tag:blogger.com,1999:blog-26666124.post1550030309869332715..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Guest Blogger Jesse: When Patients Don't PayUnknownnoreply@blogger.comBlogger120125tag:blogger.com,1999:blog-26666124.post-84107567884796159702016-01-16T17:45:25.211-05:002016-01-16T17:45:25.211-05:00A clinic in my town made 3 separate appointments f...A clinic in my town made 3 separate appointments for me. They would not see me because of a past due bill. Each week I went back as they kept rescheduling my appt. I was finally able to scrounge up some money to pay some of the bill off. I showed up for my fourth appointment, yet to be seen. The doctor said he cancel my appointment and made plans to be out of the office. I needed help. Two weeks later I ended up locked up in psych ward in our hospital from my anxiety being so bad and not sleeping for 5 days. If the psychiatrist would have seen me once out of the 4 times I took off work for my appointments I am certain I would not have went crazy and my children observing my breakdown. I want to do whatever I can to shut this clinic down legally. Btw... I did have insurance with no Co pay when I was seeking help. This is very unethical and cruel to people who have mental illness. Any suggestions would be appreciated.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-83300666913667199822011-10-29T03:06:30.002-04:002011-10-29T03:06:30.002-04:00As a Canadian, I just shake my head in amazement a...As a Canadian, I just shake my head in amazement at what Americans go through. What I also find very interesting is how so many people justify the way things are. Somehow they think just because something is the way it is, well it must be right then. For example, believing that to have a professional relationship there needs to be payment by the patient. That's hogwash. I know this for a fact because nobody pays the doctor directly here and our relationships with doctors are perfectly professional. As for appreciating it more if you pay, that's BS as well. In fact, it's easier to appreciate a doctor's service and see them as giving people when you're not negotiating a fee and handing them cash when you're sick and vulnerable. Americans are SO WEIRD sometimes. It really makes me scratch my head in amazement.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-13125029754042964222011-10-27T16:37:37.899-04:002011-10-27T16:37:37.899-04:00I was involuntarily committed to an eating disorde...I was involuntarily committed to an eating disorders unit on a psych floor of a major hospital for several months. Now I am expected to pay for it....over $20,000! What will happen if I refuse to pay? I do not believe I should be held responsible since I did not choose to be there and was locked up against my will. I was NOT suicidal.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-38145242801698463612011-07-10T22:22:58.411-04:002011-07-10T22:22:58.411-04:00Anon: Your "therapist" should (There'...Anon: Your "therapist" should (There's that S word again.) have informed you of the policy at the start.<br /><br />To the best of my knowledge the only way to treat Medicare subscribers without "accepting" the maximum allowable charge is to "opt out." If she opted out, Medicare requires that she have you agree in writing that you will never bill Medicare for her services.moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-12555384733261449862011-07-10T19:36:25.302-04:002011-07-10T19:36:25.302-04:00I started to see a new therapist recently informe...I started to see a new therapist recently informed me that patients are permitted one same day cancellation per calendar year. I asked her if there were exceptions in the the event of an emergency and she said that she is "afraid not." She is a very nice, caring ,competent person but I suffer from severe anxiety and have been worrying about this ever since she informed me of this ,which was last week, following my first cancellation. Compounding this is that I have Medicare. She does not accept Medicare, but she is a specialist in D.B.T. and I had a great deal of trouble finding someone who accepted Medicare who is really trained in D.B.T. so in desperation I agreed to pay her out of pocket. She charges $175 for a 45 minute session. I have paid her out of pocket for a number of sessions. Hopefully, Medicare will be reimbursing me about $106 of the $175. HOWEVER, should I be unable to make an appointment due to illness or emergency, I will be liable for the FULL $175 for the session that did not take place, other than the approximately $69 that would ordinarily be my share of the fee, as Medicare will not reimburse for a session that did not take place. <br />$175 would be too expensive for me for a session that DID take place ! I do understand that doctors do need to be paid and that if appointments are canceled on the same day a therapist may not be able to fill the time slot. I am curious as to the opinions of the therapists who are reading this. <br />I have only been seeing this therapist for about 2 months. I am not sure whether to continue seeing her or whether to look for someone else. I am not speaking of canceling for a frivolous reason ,obviously.As it happens, two days after she informed me of this, I was in a minor car accident on the way to a doctor's appointment. One of the things that went through my mind immediately was "Would my therapist bill me for a session if I am in a car accident on the way to session with her ??"<br />Perhaps, one way or another, therapists might benefit from knowing that for patients such as myself, the anxiety about worrying about such a billing policy can exacerbate their patients original symptoms. I am not sure if I was still in the car after the other car slammed into me, or later in the day, when I first thought of whether my therapist would have billed me. I DID have to cancel therapy the week before- because there was a car accident in front of me on the highway and state troopers came along and closed down the entire highway ! I can tell you that I will be one resentful patient if I am behind another car accident, which results in a road closure (yes, I saw another such scenario 24 hours later in the opposite direction- highway closed in opposite direction with many police, fire and emergency vehicles due to an accident )which interferes with my making it to a therapy session, or I have a medical emergency, or there is some other circumstance beyond my control,and I am billed. <br />I think in writing this , I have made my decision, but I hope therapists reading this who do bill for all cancellations that are not 24 hours in advance will take circumstances that are beyond a patient's control into consideration. (both road closures could be verified , I am sure, with local traffic reports, news,etc).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-87338670900666313942011-06-18T15:45:19.030-04:002011-06-18T15:45:19.030-04:00The Lounge Lizards offer their wisdom:
http://www...The Lounge Lizards offer their wisdom:<br /><br />http://www.youtube.com/watch?v=xNuCfD5bICQmoviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-834404223480412332011-06-18T15:34:33.061-04:002011-06-18T15:34:33.061-04:00Rob,
Sorry for my ignorance. Can you please revi...Rob, <br /><br />Sorry for my ignorance. Can you please review for me the bit about all women who needed a forceps delivery in 17th century England having equal access to a doctor who could perform one?Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-19139553652132118272011-06-18T14:29:03.693-04:002011-06-18T14:29:03.693-04:00Dinah - its nice to know you help patients with pa...Dinah - its nice to know you help patients with paperwork.<br />-<br />Living with BPD I've learned and faced a lot of places that consider me incurable/untreatable aka hopeless cause. <br /><br />I avoided the insurance noncoverage issue as I started this path with a depression diagnoses as a teenager. It was several more years and doctors before one of them clued me into the BPD. (I'm pretty sure the first one knew and didnt tell and one later tested and still didnt tell) <br /><br />I will also acknowledge I find using "depression" as a better descriptor/cover for my psych meds when dealing with my non-mental health provider specialists for my other chronic illness issues. <br /><br />The stigma of the diagnosis is frustrating. People expect BPDs to be a mess and I'm not. I've been there and it was horrible and I wont go back even when it means buying Linehan's book and reading myself because I cant find a dbt group that meets after work. Or paying full price for therapy when I do find finally find a good match with a provider. <br /><br />I wish more providers understood BPDs are redeemable. I'm not hurtful anymore. I play well with others, hold down a job and have lasting meaningful relationships. But I dont do it alone. <br /><br />Everyday I wake up and know my brain lies and I am not to trust it and with help I will hold the line against it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-80945189802797379302011-06-18T12:48:27.199-04:002011-06-18T12:48:27.199-04:00This revisionist history of the economics of medic...This revisionist history of the economics of medicine would be amusing if this stuff weren't so damn serious. I recommend everyone read Paul Starr's "The Social Transformation of American Medicine" Starr is a committed Socialist and no lover of the free market, but he tells the truth about how we got into the mess we're in. He places the blame squarely at the feet of the medical profession. Much as I disagree with Starr's prescription, his "history of present illness" is devastatingly on target.<br /><br />With due respect to my interlocutors, America did indeed enjoy a period of relative market freedom. Then came licensure, socialization, the growth of the hospital and worst of all, employer-based third-party insurance. The history is all there, folks. Go and study it.rob lindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-21127986557990661582011-06-18T12:40:06.786-04:002011-06-18T12:40:06.786-04:00Moviedoc,
I read Atlas Shrugged. It was horrible....Moviedoc,<br /><br />I read Atlas Shrugged. It was horrible.<br /><br />Nobody has said anything about forcing anyone to work. Under a single-payer system, we all have equal rights to access the existing health care. If we don't find it sufficient we can agree to pay more into the system.Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-7735565316616695282011-06-18T12:35:11.090-04:002011-06-18T12:35:11.090-04:00If the free market worked so well, we wouldn't...If the free market worked so well, we wouldn't have felt the need to implement safeguards for the neediest. <br /><br />Personally, I want to live in a society where my fellow-citizens have all had access to a good education. It makes life better for me. I want to live in a society where the poorest have access to welfare and aren't begging in the street. I want to live in a society where everyone has clean water, even in poor neighborhoods. Where all children's milk is pasteurized, not just the well-off children. Where we all have access to good health care, including mental health care. <br /><br />I live in Canada, so I pretty much have all these things. They improve my quality of life. I pay taxes for these things and do so happily, because I want them. I also make significant donations to Centraide/United Way and to FAVL (Friends of African Village Libraries) because the opportunity to make the most of life is something we all deserve. <br /><br />We've tried a lot of things over the years. Pure charity, which in all societies over the world has ended up with widows putting their children on the street to beg. Debtors prison and poorhouses, which deny the poor and ill the means to change their situation. Prohibition was an attempt to protect women and children from husbands and fathers who would otherwise drink away all their wages, but we ended up going with minimum wage laws and welfare instead so that families of alcoholics didn't have to starve. <br /><br />If the free market worked so well for medical care, there wouldn't be a market for health insurance and Canadians would not be so satisfied with our single-payer system. There would never have been a perceived need. <br /><br />So you can squawk all you want about how wonderful the free market would be if we'd only just try it, but we have tried it. We didn't like it.Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-76593667737841000812011-06-18T12:11:06.847-04:002011-06-18T12:11:06.847-04:00Anon: I do.
Anon a few anons ago with borderline ...Anon: I do.<br /><br />Anon a few anons ago with borderline personality disorder: if that's your only diagnosis, no matter how bad and how disruptive to your life your condition is, insurance doesn't pay for treatment of personality disorders.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-66646777408123403182011-06-18T11:19:33.023-04:002011-06-18T11:19:33.023-04:00Moviedoc - you're right, what we have doesnt w...Moviedoc - you're right, what we have doesnt work and everyone deserves to be paid for the work they do. I've read some interesting numbers that looked at the total amount paid by an average worker and his employer across a lifetime that show that amount would typically be enough to cover an average persons lifetime medical expenses. Problem is when we are young we cant borrow against future money we might earn when we are older (oh wait, thats what most people are doing with college and look what negative impact med school loans are having on even this conversation) <br /><br />Bottom line is I am trying the best I can to take care of myself with the resources I have and its frustrating to run into so many complications and feel so shut out by the same people claiming to want to help. <br /><br />We all want the world to be different. One thing therapy teaches me is to accept the world as it is and work with what I have.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-65045343246996238882011-06-18T11:07:12.919-04:002011-06-18T11:07:12.919-04:00What happened to "first, do no harm"
I...What happened to "first, do no harm" <br /><br />Is it like most things in this country? Available to only those who can afford to pay for it?<br /><br />Rob - please reread - I didnt demand free services. I asked for docs to consider helping by accepting the payment resources I had such as my insurance. As to your question about other services - I like the other Anons response.<br /><br />Dinah - if you know your patients arent filing the forms and its hurting them why do you not offer to help?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-55635484060066843122011-06-18T11:00:52.087-04:002011-06-18T11:00:52.087-04:00Medical care with insurance is not really free mar...Medical care with insurance is not really free market in that insurance acts as a subsidy and drives the price up. Also it has morphed from insurance to prepayment. Paying for treatment of BPD from the first dollar is like using auto insurance to pay for oil changes. If medical care ever becomes a "right," we'll need to provide for those 40k people who died because they couldn't see a doc way before we provide psychotherapy. The problem with making a right is that society can't force me to work. Read Atlas Shrugged. I feel like Pied Piper, MD already. Think about how this looks to the people you hope will become physicians. It's probably not consistent, I'm leaning toward single payer myself, anything to shut down the health insurance industry completely. This isn't working.moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-21389350431082229552011-06-18T10:37:51.182-04:002011-06-18T10:37:51.182-04:00I don't really think doctors should 'band ...I don't really think doctors should 'band together' and abandon insurance companies in an organized way.<br /><br />The insurance companies must provide some level of service, and if people paying the premiums are not satisfied, then a competition between them is created. Unfortunately, people don't tend to complain to their employers (the decision makers about the policies offered) about their mental health care because....<br /><br />I know it bothers people that shrinks opt out, and it does give the insurance companies a break--I have patients who don't bother submitting their claims even though they could use the money and have the coverage. <br /><br />Does it bother people that insurance companies create a system of hassles so that doctors won't participate and patients are left with the high-volume practice shrinks? <br /><br />The educational system may not be a bad analogy-- everyone gets the basics for free, you want more or different then you're free to go to a private school or hire tutors. Where we live the public schools are so bad that the private schools have lots of competition for their 25K/year kindergartens. There do seem to be comparable issues.<br /><br />Market pressures--perhaps it keeps medical school competitive and ensures a higher quality of doc, but who knows? It was a long, expensive, ride to get here. <br /><br />This is our first post with over 100 comments. Go Jesse!Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-89611139789829648182011-06-18T10:07:49.236-04:002011-06-18T10:07:49.236-04:00Rob wrote: "What other good in your community...Rob wrote: "What other good in your community does someone ELSE buy for you because you need it to live?"<br /><br />In a humane society a community provides the necessities of life to those in need. Some communities provide all manner of goods and services to people in need. Those of us who can afford it and do not help live with a false belief that they or their family members will never ever be in need.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-88395828233714852832011-06-18T08:29:05.803-04:002011-06-18T08:29:05.803-04:00Answer to the "car accident" question: I...Answer to the "car accident" question: I can send a bill, but the victim is under no obligation to pay it. BUT, in states with no Good Samaritan law, I may be sued if there's a bad outcome! By the way, what's the usual and customary charge for assisting at a car accident? Just asking. <br /><br />There was a confusing comment from someone claiming that health services need to be paid for by third parties because she needed the service to live. What other good in your community does someone ELSE buy for you because you need it to live?<br /><br />Regarding the high cost of services: let me speak from my own experience doing pediatric primary care. If the free market operated here, there would be WAY fewer pediatricians and the costs of obtaining my services would be much lower. The regime of third-party employer-based and governmental reimbursement has mangled the economics of my profession beyond recognitionrob lindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-61101805469742001772011-06-18T07:33:44.843-04:002011-06-18T07:33:44.843-04:00Teachers working in public school ought to have th...Teachers working in public school ought to have this figured out by now, too. Indidividual teachers already opt out of the system in which they are overworked and subject to all sorts of hassles. These teachers work in private schools. Now is the time for all teachers to abd together and opt out en masse. Groups of teachers can set up their own fee based schools. They could offer so much more this way. If all teachers opted out or rather into the free market system of schooling, psrents would have to stop smoking and drinking and lazing about and would finally be motivated to get a job to pay for they child's education. Bus drivers, if you are listening to this, opt out also, buy a bus of your own and charge 5 dollars a block to anyone who does not want to walk. Band together and all do this. It is a free market, unshackle yourselves and be free.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-11982532851844205332011-06-18T05:58:34.880-04:002011-06-18T05:58:34.880-04:00Lisa - I think you are missing the part where pati...Lisa - I think you are missing the part where patients are sick and dont exactly have extra energy to fight the system. And patients with mental illness are too drown in stigma to have a voice for change. It seems the only change that happens for them is forced treatment.<br /><br />Yes healthcare needs to change in America. I would love to have a single payer system not tied to my employment. But right here and now I am ill and I need treatment and my employer sponsored insurance is all I have that helps me afford it. <br /><br />Do you think people going without care will make a difference? We let people go without care now. We let them freeze to death in the streets and starve as we walk by. To make ourselves feel better we blame them for not being good enough or trying enough or working enough to live.<br /><br />I'm not interested in dying for a cause or being the example that helps change things. I'm not stoic enough. It is not my fault I'm sick and I work hard to take care of myself but I can not do it alone. Needing help shouldnt make me a lesser person. It does not demonstrate how I am a failure and does not mean I deserve to suffer more than othersAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-60590867392327139022011-06-18T05:13:24.462-04:002011-06-18T05:13:24.462-04:00Medical care shouldn't use the models of a fre...Medical care shouldn't use the models of a free market economy. It's not retail or the service industry where one can go and shop for diseases or cures or treatments. Patients shouldn't view their doctors as simply a good to consume when they have a broken finger or they got to fat from eating McD's. As it is, patients (in America, at least) live reckless lifestyles with the view that health care is simply another thing to consume and their doctors should do what the patient wants because s/he is buying their time. It's ridiculous! No wonder so many doctor related blogs are complaining about how rude and unappreciative patients are {not this blog :)} Health care is very different than purchasing a shirt or the services of a masseuse.<br /><br />Sarebear, there are a lot of problems with the way health care is distributed and financed. Insurance companies simply do not have subscribers best interests in mind. Their primary goal is to make the most money by (as plenty of providers have pointed out) not adequately compensating the doctors and denying necessary care whenever possible. <br /><br />People have to take responsibility for their wants and needs. If doctors as a whole stopped accepting insurance, people wouldn't just sit around and allow their illnesses to fester. Eventually someone will get mad and someone will do something about it and people will start demanding changes. <br /><br /><br />I have a side question: Say a doctor found herself at the scene of a car accident. The ambulance has been called and none of the injuries are life-threatening. Still, the doctor assists while waiting by helping to clean up cuts and scrapes until the ambulance arrives. Would the doctor send a bill? Just general curiosity.Lisanoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-73825481598393459752011-06-18T04:08:54.509-04:002011-06-18T04:08:54.509-04:00As Sarebear pointed out - limited availability of ...As Sarebear pointed out - limited availability of docs + high cost means patients typically opt to forgo treatment instead of fight the system. Docs not taking insurance is a plus for the insurance company as it raises the likelihood a patient will not get treatment at all - one less thing the insurance needs to reimburse. <br /><br />I find it hard to see how you can both the support the argument of not taking insurance but also demanding involuntary treatment of the sickest of patients.<br /><br />Rob - is it really free market if I require the services to live? As someone with Borderline personality disorder I should not give up treatment any more than I should not get treatment for my diabetes. But as someone with BPD my choice of providers is not only limited by providers insurance status and treatment offerings (not much works well for BPD) but by provider discrimination (somehow I am bad, difficult patient even before I walk in the door.) In a free market I would be paying every extra dime I had for treatment and that to me looks like extortion. <br /><br />In the face of everything I want to keep the life I've built. My husband, my home, my job, my family, my friends are all important to me. As a borderline I know its very real how easily I could screw it all up and be alone. Ongoing treatment stands in the way of me giving in to irrational parts of myself. There isnt choice here, I do what I must and I will pay what I have to.<br /><br />I'm not saying as docs you should treat everyone or treat patients for free but remember that not all patients you turn away are worried well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-71008737385477960182011-06-17T23:01:47.900-04:002011-06-17T23:01:47.900-04:00I understand that those are the reasons behind ide...I understand that those are the reasons behind ideas of masses of doctors standing up to insurance as a group or groups, but the reality would negatively affect alot of people, although one has to wonder what SHORT of a massive doctor uprising WOULD get the ins. co's attention, anyway . . . but I certainly understand individuals opting out of the system, like you, even if it leads to a profession like yours tending to have more opt out of the insurance system than others.<br /><br />There don't seem to be any decent solutions, I just HAD to pipe up to the notion that doctors accepting insurance is bad for patients . . .<br /><br />Thanks, Clink! :)Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-32006116612650902352011-06-17T20:40:29.406-04:002011-06-17T20:40:29.406-04:00Geez, one of you asks for hot ,hot,hot and another...Geez, one of you asks for hot ,hot,hot and another steals the voice of another culture to provide reasurance that there won't be any flames wars. Odd ducks.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-13980835618121588582011-06-17T20:31:20.669-04:002011-06-17T20:31:20.669-04:00Sarebear,
The theory behind mass refusal of insura...Sarebear,<br />The theory behind mass refusal of insurance participation by doctors isn't to freeze patients out of care (the way many, but not all, are now). The idea would be that this would force insurance companies to alter their policies so that doctors would then want to participate: that they might make the process of submission easy and the reimbursement rates reasonable so that most/all doctors would want to participate, and then many more physicians would be available to everyone. The idea would be to open access to care..that would be the theory. <br /><br />As is, many of the poor are covered by Medicaid, the disabled by Medicare, and the wealthy have good insurance. It's the working, uninsured poor who are in the worst shape. And the working insured poor have limited choices for psychiatric care because shrinks like me just can't cope with the submission (re: rejection) hassles, and the low rates. <br /><br />It all seems unfair because it is unfair. <br /><br />As a solo private practitioner working part time, there is just no way I can deal with the insurance companies and the aggravation-- I'd rather work for free.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.com