Monday, October 9, 2017

Saturday night

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mr. Plan: "Hi, sorry to call you after hours, but I need to see a neurologist and was wondering if you take Sick & Tired HMO."

Dr. Grumpy: "No, I'm sorry, I don't have a contract with them. You might try Dr. Brain, I believe he does."

Mr. Plan: "But I really wanted to see you. Can't you make an exception and take Sick & Tired just for my case?"

Dr. Grumpy: "I can't do that, and they don't allow it. I mean, you could pay cash to see me, but even then they won't pay for any tests or medications I might order. So you're best off just seeing someone in the plan."

Mr. Plan: "You can't send them a letter saying you're making an exception in my case, and that you promise not to see anyone else on their plan again?"

Dr. Grumpy: "It doesn't work that way. Let me give you Dr. Brain's number."

Mr. Plan "Thanks for nothing."

Click.

9 comments:

Moose said...

"and this is all the fault of Obamacare!"

It's really amazing how people don't understand any of their own insurance. I was reading something the other day where someone thought that car insurance automatically means that if someone hits you and totals your car, the insurance pays you the amount you paid for it.

Packer said...

Dr. Nerve is on the plan.

Why do neurologist have strange names, Nerve, Grumpy, Brain ?

Grumpy you would be doing a service to your readers to give a down and dirty on how plans work. Our plan allows us to see whatever provider I want. My neurologist , Dr. Voluptousness
was an easy choice.

Stacey Gordon said...

Because now everyone is special and the rules never apply to them.

Anonymous said...

Dr. Grumpy, you are a really nice man. Getting a call like this after hours deserves a lot more harshness than you gave.

John Woolman said...

I have to say that I get more insight into how the US health care system works from reading your blog than I get from reading all those worthy articles in NEJM. Thank you! - From the UK

Kassy said...

You reference something that is new, and very disturbing, to me.
Insurance won't pay for a valid legal prescription because the doctor who wrote it isn't on their insurance panel.
That is just wrong. It's a prescription. Who cares who wrote it as long as they have prescribing authority?

Anonymous said...

As a pharmacist, I mostly see that with medicaid patients. You need to be registered with the state's medicaid system in order to have prescriptions filled under your name through medicaid.

Anonymous said...

Someday, some day, this will all change. Mark my words. On this day in October of 2017, somewhere, somehow.

Edelnickel said...

Wow, I'm shocked that you don't have a free choice of doctors. If my insurance told me they'd not pay for my doctor I'd tell em to get the hell lost. Your system is so unbelievably bad. I feel sorry for all patients. Land of the free, my arse.

 
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