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Old 11-21-2017, 09:19 AM
 
13,482 posts, read 9,615,257 times
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Quote:
Originally Posted by 2sleepy View Post
What's up with that? When I lived in Nevada I would occasionally hear people claim that the Nevada Dept of insurance was cherry picking which health insurers could sell in the state, basically creating a monopoly - is that true?
Don't know about the Dept. of Health Insurance. I can say Sierra ( now UHC ) touches just about every private health insurance claim around here, or otherwise has something to do with it. Their PPO network is leased out to almost all of the big self-insured groups in the valley, they are third party administrator for some unions and such. They are the largest HMO and PPO in the area, as well as operating both Senior Dimensions and AARP Medicare Choice Plans.
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Old 11-21-2017, 04:29 PM
 
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Quote:
Originally Posted by quebon View Post
I feel for you for just having to type that. What a situation. So why do many of the foreign doctors first go to northern Nevada, typically do one year and then travel south to practice in the Las Vegas area?
Quote:
Originally Posted by 2sleepy View Post
Maybe because Reno is boring and windy?
Quote:
Originally Posted by NLVgal View Post
I'm guessing, but likely because Reno is where the med school is located. We are supposed to be getting one soon, which might alleviate the shortage of doctors somewhat, but because the insurance companies here like to pay 20% LESS than Medicare, we will likely still be short.
NLVgal got part of it but it's changed now too so allow me to update. This gets into the nuances I mentioned prior about programs and the match.

The Univerity of Nevada School of Medicine (UNSOM) used to be the only show in town for the State of Nevada MD programs. There is also Touro University in Henderson which churns out DOs. They are both doctors but different paths and DO's take the COMPLEX exams instead of the USMLEs, and they have a separate DO match, but they can sit for the USMLEs and do the MD match in addition to the DO match.

Until recently Univeristy of Nevada School of Medicine had a satilite campus in Las Vegas with a large residency program. Well, several residency and fellowship programs. While it's main medical school is in Reno. If you spend anytime in it Reno and its surroundings area is a beautiful place imho. I think I would have loved to have gone to college there for my under grad. For their medical school it is my understanding that their first and second year students remain on campus in Reno and then their third and fourth year students used to come to Las Vegas for rotations or 'clinicals' as part of their curriculum. That is up until 2017 which was designated as the year everything changes in the Southern Nevada medical community based off the fiscial new year for government moneies allotted to various programs.

My observation was everything switched over about a year earlier. UNSOM changed their name over to the University of Nevada Reno School of Medicine and rebranded itself with the addition of Reno in their title. Their third and fourth year medical school students now do clinicals in partnership with local medical learning opportunities and rural ones.

Their residency and fellowship programs in Las Vegas were switched over to the newly approved and accredited University of Nevada Las Vegas School of Medicine (UNLV SOM). The school just got its first class of medical students all on full ride scholarships which they fundraised for their first two years of incoming students and they are fundraising for 100 million to build the school on the Shadow Lane campus near University Medical Center (UMC) in the recently expanded and designated medical district.

So the medical community in Las Vegas is going threw a period of growth and changes to keep up with its growing population. To get the government money to approve the new medical school they cited studies for the shortage of doctors in Nevada and said those that do their training in a city such as medical school, residency or fellowship have a larger percentage of staying in that area or coming back and practicing medicine there.

We're definitely thinking about it ourselves.

They got the money they needed from the Governor who was an advocate for it but it's not the only new medical School in Southern Nevada. There is also Roseman in Summerlin that is a private company on a similar timeline as UNLVs medical school. Except Roseman bought their buildings and have a medical school ready to go but their accreditation was delayed. UNLV will work in partnership with UMC which is a community based hospital. Some Medical schools have their own research hospitals which I believe is the ultimate goal of UNLV.

So there's Touro, UNLV SOM (2017) and Roseman (2018) medical schools in Las Vegas. Two of them are new. If Roseman passed accreditation their first class will be in 2018 and they did the same thing as UNLV offering full ride scholarships to their first few classes to bring in the brightest students.

Then there is UNRSOM in Reno.

As for post graduate training in Residencies and Fellowships The State also voted to expand programs and spots. So we have the ones at UMC which used to partner with UNSOM/UNRSOM but now partners with UNLV SOM and my husband's residency class was the last class to graduate from UNSOM/UNRSOM before it turned into UNLV. A lot of the faculty stayed in Las Vegas and teach the same programs just the schools changed. Some of the faculty did go back to Reno to live and work while others took opportunities elsewhere.

Another residency program also opened up at Mountain View Hospital which is a Tennessee based private hospital from my understanding and they rencently when through a 90 million upgrade on their hospital. Every year from 2017 and on for the next couple of years the residency programs are slotted to expand in Southern Nevada to bring in more talent to train and hopefully they'll stay.

They didn't have what we needed to continue training or we might have stayed. We had to go out of State. It's still a match process for Fellowship so it's a crap shoot where we could have ended up anyways.

Meanwhile, UNRSOM went back up north and is expected to chisel out their northern market much the same why they pioneered Southern Nevada. They're made of hearty stuff and there is a real need to work a way and root into rural medicine and address that need beyond telemedicine. I am partly sorry for what happen to them because the State took money from them and cut their programs to give that money to Southern Nevada to start their own programs but I see now it needed to happen. Their Internal Medicine program was one of the largest in the country. Twice the size of most and I recall thinking they had room for two schools looking at it from the start. That's what happens with growth. It spilts and divides and continues to grow or not.

Valley Hospital also has a DO residency program. It's behind UMC in the same designated medical dist area. So we have residency programs at Valley Hospital, expanding residency programs at UNLVSOM which used to be UNSOM, and UNSOM is now UNRSOM and they're expanding residency programs in Reno and rural areas of northern Nevada, and finally we have Mountain View Hospital starting its own residency programs and expanding them each year while upgrading its facilities. Meanwhile UNLV and Roseman are building medical schools in Las Vegas and the city expanded the Las Vegas Medical District in the urban core and NW to a designated 638 acres for future development.

There is a lot happening in Nevada and it's exciting!

I think I covered it all? I'll probably remember more later. NLVgal can answer the insurance questions about providers better than I can. We didn't get to private practice and billing, but I know from several medical community meeetings the gist of what's going on. I'll admit not enough though, but just enough.

Last edited by Merry Lee Gather; 11-21-2017 at 04:45 PM..
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Old 11-22-2017, 06:06 AM
 
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Merry, as always, thank you for the informative post! I knew it wasn't easy, but the path to being an MD seems extremely complex. At what point does someone finally get to say,"I want to live here, and either send out resume's, or just move and hang out their own shingle?

Selfishly, I hope you and your husband do return, as I think Las Vegas can always find room for more great people like you..
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Old 11-22-2017, 06:38 AM
 
2,953 posts, read 1,394,375 times
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Quote:
Originally Posted by NLVgal View Post
Don't know about the Dept. of Health Insurance. I can say Sierra ( now UHC ) touches just about every private health insurance claim around here, or otherwise has something to do with it. Their PPO network is leased out to almost all of the big self-insured groups in the valley, they are third party administrator for some unions and such. They are the largest HMO and PPO in the area, as well as operating both Senior Dimensions and AARP Medicare Choice Plans.
Just askin' - trying to figure out how/why other than no competition in insurance in NV its such a mess. And it wa this way befoe the ACA act. As I boutgh coverage here since 2001 for our employees. Having smokers and one obese gal mad this difficult and I had to joing the chamber to get decent rates.

I now have Sierra Gold PPO. How does their PPO network being leased out to all big insurd groups in LV affect me. As an individual, if it does.

I think UHC is violating the 'reason' of health care insurance. At least they were with HPN.
I will see how I do with Sierra and if I still fell this way. I know they are with RX's. My phar said they won't run all RX's trough under health insurance if the generic is lower without the insurance. Which I know for most of mine, it already is.

Merry , I don't know you but hope you come back here too to practice.
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Old 11-22-2017, 08:57 AM
 
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It just means your doctors are not getting paid very much. I had a 99212 ( cpt code) visit with my doctor a few years back. ( I can relate personal anecdotes, but have to limit professional ones ) My EOB ( explanation of benefits ) came in the mail. I paid my copay, of course, and Sierra kicked in $13.00.

This is why medical care here is often lacking. You can't pay employees to book an appointment, pull a chart, check you in, and wear clean gloves ( which cost quite a bit, Thanks, McKesson ) for $13.00. My copay was $25.00. Total = 38.00. My hair stylist makes more than that.

Any questions, people?
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Old 11-22-2017, 09:40 AM
 
Location: la la land
27,282 posts, read 11,390,706 times
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UHC is the devil. When we lived in Reno my husband had a UHC HMO plan for a while. His dentist found a lump in a salivary gland and told him to see his PCP. His PCP requested a referral to an ENT doc but UHC denied it and said it was a 'dental issue'. It went back and forth like that for awhile, with him being referred to his dentist then back to his PCP. At one point they decided that he didn't need to see an ENT, he should see an oral surgeon and referred him to one 100 miles away. I complained to everyone I could find, his employer's HR dept, NV dept of insurance, UHC etc. I don't know if my complaints worked or if they just got tired of me calling them every day but a few weeks later UHC approved the referral to a local ENT.

PS, the logical question here would be "did his PCP examine the lump to try to determine what treatment was needed?" newp..his PCP sat across the room from him and didn't even look at him, let alone examine him
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Old 11-22-2017, 02:19 PM
 
2,953 posts, read 1,394,375 times
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Quote:
Originally Posted by NLVgal View Post
It just means your doctors are not getting paid very much. I had a 99212 ( cpt code) visit with my doctor a few years back. ( I can relate personal anecdotes, but have to limit professional ones ) My EOB ( explanation of benefits ) came in the mail. I paid my copay, of course, and Sierra kicked in $13.00.

This is why medical care here is often lacking. You can't pay employees to book an appointment, pull a chart, check you in, and wear clean gloves ( which cost quite a bit, Thanks, McKesson ) for $13.00. My copay was $25.00. Total = 38.00. My hair stylist makes more than that.

Any questions, people?

*RAISES HAND*

Sorry about my post, I am cringing (and giggling) over typos etc. No, I'm not smoking or drinking. My grammer/spelling check won't work with CD and don't see one on cd. I know I should check but trying to get too mcuh stuff done at once. Bless you all for not saying anything.

Not being in the medical field, I'm still not understanding what I bolded. When you use the terms PPO group is leased out to all big self insured groups in the valley. Can you give me an example of a Big self insured group and what does that have to do with me and buying my own insurance? I'm trying to come up with another example I can understand. It sound to me like there are lots of middle men somewhere who have no business being there. But again I don't know.

Doctors can be heavy on staff. We are good friends with one of our doctors (specialist). Told me if I ever have an issue with staff, let him know. Never have had, hubs had issue with one but many others must of too. We never said anything. She was let go. Not a type of peroson that should work with the public. We've been going to him for 17 years and he still has some of the same staff. He does well as a specialist.

I think doctors overall are underpaid, unless they are plastic surgeons.

Don't want to repeat myself but David Copperfield bought a house in the Ridges for $17.8 million FROM A EXECUTIVE THAT WORKS AT SIERRA PPO. WTH is an employee with a health insurance company making that kind of money? He WORKS there, doesn't own it.

I have no issue with Copperfield having that kind of money. His business, like ours, NONE of you need. Yippy for him. he's talented, found a niche he's good at and became a brand. But what he does is not life and death for us. (Trust me he's not dying doing any of his tricks.)

BUT if it's a service (Health insurance) that people have to have, they buy into and think they are covered. Then turned down cause of greedy exec's, yeah I got an issue. Just like I have an issue with Big pharma.

When I was with the LV chamber crappy HPN insurance group for 9 years, we were working a couple times a year in LA, week or more at a time. I called HPN and said, who do I go to in LA if something should happen. They actually told me to get in the car and go to the NV state line. zI said kind of hard if someoen has a heart attack or gets hit by the bus. NO comment from them.

Man I can't wait to turn 65, how sad is that!
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Old 11-22-2017, 03:23 PM
 
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Medicare for everyone is the answer. Whip out the actuarial tables, and figure out a premium for everyone that will make it self-funded.

I've done this for 26 long years. It IS the answer.
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Old 11-22-2017, 03:43 PM
 
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Originally Posted by NLVgal View Post
Medicare for everyone is the answer. Whip out the actuarial tables, and figure out a premium for everyone that will make it self-funded.

I've done this for 26 long years. It IS the answer.
Kind of interesting. I never paid a single dime for health care until I turned 65. Mother's and Father's plans until I went to work and had my own. That then covered me until I reached 65. It would have continued to the end of life except the Feds got into the act with Medicare.

Now I pay a little over a grand a month for myself and wife. About half for Plan Fs and the rest for drugs.
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Old 11-22-2017, 04:07 PM
 
13,482 posts, read 9,615,257 times
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Originally Posted by lvmensch View Post
Kind of interesting. I never paid a single dime for health care until I turned 65. Mother's and Father's plans until I went to work and had my own. That then covered me until I reached 65. It would have continued to the end of life except the Feds got into the act with Medicare.

Now I pay a little over a grand a month for myself and wife. About half for Plan Fs and the rest for drugs.
You need to call me.
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