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More doctors are charging fees to respond to patient messages

wsj.com

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

#171

Post by twobitshifter »

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…

Had an eye doctor set up a follow visit appointment for my wife. We went for the follow up and he said “I don’t know why i’m seeing you for this” said it looked fine and then asked us to come back again in a month.

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

#172

Post by bdunks »

betaby wrote: post #151
ktosobcy wrote: post #148

Earlier quoted context omitted.

Uhm... in Poland there are usually "refill forms" at your chosen / doctors office, you fill it out, drop at the reception and then you get prescription code via sms with which you can claim it at any pharmacy (that has the drug)

[flagged]

Only 10% of the increase in medical cost in the US is attributable to doctor salaries. The remainder is administrative overhead, Rx costs, insurance administration, etc.

There are now 10 administrators for every 1 doctor.

Since 1970, the number of physicians has increased by 2x. The number of administrative staff has increased by 38x.

If each administrator is making 100k+ - 150k+, that's significant cost.

Some of these crazy billing practices are due to the private equity buy-ups and consolidation, creating workflows and fee structures that are hostile to patients and doctors, but benefit the PE firms.

https://www.commonwealthfund.org/publications/issue-briefs/2...

Lots more data here: https://www.healthsystemtracker.org/

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

#173

Post by autoexec »

mindslight wrote: post #68
aeturnum wrote: post #62

Earlier quoted context omitted.

I have a partner who's a nurse practitioner in primary care and I just want to emphasize how hellish it is for people on the inside as well. The economic model of running a healthcare business is entirely based on their ability to bill for provider time. Healthcare providers have very high costs to match their very high fees and also pay a bunch of people to 'help' providers see more patients. A big part of this mix…

I think people tend to get stuck on the ridiculous charges/billing and don't often get to the point where they appreciate just how bad the provided healthcare is, and how much it utterly destroys patient agency by replacing it with bureaucracy. The provider/"insurer" dynamic is really the deep set home of the rot. As a table stakes reform, health "insurance" companies need to be prevented from managing healthcare and…

> - the industry would be better off if someone with her education (and likely experience) was actually providing healthcare.

Worse the odds are good she was hired to help the insurance company prevent people from getting healthcare.

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

#174

Post by alistairSH »

rqtwteye wrote: post #164
lotsofpulp wrote: post #140

Earlier quoted context omitted.

It’s bad optics to employ someone who doesn’t know what emergency means.

The system should not be that complex and full of traps. I rarely go to a doctor and when I have to go every few years I have no idea how things work and what to avoid.

It's not.

ER - life or death (if you can drive yourself, it's probably not an emergency)

Urgent Care - you have the flu, and your PCP isn't available; minor emergencies (but you can still drive yourself)

PCP - flu, check-ups, whatever

The balance billing and OON charges are separate issues from over-use of the ER.

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

#175

Post by alistairSH »

arealaccount wrote: post #168
gotbeans wrote: post #149

Earlier quoted context omitted.

26k for an mri /w contrast last week because insurance decided it's not necessary despite the doctor asking for it. Now the doctor has to put an appeal to explain medical necessity, I'm at his mercy.

Is insurance the villain on this one of the hospital charging insurance 26k for an MRI?

Possibly all of the above.

An MRI shouldn't cost $26k, even with contrast, and at a hospital.

If this was non-emergency, it should have been pre-cleared with insurance per their policy.

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

#176

Post by sokoloff »

Someone1234 wrote: post #137
sokoloff wrote: post #99

Earlier quoted context omitted.

> 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?

I think you misunderstood their story. They [rightfully] got charged for the ER at Hospital #1, but were mistakenly charged for the ER a second time at Hospital #2.

Indeed I did. It now says "second hospital" in the last paragraph. I can't know whether I mis-read or if it was edited to clarify, but I definitely did misunderstand the story.

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

#177

Post by adolph »

ericd wrote: post #64

A 15 minute email from my lawyer costs about $150, I don’t see why we should be outraged about $25? It’s much harder and more expensive to become a doctor.

Lawyers did pricing better than doctors. Medicine hid costs through a payment plan lumped in with hazard insurance. Now that the game of hide the money has played out, people see real costs and they act shocked.

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

#178

Post by codemac »

thaddeusmt wrote: post #166

My spouse is a physician, and "patient messages" (aka "non-face-to-face" encounters) usually aren't reimbursed by insurance. Having a friendly online conversation with a patient doesn't generate the "RVUs" they need (contractually!), so time spent messaging is time taken out of their personal day on top of their regular workload. Responding to messages can also just be very difficult and time consuming. Maybe you ask…

If my actual doctor responded to my messages within some SLA (2 days?) then I'm more than happy to pay much more.

Now a days what happens is I send a message with photos or many details, and some poor nurse who is assigned message triage is going through many and responds with generic pointless text for my issue.

Then I get charged $15.

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

#179

Post by FireBeyond »

sokoloff wrote: post #99
FireBeyond wrote: post #29

Earlier quoted context omitted.

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?

Present with abdominal pain, admitted, CT imaging, pain management. Imaging read, kidney stone diagnosis confirmed (and of such a size that it needed immediate management). No urology available at hospital one, and because of narcotics on-board, transferred to nearby hospital via ambulance that did have a urologist available, so I could go straight to theater.

But yes, hospital two tried to charge me for an ER visit, as well as the surgical billing (which of course was reasonable).

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