<p>Sorghum-
Say you have a procedure done for which the Dr. charges $5,000. The Dr has a contract with your insurance carrier and must accept their allowable rate of $2500. Your cost (out of pocket copay ) is $20. Who is paying this bill?</p>
<p>But I don’t get it, without us paying the insurance, the insurance carrier wouldn’t pay the bill. We are indirectly paying the bill.</p>
<p>The employee pays all or part of their insurance to maintain their insurance, regardless of whether they ever see a doctor. Its like auto insurance that we all carry, regardless of whether we ever have an accident. thats why its called “insurance”. The issue of who pays for the insurance is tangentially related to who pays the Dr.</p>
<p>Right, DrGoogle. If you dont pay your premium, you dont have insurance. And then you get to be the direct customer because you are a private pay patient with no healthcare coverage.</p>
<p>“The Is your provider in individual practice or in a group practice?”</p>
<p>The provider is in a group practice. It’s a pretty big practice, with a number of clinics in the area, and several specialty doctors involved.</p>
<p>So in your case, busdriver, the big multi-clinic, multi specialty practice probably negotiated a pretty good reimbursement rate, because they have a lot of leverage as a big game in town. </p>
<p>The saddest thing I’ve seen is when large provider groups and/or hospitals get into a stalemate with an insurance carrier and announce that they will no longer be accepting that insurance. In most cases it gets resolved, after it hits the papers and upsets thousands of patients, but in some cases the facility stands firm, no longer accepts that insurance (and it may simply be fiscally unmanageable to accept the rates being offered, keep the doors open and provide good care), and in several cases scheduled procedures had to be cancelled because the facility would no longer be in network with that insurance carrier.</p>
<p>I never had that problem. My neighbor closed his practice and joined Kaiser because was hiring like crazy and he thought there is a small window of opportunity to join. His wife still has her practice though.</p>
<p>can you clarify post 226, drgoogle? You never had what problem?</p>
<p>Yes, that would be sad, jym. Would be very tough to lose a doctor you loved because of insurance. I know that was a huge problem around here because the ACA insurance wouldn’t cover some of our top providers, including Childrens Hospital and Seattle Cancer Care Alliance. Don’t know if they’ve worked it out, but some people were really counting on having those doctors and procedures done by the top specialists. A friend of mine started advising her patients to go on Medicaid if they could find a way to, because Medicaid would cover it. That’s just sad.</p>
<p>We’ve never had anyone not accept our insurance, BC/BS, except my bioidential doc, but they accept no insurance.</p>
<p>Its more likely that the top providers wouldnt accept ACA, not the other way around. </p>
<p>Actually, I don’t think so, in this case. There was a huge hubbub about it. The Children’s Hospital actually sued because they were excluded from the exchange. In fact, I think many of our top hospitals here were left off the exchange. I hope it was worked out, because people were very unhappy.</p>
<p>“Well I KNOW who pays the bills - the patient. Who pays for the insurance?: either the patient, or the employer as a part of the patient’s compensation. Any way round the patient, as customer, is paying AND demanding better service.”</p>
<p>If you are paying the actual cost of your health insurance, and you negotiate the rates and the terms, than you are the customer, but hat is not true for most people. And that would make a much more educated and powerful consumer than most. That gives you the right to prioritize timeliness and apologies, while most larger folks are negotiating have different priorities . Don’t get me wrong;they DO value customer satisfaction. But they also value how fast you get your records done, how many patients you see, how much you cost, and a host of other things. To most of us, it feels like we work for your employer, and by extension, for our own. </p>
<p>Down on the ground, the devil is in the details. If I say okay, and give the rx, and get put on time rather than take the time to explain, how does that affect your priorities, and your employers? Potentially makes everyone happy nut keeps me up nights. Or it did. </p>
<p>But like I said, now I am punctual and can apologize like a pro!</p>
<p><a href=“http://seattletimes.com/html/localnews/2022371201_exchangenetworksxml.html”>http://seattletimes.com/html/localnews/2022371201_exchangenetworksxml.html</a> interesting</p>
<p>Yes, jym, I think that may be an issue for many top providers in other cities too. The ACA doesn’t want to cover the expensive (but sometimes the best) providers. They just aren’t willing to pay the money.</p>
<p>It’s definitely an issue in other areas. In my city lots doctors are not taking ACA insurance, either. Low reimbursements are the stated reason.</p>
<p>Busdriver, I have heard they can reimburse physicians less in California, perhaps because so many want to be here. </p>
<p>I have had many patients coming in after years of Kaiser because it was way to expensive! Never thought I’d see the day! Problem seems to be the huge deductibles. Really changes the dynamics!</p>
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<p>Patients should just do what they’re told or risk not being a good “team player”? I have no patience with people who believe, as was stated upthread, that we should be grateful we can get in to see a doctor or those who believe we should just do as we’re told. I’m fortunate to have a great physician who I’ve been with for more than 20 years. However, although I’ve known many excellent health care providers over the years, I’ve seen some doozies. Like…</p>
<p>…the doctor who insisted to my uncle that the recurring headaches he was having were due to a head cold and not the car accident he’d had a handful of weeks earlier. He sent my uncle home with pain reliever which my uncle dutifully took until he lapsed into a coma. After his death my grandmother was awarded an extremely large settlement.</p>
<p>…or the surgeon at a different hospital who saw my husband the Friday afternoon he blacked out at work and told him he had a brain tumor, but he had to leave because he had a golf tournament and he’d be back early Monday to perform surgery. We were shell shocked, and even more so when an armed guard came by early that evening to escort me out because, no matter how terrified my husband was, “visiting hours (were) over.” The next morning (Saturday) I called the hospital my family had been using for the last 50 years, although it was several hours away, and arranged for an immediate transfer. My husband spent the next several days undergoing tests and discussing options with the surgeon at that hospital, and I spent every minute there until he was released. After a very successful surgery we received a 5 figure bill from the hospital with a form that stated if we paid a VERY LOW 4 figure amount, their foundation would cover the rest. We did, so they did.</p>
<p>…the nurses at still another hospital who thought during my 36 hour back labor was a good time to have a private contest to see how many expectant mothers they could get through labor without having to resort to pain medication. I can tell you from experience that walking doesn’t relieve the pain of back labor. Neither do whirlpools, rocking, swaying, or deep breathing. At all. </p>
<p>…or how about the physician who was so fascinated by how many years my elderly mother had lived with her chronic medical condition (even though she was in the hospital for something unrelated to it) that he wanted to do some medical tests on her. When she refused to be his guinea pig he told her if she didn’t comply he could have her declared incompetent and it wouldn’t matter what her health care proxy said, neither she nor any of my siblings would be able to control her medical care. We made a swift call to our attorneys and she was released before the end of the business day.</p>
<p>The number of other issues my family and I have encountered over the years are many and varied: I’ve caught incorrect drug dosages because staff can’t transcribe amounts or # times/day correctly. My pharmacist has caught prescriptions for temporary meds that interact with a long term permanent one (even though we take every doctor a complete list of current medicines). I’ve dealt with hospital staff who blithely say, “mom (or dad) has no allergies, right?” when not only do both have them, some are to very common antibiotics (which they should know because it’s in their records and on the medical papers we carry to every appointment and ER visit) and we mention it frequently during our stay. There have been a number of misdiagnoses by physician’s assistants on my asymptomatic kid that resulted in middle of the night ER visits for fever reducers and antibiotics to get a spiking temperature under control and treat the pneumonia and strep that were decidedly NOT colds, no matter how much the PA wanted to insist they were.</p>
<p>I’m all for working together and I agree that, in some respects, proper medical care takes teamwork. Ultimately, however, I’m responsible for my family’s medical care, so any medical personnel I engage work for me. They aren’t doing me a favor, and I’m not beholden to them because they spent years and a tremendous amount of money to get their degree. I’ll happily listen to their advice, carefully research it, then act in the way I believe best benefits my family. </p>
<p>If each visit takes 15 minutes but you have only allotted 10, then everyone will back up but you will have to stay late.
Why can’t they keep track of data of how long each visit take and plan accordingly? or at least if I call ahead and see how far behind they are, don’t lie to me and say they are on time and then I have to wait 45 minutes anyway.
My Pulmo always makes me await an hour…i don’t understand how they can’t figure it out. Never wait at the dentist…and if they are running behind they call you.</p>
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Because if there is a no show, they lose money. So they have to book tight to be sure they are making money.</p>
<p>I don’t have a problem with the length of waiting time the OP is upset with. Most of the time I am not seen by the physician until 30 minutes after my appointment time. But I always feel as if I am the most important person in the room when the doctor arrives. If I didn’t, then I’d have a problem.</p>
<p>Well that sure is a littany of unusul experiences. As an aside, a Dr doesnt unilaterally declare someone ncompetent, but moving on.</p>
<p>The point is that s disgnostic workup is just that-- listening to the history and symptoms and formulating diagnostic possibilities and doing appropriate tests. If the patient leaves out a critical piece of their history, then the Dr may go down the wrong path.</p>