Found out I was denied care by clinic

[lusciousleaves]

I've been a patient of this clinic for 8 years or more and never had a problem until all of this started. Sometime about a year ago, they said we were limited to 2 problems per visit. Then a few months later, I was told we were limited to 1 problem per visit. When I asked about this new clinic policy I was told, "It's not just us, it's everyone who's doing it. This is because of the new healthcare law."

I've had to put off care for several issues for months because of being limited to only talking about one issue per visit, both times requiring a specialist referral because their testing picked up problems.

So today, I finally get a chance to go for another issue I've put off for quite awhile, but this one issue is actually three, you know, like I have pain and swelling in a joint and a possible skin issue in the same area. Is it part of everything else I have going on, part of the same problem, or three separate problems? That sort of thing. So I'm limited to talking about one thing only. Do you see the dilemma? And now, my doc is on a leave, so I'm seeing someone who knows nothing about my health history and likely doesn't have time to look through my records because the place has become an assembly line and I'm, you know, not allowed to talk about anything but that one issue I'm there for.

This time, I asked the gal at the front desk, letting her know I needed to talk to the doc about more than one thing with this and it wasn't just pain (like whoever scheduled my appointment wrote down as the reason for the visit) and sort of complained about this "one problem per visit" policy. The reply was that was my insurance company setting the limits, not the clinic.

While in the waiting area, I called the insurance company to ask them why, seeing as how we pay more now for a better policy, why are we being limited to 1 issue per office visit. The insurance rep said we could see a doc for 10 issues per office visit if we wanted to. She contacted whoever needed this information at the clinic office while keeping me on hold and then came back on the line to tell me the clinic didn't have this policy except that when you call to make an appointment, you have to tell them what problems you're there to discuss with the doc so they can schedule the time for it.

See? I had the feeling they were trying to squeeze me out of being seen in their office, and now I'm sure of it. I've been labeled a "difficult" patient and have been systematically denied care by this place over the course of the last year while paying more for the benefits to receive it. Plus, they lied to me about their office policy.

[Jules A]

Sounds like it is time to find another physician.

How unfortunate they didn't just have the courtesy to tell you they aren't a good fit for your health care needs.

[lusciousleaves]

Sounds like it is time to find another physician.

How unfortunate they didn't just have the courtesy to tell you they aren't a good fit for your health care needs.

There doesn't seem to be any place that is.

[rdmc]

Here's an article I read on the CBS website awhile ago where a woman discovered she was charged for asking too many questions:

http://www.cbsnews.com/8301-204_162-...uestions-fair/

I did a little further snooping to try to understand it, and it's a coding issue, and especially when it comes to the insurance company and the no charge to the patient physical that is included in ACA.

So if you bring up anything outside the "normal" things that would be covered in a well visit (which is supposed to be covered 100% by the insurance company because of the ACA), the doctors will code an extra charge to cover the extra time they spent above and beyond what they would have spent for a well care visit.

My husband's went for his physical and his GP actually notified him of this ahead of time. Also, they are cutting back on the number of tests they order, because those tests can bring up false positives, so that's why they're advising the doctors not to automatically order them, i.e. mammograms aren't automatically prescribed every year...the National Cancer organizations and Mayo are saying every other year. With men and prostate blood tests (PSA) they're not recommending testing unless they show symptoms, whereas before it was an automatic screening every year once a man reached a certain year.

It's going to be a bumpy ride as the new health care laws come into effect, because there are loopholes (companies...seems like lots of fast food chains are cutting hours to just under 30 hours so they don't have to offer ins.), and interpretations that will have to be tested.

Our new group healthcare options (we're insured through husband's employer...very large group, mainstream insurance company) were just rolled out. Open Enrollment is in March.

Everything's going up...deductibles, doctor copays, drug copays, hospital copays, out of pocket expense limit...this really went up, limits on PT, ER copay which went up a lot too...and besides all that, the cost per month is going up, especially the family plan costs. We just pay the "couple" cost, which will run us about $300 a month, but with the same plan, the family coverage cost is going to be $450 per year. (And we don't buy the high end policy PPO, we take the other option which is an EPO...you have to stay in network, no payment for out of network.)

Lots of folks are grumbling, but you're going to have to be insured, and with MS (the pre-existing condition insurance offered through the state pool is very expensive, about double our group cost), it's our most affordable option and it is good insurance, just going to cost us more to buy and cost more out of pocket on top of that. For us, we'll manage fine, but for a family, it's going to be pricey.

[lstrl]

That sounds like an excuse to get more money out of the insurance company. Whatever their reasoning for doing it, that just means you really need to find another place to go. If not for patients, they wouldn't be in business, so they need to take what they can get and give the best treatment possible.

[rdmc]

Everything's going up...deductibles, doctor copays, drug copays, hospital copays, out of pocket expense limit...this really went up, limits on PT, ER copay which went up a lot too...and besides all that, the cost per month is going up, especially the family plan costs. We just pay the "couple" cost, which will run us about $300 a month, but with the same plan, the family coverage cost is going to be $450 per year. (And we don't buy the high end policy PPO, we take the other option which is an EPO...you have to stay in network, no payment for out of network.)

Oops, my bad, make that family plan $450 per month, not per year.

[CaroleL]

Lusciousleaves,

I'm so sorry you're having to go through this.

Thinking of you!

[Thinkimjob]

Good lord, I thought Obamacare was going to fix this. What a joke! One problem per visit? So presumably if you had an arm and a leg cut off they'd only deal with one at a time?

Here in Orsytralia, a 'long' visit (all bits examined,pap smear, bosom, blood pressure, scripts, maybe an hour long) costs $140 ($80 back on private health cover). Free ($5/$10 on social security).

[JerryD]

Look at these posts, closely. The common thread is that the patient doesn't know what, specifically, they are being charged for. 1 complaint/problem per visit? What about getting all of the treatments and examinations, etc., clearly written in common language (English) for the patient to review?
The problem is the medical community is the 'only' service that bills the customer in 'codes'. And the insurance companies are good with that. I don't have a problem with the doctors, the insurance companies and anyone else in the health care system using 'codes' amongst themselves. Don't use that trade code when you communicate with me. Seems like something is being hidden.
When you take your car into the repair shop, the billing is given to the customer in 'plain' English. Even though the repairs are 'coded' in the repair manuals. Just sayin'

[Andy75]

Last summer, I had a doctor say that she could not perform a minor procedure, because the healthcare bill limited how much she would be reimbursed. She would lose too much money and that other doctors stopped performing it to. The healthcare bill tied their hands. I even said that I had no problem paying the difference, but she said that would violate her agreement with my insurance company.

I found another doctor who had no problems.

Definitely try to find another doctor.

[onlyairfare]

As long as we expect "someone else" to pay the bill - namely the insurance company - the bill will be rendered however the insurer demands it. When someone else pays the bill, they are the customer, not the patient; in the US, that customer/payer is usually the employer (or government entity) who purchases the insurance, not the patient.

When you go to the car repair shop, you pay the bill yourself directly so you really are the customer. A lot of the personal relationship was lost when we went from the patient paying the doctor to the insurer paying the doctor.

I suspect some doctors are using the new healthcare law as an excuse for their resentment of the power of the insurance companies. Most of Obamacare does not go into effect until January 1 of next year, but Medicare and Medicaid have had a lot of burdensome regulations and complex billing requirements for many years.

OP, I'm sorry you are having such a hard time with all of this. As patients, we get caught in the middle while employers, insurers and government battle it out.

[lstrl]

Look at these posts, closely. The common thread is that the patient doesn't know what, specifically, they are being charged for. 1 complaint/problem per visit? What about getting all of the treatments and examinations, etc., clearly written in common language (English) for the patient to review?
The problem is the medical community is the 'only' service that bills the customer in 'codes'. And the insurance companies are good with that. I don't have a problem with the doctors, the insurance companies and anyone else in the health care system using 'codes' amongst themselves. Don't use that trade code when you communicate with me. Seems like something is being hidden.
When you take your car into the repair shop, the billing is given to the customer in 'plain' English. Even though the repairs are 'coded' in the repair manuals. Just sayin'

That is a very good point and I totally agree. While on that topic, watch your bills closely and question anything that doesn't sound right.

I once had a $200 physical therapy consultation bill come to me that was not covered by insurance. I knew it was a frivolous charge when I was supposed to pay $25 a session and it wasn't my first time in physical therapy, yet I'd never gotten a consult bill the year before when I had to go. I called and sure enough, it got dropped. I think that was the hospital trying to get every bit of money they could.

I've also gotten a bill months after a service and it never stated what it was for, only the date of service (and I paid that bill months ago). Again, I called and got it dropped. After having stuff like this happen to me multiple times, I don't trust medical places and their billing at all. I really do believe that they get so much knocked off by their negotiation with the insurance companies that they're trying to get every penny possible because they think we're too stupid to investigate.

[lusciousleaves]

Then I might be getting overly sensitive assuming it's just me they're doing this too?

I was thinking that with someone like me, who can't be cured and has multiple ongoing issues with each visit, is going to bring down their quality care scores resulting in lower reimbursements from insurance companies. They're all talking about reimbursing providers for quality of care now rather than quantity, and someone with complex problems could conceivably bring down their quality scores. I really am feeling like the patient hot potato, getting tossed from doc to doc.

[cosake]

Billing by codes is definitely difficult. It helps clarify some things and makes billing universal to multiple insurance companies, but not necessarily the best solution.

I know a lady who was billed thousands for a delivery room and doctor to deliver her baby when the baby was in fact born on the way to the hospital - no delivery room or doctor involved. The hospital of course fixed it, but the code they used billed for the entire "package".

[suziq38]

Try to find another place to go. They are just not working out.