Health Care Providers and Fear of Not Getting Paid...A Rant

[LibDemAlways]

Yesterday I took my 90-year-old mother to her primary care physician because of a small cyst on her hand. The doctor was hesitant to do anything about it and referred her to a hand specialist. OK, fine. The next half hour her doctor spent trying to locate a specialist who would take Medicare. When that task was finally accomplished, I called immediately to set up the appointment.

All, and I repeat all, the new office cared about was how they are going to get paid. They didn't ask a single question about the problem itself. They insisted that I produce health insurance info on the spot over the phone. I told them I'd get back to them this morning since the appointment isn't until tomorrow. So, I'm sitting here at home focusing on some work I need to get done when the phone rings. It's the doctor's office desperate for the insurance information and getting nasty about it. My mother has Medicare plus excellent supplemental insurance. I told the receptionist this when I set up the appointment yesterday. I had every intention of calling them a little later on with the specifics.

I know this is a small thing and ultimately my mother will get the care she needs, but I'm more than a little pissed off about the brazen money-hungry attitude of the office. I'm grateful they accept Medicare and whatever procedure is necessary will be covered, but God almighty, a little human compassion by a physician's office with regard to an elderly woman's health issue would be much appreciated. Rant over.

[still_one]

1. That is why some practices do not accept Medicare, or it is vital to have supplemental. That has

Been happening for some time, however, you won't find any large reputable facility that I know of who won't accept it

Like mayo clinic, John Hopkins, major hospitals, and medical facilities

[Worried senior]

2. several years ago

my husband needed a heart cath. At the time he had a BC Medicare Advantage plan which was very good, since then it has been discontinued of course, but when the hospital called to verify his appointment they were concerned too about payment. At the time of check in he offered her the check to cover his co-pay, she didn't want it.

Just as he was ready to go in for the cath a clerk came running in the room to collect payment, mind you this was $25.00. Really made me mad, what if things had gone differently and the payment would have been the last thing on our minds.

It was a lot less cost effective for her to have to chase us down than it would have been to collect it in the first place.

[LibDemAlways]

7. Jeez, making an issue of $25.00 as the patient is being prepared for

a heart cath? That's low. "How are you going to pay?" has replaced "What's wrong? How can I help you?" as the biggest concern of the medical establishment.

[Donald Ian Rankin]

3. Would you pay for the medical care of every stranger who asked?

The state has a responsibility to provided health care to everyone; private individuals - including those who make a living by providing health care for money - do not.

The problem in America is that not everyone who needs it can get healthcare paid for by the state, not that private individuals refuse to provide healthcare without being paid.

[LibDemAlways]

4. The issue is not whether the doctor should get paid. Of course he should. And I

agree that everyone should be covered, and hopefully, the Affordable Care Act will make inroads in that direction - though I'd much prefer to see government funded healthcare for all.

The issue here is the intense focus on the monetary transaction and the lack of consideration for the problem driving the consumer to the doctor in the first place. No concern for whether or not my mother was in pain (she was) or how long the problem had been festering. No, only provide your insurance info or you don't get in the door. It's the attitude that bugs.

[TheKentuckian]

5. Sure, but I think the poster was just desiring some soft skills and some emphasis on the care too.

People need for their loved ones to be something more than an accounting entry. At least lip service to that effect because as is, it is hard to feel like there is any actual concern other than getting paid.

At least pretending and a "how are you doing?" before the collections effort is a reasonable customer service expectation.

[LibDemAlways]

6. Thanks for "getting" it. One thing I've

learned here on DU is that no matter what you post, someone will diss you for it. Just needed to let off a little steam over my mom being treated like her wallet is all that matters.

[FSogol]

8. +1. True about DU.

PS. Good luck with your Mom.

[TheKentuckian]

14. Right on though I don't see what there is to get, it seems really basic and natural to me.

[Texasgal]

9. As a health care worker

please let me try to explain pre-insurance to you.

I work for a surgical opthalmic practice. We do alot of cataract IOLS and corneal surgery.

We try to get pre-insurance done before the patient shows up at 6:00 AM. Without pre-insurance the patient will show up without insurance authorization and have to be rescheduled It;s not good.

Please don't think that pre-auth is bad thing...sometimes it's really for the patient. Insurance auths are hard for all of us... including the patient.

[LibDemAlways]

11. I never said I wouldn't get them the info. I had every intention of getting

them what they needed. The rant was focused on their lack of concern about anything other than my mom's wallet.

[Honeycombe8]

10. All dr offices I make appts with require insurance info on the phone.

I have regular insurance (thank goodness). They all require the group #, my id #, the phone # of the company, etc. I guess they've had too many instances of patients showing up without their card. I actually did that one time...I left my card in my other purse. They were so rude to me. They were still going to see me, but I left, telling them that I thought I'd rather see a doctor whose staff was a little nicer to the patients. They stared at me w/their mouths open as I left.

[LibDemAlways]

12. Asking for insurance info over the phone is new to me. I've always

anticipated that it would be expected when I showed up for the appointment. I've been to plenty of Dr's appointments with my mom and this is the first time the staff got nasty with me about the payment issue before she even set foot in the office. Concern for the well being of the patient is definitely, in that office, secondary to the patient's ability to pay. Sounds like your encounter was similar.

[Honeycombe8]

17. Well, ALL drs. I've made appts w/in recent yrs asks for the info on the phone.

The instance where they were rude was when I did indeed show up without the card. I had given the info over the phone, but they all make copies of it these days, which is why you have to present it at the office. I guess that's why they were going to see me, because they had the info. They just didn't have the card.

I guess I expect less from drs than you. It's a business. Getting paid is a big deal for them, getting the info to get paid. Getting paid is a big deal for me, too, so I understand that. They have forms to fill out and so many patients to see that I try to do whatever they want. I don't know how they'd react if I didn't give them the info over the phone because I always had it handy. Maybe they would be rude, or maybe they'd be okay with it. I don't know.

[slipslidingaway]

13. Too many doctors and dentists offices are now primarily are focused on payment ...

with patient care following behind.
It is as if the provider, in many instances, no longer has the final say because the office is being run by non-providers whose sole focus is profit.
Gone are the days when payment was secondary and care was the main focus.
I mention dentist because that was my recent experience with a large firm when they demanded payment in advance for all of the bridge work before it was performed. The dentist sat there while the office manager talked of corporate policy.
It used to be the providers had final say, but there were obviously other financial people behind him pulling the strings.
Care and working with people has definitely taken a back seat!!!

[LibDemAlways]

15. I was sitting in my dentist's waiting room a few years back when

the receptionist took a call. All I heard was her side of the conversation, but I found it very disturbing.

A patient was looking for an emergency appointment. He was in pain. Her only response, repeated robotically, was:
"I'm sorry you are in pain, sir. But you still owe us $300.00 and Dr. X will not see you until the bill is paid." She must have said it 5 or six times while the guy pleaded. He must have offered to pay a portion of the outstanding balance because a couple of times she added, "No, sir. We must have the full $300.00"

I thought that was incredibly cold and callous then and I still think so. After that visit, I changed dentists.

[slipslidingaway]

16. Good for you for leaving to find a more compassionate provider...

as you stated, and from my recent experience, things have changed and not for the better IMHO.

Wishing your Mom gets the care she deserves

[Honeycombe8]

18. I understand their position. We don't know the whole story, either.

You don't work for free, do you? I know I don't.

I work in for a firm in the service business. We perform (1) a service, in return for (2) money. That's a two-part deal.

Your dentist obviously didn't require payment in advance, so that's good. And for all you know, that patient had owed that bill for months. For all you know, he was calling the dentist on iPhone that he bought with the money he should've paid the dentist with. We just don't know.

But no, I don't expect care providers to work for free. They have bills to pay themselves.

[slipslidingaway]

19. Just jumping in here and I agree we do not know the entire story ...

on the other hand for all we know this person could have already paid down a portion of the bill and had made payments in the past, just had not finished the making the payments.

As believable as assuming "he was calling the dentist on an iPhone that he bought with the money he should've paid the dentist with. We just don't know."

We're still paying bills to doctors in NY, NJ and Florida for follow up treatment after my husband's bone marrow transplant, not one of them has refused to see him. We're selling out home to hopefully put us in a better position to handle all these out of pockets expenses, extremely thankful for having a good insurance policy, but still the costs are very high.

So yes you never know the circumstances and the group of dentists that I went to see were controlled by financial people trying to squeeze every last dime from people, even in advance where possible.

My daughter, who is in her second year of her residency, agrees with my observation that the focus has shifted towards profit and away from care, we're very familiar with her med school debt.

There really needs to be a balance and unfortunately with financial control of providers the balance is being tipped away from care and towards profits.

[Honeycombe8]

21. Again, I'll ask: Do you work for free?

That's what people are upset about. That OTHER people won't work for free, for customers who didn't pay in full the first time around. Well, duh!

It's a business. The dr has rent to pay, salaries, ins. premiums, malpractice insurance, business equipment, and other business expenses. After he pays that, he has his own bills to pay: his mortgage, utilities, kids, his own dental and medical bills, car note, insurance for house and car, etc. I don't expect anyone to work for free, unless there's a very unusual situation...like someone injured in the street when he's walking by.

I don't work for free. I have bills to pay. I'm dedicated, but it's a two way deal: I work for you and do a good job, and in return, you pay me.

That patient owed $300 and offered to "pay on" the prior bill. Which means he wasn't paying on it before. He just had an outstanding, unpaid total bill. That's not like someone making regular payments, paying down a bill. I would think most care providers would cont. to see a patient if they timely paid "on" a bill every month.

[LibDemAlways]

25. You work. You expect to get paid. I get it.

I'm know there are deadbeats around who don't pay their bills. You don't pay the electric bill, the lights eventually go out. There's a cost for not paying bills.

However, a doctor or dentist or other health care provider is in a position to alleviate another person's pain and suffering, and I think, when that pain or suffering is acute, he or she should not let $300.00 become an insurmountable roadblock, especially since the man offered to pay what he could at the time. I'm sure it wasn't pleasant for him to have to beg for an appointment and basically be told, "Sorry, you have to suffer."

As I said elsewhere on this thread, I sometimes put in time at work without getting paid for it. And, that's not really the issue here. The man never told the receptionist he wasn't going to pay down the bill. What that office did to him was just cruel.

[Honeycombe8]

37. I agree with the business's position, I guess.

He was NOT paying down his bill, or they wouldn't have been having a discussion of him "paying something" on his prior bill.

He just had an outstanding bill that he had not paid.

That dentist is not in the charity business. There are dental schools and such he could've gone to for dental work, if he couldn't afford a regular dentist.

Why pick on THAT dentist just because the patient had been there before? You could say the same about ANY dentist. Why didn't he start calling around to see any dentist, and everyone could get angry at ALL the dentists for not seeing him for free. He called THAT dentist because he wanted treatment for free.

Just because you're in the health care business does not mean you work for free. If he's poor, he would be able to get Medicaid to pay (if he can find one that takes Medicaid). So presumably he's not poor. The OP doesn't say that.

So if he has sinus trouble and he's suffering, does he expect his GP to see him for free?

You don't get health care for free because you're suffering, unless it's bad enuf to go to ER, where they have to treat you for free if you're bad off.

We all wish we had universal care, but we don't. So I don't expect one doctor to treat me for free just because I happened to have gone to him before (and stuck him with an unpaid bill for prior services). That may have been his assistant's Christmas bonus that went out the window, when he didn't pay that bill.

[slipslidingaway]

35. Nobody is expecting anyone to work for free ...

and as stated we do not know the full story.

But unlike your first reply, my first thought was not to think the guy had bought an iPhone with money he should have paid the dentist.

[Honeycombe8]

38. The OP doesn't say he's poor. And yes, he expected the dentist to work for free.

That's what it means when you don't pay the bill. He wasn't paying anything on the bill, or they wouldn't have been discussing the possibility of him paying something on his outstanding bill.

Why you would think that THAT particular dentist has any obligation to provide free treatment, instead of any other dentist, is beyond me. The man could've started calling all the dentists in town until he found one to see him. If he couldn't find one, then you'd be angry at ALL the dentists? That's a system you're angry with, not a person.

[slipslidingaway]

40. Where you there? Again we do not know the full story...

I'm just not going to assume the guy bought a phone instead of paying the balance.

[Gormy Cuss]

42. I've worked for free.

Last edited Sat May 4, 2013, 04:37 PM - Edit history (1)

Sometimes it's the right thing to do. When other clients were paying me enough to pay the bills and I was working with a nonprofit with woefully inadequate funding, I'd toss in some effort without billing. I've also worked for free when it was a good client who was likely to provide more work in the future.

[LibDemAlways]

22. No one should have to sell a house in order to stay afloat with

medical bills. I am very sorry to read this.

Yes, profit is everything. When I finally got my mom in to see the doctor yesterday I witnessed the receptionist trying to tie up $5000 on a patient's credit card "until we get your insurance payment." He stood his ground and paid his usual $50.00 deductible. It's a giant racket.

[slipslidingaway]

36. Thanks, we are among the lucky ones ...

we'll find less expensive housing and hopefully be able to stay on top of the annual out of pocket expenses that we'll have each year.

There is a real shift coming IMHO, many of the providers do not want to deal with insurance companies (which is understandable) and they are giving this task to others who are solely focused on getting every penny as soon as possible. It used to be the providers would use their own discretion and had the final say with bills, but that is changing.

Glad this patient stood his ground, unfortunately more people will see this in the future and it is good to be aware of this practice and the coming shift. It is no longer allowed to have blood drawn at certain national labs without giving them a back up credit card, even though you have insurance. The job offers my daughter is now receiving, a second year resident, all mention the fact that billing/insurance will be handled by others.

"...When I finally got my mom in to see the doctor yesterday I witnessed the receptionist trying to tie up $5000 on a patient's credit card "until we get your insurance payment..."

Thanks for highlighting this issue, it will be interesting!

[LibDemAlways]

20. You know what? I do frequently work for free. I'm

a substitute teacher and am required to fill in for a specific classroom teacher on a specific assignment. Frequently, however, on what would normally be that teacher's "break," I am assigned to a different classroom as a "volunteer" aide. I don't get a choice. I'm off the clock and I do it for free or I don't get called.

The man in question was offering to pay a portion of the bill he still owed. They turned him down. I think that's cruel. I hope in your business you treat the customer better.

[Honeycombe8]

39. Do you pull out your checkbook and offer up $2,000 to ease your employer's suffering?

That's what you are asking that one dentist to do...you don't know what it would've taken to "ease" his suffering.

And why? Because that man had happened to have gone to that dentist before? Why not get angry at another dentist? At all dentists? At all doctors?

What you choose to do is your own business. The dentist doesn't work alone...and he has business expenses to pay for. When you choose to "work for free," you're not involving several assistants and don't have overhead expenses like a professional practitioner does.

This guy had an outstanding bill that he had not been paying on. Period. I've been dirt poor before but always managed to pay SOMETHING on any bills I owed, even if it was only $5. It's a RARE circumstance that a person can't pay something on the money he owes for another person's labor. And if he had that rare circumstance, he would've written a letter or called and told them about it, so they wouldn't have been having that discussion on paying SOMETHING on his outstanding bill.

I get what that man was about. I think you don't. Just because someone doesn't pay his bill does not automatically mean he's an upstanding, hard working, citizen who does his best to pay others for the labor they perform on his behalf. It doesn't automatically mean he's having financial difficulties that are extraordinary, or that he lost his job. It could be. But it doesn't automatically mean that.

I'll tell you why he called that dentist instead of another one. Because he didn't plan on paying the new bill, either, and he knew this dentist didn't require payment at the time of service. Mine does. I expect that dentist will change his policies, so he doesn't get stuck with unpaid bills in the future.

[bike man]

23. Every single time my primary care provider has had to refer me to someone else, the

office staff knew who accepts Medicare along with my supplemental insurance.

You typed "The next half hour her doctor spent trying to locate a specialist who would take Medicare. When that task was finally accomplished, I called immediately to set up the appointment."

It has never taken more than one phone call, and I watched while it was being done, with my appointment being made for me during that one phone call.

Perhaps the office staff at my doctor's office is more efficient.

[LibDemAlways]

24. Fewer and fewer doctors in this area are accepting Medicare patients. As it is,

my mother's primary care doctor's office is bare bones in terms of staff. One woman schedules the appointments and processes the paperwork for incoming patients. It was late in the afternoon, and my mom was the last patient. The receptionist was going through a long list of appointment reminder calls, and the doctor herself was kind enough to locate a specialist who does still accept Medicare. Several offices told her they have recently stopped accepting Medicare patients. Once she gave me a name, I called the office on my cell phone immediately. None of that was a problem for me. What grated was the attitude of the specialist's office. They were not at all interested in what my mom's issue was, only that she had plenty of insurance. "Profit before patient" ought to be inscribed on their door.

[bike man]

30. In their defense, it is not unreasonable for them to expect payment. They do have expenses. nt

[LibDemAlways]

31. Bike Man, of course they were going to get paid. I told them

my mom was well insured and that I would get back to them the next day with the info. That wasn't good enough. They called early in the AM to literally hound me.

I was in their waiting room the next day when I witnessed a man being told he had to hand over his credit card and tie up $5000 until his insurance payment came through. He remained calmer than I would have.

It's all about the money. The patient is nothing more than an insurance cash cow.

[sylvi]

26. Well, to be honest

the office worker scheduling the appointments usually isn't qualified to take much of a medical history over the phone, and if you were referred by another physician, they have likely already faxed the pertinent data and records to the consulting specialist.

Still, there's no excuse for them being "nasty" though, and an "Oh, I'm sorry to hear that" goes a long way. Perhaps you should mention that to the doctor.

[LibDemAlways]

28. Sylvi, the appointment scheduler never even asked

what the problem was. The office didn't care enough to even make a note on a chart.

My mom is well insured. God help the millions who aren't. Their life must be a living hell when trying to get a medical issue resolved.

[davidn3600]

27. That's nothing compared to what I've seen

My brother went to a dentist not too long ago. And the person taking the payment didnt like the idea he was using a credit card to pay for the co-pay. They wanted a check or cash...why? Because they said, "these banks charge us a fee every time we swipe a card."

A lot of these places have really become penny-pinchers. If they are that cheap with credit card fees, imagine where else they are trying to save money!

[LibDemAlways]

29. If a business agrees to accept a credit card as

payment for a service, said business has no right to bitch at the consumer about fees. That's tacky.

I'm going to get in trouble with some DUers here for saying this, but the doctors and dentists in my area live very well. My mom's eye Dr. lives in a 6500 sq. ft. mansion. My daughter's orthodontist has movie stars for neighbors in his gate-guarded community. The hand doctor she went to see the other day occupies a lavish office befitting a Fortune 500 CEO. I'm not saying they don't deserve to enjoy the fruits of their many years of school and all of their hard work. They do.

However, the emphasis on payment and squeezing the last dime out of every patient to the exclusion of all else is just unseemly and exudes nothing but greed.

[cbdo2007]

32. God forbid they actually check your insurance BEFORE you go in!!!

Usually the post we get is, "Just found out insurance isn't paying for doctor visit. Why should I be responsible when I was referred by my PCP?? Shouldn't the doctor's office know my benefits and whether or not I'm covered? blah blah blah". (I've seen this a million times.)

Now, the doctor's office is actually calling to verify benefits and PEOPLE HERE STILL COMPLAIN!!!!!!!! THEY ARE DOING THIS FOR YOUR BENEFIT SO YOU DON'T HAVE TO PAY OUT OF POCKET IF THE SERVICE IS NOT COVERED OR SOMETHING ELSE GOES WRONG. THIS IS HOW THE SYSTEM IS SUPPOSED TO WORK.

Good grief, this is so sad.

[LibDemAlways]

33. Where did I write I wasn't going to provide the insurance info?

I had every intention of providing it. I was actually going to take photocopies of my mom's cards and fax them over. I told them this when I made the appointment. But that wasn't good enough. They called me back early in the AM to hound me about it. And they were very rude on the phone.

A little civility in a customer service situation goes a long way.And you don't need to do the CAPS thing to make your point. I get it.

[cbdo2007]

34. APPARENTLY NOT

Your complaint is still that they are verifying your insurance BEFORE you come in, rather than wasting both of your time of you coming in there and waiting 30 minutes extra for them to get confirmation from the Insurance company, only to find out the service may not be covered, then they bill you 2 weeks later and you write in about how they should have checked BEFORE you came in for the service.

Again, they are doing this for YOUR BENEFIT so you don't get a bill afterwards that you weren't expecting. They get their money either way, either from insurance or from your Mom. They don't care who is paying.

That's fine if you have a problem with their customer service but don't frame this as a health care issue in that case because they are being helpful to you in that regard, even if they are being rude with how they are going about it. There are rude people in all businesses.

[bemildred]

41. It's a failing system, of course it sucks. nt