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Message
re: Provider Based Billing at a Clinic
Posted on 8/15/19 at 3:20 pm to iAmBatman
Posted on 8/15/19 at 3:20 pm to iAmBatman
quote:
except most people have insurance through an employer so they have no way to "get a better network," unless they want to get a Obamacare care, which may be way more expensive than one provided by their employer.
Get a better job.
1
Posted on 8/15/19 at 3:27 pm to TH03
quote:
Get a better job.
better job =/= better insurance network
you're usually better at this
Posted on 8/15/19 at 3:35 pm to LarryCLE
quote:
I agree that a lot of it seems like scam, but do you really think you’ll pay less under a single payer system? (Assuming you’re a taxpayer)
I don't know. Probably not. But it might be "simpler".
Posted on 8/15/19 at 3:39 pm to LSUFanHouston
quote:
quote:
I agree that a lot of it seems like scam, but do you really think you’ll pay less under a single payer system? (Assuming you’re a taxpayer)
I don't know. Probably not. But it might be "simpler".
It would be really simple. Your taxes would double, physicians would quit, physican offices and hospitals would close, appointments would be rationed by time since price and quality would be irrelevant, and you’d wait 6-8 months for procedures or appointments that take 2-4 weeks now.
FWIW I’m posting this from my office in a hospital
Posted on 8/15/19 at 3:56 pm to jbgleason
quote:
Wouldn't cover OLOL. Only the General.
Have you been around the OLOL ER lately?
They're doing you a favor.
Posted on 8/15/19 at 4:01 pm to LSUFanHouston
So you chose to utilize an urgent care after hours for a non emergent issue...strep throat?
And you are mad that the after hours urgent care center which has less predictability in revenue flow and overhead charged you more?
I remember the last time I brought my dog to the emergency vet after hours he charged the exact same as normal office hours. And the last time I called a plumber over in the middle of the night for a busted pipw there was no additional charge for the 2 am service call. And when I needed that part for my truck so I could drive to work the next morning the price of part from the 1 place that would open their door at 10 pm was the same as at good ol auto zone.
Except none of that occurred. In reality I was utilizing a service after hours and I paid for that convience. Why do you expect diffrent?
Take your kid to normal office visits for simple stuff and stay out of the damn ER and urgent care clinics.
And you are mad that the after hours urgent care center which has less predictability in revenue flow and overhead charged you more?
I remember the last time I brought my dog to the emergency vet after hours he charged the exact same as normal office hours. And the last time I called a plumber over in the middle of the night for a busted pipw there was no additional charge for the 2 am service call. And when I needed that part for my truck so I could drive to work the next morning the price of part from the 1 place that would open their door at 10 pm was the same as at good ol auto zone.
Except none of that occurred. In reality I was utilizing a service after hours and I paid for that convience. Why do you expect diffrent?
Take your kid to normal office visits for simple stuff and stay out of the damn ER and urgent care clinics.
This post was edited on 8/15/19 at 4:14 pm
Posted on 8/15/19 at 4:27 pm to Bleeding purple
quote:
So you chose to utilize an urgent care after hours for a non emergent issue...strep throat?
It's not an urgent care. It's an after hours clinic. Our doctor - part of LCMC as well - has told us and all of his other patients to treat it like going to the primary care doctor.
The doctors at the After Hours Clinic are not emergency doctors. They are regular ole pediatricians.
Further, BCBS charges a $50 co-pay for urgent care visits.
This is in no way, no shape, no how, an urgent care.
So your entire preachy statement is 100 percent invalid.
We've used this clinic probably 8 times over 6 years. The first 7 times, we paid a $25 co-pay (not a $50 urgent care co-pay). The 8th time is what I described in the OP.
quote:
Except none of that occurred. In reality I was utilizing a service after hours and I paid for that convience. Why do you expect diffrent?
I would expect an urgent care to have a higher level of service and a higher co-pay, but again, that's not what happened here.
Also, for your rant to be accurate, it would be like during the day, the plumber charged you his rate, but at night, the plumber charged you his rate, plus a portion of his truck insurance and truck note.
quote:
Take your kid to normal office visits for simple stuff and stay out of the damn ER and urgent care clinics.
So, your kid is sick on a Sat evening. Do you:
1) Utilize the primary care clinic facility that night and get your kid started on meds, so the can go to school on Monday?
2) Do nothing, kid feels like crap for 36 hours, misses school Monday, parent misses a day of work, to then try to get an appt on Monday at your pediatrician?
Posted on 8/15/19 at 4:27 pm to iAmBatman
quote:
you're usually better at this
Shitty jokes?
I beg to differ.
Posted on 8/15/19 at 4:31 pm to LSUFanHouston
quote:
I 1,000 percent understand WHAT they are doing. It's basically legal fraud.
The legality of these billing practices are in question and there is currently extensive ongoing litigation regarding these types of situations and some larger legal battles with TPA Billing Facilities for hospitals.
Posted on 8/15/19 at 5:00 pm to LSUFanHouston
The after hours clinic is operating as an urgent care and has the same predictability of revenue and overhead I discussed earlier. It may not be legally labeled or recognized as an urgent care for various reasons but that is exactly what it is operating as. The providers working there are working after hours, likely paid hourly in addition to a percentage of billable claims and that convience is costly.
MANY er docs and nearly all urgent care docs are not EM trained physicians and are "regular ole" Family medicine docs. And in this situation with a limited age of patient they can be pediatricians.
Your doc was wrong if he said it is the same as going to primary care visit as clearly evidenced by the difference in billing and not seeing your PCP.
Businesses are allowed to make changes in their charges and financial flow to facilitate profitability and sustainability. If there was no notification of this change they were ethically wrong and likely legally wrong. Though I bet you received correspondence either pre visit as a previous patient, or immediately prior to being seen that detailed the biling practice. You likely even signed that it was reviewed.
It does not matter how the plumber itemized the charges. I was charged extra for the convience of a late night call as you were.
The kid scenario has a multifaceted answer.
I would give antipyretics, manage symptoms and if I felt he needed abx get one of my partners to call it in as I dont prescribe for my own family.
But short of that ability to call a partner, I would call the on call physician and describe issue and get meds called in. If that didnt work I would either have him tough it out until Monday am or go to urgent care if too bad.
I realize patients in different locations have that decision tree blocked in various ways. I have always seen all sick kids same day in my office so there is no "truth to get an appointment" I also take walkin appointments so no concern about waiting forever to be seen and taking an entire day off work.
The truth is the VAST majority of what is seen in Urgent care and much of what is seen in ER could be and should be managed in the PCP office the same or next day.
MANY er docs and nearly all urgent care docs are not EM trained physicians and are "regular ole" Family medicine docs. And in this situation with a limited age of patient they can be pediatricians.
Your doc was wrong if he said it is the same as going to primary care visit as clearly evidenced by the difference in billing and not seeing your PCP.
Businesses are allowed to make changes in their charges and financial flow to facilitate profitability and sustainability. If there was no notification of this change they were ethically wrong and likely legally wrong. Though I bet you received correspondence either pre visit as a previous patient, or immediately prior to being seen that detailed the biling practice. You likely even signed that it was reviewed.
It does not matter how the plumber itemized the charges. I was charged extra for the convience of a late night call as you were.
The kid scenario has a multifaceted answer.
I would give antipyretics, manage symptoms and if I felt he needed abx get one of my partners to call it in as I dont prescribe for my own family.
But short of that ability to call a partner, I would call the on call physician and describe issue and get meds called in. If that didnt work I would either have him tough it out until Monday am or go to urgent care if too bad.
I realize patients in different locations have that decision tree blocked in various ways. I have always seen all sick kids same day in my office so there is no "truth to get an appointment" I also take walkin appointments so no concern about waiting forever to be seen and taking an entire day off work.
The truth is the VAST majority of what is seen in Urgent care and much of what is seen in ER could be and should be managed in the PCP office the same or next day.
Posted on 8/15/19 at 5:07 pm to LSUFanHouston
If it was a single payer situation you wouldn’t have been billed like that because you would have never got into the office at least for anywhere from a few weeks to months before you can get an appointment. All these libtards saying it would be better fail to mention this when they talk about it. Screw that shite.
Posted on 8/15/19 at 5:14 pm to Bleeding purple
quote:
The providers working there are working after hours, likely paid hourly in addition to a percentage of billable claims and that convience is costly.
I can tell you in this instance that this is false. These are salaried doctors who are assigned to the clinic. Many of them are younger and will likely move into one of the more traditional practices over time, as spots open up. They aren't getting a commission or percent of claims.
quote:
Your doc was wrong if he said it is the same as going to primary care visit as clearly evidenced by the difference in billing and not seeing your PCP.
He is now wrong. He wasn't wrong for the first five years. Again, the situation changed.
quote:
It does not matter how the plumber itemized the charges. I was charged extra for the convience of a late night call as you were.
Again, it's not comparable.
IF the clinic said, hey, we are no longer a regular clinic but are now a urgent care, fine, that makes sense to me.
If the clinic had said, hey, all of our docs are now independent contractors and will bill you accordingly, fine. But that didn't happen either.
quote:
I would give antipyretics, manage symptoms and if I felt he needed abx get one of my partners to call it in as I dont prescribe for my own family.
But short of that ability to call a partner, I would call the on call physician and describe issue and get meds called in. If that didnt work I would either have him tough it out until Monday am or go to urgent care if too bad.
You can't really compare your knowledge base and tolerance level with the average person, though.
Also, our doctor has said we should only call the on-call doc IF THE AFTER HOURS CLINIC IS CLOSED. Why? Because rather than call an on-call doc, they want us to actually be seen.
quote:
The truth is the VAST majority of what is seen in Urgent care and much of what is seen in ER could be and should be managed in the PCP office the same or next day.
As I've now said several times, we, and our doctor (and all of the other doctors at his practice) don't consider this to be operating as an urgent care. They see it as an extension of their regular practice.
Having said that, the dynamics have changed. And it will likely impact how we handle our kids illnesses going forward.
Posted on 8/15/19 at 5:34 pm to jbgleason
quote:
What's really fun is when you go to the ER, for a legit emergency, and then some lab test comes back as "out of network" and adds $750 to the bill. I drove the extra 10 minutes past one ER(in intense pain) to go to the one that was "in network" and then some flunky that pulls my blood is "out of network"? Am I supposed to ask everyone that approaches me? fricked up
This. You can go to an ER for a broken bone, and that hospital can be in network, but the radiologists that read your xrays, mris, etc FOR that hospital are out of network. And the hospital may or may not tell you that upfront. And those radiologists can bill you for 100% of their charges.
This is happening more and more frequently now. Mainly bc private insurance companies want to pay less than Medicaid’s reimbursement for many services- and the doctors (understandably) don’t want to accept that.
Vantage is one of the WORST at doing this.
Posted on 8/15/19 at 5:41 pm to LSUFanHouston
I understand your frustration
It sounds much of it has to do with communication
Simply put the after hours clinic is a convience. Further, for several reasons the cost of care per pt seen in the after hours clinic is more than in the normal clinic. As a result the admin and possibly the docs are well aware it is not simply an equivalent extension of their normal practice and are telling you so (if not verbally) through the new billing practice.
It sounds much of it has to do with communication
Simply put the after hours clinic is a convience. Further, for several reasons the cost of care per pt seen in the after hours clinic is more than in the normal clinic. As a result the admin and possibly the docs are well aware it is not simply an equivalent extension of their normal practice and are telling you so (if not verbally) through the new billing practice.
Posted on 8/15/19 at 5:54 pm to the_watcher
quote:
would be really simple. Your taxes would double, physicians would quit, physican offices and hospitals would close, appointments would be rationed by time since price and quality would be irrelevant, and you’d wait 6-8 months for procedures or appointments that take 2-4 weeks now.
FWIW I’m posting this from my office in a hospital
Taxes would double?? Not like we aren't already paying much higher insurance rates to cover embedded costs of the uninsured. I would have to understand your definition of existing "quality" care as in my experiences it can be, and often is, quite variable in the same facility with existing private insurance.
Posted on 8/15/19 at 6:07 pm to Bleeding purple
quote:
I understand your frustration
It sounds much of it has to do with communication
Yes. LCMC has exploded in size by buying up practices/hospitals, and it seems that at many times the employees themselves don't know what's happening.
It's possible our regular pedi doesn't even know this change has occured, since it's not something he's directly involved with.
quote:
Simply put the after hours clinic is a convience. Further, for several reasons the cost of care per pt seen in the after hours clinic is more than in the normal clinic. As a result the admin and possibly the docs are well aware it is not simply an equivalent extension of their normal practice and are telling you so (if not verbally) through the new billing practice.
Prices rise and things change. The way this has gone down probably means I won't use the after-hours clinic again. I don't care about the extra $25, but this is a poor way of doing business.
In the non-medical world, when a business has higher costs, they simply up their prices and life goes on. It's possible that BCBS didn't agree with them hiking up their prices, so they are using this new method as a way to get more money.
Quite honestly, if the cost per pt is more... just call yourself an urgent care clinic, charge me my higher co-pay, and move on. If they came out and said, "hey, really, we are urgent care, and we are changing to this" at least that would be reasonable, transparent, and intellectually honest.
Posted on 8/15/19 at 6:09 pm to tirebiter
quote:
Taxes would double??
When people say this, they seem to forget that while taxes would go up, you also would no longer have insurance premiums or medical bills to pay. You would also have removed the profit margins from the insurance companies. I say profit margins, because most of the expenses of the insurance companies would likely be transferred to the government.
Posted on 8/15/19 at 6:34 pm to LSUFanHouston
Our clinic started charging a facility fee about a month ago. We (the providers) had no say in it. We have received a lot of complaints about it, and understandably so.
The only good news is that they should be going away in 2022
Hospitals do provider based clinics both the extra facility fee, but they also get discounts and medicines and other things.
The only good news is that they should be going away in 2022
Hospitals do provider based clinics both the extra facility fee, but they also get discounts and medicines and other things.
Posted on 8/15/19 at 6:58 pm to Bleeding purple
quote:
Also, for your rant to be accurate, it would be like during the day, the plumber charged you his rate, but at night, the plumber charged you his rate, plus a portion of his truck insurance and truck note.
quote:
It does not matter how the plumber itemized the charges. I was charged extra for the convience of a late night call as you were.
Well this sure sounds like medical billing in a nutshell.
“Don’t worry about what the bill says, just know that the total is justified.”
Posted on 8/15/19 at 7:00 pm to LSUFanHouston
quote:
So, what used to be a $25 visit to the doctor, now is $25 plus $28.33 = $53.33. Nothing has changed except how they bill. It's crap like this, why more and more people are willing to consider single payer.
Do you know that medical reimbursement has been declining for years. Put that into perspective at your own job. Someone is telling you that services you provided years ago for a certain price not o ly don't increase with inflation but they are actually worth less. How would you feel?
You got a seperate charge for the overhead of the facility because insurance for kids doesn't pay shite. And before you complain about a doctor's salary go look up a pediatricians salary.
But the worst part about your shitty rant is that you think single payer magically makes goods and services less expensive. When single payer happens you will just bitch when you have to pay not only your costs but every other leeches when taxes are due
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