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More doctors are charging fees to respond to patient messages

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

#201

Post by kelnos »

BobaFloutist wrote: post #181
dghlsakjg wrote: post #152

Earlier quoted context omitted.

You have no idea what this person was being seen for. It is fairly common for someone to be advised to seek emergency treatment out of precaution to ensure that a minor symptom is not indicative of a severe problem. For example dizziness can be a completely nothing-burger inner ear problem treated with a bunch of motions from youtube, or it can be a stroke. The ER exists to make that distinction. Part of all those lo…

>You have no idea what this person was being seen for. I feel fairly comfortable assuming that they were being seen for a minor-to-moderate burn.

Maybe true, but as non-doctors, we are not necessarily qualified to self-diagnose the severity of a burn. We shouldn't be financially penalized for injuring ourselves and then -- in the stress and fear of the moment -- not being sure if our injury amounts to an emergency, or something much less urgent.

Well, at least, a functioning health care system shouldn't penalize for that sort of thing. We don't really have that in the US.

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

#202

Post by kettro »

QuantumGood wrote: post #183
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…

One Medical charges $9/month (through Amazon), all video visits are free (if you click the proper link), and I've had multiple prescriptions renewed that way. Three times waited less than a minute, longest wait was 15 minutes, and the app will call you back if you wish so you don't have to keep the app open.

My company pays for One Medical, and it’s honestly the best practice I’ve been to in the US. I can typically get an appointment the next day, there are tons of offices (in SF), and everyone is kind and efficient.

They ask you to set a primary care doctor, but I have had more success with seeing a small group of their more available non-MD physicians.

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

#203

Post by kelnos »

dylan604 wrote: post #194
dghlsakjg wrote: post #185

Earlier quoted context omitted.

That was the treatment received, but perhaps they were referred to the ER by EMS for smoke inhalation. I don't know either, but the broader point is that people are referred to the ED by medical professionals for seemingly minor issues all the time, and that the incentives are all lined up to treat stupid shit in the ER rather than have someone tell them to go somewhere that makes more sense.

> That was the treatment received, but perhaps they were referred to the ER by EMS for... Isn't it CYA for any EMS to recommend you visiting the hospital, so they just say it to anyone. That allows them to later say that you failed to follow recommended advice.

Maybe so, but so what? If a medical professional tells me I should go to the hospital, I'm going to go. I'm not a doctor. I don't know how to diagnose injuries and illnesses beyond a very basic level.

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

#204

Post by qudat »

kergonath wrote: post #107
oefrha wrote: post #19

> Dr. Lauren Oshman, a family physician and associate professor at the University of Michigan Medical School, says she initially experienced some patient resistance and anger about the prospect of being billed for emails. > Now, she says, patients are typically pleased that they are able to get a direct response from her through a portal message. > “They’re thrilled when they get me directly,” she says. Geez, this co…

> Geez, this could make corporate PR people blush. Yeah, it’s embarrassing. I am not “thrilled” to talk to a doctor directly. I pay for it, and when I do it’s because I have a reason to, which kind of limits the thrilling aspect. I expect it, and I need it, sure. But it’s not being able to talk to my doctor that elicits an emotional response, and it tends to be anger.

Hmm. I'm not sure if this is just a difference between private practice and hospitals, but there is a ton of questions that can and should be serviced by non-physicians (e.g. RNAs, nurse practitioners, physician assistants). Their role in patient care is consistently growing in importance. It's rare for me to send a message through a patient portal and have a physician answer it. It's always someone on the staff.

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

#205

Post by macNchz »

Someone1234 wrote: post #142
edm0nd wrote: post #102

Earlier quoted context omitted.

Counter point, why did you even bother going to the ER if that is all that was required? That solution doesn't really scream "emergency" and seems like a waste of their time and resources...

Medical providers are constantly telling patients not to self-diagnose/self-treat/play google-doctor, but as soon as there is a billing problem, everyone uses that to victim blame. Kind of messed up if you ask me. Personally I am not qualified to determine what a treatable and non-treatable burn looks like. Where I went to school they don't teach that.

A component of this is fear of liability in a highly-litigious environment. Nobody wants to be the one who told someone to wait and see instead of going to the ER, only to have the person wind up dying or suffering serious harm.

This is further exacerbated by the limited safety nets in the US–even people who would on principle deign to sue others who tried to help them in a time of bad luck may find that a lawsuit is the only way they'll be able to maintain a decent lifestyle after the loss of a partner, or with a newfound need for long-term care.

One more layer is the fact that doctors are so overbooked. Many people cannot reasonably get appointments with their family doctor (if they have one) on short notice, so some things that, in the past, might have been a "wait-til-morning then call the GP to drop in same-day" are now "GP is booked three months out, guess we're going to the hospital".

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

#206

Post by buran77 »

hiddencost wrote: post #11
buran77 wrote: post #8

In some countries in Europe, if you have private insurance they'll pull off the "call charge" trick as often as they can. Need to make or reschedule an appointment? Make a call. Did some blood test and need the results? Call to get them. They call you to tell you they can't make the appointment and need to reschedule? You still get charged. If it's not a call it's a fake shot. Fake disinfection charge. And so on. The…

[flagged]

> they tend to not be well supported by the number

Personal opinion or did you ever talk to anyone investigating these things?

First of all, the fraud is committed by the patient, they're the one submitting the claim to their private insurance without validating it. Secondly, it will always be called a mistake if you object to it. But nobody does because remember, private insurance pays anyway. On top of it once you object and have a few arguments with them you may even find yourself having difficulties to get an appointment if it's a desired doctor with a queue at the door.

There are no numbers because this is not investigated, there just aren't resources for this. Nobody with a private insurance bothers reporting a $5-10 shot they never received and nobody wastes resources to investigate it. I've seen attempts to swindle me out of 5 digit sums of EUR that would have otherwise been blindly paid by the insurance. I actually checked everything, I objected, it was called a system error. I have acquaintances who work with the authorities and they confirmed that even if you find a pattern it's impossible to prove intent, so it never goes further than "we correct the mistake for those who report it".

Politician corruption is basically non-existent, and Al Capone just didn't pay tax. According to the numbers.

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

#207

Post by Arrath »

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!!

I was in a multiple rollover accident and wanted to get a scan because, well, I was hanging upside down by my seatbelt for a while so I thought it would be prudent to make sure my neck or something didn't get fucked up.

The ambulance ride alone from the accident site to the hospital (like, 5 miles) was several thousand dollars.

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

#208

Post by kelnos »

alistairSH wrote: post #174
rqtwteye wrote: post #164

Earlier quoted context omitted.

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.

Your simplistic description shows that you don't even know what you're talking about! The ER is for far more than life or death. A broken bone -- no matter how minor -- is a perfectly reasonable reason to visit the ER. Urgent care may work just as well, but there are many reasons why urgent care might not be a great option for people in their circumstances.

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

#209

Post by [deleted] »

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…

[deleted]

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

#210

Post by dylan604 »

kelnos wrote: post #203
dylan604 wrote: post #194

Earlier quoted context omitted.

> That was the treatment received, but perhaps they were referred to the ER by EMS for... Isn't it CYA for any EMS to recommend you visiting the hospital, so they just say it to anyone. That allows them to later say that you failed to follow recommended advice.

Maybe so, but so what? If a medical professional tells me I should go to the hospital, I'm going to go. I'm not a doctor. I don't know how to diagnose injuries and illnesses beyond a very basic level.

That's exactly the point. People forget that EMS are not doctors. All they have is way more medical training than the average civilian. That's why it's a CYA for them. So the person that shows up to the ER as advised by EMS which later turns out to be a non-emergency is not the fault of the patient. Why punish them with unholy fees?
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