Monday, June 23, 2008

There's a very interesting article in Reader's Digest that I encourage everyone to read. It's 41 Secrets Your Doctor Would Never Share (Until Now). It's quite eye opening, and for those of you who won't have the opportunity to pick up a copy of July's issue, I'll happily quote a little bit here...of course giving full credit to READER'S DIGEST:

The following are quotes from actual doctors (I suppose):

"Hospitals want physicians to send patients home faster, so some doctors are given bonuses for getting their patients out of the hospital quickly."

Now that's a scary thought. I think that's been going on for a long time because I remember the difference in two of my own hospital experiences. The last time I had a child, I almost imagined there was a giant funnel slide in the delivery room where mother and new baby were expelled to the outside. I happened to have a c-section so my slide didn't occur until they were sure my stitches would hold up. :)

""Nine-four percent of doctors take gifts from drug companies, even though research has shown that these gifts bias our clinical decision making."

"Doctors often make patients wait while they listen to sales pitches from drug reps."

I wondered about that. I visited the doctor last week and my appointment was delayed by forty-five minutes. A never-ending stream of business-suited men and women with black bags on rollers passed in and out the door while I sat there making myself believe the doctor was giving quality care to the patients and I shouldn't complain if I wanted equal time. This news kinda shatters that fairy-tale. I have a suggestion. How about passing the goodies on to the patients. It might make up for having to share coughs and sneezes longer than necessary in the waiting room. How many times have you gone to the doctor for something non-contagious and actually caught a cold or flu? I know I have. Would separate waiting rooms be nice?

"It's pretty common for doctors to talk about their patients and make judgments, particularly about their appearance."

THIS supports my post from yesterday. Remember, be aware of what doctors are writing in your chart. You have a right to see it and disagree with it. No one should make personal observations that will influence how other doctors treat your health concerns.

A good friend of mine, Kayelle Allen, has hospital experience to share, and recently posted some very helpful info on my yahoo group. She's given me permission to share it here:

1. You have the right to ask for an itemized bill. Every time a nurse gives you a pill (or anything) it's recorded. There are charges for every single thing they do. while you're sick, you may not remember getting pain reliever, but if you get the bill and you were there 3 days, and you have 44 charges for those pills -- chances are someone transposed a number or wrote something down wrong. 2 pills every 4 hours for 3 days would be 36 pills. You can request an audit, a change, or an explanation. You may be entitled to a refund. Other things might be duplicated too. Some insurance companies offer a bonus if you find errors on your itemized bill - a percentage of what you save them!

It's helpful to have "secondary insurance", which is a smaller, less expensive policy that covers coinsurance and co-pays. For example, your hospital bill might have a co-pay of several thousand dollars. Your secondary insurance may pay all but 10%, leaving you with a much more manageable amount to pay. If you have another insurance, like Aflac or AARP, they may pay that additional amount.

I recommended everyone in my family get some type of secondary insurance, as this can really help in times of physical distress when the last thing you want to think about is money and can you afford a possible life-saving test.

Not giving a recommendation of Aflac (the duck) but they have some policies that pay you - so you can use the money while you're in the hospital to help your family get by while you're not there.

The other to keep in mind is like buying a car, you can negotiate paying your bill. Say your expenses are $3000, and you could come up with $1200, but that's all. Call and ask for the business office and ask to speak to a collector for commercial insurance (non-medicare, non-medicaid). Tell them that you could pay this amount and ask if they will give you either a discount or a grant, to accept a "write off" of that amount. I've been amazed at how often our hospital has done this.

One more thing to ask when you're choosing a hospital (assuming you have time), ask if they balance bill the patient. And/or ask your primary insurance if their contract requires this. What it means is that if the insurance pays 80% of the contracted rate (very often the case), does the hospital bill the patient the other 20%. Some insurance contracts (in fact many) require that the hospital does not. That means the hospital will not charge you that extra 20% but will write it off.

I don't sell insurance, but I do bill it - and I can vouch for the fact that two patients who are in the hospital for the same type of treatment will end up (due to insurance coverage) owing anywhere from $360 to $3600. Talk to your insurance person and see what kinds of coverage you qualify for.

Remember to ask for an itemized bill after you leave (patients rarely have to pay anything for this). DO make certain you are precertified (insurance can refuse to pay all costs if this isn't done) - and even if the hospital says you are, call your insurance company and make sure. Ask for claim # and the person's first name and last initial. Write it down and keep it together. Make sure you have all insurance cards when you go to check in or do preop or precert work.

Last of all, once you get in the hospital, even if you feel bad, treat your nurses and doctors like angels. Their whole job is to get you well and on your way home. You want them to be sorry to see you go, but happy that you are better. *wink* A merry heart does as much good as medicine.

I'll follow up Kayelle's suggestions with the last quote from RD:

"Doctors get paid each time they visit their patients in the hospital, so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten."

So, my friends. Pay attention to your bills, your doctor and your medical rights. attention to the coat medical people wear in hospitals...I had no idea the length of the white coat is related to the length of training. Medical students wear the shortest coats of all. Beware of the person wearing only a collar! *lol*


Chris Redding said...

Do not schedule surgery for the beginning of July.
July 1 is when the new residents come in.
Always be nice to the cleaning staff. They can get you extra goodies.

Jannine said...

I didn't know that, Chris. So if you need to be in the hospital, the best time is spring.

It's scary about some of the practices of doctors. It makes you wonder if they care more for their paycheck than their patient.

Great subject, Ginger.

Anonymous said...

I felt compelled to comment on this post, even though I haven’t read the article in Readers Digest. I just wanted to advise people not to always believe everything they read, especially the information provided by one of your bloggers.

1. Hospitals want to send people home as soon as possible in order to actually make some small profit from an individual’s stay. It is not a question of cutting corners on your healthcare, but rather the need to keep their doors open. This is called “Managed Care”. Physicians and facilities no longer call the shots for your treatment. The medical staffs of insurance carriers do. If, in fact, a doctor receives a bonus for speeding up a hospital stay, the insurance company pays the bonus, not the hospital. Hospitals can no longer pay physicians “Kick-Backs”.

2. I’ve worked in the healthcare industry for many years, both in hospitals and private practices, and I have never seen a drug company rep compromise or influence the care of patients. Years ago, drug companies did court doctors with free trips, golf games and extravagant meals but this is no longer a common practice. They still bring in lunches, pens, coffee mugs and such, with these perks going to the office staff who squeeze them into the appointment book. Often times, these visits are the only time docs have the chance to hear about new meds or equipment and they certainly don’t make time for all. Patients do receive the benefit of these visits, as the doctors are supplied with multiple samples which in turn are provided to patients at no charge. I have personally received samples that have saved me hundreds of dollars…all you have to do is ask.

3. Most doctors don’t even take the time to read or review their own notes, much less another doctor’s. How many times has the same doc asked you if you are allergic to any medications, even though it is recorded in your chart? When reviewing your medical records from another doctor, they are usually only interested in test results and almost never even request progress notes. They are not interested in another’s opinion…they want to form their own.

4. If you are one of a handful of patients who still has indemnity insurance, you may want to see an itemized bill, but most insurance companies negotiate for a flat rate. It doesn’t really matter whether or not you were billed for 2 or 222 band-aids, the facility still gets the same amount.

5. Back in the 90’s, the Federal Government passed legislation that banned the practice of “Enticement”. It used to be common practice for docs and hospitals to accept insurance reimbursement as payment in full (Back when indemnity insurances paid a percentage of BILLED charges and they still made a healthy profit) but this is no longer legal. I remember when one of my employers, along with others like the Mayo Clinic actually paid a patient’s airfare, but that practice was also been banned. In order for any provider to write off a patient’s balance, it first has to be established that paying would create an appreciative financial hardship for that patient and this must be documented, in form. If a provider is in violation of this law, the insurance company can retaliate. A facility I worked for was caught doing this and Blue Cross audited all claims submitted to them for the prior 6 months and penalized the hospital by reducing their payments in the amount of the written off balances. The hospital lost thousands of dollars. Balance billing is MANDATORY and if any provider tells you otherwise, they are in violation of the law. This is the number one example of provider “Enticement”.

6. Not all physicians are paid for in-patient visits. In many instances, a surgeon can bill separately for his initial consultation, but his rounds are included in his flat rate fee and in most cases, this fee is substantially less than what your dentist is paid for 2 lousy root canals and the surgeon's malpractice premiums are ridiculous. It was mentioned in a previous comment that other physicians can bill for seven visits, even if they only see you five times. This is not only incorrect, it is illegal. If you suspect a doctor has improperly billed or billed for visits never received, report him. This is fraud.

7. A significant amount of insurance contracts are payed by DRG’s (Diagnostic Related Groups) and that flat rate is not negotiable. If you are admitted for a routine gall bladder surgery, that hospital is lucky to receive $3000 and have you out in one day. But in the sad event you develop severe complications and require Intensive Care and 30 days in-patient days, the reimbursement is the same. Yes… I know the diagnosis code can change and billers can do extraordinary things, but the paltry addition to the original $3000 is negligible. It simply never covers the cost.

8. Please remember that providers have little or no control of your healthcare…it’s the HMOs and other payers. The good old days of medicine are over…treatment used to be based on your doctor’s opinion of medical necessity but now its up to the “professional” answering the 800 PRE-Cert number. Don’t blame your doctors, people. Yes they’re busy and appear to see too many patients but you don’t have their contract in front of you. In order to be graced with an HMO contract, they often have to agree to be assigned so many lives (patients). New physicians trying to establish some sort of practice literally have no choice. And if you don’t like the doctor, find another mechanic. You take that much interest with you car, but you can’t do it for yourself?

9. To those who complain about paying a portion of any healthcare bill, please stop and think of others who have absolutely no coverage. That would be me and millions of others who have the choice of a roof over our heads or medical insurance….how would you call it? And as for secondary insurance…oh how blessed you truly are.

Unknown said...

Dear Anon:
I don't think anyone believes that someone's blog is the be all and do all about the topic at hand, but I can tell you that my experience with the notation in my chart was very real and affected the way I was perceived by the other doctors in the group. They do read the notes written right inside the chart, but I agree, I'm sure they don't have time to READ the entire thing. It only takes a glance to catch one negative word.

As for the RD article, I can only attest to what it said, and the comments were supposedly made by people in the health field (doctors, nurses, aides). They know far more than I.

The other information in the post and comments are most likely based on real personal experience. While they may not be true for all, I certainly wouldn't devalue their input, anymore than I would yours. Thank you for your comments. Most appreciated. I can't imagine how very scary it is not to have health insurance. I pray this is something the new administration will fix, but I have serious doubts that much of anything will change. Blessings to you.


Anonymous said...

Physicians really do fall into the category of human. There are good, bad and indifferent ones, competent, kindly and idiot ones. Based on their experiences and assessments, they do form an opinion. Have you never been tagged by a sales clerk as a complainer? Doctors are not superior to any other person when it comes to forming personal opinions of others. You may want to revaluate your own personal presentation, as there may be a remote chance you are just a whiner and complainer, suffering nothing more than a personal need for attention. The proof is in your blog.
Not the former anonymous blogger, but a new one.

Unknown said...

Dear Second Anon:
I could have trashed your comment, but rather than deny you your moment of pleasure, I would ask if you are going to personally attack me and make clueless observations, at least have the courage to identify yourself. Anyone can make a hit and run under a mask, but it takes a brave soul to show their face instead of their ass. It always amazes me why people stay here they obviously aren't having a good time, and clearly aren't wanted. Please spare me from inflicting anymore of my whining and simpering on your poor precious self.

Phyllis Campbell said...

Dear Anon blogger...

One question. Why can't you let Ginger - or anyone for that matter - have their own opinion? Is this not a free country? Ginger said she's experienced things like what she blogged about - okay, let it be, even if you haven't. Just because YOU said it didn't happen, doesn't mean it's gospel truth.

Blogging is about people's opinions, right? They why can't Ginger have her own - or her friends, for that matter?

It boils down to this, Anonymous, if you don't like what Ginger has to say, then don't read her blogs. Because there are MANY of us that are very interested in what this amazing woman and friend has to say.

Jealousy doesn't look good on you, Dear Anonymous person... Please leave or just shut your trap.


Anonymous said...

Having been on the receiving end of poor medical care in the past, I find it never hurts to ask questions, be informed and not take the words of a doctor as as the end all be all, they're human and nothing is worse then having to deal with a medical professional that thinks he/she is GOD come down amongst the humans.

Since I've not read the article but doubt RD is going to print heresay or facts not researched I'd say the first anny author has been lucky. And has to wonder what Anny 2's problem is. Seriously, no one was whining or pointing fingers just a normal little discussion. I hate it when people have to hide behind anny author things. If you believe in what you're saying, and stand beside your opinions, pony up a name for crying out loud. I seriously doubt it will leave a mark...

Jannine said...

To both Anons:
Ginger's blog touched on many aspects of the medical field, and the fact her quotes came from a RD article written by a professional doesn't mean everyone has to take these words as the gospel truth. What Ginger offered was a look at the article and the opportunity for her readers to express their opinions on the medical insurance crisis.

The first Anon's comments read like the riot act. There is no need to put anyone down for their opinion. Maybe you are angry because you don't have medical insurance and can't see past the injustices created by the insurers. I think we have all been affected in some way by the high cost of insurance. However, those who can pay the high cost and can obtain secondary insurance, I say bravo to them.

If you want to expose one of the reasons for the high cost of insurance, you might want to consider the current illegal population in this country. Citizens of the U.S. are taxed to absorb their medical costs. If we weren't taxed heavily, there might be enough money for every U.S. citizen to have insurance.

In reality, I believe medical insurance has gone downhill in this country because of many factors, some we don't even know about.

We need to keep in mind that we are in this mess together. Please don't judge one person's opinion. Our differences is what makes up this country. Our opinions do matter. But we need to let everyone have their say without fear of judgement.

Rita Karnopp said...

I'm in the midst of computer troubles... BUT...I'm praying this message does get through.

What perverse pleasure would a person have for slamming and attempting to belittle a lovely lady who has many true and devoted friends and fans?

No one has asked for demeaning's a blog...which means 'a persons opinion'... you don't like it... please leave.

We believe in supporting each other with uplifting, positive, and loving comments. This isn't a space or place to be condesending or rude.

In my opinion...Ginger doesn't deserve any more RUDE comments. You don't like that... please just leave.

Ginger is a dear friend, and I won't sit by and let her or her opinion be attacked.

Tabitha Shay said...

To Anon One and two,
First, I'd like to know why you have to hide behind a wall of secrecy, it's not like any of us can reach out and zap your ass, although some of the things you said were mean, spiteful, hateful and just plain ugly and said to a woman who has every right to say what she wants, it's her blog site!!!
But there was nothing in her blog I saw any reason for anyone to accuse her of whining or attack her personally...that is just plain hateful, you must be a very miserable person or very jealous.
Secondly,I'm a retired nure and let me tell you, no, I haven't worked in billing, but I've worked in hospitals and clinics...True, there are samples given to the Dr.'s, thousands of them, and they have them, I've seen them, in fact, I've worked in a doctor's office where one back room was filled, wall to wall with every kind of sample you could imagine. Were they offered freely to the patients? Hell, no!...Anon. one said all you had to do was ask...I say, Why should you have to ask? I can promise you, the doctor and staff know if you have insurance or not, it's the first damned question asked. If one doesn't have insurance, then it's most likely he/she can't affored to fill the friggin' prescription the Dr. sits there and writes down for the patient, instead of asking, "Can you affored to fill this? If not, I've got samples..." It takes but a second to ask.
As a person who is disabled, my income is limited, many times the prescriptions I'm handed gets shoved in my purse and finally ripped up and tossed away because I can't affored to fill them. It would have been very nice and less embarrassing if the Dr. would just have asked me if I could fill the prescription.
Now, as a once nurse, I've pretty much seen it all...I've seen the medical errors covered,the surgical errors made, deaths caused by medical errors, the wrong blood type hung on the yes, you have a right to ask questions...I always do...and I've ticked the nursing staff off plenty of timesand the doctor...Do I care? You can bet your sweet petunia, I don't...Unfortunately, about three years ago I had to have several units of blood. Every time the nurse walked in to hang it, I asked if she had a second nurse read off the numbers..."Are you sure it's my blood type?" Yes, it pissed her off...who cares. When she asked me if I was questioning her ability to do her job, I replied, "Your damned, right I am...this is MY life!!!"
To Anon Two...Nurses and doctors are overworked, people make mistakes, some people whine, but the lovely lady who posted the blog on her own site did not whine or make any mistakes when she posted and she didn't deserve to be humuliated...if you haven't grown a set of balls big enough that makes you brave enough to sign your name, then keep your ass off Ginger's site and leave her be...she doesn't need your nasty remarks and neither do her fans...Tabs

Anonymous said...

Dear me, Anon Commenter#2, I can tell you there's absolutely no need for the personally insulting tone of your comment - or are you also an Anon Listener too? I don't really understand what you're trying to say anyway, except to have a go at Ginger, unless you're a physician yourself? How rude, and how useless to either the discussion or the social sharing of friends. This is a personal, informal blog (and a damned good one), not a governmental agency or chat show phone-in or Tv debate etc etc. Perhaps you should write to RD instead if you feel that deeply about the subject.

Interesting discussion, Ginger, though I come from the relatively thankful UK where we have the National Health Service. We may have to wait months for treatment, but it's free when we get it, and the medical staff are largely the same as in the private hospitals. I had insurance once with an employer but don't have it now, although it's an automatic benefit with our US parent company.
This topic is very personal to *everyone*, and it's natural we feel deeply about it. I suppose that the medical profession - whatever position it holds itself out to - is still run by humans at the end of the day, and there will be bad and good. Like any large institution, as well, it's going to be prone to entrenched practices and some abuses. But a little like teaching, it's a profession that most people choose as a vocation, and I know many who struggle to do their best within its restrictions. We all have to join in obviously, and take responsibility ourselves, like Tabs says.

And in conclusion, even though we might feel deeply, we can still surely listen to others and be civil!! I agree with your commenters, why do people like the Anon#2 bother commenting if they just want to abuse?!!

Clare :)

Unknown said...

I worked for two of the best physicians in Robbinsville, New Jersey before moving to Virginia. I really admired their dedication. Yes, it is a business, but they also made sure that patients were cared for and treated with dignity. We saw about 80 patients daily in the office of 2 physicians, 1 Nurse Practioner from 9am to 4:30pm with 1hour away for lunch. I was proud to work for those doctors and I wish that all physicians had the determination, dignity, heart and compassion of these guys. It takes alot to deal with the different types of people that walk through the doors, but we always got through each day with laughter and smiles. We had the BEST Practice Administrator who would leave little gifts on our desks at any given moment, just to say THANK YOU FOR A JOB WELL DONE. She always took time out to talk with us and help resolve any problems work related or not. It was like family in that office. The doctors always made sure that we were happy, but they did not tolerate certain things. If they did their jobs, they definitely expected us to do our jobs. If patients were obese (that is the medical term for being over weight) one of the doctors always gave it straight, but the other doctor curved his tongue a bit (especially if the patient was older).
What I loved the most about their practice was that they would instruct us to do certain things to ensure that the patient took responsibility for their health. Some patients would call in for refills of the little blue pill. We were instructed to tell them to call back when you have the full name of the medication, the dose and how often they took this medication. Of course we would not say it to them in that manner (well, some of the younger girls would) but it worked most of the time. They also encouraged us to know our patients, not only their medications and conditions, but their habits.
There was an older lady that started to call in frequently for the same medication and she never remembered that she called before. We would redirect her, document and then we followed up (prior to the updated HIPPA policy)by contacting her daughter who was in another state. Later, we found out that this patient had Alzeihmer's and she had to move with her daughter for additional assistance and monitoring. Something that simple made a difference. If someone didn't pick up on that behavior, this patient might have harmed herself or others unknowingly. I wish their were more medical practices like the one that I worked for in 2003.


Unknown said...

Thanks for the very nice post about your past experience. Isn't it amazing how working for someone who treats everyone with decency and respect instills in us the desire to do our very best work for them? Sounds like you found some very professional and caring doctors. The one I have at the present sounds very much like that, and his office and staff is always friendly, helpful and available. There are practices around like you described, unfortunately, they are too far and few between by my experience, but then it's not just Doctors, it's service to the public in general, but that could well be our own fault. I might blog on this today. Thanks for the inspiration.


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