Up Close and Personal: Healthcare gone awry?

Happy Herbs

Okay, get this:

Since moving to my current community and finding a doctor, who started out in a private medical practice, I have had three different “practitioners” as my go-to doctor. One after another, these associates left the practice, and I ended up seeing someone new. I’ve seen three different doctors and a nurse practitioner over an eleven-year period. It’s always been a mystery to me who my official primary care physician is.

Is it the head doctor on the stationery or the nurse practitioner or new doctor who’s actually looking at me? Who am I supposed to write on all the forms when I go to see a specialist? It’s always been confusing.

Well, anyway, a year or so ago, the head doctor (or whatever he is called) decided to hook up with a larger medical entity. I didn’t know what that meant, but okay, fine, it wouldn’t really affect me. Except suddenly I could never again get a quick, that-day appointment for, say, bronchitis or an ear infection or if my daughter ended up scratching her cornea with a flake of mascara that fell as she tried to build four-inch black lashes that would do Katy Perry proud (yes, that just happened this week). Before the switch, the scheduler would always squeeze me in to see one of the doctors, somehow, that day or early the next morning at the latest.

Now when I call for that kind of unexpected problem, I usually get a machine, and I end up leaving a message. Two or three hours later, I receive a call back telling me there are no appointment times, and I am directed to go to the walk-in clinic. We have had to do this at least five times. 

I’m laughing (not really) because this time, when I finally got the call back about the eyeball that was swollen half-shut and as red as the planet Mars, I was already AT the walk-in clinic, one step ahead of the game, for once. I’ve now been properly trained to just go to the clinic unless I have a scheduled appointment. Only took me a year and a half.

So, I’m wondering. Does the walk-in clinic cost my insurance company more money? Probably. And it gets better. Read on.

This year, the medical entity–with which my doctor’s office had aligned a year or so ago–merged with an even larger medical entity. The nurse practitioner I had seen for my last appointment was let go. I don’t get sick too often, so I only saw her once for a yearly check-up last summer (I’m a woman; you can figure out what that entails), but if this trend continues, how many more doctors/nurse practitioners over the years will have to get up close and personal with my up-close-and-personal? I’m getting a little testy about it, and not just because I’m peri-menopausal!

Since Christmas, I have received three separate letters telling me that I have to reschedule three appointments (a follow-up and next year’s annual exams) for myself and daughter because of the lay-off. Today, when I called to do so, I found out that the doctor who is taking over the patients is now going to be my PCP (Oh, really? That’s news. At least I know who to write on the forms, though), and she won’t do a physical until I have an office visit with her FIRST, as a new patient.

Um, I’m not a new patient. I have been a patient of this practice for eleven years. It was not my idea to switch to her, thank you, so why do I need to have an extra appointment to see a replacement doctor? I’ve never had to do that before. And what is the purpose of that appointment?  

Because I am over 40 and could really care less about offending anyone, I politely asked: So are you charging my insurance company for a visit that is for NOTHING? What will it be coded as? 

It will be coded as “an extended office visit.” Huh. 

I don’t know about you, but that sounds to me like (ch-ching!) charging the insurance company for absolutely no reason. I said as much.

Did I want to talk to the office manager?

Well, yes.

I was transferred. To a voice mail. But that was an accident. When I called back later, I scheduled the appointments. And then I asked more questions, and got some solid answers.

Here is the deal: My doctor is now working for the large medical entity rather than having his own practice. That is why the larger medical entity could lay-off the nurse practitioner as soon as the merger between two hospitals went through and the process of reorganization began. Still doesn’t explain why I (and my insurance company) have to pay for an extra appointment to see a doctor when we didn’t initiate the change, but I’ll explore that more later. Possibly when I alert my insurance company.

And remember the walk-in clinic? It is also owned by the larger medical entity. Do they charge more for walk-in care than a visit to a doctor? If so, does this explain why any non-scheduled health problems get sent there instead of to the doctor’s office?

I’m not a big fan of insurance companies, but, gee, this seems slightly fraudulent. Thanks to the Affordable Care Act (Obamacare), my husband is now paying more out of every paycheck for the insurance we already had. No wonder. Maybe the insurance company is being ripped-off, too! Additionally, I was told recently by the spokesperson for the “larger medical entity” that the hospitals in question were looking at a 33 MILLION DOLLAR deficit of free and reduced-cost care costs for those unable or unwilling to pay for the medical treatment they receive at the hospital. Looking at it that way, I kinda can’t blame the hospitals for trying to cut costs where they can and billing the insurance company more when they can. So for those who think that Obamacare is some “new” socialist agenda, realize that your insurance company–or you–was/were probably being charged extra anyway to cover the costs of free care for other people. (Libertarians, please feel free to chime in.)

This is not to say that my doctors haven’t been good. They have. In fact, I really appreciate the work they do, and I’ve been super happy with the care I and my family have received. It’s all this other stuff…the administrative stuff, the money stuff…


I’m not going to draw any more conclusions out of this today. 

I’m sure you all have your own stories about healthcare in America gone-awry. Go ahead and post! We can all contemplate the crazy together.

And if you live in my neck of the woods, check out my series of articles about alternative and complementary health care in the Waterboro Reporter. 


6 responses to “Up Close and Personal: Healthcare gone awry?

  1. UGH!!! I was so wanting this to be a good thing!

    • It might still be a good thing, Cindy. The 33 million deficit I quoted probably indicates that costs had already increased significantly for insurance and for patients who were paying out of pocket…in order to cover the cost of the uninsured or under-insured. This restructuring maybe will be more transparent? About where the costs are? And why? I’d like to see more preventive care, i.e. doctors start talking specifically about processed foods/sugar that is ruining our healthcare.

      • Right! Prevention and early diagnosis are the big holes in the system as we’ve known it. My poor sister, supporting herself with a restaurant job, living in a rented room and getting around by city bus, was just diagnosed with stage 4 lung cancer. She’d had warnings, but no insurance. It’s easy for me to sit up here and say she should have gone out of her way to get supplemental medical care or gone for free evaluation…yet I’ve put off mammogram for going on three years, for the same reason. Treatment is a lot cheaper…and more possible…when those things are caught early. Cost IS a big consideration, whether we like it or not. I had one small blood test as a requirement for the refill of one prescription last winter. Over four hundred dollars! That’s more than my budget allows for all medical and dental care for a year! And I’m in a so much better position than many many others. I don’t want charity; I don’t want socialized medicine. I do believe, though, that we need to find some way to make basic diagnostics and preventative medicine more accessible.

      • Yes. Seems to me that there could be an evaluation of the entire healthcare system here…figuring out why it is so expensive. Treatments, as you say, are expensive. Drugs are expensive, too, and do they really work? Are they worth the cost?Does a blood test HAVE to cost $400??? That is outrageous! I’ve already decided I will not take cholesterol-lowering drugs or high blood pressure medication. So it is in my best interest to learn all I can about nutrition and exercise and keep myself as healthy as possible.

  2. The provider contracts with the insurance companies allow them to charge for a preventive care visit AND a sick visit (extended office visit) during the same office visit. Not all offices do it, but several do. Both sides point fingers: “the insurance company tells us to split the billing” and “providers won’t sign the contracts with us without allowing them to charge for more complicated visits.” My problem is that it has discouraged patients from fully disclosing health issues for fear of being charged. I encourage them to seek preventive care because it is covered in full (YAY!), but if the doctor asks how that rash is that they mentioned last year then there could be an additional office visit charge (BOO!) I HATE THIS! These changes are not due to the Affordable Care Act because they have been doing it for my HSA plans for several years (even before PPO or HMO plans had to cover preventive care at 100%). In addition, preventive blood tests like cholesterol screenings that are recommended for all of us at a certain age are now required to be covered in full if preventive (this is an ACA rule); however, some practices will not code it as preventive if you have ever had a high cholesterol reading. So what if it was three years ago, you don’t take medication, and you are following the same preventive care schedule as every other person with good cholesterol numbers? Depends on the practice as to whether they charge for simply a preventive screening or for a cholesterol screening with a diagnosis code. I have had some employees told by the physician’s office that to reprocess the claim with a preventive code so that it is covered in full would be insurance fraud. Um, I think it would actually be a correction. I work on these issues daily, and it is the most difficult part of my job to ensure that employees understand their health plans. Unfortunately, I have to say, “It depends on who your physician is…” a lot.

    I believe that the health care system needs reform, but I think that costs and care delivery need to be addressed sooner rather than later. Making policies available on the Exchange/Marketplace does not change these issues. I might tell you how I really feel in person…

    • Wow, thanks for the in-depth explanation. All this stuff seems so complicated to me…how can the average person comprehend what is happening? I’m just not impressed by any of it–but I sure am grateful for my asthma medication.

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