Ever wonder why Doctors have Practices?

[SteveR]

Because they never get anything right...................

DocAJ, you are excluded from above. You seem to be one of the few good ones out there. Old Savage you too!!

Another thing that irritates me more and more, are the people who work in medical offices, you know the ones who do scheduling, I call to make an appointment for an MRI, I have the script/image order. Anyway I try to explain what I need MRI-ed, give her the spelling of the what the Dr wants imaged, and the diagnosis code, then she tells me I am wrong. OK, then she tells me I need prior approval from my insurance, well I don't need prior approval, anyway, I said at this point I will pay cash, she then directs me to the hospital payment people. I leave a message there, of course no answer, still haven't called me back, (thats been 5 hours now). Unbelievable if someone offed me cash to do work, I would be on the phone in 10 seconds.

Ok, I call my insurance, who agree with me, no prior approval needed, the insurance rep, calls the MRI woman back, conferences me in the call, the MRI woman is arguing with the insurance rep . So finally insurance part is covered.

Now MRI woman, is telling me that I am wrong with what needs to be looked at, so now I have to wait another day for my Dr office, who is closed today to send the MRI woman the script and explain what is needed to be imaged. I looked on the internet to see what it meant on the script, and yes it was exactly what I was trying to explain to MRI woman. So I call her back and tell her what I found, well MRI woman says I am not smart enough and the internet is wrong.

Now all she does is schedule, I need to know what the schedule is and what is available, because i need a ride to and from the MRI, well she can't help me without talking to my Dr. I don't know but for someone who schedules she thinks she runs the place.

Anyway, jumped to her supervisor, now he will take care of this and talk to my DR tomorrow to just verify for the radiologist that they are MRI-ing the right spot.

So unbelievable that something a simple as scheduling has to be a nightmare. I do understand that they have to know what is being imaged, and allow time for it, but 45 mins to 1 hr is plenty.

Rant off,
Steve

[Pete44ru]

Unbelievable if someone offed me cash to do work, I would be on the phone in 10 seconds.

Nobody can wring extra/excess payment from a cash payment............

I've found that many medical treatments centers have different pricing for insured customers & cash customers.

To wit, my wife was speaking with a kind-hearted billing rep about a $350 ( the wife's insurance co was resisting paying anything) invoice for her mammogram - when my wife was complained about the cost, the clerk offered to alter her paperwork & classify her as "un-insured" @ $175, ILO the $350. (she accepted the offer, naturally)


.

[Blaine]

I'm pretty sure Chiropractors are not true docs....

[stretch]

Steve, it is indeed maddening.

It is to the point that I can routinely get better service
for, and enjoy more consumer protections while servicing
my car.

To wit:

1. Per hour labor rates MUST be posted in an automobile repair faclility.
Not so for a doctor's office.
2. I call up my mechanic, and can usually get the car serviced the same
day or the next. I usually get told that my doctor's office can't
see me when I'm sick becasue they're too busy with (mostly!) routine
stuff. Go somewhere else if you're really sick.
3. For my car, I can approve the work, I can set dollar limits, and I can insist
that all of the old parts are returned. (Okay - that last one I won't insist on
with the medical community)
4. Labor rates are charged very much differently in the medical community.
Insurance companies' contracts specify as little as 25 cents on the dollar
vs. what you or I might be charged cash for by a hospital. The insurance
companies are not obligated to disclose the deals they get, it's sometimes
considered proprietary information!!
5. Phone calls not returned by the mechanic mean he goes out of business.
There are no repercussions if the doctor doesn't return your call.

It's a really frustrating system designed primarily to make lots of money
for insurance company shareholders and specialty physicians.

-Stretch

[AJMD429]

Labor rates are charged very much differently in the medical community. Insurance companies' contracts specify as little as 25 cents on the dollar vs. what you or I might be charged cash for by a hospital. The insurance companies are not obligated to disclose the deals they get, it's sometimes considered proprietary information!!

Sometimes it's more like ten cents on the dollar, especially with 'lab work'.

On top of that, the insurance company can require that any 'balance' be billed to the patient, or the 'full price' (which they inflate) be paid if the service is deemed (after the fact) to be 'not medically necessary'. That serves as a deterrent to the patient to keep them from daring to do any testing they aren't absolutely sure will be 'covered' (which is never guaranteed), and they are intimidated into going where it is 'in network', even if it costs less money out of pocket to go elsewhere.

I even had an insurance company cut MY reimbursement 20% because I refused to prevent 'their' patients from going to labs that cost them less out of pocket than the 'in-network' ones. Since my profit margin is only about 15%, every time I saw one of 'their' patients, I lost money. A relocation of my office thankfully reset the fees somehow.

Our healthcare 'system' is GREAT at making simple things complicated, and more time-consuming than necessary. Then we wonder why the costs are so high.... ....of course the majority of folks turn for a 'solution' to the same government bureaucracy that caused all of this to 'fix' it, and it predictably keeps getting worse every time they 'fix' it....

[vancelw]

I'm pretty sure Chiropractors are not true docs....

<Insert requisite tuba retort here>

[SteveR]

Unbelievable if someone offed me cash to do work, I would be on the phone in 10 seconds.

Nobody can wring extra/excess payment from a cash payment............

I've found that many medical treatments centers have different pricing for insured customers & cash customers.

To wit, my wife was speaking with a kind-hearted billing rep about a $350 ( the wife's insurance co was resisting paying anything) invoice for her mammogram - when my wife was complained about the cost, the clerk offered to alter her paperwork & classify her as "un-insured" @ $175, ILO the $350. (she accepted the offer, naturally)


.

I didn't realize that they can be worked with, I bet the hospitals and insurance companies make more with people using insurance. Unreal!

Steve

[SteveR]

I'm pretty sure Chiropractors are not true docs....

I'm not going anywhere near this one!! lol

Steve

[SteveR]

Steve, it is indeed maddening.

It is to the point that I can routinely get better service
for, and enjoy more consumer protections while servicing
my car.

To wit:

1. Per hour labor rates MUST be posted in an automobile repair faclility.
Not so for a doctor's office.
2. I call up my mechanic, and can usually get the car serviced the same
day or the next. I usually get told that my doctor's office can't
see me when I'm sick becasue they're too busy with (mostly!) routine
stuff. Go somewhere else if you're really sick.
3. For my car, I can approve the work, I can set dollar limits, and I can insist
that all of the old parts are returned. (Okay - that last one I won't insist on
with the medical community)
4. Labor rates are charged very much differently in the medical community.
Insurance companies' contracts specify as little as 25 cents on the dollar
vs. what you or I might be charged cash for by a hospital. The insurance
companies are not obligated to disclose the deals they get, it's sometimes
considered proprietary information!!
5. Phone calls not returned by the mechanic mean he goes out of business.
There are no repercussions if the doctor doesn't return your call.

It's a really frustrating system designed primarily to make lots of money
for insurance company shareholders and specialty physicians.

-Stretch

I like cars, much simpler. Too bad the medical industry wouldn't work the same.

Steve

[SteveR]

Labor rates are charged very much differently in the medical community. Insurance companies' contracts specify as little as 25 cents on the dollar vs. what you or I might be charged cash for by a hospital. The insurance companies are not obligated to disclose the deals they get, it's sometimes considered proprietary information!!

Sometimes it's more like ten cents on the dollar, especially with 'lab work'.

On top of that, the insurance company can require that any 'balance' be billed to the patient, or the 'full price' (which they inflate) be paid if the service is deemed (after the fact) to be 'not medically necessary'. That serves as a deterrent to the patient to keep them from daring to do any testing they aren't absolutely sure will be 'covered' (which is never guaranteed), and they are intimidated into going where it is 'in network', even if it costs less money out of pocket to go elsewhere.

I even had an insurance company cut MY reimbursement 20% because I refused to prevent 'their' patients from going to labs that cost them less out of pocket than the 'in-network' ones. Since my profit margin is only about 15%, every time I saw one of 'their' patients, I lost money. A relocation of my office thankfully reset the fees somehow.

Our healthcare 'system' is GREAT at making simple things complicated, and more time-consuming than necessary. Then we wonder why the costs are so high.... ....of course the majority of folks turn for a 'solution' to the same government bureaucracy that caused all of this to 'fix' it, and it predictably keeps getting worse every time they 'fix' it....

So true, it might get better someday. We can only hope!!

Steve

[AJMD429]

I'm pretty sure Chiropractors are not true docs....

Actually, if you have earned a college degree with the title 'doctor' in it, you are, indeed, a "doctor".

There are Doctors of Pharmacy, Doctors of Chiropractic, Doctors of Medicine, and many Doctors of Philosophy - they all are perfectly entitled to be addressed as "Doctor..."

Most of 'us' (the 'doctor' types) prefer to use the term when dealing with our patients, to signify that we are engaging in a legally protected, therapeutic, interaction at that time, and often drop the 'doctor' when out mingling with the public and not wanting to be held to professional accountability. If I call my Dentist to ask about my tooth pain, I ask if "Doctor [Smith]" is there, and give MY name without the title, as I'm "just a patient" at that point. On the other hand, if I call him to tell him his prostate exam is due (only after he's fixed my sore tooth), I say This is "Doctor J" calling. If I'm just calling him to ask if he's going to the race next week, we're both going to use our first names. None of that is etched in stone, and most of us don't really get all that hung up on the 'title', but it does help set the tone of the conversation and interaction so nobody misunderstands the expectations (if I'm just 'me', and you tell me you feel like stuff, I'll probably just tell you to have another beer and see if it goes away, or one-up you by saying I feel worse - but if I'm in "doctor" mode, I'll start asking you your temperature, what color your poop is, and to tell me a list of all your medications... ).

Anyhow, please respect ALL who earned an advanced degree of some sort, 'doctoral' or otherwise.

(An exception can be made if the individual is a pompous anal sphincter type who flaunts their degree and tries to use it to impress everyone. )

[Pete44ru]

.

Hey, AJ - I guess that also makes you a Doctor of Leverguns .................




.

[Blaine]

An exception can be made if the individual is a pompous anal sphincter type

I agree. (I'm going to a bone cruncher next week....)

[vancelw]

medications... ).

Anyhow, please respect ALL who earned an advanced degree of some sort, 'doctoral' or otherwise.

(An exception can be made if the individual is a pompous anal sphincter type who flaunts their degree and tries to use it to impress everyone. )

You mean, the Medical review department employed by the insurance companies
Lets you know real quick he's a D.r, but wants to diagnose you (and over rule your real Dr.) without ever having seen you as a patient.

[boolitshooter]

FWIW,
Doc AJ and today most medical Docs have their hands tied. The Insurance Co's control their practices along with the Gov. Regulations, ie Medicare and Medicade.
For example, my father was a Doc and got along quite well with a nurse and a part time billing person until the late 70's.
Then it all started to change due to govt. regulations and Ins. Co's. Not to leave out the malpractice attorneys. The Doc's then had to schedule more tests to CTAs....s. Then the Ins. Co's got more involved in dictating treatment and demanding which Labs, Pharmaceys, and rehab places they would approve.
By the time my Dad retired he had 4 people full time to administer all of the back room paper work to satisfy all govt and Ins requirements. BTW he retired in 2011.
It's not the Doc's fault. It's the Govt. and Ins. Co's. Plus now most Doc's are employed by major Health care company's.
Medical treatment is now a commodity and will only get worse in the future.
Choose your primary care provider carefully.

[boolitshooter]

Additionally another thing that is upsetting many Practices have PA's to see you and not the Doc.
There is no difference in the billing rates, WTF, this is a crappy practice.

[Blaine]

Additionally another thing that is upsetting many Practices have PA's to see you and not the Doc.
There is no difference in the billing rates, WTF, this is a crappy practice.

FWIW, all 20 years in the military, I had complete confidence in the Enlisted Men/Women who were medics, and the Warrant Officer that were PAs.....It freed up the real Docs for serious issues.

[vancelw]

FWIW,
Doc AJ and today most medical Docs have their hands tied. The Insurance Co's control their practices along with the Gov. Regulations, ie Medicare and Medicade.

No, their hands are not tied. Most do, however, have to make choices to maximize the income of their practice. I know of two doctors in my area who will not take insurance of any sort. Cash only. They refuse to let someone other than themselves and the patient determine the treatment.

My point was, it is medically unethical for a Dr. to treat a patient without actually seeing said patient. Yet, the insurance companies want to use these flunkies (who can't hold a successful practice of their own) to deny procedures. Yes, their policy is to deny, deny, deny. They hope you will give up, pass over into another deductible period, or perish before they have to pay for your expensive procedure. Last time they tried that with me, I simply told them okay....I would run another 20K in tests and then they could take my gallbladder out...or they could do it now (like my surgeon recommended) and save some moolah.

Choose your primary care provider carefully.

This, I fully agree on.

[boolitshooter]

Blain,
I completely agree with you.
I was a medic in 67/68.
Sure had to grow up fast. "Scared" as Hell.
I ended up spending my tour at Ft. Sam Houston in San Antonio due to a knee injury.
I was very fortunate, but in reflection the solder's I helped was a real blessing.
I didn't realize it at the time, just a kid. Today now I wish I could have done more.
Sorry all, I got off track on Vietnam, couldn't help it. Eyes are misty now.

[Griff]

.
Hey, AJ - I guess that also makes you a Doctor of Leverguns .................

.

I thought that was JMiller!

[AJMD429]

.
Hey, AJ - I guess that also makes you a Doctor of Leverguns .................

I thought that was JMiller!

I would definitely defer to 'Dr. Miller' when it comes to Levergun knowledge...!

[AJMD429]

(An exception can be made if the individual is a pompous anal sphincter type who flaunts their degree and tries to use it to impress everyone. )

You mean, the Medical review department employed by the insurance companies Lets you know real quick he's a D.r, but wants to diagnose you (and over rule your real Dr.) without ever having seen you as a patient.

Yep. That's precisely the type I was thinking of when I posted that...!

Additionally another thing that is upsetting many Practices have PA's to see you and not the Doc.
There is no difference in the billing rates, WTF, this is a crappy practice.

Charges may be the same (since they use the same overhead), and a good one does provide 'the same' care in the sense that a good Nurse Practitioner (haven't worked with PA's) operating in a well-run practice, will practice far better medicine than the average MD does.

Reimbursement is actually 'docked' 20% by our friends at Anthem (the largest insurer, and the state Medicare contractor), so with an overhead of 15%, any Medicare patient coming in to see me makes me an average profit of about $15, but becomes a 'freebie' when she sees them. Kinda sucks, since she'll spend 45 minutes with them and be far more thorough than the other area physicians.

Yes, their policy is to deny, deny, deny. They hope you will give up, pass over into another deductible period, or perish before they have to pay for your expensive procedure. Last time they tried that with me, I simply told them okay....I would run another 20K in tests and then they could take my gallbladder out...or they could do it now (like my surgeon recommended) and save some moolah.

Yep. That's the way to deal with them. When they push back at me, I don't get angry or emotional, I just tell them like it is - they know that if they don't do what I want, I can bounce the patient between so many specialists it will cost them tens of thousands of dollars. Really sad that I have to threaten like that just to get a $75 blood test covered (that I make ZERO money on because it is sent to an outside lab, and that lab bills the insurance).

[SteveR]

Yes, their policy is to deny, deny, deny. They hope you will give up, pass over into another deductible period, or perish before they have to pay for your expensive procedure. Last time they tried that with me, I simply told them okay....I would run another 20K in tests and then they could take my gallbladder out...or they could do it now (like my surgeon recommended) and save some moolah.

Yep. That's the way to deal with them. When they push back at me, I don't get angry or emotional, I just tell them like it is - they know that if they don't do what I want, I can bounce the patient between so many specialists it will cost them tens of thousands of dollars. Really sad that I have to threaten like that just to get a $75 blood test covered (that I make ZERO money on because it is sent to an outside lab, and that lab bills the insurance).

This is very good to know. Thanks both of you.

Steve

[SteveR]

Choose your primary care provider carefully.

This, I fully agree on.

Good advice. I have a PPO type of insurance, it acts like an HMO when the Dr's are in the network, but if not then it is like a Major Medical type plan where I pay the deductible. The best part is I can choose to a point the Dr's I wish to see. Also it is great for getting tests like MRI where no prior approval is needed.
But what makes it hard is the ignorant people in the Dr office, who argue that I am wrong and that the insurance doesn't cover things, and that leads to me getting very upset.
Another problem I have found is if seeing multiple Dr's for different conditions, I have a work related injury and have been seeing the same Dr for about 14 years, when I needed to find a "primary" dr, well not many wanted to see me because of meds being prescribed by my other Dr.. They wanted me to stop seeing my Dr and see them for everything. Because I wouldn't they refuse to see me.
But if you are some illegal border jumper, then oh don't worry come right in, we will see you ahead of the poor schmuck with insurance, who is working and not a criminal.

Steve

[Sixgun]

To make it all worse, lawyers also "practice". Yea, they practice with other people's money.----6

[piller]

I also deal with insurance companies and the people who manage offices and think they are the one with the degree. When I send a bill to an insurance company, I am paid back average wholesale price minus 15%, plus $5 for the time and cost of materials. If it weren't for the cash patients, all pharmacies would lose money on each and every prescription. Walgreens made news a couple of years ago when they refused to take a contract with Express Scripts due to the amount of loss per prescription. Wal Mart loses money on each prescription just to get you in the door. They pay $4 per 30 days worth of pills made in India and sell them to you for $4. There is no profit and no cost for the time spent putting it together. If they get yo in the door and you shop for an hour, you have more than made up for the loss.

When calling Doctor's offices or hospitals for information, there are times when I really want to reach through the phone and punch the persons whom I am speaking with. Many times the person on the other end is great at their job, but then there are times when they don't listen to my question and give me an answer that is idiotic. When a prescription for a controlled substance comes in, it needs to have the DEA registration number on the face of it. Due to the type of clientele they serve, some Doctors understandably leave it off and have the Pharmacy call for the number. When we call and the person on the other end tells us that we should have it on file, it is a problem. We are also calling to verify that the prescription is legitimate. Fake scripts are a very common and real problem. There are other issues that we call for, such as insurance rejections on the medicine prescribed. I usually am put through to a RN or somone else who can help to get this situation straightened out. However, there is the occasional reply "The Doctor wrote what he wanted and the patient just needs to get it!" If it is too expensive for the patient, then we call. Such a reply is foolish because it causes the patient to walk away without any medicine. The Prior Authorization process is available, and must be done by the prescriber's office. Of course, if the insurance companies had to work under the rules that Hawaii had in place for them before the UNaffordable lack of Care Act, then things would work much better.