Healthcare in Delaware (codes, move, health care)

[Laural]

Now on the otherhand once we established a relationship with the front desk people, and they saw me a lot (I have lots of health issues) and we became friendly we could get in anytime we wanted but that didn't happen over night. I think it's a power trip they have.

[rockky]

movin, No. Not just in DE. If you are BC/BS, and the doctor you are seeing participates with them, the doctor must accept what the insurance company pays as full payment. It's that way everywhere.

I am not on an HMO or PPO or whatever the newest incarnation is that the insurance industry has now. I'm on a Traditional plan. I don't have to choose the doctors that pay to play.... so to speak. It was my understanding that I choose my own doctor, and as long as they are in network, what I said above is how it's supposed to work. However, there must be out of out of network providers within those participating with BC/BS. My carrier is out of Philadelphia, and it's huge...but they apparently don't hook in with doctors in DE.

I called everyone for whom I could find a phone number. I got nowhere.

[maryCh]

Hi movn2del,

My next move (hopefully, Tuesday) is to check in with the consumer's unit at the department of insurance here in DE. That seemed to help when we were dealing with the NY insurance in NC; and may help here in DE.

The sales pitch given by the reps from the insurance companies to benefits admin folks is the whole thing of "in network" and "out of network" rates. Makes it sound so easy on the employees, and their families. However, real life experience (as mentioned by several in this thread) is a whole other ball game.

Doctors spend an unbelievable amount of time getting their own sales pitch from the reps, trying to sign the practice on to be an "in network" provider for a given insurance carrier. BC/BS being one of the biggest, nationwide. But doctors offices are getting burned by the companies, almost as badly as the patients. The system is virtually too complex for the average Jane or Joe to understand, and follow up on the EOB's, etc. to get the accounting ironed out. Part of the reason a lot of doctors don't want to sign on one new patient or family for a provider that they will likely not encounter with any other patient(s).

One thing I have found that MIGHT be helpful for you and me (and others moving with NY insurance) is that, typically, the "usual and customary" charges for a given billing code is higher on the NY plan than the rate charged by the docs here in DE. I.E., basic new patient set up may bring $75 charge for the doctor, while the insurance plan from NY allows, say $100, for the same code. As you know, a lot of that is because NY docs have negotiated the higher pay outs because of THEIR expenses. Now, a savvy business manager in the doctors' office can see the profitability of accepting us and our families as new patients. But finding a doctor with a good business manager is the hard part!

I'm not sure of a formula that works, but do be ready for a tough road ahead in the search for a family doctor. Our experience has been... the better the doctor in practicing his field, the worse he/she seems to be in managing the business side of being a doctor! And that has applied in just about every state we've lived in (and that's been a few over the years). The state of healthcare all across the country is horrendous, so just be prepared to spend a large amount of time finding the situation that is right for you and your family.

It is a very scary situation, and makes the consumer/patient become pretty frustrated in working through the process. My professional background is in insurance, so in some ways I understand the nuances better than other folks. Believe me, my "field of expertise" only gives me more patience with this issue... nothing more, nothing less.

Good luck to all struggling through this; and I fall back on contacting the consumer complaint department of the insurance commissioner's office. One thing to keep in mind... the commissioner IS an elected official, and their office has the public duty to file and investigate consumer's complaints. THIS does apply in all 50 states (as I recall), so pull the "taxpayer" card if you need to! Sometimes, THAT works as well.

Mary

[rockky]

Good thoughts and advice, Mary. Thanks!

[anniebleu]

I could write a very long post on several of the subjects contained here, but it's another one of those days when I've got only a few minutes for the forum, so you all are spared!

Let me start by saying that in terms of insurance, as well as doctors' offices (billing) errors, and all related problems, it certainly isn't limited to Delaware, though (and Mary's right about doing this), I was in touch with the insurance commissioner's office a number of times about problems within the state.

I have known many people who've lived in Delaware for many years, or just a few, who've left the state because of serious (health, medical and related) difficulties here, but in all cases this was because they couldn't find doctors, specialists, or hospitals capable of providing needed treatment. Some of them were truly sorry to leave. In my family's case, we ultimately found a local office to handle immediate (as in no time to go anywhere else needs) for one family member, though the main doctors / hospital are in another state. Note: we settled on the out-of-state doctors and hospital in this case, after long years of traveling to other major hospitals in other states.

Even the best hospitals do not necessarily (and this means almost never) have the best, most informed people in their billing offices, and I've had several or more years largely taken from my life in terms of time spent dealing with two different hospitals with great reputations. It has often happened that those billing will state that the problem is with the insurance people--and vice versa--so guess who devotes much of her time and energy to correcting the mistakes of both? I think I am, after too many years, seeing signs of improvement. I hope I'm right.

The thing that has amazed us, though we've heard the same report from many others, is that the doctors (internists) and specialists at major hospitals tend to spend much longer with us, yet charge the same fees, as right here in Dover. We are lucky to get 10 minutes with the best doctor, overall, we've been able to find here, but a regular check-up with our out-of-state internists is half an hour! We also find these doctors' office staffs to be far more helpful and the doctors themselves far more reachable. In more than one case, doctors welcome and respond to email.

As I've said many times, I think I see signs of some improvement here. I so hope I'm right, and certainly hope it continues, but I can tell you that this area, all the subjects mentioned, has been an enormous problem for SO many people I've met in Kent, Sussex, and New Castle counties.

I typed fast!

[rockky]

Thank you, Annie.

It was never my intention to 'be negative' or try to keep anyone from choosing DE as their permanent home.

There are some problems with health care and insurance here, and if someone had given me a heads up to look more deeply into some things I may have had an easier time of it. If nothing else, I wouldn't have been the patient patient I was and had faith that the system is a good one.

I was told that it wouldn't be a problem, and my insurance carrier will simply process as it always has. Eh, no it didn't.

Fore warned can stimulate people into making some extra calls before they make a decision with the impact these issues may have on their quality of life.

[elizamary]

I just have to say health care in this country is not the greatest nationwide. I'll applauld with the number of Americans that can't afford health care.
The insurance and drug companies are robbing us blind.
My cousin had a probem in PA at one hospital. They gave her husband 6 months to live and said there was nothing they could do.
She did some research and brought him to university of Penn where they reconstructed his bladder from intestines and other parts of his body. He had bladder cancer.
that was 17 years ago and after numerous operations over the years, he is a happy healthy man living the good life.

[elizamary]

Doctors appointment report:

Went very well and I was extremely pleased. This office, as far as I can see on my first visit, does not schedule 20 people at once. I didn't hve to wait at all, she took her time and was very thorough leaving no stone unturned.
The practice was central Delaware family medicine and they have a few doctors there.

[maryCh]

Thanks for the info, elizamary, and good to hear THIS doctor was better than the OTHER one (you know, the witch doctor)!

I'll put them on my list of docs to call to see if they will take us, and our out of state insurance.

Mary

[elizamary]

Originally Posted by maryCh

Thanks for the info, elizamary, and good to hear THIS doctor was better than the OTHER one (you know, the witch doctor)!

I'll put them on my list of docs to call to see if they will take us, and our out of state insurance.

Mary

Much better. I didn't have to wait, in fact they took me early. She talked to me and then the examine which took about an hour. Was a first time visit that is why.
Now Bill is going to them too.
The witch doctor was good on the first visit both Bill and I loved her until she left the practice.
Even though we loved her, the office staff was not that nice and we did have to wait forever. There is so much confusing and it certainly is not at all organized.

This practice is all women. In fact, two of my neighbors go to them. Both their husband have been seriously ill. Both these women are outspoken and if they didnt' like this doctor, they would surely let it known.
The one specializes in geriatrics.
I also heard their bedside manner is the way it should be.
So far it is all good.
We see Dr. Areallano.