Email from physician's office - new fees
I don't know about you, but I've been getting $5 bills from my doctors for the last year or so - never have quite figured this out. This is after paying my co-payment at the office when I arrive for an appointment.
Today, I received this - seems a bit brazen to me, but I presume it's the way many practices are handling whatever it is which has changed:
To our patients:
We have implemented a policy requiring a credit card held on file effective 08/17/2016. As you may be aware, the current healthcare market has resulted in insurance policies increasingly transferring costs to you, the insured. Some insurance plans require deductibles and copayments in amounts not known to you or us at the time of your visit.
Similar to hotels and car rental agencies, you are asked for a credit card number at the time you schedule your appointment and the information will be held securely until your insurance(s) have paid their portion and notified us of the amount owed by you the insured. You will receive a statement. At that time, any remaining balance owed by you will be charged to your credit card and a copy of the charge will be e-mailed or mailed to you. This is an advantage since it makes checkout easier, faster and more efficient. This in no way will compromise your ability to dispute a charge or question your insurance company's determination of payment.
Patients with Medicaid or CHIP coverage are exempt from having a credit card on file.
If you have any questions about this payment method, do not hesitate to ask.
So, they REQUIRE one to provide a credit card number for them to charge extra fees to whenever they are notified the patient owes more. They promise to notice that they have made charges to the card until after the transaction.
Comments
RUN! Fire them, that is robbery by permission,
Fees over copays? No. Call your state.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
I am curious what's changed
...I'd like it explained to me. Pushback may be necessary.
But, yeah - I haven't been to that office in a year. I'd been seeing this doc for six years, then I had a mysterious situation which caused me a good bit of discomfort (turned out to be significant dehydration caused by a new medication which was causing very bizarre issues with my blood pressure and making me feel as if I was going to pass out). I was having difficulty describing the sensations, and he was acting as if I were crazy (which I may be in other respects, but not about this). I've already done my quota of being told I'm nuts when I have a physical issue which is confounding my normal homeostasis.
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
Adverse effects of medication
Big pharma has poured vast resources into corrupting the record and convincing docs there is no such thing as adverse effects, when in fact adverse effects abound. Dopamine agonists are notorious for causing low blood pressure.
More here: When Good Doctors Prescribe Bad Medicine
Very interesting that you say that
...have been trying to find a doc to flesh out what happened, and that could potentially be a clue. I was actually having rather off the charts high diastolic pressure when I tested. Dunno. Chemistry between individuals is so different (er, I tend to be an outlier).
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
I can't honestly blame the
I can't honestly blame the doctor's office for this - they are the ones getting caught between the patients and the insurance cos. When the patient has paid the co-pay, and then the insurance co disallows part of the rest of the bill, the doctor then has to initiate a bill to the patient, and then wait for it to get paid. And since the insurance cos are not exactly known for their speed at handling claims, this means that it might be a couple of months before the doctor is even able to begin this process. I just consider this to be one more symptom of how totally screwed up our entire healthcare delivery system is. And frankly, their point is correct that in any other business, it is considered perfectly normal to require either a CC guarantee or payment in advance.
I'm happy to pay in advance
I actually already do with my copayment. What happened that what's due from me now exceeds that amount? I understand that the doctor's office is not in control of whatever going on. But is there a limit to what they may be told by the insurance company I owe on top of my copayment? $100 could really screw up my accounting if I'm unaware of charges coming in.
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
informed consent
In any other business, you likely won't die without their services, and you wouldn't agree to pay an unspecified amount, in advance of service.
The practice described should be illegal, or severely restricted by law, imo.
That is essentially what has been happening behind the scenes,
though.
For the most part, patients don't actually know the price of a Dr's services in advance of service. The old insurance model was protecting us from this reality.
And different doctors charge wildly different prices for a given service.
~OaWN
I wonder
I wonder what patients who were never fortunate enough to experience the 'old insurance model' are thinking of a system that forces them to pay for insurance for services that they still cannot afford, because of deductables and 'credit card holds'?
It's a good thing $$Hillary is going to fix all of this. /snark
The practice described should
I agree in principle, but the problem here is not the doctor but the fact that the insurance reimbursement is not determined until after the fact. The doctor makes an easy target, but let's not lose sight of where the root of the problem lies. After all, the only change being described here is that the doctor is requesting an advance payment guarantee, whereas formerly he would be sending a bill to the patient later. The problem of facing an "unspecified amount, in advance of service" has always been there, and has nothing to do with the doctor himself. That is and has always been in the control of the insurer.
Some people don't use credit cards
What are they supposed to do? I would change doctors if this happened to me.
Sounds like the Doctors are Getting Hurt by the Reindeer Games.
From the doctors perspective
BEFORE
- they saw you
- they collected a co-pay from you at the time of service
- they billed the insurance company for the rest,
- and then re-billed the insurance company as necessary. What fun! Eventually they essentially "got it".
NOW
- they saw you
- they collected a co-pay from you at the time of service
- they billed the insurance company for the rest,
WHO NOW SAYS HUGE DEDUCTIBLE APPLIES - PATIENT IS RESPONSIBLE FOR CHARGES!
The doctor is apparently getting this message frequently. Which means that
- they now need to go back to the patient to collect the money that they are owed.
From the doctor's perspective, it must be a huge pain in the neck for them to have to go back to the patient and bill you and get the money, money that in the past the insurance companies would have paid because deductibles were not so ridiculous!
The doctor is in a hard place. Seems to me that the next logical step for the doctors is to collect all money for their services on the day of the visit, and then issue refunds IF AND ONLY IF the insurance company actually pays them anything. And they might give discounts if you pay up front, and allow them to skip the hassle of working with the insurance company at all.
I don't think that it sounds like a case of new fees, per se, if I understand correctly. The doctor is simply trying to get paid. In the end, it might even be a good thing because the whole insurance thing seems to be breaking down. If doctors charge at the time of the service, they would tend to have up-front prices for their services, which would allow consumers to shop around ...
It is actually wild to see this happening ... to me it looks like a sign of the insurance system starting to collapse, and sooner rather than later.
~OaWN
I understand what you're saying, but this isn't any other
business. I would be looking for a doctor who would treat me regardless of my ability to pay. Most people are only one emergency away from disaster, http://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-americans-don...
Sure, 15% of that has a credit card to put such on. But what if your doc charges something disputed, so you're not able to charge something else you need? AFAIK, when you have a disputed charge, that money is still tied up until the dispute is resolved.
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I would be looking for a
Good luck. I think that went out with Marcus Welby.
I'm hoping maybe community health centers or health departments
might take some paying patients? I'd look into it, anyway.
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This is dispicable. So only people with
credit cards (CC) or Medicaid or CHIP (California Highway Patrol?) can get health care? Their justification is that people are required to have a CC on file to rent a hotel room or car. It's not the same. Not everyone uses hotels or rental cars.
A credit card is a privilege. Heath care is (or at least should) be a right.
This seems very suspicious. I'd write a letter to the state in regards to the insurance company.
The people, united, will never be defeated.
I completely agree with you.
This practice is making the possession of a credit card their gatekeeper to healthcare. What happens to their patients who for whatever reason don't have a credit card - denial of service?
I too would be looking for another doctor's office and I think I would make a call to the insurance commission as well about this practice.
" “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR "
I took my daughter to an ENT whose office kept billing us
$11 and something each month. This was years ago and I trusted that any charges were legitimate, silly me. I tried speaking to the office manager, but he tuned his back on me!
A dermatologist's practice kept submitting multiple claims to Tricare for one date of service. They shut down after an investigation showed they were up to some major shenanigans.
This is what happens when "biznez" and medicine merge.
"The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"
I am having a much better experience after switching to
a different ACA provider in Texas. For the first two years I used Blue Cross. They sucked so bad. Last year I broke my ankle and it took me a month to see a bone doctor dude because my primary care physician was on vacation - totally out of pocket - so I couldn't get a referral from her, plus it was even hard to find a doctor who would see me at all. Fortunately, they had put me in a boot and given good instructions at the emergency room, so everything was healing correctly. I was pretty lucky the bone dude didn't have to rebreak it and put pins in.
So last fall I dumped Blue Cross and went with First Care. My monthly payment is about $80 less, co-pays are less, deductible is the same. Early on I had no problem refilling the prescription with the new plan. I thought I might be screwed when I discovered there were no doctors on the plan in Ennis, Corsicana, and Waxahachie - where I had always gone for medical stuff. However, then I discovered they had doctors and hospitals in Hillsboro, Waco, and Mexia.
I fractured a rib last week. Why I thought it was OK to body-slam a stuck door at age 59?? I don't know. Thought I just pulled a muscle, but when it kept getting worse, my husband finally suggested "maybe you broke a rib?"
Being on the First Care plan gave me the option of going to an urgent care place instead of an emergency room. My plan said I didn't need a referral from my primary care physician to see any doctor under the plan. Wouldn't have been able to do that with Blue Cross because they require referrals - even for urgent care (they did last year anyway).
Getting to be a long story here, but the bottom line is . . . I received good medical care for a similar type of injury (broken bone). It cost me $30 with the First Care solution. Cost me $400 - $500 out of pocket immediately with Blue Cross.
And the Blue Cross website never worked. First Care works all the time.
First Care is this small outfit out of Lubbock.
It sure looks like the ACA is falling apart though. I have a friend who is rushing to get both knees replaced before the end of the year, just in case it goes away.
Marilyn
"Make dirt, not war." eyo
If there are other doctors you can switch to, then I would
contact this doctor to let him/her know why you are considering switching. I would not agree to this unless I had no choice, i.e., there are no switchable doctors. I would tell him/her what others have commented, i.e., a credit card is a privilege that may not always be available but health care should be a right; it is not the same as a hotel because you would never be in dire need of a hotel room; also they do not keep your card on file all the time, only while you reside there, limiting the potential for identity theft. And you do not trust the doc's staff to ensure the amount is correct BEFORE charging your card. It is essentially giving them a blank check and you are not comfortable with that at all.
IF they do this the way they should, then they're going to be waiting all that time for the insurance to make a decision anyway. It should not take all that much longer to get in touch with you and ask you to pay your portion. At that time, you can decide whether or not to put it on a credit card.
This may be a ham-handed office manager rather than the doc, who in running a small business probably does not want to see a mass exodus of patients, and if that happens the OM will never admit what s/he did. So that's why I think you should try to contact the doctor directly.
I know a vet's office where office staff were ripping off the patients for extra payments, unknown to the doc. So I would not trust anybody to keep my credit card on file and use it properly. This would be a deal breaker for me.
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I actually left for other reasons
this doc really hates ACA - am pretty sure he's on board with whatever they are doing. He's very hands-on.
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
Oh, you already left? Good. Then you can just tell them NO,
that's the deal breaker, goodbye, you're not getting my card number. If they hear from a few "unreasonably obstinate" people, maybe they'll walk it back for the rest.
Probably not. But it won't hurt anything since you're already gone.
I haven't been to the doc in a long time, but I know the hospitals here love the ACA. They all expanded in anticipation of a great rise in paying patients.
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I had a sleazy walk-in clinic try that on me...
I went there on a weekend when I figured I had gotten Lyme Disease yet again, and I wanted to get started on the Doxycycline as soon as possible knowing that literally 24 hours after the 1st dose you feel a lot better. My regular doctor had already closed...
I had gone there, and given all the insurance info, then waited a ridiculous amount of time in the waiting room. I was about to walk out when they finally brought me into an exam room. Once in there I again waited for a ridiculous amount of time, when I opened the door, and went to leave. They rush over apologetic assuring me the doctor would see me next, and very soon. At this point with about 3 hours of waiting invested, I stayed, I shouldn't have...
The doctor finally came in I told him that I had Lyme Disease and this was about the 4th time so I know it is, here's the bullseye rash, give me the damn script and I'll be on my way so you can get to the next patient that waited too long for you. The doctor ordered the blood test, and left not to be seen again. I waited a while longer, then they came in took the blood, gave me the script, and I paid the co-pay and left.
About a month later they sent me a bill for $5 with that same claim. I called the office and confronted them about their sleazy billing practice, and the longest wait I had ever endured waiting for a doctor...
I'm not sure what their reply was as I was speaking and not listening...
But they knew that was $5 they would never see...
I don't think they are there any more and the local hospital has opened a clinic in the same strip mall...
I'm the only person standing between Richard Nixon and the White House."
~John F. Kennedy~
Economic: -9.13, Social: -7.28,
I had to wait five and a half hours for the doctor once.
Supposedly some kind of emergency, but "she'll be right in". This was back in the HMO days, you couldn't leave or you'd have to pay full price out of pocket for the visit, at least that's what they said and I didn't want to risk it. They refused to reschedule. My appointment was at 1 PM, I finally saw the doc at 6:30 PM and I refused to accept her apology. I switched docs shortly thereafter. But I win the waiting-for-the-doc horror story competition unless someone else waited longer!
(I had to see her once more before I switched. I took food and drink and loudly told everybody in the waiting room how I'd had to wait five hours last time and they wouldn't even let me go get a drink of water. They got me back there in a room - to shut me up I'm sure - in about 3 minutes!)
Please check out Pet Vet Help, consider joining us to help pets, and follow me @ElenaCarlena on Twitter! Thank you.
It's a sleazy move. Change doctors fast. nt
"Love One Another" ~ George Harrison
I may be way out of date /
I may be way out of date / behind the times on this, but it used to be that even after the patient paid their co-pay and the doctor submitted his / her charges that the insurance companies had a customary charge for the medical code of the service being billed. Anything above that the doctor had to "eat," fair or not. I never knew if that was decided individually by each insurance company or state law or what exactly set the customary charge for a given service.
In my case I have to get lab work every few months for monitoring a condition, and I thought it had been established that when I go to the doctor's office just for the lab work and didn't see the doctor that I didn't owe the $25.00 co-pay, and on one occasion they had applied my co-pay for a lab visit to my follow-up visit with the doctor a week later. Well, the most recent time I went I got an invoice from the doctor's office showing that they deducted $25.00 from the part of the lab bill that the insurance company didn't pay and billed me for it. I just went ahead and paid it because I get really angry when I have to maneuver through these kind of billing quagmires, and it was worth it to me not to have my blood pressure spike or end up making an ass out of myself.
So, basically I don't understand what has happened to what I thought was the rule that the doctor can't come back to the patient for charges that the insurance disallows for being more than their standard reimbursement for a given procedure. Maybe this has changed. If so, then good on those health industry lobbyists for doing such a fabulous job finding a new way to gouge the patients / sarc.
Meanwhile, my own sister is one of the people who can't afford health insurance under the ACA in VA, so she pays the fine. Her employer gives her some kind of medical savings account money, but it's not enough. It all makes me sick, no pun intended. Oh how we need to catch up to the developed world and have something like Medicare for every damn body! There should also be a way to make sure that people that fall in-between qualifying for Medicaid and not being able to afford the standard out-of-pocket charges for Medicare can have a sliding scale based on income for those charges.
I was STUCK before I qualified for Medicare
I was in a job which pain little and I hated and they hated me. But I couldn't leave because I had insurance and leaving there was too big a risk about whether I'd qualify for it someplace else. I had my first cardiac surgery in my mid-20s. Mercifully (?) a few more surgeries within a couple more years and I had enough brain damage to qualify. But what a racket to get in - a lotta folks die trying (I do not kid).
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
insurance companies had a
What you are describing here is an "in-network" arrangement. This could be either an HMO or a PPO, either way it's a private contract between the doctor and the insurer. The doctor agrees to accept the insurance reimbursement cap in return for being listed by that insurer as a "network provider". This is what is meant when a doctor says whether or not he "accepts" a given insurance. If he's "out of network", he can charge whatever he wants, and you are legally responsible for anything the insurance doesn't pay. More and more doctors are dropping out of these networks, though, as the insurers squeeze the caps tighter and tighter, while making the doctors jump through ever more complicated hoops.
Another factor is that more and more doctors are outsourcing their billing to third party medical billing companies, so the doctor himself may be completely unaware of what is going on. In this case, you may get some satisfaction by talking directly to the doctor. That happened to me once - my doctor changed to a new billing company, but received so many complaints about their practices from so many long time patients that he ended up changing back.
This is a very late reply, so
This is a very late reply, so you may not see it, but thank you! That makes perfect sense. My doctor is supposed to be in-network. One day before I have to go back for lab work, I'll call up the insurance company to double-check this coverage.
My own brother is a doctor, and he does his best to see that his patients qualify for the insurance coverage they've paid for, and he also gives away a lot of free care for people who otherwise wouldn't be able to have procedures that aren't covered. He wants to be paid fairly for his services, but he especially wants to help his patients. He's one of the good ones.
He's one of the good ones
Yes, a lot of people are IMHO too quick to jump on the doctors for problems that are caused by the insurance. Certainly there are some doctors who deserve all the scorn that they get, but there are a lot of others who really are trying their best. And when people talk about doctors "getting rich", they really do need to differentiate between GPs and specialists.
I find this really sickening
and I'm sorry, but I really am sick of feeling sorry for the doctors too. If more doctors perhaps stood up to these damned insurance companies maybe they wouldn't have as many issues with reimbursement. But they want that high pay along with NO real responsibility for the actual patient outcome, it's just all about the paycheck. Sorry, but I don't feel sorry for them. They haven't helped push for any kind of universal or single payer system, so fuck them, let them die on the vine if they can't get reimbursed from the shitty system they help perpetuate. The AMA did its part a long damned time ago tarnishing the idea of socialized medicine, let them reap what they've sown.
Yes, this is merely a rant too, I get that maybe it's not logical but I am sick to death of it today!
And hey, if you don't have a CC, I'm sure your debit card will do - any way they can bleed that last dime out of you, they'll do it. Next step I suppose is a full credit check before any new patient will be accepted...
Only a fool lets someone else tell him who his enemy is. Assata Shakur
I love your rant and agree wholeheartedly.
Except no, never give anyone your debit card!! They'll take the money right out of your bank account and it's gone unless you win a dispute. That's even worse than your credit being gone unless you win a dispute. Can't pay rent on a credit card usually! I have heard, but fortunately never experienced it, that it's harder to win a dispute with a debit card too - they already have your money, whereas with a credit card they have to hope you'll pay it eventually and know you probably won't if you don't think the charge is fair. .
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Those poor doctors and poor pharmas...
http://well.blogs.nytimes.com/2016/08/22/epipen-price-rise-sparks-concer...
The Epi Pen, folks. We buy them because our loved ones have severe allergies. Usually and HOPEFULLY they aren't needed and they expire. They used to be around $30 to $40 dollars. Then they jumped to $50. Now..
$350.
IF your child is of school age, you need to provide one set to the school.
SO lets see why the increase... aw... some elitist BS
http://www.nbcnews.com/business/consumer/mylan-execs-gave-themselves-rai...
"EpiPen prices aren't the only thing to jump at Mylan. Executive salaries have also seen a stratospheric uptick.
Proxy filings show that from 2007 to 2015, Mylan CEO Heather Bresch's total compensation went from $2,453,456 to $18,931,068, a 671 percent increase. During the same period, the company raised EpiPen prices, with the average wholesale price going from $56.64 to $317.82, a 461 percent increase, according to data provided by Connecture.
In 2007 the company bought the rights to EpiPen, a device used to provide emergency epinephrine to stop a potentially fatal allergic reaction and began raising its price. In 2008 and 2009, Mylan raised the price by 5 percent. At the end of 2009 it tried out a 19 percent hike. The years 2010-2013 saw a succession of 10 percent price hikes."
The amount of epinephrine in these emergency pens is worth $1. One Dollar. A one dollar amount of medicine for emergency needs. But Ms. Bresch's needs $19M salary. Think of her needs, her wants, her life.. .Not the school kids this year who will die because they can't afford to provide Ms. Bresch their souls.
Come on my fellow peasants and neighboring slaves. Work harder. Work longer and die quicker.
"Love One Another" ~ George Harrison
Lordy. How is this even patented? It's epinephrine, for heaven's
sake. Well, just sneak up behind the kid and scare him.
Or show him the price of the pen! That oughta send his epinephrine soaring.
Please check out Pet Vet Help, consider joining us to help pets, and follow me @ElenaCarlena on Twitter! Thank you.
There isn't a word for how
There isn't a word for how vile these people are. They must also be spending HELLA dollars on ads because I see them all the time even though I'm mostly fast-forwarding through them on DVR. They have all kinds aimed at different demos - ones aimed at parents, ones aimed at teens appealing to their burgeoning sense of taking care of themselves and growing up, and then there's the one with the scenario of a dire attack hitting at a party that is filmed from the point-of-view of the attack sufferer having a terrible reaction to eating a brownie that a friend forgot had included peanut butter in the recipe.
I had read other places that the price had gone up astronomically, but I didn't know the reason was this horrible. Time for some extremely-bad PR and social media shaming in case that might work to get these jerks to lower the price. Even so, they'll never go back to what it used to be. Unless the FTC actually does something, they'll just wait until the heat dies down and jack the price back up again. This Mylan company is run by disgusting, revolting, horrid, wretched scum of the earth death-eating horror shows! Talk about the job of CEO being a haven for fucking sociopaths!
Edited to fix spelling error, but then a little more rant came out too.
But there's a FACE for it since Pharma Boy came along
https://images.search.yahoo.com/search/images;_ylt=AwrBT0du7bxXsJQA9k1XN...
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
I remember when they were very easy to buy
I recall my Mom being upset at the new price of $4 a piece
The first time I had seen one was at a school field trip. A girl was stung by a bee and the school nurse (remember when we still had those?? LOL) she got out an epi pen. Now you have to send those with your kids.
I used to have an extra in the car. An extra in the packs. But at $350??? What's a parent to do?
I hope the woman who runs Mylan gets her karma.
"Love One Another" ~ George Harrison
Now they are
advertising the damn things, which is ridiculous! Either you need them to save your life or you don't. Advertising is ridiculous! But now the can say they have costs to recoup. A-holes.
Edited for misspelling ridiculous. Twice! Bad spelling day.
"The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"
I remember a time when my own mom was mad
about them being $4 a piece.
"Love One Another" ~ George Harrison
Check out her daddy. nepotism works!
Joe Manchin is daddy.
Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.
I think this would be a good
I think this would be a good idea as an OPT IN service, but to mandate it seems ... a bit much in my opinion.
I'm curious to know what they mean specifically by "the current healthcare market has resulted in insurance policies increasingly transferring costs to you, the insured. Some insurance plans require deductibles and copayments in amounts not known to you or us at the time of your visit."
I've sent an inquiry to my Congress Critter today
to learn what heck this means - what changed?
'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member
Poor poor MDs!
They only make 50% more than MDs in other countries. Of course they need a blank check from their patients.
Ahhh!!!
The best healthcare system in the world!
“Our enemies are innovative and resourceful, and so are we. They never stop thinking about new ways to harm our country and our people, and neither do we.”
George W. Bush