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My family has been with Freelancers Union's health insurance for some years, but their current Obamacare manifestation through BC/BS and their minimal primary care facilities are pretty abysmal and seem to be getting worse.
There's no way to contact my current primary care physician, except through a labyrinthian system of intermediaries who are often unavailable. There appears to be no accountability whatsoever, when there's a major problem: after getting a routine colonoscopy through my PCP it turned out that the anesthesiologist was not in-network. Sudden huge bill.
Any NYC freelancers have advice or warnings about other companies? I'm not looking for disaster-only care, with huge co-pays and deductibles (although these seem to be the new norm anyway). I guess I'm looking for what's generally called a silver plan.
I'd really like to hear about others freelancers' healthcare experiences and options.
I can't comment on your complaints concerning Freelancer. Your PCP was at fault for sending you to an endoscopy facility that used a non-network anesthesiologist. Don't pay his/her bill. An anesthetist or anesthesiologist is only necessary when they use propofol to sedate you. Versed is the sedation drug of choice in colonoscopies and the gastroenterologist or a nurse can administer it themselves. This clinic was padding the bill as so many do.
I can't comment on your complaints concerning Freelancer. Your PCP was at fault for sending you to an endoscopy facility that used a non-network anesthesiologist. Don't pay his/her bill. An anesthetist or anesthesiologist is only necessary when they use propofol to sedate you. Versed is the sedation drug of choice in colonoscopies and the gastroenterologist or a nurse can administer it themselves. This clinic was padding the bill as so many do.
In the Northeast (and that includes NYC), most colonoscopies are done with propofol and an anesthesiologist. Versed for colonoscopies fell out of favor a long time ago here. There are still some that do it that way, but they are in the minority. Gastroenterologists prefer propofol because the patients don't move at all, making their job easier and making it less likely for them to miss something. Also, they like having a doctor in the room that is trained in dealing with emergencies, just in case something goes wrong. The few that stick to the old way are usually vocal about it though. Most gastroenterologists in the northeast that have come out of their residency in the last 10 years have likely never even given sedation for their own colonoscopies.
That said, the OP's gastroenterologist should have told him/her that the anesthesiologist doesn't accept his/her particular insurance. They should take it up with the gastroenterologist, but to not pay the anesthesiologist would not be fair. He did the work and he should be paid for it, just like anyone else who provides a service for you.
In the Northeast (and that includes NYC), most colonoscopies are done with propofol and an anesthesiologist. Versed for colonoscopies fell out of favor a long time ago here. There are still some that do it that way, but they are in the minority. Gastroenterologists prefer propofol because the patients don't move at all, making their job easier and making it less likely for them to miss something. Also, they like having a doctor in the room that is trained in dealing with emergencies, just in case something goes wrong. The few that stick to the old way are usually vocal about it though. Most gastroenterologists in the northeast that have come out of their residency in the last 10 years have likely never even given sedation for their own colonoscopies.
That said, the OP's gastroenterologist should have told him/her that the anesthesiologist doesn't accept his/her particular insurance. They should take it up with the gastroenterologist, but to not pay the anesthesiologist would not be fair. He did the work and he should be paid for it, just like anyone else who provides a service for you.
It used to be that the gastroenterologist did not want the patient to be totally out so they could respond to commands from the doctor.
If we are talking about fairness to the anesthesiologist, he/she should send a bill for the amount the insurance company would have reimbursed. It's very likely he/she sent a bill for the full "uninsured" rate which is highway robbery.
It used to be that the gastroenterologist did not want the patient to be totally out so they could respond to commands from the doctor.
That is only because with versed, and valium before that, patients would often unintentionally fall asleep. But not a deep sleep like with propofol. More of a "twilight" sleep. And in this twilight sleep, they squirm and move around. With versed, ideally you want to keep them awake so they can follow commands and stop moving around when they are told. With propofol, the sleep is deep enough that they don't move around at all.
Quote:
Originally Posted by martinjsxx
If we are talking about fairness to the anesthesiologist, he/she should send a bill for the amount the insurance company would have reimbursed. It's very likely he/she sent a bill for the full "uninsured" rate which is highway robbery.
The insurance company negotiates that rate. And if the provider doesn't take that insurance, it is probably because the insurance company was lowballing them. So if they wouldn't accept that rate from the insurance company, why would they accept it from an individual? Highway robbery is a very subjective term. Lets say there is a complication, and the anesthesiologist uses his/her extensive medical knowledge and training that they spent many years to learn, to save your life? Is it really highway robbery?
An anesthesiologist doesn't get paid well for giving drugs. Anyone can be taught to do that. He/she gets paid well for the times that things go horribly wrong.
The insurance company negotiates that rate. And if the provider doesn't take that insurance, it is probably because the insurance company was lowballing them. So if they wouldn't accept that rate from the insurance company, why would they accept it from an individual? Highway robbery is a very subjective term. Lets say there is a complication, and the anesthesiologist uses his/her extensive medical knowledge and training that they spent many years to learn, to save your life? Is it really highway robbery?
Slightly off-topic, but here's what happened: The bill from the anesthesiologist was for the full amount, $2,060, or something like that. The insurance company's explanation indicated that they would have offered slightly under $500 for the service. Had the doctor been in-network, I would have paid the insurance company's estimate of the service's worth (due to my deductible) and saved myself $1500.
I don't doubt that the doctor's price is too high and the insurer's price too low; isn't this part of the game?
However in the current state of healthcare I think the consumer gets repeatedly shafted as the companies try to figure out a million ways to shift the cost to them through complicated co-pays, deductibles, etc.
But I'd still like to know about what other freelancers are doing for their insurance. Surely there are thousands of you here in NYC? Talk to me! This MUST be a big topic...
I can't comment on your complaints concerning Freelancer. Your PCP was at fault for sending you to an endoscopy facility that used a non-network anesthesiologist. Don't pay his/her bill. An anesthetist or anesthesiologist is only necessary when they use propofol to sedate you. Versed is the sedation drug of choice in colonoscopies and the gastroenterologist or a nurse can administer it themselves. This clinic was padding the bill as so many do.
Of course, it's easy to say "Don't pay the bill', but you know where that leads- a collection agency and a bad credit rating. That's not worth it.
My recourse is to file a claim with the insurance company, and ultimately take it to a NYS arbiter after the company rejects it. Which I will do. Without high hopes.
But I'll be damned if I'll stay with Freelancers Medical.
That said, the OP's gastroenterologist should have told him/her that the anesthesiologist doesn't accept his/her particular insurance. They should take it up with the gastroenterologist, but to not pay the anesthesiologist would not be fair.
It's a good point, and I will, but after all, he'll make some excuse and I have zero leverage with him.
Slightly off-topic, but here's what happened: The bill from the anesthesiologist was for the full amount, $2,060, or something like that. The insurance company's explanation indicated that they would have offered slightly under $500 for the service. Had the doctor been in-network, I would have paid the insurance company's estimate of the service's worth (due to my deductible) and saved myself $1500.
I don't doubt that the doctor's price is too high and the insurer's price too low; isn't this part of the game?
However in the current state of healthcare I think the consumer gets repeatedly shafted as the companies try to figure out a million ways to shift the cost to them through complicated co-pays, deductibles, etc.
But I'd still like to know about what other freelancers are doing for their insurance. Surely there are thousands of you here in NYC? Talk to me! This MUST be a big topic...
Yes, $500 is low. Especially for NYC. I get $750-$1000 depending on the company in NJ, and I would imagine it would be a little higher in the city. $2k is excessive though. Maybe call the anesthesia group and try to work out a reduced rate. Anyway, sorry for the thread jack.
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