Mary: "Dr. Grumpy's office, this is Mary."
Mrs. Call: "Hello, I was referred by Dr. Unka to see Dr. Grumpy."
Mary: "Sure. What insurance do you have?"
Mrs. Call: "Sikazchit PPO."
Mary: "Oh... I'm sorry. We don't take that insurance. Let me give you the names of some other neurologists you can try..."
Mrs. Call: "Dr. Unka wanted me to see Dr. Grumpy."
Mary: "He probably doesn't know we're not contracted with Sikazchit PPO. There's Dr. Brain, who..."
Mrs. Call: "I. Don't. Think. You. Understand. This is Dr. Unka who referred me. He wants me to see Dr. Grumpy. So make me an appointment."
Mary: "But we don't take your insurance. Do you mean you want to do this as cash pay?"
Mrs. Call: "Don't be ridiculous. Since Dr. Unka referred me you should be seeing me as a courtesy to him."
And as a courtesy to Dr. Grumpy you should be paying him!
ReplyDeleteOh, is THIS how it works? As a rare disease patient who gets at least 4 or 5 annual referrals to specialists (typically from other specialists), I seem to be getting bamboozled by my doctors, because they always charge my insurance or make me pay out of pocket. I had no idea they were supposed to be seeing me gratis as a favor to the referring physician....
ReplyDeleteSee, this is why people are losing respect for the medical profession. ;)
Yet another raise for Mary!! So how did it turn out???
ReplyDeleteHonestly, if this is Mrs. Call’s first time experiencing illness with referral to an out of network specialist, I feel for her. She’s in for a rude awakening. The system kind of sucks.
ReplyDeleteAmen, bobbie. So, why don't you take "Sikazchit?"
ReplyDeleteUs perfect specimens do not understand why we have to actually comprehend the current healthcare system, nor contribute to it in any way. We will never get sick, never experience a catastrophic illness, nor be involved in accidents, or situations that we can plan for well in advance by eating our perfectly balanced meals, exercising daily, avoiding risks and communicable diseases, and select our perfect ancestors. We are the Cyborg! We are not subject to the pitiable earthling weaknesses nor their man-made conundrum that healthcare costs are for the 'others'.
ReplyDeleteAs a Canadian this question both fantasizes and horrifies me.
ReplyDeleteDoes Mary keep a bottle of Cutty Sark in the desk?
ReplyDeleteMrs. call I Agee with you wholeheartedly. And Thank you for all of your recent hard work as Democratic Congress woman and for your 38 terms served. I am beginning to see the logic in our form of government
ReplyDeleteThank you Dr G for once again providing insight into the US healthcare system for us Brits....
ReplyDeleteTo those who seem to prefer the Canadian and British health care system, let me clue you in. When Mrs. patient gets to the correct doctor who has her insurance company, He/she will see her within a week, not six months from now as the way it is in your system.
ReplyDeleteI thought the British NHS was good until I started getting old and I needed it.... And yes, the last time I tried to get an appointment with a family doctor, not a specialist, I had to wait 3 weeks. But please don’t let us get involved in a spitting match about the advantages and disadvantages of the different health care systems. They are all imperfect, underfunded and buffeted by politician’s whims and foibles. Dr G provides a nice insight in specialist practice in the US from his perspective which i find illuminates my own experience as a physician in a very different system. As to which is the better system, I’d say you could ask the epidemiologists about overall population health. I don’t think they will have an answer that will satisfy anyone
ReplyDelete"In fact, YOU should be paying ME."
ReplyDeleteDepending on where someone lives in the U.S. they may have months long wait to see a specialist anyway, IF there is one qualified enough in the area. There are what I'd consider dead zones for healthcare in the U.S., where no high/mid qualified providers want to go. So to use the wait times as a con to argue against nationalized health system is failing to see the greater picture of access issues we have in the U.S.
ReplyDeleteDear Mrs. Call, why not call your insurance company and have them explain it to you.
ReplyDeleteThe first thing I always check during open season is If Dr Grumpy takes Sikazchit insurance.
ReplyDeleteI am a subspecialty-trained neurologist in a large academic practice in the US. There are five other docs with my subspecialty, and two physician's assistants. My new patient wait time is 10 weeks; some of my colleagues who have been here longer and have fewer New slots are booking out 5-6 months.
ReplyDeleteTo Anonymous at 2:42pm, I've never heard of someone getting an appointment with a specialist "within a week" here in the US. Even when I established care with a primary care doctor after moving to a new city, it was about 4 weeks' wait -- this was in a large East Coast city, not an under-served rural area, and my insurance was a 'go-anywhere' plan. The US system has bad access AND high costs, it's the worst of both worlds!