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New trend in health care??-- Privia


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#1 Mom0012

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Posted 15 July 2009 - 08:59 AM

I received a letter from my doctor yesterday "inviting" me to join Privia. If I join, I will have more direct access to my doctor, and he can spend more time with me when I come in for appointments. If I don't join, he may not be able to see me any more. I'll have to see a nurse practitioner who he will be hiring instead.

I have to say this was extremely upsetting to me and quite a shock since the Privia membership is $2000 a year per personand both my husband and I see this doctor and have been seeing him for almost 10 years. I am very dependent on him at this point because he is treating me for chronic lyme and he is the only one I trust to help me get better. I can't afford to pay an additional $4000 a year just so that I can get a guarantee that I can see my own doctor!

I have had so many bad experiences with doctors but this one has been excellent. He has been caring and compassionate and he is smart and on top of things. He hasn't accepted insurance for a number of years and my husband and I have been willing to pay out of pocket to see him, but adding another $4000 on top of that really seems outrageous, especially considering my husband probably only sees him once a year.

He says his reasoning is that he is getting so many patients that need to be treated for lyme, he doesn't want to limit the number of people he can treat. He has been speaking on NPR and has been on television and I'm sure he has tons of people who really do need treatment. To me, though, he should refer his new patients to the nurse practitioner and continue to treat the patients he has already has a relationship with. What do you think?

I'd love to hear from anyone who understands more about Privia and if this is something that is going to start cropping up everywhere.

Lisa

Edited by LisaTheresa, 15 July 2009 - 09:29 AM.


#2 fj62

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Posted 15 July 2009 - 04:13 PM

I know something about this concept. My dh is doing this in his practice. Because of poor reimbursement and high overhead, physicians have to push people through so fast and the quality of care leave both physician and patient frustrated. My dh actually left private practice and went back to the hospital full-time for this reason. After a few years, a colleague approached him about joining his practice which is also fee based. Dh loves it. His previous practice was full at about 3000 patients; he will only take 250 in this practice- in order to enable him to spend as much time as needed with each patient. He just lost a dear 90 yo woman who he spent a lot of time with- he even went to her home probably half a dozen times(this isn't part of the deal, but she was in an assisted living complex near his practice and it was sometimes difficult for her adult children to get her there) The point is, because of the fee, he is able to do this. He has had patients ask him to research alternative options for treatment- he'd never have the time in a traditional practice to do this. Patients are guaranteed to see him same day if they call by noon. During off hours, they talk to him directly. The office staff is very professional and is very service oriented In fact the mantra for any patients request is- unless it's illegal, immoral, or unethical, the answer is "YES!" He's only been at this for 1 year, but so far we are very proud of what he's giving his patients. Hope that helps.

#3 Alice

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Posted 15 July 2009 - 04:24 PM

It's a form of concierge medicine.

On Privia:
https://www.priviahe...rship/faqs.html

An article from NY Times about concierge medicine that highlights the benefits but also some of the criticisms.
http://www.nytimes.c...gewanted=1&_r=1

#4 mom2moon2

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Posted 15 July 2009 - 04:26 PM

It's weird that a couple of weeks ago I just finished one of Robin Cook novel about this. It's called Concierge Medicine. And at the end of the book, there is a quite lengthy article about this. Obviously, there is a good and bad aspect of it.

It's been there for a while, though.

The previous poster explains it well.


Now, with that $4000 fee .... do you still have to pay a copay if you need his service ? If he operates you, will he charge you extra ? Or is it just for reserving the spot ?

(Sorry .. just curious)

#5 BikeBookBread

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Posted 15 July 2009 - 04:27 PM

Hope this doesn't wade too far into the muddy "political" waters, but will this even be an issue if nationalized health care gets ram-rodded through in the next few weeks?

Edited by BikeBookBread, 15 July 2009 - 04:32 PM.
grammar correction


#6 Alice

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Posted 15 July 2009 - 04:37 PM

Hope this doesn't wade too far into the muddy "political" waters, but will this even be an issue if nationalized health care gets ram-rodded through in the next few weeks?


I think whatever happens to health care here, this kind of care will still be available. I am not at all an expert but I believe for example, that in the United Kingdom even with the National Health Service you can still purchase private care that is either above and beyond what is available through NHS or you can be a private patient paying on your own. Generally, the private patients are paying more but are receiving the more personal care similar to the concierge docs. I'm not sure how it works for docs in the UK...if they can choose to only accept private patients or not. My guess is that what kind of overall health care system we have will be less an issue for people that can afford this kind of care.

I did a quick search for Private Patients vs NHS in UK and got a bunch of sites showing the different fee structures and services offered at various UK medical facilities. But again I'm not an expert on exactly how it works there.

#7 newbie

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Posted 15 July 2009 - 04:48 PM

I know something about this concept. My dh is doing this in his practice. Because of poor reimbursement and high overhead, physicians have to push people through so fast and the quality of care leave both physician and patient frustrated. My dh actually left private practice and went back to the hospital full-time for this reason. After a few years, a colleague approached him about joining his practice which is also fee based. Dh loves it. His previous practice was full at about 3000 patients; he will only take 250 in this practice- in order to enable him to spend as much time as needed with each patient. He just lost a dear 90 yo woman who he spent a lot of time with- he even went to her home probably half a dozen times(this isn't part of the deal, but she was in an assisted living complex near his practice and it was sometimes difficult for her adult children to get her there) The point is, because of the fee, he is able to do this. He has had patients ask him to research alternative options for treatment- he'd never have the time in a traditional practice to do this. Patients are guaranteed to see him same day if they call by noon. During off hours, they talk to him directly. The office staff is very professional and is very service oriented In fact the mantra for any patients request is- unless it's illegal, immoral, or unethical, the answer is "YES!" He's only been at this for 1 year, but so far we are very proud of what he's giving his patients. Hope that helps.


So is there a copay and what about hospitals???

This sounds ideal for us, because its 5k less than our HMO. What is hidden? And are they across US?:bigear:

#8 Emmy

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Posted 15 July 2009 - 04:53 PM

This sounds ideal for us, because its 5k less than our HMO. What is hidden? And are they across US?:bigear:


But dr fees are the least of your issue if you get really sick or are in an accident.

#9 Alice

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Posted 15 July 2009 - 04:59 PM

So is there a copay and what about hospitals???

This sounds ideal for us, because its 5k less than our HMO. What is hidden? And are they across US?:bigear:


The fee for most of these is solely to have "access" to your doctor. It's considered a membership fee. You will still get billed for any services the doctor provides. You would certainly get billed for labs, Xrays, hospitals ,etc. You can still have insurance with the Privia model and with some other concierge services and they can bill the insurance or some docs who don't accept insurance would still bill you directly. You are paying more for the fact that the doctor only accepts a small number of patients so you are promised better access and things like less or no waiting.

#10 newbie

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Posted 15 July 2009 - 05:11 PM

So, it sounds like best model, is go HSA or catastrophic healthcare and add on concierge doc. Hmmmm.

#11 NoPlaceLikeHome

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Posted 15 July 2009 - 05:17 PM

I have very mixed feelings about Privia. Just imagine if all doctors used Privia... If that were true, then I guess most Americans would be out of luck:confused: This would result in only the priviledged few being able to afford a doctor.

I cannot help but be concerned that many doctors only care about the money and not the patients. As a nurse who worked for 22 years on the front lines in the hospital I know that there are many who do care, but I also suspect that there are many who do not.

I think that perhaps medical education should be subsidized to offset lower re-imbursements for doctors. I have also noticed that is has become easier to practice medicine now a days for doctors in that they are often in a large group and rarely have to take call at night. In addition, they often hire a nurse practitioner to take call for the phone calls at night. They even do not have to make rounds at the hospitlas anymore locally since they have hospitalists that admit and take of the patients. In other words, I do not think it is sustainable or warranted for doctors to be multi-millionaires. I know I went into nursing because I cared and not for the money;)

I also think that doctors should not be able to turn away a patient on medicare or medicare. Hospitals cannot turn away patients without insurance so I think the same should apply to doctors. If the doctor has a conflict with the patient then of course, he could refuse IMHO.

These are just my honest opinions:)

#12 Alice

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Posted 15 July 2009 - 05:25 PM

So, it sounds like best model, is go HSA or catastrophic healthcare and add on concierge doc. Hmmmm.


This might be the best model for an individual if you knew you had the ability to cover any health care needs that come along. Like I mentioned, you would still be billed for all services. The concierge fee is really only getting you "membership". You would still be billed for office visits, medications, labs, Xrays, or any other services the doctor provides and ordinarily charged for.

#13 sleepymommy

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Posted 15 July 2009 - 05:45 PM

With the new proposed changes in healthcare, we are more likely to see much more of this kind of private practice. It simply isn't practical for doctors to work more hours, see more patients and get less reimbursed for their services.

After 4 years of undergrad, 4 years of medical school and 6 years of postgrad training (residency and fellowship), most doctors are starting out in their 30s with up to $300,000 of student loans. Add to this the decline in wages and the increase of malpractice and liability.

It's not that they don't care about their patients, they go into the field b/c they want to help. (This is not the 80s when being a doctor automatically meant rolling in dough, business sectors and IT sectors have much more money making potential and the amount of schooling and training docs have to go through is not easy) It's that they do care about their patients, hence the reason they want to give more individualized attention.

All doctors obviously won't be using this model, but I suspect that as in other countries where there is "free healthcare" for all, there will also be much longer waiting times for appointments, sometimes months will be booked in advance. These countries also have the option of out of pocket payments to private docs who are more easily accessible.

Just my 2 cents :)

#14 Paula in MS

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Posted 15 July 2009 - 05:51 PM

I received a letter from my doctor yesterday "inviting" me to join Privia. If I join, I will have more direct access to my doctor, and he can spend more time with me when I come in for appointments. If I don't join, he may not be able to see me any more. I'll have to see a nurse practitioner who he will be hiring instead.

I have to say this was extremely upsetting to me and quite a shock since the Privia membership is $2000 a year per personand both my husband and I see this doctor and have been seeing him for almost 10 years. I am very dependent on him at this point because he is treating me for chronic lyme and he is the only one I trust to help me get better. I can't afford to pay an additional $4000 a year just so that I can get a guarantee that I can see my own doctor!

I have had so many bad experiences with doctors but this one has been excellent. He has been caring and compassionate and he is smart and on top of things. He hasn't accepted insurance for a number of years and my husband and I have been willing to pay out of pocket to see him, but adding another $4000 on top of that really seems outrageous, especially considering my husband probably only sees him once a year.

He says his reasoning is that he is getting so many patients that need to be treated for lyme, he doesn't want to limit the number of people he can treat. He has been speaking on NPR and has been on television and I'm sure he has tons of people who really do need treatment. To me, though, he should refer his new patients to the nurse practitioner and continue to treat the patients he has already has a relationship with. What do you think?

I'd love to hear from anyone who understands more about Privia and if this is something that is going to start cropping up everywhere.

Lisa



I could see his point if he were accepting insurance and having many of his fees written off. In this case, he doesn't accept insurance. So why not just increase his fees on a case by case basis. In this way, you would be buying more time with him everytime you go in.

#15 Mommyof4ks

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Posted 15 July 2009 - 06:44 PM

With the new proposed changes in healthcare, we are more likely to see much more of this kind of private practice. It simply isn't practical for doctors to work more hours, see more patients and get less reimbursed for their services.

After 4 years of undergrad, 4 years of medical school and 6 years of postgrad training (residency and fellowship), most doctors are starting out in their 30s with up to $300,000 of student loans. Add to this the decline in wages and the increase of malpractice and liability.

It's not that they don't care about their patients, they go into the field b/c they want to help. (This is not the 80s when being a doctor automatically meant rolling in dough, business sectors and IT sectors have much more money making potential and the amount of schooling and training docs have to go through is not easy) It's that they do care about their patients, hence the reason they want to give more individualized attention.

All doctors obviously won't be using this model, but I suspect that as in other countries where there is "free healthcare" for all, there will also be much longer waiting times for appointments, sometimes months will be booked in advance. These countries also have the option of out of pocket payments to private docs who are more easily accessible.

Just my 2 cents :)


After reading through this thread this was my thought exactly! We live in a 'medical' town where the hospital admin cares about the money, but the docs care a great deal about their patients. The docs would love to provide more time for the patients to talk to them, but the reality is that money makes the hospital/clinic go 'round. I had never heard of privia or private ins. in a 'free healthcare' society, but it is great to know that this is available. At least I know my son will still get the quality of care that he currently does with his specialist should 'free' care become a reality! It just might cost a small fortune lol. Sad though, because currently he gets great care for just over $1000 in insurance a year *sigh*.

If your hubby does not see the doc much, then could you buy the privia membership and have your dh see the NP? You might want to jump quick if there are only 250 spots!

#16 Mom0012

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Posted 15 July 2009 - 07:38 PM

Now, with that $4000 fee .... do you still have to pay a copay if you need his service ? If he operates you, will he charge you extra ? Or is it just for reserving the spot ?

(Sorry .. just curious)



Yes, I still have to pay all the fees I did in the past. This doctor accepts no insurance, so I will still have to pay everything out of pocket in addition to the $2000 fee. The fee only guarantees that I will be able to continue to see this doctor. In theory, I will get better care, but honestly, I felt like the care I was getting was more than adequate.

Lisa

#17 Mom0012

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Posted 15 July 2009 - 07:39 PM

So is there a copay and what about hospitals???

This sounds ideal for us, because its 5k less than our HMO. What is hidden? And are they across US?:bigear:


You would still pay copays if your doctor accepts insurance and you would still need to pay your health care premiums.

Lisa

#18 Mom0012

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Posted 15 July 2009 - 07:42 PM

I know something about this concept. My dh is doing this in his practice. Because of poor reimbursement and high overhead, physicians have to push people through so fast and the quality of care leave both physician and patient frustrated. My dh actually left private practice and went back to the hospital full-time for this reason. After a few years, a colleague approached him about joining his practice which is also fee based. Dh loves it. His previous practice was full at about 3000 patients; he will only take 250 in this practice- in order to enable him to spend as much time as needed with each patient. He just lost a dear 90 yo woman who he spent a lot of time with- he even went to her home probably half a dozen times(this isn't part of the deal, but she was in an assisted living complex near his practice and it was sometimes difficult for her adult children to get her there) The point is, because of the fee, he is able to do this. He has had patients ask him to research alternative options for treatment- he'd never have the time in a traditional practice to do this. Patients are guaranteed to see him same day if they call by noon. During off hours, they talk to him directly. The office staff is very professional and is very service oriented In fact the mantra for any patients request is- unless it's illegal, immoral, or unethical, the answer is "YES!" He's only been at this for 1 year, but so far we are very proud of what he's giving his patients. Hope that helps.


I'm glad this has worked out for your husband. I'm really starting to understand the concept more, it's just that I can't afford to pay $14,000 a year for health care between premiums, out of pocket expenses and now these membership fees. We already pay $10,000 now. And then what if my children's doctor starts doing it? We're talking $18,000 a year for health care then. If I wasn't so dependent on this doctor for treatment, I wouldn't be so upset. I'd just switch to another practice.

Lisa

#19 Mom0012

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Posted 15 July 2009 - 07:46 PM

If your hubby does not see the doc much, then could you buy the privia membership and have your dh see the NP? You might want to jump quick if there are only 250 spots!



I spoke with the office administrator today and I may actually wind up doing this. Apparently, I can pay on a monthly basis and drop out at any time. I am considering doing this until I feel my health is better under control, but it just makes me sick to think that once I can't pay these huge fees, my doctor will no longer see me.

Lisa

#20 TeacherZee

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Posted 15 July 2009 - 07:47 PM

I think whatever happens to health care here, this kind of care will still be available. I am not at all an expert but I believe for example, that in the United Kingdom even with the National Health Service you can still purchase private care that is either above and beyond what is available through NHS or you can be a private patient paying on your own. Generally, the private patients are paying more but are receiving the more personal care similar to the concierge docs. I'm not sure how it works for docs in the UK...if they can choose to only accept private patients or not. My guess is that what kind of overall health care system we have will be less an issue for people that can afford this kind of care.

I did a quick search for Private Patients vs NHS in UK and got a bunch of sites showing the different fee structures and services offered at various UK medical facilities. But again I'm not an expert on exactly how it works there.


You are right about the UK. This is also the case in Sweden although to a lesser extent than in the UK. I will say this and then I will shut up: I have never felt rushed with a doctor in either Sweden or the UK under the national health service and I think that it is because they do not get paid per volume of patients. I have always felt like they had time for me. :leaving:

#21 Mom0012

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Posted 15 July 2009 - 07:52 PM

With the new proposed changes in healthcare, we are more likely to see much more of this kind of private practice. It simply isn't practical for doctors to work more hours, see more patients and get less reimbursed for their services.

After 4 years of undergrad, 4 years of medical school and 6 years of postgrad training (residency and fellowship), most doctors are starting out in their 30s with up to $300,000 of student loans. Add to this the decline in wages and the increase of malpractice and liability.

It's not that they don't care about their patients, they go into the field b/c they want to help. (This is not the 80s when being a doctor automatically meant rolling in dough, business sectors and IT sectors have much more money making potential and the amount of schooling and training docs have to go through is not easy) It's that they do care about their patients, hence the reason they want to give more individualized attention.

All doctors obviously won't be using this model, but I suspect that as in other countries where there is "free healthcare" for all, there will also be much longer waiting times for appointments, sometimes months will be booked in advance. These countries also have the option of out of pocket payments to private docs who are more easily accessible.

Just my 2 cents :)


I can see this side of it as well. It's just upsetting to think that so much of our income would go to basic healthcare. I'm also afraid that once these membership practices get set up, that the fees will continue to rise and the quality of care may decrease over time. I hope not, but that seems to be the way things tend to go.

Lisa

#22 mommaduck

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Posted 15 July 2009 - 07:56 PM

I'd just like to know where all the doctors are that used to care enough to accept chickens as payment.

But then we'd need schools that accept chickens also ;)

#23 ekarl2

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Posted 15 July 2009 - 08:19 PM

I'd just like to know where all the doctors are that used to care enough to accept chickens as payment.

But then we'd need schools that accept chickens also ;)


It would help if the docs could pay their astronomical malpractice premiums with chickens ... hmm .. there's an idea here ...

#24 mommaduck

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Posted 15 July 2009 - 08:47 PM

It would help if the docs could pay their astronomical malpractice premiums with chickens ... hmm .. there's an idea here ...


But then the insurance corporations would have to dissolve and go back to farming chickens :lol:

#25 Mommyof4ks

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Posted 15 July 2009 - 08:55 PM

I spoke with the office administrator today and I may actually wind up doing this. Apparently, I can pay on a monthly basis and drop out at any time. I am considering doing this until I feel my health is better under control, but it just makes me sick to think that once I can't pay these huge fees, my doctor will no longer see me.

Lisa


It is sad that the doc won't work with patients that can't pay those fees. Hopefully you can work something out. The chicken idea would work well! There is still a good deal of bartering around here, but not so much for healthcare.

#26 Starr

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Posted 15 July 2009 - 10:45 PM

I believe he is still responsible for the PA's care. Could you insist he review your treatment from time to time?

#27 Laura Corin

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Posted 16 July 2009 - 03:44 AM

I think whatever happens to health care here, this kind of care will still be available. I am not at all an expert but I believe for example, that in the United Kingdom even with the National Health Service you can still purchase private care that is either above and beyond what is available through NHS or you can be a private patient paying on your own. Generally, the private patients are paying more but are receiving the more personal care similar to the concierge docs. I'm not sure how it works for docs in the UK...if they can choose to only accept private patients or not. My guess is that what kind of overall health care system we have will be less an issue for people that can afford this kind of care.

I did a quick search for Private Patients vs NHS in UK and got a bunch of sites showing the different fee structures and services offered at various UK medical facilities. But again I'm not an expert on exactly how it works there.


Most insurance policies don't pay for private GPs, but will for more complex problems. Private GPs are pretty rare beasts in consequence, as they are only paid for by people with the cash.

Specialists normally work in the NHS (because that is where the facilities are and the reputations are built) but may also work one day a week in a private hospital. There they will offer usually the same treatment but in more luxurious circumstances and often quicker.

All emergency treatment goes through the NHS - private hospitals don't have ER facilities - so if anything goes extremely wrong with a private operation, you will be ambulanced to an NHS hospital for the best emergency care.

Laura

#28 Alice

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Posted 16 July 2009 - 05:23 AM

Most insurance policies don't pay for private GPs, but will for more complex problems. Private GPs are pretty rare beasts in consequence, as they are only paid for by people with the cash.

Specialists normally work in the NHS (because that is where the facilities are and the reputations are built) but may also work one day a week in a private hospital. There they will offer usually the same treatment but in more luxurious circumstances and often quicker.

All emergency treatment goes through the NHS - private hospitals don't have ER facilities - so if anything goes extremely wrong with a private operation, you will be ambulanced to an NHS hospital for the best emergency care.

Laura


That's interesting, Laura. Thanks for posting. I admit to not really knowing how the UK system works but I remember when reading a few novels set in the UK (Saturday by Ian McEwan and the newest PD James mystery) that it seemed that there were private patients as well as NHS patients. A quick search on the Internet confirmed that this seemed to be the case. But I was hoping someone from the UK would post and clarify.

#29 fj62

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Posted 16 July 2009 - 06:10 AM

I'm glad this has worked out for your husband. I'm really starting to understand the concept more, it's just that I can't afford to pay $14,000 a year for health care between premiums, out of pocket expenses and now these membership fees. We already pay $10,000 now. And then what if my children's doctor starts doing it? We're talking $18,000 a year for health care then. If I wasn't so dependent on this doctor for treatment, I wouldn't be so upset. I'd just switch to another practice.

Lisa

In his practice, if you didn't have insurance, he would not bill for the office visits. Obviously, you would still have outside labs, tests, etc.. though.

I hope that you will be able to figure something out.

Not to hijack the thread, but wasn't there a new documentary coming out about Lyme? Have you seen it?

#30 Laura Corin

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Posted 16 July 2009 - 07:42 AM

That's interesting, Laura. Thanks for posting. I admit to not really knowing how the UK system works but I remember when reading a few novels set in the UK (Saturday by Ian McEwan and the newest PD James mystery) that it seemed that there were private patients as well as NHS patients. A quick search on the Internet confirmed that this seemed to be the case. But I was hoping someone from the UK would post and clarify.


Did you enjoy 'Saturday'? I've been reading Ian McEwan since he was publishing his (very odd) short stories. 'Enduring Love' is my favourite, but I wish I could read it slowly - it always drags me through at high speed.

Laura

#31 abreakfromlife

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Posted 16 July 2009 - 08:31 AM

but will this even be an issue if nationalized health care gets ram-rodded through in the next few weeks?

Not if the bill as currently written goes through.

INVESTOR'S BUSINESS DAILY Editorial
Right there on Page 16 is a provision making individual private medical insurance illegal.

#32 plansrme

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Posted 16 July 2009 - 08:38 AM

Not if the bill as currently written goes through.

INVESTOR'S BUSINESS DAILY Editorial
Right there on Page 16 is a provision making individual private medical insurance illegal.


Thank you for posting this. Very informative.

Terri

#33 Mom0012

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Posted 16 July 2009 - 06:07 PM

In his practice, if you didn't have insurance, he would not bill for the office visits. Obviously, you would still have outside labs, tests, etc.. though.

I hope that you will be able to figure something out.

Not to hijack the thread, but wasn't there a new documentary coming out about Lyme? Have you seen it?


The documentary is called Under Our Skin and I have seen it. It wasn't until I saw the documentary that I truly understood what a precarious position I was in. Doctors who are treating chronic lyme are at risk for losing their medical licenses and, because of that, very few are willing to treat patients like me.

Lisa

#34 Mommyof4ks

Mommyof4ks

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Posted 16 July 2009 - 06:42 PM

Not if the bill as currently written goes through.

INVESTOR'S BUSINESS DAILY Editorial
Right there on Page 16 is a provision making individual private medical insurance illegal.


Well that is just plain scary!


What's with the ads?