Help me decide how I should feel about this

[Jean in Newcastle]

One group of doctors we visit uses an online message system that is just wonderful.  You can route messages by type (rx refill gets sent to a different place than a non-emergent medical question).  90% of questions are answered by the Physician's assistant after they've looked up your chart or asked the doc. a quick question.  Complicated questions get a call back from the actual doctor.  If he thinks the situation is too complicated for that, then he won't hesitate to tell you to come in for an appointment - same day or next day - billed in full.  

 

Another group of doctors has on-call doctors that will field questions.  You get billed for those at a lower rate than an office visit but still covering their time.  I don't begrudge them that because it is tied to an actual service but saves me driving time.  

[StephanieZ]

The insurance saturation for veterinary medicine and human medicine is very different.  Physicians who have contractual relationships with insurance companies have an agreement on what fees will be paid for the service and often that fee is far below the market value of the service.  So your point that they should just charge more for the "billable" service is often not applicable.  The insurance contract likely has already eroded a significant chunk of the profit margin.  

 

Of course, physicians do not have to contract with various insurance companies, and I think we're going to see more of that in the future.  The pediatrician our children see does not accept or bill any commercial private insurance.  She does accept Medicaid because she feels that children who qualify for Medicaid are not usually in a position to pay out of pocket and then get reimbursed.  She expects payment in full at the time of service and provides an itemized receipt with the applicable service codes.  We then submit that paperwork to my husband's insurance and get reimbursed at their out of network rate.  This allows her to set a fee for the service that she feels is reasonable and requires the patient to pay her fee because she is dealing with them directly and has no contractual agreement with their insurance. It also reduces a big chunk of her overhead because she no longer has to submit claims to the insurance, resubmit claims to the insurance, or wait six months or more for a valid claim to be paid.  We do pay more out of pocket than we would if we used an in-network pediatrician but the quality of care is far superior and worth it.

 

The doctor's practice makes a strategic business decision on whether to accept an insurance plan. That's the business's call. Google up average doctor salaries for any specialty, and I think you'll find they are respectable salaries. Most in the 150k - 300k/yr range. Not starving. (I don't begrudge anyone a good living, UNLESS they cry "poor me" trying to guilt others into donating "optional" fees.)

 

In any event, it is the business's decision on whether or not to accept an insurance plan, and I really don't think it is ethical to say you participate with an insurance plan and then tack on unexpected clerical or other fees. I think they are skating around their insurance contracts, and I don't think it is ethical. Personally.

 

I think they have to make hard business decisions on which insurance plans to accept, and negotiate adequate compensation . . . or they can go fee-for-service and not "participate" with insurance plans . . . I think there are middle grounds where a doctor can "accept" but not "participate" in a plan, but I really have no idea, as I am not a human medicine person in any way other than as a consumer. 

 

However, I do feel like these "concierge" type services can really be a scam. My mom's long term PCP changed ownership a couple years ago, and she got an "optional" bill/invitation/solicitation for some type of concierge service that was over $1000/yr, and it was supposedly optional, but she paid it. I think it was around $1500 for the year. She got ABSOLUTELY NOTHING for that optional $1500. She was already on medicare, already diagnosed with early Alzheimer's, and I think it was completely unethical for the doctor (who diagnosed her and was still supporting/encouraging her independent living and self-management of her finances) to solicit that big chunk of change for which she would get nothing, as she wasn't savvy enough to understand or utilize whatever services (if any of value) might have been included in the fee, and the marketing made her think it was important for her to do so, and that if she didn't, the doctor might "fire" her. The practice was a reputable GP with a concentration in geriatrics. At the time, it wasn't worth the $1500 to upset Mom (further, during a very distressing time after her diagnosis) by arguing with her about the decision, so I let it slide after a few gentle attempts to get her to reconsider/consult others/etc. She could afford to waste it, and she did. Fortunately, it was just one year and she could afford it. So, anyway, I think they scammed my mom and surely hundreds of other folks. So, yes, I have a bad taste in my mouth for these "optional" extra fees. Charge what you want, but don't say you are participating with an insurer and then add on extra fees that won't be covered by the insurer and, are, indeed, likely prohibited from being "billed". 

 

At the end of the day, I have other places to give my charity other than to any skilled professional. I don't ask clients to donate "optional" fees to our practice. We offer services in exchange for clearly disclosed fees. You choose to come to us, or not, and I'm not ashamed to make a good living in this honest exchange. But, I would be ashamed to ask clients to give me "optional" fees, knowing that we make more $ than 98% of them. 

 

How would that be OK? IMHO, it's just not cool to guilt people into giving you "optional" fees when you are better off than most of them. I call bullshit on the offices that do the guilt thing. Not cool. 

 

IMHO, it's OK if I come out with a good living, or if I end up broke, or vice-versa, so long as it is an HONEST exchange. I don't think this "optional fee" business is honest. 

 

I'm not saying you have to leave the DR. In that position, it is entirely likely that I'd cough up the extra $$ and never say BOO about it. Having a doctor we trust and who is responsive and capable is a very valuable commodity, and my personal opinion about the ethics of their billing practices is unlikely to have a serious impact on my vital choices of health care practitioners. So, do whatever seems right to you. Pay it, or not. Just don't feel guilty about it either way. You're presumably buying something that is worth it to you. 

[Murphy101]

Concierge doctors around here are $2000/yr. They do not take insurance and do not charge for office visits. Your insurance would be needed for labs, supplies, and hospitalizations. For the $2000, one gets unlimited office visits and the doc's cell phone number. While it seems expensive, these concierge docs are getting plenty of business. It is a good alternative for many people.

I have been interviewing concierge doctors for the last couple weeks for dh and I. We do not have insurance, nor prospects of getting it anytime soon. We have a very tight budget and when dh went on the exchange to look just for him, it was laughable. No way. More than or mortgage payment every month and then we'd still have to scrounge for money for copays and deductibles to actually maybe use it? *smh*

 

But we do want to take care of ourselves and not let anything build up until we need emergency care if we can avoid that.

 

So concierge drs are what we are looking I it.

 

My chiro is already one and we are quite happy. Seeing him is cheaper than when we had insurance.

 

The rate for drs varies. Some bring a phlebotomist with them so you don't have to go to a separate lab for blood work, which is really helpful. They list the cost of most common blood work up front. As well as X-rays and sonograms and where they suggest going. (But you can go anywhere, you'll just have to arrange payment there.)

 

Some come to the house. Some don't. Some offer 24/7 services. Some are more 8-6, but they guarantee you will always get in same day and take as long as needed. Some work in a practice with other drs and staff. Some are just themselves and one or two staffers or their spouse who has a medical background. They all have license at at least one if the major hospitals in town and in some cases also have hospital duties.

 

The monthly fee for just dh was between $75 and $100 a month. And that gets him access to those drs anytime without an additional fee. In person or not. Anything done in office/at the appointment is usually included. Anything they have to send out, of course, has a fee from wherever they send it and all of them list those fees in black and white.

 

This of course is not insurance.

 

But if I was paying insurance AND the dr wanted to charge additional?

 

No. I wouldn't pay it. He signed a contract to charge you a specific rate and you are paying it. It seems ... Unseemly to me to then also turn around and tell the patient he wants them to pay an additional rate.

 

I'm willing to agree drs aren't paid what they are worth. But they need to stop signing contracts that don't pay what they are worth if they want that to change. Every time they sign with insurance, they perpetuate it.

[Murphy101]

I don't think the fee is far below market value. I think they have so much overhead bc of insurance that they actually get very little of the fee.

 

Most of the concierge drs? If I don't have a monthly contract with them, they will still come out to the house for less than $200.

 

On our previous insurance plans, the dr was billing more than double that to insurance, but they spent a fortune in staff and paperwork and time to get it. So yes, the patient might pay less than $100 copay+ deductible, but that's not the only payment for the visit that the dr is suppose to receive.