Should I file a complaint re this doctor?

[PaKettle]

Tell me if this seems wrong to you, or am I looking at it wrong...

Like most of the U.S. I have an HMO health plan. My employer pays most of it but I supplement it to the tune of about $125/month, to cover my wife and I.
Then, we have to pay $15 copay for our Primary Care Physician and $30 for a specialist.

I have been having ongoing tingling in my arms and pain in my back and shoulder, so my PCP sent me to a neurologist. He ordered some MRI's and nerve tests and told me to come back for a follow up.

So I have to drive 15 miles, pay for parking, spend a couple hours of my time and pay $30 to see this neurologist for this "follow up" appt. after having had the tests done.

So when he comes in to see me, he does not ask me any questions other than "Are you still having the problems?", then he says my tests showed no nerve or brain damage, and he's going to refer me to a physical therapy office. Literally he spoke to me for about 120 seconds and that was it.

For THIS I had to spend 2 hours of my time, drive across town, pay for parking, and give him $30???! (which is only a partial payment, because I know the HMO is probably paying him another $90 or so)

I think this is outrageous and I should ask for my money back and file a complaint with the HMO and Medical Group. This is just pure abuse not only of me, the patient, but of the HMO, on his part.

Why couldn't he have just called me on the phone and said, "Your tests came back negative and so I'm going to send you a referral for physical therapy. Call if you have any questions or want to come in to talk to me."

Again, he did not ask me ONE question during this approximately 2 minute appt. that was not info he already knew. He did no further examination and asked no further questions. For this I am paying $30 and he's billing $120 or so for a follow-up appointment???

Am I wrong, or is this just abusive of me and the HMO? No wonder our medical costs are so high in this country!

If enough of you say it is wrong, then I'm writing a formal letter of complaint re this abuse. If you say it's not and I'm just being a curmudgeon, then I'll let it go.

[Flamingo]

Unfortunately, due to HIPPA privacy laws, most doctor's will not talk on the telephone about tests and results and require the patient to come to the office; that is also done for legal and insurance purposes and what is required under the contract the physician has with the patient's insurance company. Since you are a paying customer of the HMO and felt the visit was a waste of money and time, it never hurts to complain. The HMO should be made aware of this doctor's actions as to your situation since he did not spend that much time with you, take your blood pressure or listen to your heart or any other office procedure.

Our PCP through our HMO does the same thing - you have to go in for an appointment for test results; however, our PCP always spents at least 10 to 15 minutes going over everything and doing blood pressure, weight, listens to chest and heart, etc. at every visit. Specialists usually do the same thing. If dissatisfied, complain.

[AngelinaCatHub]

Pa: Welcome to the wonderful World of Healtcare. Just wait till we get it "Federalized", you ain't seen nuthin yet. Flamingo is right, but I would think that a call would not breach a law, but, let us say, what you are paying makes up for those who are indigent or misuse the system. Fair???? Who said life is fair?

I was turned down for a very needed hernia operation as I 'fessed up' to being in bankruptcy. My alternative is: Wait a year till I'm 65 for medicare, or let it go to the point of emergency.

Money buys life.
Money buys Justice (ask OJ)

Just my opinion, Pa. I love your advice and read you often. 'Hub

[PaKettle]

Unfortunately, due to HIPPA privacy laws, most doctor's will not talk on the telephone about tests and results and require the patient to come to the office; that is also done for legal and insurance purposes and what is required under the contract the physician has with the patient's insurance company. Since you are a paying customer of the HMO and felt the visit was a waste of money and time, it never hurts to complain. The HMO should be made aware of this doctor's actions as to your situation since he did not spend that much time with you, take your blood pressure or listen to your heart or any other office procedure.

Our PCP through our HMO does the same thing - you have to go in for an appointment for test results; however, our PCP always spents at least 10 to 15 minutes going over everything and doing blood pressure, weight, listens to chest and heart, etc. at every visit. Specialists usually do the same thing. If dissatisfied, complain.

Thanks for that information. I should have known that the problem was the LAW and how it makes people do stupid unnecessary things that drive up the cost of living and decrease the quality of life for everyone. No offense to the attorneys, but really, laws like these are just stupid and contribute to the problems in our economy, especially health care.

But since what you say is probably the circumstances at work here, I don't think I will file a complaint. He was a nice man and gave me a referral that I was hoping he would give me. I just felt it was wrong to require me to come in for that, but now I see that it was probably a legal reason.

However, as you say, I may write the HMO and give them my 2 cents about why this kind of policy and procedure is inflationary and stupid. Probably will do much less good than writing my complaint here, though. At least this provided me with some insight.

[CindyLou]

I know its frustrating, but this is the way things work with healthcare....

Also, remember, you aren't just paying for the exact minutes your doctor spent with you. You are also paying for the time he spends doing research on your case, reading relevant articles over time, talking with the Radiologist regarding your test results, paying his staff to schedule your appts for your tests, the fax paper that your results print on when sent to you, the phone line to call and remind you of your appt and be available to you when you call, the file folder your file is in, etc etc etc.... and also paying back loans for his education in order to handle your case and make the right decisions regarding your care.

He also has a responsibility to follow up with you and make sure you aren't having any further symptoms or pain. A doctor is not required to examine you in order to charge for your visit. There are different levels of visits that are charged to the insurance company.....however you still pay just one copay.

I hope this help,
Cindy

[PaKettle]

I know its frustrating, but this is the way things work with healthcare....

Also, remember, you aren't just paying for the exact minutes your doctor spent with you. You are also paying for the time he spends doing research on your case, reading relevant articles over time, talking with the Radiologist regarding your test results, paying his staff to schedule your appts for your tests, the fax paper that your results print on when sent to you, the phone line to call and remind you of your appt and be available to you when you call, the file folder your file is in, etc etc etc.... and also paying back loans for his education in order to handle your case and make the right decisions regarding your care.

He also has a responsibility to follow up with you and make sure you aren't having any further symptoms or pain. A doctor is not required to examine you in order to charge for your visit. There are different levels of visits that are charged to the insurance company.....however you still pay just one copay.

I hope this help,
Cindy

CinyLou, glad they added back your # of posts!

Thanks for the feedback.

I understand that a doctor - in this case, a neurologist - has a lot of costs. And I do not begrudge him the original money for the first appt. in which he examined me and referred me for MRI's and nerve conduction studies.

However, I think the second appt. - aside from any legal requirements as stated in Flamingo's post - was unnecessary and superfluous.

His looking at the test results should be included as part of the original appointment, and I'm sure it took him all of 1 minute to read those as well. I have seen them and 99 times out of 100 someone at the MRI lab writes on the results that there is "nothing out of the ordinary" so the doctor doesn't even have to study it.

Would it not make a lot more sense to conduct this follow-up - in a case like this, where the "follow-up" is simply to give me another referrral - by telephone?

In fact, given that the ONLY question he asked me is if I was still hurting or not, I think he could easily have just LEFT A MESSAGE on my home phone:

"Your results are back, and they are normal. If your pain is any worse, please call for an appt. but if everything's the same, I am sending you a referral for physical therapy. If you have any questions, make an appt. to see me." Period.

Quicker for him, quicker for me, saves me money, saves the HMO money, saves gas, and the ONLY ONE BENEFITTING BY NOT DOING IT THAT WAY IS THE NEUROLOGIST who makes another $100 plus from me and the HMO for the "follow up" appointment in which all he did was ask me if I was any worse and tell me he is going to refer me to another specialist.

I can understand that doctors sometimes need to do a follow-up, but was this really even a follow-up, being that he only saw me for 2 min. and asked me one simple question? I don't really think so. But that's just me.

If it's a legal reason that he had to see me and could not do it by phone, then I can accept that (though I think that law should be changed to allow phone consultation). But otherwise, I think it's just a matter of a greedy doctor charging for an extra visit that was not necessary at all.

[CindyLou]

Hi Pa,
Yea I was really happy about getting my stuff back!!

You know I don't disagree with you, but if a doctor did all their followups by phone they would all add up to many hours per day on the phone for which they would not get paid. There are many circumstances, including this one that warrant a quick phone call, but I would guess that he made that follow up appt with you as you left the first time before he know the test results were normal. Then no one followed up to cancel the appt and just tell you it was fine. The problem is that the Drs salaries have really decreased and they too are cutting back on their office staff, etc.

As you probably know, I'm in the medical field and see stuff just like this every day.

My husband made a drs appt for yesterday to get the wax cleaned out of his ears (yuk, I know..but his body does not make the enzyme that thins out the wax and he gets lots of it near the ear drum). Anyway, he went in for the appt and the doctor looked in his ears and said yep they need cleaning, but he said he had to get a authorization from the insurance company and he has to go back next week. So the insurance company has to pay an extra visit because they want an auth. If they would have just let him do it while he was there they could have saved the cost of another appt.

Its just crazy, but I don't think things will change anytime soon. Its a very broken system that does not benefit the patient or the healthcare provider!!!!

[lillaimof2kids]

First off - I'm glad your test results came back OK.

I know exactly what your talking about. I had a Dr. (OB-Gyn) spend maybe 20 seconds with me about my migraines Not being related to my girly issues. One month later I found out he's in rehab and has been there for almost 2 months now.

It's very hard to find a good Dr. anymore. Especially a good specialist. I just fired my Neurologist after he let me lay in bed for 5 days with a migraine. He wouldn't call me in any meds to try to stop it. None of my other meds touched it. All he would tell me was to up my preventative medication - which aparently isn't working. I did recently find a wonderful PCP who I wish I would've found months ago. My 1st visit he spend over 30 min. with me. Each visit after that he spends at least 15+ min. with me. He wants to help and I don't feel like I'm interupting his day when I need to get into him quickly.

Anyway, our medical system is a crock sometimes! At least you had testing done! I've had a CT Scan, but can't get a Dr. to order a MRI. I have ins., so what's the big deal, just write it down on a piece of paper and I'll do the rest. I've only worked 2 full weeks this year because of my migraines. Dr.'s don't seem to bat an eye over that...strange!

Unfortunately, I don't know what a complaint will do. I wish we had more say when it comes to our medical situation. We're at their mercy.

[Flamingo]

CinyLou, glad they added back your # of posts!

Thanks for the feedback.

I understand that a doctor - in this case, a neurologist - has a lot of costs. And I do not begrudge him the original money for the first appt. in which he examined me and referred me for MRI's and nerve conduction studies.

However, I think the second appt. - aside from any legal requirements as stated in Flamingo's post - was unnecessary and superfluous.

His looking at the test results should be included as part of the original appointment, and I'm sure it took him all of 1 minute to read those as well. I have seen them and 99 times out of 100 someone at the MRI lab writes on the results that there is "nothing out of the ordinary" so the doctor doesn't even have to study it.

Would it not make a lot more sense to conduct this follow-up - in a case like this, where the "follow-up" is simply to give me another referrral - by telephone?

In fact, given that the ONLY question he asked me is if I was still hurting or not, I think he could easily have just LEFT A MESSAGE on my home phone:

"Your results are back, and they are normal. If your pain is any worse, please call for an appt. but if everything's the same, I am sending you a referral for physical therapy. If you have any questions, make an appt. to see me." Period.

Quicker for him, quicker for me, saves me money, saves the HMO money, saves gas, and the ONLY ONE BENEFITTING BY NOT DOING IT THAT WAY IS THE NEUROLOGIST who makes another $100 plus from me and the HMO for the "follow up" appointment in which all he did was ask me if I was any worse and tell me he is going to refer me to another specialist.

I can understand that doctors sometimes need to do a follow-up, but was this really even a follow-up, being that he only saw me for 2 min. and asked me one simple question? I don't really think so. But that's just me.

If it's a legal reason that he had to see me and could not do it by phone, then I can accept that (though I think that law should be changed to allow phone consultation). But otherwise, I think it's just a matter of a greedy doctor charging for an extra visit that was not necessary at all.

The change with the HIPPA laws in the health field (privacy laws) just increased the work and paperwork done by the HMOs, PPOs, etc., etc. and also for the doctor's offices; whether PCPs or specialists. I am sure you signed prior to visiting both doctors privacy forms and you received a copy. Read it. I am also linked to the medical field and remember the chaos HIPPA brought to the medical and legal professions several years ago. One of the things you mention above, leaving results on the phone, is not done anymore due to these laws. It is unbelievable the compliance that is needed for each patient. CindyLou provided some great information and I could go on and on myself about some things as to the appointment you described but just as in anything, if you felt your time was wasted for a few minutes of the doctor's time, him just sitting and viewing your chart for a few minutes and telling you your're fine, take your chart to the desk and pay your copay, your complaint are what could help change flaws in the system and alert the HMO to the lack of time spent with you discussing your situation and just getting another referral. Specialists have high fees due to many reasons; malpractice insurance, nonpaying patients, uninsured patients, and costs to run their medical office and staff. It's astronomical.

With the high cost of gas now, many people are going to put off going to the doctor just because they cannot afford to get there or pay the copays, which continue to go higher each year as more costs are passed on to the consumer to pay for health care costs. In just the past few years, our own HMO has initiated $100 copays for CT Scans or MRI's and $50 copayments for ultrasounds or echocardiagrams, and other similar tests. They are trying to hold down the extreme costs of these services and all the unnecessary scans/tests that are done by some doctors because ultimately we pay for it all. Prior to that, for years those tests for us were covered 100%. And copays will just go higher as more costs are passed on to the consumer to be responsible for their own health care costs.

Times are a changing...think how bad our grandchildren and great-grandchildren will have it.

[Bandit]

Am I wrong, or is this just abusive of me and the HMO? No wonder our medical costs are so high in this country!

I think a PPO offers a little plan & gives better options for who you can choose, then if you have to time to locate a good one thru PPO find one on the list, close to home, someone who cares & is not in one of these huge health groups that tells doctors to screw the patients from start to finish.

But what heppens often is you need emergency care & get stuck with these rotten meat rack doctors and assistants with the routine business or nothing at all. So you go round & round in circles for a very long time.
I think it would be wise Pa, for you to shop around for the specialtist & then since you have hmo, have your regular MD refer you to the speciatist that you think is best...just like interviewing a lawer.

It is becoming harder & harder to find good doctors who will find mercy & give you breaks here & there. They dont wantr to do anything more than what they want to do & they wont lift a finger to really help you but will be very glad to get referals & send you to referals within their little network.

I am not for weekly chiropractic manipulation but I do believe they know & see a lot of things that can be healed through adjustments & they find the problem much quicker than these dodo birds who only do one thing. Maybe check that out as well if you dont have to travel so far.


& yes the system is highly abusive because there are too many of them who do not care...so when you find a good one, stick with them!

[Bandit]

In just the past few years, our own HMO has initiated $100 copays for CT Scans or MRI's and $50 copayments for ultrasounds or echocardiagrams, and other similar tests. They are trying to hold down the extreme costs of these services and all the unnecessary scans/tests that are done by some doctors because ultimately we pay for it all. Prior to that, for years those tests for us were covered 100%. And copays will just go higher as more costs are passed on to the consumer to be responsible for their own health care costs.

Times are a changing...think how bad our grandchildren and great-grandchildren will have it.

That is exactly what is happening. When it gets to the point you have to pay for your own insurance & then start paying all these 'EXTRA' co pays, there is no way most people can do it & they know it. The sad part is those scans do not cost as much as they charge & I know this is a fact because of all I have been though on those xray machines.

They could charge us way less & still be making huge profits, but they insist on screwing the insurance companies, so the insurance screws the patients.

We are headed to that pretty dragon in the sky & the entire globe will be laying permanent feng shui lines as the gears are in place & are not going to change their rotations for the future generations. Incinerating will be the most cost effective way of treating the elderly & the poor with no insurance.
When would you like to schedule your incineration for treatment, there is only a 100 dollar copay & insurance covers the rest. ( i hope not but you never know with the way some people & countries think today)

[JollyGG]

I have seen them and 99 times out of 100 someone at the MRI lab writes on the results that there is "nothing out of the ordinary" so the doctor doesn't even have to study it.

This is true. However, the doctor is still supposed to look at the tests. The tech doing the scan is not usually a trained MD. They write they initial impression of the test to give the doctor some insight into how to priorize reading the tests. After all the tech wants to make sure that doctor looks at the scan where the tech suspects an anurism first. The doctor is still supposed to look at each and every test themselves. Now if they do or not probably depends in a large part on your doctor, the lab he has do the work, his original paitient assesment and other factors.

[FreshLikeADaisy]

Incinerating will be the most cost effective way of treating the elderly & the poor with no insurance. When would you like to schedule your incineration for treatment , there is only a 100 dollar copay & insurance covers the rest...

SOYLENT GREEN IS PEOPLE!!!!


Heh, sorry, had to do it. Hope no one was eating.

[PaKettle]

Thanks for all the comments.
I am leaning towards not complaining as I don't have time and it would do no good.

I get mad every time I think that I am paying (me and the co. I work for are paying) around $7200/year for health care but then they still charge me $30 for an appt., $20 for a prescription, and don't want to refer me to a masseuse or chiropractor or anyone like that who might actually HELP me. But they will send me for 3-4 MRI's which I think charge around $1000 each to the HMO. So I pay $30 for 2 minutes with a neurologist but nothing for an MRI. Go figure...

Don't get me wrong, I am glad they are willing to do an MRI to make sure I don't have a brain tumor or spine damage. BUT, they have now done 4-5 of them over the past 2 years and I am TELLING them that I am sure the problem is physical, that my neck and shoulders got tweaked out of whack during my whiplash accident 3 years ago when all this started. But they don't listen.

That's another issue: how doctors don't listen to what YOU think or say. They form their own opinions and won't let that be influenced by your own feedback. It's MY body, but why should they think I know anything about what is going on with it? Doctors pretty much suck nowadays.

[JRScott]

Sorry Pa

Like you say it would do no real good

If we get that National Health care system its going to even be worse, look at how the government runs the VA hospitals....