover policy you submit the bill and pay 100% of the negotiated rate until you hit the cat limit.

Also you pay that through a HSA (a 401k for health bills) so pay it with pre tax money and once over $1000 is in there can invest it like a 401k

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[FLDVCFamily]

$1650. is a bargain compared to what my doctor charges. (Of course, this is Fairfield County CT.) I was shocked and horrified when I received a letter last year explaining that she was moving to the concierge plan, and that patients would have to pay $4000. per year (per family member) to continue to receive care. Needless to say, I am shopping for a new doctor. However, I am thinking that people who accept to pay this much are going to be very demanding patients and will expect the doctor to be at their beck and call 24/7. It remains to be seen whether doctors will rethink this arrangement a few years down the road.

That's exactly what I was thinking...these may be very "needy" patients, whether they are sick or not. The doctor could have whittled his/her practice down to just the most demanding of patients. If they get enough calls at 2am for a hangnail, perhaps this practice model won't seem so appealing after a while.

Also, the constant need to market the practice in order to get that 4K a year is going to get old...

 

[Passepartout]

I hope my PCP doesn't see this thread and get the idea of upping his income by pre-gouging his patients. While I can see it from the doc's point of view as 'thinning the herd' of patients to those who can (a) afford the surcharge, (b) are willing to also be an active participant in their own healthcare, and (c) feel that seeing fewer patients, for longer appointments somehow equates to healthcare more closely aligned with their view of the community needs. I can certainly also see it from the point of view of a patient who sees it as greed. Price gouging. Healthcare rationing. Elitism.

It reminds me of places in the world where there is a single-payer system in place for the masses, but if you want specialized care, when you want it, you go to a private clinic or hospital and pay, pay, pay.

Jim

 

[geekette]

What would happen if there was no more insurance?

• Working class people who live from paycheck to paycheck would not be able to get to work if their cars died and they didn't live in an area with great public transit;...

I remember what it was like when insurance didn't pay much for office visits. Your child fell at school and was limping, and you'd let them limp for awhile as long as they weren't crying, etc.

Fern

Never have I had car insurance that covered car dying, only accidents. Maybe this coverage is available but I bypass it?

Thank you for explaining why I went around with a broken arm for weeks when I was about 4.

 

[ronparise]

What would happen if there was no more insurance?

• Working class people who live from paycheck to paycheck would not be able to get to work if their cars died and they didn't live in an area with great public transit;
• People who lose their houses in a fire wouldn't be able to rebuild;
• People who are robbed/burgled would be unable to replace anything;
• People without health insurance may not get vaccinations and spread diseases which are avoidable through vaccines;
• People without health insurance who have chronic health problems which require treatment will die if they can't afford treatment.
• Add your own items to the list...

I remember what it was like when insurance didn't pay much for office visits. Your child fell at school and was limping, and you'd let them limp for awhile as long as they weren't crying, etc.

Fern

Its not health insurance or the quality of health care that's the problem, its that both industries are "for profit".

 

[SMHarman]

Its not health insurance or the quality of health care that's the problem, its that both industries are "for profit".

And the health care billing industry. That's an only in America thing.

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[geekette]

Its not health insurance or the quality of health care that's the problem, its that both industries are "for profit".

I agree, Ron, it would be nice to take the profit motive out of misfortune of others. At least health insurers now have a requirement to spend a % of premiums collected on actual patient care and refund if that didn't happen. I have never gotten a refund on car or house insurance for not using it, and in fact get charged more if I use it! booo!!!

I would far rather self-fund but state law says I have to have car insurance, fed law says I have to have health insurance and my mortgage holder says I have to have home insurance. oh well...

 

[ronparise]

And the health care billing industry. That's an only in America thing.

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I spoke at length to a Canadian client of mine about our respective healt car systems he is a doctor

The only difference between a Canadian doctors
office and a USA doctor is that the Canadian doctor doesn't have to hire an insurance company liaison and a billing staff nor do they have to hire collection agencies to collect their money

He notifies the provincial government and he he gets paid

The really big difference is that he can talk to his patient about their care without a discussion of how they will pay for it and without asking their insurance companies permission

 

[am1]

Best of both worlds? I think a minimum safety net is a must and would keep overall costs down. The Canadian system may be too expensive and people with money go elsewhere anyways for operations.

It reminds me of places in the world where there is a single-payer system in place for the masses, but if you want specialized care, when you want it, you go to a private clinic or hospital and pay, pay, pay.

Jim

 

[VacationForever]

Its not health insurance or the quality of health care that's the problem, its that both industries are "for profit".

Don't be confused by "for profit" vs. "non-profit". There is not a difference, the former has "stockholders" to pass profits on to while the latter passes profits back as higher CEO and staff wages etc. Kaiser Permanente here in CA is non-profit but their employee wages surpass other "for profit" healthcare systems. Premiums at Kaiser is also higher than other health organizations.

Every business's prime goal is to not go out of business. When we see these concierge / boutique doctor practices levying extra fees, I can bet you that they are not laughing all the way to the bank. It is likely to be something that they need to do to remain in business.

 

[ronparise]

Don't be confused by "for profit" vs. "non-profit". There is not a difference, the former has "stockholders" to pass profits on to while the latter passes profits back as higher CEO and staff wages etc. Kaiser Permanente here in CA is non-profit but their employee wages surpass other "for profit" healthcare systems. Premiums at Kaiser is also higher than other health organizations.

Every business's prime goal is to not go out of business. When we see these concierge / boutique doctor practices levying extra fees, I can bet you that they are not laughing all the way to the bank. It is likely to be something that they need to do to remain in business.

Im not confused, I was very careful not to use the term "non profit"

I want a system where we all pay according to our means and we recieve according to our needs. Medicial school and research ought to be paid by us all in the same way as well

 

[Fern Modena]

Don't know if this is OT or not.

I recently had to go to Urgent Care for a wound on my hand which had difficulty clotting and then reopened on Day 2. Also needed a tetanus shot.

I called my PCP first. She said I should go to Urgent Care because her (group) practice doesn't stock tetanus shots any more, nor do they do stitches.

I hate Urgent Care. The waits are long (no appointments), and I feel the care is substandard.

I was seen by a physician's assistant, who is the only practitioner there. He looked at the wound, which had stopped bleeding finally, and then left, wrote some notes, and sent in a medical assistant to put ointment on it, three steri-strips and a bandage. She then gave me a tetanus shot.

They billed my insurance $200. for an outpatient visit, $100. for debride of skin/tissue, and $95. for the tetanus shot ($50. for the medicine and $45. for administering the shot, two separate items).

Office visit had a $106. write off, and after Medicare and secondary ins paid I owe $2.85. The shot write off was $35.66 total, and my share was $2.96.

BUT HERE IS WHERE IT GETS INTERESTING...Medicare paid nothing for the debriding of skin/tissue. My secondary stated that since it wasn't an item Medicare paid for, they wouldn't either, and that I had no liability. The Urgent Care billed me $59.18 after a write of anyway.

There was no debriding done, it was a false charge to begin with!!! I called their billing people, and they tossed it around for awhile, even after I told them that A--such a treatment had not been done, and B--my insurance said I wasn't liable for payment anyway.

I told the biller I wasn't going to pay, they needed to investigate. I called back yesterday (since she hadn't called back) and she said she "just found out" the bill was in error and I owed nothing.

I know it wasn't a lot of money, but it was fraud plain and simple, and I wasn't going to pay it. You have to keep after your medical bills.

Isn't it amazing how much they inflate the bills compared to what they'll accept to settle them?

Fern

 

[SMHarman]

It reminds me of places in the world where there is a single-payer system in place for the masses, but if you want specialized care, when you want it, you go to a private clinic or hospital and pay, pay, pay.

Jim

The UK NHS has these tiers.
Tier 1. free at point of use NHS. HMO model with everything first through your PCP.
Tier 2. Private top up cover. If the NHS wait is too long you get the treatment done privately. Top up policies are low cost as they don't inclued what the NHS excels at. Delivering Baby's, ER etc. This actually assist the NHS by removing consumers from the system and redirecting them.
Tier 3. Pay pay pay. Harley St and all that.


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[Passepartout]

The UK NHS has these tiers.
Tier 1. free at point of use NHS. HMO model with everything first through your PCP.
Tier 2. Private top up cover. If the NHS wait is too long you get the treatment done privately. Top up policies are low cost as they don't inclued what the NHS excels at. Delivering Baby's, ER etc. This actually assist the NHS by removing consumers from the system and redirecting them.
Tier 3. Pay pay pay. Harley St and all that.


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Much the same in Mexico, India, Thailand, others. Basic- safety net medical care underwritten by government, then private care for those who can- or choose- to afford it. Elective care- like plastic surgery, eyeglasses, dental- non emergency, e.g. orthodontia, is fully optional at extra cost. I suppose insurance can be bought to cover the 'upcharge', but don't know the numbers. Then there are places like Germany, Japan, France where top tier medical care is fully covered.

 

[SMHarman]

Much the same in Mexico, India, Thailand, others. Basic- safety net medical care underwritten by government, then private care for those who can- or choose- to afford it. Elective care- like plastic surgery, eyeglasses, dental- non emergency, e.g. orthodontia, is fully optional at extra cost. I suppose insurance can be bought to cover the 'upcharge', but don't know the numbers. Then there are places like Germany, Japan, France where top tier medical care is fully covered.

The UK tier 1 is no more basic than tier 2. It just has no spare capacity, so that MRI is at 4pm on the 28th. Not when it suits you.

http://www.medicalnewstoday.com/releases/299583.php?tw

Shows how well the PCP work.

Likely you are also seeing the same doctor. M-W NHS Th and Fr private.

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[WinniWoman]

I am sitting I a doctors office right now. Had a 3:45 appt. It is now 4:10. 5 more minutes and I am walking out. Another issue with these MD offices. My time is just as valuable. I am not going to wait more than a half hour.

 

[isisdave]

That's exactly what I was thinking...these may be very "needy" patients, whether they are sick or not. The doctor could have whittled his/her practice down to just the most demanding of patients. If they get enough calls at 2am for a hangnail, perhaps this practice model won't seem so appealing after a while.

Also, the constant need to market the practice in order to get that 4K a year is going to get old...

These docs are typically in a group practice, so they're only on call for midnight hangnails one night a week.

I just got an ad from a new local group. It is $1650 each, but that includes office visits and a short list of other services.

 

[isisdave]

I am sitting I a doctors office right now. Had a 3:45 appt. It is now 4:10. 5 more minutes and I am walking out. Another issue with these MD offices. My time is just as valuable. I am not going to wait more than a half hour.

Everyone's time is valuable. But, the alternative is for the doctor to say "gee, I'm only halfway through fixing this, but your time slot is over, so see ya!"

Really, what's your suggestion? A rule of life I've observed over many years is Things Often Take Longer.

I try to book appointments very early in the day or right after lunch.

 

[presley]

I just got an ad from a new local group. It is $1650 each, but that includes office visits and a short list of other services.

I'm curious what things it pays for. I can't imagine why anyone would go to the doctor enough to warrant $1650./year. Maybe things are different in different areas. Here, the doctor is only a doctor visit - maybe 10 minutes between interview and exam. All labs are done at the lab. All tests are done at other places. Urgent care and emergencies are handled at Urgent Care and at the hospital. I cannot imagine getting anything from the doctor worth anywhere near that fee.

If I found a doctor who did labs, X-rays, urgent care and other services for an annual fee of $1650., it would be worth it to me.

 

[WinniWoman]

Everyone's time is valuable. But, the alternative is for the doctor to say "gee, I'm only halfway through fixing this, but your time slot is over, so see ya!"

Really, what's your suggestion? A rule of life I've observed over many years is Things Often Take Longer.

I try to book appointments very early in the day or right after lunch.

Uh- well that is what I normally do. I work in healthcare so I know the drill. I always had the 1st appt after the doc's lunch which coincided with my lunch break. A few times I have gotten first appt in the morning, but it always seemed like the doctor got in late.

I had to call for this appt. months in advance- it is just an GYN annual exam. The 2 docs I normally would see are no longer working in the office near where I work. So I had to take a late afternoon appt. in an office near where I would be working today (I work out of different offices). I think waiting 30 -40 minutes is the max a person should have to wait, unless the doc has a REAL emergency. At the very least, the staff could tell you how much longer he might be or whatever. I work with doctors all day, so I know what goes on in these offices and how they schedule and so forth. I have already had to go through 4 docs here over the years- 2 retired. These next 2 merged in with a big monopoly group and now the scheduling is all messed up.

I finally got up after 30 minutes. No front desk person to be found. So I walked down the hallway and found someone else. Nicely told her I was leaving. Asked to reschedule. Well- hmmmmm- all the annuals are booked. Can I have the 1st appt. after one of the docs gets back from lunch? Or. first thing in the morning before he gets backed up. Hmmmmm....- now 10 more minutes goes by. You know what? I have wasted enough time. I am tired after work. I'll give you a call tomorrow and check my own boobs tonight in the shower!

Now- if I was sick and /or in pain/ or needed medicine, I would have no choice to wait. Unfortunate for poor people in this situation.

 

[Beaglemom3]

I am sitting I a doctors office right now. Had a 3:45 appt. It is now 4:10. 5 more minutes and I am walking out. Another issue with these MD offices. My time is just as valuable. I am not going to wait more than a half hour.

Do you have any idea why that happens ?

Someone books an appt. for "GI" upset. Upon close examination and evaluation, it turns out to be something concerning, so an EKG is done and an it's ominous. So arrangements are made to get them to the ER.

Someone comes in with a headache, but it's not a headache, it's something potentially lethal. So the clinician arranges for this person to have a CT/MRI and consult stat.

Someone comes in with bronchitis, but it's probably pneumonia.

Someone comes in with feeling "generally unwell", so it's the clinician's job to connect the dots and figure things out. Frequently, the patient is a poor historian and it takes much longer.

Someone is squeezed in for bad flu symptoms due to being infected by someone who should refused to take the flu shot, but you have to get them over to the hospital for a couple liters of rehydration.

ETA: The two patients before you arrived late making all other appts. late.


For someone who says that she is/out of medical offices for work, I would think that you would not feel so entitled.

Mind you, the clinician probably hasn't had lunch or had a bathroom break.


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