<p>achat, the first place to look is in your plan summary, it will be right there. Depending on the size of your company and the state you live in, it can be different. WA state just signed off dependents to 25, school or not. Used to be 23. This applies to WA based business and their plans. Big companies that self insure would at a minimum follow federal guidelines. They have a choice to do more. </p>
<p>If your coverage stops at 21 or graduation, you can look for either short term medical or individual coverage depending on the state you live in. Usually a health plan for a young person shouldn’t be all that bad. Check with your office of the insurance commissioner for help. They will gladly provide you information on how health plans work in your state. While they can’t recommend certain companies, they can provide the ground rules of play.</p>
<p>Doubleplay: the office visit is reimbursed by insurance companies at about $35 - $40; no way does insurance pay $135 for an office check up. MD’s have a standard office visit fee and then charges are added for procedures such as xray, lab etc. MediCal pays about $8. I don’t know what Medicare pays these days, but it is not enough to cover the cost of the phones, lights, receptionist, biller, insurance, etc. MD’s do NOT make a living off of office visits. My H left private practice because he made every effort to keep his patients well and out of the hospital. He did not have a lot of procedures to bill for. At least in California, no generalist, internist, family practioner, pediatrician can survive on an office practice/office visits alone.</p>
<p>Why does an MD charge what they do…Well Malpractice insurance is one big reason. My brother recently left California to work for a major Medical Teaching institution in Baltimore. As a practicing neurosurgeon in California, he was paying $250,000 malpractice insurance annually. To move, he had to pay $100,000 “tail insurance” to cover just incase 10 years from now, someone sued him.</p>
<p>“no way does insurance pay $135 for an office check up.”</p>
<p>One thing to keep in mind with billings, there’s what you charge and what you report to uncle bucks. While posting $135 for an office visit off the street, the provider of service might also decide to take a lesser amount and write off the rest. Write off the rest? Uncle bucks factors into the equation too. </p>
<p>Remember, it’s not what you make, it’s what you keep.</p>
<p>Going back to the office visit (the “check up”)…</p>
<p>We got into a brooha on behalf of my parents with their family practice doc this past year. He insisted on them going in once a year for a physical or he wouldn’t continue to treat them. Ok, fine. It isn’t covered by Medicare, and therefore not picked up by their supplemental, so they were paying out of pocket. Dad goes in, they take his BP, listen to his heart, check his ears and throat; no blood work or urine work. He gets a bill for something like $150. Mom goes in, the same thing happens. </p>
<p>About six months later, the doc tells them they need to come in AGAIN. This time he charges them for an office visit, which goes to insurance (about $50), PLUS the physical, which again was $150 and they had to pay out of pocket. The doc did the same exact thing both times. By this point, they’d had it, and argued that either, a. they weren’t going to keep going in every 6 months for physicals, or b. have the doc put it down as an office visit and be done!</p>
<p>Needless to say, they didn’t win the battle and are now looking for a new doc. Like I said, $150 for 5 minutes. I still don’t understand.</p>
<p>Doubleplay, where I live it is very hard to find a Dr if you receive Medicare. Medicare does not reimburse as much as other insurance and Drs. just won’t take you as a patient. It is a problem when the elderly move here.</p>
<p>Your parents should be seeing an Internist, not a family practice Dr. While FPD say they cover all ages, how can someone who is doing pediatrics and delivering babies keep up with what is good care for the elderly?</p>
<p>Also, if your parents take any medication, they MUST have liver function tests, and if it is a complete physical they should have all the blood tests done, as well as urine tests, and a flu shot and I would recommend a cardiac stress test. Women need to be checked for osteoporosis. These are mandatory tests. Medicare no longer pays for liver tests more than once a year, but if they are on cholesterol or other medications, they must have them 2x and pay themselves. I have never had a Dr. refuse to order a blood test.
Usually you go to a lab, and they do the billing. </p>
<p>Don’t depend upon a Dr to take good care of you. You have to manage him/her, and quite aggressively at times.</p>
<p>jamie, I wan’t clear- the Dr. was an internist, and he was also with a Family Practice group. So I referred to him as a family practice doc. According to my dad, he didn’t do any invasive testing, which is why dad was so torked. When we spoke to the liaison for the medical group, she said from now on I should actually go in the room with my parent, because at this point it’s his word against the docs.</p>
<p>The blood work and all that went under seperate billing.</p>
<p>“The blood work and all that went under seperate billing”</p>
<p>labs have their own tax id and are a separate entity.</p>
<p>Do you know what type of supplement your folks bought? If it’s one of those $0 dollar things they have signed their independence away. Let me know a bit more about what supplement they have and I might be able to tell you how it works. The Doc may be doing what he is because the plan they have requires him to. </p>
<p>But one thing to also consider, even that internist has put years into education as a doctor, the cost you are paying is for his ability, which also includes observation and Q &A. With older folks, 6 months can produce dramatic change in an elderly person. </p>
<p>You should go next time, not so much to referee, but to see what going on.</p>
<p>Our health insurance covered the kids until the day of graduation and no farther. However, we were able to get them individual insurance, HSA-qualified with a 2500 dollar deductible, for $71/month through Regence Blue Shield. Within days my D went to the emergency room with an ear infection. Initial bill was for $561–but Blue Shield negotiated it to less than $500—even though it was full paid by my D as part of her deductible. </p>
<p>My husband and I have had terrible-but-wonderful health insurance for 7 years now. It has a huge family deductible ($4K/year), costs a fortune ($12K/year) but they don’t argue about the bills when they get them. When I needed knee surgery a few weeks ago, my rep (whom I know by first name) called my doctor to assure him it was all covered–then called me to let me know she’d done so. And wished me luck.</p>
<p>So last night there was a health care forum in my town. It was packed! The two senators were there and wanted to talk about prescription drugs - the audience wanted to talk about single payer. The head of the state department of social and health services wanted to talk about children’s health insurance and services for immigrants - the audience wanted to talk about single payer. The head of the state hospital association spoke about the shortage of nurses - the audience wanted to talk about single payer. The head of the local hospital spoke about the scarcity of docs in the community - the audience wanted to talk about single payer.</p>
<p>It was like the high mucky-mucks and the audience were inhabiting different universes. A Medicare client spoke about how it is almost impossible to find a doc who will accept Medicare or Medicaid, and how some of his friends now use the emergency room as their primary care doc. About a quarter of the audience polled said they had a relative or a close friend who lived in British Columbia. One person on an HMO spoke about how difficult it was to get a specialist referral from the HMO, effectively making for much, much longer wait times than is reported (that is our experience as well).</p>
<p>There was no question what a very knowledgeable audience wanted. And it was also clear that there wasn’t a single politician or so-called community health leader prepared to fight for them.</p>
<p>I have been reading all your responses. I help my mom deal with the insurance system at 98 when I am in the U.S. She is lucky to have wonderful insurance from my Dad’s old company plus medicare. So I have some understanding of your plight. My sister discusses her programs and she seems to be o.k. Actually very good and she is retired from a California school district. Since they are both living in the SF Bay Area, they should have excellent health care. I think they do; though my dad is dead because he was misdiagnosed. But then, that happens, he was 95 and well, I don’t think there is the same urgency with older people as with younger people. He was provided with the best hospice care possible and he went out like he lived. All that said, my care is better by a long shot. My private insurance is better; my doctors are all UK or US trained. I pay about $700 a year for my son and myself. Next year, it will be totally free for me and my son will need his own policy with this company because he turns 21. I can see whoever I want; I can go where I want in any country on the planet EXCEPT the USA. I could pay for that premium but don’t see the need. I am covered for anything that happens to me when I visit. I just can’t go for a medical visit. Why would I want to when I can go to France, the UK, Germany, Israel, India and see their specialists if need be.</p>
<p>Moore’s film certainly resonated with me. I agree that one of the biggest problems we have in this country is the conflict of interest between the patient and the insurance company. Too often it’s the insurance company that essentially decides what care you will receive. It’s cetainly in their best interest that you recieive as little as they can get away with paying for.</p>
<p>When my daughter was 10, she fell on a bicycle and broke her tibia. We came to the emergency room of Little Company of Mary at 7pm on a Friday evening, daughter in great pain. They quickly took her to a room and gave her pain medication, which helped temporarily while a doctor who was present examined her, and we provided our insurance information. The doctor told us that the bone needed to be set, and he would locate an orthopedist to take care of it.
After a while, he came back and said that since there was no specialist on the floor, and one would need to be called back, our insurance wouldn’t “allow” him to proceed with an orthopedist- he would splint the bone, and we would have to make an appointment and go to the ortho on Monday. I argued with him that we would be willing to pay for the set now, but he said it wouldn’t make sense and would make it difficult to get our insurance to pay for the follow-up care, and the leg would be fine until Monday. He basically refused. Never having had a broken bone, or a kid with one, I had no idea what a mistake I was making by taking my kid out of the hospital with only a splint on a tibia that was fractured in two places. She was in pain the entire weekend - couldn’t dress or go to the bathroom by herself, or move her leg even a little without great pain. Once we did get to the orthopedic specialist, he had to rebreak the bone and then put a cast on. She did fine after that, but what a needless ordeal simply because the insurer didn’t want to pay the extra cost of having the hospital emergency orthopedist come back to take care of her.</p>
<p>Then there was my brother, 18 mos. older than myself. He went to his primary care doctor (state of Washington ) complaining of a mole that was bothering him on his leg… The doctor burned it off, and said to watch it and return if it was still a problem.<br>
Six months later, brother was back, again with the complaint, as the mole looked uglier than it had been before. My bro asked for a dermatologist referreal - doctor said he could shave some off and send it to the lab himself.
The test came back benign.
Six months later - you know where this is going. Because the doctor had burned the mole, and then only sent a shaving instead of a cone biopsy as a dermatologist would have done, he missed the cancer. My brother died five years later from melanoma because one doctor wanted to save money by not referring him to a specialist. The family sued. My mom and I went up and found his wife and four sons a good lawyer (one of those damn malpractice attorneys), but losing my brother at age 50 was so sad and unnecessary. My brother’s mistake was trusting the doctor, not knowing there was any conflict of interest in his decision making. </p>
<p>Our system is quite broken. What made the most sense to me about Moore’s movie was his last conclusion. Until we start realizing that we are all in this together, we won’t be able to fix it.</p>
<p>I was surprised yesterday to encounter another issue with health care here in the US that I don’t think anyone has mentioned yet–problems getting my S his required immunizations for college. After waiting two months to get an appointment with S’s doctor, I called to confirm his appointment a couple of days ahead of time. I reminded receptionist that he was coming in for immunizations and told her which ones. She responded that they did not give Hep A and would have to check on the others. But she told me that first I would have to contact my insurer and make sure they would pay. I told her if they didn’t I would pay out of pocket anyway. But she proceeded to lecture me on how much time it took for them to deal with the insurance companies and that I shouldn’t even come in if I didn’t get the prior authorization (which BC/BS does not give for immunizations). I asked to speak to the doctor because I thought maybe she was exceeding her authority, but when he called me (a surprise in itself) he told me that he loses money giving immunizations and would just as soon we go elsewhere (didn’t suggest where) for that. I thought this was highly inappropriate and I suggested that I thought as a physician he might find it gratifying to administer preventive treatments that could spare his patients so much potential illness and misery. No Marcus Wellby moment ensued.</p>
<p>After the forms are signed we will be looking for another doc. But here near Baltimore, MD, I have found great difficulty in locating docs. I tried to get an appointment with a dermatologist in December, and the earliest I could get in is this September. I have lots of spots and moles and a family history of skin cancer. But the dermatologist’s phone message is a recording about the cosmetic treatments they offer. Guess those are the patients they really want to see.</p>
<p>Reading these stories, I feel so lucky to have the HMO we do have. Every year, we get reminders of the dates for free flu shots. My kids got free meningitis shots before college. If I travel, I can go in for free immunization. We get reminders for yearly check-ups and I get one for mammograms (and if I don’t make an appointment soon, a nurse calls to remind me).</p>
<p>SIcko was a nice ‘trailer’ covering some health care issues. But he left out the real meat- Insurance companies, Exec golden parachutes and litigation(lawyers fees not the settlements)! If MM had any guts he would have delivered that information to the audience in order to begin a meaningful dialogue. Sorry state we are in. After all the political speeches are delivered nothing has happened to make the system work.</p>
<p>Had a very minor outpatient proceedure last year. Our insurance co paid $250 for the room where the thorn in my thumb was removed. As a walk in w/o insurance the charge would have been $2750.</p>
<p>My wife had to go to a doctor and a hospital emergency room in Ireland last year. The dr visit was free and the emerency room charge was $67. The care she received was great and the receptionist in the ER got several pain pills to tide her over until she got to a drugist. She had to immediately go to the ER when we got home and because I took her, nobody would even help her get inside! It turned out to be a pinched nerve near her knee.</p>
<p>We have great health insurance… after a $1K/person deductible, they pay 80% and we pay 20%… and they do it without arguing, and I don’t need referrals, etc. The catch is… they don’t negotiate prices, so that $2750 that originaloog mentions… well, we pay 20% of that. When I had my bone surgery recently, I talked the doctor into letting me out after 24 hours (he wanted 48) by agreeing to go to a luxury hotel a block away from the hospital. A night there with all the room service I could want (and quiet, which is what I really wanted) was still cheaper than our 20% of the standard one-night charge.</p>
<p>“My brother died five years later from melanoma because one doctor wanted to save money by not referring him to a specialist.”</p>
<p>But it is not just one doctor; it is entire health care systems. In my state, HMOs actually PAY doctors extra not to make specialist referrals. So, for many procedures, from the time the specialist need would actually have been identified to time of receiving treatment, wait times are often longer, some times MUCH longer, than in Canada, and this is for people with insurance. I think Moore actually understated the reality. (For those without insurance - they never get on the waiting list.) And Canada is the worst case - none of this nonsense exists in Australia, Germany, France, England. </p>
<p>The problem in the U.S. system is not the uninsured, the underinsured, etc. It is the pursuit of profit sandbagging people’s health.</p>