Seeking affordable primary care

[Ava]

I've been to different doctors and very disappointed with mediocre care received coupled with outrageous bills.

I haven't gone to the doctor for a checkup in a while and I really need to.

So I called a community clinic in my town and they gave me an appointment. But they are federally funded and charge according to need. They asked me to bring the two last paychecks to the appointment.
I make enough that I'm now thinking this may cost me more than a regular doctor.

A coworker recommended a doctor that charges like all the oth9but uses Quest for blood work. All the other doctor's used different labs that are out of my network and end up costing me an arm and a leg.

What's the best option for me?

[justme]

Most likely to go on your insurance's website and find a doctor in-network. And if they don't use an in-network lab for blood drawn in the office to instead ask for a lab slip and take it to an in-network lab. 

I would assume that if your income is high enough (and I'm assuming it's high enough) that the community clinic would charge you the full amount/the top of their sliding scale. Which is probably around what an in-network doctor would cost you, but if the community clinic isn't in-network it wouldn't go towards and in-network deductibles if you have them. 

[Ava]

Jun 21, 2019 10:10:27 GMT -5 justme said:

Most likely to go on your insurance's website and find a doctor in-network. And if they don't use an in-network lab for blood drawn in the office to instead ask for a lab slip and take it to an in-network lab. 

I would assume that if your income is high enough (and I'm assuming it's high enough) that the community clinic would charge you the full amount/the top of their sliding scale. Which is probably around what an in-network doctor would cost you, but if the community clinic isn't in-network it wouldn't go towards and in-network deductibles if you have them. 

That's exactly my fear. The clinic will charge me as much as an in network doctor.

I've gone to my insurance website and always choose a doctor from there. But they always send me to a lab of their choosing and charge me a second visit to discuss the lab results.

I may go with the doctor recommended by my coworker since he's in network and uses Quest.

[dannylion]

If you find a doctor you like who uses a lab that is not in your network, you can ask for a prescription for your labs and have them done at a lab that is in your network.  They will send the results to your doctor. 

[Ava]

Jun 21, 2019 10:29:00 GMT -5 dannylion said:

If you find a doctor you like who uses a lab that is not in your network, you can ask for a prescription for your labs and have them done at a lab that is in your network.  They will send the results to your doctor. 

That's the way it's supposed to be. But nowadays it looks like they have contracts with certain labs or something. They point blank told me I had to use their lab and they couldn't give me a slip for another lab. Very frustrating because Quest is in network and very cheap for me.

[Deleted]

Jun 21, 2019 10:23:25 GMT -5 Ava said:

Jun 21, 2019 10:10:27 GMT -5 justme said:

Most likely to go on your insurance's website and find a doctor in-network. And if they don't use an in-network lab for blood drawn in the office to instead ask for a lab slip and take it to an in-network lab. 

I would assume that if your income is high enough (and I'm assuming it's high enough) that the community clinic would charge you the full amount/the top of their sliding scale. Which is probably around what an in-network doctor would cost you, but if the community clinic isn't in-network it wouldn't go towards and in-network deductibles if you have them. 

That's exactly my fear. The clinic will charge me as much as an in network doctor.

I've gone to my insurance website and always choose a doctor from there. But they always send me to a lab of their choosing and charge me a second visit to discuss the lab results.

I may go with the doctor recommended by my coworker since he's in network and uses Quest.

I have a friend who does it the other way around.  She goes and gets bloodwork done at their office before her scheduled visit.  There's a charge, but it's not the cost of a doctor's visit.  Then she goes to her visit with the doctor, and they discuss any results that are a concern as part of the visit.  That makes a lot of sense.

My doctor does it the way you describe, drawing blood as part of the visit and then sending it to the lab.  However, I never have to go in to discuss the results.  If there is a problem, they call me to discuss and tell me then whether I need to go back in.

By the way, Quest will give you direct access to your lab results as well as your doctor.  They have a portal.  My doctor's office was surprised that I knew the results before they even called.  Quest is my favorite lab.  

[justme]

Jun 21, 2019 10:23:25 GMT -5 Ava said:

Jun 21, 2019 10:10:27 GMT -5 justme said:

Most likely to go on your insurance's website and find a doctor in-network. And if they don't use an in-network lab for blood drawn in the office to instead ask for a lab slip and take it to an in-network lab. 

I would assume that if your income is high enough (and I'm assuming it's high enough) that the community clinic would charge you the full amount/the top of their sliding scale. Which is probably around what an in-network doctor would cost you, but if the community clinic isn't in-network it wouldn't go towards and in-network deductibles if you have them. 

That's exactly my fear. The clinic will charge me as much as an in network doctor.

I've gone to my insurance website and always choose a doctor from there. But they always send me to a lab of their choosing and charge me a second visit to discuss the lab results.

I may go with the doctor recommended by my coworker since he's in network and uses Quest.

You don't have to go to the lab they tell you do. Ask for them to give you the paper work to go to an in-network lab.

A second visit to discuss lab results is not out of line. With doctors that I have an on-going relationship with they give me a lab slip to do my lab work before my appointment. They'll also sometimes call me with results, but again I have an on-going relationship with them and we had usually gone through the options depending on results before hand. Not to mention doctors don't charge you for phone calls, so expecting them to call you for anything that would take more than 5 minutes is asking them to work for free. 

And honestly, the clinic should charge you as much as anywhere else. The clinics are for those without insurance or those with a high deductible plan who can't afford to pay for doctor's visits. This usually means those under the poverty line or some multiple of it. For a single adult the federal poverty line is $12k. So even if they did sliding scale up to 4x the poverty line that would only be for those that make $48k or less. 

[Ava]

Jun 21, 2019 10:37:42 GMT -5 @bamafan1954 said:

Jun 21, 2019 10:23:25 GMT -5 Ava said:

That's exactly my fear. The clinic will charge me as much as an in network doctor.

I've gone to my insurance website and always choose a doctor from there. But they always send me to a lab of their choosing and charge me a second visit to discuss the lab results.

I may go with the doctor recommended by my coworker since he's in network and uses Quest.

I have a friend who does it the other way around.  She goes and gets bloodwork done at their office before her scheduled visit.  There's a charge, but it's not the cost of a doctor's visit.  Then she goes to her visit with the doctor, and they discuss any results that are a concern as part of the visit.  That makes a lot of sense.

My doctor does it the way you describe, drawing blood as part of the visit and then sending it to the lab.  However, I never have to go in to discuss the results.  If there is a problem, they call me to discuss and tell me then whether I need to go back in.

By the way, Quest will give you direct access to your lab results as well as your doctor.  They have a portal.  My doctor's office was surprised that I knew the results before they even called.  Quest is my favorite lab.  

That is a great idea but I'm not sure Quest will let me get lab work done without a doctor's request. And I don't really know what to tell them to check. The second visit is frustrating because all they do is read the lab results and discuss with me. All the doctor's I've seen do it this way. I have a chronic condition so I have no way to skip this. But it's so frustrating and expensive to pay for two visits.

[dannylion]

Jun 21, 2019 10:34:52 GMT -5 Ava said:

Jun 21, 2019 10:29:00 GMT -5 dannylion said:

If you find a doctor you like who uses a lab that is not in your network, you can ask for a prescription for your labs and have them done at a lab that is in your network.  They will send the results to your doctor. 

That's the way it's supposed to be. But nowadays it looks like they have contracts with certain labs or something. They point blank told me I had to use their lab and they couldn't give me a slip for another lab. Very frustrating because Quest is in network and very cheap for me.

Then when you are interviewing potential new doctors, be sure to include a question about whether they will give you a script for your labs if they use a lab that is not in your network.  If it were me, I would press the issue of the lab script with the doctor.  I expect they can give you a script, but they get a commission from using certain labs, or maybe they are just too lazy to make the effort to make it possible for patients to get the labs done elsewhere.  Was it the doctor who told you that or other office staff?  I'd confront the doctor directly.  If I didn't like the answer, I'd be finding a new doctor.   Getting a script for your labs is not an unreasonable request.  You are the paying customer.  You have a right to ask for and receive what you need from your provider. 

[Miss Tequila]

Jun 21, 2019 10:34:52 GMT -5 Ava said:

Jun 21, 2019 10:29:00 GMT -5 dannylion said:

If you find a doctor you like who uses a lab that is not in your network, you can ask for a prescription for your labs and have them done at a lab that is in your network.  They will send the results to your doctor. 

That's the way it's supposed to be. But nowadays it looks like they have contracts with certain labs or something. They point blank told me I had to use their lab and they couldn't give me a slip for another lab. Very frustrating because Quest is in network and very cheap for me.

I've never heard of that.  My doctor has a lab on site but I do not have to use it.  I've gone to another lab when it is more convenient.  I would find another doctor because that is not right.  

[TheOtherMe]

I am an established patient with a health care provider.  My routine lab work is scheduled so that it is done before I see her.  It was scheduled last October for this October.  

When I see the doctor, the lab work will be discussed.

If something comes up during the year, it's a different situation, although they will usually discuss over the phone in a brief call since they are looking for something specific.  The call is with the nurse, not the doctor.

[TheOtherMe]

Community clinics that I am aware of are income based because they are for low income people and those without insurance.  

For that reason, a sliding scale is used.  If your income is high enough that you will be charged the full cost, I don't think a person should use them.  Let the people for whom the community clinics use them.  There are lots of people with no other access to health care or insurance or where (around here) there is a waiting list for Medicaid patients.  Let these people get health care.

[busymom]

What type of doctor are you looking for?  Personally, I've done better going to Internal Medicine doctors, rather than Family Practitioners.  JMHO.

[Ava]

Jun 21, 2019 10:49:53 GMT -5 Miss Tequila said:

Jun 21, 2019 10:34:52 GMT -5 Ava said:

That's the way it's supposed to be. But nowadays it looks like they have contracts with certain labs or something. They point blank told me I had to use their lab and they couldn't give me a slip for another lab. Very frustrating because Quest is in network and very cheap for me.

I've never heard of that.  My doctor has a lab on site but I do not have to use it.  I've gone to another lab when it is more convenient.  I would find another doctor because that is not right.  

That's exactly what I'm going to do.
One of the doctor's was affiliated to a hospital and I had to use their lab. The other was a stand alone clinic who had someone from one local hospital on site to do draw blood. They refused to let me use another lab and that hospital was out of network.

I ended up paying $650 out of pocket with a hdhp every three months. I was so frustrated that I stopped going to the doctor but I really need to take better care of my health.
I just don't want to pay so much and be limited to a lab that's really expensive for me just so the doctor gets whatever out of it. The two visits are also bad because of time and cost but I don't see a way around it.

[Ava]

Jun 21, 2019 10:56:16 GMT -5 busymom said:

What type of doctor are you looking for?  Personally, I've done better going to Internal Medicine doctors, rather than Family Practitioners.  JMHO.

I'm looking for a primary care doctor.

[justme]

Don't you have diabetes though? And I'm assuming that's what your bloodwork is for all the time? Because usually primary cares only do bloodwork once a year unless you have something to warrant more frequent monitoring. If it was me, I would be seeing an endocrinologist for anything diabetes related. Primary cares just don't have the knowledge base to handle that care. 

[Ava]

None of the doctors I've visited so far opens the lab test results until I'm in the office with them and paying for the second visit.

I want to at least eliminate the out of network labs and use Quest to bring my costs down

But I agree that the community clinic is not a good idea
I'm going to cancel my appointment with them

[Cheesy FL-Vol]

Jun 21, 2019 10:57:56 GMT -5 Ava said:

Jun 21, 2019 10:49:53 GMT -5 Miss Tequila said:

I've never heard of that.  My doctor has a lab on site but I do not have to use it.  I've gone to another lab when it is more convenient.  I would find another doctor because that is not right.  

That's exactly what I'm going to do.
One of the doctor's was affiliated to a hospital and I had to use their lab. The other was a stand alone clinic who had someone from one local hospital on site to do draw blood. They refused to let me use another lab and that hospital was out of network.

I ended up paying $650 out of pocket with a hdhp every three months. I was so frustrated that I stopped going to the doctor but I really need to take better care of my health.
I just don't want to pay so much and be limited to a lab that's really expensive for me just so the doctor gets whatever out of it. The two visits are also bad because of time and cost but I don't see a way around it.

Does your insurance and health care provider have a video visit option? The co-pay for that scenario is usually much lower and you could use that option for the lab results discussion where you don't even have to run out for the appointment.

[Ava]

Jun 21, 2019 11:19:27 GMT -5 Cheesy FL-Vol said:

Jun 21, 2019 10:57:56 GMT -5 Ava said:

That's exactly what I'm going to do.
One of the doctor's was affiliated to a hospital and I had to use their lab. The other was a stand alone clinic who had someone from one local hospital on site to do draw blood. They refused to let me use another lab and that hospital was out of network.

I ended up paying $650 out of pocket with a hdhp every three months. I was so frustrated that I stopped going to the doctor but I really need to take better care of my health.
I just don't want to pay so much and be limited to a lab that's really expensive for me just so the doctor gets whatever out of it. The two visits are also bad because of time and cost but I don't see a way around it.

Does your insurance and health care provider have a video visit option? The co-pay for that scenario is usually much lower and you could use that option for the lab results discussion where you don't even have to run out for the appointment.

My insurance has that option but it's only for something specific like a cold or fever etc. I don't think primary care providers participate.

[The Walk of the Penguin Mich]

You really need to read your policy cover to cover to understand it.  TD gets his bloodwork done before he sees his endocrinologist, he has a standing 6 month order.  So when he goes in to see him the first time, the doctor has his most recent lab results.  If they need to titrate his meds up, the rest is done by phone.  This is because he has a chronic condition (not diabetes, but this would work for this as well) and he needs to be monitored for changes.  If you are needing bloodwork done every 3 months, something you have is not stable.  

My bloodwork is usually done after my appointment as it is largely normal.  So I receive a copy in the mail and there is nothing to discuss.

If your doctor will not give you a lab slip to take to the lab your insurance covers, then you need to change doctors.  I really do suggest that you look for internal medicine rather than family practice, especially if you are needing to control something like diabetes.  You also might want to see an endocrinologist for this as well.  It may cost you more up front, but you will have better control of your condition.

[Ava]

Jun 21, 2019 11:53:26 GMT -5 The Walk of the Penguin Mich said:

You really need to read your policy cover to cover to understand it.  TD gets his bloodwork done before he sees his endocrinologist, he has a standing 6 month order.  So when he goes in to see him the first time, the doctor has his most recent lab results.  If they need to titrate his meds up, the rest is done by phone.  This is because he has a chronic condition (not diabetes, but this would work for this as well) and he needs to be monitored for changes.  If you are needing bloodwork done every 3 months, something you have is not stable.  

My bloodwork is usually done after my appointment as it is largely normal.  So I receive a copy in the mail and there is nothing to discuss.

If your doctor will not give you a lab slip to take to the lab your insurance covers, then you need to change doctors.  I really do suggest that you look for internal medicine rather than family practice, especially if you are needing to control something like diabetes.  You also might want to see an endocrinologist for this as well.  It may cost you more up front, but you will have better control of your condition.

Great advice. I will talk to the new doctor about a standing order for lab work so I don't have to visit twice. I will also ask them on the phone about using Quest before I book an appointment. If they refuse to use Quest I'll continue looking for another doctor.

[busymom]

Jun 21, 2019 10:59:23 GMT -5 Ava said:

Jun 21, 2019 10:56:16 GMT -5 busymom said:

What type of doctor are you looking for?  Personally, I've done better going to Internal Medicine doctors, rather than Family Practitioners.  JMHO.

I'm looking for a primary care doctor.

      Yes, I did mean for a primary care doctor.  There are options in the community we just moved to.  Some are Internal Medicine doctors, who have adult patients only, and some are Family Practitioners that are doctors for both children and adults.  I've had better experiences with the Internal Medicine doctors.

[The Walk of the Penguin Mich]

Jun 21, 2019 12:50:22 GMT -5 busymom said:

Jun 21, 2019 10:59:23 GMT -5 Ava said:

I'm looking for a primary care doctor.

      Yes, I did mean for a primary care doctor.  There are options in the community we just moved to.  Some are Internal Medicine doctors, who have adult patients only, and some are Family Practitioners that are doctors for both children and adults.  I've had better experiences with the Internal Medicine doctors.

Me too.

[stillmovingforward]

FWIW - I got to what is considered a low income clinic but I have a good income. They give me a receipt that I send to the insurance. It does cost me more than a standard doctor office BUT they give me excellent care and lots of time. Due to 'your charge covers the cost of 2 uninsured people'. Its worth it just for the time they spend with me.

[Happy prose]

Find a doctor, make an appointment two weeks out, and ask them to mail you a prescription for bloodwork. Take it to your lab, and the dr will have the results to discuss with you at your appointment. One visit.

[Deleted]

Two suggestions, one from personal experience.

I'm getting ads on FaceBook for Sesame Care with low prices for specific things; my guess is that they find doctors who have appointment space to fill and are willing to accept a cut rate.  Now, that could be new docs trying tp build their practices, or docs who are so bad no one books them- I don't have any experience with them.


Second- I thought I was golden when I qualified for Medicare and my doc ordered the usual bloodwork- the routine stuff such as cholesterol components and fasting blood glucose, as well as A1c since my fasting glucose rate is typically around 110. I got a note from Medicare that about $800 of the tests were "not medically necessary" and thus would not be paid. I assume the doc's office didn't code them correctly. I subsequently got a note saying that they hadn't had me sign an Advance Beneficiary Notice so I wasn't liable. SO- this last time I got onto requestatest.com. You choose which tests you want and which lab you want to use (I had my choice of multiple LabCorp and Quest labs nearby). They tell you what it will cost, you give them your credit card info and you show up. I got everything I needed plus a urinalysis (hadn't had one in decades but was part of one of the packages) for $177 total. The results were on-line an a couple of days. Bonus: I tweaked my dietary habits a bit and want to see if they had any effect. I plan to redo some of the tests in July (midway between doc visits). No need to pay for an office visit to do that.

[dannylion]

Jun 21, 2019 14:30:22 GMT -5 @athena53 said:

Two suggestions, one from personal experience.

I'm getting ads on FaceBook for Sesame Care with low prices for specific things; my guess is that they find doctors who have appointment space to fill and are willing to accept a cut rate.  Now, that could be new docs trying tp build their practices, or docs who are so bad no one books them- I don't have any experience with them.


Second- I thought I was golden when I qualified for Medicare and my doc ordered the usual bloodwork- the routine stuff such as cholesterol components and fasting blood glucose, as well as A1c since my fasting glucose rate is typically around 110. I got a note from Medicare that about $800 of the tests were "not medically necessary" and thus would not be paid. I assume the doc's office didn't code them correctly. I subsequently got a note saying that they hadn't had me sign an Advance Beneficiary Notice so I wasn't liable. SO- this last time I got onto requestatest.com. You choose which tests you want and which lab you want to use (I had my choice of multiple LabCorp and Quest labs nearby). They tell you what it will cost, you give them your credit card info and you show up. I got everything I needed plus a urinalysis (hadn't had one in decades but was part of one of the packages) for $177 total. The results were on-line an a couple of days. Bonus: I tweaked my dietary habits a bit and want to see if they had any effect. I plan to redo some of the tests in July (midway between doc visits). No need to pay for an office visit to do that.

Wow!  That's a lot for what in ordinary circumstances are probably considered routine labs.  My doc's office has me sign the form telling me that some of my labs are not covered by Medicare, but it's never been more than about $150 or so, and my regular health insurance has always covered whatever Medicare doesn't pay, so it hasn't been an issue.  Good to know about choosing your tests and labs.  I'm making a note of that just in case.  

[Deleted]

Quest has a service you can use without your own doc's orders; it's called Quest Direct.

questdirect.questdiagnostics.com/products

Jun 21, 2019 14:55:00 GMT -5 dannylion said:

Wow! That's a lot for what in ordinary circumstances are probably considered routine labs. My doc's office has me sign the form telling me that some of my labs are not covered by Medicare, but it's never been more than about $150 or so, and my regular health insurance has always covered whatever Medicare doesn't pay, so it hasn't been an issue. Good to know about choosing your tests and labs. I'm making a note of that just in case.

Yeah, I know- $800 was the "sticker price" and we all know how realistic THAT is.

[Ava]

I feel I have received great advice.
I will make an appointment with a doctor that accepts Quest which I'll ask when I call.
After the first visit I'll ask for a standing order with Quest so the lab results are ready so I don't have to pay for a second visit. The doctor doesn't want to do this I'll look for another doctor.

Great advice and I hope this helps others who read this thread

[garion2003]

My primary care doctor and the lab are in the same building (well the draw station is in the building, they send it off to Quest to be processed). I do a fasting lab 2 weeks or so before my regular appointments - my PC will email the results to me via a secure portal, and then we'll talk about the results at the appointment.

I also do an "off cycle" blood work for a 3 month renewal of a prescription, I'll get the blood drawn and once he's seen the results he will send down the prescription to pick up.

I suppose I could use other labs but since everything is the same building and all the systems work together, I go with what is easiest