The cost to talk to a doctor

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Tracker968
Posts: 64
Joined: Tue Feb 23, 2016 9:32 pm

Re: The cost to talk to a doctor

Post by Tracker968 » Sun Aug 25, 2019 6:46 pm

Some of you have mentioned paying cash. I recently was out of town, more than 100 miles from nearest in-network clinic, and went to the local small town clinic. They said they do not take cash patients, everything goes through insurance. I thought that was strange. Still waiting for my bill.

sawhorse
Posts: 3461
Joined: Sun Mar 01, 2015 7:05 pm

Re: The cost to talk to a doctor

Post by sawhorse » Sun Aug 25, 2019 7:09 pm

My experience with a teledoctor consultations was useless. I had a bad cough and was hoping to get some benzonatate as I had used that previously with great success. The doctor told me to go to the emergency room in case it was pneumonia. :annoyed

I think they're so worried about liability that it renders remote consultations useless.

international001
Posts: 1163
Joined: Thu Feb 15, 2018 7:31 pm

Re: The cost to talk to a doctor

Post by international001 » Sun Aug 25, 2019 7:11 pm

graeme wrote:
Sat Aug 24, 2019 8:29 pm
With my previous employer based health insurance, if I wanted to talk to a doctor it would generally cost a $45 copay. My employer now uses a high deductible health plan (HDHP) with a deductible of $12,000. When I called to ask what it would cost to talk to my doctor, they said it depends on what's discussed. When pressed, they said the minimum would be around $150 and it could be more than $600 depending on what we talked about. Any tests ordered would be additional, of course.
I have paid $30 in Greece for 1-2 hours of consultation. They spoke English. Cash.
I guess the only limit to US price is when it becomes cheaper to flight to a place to get the same service.

IngognitoUSA
Posts: 182
Joined: Sat Mar 11, 2017 7:54 am

Re: The cost to talk to a doctor

Post by IngognitoUSA » Sun Aug 25, 2019 7:16 pm

toofache32 wrote:
Sun Aug 25, 2019 6:44 pm
IngognitoUSA wrote:
Sun Aug 25, 2019 6:31 pm

As for liability, we as a Nation have waived most of your rights into Arbitration, Medical field is not immune.
I'm not sure I understand what you mean.
Example: You have the worst headache of your life. The doctor skyping you from India says take tylenol. Turns out you have an aneurysm which bleeds and you have a stroke. We know how this plays out in the USA with lawsuits, but how do you hold the Indian doctor liable?
If the app is from overseas and the doctor is overseas, you probably can’t do anything. However, many people are willing to pay lower costs in order to take that chance.

Similar to auto insurance limited tort in NJ.

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: The cost to talk to a doctor

Post by toofache32 » Sun Aug 25, 2019 8:06 pm

international001 wrote:
Sun Aug 25, 2019 7:11 pm
graeme wrote:
Sat Aug 24, 2019 8:29 pm
With my previous employer based health insurance, if I wanted to talk to a doctor it would generally cost a $45 copay. My employer now uses a high deductible health plan (HDHP) with a deductible of $12,000. When I called to ask what it would cost to talk to my doctor, they said it depends on what's discussed. When pressed, they said the minimum would be around $150 and it could be more than $600 depending on what we talked about. Any tests ordered would be additional, of course.
I have paid $30 in Greece for 1-2 hours of consultation. They spoke English. Cash.
I guess the only limit to US price is when it becomes cheaper to flight to a place to get the same service.
What does it cost them to provide care?

an_asker
Posts: 2493
Joined: Thu Jun 27, 2013 2:15 pm

Re: The cost to talk to a doctor

Post by an_asker » Sun Aug 25, 2019 8:27 pm

toofache32 wrote:
Sun Aug 25, 2019 5:59 pm
an_asker wrote:
Sun Aug 25, 2019 5:09 pm
[...]
I seriously doubt he can offer all his patients that level of care while still staying solvent. If not, he should reveal his business model to all doctors!
This is how I run my practice. All my patients have my cell and I call them in the evening to review test results to save them a trip back to the office. I stay solvent because I don't participate in discount plans.
Wow!! :thumbsup :thumbsup

But I really doubt too many doctors are like this - at least, I don't think any of my doctors have been like this in the last three decades (more or less) in the USA!

PS: Yes, I've gotten calls backs from dentists (as have my kids) after major tooth extractions... but definitely not to review test results. In fact, primary doctors have always had me visit to go over blood work results. Now I go by routine, even though it means a co-pay of $40, even though I can see the results (which I previously didn't have access to - I believe this is some new rule that recently got passed) online.

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: The cost to talk to a doctor

Post by toofache32 » Sun Aug 25, 2019 8:33 pm

an_asker wrote:
Sun Aug 25, 2019 8:27 pm
toofache32 wrote:
Sun Aug 25, 2019 5:59 pm
an_asker wrote:
Sun Aug 25, 2019 5:09 pm
[...]
I seriously doubt he can offer all his patients that level of care while still staying solvent. If not, he should reveal his business model to all doctors!
This is how I run my practice. All my patients have my cell and I call them in the evening to review test results to save them a trip back to the office. I stay solvent because I don't participate in discount plans.
Wow!! :thumbsup :thumbsup

But I really doubt too many doctors are like this - at least, I don't think any of my doctors have been like this in the last three decades (more or less) in the USA!

PS: Yes, I've gotten calls backs from dentists (as have my kids) after major tooth extractions... but definitely not to review test results. In fact, primary doctors have always had me visit to go over blood work results. Now I go by routine, even though it means a co-pay of $40, even though I can see the results (which I previously didn't have access to - I believe this is some new rule that recently got passed) online.
Again, I don't participate in discount plans. Your copay is irrelevant in my office because you pay my fee. I am not the lowest bidder.

an_asker
Posts: 2493
Joined: Thu Jun 27, 2013 2:15 pm

Re: The cost to talk to a doctor

Post by an_asker » Sun Aug 25, 2019 9:58 pm

toofache32 wrote:
Sun Aug 25, 2019 8:33 pm
an_asker wrote:
Sun Aug 25, 2019 8:27 pm
[...]
Wow!! :thumbsup :thumbsup

But I really doubt too many doctors are like this - at least, I don't think any of my doctors have been like this in the last three decades (more or less) in the USA!

PS: Yes, I've gotten calls backs from dentists (as have my kids) after major tooth extractions... but definitely not to review test results. In fact, primary doctors have always had me visit to go over blood work results. Now I go by routine, even though it means a co-pay of $40, even though I can see the results (which I previously didn't have access to - I believe this is some new rule that recently got passed) online.
Again, I don't participate in discount plans. Your copay is irrelevant in my office because you pay my fee. I am not the lowest bidder.
I know about you - you already wrote on another thread that you wok for a hospital where you are in network but in your private practice you don't accept insurance. And anyway, I was talking of a PCP not a dentist.

Dentists are a whole different ballgame. And - this is my personal experience - there is a wider variance in the skill level and (dare I say it) money grabbing desire. Just based on how you operate you are one of the better ones (as is my current dentist).

Heck, just a couple of days ago, Dave Ramsey talked about the dentist he saw three decades ago who suggested $3000 of dental work without which DR would lose his teeth (and apparently, he still sports a full set - including his wisdom teeth ... after he said "buh bye" to that dentist). So, my experience is definitely not unique. But again, remember, we're not talking about you - after all, I'm sure Dave Ramsey did visit some other much more honest dentist - don't think he would tolerate that toothache for three decades! ;-)

an_asker
Posts: 2493
Joined: Thu Jun 27, 2013 2:15 pm

Re: The cost to talk to a doctor

Post by an_asker » Sun Aug 25, 2019 10:05 pm

toofache32 wrote:
Sun Aug 25, 2019 8:06 pm
international001 wrote:
Sun Aug 25, 2019 7:11 pm
graeme wrote:
Sat Aug 24, 2019 8:29 pm
With my previous employer based health insurance, if I wanted to talk to a doctor it would generally cost a $45 copay. My employer now uses a high deductible health plan (HDHP) with a deductible of $12,000. When I called to ask what it would cost to talk to my doctor, they said it depends on what's discussed. When pressed, they said the minimum would be around $150 and it could be more than $600 depending on what we talked about. Any tests ordered would be additional, of course.
I have paid $30 in Greece for 1-2 hours of consultation. They spoke English. Cash.
I guess the only limit to US price is when it becomes cheaper to flight to a place to get the same service.
What does it cost them to provide care?
I don't think the difference is as much due to the cost of providing care as much as it is - in the USA - to recoup the money spent to get the education and training. And also a function of the generally higher wages among the general population. How many folks in Greece have a wage that's equivalent to the minimum wage of $15/hour?

In India too, the fee to consult with a doctor (general practitioner) is the equivalent of a few dollars. But one needs to see that in light of what it costs to make a living there. If you can get a full meal for a couple of bucks (well, not gourmet meals), surely a fee of say $5 for a fifteen minute consult is not really cheap for someone living there? [granted folks in IT - in India also - make way way more than average and for them such a consult would be a pittance]

Turbo29
Posts: 600
Joined: Tue May 01, 2018 7:12 am

Re: The cost to talk to a doctor

Post by Turbo29 » Sun Aug 25, 2019 10:06 pm

GerryL wrote:
Sun Aug 25, 2019 4:47 pm

My experience with the on-call nurse line from an insurance plan was that I was always directed to see a doctor -- quickly -- but maybe that is just because I only called with worrisome symptoms (face getting numb hours after a fall, facial paralysis, among other incidents).
When I got stung by a scorpion my insurance co. advice nurse told me to go to the emergency room immediately. Instead I looked more online and found the advice to call the Arizona Poison Control Center (they field ~2000 to 3000 calls per year for scorpion stings). The poison control nurse just laughed when I told her the insurance co. nurse told me to go to emergency. She actually said, "No, no, no, they always get this wrong." She told me that -if- I started hyper-salivating or twitching I should go and if these symptoms were going to manifest it would be within 6hr. Neither happened, and I was fine. Can only imagine what the emergency room would have cost.

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: The cost to talk to a doctor

Post by toofache32 » Sun Aug 25, 2019 10:09 pm

an_asker wrote:
Sun Aug 25, 2019 9:58 pm
toofache32 wrote:
Sun Aug 25, 2019 8:33 pm
an_asker wrote:
Sun Aug 25, 2019 8:27 pm
[...]
Wow!! :thumbsup :thumbsup

But I really doubt too many doctors are like this - at least, I don't think any of my doctors have been like this in the last three decades (more or less) in the USA!

PS: Yes, I've gotten calls backs from dentists (as have my kids) after major tooth extractions... but definitely not to review test results. In fact, primary doctors have always had me visit to go over blood work results. Now I go by routine, even though it means a co-pay of $40, even though I can see the results (which I previously didn't have access to - I believe this is some new rule that recently got passed) online.
Again, I don't participate in discount plans. Your copay is irrelevant in my office because you pay my fee. I am not the lowest bidder.
I know about you - you already wrote on another thread that you wok for a hospital where you are in network but in your private practice you don't accept insurance. And anyway, I was talking of a PCP not a dentist.

Dentists are a whole different ballgame. And - this is my personal experience - there is a wider variance in the skill level and (dare I say it) money grabbing desire. Just based on how you operate you are one of the better ones (as is my current dentist).

Heck, just a couple of days ago, Dave Ramsey talked about the dentist he saw three decades ago who suggested $3000 of dental work without which DR would lose his teeth (and apparently, he still sports a full set - including his wisdom teeth ... after he said "buh bye" to that dentist). So, my experience is definitely not unique. But again, remember, we're not talking about you - after all, I'm sure Dave Ramsey did visit some other much more honest dentist - don't think he would tolerate that toothache for three decades! ;-)
Nobody here is talking about dentistry. I have an MD and treat medical problems.

an_asker
Posts: 2493
Joined: Thu Jun 27, 2013 2:15 pm

Re: The cost to talk to a doctor

Post by an_asker » Sun Aug 25, 2019 10:15 pm

toofache32 wrote:
Sun Aug 25, 2019 10:09 pm
an_asker wrote:
Sun Aug 25, 2019 9:58 pm
toofache32 wrote:
Sun Aug 25, 2019 8:33 pm
an_asker wrote:
Sun Aug 25, 2019 8:27 pm
[...]
Wow!! :thumbsup :thumbsup

But I really doubt too many doctors are like this - at least, I don't think any of my doctors have been like this in the last three decades (more or less) in the USA!

PS: Yes, I've gotten calls backs from dentists (as have my kids) after major tooth extractions... but definitely not to review test results. In fact, primary doctors have always had me visit to go over blood work results. Now I go by routine, even though it means a co-pay of $40, even though I can see the results (which I previously didn't have access to - I believe this is some new rule that recently got passed) online.
Again, I don't participate in discount plans. Your copay is irrelevant in my office because you pay my fee. I am not the lowest bidder.
I know about you - you already wrote on another thread that you wok for a hospital where you are in network but in your private practice you don't accept insurance. And anyway, I was talking of a PCP not a dentist.

Dentists are a whole different ballgame. And - this is my personal experience - there is a wider variance in the skill level and (dare I say it) money grabbing desire. Just based on how you operate you are one of the better ones (as is my current dentist).

Heck, just a couple of days ago, Dave Ramsey talked about the dentist he saw three decades ago who suggested $3000 of dental work without which DR would lose his teeth (and apparently, he still sports a full set - including his wisdom teeth ... after he said "buh bye" to that dentist). So, my experience is definitely not unique. But again, remember, we're not talking about you - after all, I'm sure Dave Ramsey did visit some other much more honest dentist - don't think he would tolerate that toothache for three decades! ;-)
Nobody here is talking about dentistry. I have an MD and treat medical problems.
My bad - obviously i didn't know enough about you! :sharebeer

Starfish
Posts: 1461
Joined: Wed Aug 15, 2018 6:33 pm

Re: The cost to talk to a doctor

Post by Starfish » Mon Aug 26, 2019 12:00 am

toofache32 wrote:
Sun Aug 25, 2019 8:06 pm
international001 wrote:
Sun Aug 25, 2019 7:11 pm
graeme wrote:
Sat Aug 24, 2019 8:29 pm
With my previous employer based health insurance, if I wanted to talk to a doctor it would generally cost a $45 copay. My employer now uses a high deductible health plan (HDHP) with a deductible of $12,000. When I called to ask what it would cost to talk to my doctor, they said it depends on what's discussed. When pressed, they said the minimum would be around $150 and it could be more than $600 depending on what we talked about. Any tests ordered would be additional, of course.
I have paid $30 in Greece for 1-2 hours of consultation. They spoke English. Cash.
I guess the only limit to US price is when it becomes cheaper to flight to a place to get the same service.
What does it cost them to provide care?
I have many friends in Europe (East and West) doing medicine and dentistry.
The difference in overhead is unbelievable. Much less staff per doctor (for example no complicated insurances to deal with), no costs in education, much less liability.
Also there is no "understanding" that doctors have to make a lot of money. A friend of mine is neurosurgeon in Paris and he owns a VW Passat diesel. No Porsche, not even an entry level Mercedes. Her lives outside the expensive area and he rents. I am pretty sure he makes under 10k Euro net per month.

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: The cost to talk to a doctor

Post by coffeeblack » Mon Aug 26, 2019 12:47 am

TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?

sawhorse
Posts: 3461
Joined: Sun Mar 01, 2015 7:05 pm

Re: The cost to talk to a doctor

Post by sawhorse » Mon Aug 26, 2019 1:15 am

coffeeblack wrote:
Mon Aug 26, 2019 12:47 am
TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?
I'm not TheAccountant, but I would find those rates from a lawyer or CPA ridiculous too for a simple question.

User avatar
ResearchMed
Posts: 9372
Joined: Fri Dec 26, 2008 11:25 pm

Re: The cost to talk to a doctor

Post by ResearchMed » Mon Aug 26, 2019 1:42 am

sawhorse wrote:
Mon Aug 26, 2019 1:15 am
coffeeblack wrote:
Mon Aug 26, 2019 12:47 am
TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?
I'm not TheAccountant, but I would find those rates from a lawyer or CPA ridiculous too for a simple question.
An hour of their time (whichever specialty/profession) is worth the same, regardless of how simple or complex the question... or answer (which may be far more complex than the question seemed).
But it may be that less time is needed for some questions.

RM
This signature is a placebo. You are in the control group.

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: The cost to talk to a doctor

Post by coffeeblack » Mon Aug 26, 2019 1:48 am

sawhorse wrote:
Mon Aug 26, 2019 1:15 am
coffeeblack wrote:
Mon Aug 26, 2019 12:47 am
TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?
I'm not TheAccountant, but I would find those rates from a lawyer or CPA ridiculous too for a simple question.
You presume that your question is simple. In my experience one "simple" question is often a 10 to 20 minute phone conversation with multiple follow up questions. A simple question to a lawyer will cost you the same amount of time and dollars per hour as a complicated question. Time is time. I think the real problem is you don't value the doctors knowledge and expertise and the time it took him/her to get it.

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: The cost to talk to a doctor

Post by coffeeblack » Mon Aug 26, 2019 1:55 am

sawhorse wrote:
Sun Aug 25, 2019 7:09 pm
My experience with a teledoctor consultations was useless. I had a bad cough and was hoping to get some benzonatate as I had used that previously with great success. The doctor told me to go to the emergency room in case it was pneumonia. :annoyed

I think they're so worried about liability that it renders remote consultations useless.
So what would have happened if the teledoc did give you the medication that worked previously except this time you really did have pneumonia? And, because you delayed care for the pneumonia you had to go the ER and be hospitalized for lets say 5 days so you can get IV antibiotics. How annoyed would you be then? See you chose to self diagnose yourself, call the teledoc company and assumed you would get the same medication because it's the same thing you had before (self diagnosis). In reality you didn't know what you had. You only thought you did. That doctor did his/her job exactly right.

sawhorse
Posts: 3461
Joined: Sun Mar 01, 2015 7:05 pm

Re: The cost to talk to a doctor

Post by sawhorse » Mon Aug 26, 2019 2:43 am

coffeeblack wrote:
Mon Aug 26, 2019 1:55 am
sawhorse wrote:
Sun Aug 25, 2019 7:09 pm
My experience with a teledoctor consultations was useless. I had a bad cough and was hoping to get some benzonatate as I had used that previously with great success. The doctor told me to go to the emergency room in case it was pneumonia. :annoyed

I think they're so worried about liability that it renders remote consultations useless.
So what would have happened if the teledoc did give you the medication that worked previously except this time you really did have pneumonia? And, because you delayed care for the pneumonia you had to go the ER and be hospitalized for lets say 5 days so you can get IV antibiotics. How annoyed would you be then? See you chose to self diagnose yourself, call the teledoc company and assumed you would get the same medication because it's the same thing you had before (self diagnosis). In reality you didn't know what you had. You only thought you did. That doctor did his/her job exactly right.
I didn't self diagnose. I had already been diagnosed by an urgent care, and I would have gone to the urgent care again to get a refill if they were open and if there weren't 3 feet of snow on the ground and if I didn't feel so sick.

And no, I would not have been annoyed if it turned out to be pneumonia. I was not annoyed when a previous doctor misdiagnosed me when it turned out I had something that usually only appears later in life. I was never angry at them.

I guess what left a particularly bad impression is that I had typed up a detailed document with my symptoms, what urgent care said/did, a list of current medications, etc. I uploaded it as the website allowed. The doctor asked what was wrong, and I referred him to the file. He responded, exact words, "Hell no, I'm not reading all that." Then he proceeded to ask me questions that were answered on that document, and he got upset when he had trouble understanding because my voice was hoarse.

I think if he had better manners I wouldn't have been so upset with the experience.

By the way, if I had followed his advice to go to the ER in case it was pneumonia, I'm sure the ER doctors would have seen it as unnecessary use of the ER, as they should have.
coffeeblack wrote:
Mon Aug 26, 2019 1:48 am
sawhorse wrote:
Mon Aug 26, 2019 1:15 am
coffeeblack wrote:
Mon Aug 26, 2019 12:47 am
TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?
I'm not TheAccountant, but I would find those rates from a lawyer or CPA ridiculous too for a simple question.
You presume that your question is simple. In my experience one "simple" question is often a 10 to 20 minute phone conversation with multiple follow up questions. A simple question to a lawyer will cost you the same amount of time and dollars per hour as a complicated question. Time is time. I think the real problem is you don't value the doctors knowledge and expertise and the time it took him/her to get it.
How are you concluding that? I mentioned that I talk to a specialist over the phone every few months and pay in cash, and she charges me $75 for 15-20 minutes and $150 for 30 minutes. She's one of the leaders in her field and practices in a very high cost area. If an ordinary doctor without her CV charged $150 for a simple 10 minute question, that would seem excessive.

If you think I don't value a doctor's time at $600 for a consultation unless it lasts hours, you're right. If you think I don't value a doctor's time, you're making false accusations about me. I explicitly said that doctors should be able to bill for telephone time. In addition, I pay cash to see my psychiatrist because I don't want the insurance company finding out about it. The appointments are an hour long and cost $250. One time we accidentally went 15 minutes over time, and I insisted on paying him an extra $50 for that time even though he said he wouldn't charge me for that.

If a lawyer or CPA charged $150 for a simple 10 minute question, I would think they were excessive too.

Anyway, this isn't helping the OP who wants to know prices in advance. You're a physician. Do you have any advice on how s/he can get those prices rather than derailing the thread?
Last edited by sawhorse on Mon Aug 26, 2019 3:16 am, edited 2 times in total.

international001
Posts: 1163
Joined: Thu Feb 15, 2018 7:31 pm

Re: The cost to talk to a doctor

Post by international001 » Mon Aug 26, 2019 3:12 am

an_asker wrote:
Sun Aug 25, 2019 10:05 pm
toofache32 wrote:
Sun Aug 25, 2019 8:06 pm
international001 wrote:
Sun Aug 25, 2019 7:11 pm
graeme wrote:
Sat Aug 24, 2019 8:29 pm
With my previous employer based health insurance, if I wanted to talk to a doctor it would generally cost a $45 copay. My employer now uses a high deductible health plan (HDHP) with a deductible of $12,000. When I called to ask what it would cost to talk to my doctor, they said it depends on what's discussed. When pressed, they said the minimum would be around $150 and it could be more than $600 depending on what we talked about. Any tests ordered would be additional, of course.
I have paid $30 in Greece for 1-2 hours of consultation. They spoke English. Cash.
I guess the only limit to US price is when it becomes cheaper to flight to a place to get the same service.
What does it cost them to provide care?
I don't think the difference is as much due to the cost of providing care as much as it is - in the USA - to recoup the money spent to get the education and training. And also a function of the generally higher wages among the general population. How many folks in Greece have a wage that's equivalent to the minimum wage of $15/hour?

In India too, the fee to consult with a doctor (general practitioner) is the equivalent of a few dollars. But one needs to see that in light of what it costs to make a living there. If you can get a full meal for a couple of bucks (well, not gourmet meals), surely a fee of say $5 for a fifteen minute consult is not really cheap for someone living there? [granted folks in IT - in India also - make way way more than average and for them such a consult would be a pittance]
I'm nor judging. I'm describing.

Same job gets paid differently depending on the job and the friction costs. A taxi driver makes more money in NY than in India because it's a job difficult to export. Doctors less than taxi drivers. Except for emergency care, the extra amount they can charge is limited by health care in other countries plus a few thousand dollars.
Software engineering, for instance, doesn't have high friction costs

international001
Posts: 1163
Joined: Thu Feb 15, 2018 7:31 pm

Re: The cost to talk to a doctor

Post by international001 » Mon Aug 26, 2019 3:16 am

Starfish wrote:
Mon Aug 26, 2019 12:00 am

I have many friends in Europe (East and West) doing medicine and dentistry.
The difference in overhead is unbelievable. Much less staff per doctor (for example no complicated insurances to deal with), no costs in education, much less liability.
Also there is no "understanding" that doctors have to make a lot of money. A friend of mine is neurosurgeon in Paris and he owns a VW Passat diesel. No Porsche, not even an entry level Mercedes. Her lives outside the expensive area and he rents. I am pretty sure he makes under 10k Euro net per month.
Of course. I have paid $1.5k in US for simple pediatric kids antibiotics issue. Few nurses involved, they took the pressure 3 times, multiple rooms, etc. In Europe, you wait for doctor to be available on his desk, and you get a 5-10 minutes consultation.

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: The cost to talk to a doctor

Post by toofache32 » Mon Aug 26, 2019 8:25 am

coffeeblack wrote:
Mon Aug 26, 2019 1:48 am
sawhorse wrote:
Mon Aug 26, 2019 1:15 am
coffeeblack wrote:
Mon Aug 26, 2019 12:47 am
TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?
I'm not TheAccountant, but I would find those rates from a lawyer or CPA ridiculous too for a simple question.
You presume that your question is simple. In my experience one "simple" question is often a 10 to 20 minute phone conversation with multiple follow up questions. A simple question to a lawyer will cost you the same amount of time and dollars per hour as a complicated question. Time is time. I think the real problem is you don't value the doctors knowledge and expertise and the time it took him/her to get it.
This. We are all talking about different things here since we don't know what this mysterious "question" is.

If the question is "is it safe to take my blood pressure medicine with dairy products?" then that's free because it's yes or no.
If the question is "why is my blood pressure high even though I am taking my medicine?" then that's an entire office visit which requires examination, review of current meds, prior meds, dosages, diet, lifestyle, and maybe bloodwork for kidney function and other stuff. But wait...it was just a question, right?

Physicians don't sell widgets. They sell their time and knowledge.

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dm200
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Re: The cost to talk to a doctor

Post by dm200 » Mon Aug 26, 2019 9:40 am

It has been quite a few years since we had this practice for Primary Care - so I don't know if they continued this patient service. I cannot recall all the details, but they had a no charge patient phone call in for the first 30 minutes or so first thing each morning. Since existing patients were calling in, the Physicians had patient records available, if needed.

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Re: The cost to talk to a doctor

Post by chessknt » Mon Aug 26, 2019 10:05 am

People talking about foreign physicians as a way of outsourcing medical advice seem to be ignorant of how highly regulated medical practice is in the USA.

Telemedicine work is still provided by providers licensed in the usa and even overnight radiology using radiologists in Australia are still us-trained physicians.

Physicians with no us licensure or medical training cannot be paid to give medical advice in the USA. The same way any random person can't just be a teacher, nurse, lawyer, accountant, realtor etc without some type of licensure. If you want foreign medical advice/services on the cheap in exchange for no medicolegal protections go to that country and go get it.

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Re: The cost to talk to a doctor

Post by dm200 » Mon Aug 26, 2019 10:07 am

chessknt wrote:
Mon Aug 26, 2019 10:05 am
People talking about foreign physicians as a way of outsourcing medical advice seem to be ignorant of how highly regulated medical practice is in the USA.
Telemedicine work is still provided by providers licensed in the usa and even overnight radiology using radiologists in Australia are still us-trained physicians.
Physicians with no us licensure or medical training cannot be paid to give medical advice in the USA. The same way any random person can't just be a teacher, nurse, lawyer, accountant, realtor etc without some type of licensure. If you want foreign medical advice/services on the cheap in exchange for no medicolegal protections go to that country and go get it.
Thanks for this excellent information.

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Re: The cost to talk to a doctor

Post by coffeeblack » Mon Aug 26, 2019 10:48 am

sawhorse wrote:
Mon Aug 26, 2019 2:43 am
coffeeblack wrote:
Mon Aug 26, 2019 1:55 am
sawhorse wrote:
Sun Aug 25, 2019 7:09 pm
My experience with a teledoctor consultations was useless. I had a bad cough and was hoping to get some benzonatate as I had used that previously with great success. The doctor told me to go to the emergency room in case it was pneumonia. :annoyed

I think they're so worried about liability that it renders remote consultations useless.
So what would have happened if the teledoc did give you the medication that worked previously except this time you really did have pneumonia? And, because you delayed care for the pneumonia you had to go the ER and be hospitalized for lets say 5 days so you can get IV antibiotics. How annoyed would you be then? See you chose to self diagnose yourself, call the teledoc company and assumed you would get the same medication because it's the same thing you had before (self diagnosis). In reality you didn't know what you had. You only thought you did. That doctor did his/her job exactly right.
I didn't self diagnose. I had already been diagnosed by an urgent care, and I would have gone to the urgent care again to get a refill if they were open and if there weren't 3 feet of snow on the ground and if I didn't feel so sick.

And no, I would not have been annoyed if it turned out to be pneumonia. I was not annoyed when a previous doctor misdiagnosed me when it turned out I had something that usually only appears later in life. I was never angry at them.

I guess what left a particularly bad impression is that I had typed up a detailed document with my symptoms, what urgent care said/did, a list of current medications, etc. I uploaded it as the website allowed. The doctor asked what was wrong, and I referred him to the file. He responded, exact words, "Hell no, I'm not reading all that." Then he proceeded to ask me questions that were answered on that document, and he got upset when he had trouble understanding because my voice was hoarse.

I think if he had better manners I wouldn't have been so upset with the experience.

By the way, if I had followed his advice to go to the ER in case it was pneumonia, I'm sure the ER doctors would have seen it as unnecessary use of the ER, as they should have.
coffeeblack wrote:
Mon Aug 26, 2019 1:48 am
sawhorse wrote:
Mon Aug 26, 2019 1:15 am
coffeeblack wrote:
Mon Aug 26, 2019 12:47 am
TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?
I'm not TheAccountant, but I would find those rates from a lawyer or CPA ridiculous too for a simple question.
You presume that your question is simple. In my experience one "simple" question is often a 10 to 20 minute phone conversation with multiple follow up questions. A simple question to a lawyer will cost you the same amount of time and dollars per hour as a complicated question. Time is time. I think the real problem is you don't value the doctors knowledge and expertise and the time it took him/her to get it.
How are you concluding that? I mentioned that I talk to a specialist over the phone every few months and pay in cash, and she charges me $75 for 15-20 minutes and $150 for 30 minutes. She's one of the leaders in her field and practices in a very high cost area. If an ordinary doctor without her CV charged $150 for a simple 10 minute question, that would seem excessive.

If you think I don't value a doctor's time at $600 for a consultation unless it lasts hours, you're right. If you think I don't value a doctor's time, you're making false accusations about me. I explicitly said that doctors should be able to bill for telephone time. In addition, I pay cash to see my psychiatrist because I don't want the insurance company finding out about it. The appointments are an hour long and cost $250. One time we accidentally went 15 minutes over time, and I insisted on paying him an extra $50 for that time even though he said he wouldn't charge me for that.

If a lawyer or CPA charged $150 for a simple 10 minute question, I would think they were excessive too.

Anyway, this isn't helping the OP who wants to know prices in advance. You're a physician. Do you have any advice on how s/he can get those prices rather than derailing the thread?
Fair enough. Thank you for the explanation.

It's hard to get prices in advance because it's hard to know what needs to be done. Also, The front office receptionist or even the office managers are working in an insurance based environment. That complicates things to the tenth degree.

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Re: The cost to talk to a doctor

Post by new2bogle » Mon Aug 26, 2019 10:51 am

OP never came to reply what he or she meant by "talk to a doctor" (at least I didn't see it).

I find it absurd that people complain for only seeing a doctor for a few minutes. We pay for the doctor's expertise, not his or her time. Some appointments may require varying lengths of time for a diagnosis, but for me, the fee has always been the same. Moreover, more than half the doctors I've seen have always stopped and asked me if there is anything else and/or if something needed clarification. A few are rushed (and I don't see them anymore) but mostly they are very good.

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Re: The cost to talk to a doctor

Post by montanagirl » Mon Aug 26, 2019 11:29 am

As has been said, if you just have a question ask it through the patient portal. I've been using mine for years and they always get back with 24 hours. If the doc is on vacation the med asst will tell me.

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Re: The cost to talk to a doctor

Post by Godot » Mon Aug 26, 2019 11:59 am

White Coat Investor wrote:
Sun Aug 25, 2019 4:14 pm
Godot wrote:
Sun Aug 25, 2019 3:54 pm
IngognitoUSA wrote:
Sun Aug 25, 2019 12:33 pm
Just a matter of time before MDLIVE or some one else will use doctors overseas at a fraction the cost. What is stopping an app in India to provide medical consulting to anyone in the world. Doctors Without Borders indeed.
I'm looking forward to this.
I guess I'll just set a computer terminal on the triage desk out in the waiting room. :)

Seriously though, until you've watched someone attempt to care for a complicated, sick patient via telemedicine, you might think this is a viable alternative. I assure you it really isn't. Maybe some radiology and pathology services can be outsourced like that. But anesthesia? Emergency medicine? Surgery? Let's just say none of us are worried about losing our jobs or incomes due to this particular "threat" any time soon.
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
Estragon: I can't go on like this. | Vladimir: That's what you think. | ― Samuel Beckett, Waiting for Godot

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Re: The cost to talk to a doctor

Post by toofache32 » Mon Aug 26, 2019 12:13 pm

Godot wrote:
Mon Aug 26, 2019 11:59 am
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection)...
Oh you would be surprised. VERY surprised.

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dm200
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Re: The cost to talk to a doctor

Post by dm200 » Mon Aug 26, 2019 12:57 pm

Not in the medical field, but I would assume that a qualified Physician dealing with a patient on the phone would expend time and resources - as with an in-office patient. Same for the "qualifications and experience" of a physician. Depending on the details, some costs would be lower - such as minimal facilities usage, no patient preparation from assistant. The amount of time might be less than in person.

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Re: The cost to talk to a doctor

Post by Godot » Mon Aug 26, 2019 5:14 pm

fru-gal wrote:
Sun Aug 25, 2019 5:12 pm
About nurse lines, I have had mixed experiences:

If you get an older nurse, someone with some experience and common sense, they are very useful. If you get a newbie, they'll worry about a lawsuit if they miss something and so they'll tell you to go to the doctor.
I don't understand nurse lines. They cannot prescribe (at least w/EmpirePlan), and their advice, at least in my experience, simply belabors the obvious. I imagine if you know nothing about the human body, and take zero time to learn about it, these lines can be useful. The few times I and my family have used it, the nurse gives generic advice and suggests going to a doctor.
Estragon: I can't go on like this. | Vladimir: That's what you think. | ― Samuel Beckett, Waiting for Godot

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Re: The cost to talk to a doctor

Post by Godot » Mon Aug 26, 2019 5:19 pm

sawhorse wrote:
Mon Aug 26, 2019 1:15 am
coffeeblack wrote:
Mon Aug 26, 2019 12:47 am
TheAccountant wrote:
Sat Aug 24, 2019 9:16 pm
My doctor doesn’t charge anything to communicate using email/patient portal. Obviously you don’t want to be the little boy crying wolf and emailing them every week, but when I’ve been genuinely sick I’ve always talked to them through the portal and they never charged me anything.

IMO I’d try to find a different doctor/practice. $ 150+ just to ask them a question is absurd.
Just out of curiosity. Why do you feel talking (getting medical advice) from a doctor for 150 to 600 dollars is absurd. Lawyers charge from 300 to sometimes 3000. CPA's charge around 150. So why not doctor?
I'm not TheAccountant, but I would find those rates from a lawyer or CPA ridiculous too for a simple question.
+100
Estragon: I can't go on like this. | Vladimir: That's what you think. | ― Samuel Beckett, Waiting for Godot

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Re: The cost to talk to a doctor

Post by White Coat Investor » Mon Aug 26, 2019 7:07 pm

Godot wrote:
Mon Aug 26, 2019 11:59 am
White Coat Investor wrote:
Sun Aug 25, 2019 4:14 pm
Godot wrote:
Sun Aug 25, 2019 3:54 pm
IngognitoUSA wrote:
Sun Aug 25, 2019 12:33 pm
Just a matter of time before MDLIVE or some one else will use doctors overseas at a fraction the cost. What is stopping an app in India to provide medical consulting to anyone in the world. Doctors Without Borders indeed.
I'm looking forward to this.
I guess I'll just set a computer terminal on the triage desk out in the waiting room. :)

Seriously though, until you've watched someone attempt to care for a complicated, sick patient via telemedicine, you might think this is a viable alternative. I assure you it really isn't. Maybe some radiology and pathology services can be outsourced like that. But anesthesia? Emergency medicine? Surgery? Let's just say none of us are worried about losing our jobs or incomes due to this particular "threat" any time soon.
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

toofache32
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Re: The cost to talk to a doctor

Post by toofache32 » Mon Aug 26, 2019 7:18 pm

White Coat Investor wrote:
Mon Aug 26, 2019 7:07 pm
Godot wrote:
Mon Aug 26, 2019 11:59 am
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
So I can take call from home by using something like Skype?
Where can I sign up? Do I have to wear pants?

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Re: Our cost to visit with a doctor/PA

Post by Bogle7 » Mon Aug 26, 2019 9:40 pm

an_asker wrote:
Sun Aug 25, 2019 5:05 pm
This does not sound like an HDHP.
It is. $6K per year for her.
KP CO Bronze 5500/30%/HSA

jayk238
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Re: The cost to talk to a doctor

Post by jayk238 » Mon Aug 26, 2019 10:12 pm

IngognitoUSA wrote:
Sun Aug 25, 2019 6:31 pm
Overseas MD access is inevitable. Corporations are excellent at nudging you that way. The can say
- overnight Doctors only overseas
- your language, only overseas
- lower copay, only overseas
- certain speciality, only overseas
- lower wait time, only overseas.

And finally, if you have no insurance, then affordable access overseas.

As for liability, we as a Nation have waived most of your rights into Arbitration, Medical field is not immune.

Not all doctors will be in 3rd world countries, even first world doctors are more affordable than USA doctors.
Lol is this a farce?

I have so many patients from foreign countries where the management was beyond absurd. Cts and mris for headaches egd for simple heart burns, all sorts of care that is a hodgepodge of various standards. Its beyond belief to think doctors and apps from other nations can meet standardized care. Whatever variations exist here are multiplied when including so many different countries.

I find the antagonistic Comments more telling of the general psyche than actual meaningful commentary.

coffeeblack
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Re: The cost to talk to a doctor

Post by coffeeblack » Mon Aug 26, 2019 10:23 pm

White Coat Investor wrote:
Mon Aug 26, 2019 7:07 pm
Godot wrote:
Mon Aug 26, 2019 11:59 am
White Coat Investor wrote:
Sun Aug 25, 2019 4:14 pm
Godot wrote:
Sun Aug 25, 2019 3:54 pm
IngognitoUSA wrote:
Sun Aug 25, 2019 12:33 pm
Just a matter of time before MDLIVE or some one else will use doctors overseas at a fraction the cost. What is stopping an app in India to provide medical consulting to anyone in the world. Doctors Without Borders indeed.
I'm looking forward to this.
I guess I'll just set a computer terminal on the triage desk out in the waiting room. :)

Seriously though, until you've watched someone attempt to care for a complicated, sick patient via telemedicine, you might think this is a viable alternative. I assure you it really isn't. Maybe some radiology and pathology services can be outsourced like that. But anesthesia? Emergency medicine? Surgery? Let's just say none of us are worried about losing our jobs or incomes due to this particular "threat" any time soon.
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
WOW. Last time I checked I couldn't exam an acute abdomen through the internet. I couldn't even examine an ear. So how is the guy examining someone in the ICU or with a stroke.

TheDDC
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Re: The cost to talk to a doctor

Post by TheDDC » Mon Aug 26, 2019 10:29 pm

Teladoc is a benefit (in addition to traditional medicine on my insurance plan) my employer offers. I have not used it but would generally regard that as the best option to not get reamed (cf. other 10-20 threads dealing with the billing practices of the "face to face" American medical profession) for a simple question.

-TheDDC
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an_asker
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Re: Our cost to visit with a doctor/PA

Post by an_asker » Tue Aug 27, 2019 9:31 am

Bogle7 wrote:
Mon Aug 26, 2019 9:40 pm
an_asker wrote:
Sun Aug 25, 2019 5:05 pm
This does not sound like an HDHP.
It is. $6K per year for her.
KP CO Bronze 5500/30%/HSA
I always learn something new on these forums!! I don't know what the second sentence you wrote means. How much is the premium for the plan and is it available outside of employer? That sounds like a very sweet deal. Most of the HDHP/HSA combos I've read about or experienced have at least $100 co pay. To be honest, it is not a "co pay" it is a "pay" as the insurance pays not a dime! :oops:

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Re: The cost to talk to a doctor

Post by an_asker » Tue Aug 27, 2019 9:35 am

new2bogle wrote:
Mon Aug 26, 2019 10:51 am
OP never came to reply what he or she meant by "talk to a doctor" (at least I didn't see it).

I find it absurd that people complain for only seeing a doctor for a few minutes. We pay for the doctor's expertise, not his or her time. Some appointments may require varying lengths of time for a diagnosis, but for me, the fee has always been the same. Moreover, more than half the doctors I've seen have always stopped and asked me if there is anything else and/or if something needed clarification. A few are rushed (and I don't see them anymore) but mostly they are very good.
Poor OP has decamped!!

Luckywon
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Re: The cost to talk to a doctor

Post by Luckywon » Tue Aug 27, 2019 10:30 am

I am truly amazed at the frequency with which I am asked as a physician how I feel about my job or income being supplanted by telemedicine from India, or comments such as these two below.
IngognitoUSA wrote:
Sun Aug 25, 2019 6:31 pm
Overseas MD access is inevitable. Corporations are excellent at nudging you that way. The can say
- overnight Doctors only overseas
- your language, only overseas
- lower copay, only overseas
- certain speciality, only overseas
- lower wait time, only overseas.

And finally, if you have no insurance, then affordable access overseas.

As for liability, we as a Nation have waived most of your rights into Arbitration, Medical field is not immune.

Not all doctors will be in 3rd world countries, even first world doctors are more affordable than USA doctors.
IngognitoUSA wrote:
Sun Aug 25, 2019 12:33 pm
Just a matter of time before MDLIVE or some one else will use doctors overseas at a fraction the cost. What is stopping an app in India to provide medical consulting to anyone in the world. Doctors Without Borders indeed.
So I can't resist answering here. As noted previously here
ProfLA wrote:
Sun Aug 25, 2019 3:35 pm
A physician must be licensed to practice medicine in the state where the patient is located. Most physicians licensed to practice medicine in the U.S. would expect compensation in line with what they would receive in the U.S.
Just consider with some depth the scenarios if this were not the case. First, as a practical matter, to prescribe a medicine or order an imaging examination or submit an insurance claim, the practitioner must have a license in the state where the service was received. If these issues are legislatively circumvented in some way, and one could receive medical treatment from a physician trained abroad with no U.S. license, then we would be back to the 18th century where we have ceded any meaningful regulation of the practice of medicine. In that case, why would one go to medical school in the U.S. at all? Anyone could just hang up a shingle and start practicing. I'm sure they could find some for-profit institution abroad to send them a medical degree. If not, that seems like such a golden opportunity I might start one myself.

This is not to say telemedicine is not a thriving business. The vast majority of hospitals in the U.S. have their radiology services covered by a teleradiology company. Some of these companies employs hundreds of physicians located around the U.S. and at one time at least, one of the companies had centers in Switzerland and Australia. The reason for this was not to save money. It was because this company was primarily covering nighttime radiology and by having centers in Switzerland and Australia it was possible to cover the U.S. nighttime with physicians working daytime hours abroad. The physicians were compensated in line with radiologists in the United States, licensed in the states they were covering, and credentialed at each hospital they read imaging studies for. (A hospital's credentialing process is another level of rigor beyond requiring state licensure. It also typically includes reviewing criminal and malpractice history, training and practice history and much more.)

Another area where telemedicine is widely practiced in the hospital setting is teleneurology for stroke. The reason for this again is not to save money. On the contrary, it is an expense borne by the hospital that is necessary due to the fact that decisions regarding stroke therapy need to be made within a very short window (think seconds to minutes). The vast majority of hospitals do not have a qualified neurologist in house or available by phone who can make these decisions within the required time window. There are large teleneurology practices who make these decisions based on the imaging findings (often sent directly to them from the scanners) and the clinical data (including physical examination findings) provided by the ED physician.

I am sure the apocryphal tales of non U.S. licensed doctors in India practicing telemedicine in the U.S. will continue but that day is not today and probably not until this earth is so warm that states will have ceased to worry about regulating the practice of medicine.
Last edited by Luckywon on Tue Aug 27, 2019 10:34 am, edited 1 time in total.

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dm200
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Re: The cost to talk to a doctor

Post by dm200 » Tue Aug 27, 2019 10:32 am

an_asker wrote:
Tue Aug 27, 2019 9:35 am
new2bogle wrote:
Mon Aug 26, 2019 10:51 am
OP never came to reply what he or she meant by "talk to a doctor" (at least I didn't see it).
I find it absurd that people complain for only seeing a doctor for a few minutes. We pay for the doctor's expertise, not his or her time. Some appointments may require varying lengths of time for a diagnosis, but for me, the fee has always been the same. Moreover, more than half the doctors I've seen have always stopped and asked me if there is anything else and/or if something needed clarification. A few are rushed (and I don't see them anymore) but mostly they are very good.
Poor OP has decamped!!
Yes .. Using just elapsed time as being equal to value is a big problem. In many cases, it should be the other way around. If an experienced and well educated/trained doctor can correctly diagnose and treat a patient in ten minutes - that should be of more "value" (financial and otherwise) than a less experienced and not as well educated/trained doctor who takes twenty minutes to get to the same point.

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Re: The cost to talk to a doctor

Post by decapod10 » Tue Aug 27, 2019 11:04 am

coffeeblack wrote:
Mon Aug 26, 2019 10:23 pm
White Coat Investor wrote:
Mon Aug 26, 2019 7:07 pm
Godot wrote:
Mon Aug 26, 2019 11:59 am
White Coat Investor wrote:
Sun Aug 25, 2019 4:14 pm
Godot wrote:
Sun Aug 25, 2019 3:54 pm


I'm looking forward to this.
I guess I'll just set a computer terminal on the triage desk out in the waiting room. :)

Seriously though, until you've watched someone attempt to care for a complicated, sick patient via telemedicine, you might think this is a viable alternative. I assure you it really isn't. Maybe some radiology and pathology services can be outsourced like that. But anesthesia? Emergency medicine? Surgery? Let's just say none of us are worried about losing our jobs or incomes due to this particular "threat" any time soon.
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
WOW. Last time I checked I couldn't exam an acute abdomen through the internet. I couldn't even examine an ear. So how is the guy examining someone in the ICU or with a stroke.
typically for a stroke, a Neurologist will examine the patient via video (like FaceTime essentially) along with the help of a nurse or MD (ED or hospitalist) who is with the patient and will perform any maneuvers that the Neurologist requires. The Neurologist will have access to the patient's chart to review any imaging, labs, or medical history.

There are pluses and minues to this approach of course. The biggest advantages are (1) speed and (2) access to remote/small hospitals (3) access to multiple hospitals simultaneously. The time window to treat strokes is limited, so if it takes 30 minutes for the Neurologist to physically get the the hospital, then that's less time that you have. Small hospitals may not have a lot of specialists, so this may be the only thing they have short of transferring the patient to a larger hospital (which takes a lot of time). Also, often 1 doctor covers multiple hospitals, so if there are 2 "strokes" at different locations, then one will be delayed.

The downsides are the that the Neurologist would presumably be more skilled at performing an exam than a general doctor might be.

For "tele-ICU", one example would be where the doctor would have access to all the monitor information (telemetry/vitals, meds, chart, etc) along with video and audio access. Again, most of the management is done with the help of either an MD (like a hospitalist) or nurse (or both) at bedside.

Edit: To add to the initial question, if you tend to ask for a lot of advice from your doctor over phone or e-mail, then it may be more cost effective to join an HMO type organization where doctors are salaried. In those types of practices, telephone calls and emails are typically free or very low copay because it costs the company less to handle an issue over phone vs in person (requires less staff/space).

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: The cost to talk to a doctor

Post by coffeeblack » Tue Aug 27, 2019 12:07 pm

decapod10 wrote:
Tue Aug 27, 2019 11:04 am
coffeeblack wrote:
Mon Aug 26, 2019 10:23 pm
White Coat Investor wrote:
Mon Aug 26, 2019 7:07 pm
Godot wrote:
Mon Aug 26, 2019 11:59 am
White Coat Investor wrote:
Sun Aug 25, 2019 4:14 pm


I guess I'll just set a computer terminal on the triage desk out in the waiting room. :)

Seriously though, until you've watched someone attempt to care for a complicated, sick patient via telemedicine, you might think this is a viable alternative. I assure you it really isn't. Maybe some radiology and pathology services can be outsourced like that. But anesthesia? Emergency medicine? Surgery? Let's just say none of us are worried about losing our jobs or incomes due to this particular "threat" any time soon.
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
WOW. Last time I checked I couldn't exam an acute abdomen through the internet. I couldn't even examine an ear. So how is the guy examining someone in the ICU or with a stroke.
typically for a stroke, a Neurologist will examine the patient via video (like FaceTime essentially) along with the help of a nurse or MD (ED or hospitalist) who is with the patient and will perform any maneuvers that the Neurologist requires. The Neurologist will have access to the patient's chart to review any imaging, labs, or medical history.

There are pluses and minues to this approach of course. The biggest advantages are (1) speed and (2) access to remote/small hospitals (3) access to multiple hospitals simultaneously. The time window to treat strokes is limited, so if it takes 30 minutes for the Neurologist to physically get the the hospital, then that's less time that you have. Small hospitals may not have a lot of specialists, so this may be the only thing they have short of transferring the patient to a larger hospital (which takes a lot of time). Also, often 1 doctor covers multiple hospitals, so if there are 2 "strokes" at different locations, then one will be delayed.

The downsides are the that the Neurologist would presumably be more skilled at performing an exam than a general doctor might be.

For "tele-ICU", one example would be where the doctor would have access to all the monitor information (telemetry/vitals, meds, chart, etc) along with video and audio access. Again, most of the management is done with the help of either an MD (like a hospitalist) or nurse (or both) at bedside.

Edit: To add to the initial question, if you tend to ask for a lot of advice from your doctor over phone or e-mail, then it may be more cost effective to join an HMO type organization where doctors are salaried. In those types of practices, telephone calls and emails are typically free or very low copay because it costs the company less to handle an issue over phone vs in person (requires less staff/space).
That's interesting.

On your last comment. Those calls are free to the HMO but the doctor pays with his time. It's abusive and the HMO's don't care.

decapod10
Posts: 403
Joined: Thu Dec 28, 2017 6:46 pm

Re: The cost to talk to a doctor

Post by decapod10 » Tue Aug 27, 2019 12:13 pm

coffeeblack wrote:
Tue Aug 27, 2019 12:07 pm
decapod10 wrote:
Tue Aug 27, 2019 11:04 am
coffeeblack wrote:
Mon Aug 26, 2019 10:23 pm
White Coat Investor wrote:
Mon Aug 26, 2019 7:07 pm
Godot wrote:
Mon Aug 26, 2019 11:59 am

I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
WOW. Last time I checked I couldn't exam an acute abdomen through the internet. I couldn't even examine an ear. So how is the guy examining someone in the ICU or with a stroke.
typically for a stroke, a Neurologist will examine the patient via video (like FaceTime essentially) along with the help of a nurse or MD (ED or hospitalist) who is with the patient and will perform any maneuvers that the Neurologist requires. The Neurologist will have access to the patient's chart to review any imaging, labs, or medical history.

There are pluses and minues to this approach of course. The biggest advantages are (1) speed and (2) access to remote/small hospitals (3) access to multiple hospitals simultaneously. The time window to treat strokes is limited, so if it takes 30 minutes for the Neurologist to physically get the the hospital, then that's less time that you have. Small hospitals may not have a lot of specialists, so this may be the only thing they have short of transferring the patient to a larger hospital (which takes a lot of time). Also, often 1 doctor covers multiple hospitals, so if there are 2 "strokes" at different locations, then one will be delayed.

The downsides are the that the Neurologist would presumably be more skilled at performing an exam than a general doctor might be.

For "tele-ICU", one example would be where the doctor would have access to all the monitor information (telemetry/vitals, meds, chart, etc) along with video and audio access. Again, most of the management is done with the help of either an MD (like a hospitalist) or nurse (or both) at bedside.

Edit: To add to the initial question, if you tend to ask for a lot of advice from your doctor over phone or e-mail, then it may be more cost effective to join an HMO type organization where doctors are salaried. In those types of practices, telephone calls and emails are typically free or very low copay because it costs the company less to handle an issue over phone vs in person (requires less staff/space).
That's interesting.

On your last comment. Those calls are free to the HMO but the doctor pays with his time. It's abusive and the HMO's don't care.
For sure, there are downsides to allowing access like that to the MD's as well. Many MD's who allow that sort of access would set up a concierge-type practice where the the patient pays $x per year, but then gets expanded access to the doctor. Often in concierge practice, the MD's will give the patient their cell phone number and the patient is allowed to call anytime. That may be another option for a patient if they feel they need to talk to the MD a lot, if OP felt like they needed more access, maybe it would be worth an "annual fee" so to speak.

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: The cost to talk to a doctor

Post by coffeeblack » Tue Aug 27, 2019 12:49 pm

decapod10 wrote:
Tue Aug 27, 2019 12:13 pm
coffeeblack wrote:
Tue Aug 27, 2019 12:07 pm
decapod10 wrote:
Tue Aug 27, 2019 11:04 am
coffeeblack wrote:
Mon Aug 26, 2019 10:23 pm
White Coat Investor wrote:
Mon Aug 26, 2019 7:07 pm


I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
WOW. Last time I checked I couldn't exam an acute abdomen through the internet. I couldn't even examine an ear. So how is the guy examining someone in the ICU or with a stroke.
typically for a stroke, a Neurologist will examine the patient via video (like FaceTime essentially) along with the help of a nurse or MD (ED or hospitalist) who is with the patient and will perform any maneuvers that the Neurologist requires. The Neurologist will have access to the patient's chart to review any imaging, labs, or medical history.

There are pluses and minues to this approach of course. The biggest advantages are (1) speed and (2) access to remote/small hospitals (3) access to multiple hospitals simultaneously. The time window to treat strokes is limited, so if it takes 30 minutes for the Neurologist to physically get the the hospital, then that's less time that you have. Small hospitals may not have a lot of specialists, so this may be the only thing they have short of transferring the patient to a larger hospital (which takes a lot of time). Also, often 1 doctor covers multiple hospitals, so if there are 2 "strokes" at different locations, then one will be delayed.

The downsides are the that the Neurologist would presumably be more skilled at performing an exam than a general doctor might be.

For "tele-ICU", one example would be where the doctor would have access to all the monitor information (telemetry/vitals, meds, chart, etc) along with video and audio access. Again, most of the management is done with the help of either an MD (like a hospitalist) or nurse (or both) at bedside.

Edit: To add to the initial question, if you tend to ask for a lot of advice from your doctor over phone or e-mail, then it may be more cost effective to join an HMO type organization where doctors are salaried. In those types of practices, telephone calls and emails are typically free or very low copay because it costs the company less to handle an issue over phone vs in person (requires less staff/space).
That's interesting.

On your last comment. Those calls are free to the HMO but the doctor pays with his time. It's abusive and the HMO's don't care.
For sure, there are downsides to allowing access like that to the MD's as well. Many MD's who allow that sort of access would set up a concierge-type practice where the the patient pays $x per year, but then gets expanded access to the doctor. Often in concierge practice, the MD's will give the patient their cell phone number and the patient is allowed to call anytime. That may be another option for a patient if they feel they need to talk to the MD a lot, if OP felt like they needed more access, maybe it would be worth an "annual fee" so to speak.
Concierge medicine would solve that problem. Most people don't want to pay the extra fees. If you go to a lawyer and call him, he will start the timer and you will get a bill. People don't value doctors. It gets abusive.

User avatar
dm200
Posts: 22365
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: The cost to talk to a doctor

Post by dm200 » Tue Aug 27, 2019 1:18 pm

Concierge medicine would solve that problem. Most people don't want to pay the extra fees. If you go to a lawyer and call him, he will start the timer and you will get a bill. People don't value doctors. It gets abusive
.

I actually feel the opposite. I value Physicians and medical providers much more highly than most lawyers.

Not only do lawyers start the timer and send a bill - if you have given him/her a retainer/deposit -then he/she will almost certainly expend the hours "researching" your problem until the money runs out.

User avatar
Bogle7
Posts: 315
Joined: Fri May 11, 2018 9:33 am

KP CO Bronze 5500/30%/HSA

Post by Bogle7 » Tue Aug 27, 2019 2:03 pm

an_asker wrote:
Tue Aug 27, 2019 9:31 am
I don't know what the second sentence you wrote means. How much is the premium for the plan and is it available outside of employer?
KP CO Bronze 5500/30%/HSA
Kaiser Permanente
Colorado
Bronze (ObamaCare term)
Annual deductible=$5,500, Annual out-of-pocket maximum=$6,650
30% Coinsurance after deductible
HSA=Health Savings Account

$811/month as she is 62
individual, no employer

User avatar
White Coat Investor
Posts: 14269
Joined: Fri Mar 02, 2007 9:11 pm
Location: Greatest Snow On Earth

Re: The cost to talk to a doctor

Post by White Coat Investor » Tue Aug 27, 2019 2:56 pm

coffeeblack wrote:
Mon Aug 26, 2019 10:23 pm
White Coat Investor wrote:
Mon Aug 26, 2019 7:07 pm
Godot wrote:
Mon Aug 26, 2019 11:59 am
White Coat Investor wrote:
Sun Aug 25, 2019 4:14 pm
Godot wrote:
Sun Aug 25, 2019 3:54 pm


I'm looking forward to this.
I guess I'll just set a computer terminal on the triage desk out in the waiting room. :)

Seriously though, until you've watched someone attempt to care for a complicated, sick patient via telemedicine, you might think this is a viable alternative. I assure you it really isn't. Maybe some radiology and pathology services can be outsourced like that. But anesthesia? Emergency medicine? Surgery? Let's just say none of us are worried about losing our jobs or incomes due to this particular "threat" any time soon.
I could be wrong but I would assume that a "complicated, sick patient" would not choose to use telemedicine (self selection), or if they did their physician would recommend they see someone in person. I don't have a serious condition, so I'm planning to use a telemedicine PCP. Ideal for me. Efficient and time saving.
I love that you think the patient gets a choice. Imagine a scenario where you come into an ER with a stroke. The only neurologist on call is on the other side of a video screen wheeled in by the emergency staff and the neurologist is trying to examine by video.

I bet this is 30% of the ERs in the country right now.

It's starting to happen for ICUs and even hospitalists too.
WOW. Last time I checked I couldn't exam an acute abdomen through the internet. I couldn't even examine an ear. So how is the guy examining someone in the ICU or with a stroke.
"Show me your teeth"
"Raise your right arm and hold it up for 10 seconds. Yes, like Heil Hitler."
"Nurse, can you poke him in the left hand with a sharp broken tongue depressor? Did that feel sharp, sir?"

I'm not kidding. This IS my neurologist on call. This is EXACTLY how it works. And I'm in a "stroke receiving center."

So it's either take my word on what I found on exam, or examine the patient yourself like this to make a decision about whether or not to give TPA.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

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