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This is something a doctor I know wrote to me. He works with Anthem insurance now too. My wife is to go in to her doctor for a yearly physical, pelvic exam, and a pap smear. We wanted to do it all in one visit and save copay money and time off from work. The insurance company says that the doctor can run them all in one day, but the doctor REFUSES to do so. The doctor forced my wife to sign up for two visits. Here is what the doc we know wrote:
you are seeing the schizophrenic relationship between insurer and physician which leaves the patient in the middle-believe me when I say that I live in both worlds and I do not agree with either-the insurer is saying to you it can be done in a single visit but telling the doctor they cannot "unbundle" their charges for a part of what the insurer feels is part of a physicial exam-the primary doctor feels that if they do the general physical without a pelvic exam and the woman then sees her GYN, the insurer will pay for both services for two different visits while the primary doctor says' "why can't I get that fee" and therefore resorts to the two visit exam-(certainly no help to the patient with an extra co-pay and more time off from work or other activities for two visits)-the insurer is saying the doctor can't unbundle by charging for a pelvic exam as part of a general physical-the payer wants to bundle and the physician wants to unbundle-when I served on a physician grievence committee for the academy of medicine this was a common problem referred to as continuation of services-an example being the ENT doctor doing a bronchoscopy to examine the inside of the lungs and while doing that did something else in the trachea-he would bill for both but the insurer would say, "no, the tube was in the airway to look at the lungs and was already there so we won't pay for the second procedure"-it was so bad that general surgeons doing bilateral breast surgery would do one breast and wait a few weeks to do the other so they got paid full amount-doing both together got 100% of their negotiated fee for the first side and 50% for the second-I've known neurologists who would see a patient in the hospital on day 1 and hold off on tests he would interprete until the next day because doing it all on one day was viewed as a continuation of services and each service would be paid at a progressively decreasing percentage-never thought I would favor a single payer system but then I realize who would eventually run it and they haven't done well running Medicare or Social Security-we bemoan the poor access to healthcare for the uninusred but the system makes it difficult for everyone to have fair access to healthcare-hope I don't fall off my soap box-
The health care system here is becoming a joke. My doctor and hospital charged my insurance $16,000 for the surgery on my 3 hernias. Insurance payed them $6000. Now if I had been uninsured, I would have been expected to pay the full $16,000. Like taking out a small car loan!
you are seeing the schizophrenic relationship between insurer and physician which leaves the patient in the middle-believe me when I say that I live in both worlds and I do not agree with either-the insurer is saying to you it can be done in a single visit but telling the doctor they cannot "unbundle" their charges for a part of what the insurer feels is part of a physicial exam-the primary doctor feels that if they do the general physical without a pelvic exam and the woman then sees her GYN, the insurer will pay for both services for two different visits while the primary doctor says' "why can't I get that fee" and therefore resorts to the two visit exam-(certainly no help to the patient with an extra co-pay and more time off from work or other activities for two visits)-the insurer is saying the doctor can't unbundle by charging for a pelvic exam as part of a general physical-the payer wants to bundle and the physician wants to unbundle-when I served on a physician grievence committee for the academy of medicine this was a common problem referred to as continuation of services-an example being the ENT doctor doing a bronchoscopy to examine the inside of the lungs and while doing that did something else in the trachea-he would bill for both but the insurer would say, "no, the tube was in the airway to look at the lungs and was already there so we won't pay for the second procedure"-it was so bad that general surgeons doing bilateral breast surgery would do one breast and wait a few weeks to do the other so they got paid full amount-doing both together got 100% of their negotiated fee for the first side and 50% for the second-I've known neurologists who would see a patient in the hospital on day 1 and hold off on tests he would interprete until the next day because doing it all on one day was viewed as a continuation of services and each service would be paid at a progressively decreasing percentage-never thought I would favor a single payer system but then I realize who would eventually run it and they haven't done well running Medicare or Social Security-we bemoan the poor access to healthcare for the uninusred but the system makes it difficult for everyone to have fair access to healthcare-hope I don't fall off my soap box-
The health care system here is becoming a joke. My doctor and hospital charged my insurance $16,000 for the surgery on my 3 hernias. Insurance payed them $6000. Now if I had been uninsured, I would have been expected to pay the full $16,000. Like taking out a small car loan!
