More doctors are charging fees to respond to patient messages • Hacker News Board

Re: More doctors are charging fees to respond to patient messages

#91

Post by throwaway2016a » Fri, Mar 08, 2024, 6:27 PM UTC

gnicholas wrote: post #48

throwaway2016a wrote: post #36

I think the ridiculous thing here is not the doctor charging but that all insurance doesn't cover it. I bet there are a ton of consultants and lawyers (and maybe some accountants) on HN and most of them will charge you for time spent replying to emails. Edit: inserted the word "all" before insurance to clarify my intent.

from TFA: > Health plans covered the full cost of about 82% of claims, according to the Peterson-KFF analysis. Patients who shared the cost paid $25 on average. I would be very curious to know if my insurance is paying for the useless messages that my doctor's office sends. I sure hope not — they are next to worthless!

Regardless of if you feel they are worthless, IMO, the people who create them should not be asked to work for free. I've never found the notes from mine to be "worthless", you may want to find a new doctor.

Also, your TFA is kind of unnecessarily vulgar (You do know what the F in TFA is for?) here seeing as it doesn't change the point of my original comment. I did, however, add the word "all" incase someone took my comment to read that I didn't think any insurance covered it.

Re: More doctors are charging fees to respond to patient messages

#92

Post by sithadmin » Fri, Mar 08, 2024, 6:27 PM UTC

gnicholas wrote: post #83

bilater wrote: post #72

Earlier quoted context omitted.

The whole prescription business is such a grift. Doctors deliberately give you max 2 years of a prescription that you know you will need for longer (such as allergy meds, eye prescriptions) and then you have to waste your time and spend money just to renew it.

Is this part of the reason those online pharmacy platforms (which include a doctor who will do a very quick exam/diagnosis) took off in recent years? I mostly heard about them with regard to ADHD meds but wonder if they are also useful because they don't require you to have checkups all the time for maintenance medication.

Most of those platforms seem to require the patient to pay for a virtual visit for every refill, or require some kind of a monthly fee.

Re: More doctors are charging fees to respond to patient messages

#93

Post by anon-sre-srm » Fri, Mar 08, 2024, 6:29 PM UTC

codegeek wrote: post #20

CharlesW wrote: post #4

Here's American health care: • I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doctor first. • Fine, but I couldn't accommodate an in-person check-in. I chose a "video visit" that, due to logistics, I had to do while away from home. Because they were a half-hour late, I was effectively forced to do this from the couch of a Costco floor displ…

Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!

A long time ago, I was once charged for being browbeaten into entering a social security number on a keypad by a belligerent ER security guard at a hospital. Didn't even see anyone, but still charged.

Re: More doctors are charging fees to respond to patient messages

#94

Post by freeAgent » Fri, Mar 08, 2024, 6:29 PM UTC

anon-sre-srm wrote: post #89

freeAgent wrote: post #40

Earlier quoted context omitted.

Trust me, they are all aware of this. The problem is that, for the majority of doctors now, they do not own or control their clinics. They are either: 1)employees of the health system or 2)partners or employees of a provider's group that essentially contracts with the system to provide doctors. The doctors themselves have no real control over how their clinics operate outside of contractual negotiations.

That's the problem. The doctors should form employee owned co-ops and be sure profiteering administrators and suits aren't the ones running things.

That is basically scenario #2 (which is common), but for whatever reason they haven’t been very successful at pushing back against some of the changes that cause these issues. I don’t have much insight to offer there since I’m not at the negotiating table there.

Re: More doctors are charging fees to respond to patient messages

#95

Post by polski-g » Fri, Mar 08, 2024, 6:30 PM UTC

smallmancontrov wrote: post #27

DaveExeter wrote: post #21

Earlier quoted context omitted.

[flagged]

So why is our healthcare twice as expensive as the countries who actually do have socialized health care? When is that competition going to kick in and bring down costs? https://www.healthsystemtracker.org/chart-collection/health-...

Because we don't have death panels like in countries with government-run plans. Your insurance carrier won't deny you a bone marrow transplant because you're 85 (it costs over $1m). Other countries will deny it, because you're 85 and have had a good life.

The UK's death panel is called NICE: https://en.wikipedia.org/wiki/National_Institute_for_Health_...

We should have something similar in the US. 80% of all healthcare spending is consumed by people in the last 3 years of their life.

Re: More doctors are charging fees to respond to patient messages

#96

Post by freeAgent » Fri, Mar 08, 2024, 6:30 PM UTC

ttymck wrote: post #90

freeAgent wrote: post #40

Earlier quoted context omitted.

Trust me, they are all aware of this. The problem is that, for the majority of doctors now, they do not own or control their clinics. They are either: 1)employees of the health system or 2)partners or employees of a provider's group that essentially contracts with the system to provide doctors. The doctors themselves have no real control over how their clinics operate outside of contractual negotiations.

The problem is that they do not care, and they are not incentivized to care.

My wife is a PCP and she does care and is endlessly frustrated by the BS. There’s just not anything she can do about it.

Re: More doctors are charging fees to respond to patient messages

#97

Post by anon-sre-srm » Fri, Mar 08, 2024, 6:30 PM UTC

FireBeyond wrote: post #29

codegeek wrote: post #20

Earlier quoted context omitted.

Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!

I was in one hospital ER for a kidney stone, but they had no urology available, so they sent me via ambulance ("thankfully", as a paramedic, one of our company benefits was that if we were ever transported, they'd bill our insurance and waive any charges to us) to another hospital. Ambulance crew wheeled me into the ER bay, where a 'transport' gurney from surgery, was waiting, and I slid from one to the other, and wa…

My elderly disabled mom on a fixed income is being billed for an ambulance ride from a hospital to a long-term care facility because Medicare deemed it "unnecessary" even though the shuttle couldn't take her.

Re: More doctors are charging fees to respond to patient messages

#98

Post by BenFranklin100 » Fri, Mar 08, 2024, 6:31 PM UTC

People talk a lot about prescription drugs, but the real driver of costs are the hospitals, both public and private. Drugs account for 10-15% of total healthcare spending; it’s the hospital reimbursement & compensation framework along with private insurance that is driving the bulk of costs. It’s evolved into a patchwork, opaque, dysfunctional system where the end consumer has little view into the inner workings and is left staring at a massive bill.

Re: More doctors are charging fees to respond to patient messages

#99

Post by sokoloff » Fri, Mar 08, 2024, 6:32 PM UTC

FireBeyond wrote: post #29

codegeek wrote: post #20

Earlier quoted context omitted.

Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!

I was in one hospital ER for a kidney stone, but they had no urology available, so they sent me via ambulance ("thankfully", as a paramedic, one of our company benefits was that if we were ever transported, they'd bill our insurance and waive any charges to us) to another hospital. Ambulance crew wheeled me into the ER bay, where a 'transport' gurney from surgery, was waiting, and I slid from one to the other, and wa…

> At no point did the ER staff ever talk to me.

How did the determination that you needed urology, "oops, no urology available", and ambulance transport get arranged? It seems like some level of triage, routing, unable, re-routing had to have happened, right?

Re: More doctors are charging fees to respond to patient messages

#100

Post by ReallyAnonymous » Fri, Mar 08, 2024, 6:32 PM UTC

beej71 wrote: post #75

Volundr wrote: post #70

Earlier quoted context omitted.

I'm old enough to remember health care prior to Obamacare, and I can assure you it was broken before too. Frankly the difference I noticed post Obamacare was a friend of mine was able to get insurance in time to not go bankrupt treating her colon cancer. I can't get behind the idea that Obamacare is somehow what broke our medical system.

It was actually worse in that you could be denied health insurance. And I know a lot of people who are denied health insurance for very mundane reasons. Insurance companies had teams of people who, if you made a substantial claim, would look over your application for anything that was amiss. And if they found it, they'd drop you so they wouldn't have to pay. Your health record became a criminal record. You just hoped…

surgeon here. before Obamacare insurance companies denied payments if they deemed the issue pre-existing and were not told about it in the patient's application. I was in private practice for 10 years and now employed surgeon for 12 bc insurance companies notoriously deny payments for no legitimate reason. One time I saw a patient with an inguinal hernia and then fixed it. We were denied payment because my initial consultation said, 'presents with hernia he's had for 2 years, but now increasing in size and causing discomfort'. Their reason for denial was that he only had coverage for a year and had not told them about the hernia. From then on, my notes were very brief. 'Patient presents with symptomatic hernia'

Before Obamacare, some policies had lifetime limits, which could affect expensive treatments like cancer.

We celebrated the fact that now medicare can negotiate 10 drug prices. It should negotiate all drugs. The organization that gets the lowest prices is the VA. Congress could easily pass a law saying medicare will only pay that much and it would not cost much to implement.

System is very broken.