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Post by Deleted on May 17, 2011 7:13:06 GMT -5
I don't think it would be that easy. The doctor may have an agreement that says $X, but bill you for $Y. They do this now, with every single bill they send to insurance companies. <snip>E.G. the lab submits a $250 charge, and the insurance approves $25 or $30, that's what their agreement says. <snip>Yeah, good luck getting the difference back. I prefer not paying it in the first place. OK, I agree with you if that's the scenario. If the doctor can't be bothered to bill me for the amount negotiated with my insurance company ($X), then I won't deal with them. And I agree with you on the insane gap between the sticker price of services and the negotiated rates. It really means that the uninsured (usually the lower-income in the population, but making too much to get Medicaid) get stuck with massive charges they can't afford to pay. I get that detail on our bills, too.
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Post by The Walk of the Penguin Mich on May 17, 2011 7:26:14 GMT -5
I haven't yet encountered any doctors that don't take all or most insurances.
I have, and it's a pain in the neck. You pay out of pocket and wind up getting reimbursed a fraction of what you paid 3 months later, AFTER you've submitted all the paperwork.
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daisylu
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Post by daisylu on May 17, 2011 8:06:08 GMT -5
I haven't yet encountered any doctors that don't take all or most insurances. I recently talked my parents into getting new doctors because of this. Their doc would not even FILE with the ins co. They filed their own claims, and with the amount of care that they needed it was a logistical nightmare keeping track of everything. Plus, the care from this doc was sub-par. They do love the new doc.
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zibazinski
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Post by zibazinski on May 17, 2011 8:26:07 GMT -5
My old boyfriend had a doctor in his group that went to a cash pay. She charged 40 bucks a visit and gave you whatever you needed to do your own insurance claim. She made 6k less per year the first year, worked less, and said it was worth every penny to no longer have insurance hassles.
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on May 17, 2011 16:10:58 GMT -5
I think this is a great way for the medical community to disentangle themselves from the insurance companies and the whole mess of problems that come along with that. However, all the doctors around here that are trying it are asking for upfront annual fees that make it unreasonable for a healthy family like mine. If they asked for a retainer, and then subtracted fees out of it, maybe - but not just taking a big chunk of money and then charging me for every visit. Yep. My doctor was pretty blunt in stating this is exactly why she's doing it. She is going annual fee pretty soon, but for new patients. She warned us that if we miss an annual checkup (don't visit for a year or more) we'll be classified as new patients. She also said that (I'll have to find the letter) she is going to limit her practice to X number of patients total.
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on May 17, 2011 16:12:24 GMT -5
My old boyfriend had a doctor in his group that went to a cash pay. She charged 40 bucks a visit and gave you whatever you needed to do your own insurance claim. She made 6k less per year the first year, worked less, and said it was worth every penny to no longer have insurance hassles. Yeah- that's like when it finally dawned on me that $54 bucks a month for property management (per unit) was a good deal. Easily worth every penny.
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Post by Deleted on May 17, 2011 17:22:48 GMT -5
What you are describing, Paul, is generally called "concierge" medical care. It is supposedly a prelude for what life is going to be like for us peons once the health care reform is initiated. You guys will get the deluxe medical services . . . at a price. Those of us dependent on insurance can sit and wait in long lines, forced to be content with doctors who are forced to take too many patients in order to pay the bills.
Maybe that WILL be the model. I have no delusions that I will ever able to afford this type of care. The BMW place not only provides free beverages (not just coffee but bottled water, soft drinks, etc.) but great snacks. There's a game system for your kids, and they usually provide loaners. If they can't, they drive you wherever, even though we live 26 miles away. I can't afford that model, either. Lol.
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zibazinski
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Post by zibazinski on May 17, 2011 20:31:55 GMT -5
You are right, SS, and the fee is just to stay on their list. It does not cover office visits.
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ruger2506
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Post by ruger2506 on May 18, 2011 6:58:05 GMT -5
My doc doesn't do insurance. Period. If you're insured, and you can get re-imbursed, good for you. But she won't be bothered with it. She went from 14 on staff down to 6 (including her). Payment is due when services are rendered. Period. She sent a letter out about a year ago notifying us of the changes. Everything is all-around better. We've considered doing this as well. The ungodly amount of paperwork and BS to get paid from the INS company is mind boggling. I think this may be something for us to look forward to in the future.
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Clever Username
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Post by Clever Username on May 18, 2011 15:15:44 GMT -5
I'm not sure I follow your logic on this. 1. We all agree the insurance company has tons of paperwork. 2. In-network doctors will work at reduced pre-negotiated rates.
So, why would I work with an out of network doctor which costs more and has more paperwork? I totally get why a doc might choose this if his demand is high enough. But why would a consumer choose this.
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pepper112765
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Post by pepper112765 on May 19, 2011 13:39:57 GMT -5
I'm not sure I follow your logic on this. 1. We all agree the insurance company has tons of paperwork. 2. In-network doctors will work at reduced pre-negotiated rates. So, why would I work with an out of network doctor which costs more and has more paperwork? I totally get why a doc might choose this if his demand is high enough. But why would a consumer choose this. Because some really like their doctors. My pediatrician, who by the way, does not take my insurance, but does file claims for me, is always accessible. I even have his cell phone number. He's not like some of those doctors that require an office visit when you know what is wrong, i.e., sinus infection or something. He'll call the script into the pharmacy and then you go see him in a few days to see if everything is cleared up. He even got offended when I went to the urgent care after hours becuase I really didn't see the need in bothering him (he gets a notification regarding the visit), saying I just could have called him. I didn't want to impose. BTW, the urgent cares in my area are way better and cheaper than going to the ER. And, you get out of there quicker.
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jkapp
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Post by jkapp on May 19, 2011 14:05:25 GMT -5
This was kind of an idea I had a couple of years ago when debating whether insurance as needed: instead of insurance you choose a doctor/hospital combo and become a "member" and pay monthly/annual membership fees. Then they have their list of services that are fully covered and ones that have additional expense (and different levels of membership can cover more or less services). If you have to use a hospital or doctor outside of the membership then your member hospital covers what they would pay for that service and then the patient would cover the difference (either to the other hospital or to their member hospital).
It's almost a bit like HMO insurance, but it would be a fee structure instead of an insurance premium structure and would be administered by the hospital itself.
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zibazinski
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Post by zibazinski on May 19, 2011 14:57:55 GMT -5
DF has that kind of service and it is worth every penny. The doctor returns phone calls, emails, and even comes by the house or office. DF has A LOT of health issues. I, on the other hand, see the doctor once a year for well woman care and take no prescription drugs so I am not investing in concierge care.
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zibazinski
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Post by zibazinski on May 19, 2011 20:43:42 GMT -5
Pretty much.
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Post by Deleted on May 20, 2011 8:27:23 GMT -5
Concierge care. What a bizzaro notion. I remember when medicine was a calling. In my youth, doctors still made house-calls and not just to the fancy folk either. I remember those days, too (although I don't think I ever had a doc make a house call) but so much has changed. First of all, medical care wasn't so darn expensive. All those new tests, procedures, surgeries, etc. have costs. Plenty of people died in those days from things that are treatable now. I remember when childhood leukemia was a death sentence and still remember the name of the first child who survived it. Then docs tried charging more to patients with insurance so they could afford to treat patients who didn't have insurance. Managed care and fee schedules put a stop to that. Many docs have massive student loans and are getting peanuts for each patient from the insurance and they try to make it up in volume. I see the "concierge care" as a way to make a decent income and practice medicine the way they really want to instead of in 5-minute increments, rushing from room to room. I wouldn't buy it because (thank God) I'm healthy and don't need that sort of attention. If I need a doc fast I'll go to the Minute Clinic (and have). But there have always been 3 tiers of healthcare in this country: the Medicaid/uninsured level, the "managed care" level and the "hang the expense I want the best doctor and I don't care if it's in network or not" level. Concierge care is that 3rd level.
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zibazinski
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Post by zibazinski on May 20, 2011 8:35:37 GMT -5
So true and in DF's case, that doctor earns every penny. He also has 1500 patients down from 4k and is THINKING about adding 500 more. At 2k a pop per year plus insurance/copays, he's doing alright and now has family time. BTW, they don't "broom" the unhealthy, just the unhealthy who don't follow doctor's advice to try to be as healthy as they can. If I were a doctor, I'd think long and hard about DF but his doctor says DF does what he is told and is a keeper because of that. This doc is wonderful in his care and he can be because he has fewer patients and can now be a real doctor and financially secure as well. I KNOW he has school loans and his wife still works as well because she has loans, too, and they have kids/college/all that stuff. He isn't living in a McMansion and driving a Mercedes, not that I'd care if he did.
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Post by Deleted on May 20, 2011 8:56:01 GMT -5
BTW, they don't "broom" the unhealthy, just the unhealthy who don't follow doctor's advice to try to be as healthy as they can. If I were a doctor, I'd think long and hard about DF but his doctor says DF does what he is told and is a keeper because of that. Yeah, my sister tells me about pregnant patients who smoke. She can handle them tactfully; I wouldn't even want to treat them. (Yes, I know that's against the Hippocratic Oath but I'm not a doctor so I can have a bad attitude.) If I were a doctor I'd want to feel like a partner with my patients in keeping them healthy and managing whatever diseases they got stuck with, not just someone who writes prescriptions to counteract the effects of their unhealthy behavior.
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zibazinski
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Post by zibazinski on May 20, 2011 9:00:21 GMT -5
It is sad and the doctor said he was sorry to lose some of them but he wanted to make a living as well as practice medicine and now he does.
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zibazinski
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Post by zibazinski on May 20, 2011 9:01:25 GMT -5
They don't cut staff, your insurance is still billed and you still pay your copays. You just see your doctor immediately if necessary.
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zibazinski
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Post by zibazinski on May 20, 2011 9:20:04 GMT -5
That is a different thing. I know ONE doctor who did that and it worked for her and, yes, you paid a fee as well. Most doctors are charging the fee and still billing your insurance.
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zibazinski
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Post by zibazinski on May 20, 2011 9:22:26 GMT -5
The one doc who did that cut her staff and charged 40 bucks a visit cash but did charge a more nominal fee like a grand to stay with her. The doctors I know that are moving to Concierge charge a higher fee, like 2k a year and still bill your insurance company. They can just cut patients so service is better and faster for you.
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