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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
Mary, I'm so glad you are there to pave the way for me. I can't change insurance. It is what it is. I called the insurance co and they told me I have to use out-of-network coverage in DE. Hopefully you are right and the schedule of fees is more than what they charge in DE, since the schedule is based on NY fees. The codes are what they are. Hopefully the staff will be good with the procedure codes. I would imagine they need these codes for any insurance company.
Quote:
Originally Posted by 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.
I think I said it in a previous post, we need to advocate for ourselves. That means second opinions. Most people need a Dr. for basic stuff. When we need for more serious things, we need to do our homework. Whoever is posting or reading these threads has a computer and access to a wealth of information. I strongly suggest that is should be used. I have learned an awful lot. Dr.'s are not the G-d's they sed to be thought of as.
Quote:
Originally Posted by 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.
I'm glad you found happiness in healthcare in DE. That gives me hope for when I get there.
think I said it in a previous post, we need to advocate for ourselves. That means second opinions. Most people need a Dr. for basic stuff. When we need for more serious things, we need to do our homework. Whoever is posting or reading these threads has a computer and access to a wealth of information. I strongly suggest that is should be used. I have learned an awful lot. Dr.'s are not the G-d's they sed to be thought of as.
Thanks Charley for this forum!As a R.N. for over 20 years,owning a home in DE and living primarily in No.Va.,I can give feedback on the DE facilities having worked as a staff R.N. or travel R.N. in most of them.Christiana Medical Center should really iniatiate a standard of care for all the hospitals in DE.Working in the open heart unit in the late 90's --we gave excellent care.The cancer institute also provides excellent care.
My feelings change when it comes to Bayhealth in Dover.While my father was receiving radiation treatment for prostate cancer I was made aware that 2 treatment were cancelled due to the radiation machines were broken--there was not a Plan B.Also his insurance was billed for the entire treatments.
My sister went to the E.R. for an ankle sprain ,while there the pain increased which triggered an asthma attack --it was not addressed and she had to use her friends' inhaler,never was assessed for the asthma attack.Also a friend of mine took her daughter to the E.R. for a breathing problem and was basically told her daughter had a cold--she took her daughter to Children's Hospital of Philadelphia that night and her daughter was admitted for severe asthma where she stayed a week.I was also made aware that a sedated patient had her picture taken by staff nurses without her knowledge--the nurses of course remain employed in the E.R.
Beebe hospital gives good care,however I was made aware by friends from D.C. who have beach homes in Lewes that their cancer treatments were also cancelled due to radiation machines being broken.
I found out that some heart centers use the name of University hospitals without have any doctors that are from that setting.So basically its' just a marketing ploy to generate business.
So consumers do your research.
And on the other hand - we can't say enough positive regarding the Cancer Center at Dover (Bayhealth) which is a member of the University of Pennsylvania Cancer Network, and most especially Dr. John Lahaniatis and his staff. My husband underwent 39 radiation treatment at the Center following (I'll skip the details) surgery at Bay Health. Follow up to that, was hormone therapy, in the form of lupron shots every 3 months for over 2 years, and testing every month. I understand everybody has their own story, positive or negative, but ours was very positive and we have complete faith in Bayhealth and the Cancer Center. DianmondRN, maybe you will recognize some of the terminology, and most of all the tumor-destroying linear accelerator, the Trilogy, in this link: Radiation Oncology
One thing I have to say that I took for granted in Delaware was the amount and availability of Urgent Care Facilities.
Where I live now, in Philadelphia, I had a bronchitis issue. I happen to be uninsured to to some financial issues, and due to that, needed an affordable office visit.
Since PCP's are crap, and they work their cute little office hours, and usually contract with other doctors who don't want to deal with other doctor's patients in the same office, I was left without a viable PCP option.
I finally found an urgent care facility in PA, in Plymouth Meeting. In order to get antibiotics, I was going to have to pay $200 for their office visit. Although this is better than paying $3000 to Jefferson, this was unreasonable just to get a prescription I already know I needed. No detective work here.
Finally, I broke down and drove back down to Delaware, where I had Hockessin Walk-in, Limestone Medical Omega, Glasgow, who all charged around $60 bucks to get a decent guess game on my severe bronchitis, and issue me a script for Azythromycin (sp.)
So, there's the feather in your cap, DE... thanks!
One thing I have to say that I took for granted in Delaware was the amount and availability of Urgent Care Facilities.
So, there's the feather in your cap, DE... thanks!
So glad that worked out for you Joe. We have a number of walk-in clinics in the state, and have had for many years. The first I remember was the one on the corner of State St. & Rte. 13 in Dover which must have opened 20-25 years ago, and was considered an oddity because one never knew which doctor would see you.
I have a family doctor, only the third in my lifetime, and am fortunate that I can walk-in any time. There still are some practicing where I am, who know us by our first name, ask how the kids are, and pat us on the head! Not to mention, we can call ours at his office and he'll talk with us if we have an urgent question. Very comforting!
And on the other, other hand my family and I have the care at Bayhealth Medical --Kent General Hospital is an absolute miscarriage of healthcare.For example my aunt was treated for cancer in Dover--we were not fans of the physician you mentioned--he lacked politeness and common sense.Being a gradusted of the Wharton Scool of Business at Univ. of Penn.,I made an appointment for my aunt and wouldn't you know Bayhealth is part of the Penn. Network with other hospitals who really lack a solid reputation so instead of increasing their standards the buy the use of the name of stellar hospital systems --not one physician from Penn. works in Dover.Really Bayhealth--this is a feather in the cap of your marketing team however very unethical behavior towards your patients and the community.
My aunt did very well at Penn.,however while undergoing treatments Dr.L. called and said well maybe he should consult the doctors at Penn.,my aunt informed him that she was already being treated their for about 4 weeks and all records had been faxed to his office,he abruptly hung up.
I am glad your husband also had a good outcome--we can't quite raise and fan the Bayhealth flag.Unfortunately after living and working in New York City where situations like this would be met head on I feel sorry for the population of Delawareans who live below the C&D canal bridge you all deserve alot better regarding your healthcare choices.
Different experiences produce different opinions. I have heard stories like yours NYPAgirl and stories of the opposite.
We are new to DE and had one bad experience then changed doctors and now love our doctor.
This is just my opinion but when a person is sick with cancer and possibly dies......too often the family has to blame someone.
Now I"m not saying this is your case... I'm just throwing out food for thought due to all the pros and cons inthis particular thread.
Some doctors are lousy and should have their license revoked.
But that is pretty much everyone.
One thing i do find is DE is not at all sophisticated and that may leave doubt in peoples minds about health care in DE?????
We right now are trying to straighten out a code problem. My 17 y.o. son has severe allergy problems. It is way more then our family doctor could handle. The new doctor ordered several blood tests totaling close to $1,000 . He marked the order as routine. Blue Cross won't pay it. Blue Cross says if it was for finding the allergies we are covered 100% but Doctor has to change code. His office people don't understand. (or care?)
I find a total lack of customer service everywhere not just DE and not just healthcare. I recommend going to your primary doctor's office and see if they can get the problem straightened out for you. I assume they referrred you to the specialist and they they might appreciate some feedback if they care about you as their patient. Just a thought.
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That gives me hope for when I get there.
