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Old 12-15-2009, 05:54 AM
 
Location: Waldo County
1,220 posts, read 3,443,266 times
Reputation: 1393

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We just had an interesting experience...interesting if a waste of time.

My wife is seeking a new primary care physician. After suffering for three years with increasing shoulder joint pain, misdiagnosed by her current doctor as a result of "joints getting old", the doctor finally referred her to a specialist who diagnosed a torn rotator cuff. The surgery to repair it was successful in July, and my wife now on the road to recovery, seeks a new doctor.

Because we are planning to move next year, she tried to find a doctor within twenty miles of where we will live, and made an appointment with a doctor who has recently established his practice in Blue Hill.

When she made the appointment she discussed some of her recent history with the person answering the phone, and specifically indicated her insurance coverages that are in place. She also sent the doctor a letter itemizing in detail her recent history, and more particularly, the specific requirements that she expects to be met by her primary care doctor which includes thorough communication between doctor and patient. I drove her to her appointment because she still has some restricted motion from her surgery.

The doctor has a new building, which is attractive and neat. It is conveniently located, and when we arrived, there was no one in the waiting room, nor was there a receptionist. We were greeted by the doctor.

After the basic introductions during which my wife extended her insurance cards to the doctor, he informed us that he did not accept ANY insurance payment at all. That he was strictly a "fee for service" doctor, and any insurance processing was our responsibility.

I was quite surprised. My wife was outraged. There had been plenty of opportunity for the doctor or his (absent receptionist) to inform my wife of his payment routine well in advance of scheduling the appointment. He told us that we should have read his website before making the appointment.

In my previous life my insurance business had a subspecialty insuring medical practices. I have met doctors of all types, and had the great pleasure of insuring some of the finest doctors in this part of the country. This guy gets high marks for being among the most arrogant and perhaps, ignorant of all of them, and I met plenty of them.

I realize that doctors fees are under pressure as is the entire medical services business. Much of the pressure is purely political and has nothing to do with medecine and merely makes the doctor a scapegoat and the victim of his patience. I agree that there is a place in the future for the "concierge" doctor: one who charges fees for services to the patient instead of the doctor billing the patient for his services independently.

We left the doctor standing there in his empty waiting room. My wife was in no way going to listen to his "pitch" which he invited us to do, since she had initiated the appointment and was specific about what SHE expected to receive in services INcluding communication.

When we arrived home, I read the website thoroughly. The website is long onf the details of what the doctor expects of the patient, and pretty short on what the doctor is going to provide in the way of medical care of services. Essentially he is saying, "I'm going to charge you $75 per 20 minute visit, print out a bill, and you can go and get whatever tests you need somewhere else. Pay when you walk out the door. Visa and Mastercard accepted, and oh, well, I'll take cash if you've got it, too. Have a nice day. Oh, and don't expect to go over the first twenty minutes, because I'll charge extra."

While the concept of a concierge doctor isn't necessarily bad, I believe that it probably is a concept the time for which will be determined by a larger picture of medical services overhaul. I also believe that while Blue Hill is one of those "good" towns, with a rather healthy population of quite wealthy people, I doubt that there is enough spare change lying around to pay a doctor out of pocket. In addition, I can't quite see a wealthy, white haired dowager seeing the doctor, paying him, and then sending her medical bills to Medicare and trying to arrange for her hospitalization to be paid.

From time to time, I have performed some advisory services to former clients or their referrals. I charge an hourly rate and I am sending this doctor a bill for the two hours it cost me to find out that he is not a doctor for my wife. My biggest issue is that HE expects that ANYONE who might come to see him will have access to, and easily use the Internet. I consider this arrogance.
It is not up to the patient to provide service to the doctor. The doctor is in a service business.

My late uncle was a primary doctor in Hancock County. He was awarded the Jefferson Award for his more than fifty years of service, day and night, rain or shine, to his patients. Beginning practice in the 1930's, when doctors were ALWAYS fee for service, he delivered more than 1,000 babies during his practice years. My uncle would kick this fancy pants into Blue Hill Bay if he were alive today!

I am writing this post because I know that there will be people reading this forum who will find this interesting. I expect that there will be more fee for service arrangements in the medical service business, but I think that in Maine, the population and money pool is pretty shallow, and certainly so outside of the greater Portland (read: North Boston) area.

My wife told her neurologist this story, and he laughed, saying that the guy in Blue Hill probably wants to starve to death.

Meanwhile, our search continues.
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Old 12-15-2009, 06:30 AM
 
Location: Northern Maine
9,485 posts, read 14,286,680 times
Reputation: 8906
I posted this here before, but I'll make this short. Our welfare system of medical care in Maine is dysfunctional. Augusta is over $300,000,000 behind in payments to doctors and hospitals. Doctors who try to play within the system are closing their practices all over the place in Maine. You can't provide a service without getting paid unless you are very wealthy.

I know a Doc who has a busy practice. He takes cash, checks, a side of beef, flight time, vegetables and meat as payment. He treats loggers, guides, pilots and self employed tradesmen along with their families. He does not carry malpractice insurance. Other Docs call that "running barefoot". A guide told a visiting Doc on a fishing trip about our Doc. The visitor was amazed that any Doc could go without insurance.

"What if he gets sued?" was his question.

The guide replied, "If anybody sues Doc we'll just drown him." I bet that visiting Doc tells that story back down in the city. What the visiting Doc may not have understood is that it's true.
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Old 12-15-2009, 06:44 AM
 
Location: On a Slow-Sinking Granite Rock Up North
3,637 posts, read 5,262,215 times
Reputation: 2650
Well, I can't say I'm really shocked. I think that doc needs to find a better methodology for communication, and I believe he will once enough people have stated their disappointment as you did. It's complicated enough to decipher Explanations of Benefits now much less submit your own claims (which is what people will do if they decide to utilize his services). It's so complicated now that most throw up their hands in reality.

Here is a link to the physician referral service (although I see they don't have a website, but the address and phone number are there). I believe this particular outfit is out of EMMC Healthcare (Affiliated) and many hospitals/physicians are under their umbrella now (except for the "holdout" nuns of St Joseph Hospital - they tried - but Sister Mary Norberta told Norm Ledwin once when he tried to get them on their side, that he "couldn't afford her" ). At any rate, I'm sure there will be some affiliate in your area.

Maine Physician Referral Services - Bangor, Maine (ME) | Company Profile

Good luck.
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Old 12-15-2009, 09:16 AM
 
1,403 posts, read 3,051,712 times
Reputation: 1303
Was this doctor listed in the network of primary care physicians by your wife's insurance provider?
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Old 12-15-2009, 09:52 AM
 
Location: On a Slow-Sinking Granite Rock Up North
3,637 posts, read 5,262,215 times
Reputation: 2650
Quote:
Originally Posted by Northern Maine Land Man View Post
I posted this here before, but I'll make this short. Our welfare system of medical care in Maine is dysfunctional. Augusta is over $300,000,000 behind in payments to doctors and hospitals. Doctors who try to play within the system are closing their practices all over the place in Maine. You can't provide a service without getting paid unless you are very wealthy.
I agree. It's also not very cost-effective to have to hire employees to mire through the paperwork of getting a claim submitted, and ensuring that every i is dotted and every t crossed - less the claim be rejected, and the process need be started all over again.

I think that's why you don't see many "shingles" hung out by the family doc anymore. That's one benefit to your "non-traditional" doc (whom, by the way, I absolutely enjoy the mentality of) he doesn't have to deal with the overhead.

At any rate, it will be interesting to see if the doc that AL had the experience with is on the preferred providers list. If so, I'm not sure how the doc can negotiate to take cash payments only without going through the claims process. That would be new to me, but there again, doctors don't have to process insurances - they can require upfront payment and give the patient an invoice to submit for claim to their insurance company.
While there are some patients that are willing to do this, more often than not, they'd prefer the convience of having direct billing, so that's one reason why most doctors go that route.
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Old 12-15-2009, 05:38 PM
 
17,158 posts, read 22,167,733 times
Reputation: 31223
Quote:
Originally Posted by Northern Maine Land Man View Post
I posted this here before, but I'll make this short. Our welfare system of medical care in Maine is dysfunctional. Augusta is over $300,000,000 behind in payments to doctors and hospitals. Doctors who try to play within the system are closing their practices all over the place in Maine. You can't provide a service without getting paid unless you are very wealthy.

I know a Doc who has a busy practice. He takes cash, checks, a side of beef, flight time, vegetables and meat as payment. He treats loggers, guides, pilots and self employed tradesmen along with their families. He does not carry malpractice insurance. Other Docs call that "running barefoot". A guide told a visiting Doc on a fishing trip about our Doc. The visitor was amazed that any Doc could go without insurance.

"What if he gets sued?" was his question.

The guide replied, "If anybody sues Doc we'll just drown him." I bet that visiting Doc tells that story back down in the city. What the visiting Doc may not have understood is that it's true.
as kids my father would barter lobsters for our dentist appointments in wiscasset (he's a lobsterman)


as more employers and insurance policies include "high deductibles"
more folks are screening doctors for services (based on out of pocket)

this year i went with a "high deductable" plan (up to 6k out of pocket)
with a lower weekly premium, and of course, i got screwed-some unforseen
medical issues within the family, it doesnt take long to add up, drs.-push for all the "tests" they can to avoid being sue'd, all the while, your back pocket is burning.

if one dentist will charge 65 for a cleaning, and another 150, it does seem that dr. shopping (for services) will happen
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Old 12-15-2009, 06:16 PM
 
1,961 posts, read 4,163,781 times
Reputation: 1800
Quote:
Originally Posted by Acadianlion View Post

After the basic introductions during which my wife extended her insurance cards to the doctor, he informed us that he did not accept ANY insurance payment at all. That he was strictly a "fee for service" doctor, and any insurance processing was our responsibility.

What a waste of your time and energy......I would have been so ticked off.

I agree, the receptionist should have made it clear as a bell to your wife on the phone that it is a fee for service establishment. The brochure and paperwork should have the terms clearly listed. Maybe he is hoping that people will not back down once they get through the door and fill out all the paperwork.

Time to write a letter to the editor of your local newspaper or call the Better Business Bureau, me thinks.
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Old 12-16-2009, 03:49 PM
JC3
 
296 posts, read 707,792 times
Reputation: 355
This sounds like a case of them not being upfront during the phone call. That would be like someone saying I have medicare as insurance and after telling them that, they make an appointment with you and then tell you they don't accept medicare after you get there. I would have been very ticked off and told them so for the wasted trip and time.
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Old 12-16-2009, 06:42 PM
 
2,133 posts, read 5,144,672 times
Reputation: 1387
My (former) chiropractor has operated that way for years, however, all patients are told up front before setting an appointment how it works, and that you will have to file your own insurance claims for reimbursement after paying out-of-pocket for the visit.


I don't necessarily have a problem with concierge physicians but agree 100% that they need to make it VERY CLEAR up front.
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Old 12-16-2009, 09:27 PM
 
Location: some where maine
2,059 posts, read 3,642,159 times
Reputation: 1240
i was gona be a doctor but no one wanted to be fixed with duct tape and whisky.
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