re: I hate our healthcare system and PAs/NPs

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We hate being made out to be the assholes all the time.

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It's a bad system for just about everyone except insurance company execs. On that I think we agree.

The problem is this. When a patient goes to his internist for his annual physical, which is nominally a "free" benefit he's paying $7,000 or more a year for, he might respond to the question, "Anything you want to talk about?" While he knows the internist isn't the specialist who could give a truly informed opinion, he says something anyway. The internist then assesses it for a minute or so, imparts no information that wasn't previously known, and maybe offers a referral. That turns the "free" annual physical into a $200 visit. Without the response, the insurance company may have paid the MD $120 for a 15 minute visit, which seems more than fair. With the response, the MD tacitly codes it differently, and the patient is on the hook for $200, with no credit for the "free" benefit. To get it fixed, the patient has to spend 30 minutes on the phone with the billing department. It's horseshite, pure and simple. If you don't want "to be made out to be an a-hole all the time," don't be one. That's pure and simple, too.