PCP Wants Full Charge Up Front [Primary Care Physician]

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HIinvestor
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by HIinvestor » Sun Aug 19, 2018 10:14 pm

Definitely explore your options before burning any bridges. In our state, primary care MDs are very tough to find as well.

Turbo29
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Turbo29 » Sun Aug 19, 2018 11:07 pm

mattsm wrote:
Sun Aug 19, 2018 8:47 pm
Speaking of high deductible plans... you can't do the opposite which is get a price up front which drives me nuts. Go to doctor, find out weeks later what you owe for some procedure. It's f-ing nuts!

If you want me to pre-pay $120, then that should be the max possible you owe and I'd be fine with that.
Interestingly I was just at my doctor's and had some blood drawn. One of the persons in the lab asked, "Are you still with xxx insurance?" I replied in the affirmative. The person then produced a printout stating the amount of the charge for the blood tests would not exceed a certain amount. I asked if they needed payment then and they said "No, but his is how much you will be billed for by the lab."

CurlyDave
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by CurlyDave » Sun Aug 19, 2018 11:25 pm

To me, one of the big issues here that has not yet been addressed is what happens when the Dr. office gets the insurance code wrong, or some similar thing, which causes the insurance company to delay or deny the payment.

If only the copay has been collected up front, the Dr. office has a strong incentive to expend the effort necessary to get the insurance company to pay. If the patient has paid completely up front and is waiting for a refund, there is no real incentive for the Dr. office to spend any extra time on the claim. This can easily turn into a complete nightmare for the patient. With the inexperienced patient pitted against the insurance company, which knows every trick in the book to delay, delay and then deny payment. At least if someone in the Dr. office is battling the insurance company it is a more even fight.

I have this kind of thing happen to at least a few insurance claims every year. If you have only paid the copay you barely notice the titanic battle happening under the surface.

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ram
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by ram » Mon Aug 20, 2018 12:07 am

An increasing amount of primary care is now provided by non physicians. ( NP, PA). This is likely to increase in the future. Those patients that value primary care provided by physicians may want to accept inconveniences noted in this thread. Those that find such inconveniences unacceptable certainly do have the option to go elsewhere.

Many primary care physicians are moving to the concierge model.

Those that are staying in the conventional (non concierge) model are trying to get amount owed to them paid fully and in a timely manner. This appears to be the case with the physician under discussion in this thread.
Ram

simas
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by simas » Mon Aug 20, 2018 7:44 am

ram wrote:
Mon Aug 20, 2018 12:07 am
An increasing amount of primary care is now provided by non physicians. ( NP, PA). This is likely to increase in the future. Those patients that value primary care provided by physicians may want to accept inconveniences noted in this thread. Those that find such inconveniences unacceptable certainly do have the option to go elsewhere.

Many primary care physicians are moving to the concierge model.

Those that are staying in the conventional (non concierge) model are trying to get amount owed to them paid fully and in a timely manner. This appears to be the case with the physician under discussion in this thread.
+1. we see this as well - market is segmenting into those who want that model (smaller number of patients, good office experiences because there is lower number of appointments, less full schedule , higher staff to patient ratio) and willing to pay for it vs whose who want to go to places where it is all about transaction volume, you get 15 minutes of the doctor time max, she/he does not know your name , in and out type of approach. again, patients vote with their choices and their dollars...

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by mattsm » Mon Aug 20, 2018 9:34 am

Turbo29 wrote:
Sun Aug 19, 2018 11:07 pm
mattsm wrote:
Sun Aug 19, 2018 8:47 pm
Speaking of high deductible plans... you can't do the opposite which is get a price up front which drives me nuts. Go to doctor, find out weeks later what you owe for some procedure. It's f-ing nuts!

If you want me to pre-pay $120, then that should be the max possible you owe and I'd be fine with that.
Interestingly I was just at my doctor's and had some blood drawn. One of the persons in the lab asked, "Are you still with xxx insurance?" I replied in the affirmative. The person then produced a printout stating the amount of the charge for the blood tests would not exceed a certain amount. I asked if they needed payment then and they said "No, but his is how much you will be billed for by the lab."
I'm on a HDCP and I pay for everything basically every year unless something really bad happens. BUT I can't shop around for services because not a single doctor can tell me what something will cost.

What will this visit cost? They ask what is your co-pay... I say I'm with so and so but I have no co pay just a high deductible. I have even said I'm paying cash and they don't answer.

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dm200
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dm200 » Mon Aug 20, 2018 10:15 am

mattsm wrote:
Sun Aug 19, 2018 8:50 pm
eye.surgeon wrote:
Sun Aug 19, 2018 7:37 pm
dougger5 wrote:
Sun Aug 19, 2018 10:25 am
We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
The fact that this question is even being asked indicates how little people understand about health insurance.

Your doctor files an insurance claim for your visit as a courtesy and convenience to you, so you don't have to do it. By no means are they obligated to do so. If that bothers you, you can certainly switch doctors, but if finding a good primary care doctor that accepts new patients is as difficult as it is in much of the US, good luck.
Except most doctors office CAN'T (or won't) provide pricing up front. I'm fine filing claims and paying things if they provide the pricing. Pricing comes back weeks or days later and you have no idea what you owe if you're on a higher deductible plan. It's insane, I can't shop around or even make informed decisions about my care and the costs.
Yes - this is my understanding and experience as well.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by OSUBucks4Evr » Mon Aug 20, 2018 10:33 am

I have had several appointments with a periodontist over the last 9 months. To my dismay, I discovered at my first appointment that they handle their billing in this manner....make the patient pay the entire cost at the time of the visit, then submit for insurance reimbursement later. I wonder sometimes how they are able to stay in business, because the specialized dental work they do is highly expensive and not everyone can afford to front those costs. As an example, I was there just this past Friday (I'm several appointments into an implant procedure), and they charged $1,955 to my credit card. Ouch!!

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by hudson » Mon Aug 20, 2018 10:52 am

This is a useful and informative discussion....lots of experience and expertise!
If my PCP asked for the payment up front, I would pay it. I'd likely pay more attention to my insurance statements than I do now.
I can afford to pay; I'm retired with good insurance. Ten years ago I might have had a different viewpoint.

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dm200
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dm200 » Mon Aug 20, 2018 11:11 am

To be fair to Physicians, for reasons I do not understand, a large number of patients just do not pay their bills - resulting in lost income and/or increased costs to collect what is owed.

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HueyLD
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by HueyLD » Mon Aug 20, 2018 11:14 am

My own experience with doctor’s office reimbursement of prepaid amount was dismal.

I was told to pay the required copay upfront even though the procedure was preventive and not subject to copay requirement. Well, I did not want to argue with them so I paid what they said to pay. After the insurance was processed and all the bills settled, it was clear that they should not have asked for the copay.

The fun started after I asked for my money back. The practice said that they knew nothing about billing and gave me their outsourced billing company number. The billing company did not answer their phone and I could only leave a message. Weeks went by without call backs even though I left a message every other week. I even sent letters to both the billing company and the practice manager describing my situation. And again I received nothing but silence.

I guess they wanted me to go away so that they could pocket the money they were not entitled to receive. So, I was not happy and decided to dispute the charges with the credit card company. Thank goodness that I paid with a credit card. The credit card company made me jump through the hoops (documented communications with the practice and billing company), but I prevailed at the end.

The above is just my one person experience, but I will never do business with that practice again.

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munemaker
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by munemaker » Mon Aug 20, 2018 11:21 am

OSUBucks4Evr wrote:
Mon Aug 20, 2018 10:33 am
I have had several appointments with a periodontist over the last 9 months. To my dismay, I discovered at my first appointment that they handle their billing in this manner....make the patient pay the entire cost at the time of the visit, then submit for insurance reimbursement later. I wonder sometimes how they are able to stay in business, because the specialized dental work they do is highly expensive and not everyone can afford to front those costs. As an example, I was there just this past Friday (I'm several appointments into an implant procedure), and they charged $1,955 to my credit card. Ouch!!
Yes, I had the same experience with dental implants at an oral surgeon. This doesn't really bother me because they tell you the cost up front and my insurance pays nothing on the implants, except they cover the extraction, if required. So paying up front just avoids a lot of delays and hassles in my situation. Now if my regular dentist did this, I would have a problem with it because insurance pays a substantial part of the bill.

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dm200
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dm200 » Mon Aug 20, 2018 11:25 am

HueyLD wrote:
Mon Aug 20, 2018 11:14 am
My own experience with doctor’s office reimbursement of prepaid amount was dismal.

I was told to pay the required copay upfront even though the procedure was preventive and not subject to copay requirement. Well, I did not want to argue with them so I paid what they said to pay. After the insurance was processed and all the bills settled, it was clear that they should not have asked for the copay.

The fun started after I asked for my money back. The practice said that they knew nothing about billing and gave me their outsourced billing company number. The billing company did not answer their phone and I could only leave a message. Weeks went by without call backs even though I left a message every other week. I even sent letters to both the billing company and the practice manager describing my situation. And again I received nothing but silence.

I guess they wanted me to go away so that they could pocket the money they were not entitled to receive. So, I was not happy and decided to dispute the charges with the credit card company. Thank goodness that I paid with a credit card. The credit card company made me jump through the hoops (documented communications with the practice and billing company), but I prevailed at the end.

The above is just my one person experience, but I will never do business with that practice again.
Yes - this is what I would be concerned about as well.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by hudson » Mon Aug 20, 2018 11:26 am

HueyLD wrote:
Mon Aug 20, 2018 11:14 am
My own experience with doctor’s office reimbursement of prepaid amount was dismal.

I was told to pay the required copay upfront even though the procedure was preventive and not subject to copay requirement. Well, I did not want to argue with them so I paid what they said to pay. After the insurance was processed and all the bills settled, it was clear that they should not have asked for the copay.

The fun started after I asked for my money back. The practice said that they knew nothing about billing and gave me their outsourced billing company number. The billing company did not answer their phone and I could only leave a message. Weeks went by without call backs even though I left a message every other week. I even sent letters to both the billing company and the practice manager describing my situation. And again I received nothing but silence.

I guess they wanted me to go away so that they could pocket the money they were not entitled to receive. So, I was not happy and decided to dispute the charges with the credit card company. Thank goodness that I paid with a credit card. The credit card company made me jump through the hoops (documented communications with the practice and billing company), but I prevailed at the end.

The above is just my one person experience, but I will never do business with that practice again.
Thieves! Good job on the chargeback. It seems like the practice would have done something. It's easier to do the chargeback than to go to small claims court.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Big Dog » Mon Aug 20, 2018 11:31 am

I have a had a HD plan for the past two years (Cigna and Anthem) and in both cases, our ID cards do not show any co-payment, since the answer is that it depends (on the contracted amount). I assume other carriers are doing the same?

btw: just checked my Anthem HD card and it says, 'Office Visit $0'. And that would be correct per the terms of the contract that the provider has with Anthem.
To be fair to Physicians, for reasons I do not understand, a large number of patients just do not pay their bills - resulting in lost income and/or increased costs to collect what is owed.
Sure, but collection issues is true for many professionals/businesses. But in this case, the PCP has a legal contract with the carrier, and I would be shocked if that contract allows for billing up front.

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HueyLD
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by HueyLD » Mon Aug 20, 2018 11:37 am

Yah, I finally received a call back from someone in the billing company after the credit card chargeback but I wasn’t home. The person left a message and it was my turn to not return the call.

I have more than a few family members in health care field and I for one have no desire to not pay my bills. However, I wonder about the screwed up system we have and hope that I will not have to fight so hard again.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by scottgekko » Mon Aug 20, 2018 11:42 am

HueyLD wrote:
Mon Aug 20, 2018 11:14 am
My own experience with doctor’s office reimbursement of prepaid amount was dismal.

I was told to pay the required copay upfront even though the procedure was preventive and not subject to copay requirement. Well, I did not want to argue with them so I paid what they said to pay. After the insurance was processed and all the bills settled, it was clear that they should not have asked for the copay.

The fun started after I asked for my money back. The practice said that they knew nothing about billing and gave me their outsourced billing company number. The billing company did not answer their phone and I could only leave a message. Weeks went by without call backs even though I left a message every other week. I even sent letters to both the billing company and the practice manager describing my situation. And again I received nothing but silence.

I guess they wanted me to go away so that they could pocket the money they were not entitled to receive. So, I was not happy and decided to dispute the charges with the credit card company. Thank goodness that I paid with a credit card. The credit card company made me jump through the hoops (documented communications with the practice and billing company), but I prevailed at the end.

The above is just my one person experience, but I will never do business with that practice again.
I had a similar experience. My wife's company outsourced her department to another company so our insurance changed to the new company's carrier. The out of pocket/deductible amounts already paid were to be bridged.

I went to a scheduled dermatologist appointment. They already had the prior insurance info but due to a system change, everything had to be updated. I didn't have the old insurance card with me so I explained that the old insurance ran through the end of the month, but I also have the new insurance info. This visit should be fully covered as we had already met our deductible and max out of pocket for the year.

Since I didn't have the old insurance info with me, they asked me to pay the full amount - $280 and they would reimburse after the submitted to insurance and confirmed everything. This was in April. They then had my money. I just now got them to agree to refund my money this past Friday.
FOUR MONTHS LATER!

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dknightd » Mon Aug 20, 2018 12:04 pm

Medical billing is a mess. I feel sorry for provider and customer. I blame it on middle people who collect fees, and are unresponsive. I'm not sure how to fix this. I guess the only solution is not not need survives, or have a big emergency fund.

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dm200
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dm200 » Mon Aug 20, 2018 12:21 pm

dknightd wrote:
Mon Aug 20, 2018 12:04 pm
Medical billing is a mess. I feel sorry for provider and customer. I blame it on middle people who collect fees, and are unresponsive. I'm not sure how to fix this. I guess the only solution is not not need survives, or have a big emergency fund.
Sure is! I suspect there are multiple causes. I am SO HAPPY DW and I are now with Kaiser and have almost no problems or errors. Even when there is a very minor billing question or error - it is corrected very promptly. Such billing errors can, perhaps, even harm your health when you get frustrated by the "system".

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dougger5 » Mon Aug 20, 2018 12:50 pm

dknightd wrote:
Mon Aug 20, 2018 12:04 pm
Medical billing is a mess. I feel sorry for provider and customer. I blame it on middle people who collect fees, and are unresponsive. I'm not sure how to fix this. I guess the only solution is not not need survives, or have a big emergency fund.
That seems true for the individual. I know I've been concentrating on our EF situation for the last couple of years for reasons such as this.

As far as fixes on a macro level - I have thoughts, but I'd rather not have the thread locked. Like someone else stated, there are a lot of interesting viewpoints and experiences being related here :D
"I've been ionized, but I'm okay now." -Buckaroo Banzai

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Re: PCP Wants Full Charge Up Front

Post by Poppy1234 » Mon Aug 20, 2018 2:49 pm

letsgobobby wrote:
Sun Aug 19, 2018 11:17 am
dougger5 wrote:
Sun Aug 19, 2018 10:25 am
We have our health insurance through one of the large national outfits, and our plan specifies a co-pay for office visits at the PCP of $20.00. Recently, the PCP announce that effective at a date shortly in the future, they will require $120.00 up front, which will be reimbursed as warranted, presumably after they are reimbursed by insurance.

We are seriously considering finding an alternative provider, but aside from how seriously I view the principle of, in effect, floating them a loan, I'm curious: Can they even do this? If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
I'm a physician and think this is outrageous. It would be fair to require your copay upfront, but no more than that. Really this is a contractual dispute between your doctor and the payer, and if he is not being paid in a timely manner by the insurance company he has options (canceling his contract with insurance company, negotiating with them) that don't involve unilaterally punishing every patient and running some kind of payday loan operation. In essence your doctor is triangulating and it's neither professional nor in my opinion ethical to double bill for services (you, then the insurance company), and only then reimburse one or the other.

I would ask him to reconsider. If he won't I would write him an earnest letter detailing my ethical qualms with his practice. If no movement I would find another doctor and consider a complaint to his insurance company, the state insurance commission, the state licensing board, and his professional organization, if any.
Whoa simmer down please. I think this is a gross overreaction to someone trying to protect their practice. Like others have said, taking a copayment only is floating the patient a loan. If the patient doesn’t like it, they can find another provider with a different payment practice. Contacting the medical board, etc...that’s crazy.

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mrc
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by mrc » Mon Aug 20, 2018 3:53 pm

Many docs are switching to a direct patient care model, where they do not participate in any insurance. And get this: spend all their time practicing medicine. This office may be in such a transition. Wife's Gyn does this. She pays his fee, and walks out with (two copies of) an ICD coded summary and receipt. She files with our insurance, and since office is out of network, we don't get much back for MD, but labs and other tests receive customary coverage. She likes the practice a lot, the fee isn't unreasonable, she pays out of medical spending account, and if/when she tires of having no help from insurance she'll find another. It's the easiest care either of us gets.
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by drawpoker » Mon Aug 20, 2018 7:00 pm

dknightd wrote:
Mon Aug 20, 2018 12:04 pm
Medical billing is a mess. I feel sorry for provider and customer. I blame it on middle people who collect fees, and are unresponsive......
You betcha it is.

Every six months I see the oncologist based out of one of Baltimore's huge, well-known hospitals. And every six months comes a bill that is dated approx. one week after my Plan F has already paid them. Really.
In the beginning (like 6 or 7 years ago :shock: ) I would call the # listed for billing questions, finally get someone, patiently explain they already have my insurance info to bill the excess charges, and, tell them, in fact, You Have Already Been Paid.
They would always be so polite and nice, saying, oh, yes, just ignore that.

Yet, It STILL happens. Every time, like clockwork. I really think their computer system is so mucked up that when they get a payment for me from my Medigap, it somehow triggers something to send out a bill to me for balance owed.
I just gave up long ago. :oops:
Let them waste their paper, ink and postage if they can't figure out how to fix it.

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Re: PCP Wants Full Charge Up Front

Post by letsgobobby » Mon Aug 20, 2018 7:36 pm

Poppy1234 wrote:
Mon Aug 20, 2018 2:49 pm

Whoa simmer down please. I think this is a gross overreaction to someone trying to protect their practice. Like others have said, taking a copayment only is floating the patient a loan. If the patient doesn’t like it, they can find another provider with a different payment practice. Contacting the medical board, etc...that’s crazy.
I absolutely would find another practice and I would never, ever, treat a patient in this manner. Cash only practice, fine. But if I am in network with an insurer, it means I agree to play by those rules, and that means billing insurance first for amounts above copay. Whether strictly demanded by the insurer or not it is the courtesy I would extend to any insured patient who didn't have a documented history of not paying his bill.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by drawpoker » Mon Aug 20, 2018 8:30 pm

Before more people get their shorts in an uproar- it would be helpful to keep in mind this: Everyone acknowledges that the health care system in this country is broken. Badly broken. But nobody seems to know just exactly how to go about fixing it.

It should come as no surprise that we are going to be seeing more and more change, transitions. Just like concierge doctors becoming more and more common, PCPs adopting new (and unwelcome) payment policies. Insurers slashing networks. Or leaving markets.

Who knows what will be next?

Reading the horror stories here almost makes me grateful to be an OleFart on Medicare, clutching Plan F tightly to my chest, and hopefully staying insulated from the problems younger, still-working folks are hassling with. :| :| :( :(

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Rwsawbones » Mon Aug 20, 2018 10:48 pm

You might consider giving the Doc’s office your credit card number and authorizing the office to bill your credit card in the event that the insurer declines coverage. You would still get your interest free loan provided by the MD and the office would be assured of payment. Insurers decline coverage quite frequently and since the doc is not the insured there is no recourse. You the customer of the insurer have leverage to get the insurer to pay. A common trick of insurers is to decline payment until the Time allowed for submission of claims(usually 30-60days) has passed and them decline payment as not before filed as a “clean claim “ within that time. Primary Care Docs run ona very thin margin. A good primary care doc is worth his or her weight in gold who will go to bat for you through the entire medical and hospital system for many decades. (Full disclosure I am a primary care doc age 77. My main reason to stay in practice is to continue to care for my patients whom I had care for many years to decades. My children have long since finished college and had their weddings)

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by toofache32 » Mon Aug 20, 2018 11:06 pm

jalbert wrote:
Sun Aug 19, 2018 5:11 pm
The point of a copay (as opposed to co-insurance) is that the patient responsibility is precisely known and collected at time of service. Because this removes the uncertainty of collecting the patient co-insurance obligation after billing the insurance company, it should in theory result in lower overall costs as the costs don’t have to include a contribution for unpaid bills of other patients.

As such, it is ridiculous to ask for full payment upfront and I’d even think it ought to be a violation of the contract with the insurance company to ask for more than the copay.
The purpose of a copay is to make sure patients have skin in the game and to somewhat limit frivolous visits for a hangnails.

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Re: PCP Wants Full Charge Up Front

Post by toofache32 » Mon Aug 20, 2018 11:17 pm

letsgobobby wrote:
Sun Aug 19, 2018 1:31 pm
mountaingoatcos wrote:
Sun Aug 19, 2018 11:43 am
this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
This is a problem but the solution is to terminate those patients or demand those patients pay upfront for services. There should not be a presumption of guilt no matter how challenging the problem is.
Terminating the deadbeat patients doesn't solve anything, because that money is already lost. There is no way to know who will be a deadbeat and who will not. It has nothing to do with how wealthy the patient is. This is a cultural problem. In the USA, doctors get paid last. You pay your phone bill, your cable TV bill, your Netflix bill first, then you pay the doctor when you get around to it. This is cultural....I know women who gladly pay $100 up front every month for their haircut, but they complain about paying the same for their doctors visit at the time of service? So collecting up front is a viable solution. My office started doing this a few years ago and we found out that the only patients upset were the ones who never intended to pay to begin with. Some patients have "voted with their feet" and gone elsewhere. Which I love because they are saving me the trouble and expense of chasing down a deadbeat.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by toofache32 » Mon Aug 20, 2018 11:27 pm

mattsm wrote:
Sun Aug 19, 2018 8:47 pm
Speaking of high deductible plans... you can't do the opposite which is get a price up front which drives me nuts. Go to doctor, find out weeks later what you owe for some procedure. It's f-ing nuts!

If you want me to pre-pay $120, then that should be the max possible you owe and I'd be fine with that.
I agree. And your doctor agrees too. If only the insurance company would make this information available up front....
Amazing people still think the doctors office knows how much insurance will pay for anything. Did you read the previous post of the doctor who had 600 insurance plans to keep up with?

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Re: PCP Wants Full Charge Up Front

Post by letsgobobby » Mon Aug 20, 2018 11:30 pm

toofache32 wrote:
Mon Aug 20, 2018 11:17 pm
letsgobobby wrote:
Sun Aug 19, 2018 1:31 pm
mountaingoatcos wrote:
Sun Aug 19, 2018 11:43 am
this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
This is a problem but the solution is to terminate those patients or demand those patients pay upfront for services. There should not be a presumption of guilt no matter how challenging the problem is.
Terminating the deadbeat patients doesn't solve anything, because that money is already lost. There is no way to know who will be a deadbeat and who will not. It has nothing to do with how wealthy the patient is. This is a cultural problem. In the USA, doctors get paid last. You pay your phone bill, your cable TV bill, your Netflix bill first, then you pay the doctor when you get around to it. This is cultural....I know women who gladly pay $100 up front every month for their haircut, but they complain about paying the same for their doctors visit at the time of service? So collecting up front is a viable solution. My office started doing this a few years ago and we found out that the only patients upset were the ones who never intended to pay to begin with. Some patients have "voted with their feet" and gone elsewhere. Which I love because they are saving me the trouble and expense of chasing down a deadbeat.
You have now met an upset patient who always pays his bills. I won’t say more on this topic.

toofache32
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by toofache32 » Mon Aug 20, 2018 11:36 pm

OSUBucks4Evr wrote:
Mon Aug 20, 2018 10:33 am
I have had several appointments with a periodontist over the last 9 months. To my dismay, I discovered at my first appointment that they handle their billing in this manner....make the patient pay the entire cost at the time of the visit, then submit for insurance reimbursement later. I wonder sometimes how they are able to stay in business, because the specialized dental work they do is highly expensive and not everyone can afford to front those costs. As an example, I was there just this past Friday (I'm several appointments into an implant procedure), and they charged $1,955 to my credit card. Ouch!!
Dental insurance is an entirely different animal. It's not even insurance, it's a pre-paid gift card with rules on what you can use it for. Most have a yearly max of $1200-1500. And another huge difference is that dental insurance companies actually share their allowed fees with dentists. This is why a dentist can usually tell you what the total cost will be, how much of that cost will be paid by insurance, and how much you will be responsible for. Most people are surprised to learn that medical insurance companies do not share their fee schedule with doctors offices, unless it's a huge hospital group or someone that actually has negotiating power.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by toofache32 » Mon Aug 20, 2018 11:46 pm

Big Dog wrote:
Mon Aug 20, 2018 11:31 am
I have a had a HD plan for the past two years (Cigna and Anthem) and in both cases, our ID cards do not show any co-payment, since the answer is that it depends (on the contracted amount). I assume other carriers are doing the same?

btw: just checked my Anthem HD card and it says, 'Office Visit $0'. And that would be correct per the terms of the contract that the provider has with Anthem.
To be fair to Physicians, for reasons I do not understand, a large number of patients just do not pay their bills - resulting in lost income and/or increased costs to collect what is owed.
Sure, but collection issues is true for many professionals/businesses.
But other businesses have recourse by dinging the deadbeat's credit score. Medical debt is getting less and less important on credit scores.

TravelGeek
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Re: PCP Wants Full Charge Up Front

Post by TravelGeek » Mon Aug 20, 2018 11:50 pm

letsgobobby wrote:
Mon Aug 20, 2018 11:30 pm
You have now met an upset patient who always pays his bills. I won’t say more on this topic.
It might be insightful to read this other thread in parallel:

viewtopic.php?f=2&t=256949

Personally, I wouldn’t be upset about a $120 prepayment. I value my PCP and I know it is often hard to find a good one. The right solution to this problem isn’t for patient and doctor to get into an argument.

toofache32
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Re: PCP Wants Full Charge Up Front

Post by toofache32 » Tue Aug 21, 2018 12:06 am

letsgobobby wrote:
Mon Aug 20, 2018 11:30 pm
toofache32 wrote:
Mon Aug 20, 2018 11:17 pm
letsgobobby wrote:
Sun Aug 19, 2018 1:31 pm
mountaingoatcos wrote:
Sun Aug 19, 2018 11:43 am
this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
This is a problem but the solution is to terminate those patients or demand those patients pay upfront for services. There should not be a presumption of guilt no matter how challenging the problem is.
Terminating the deadbeat patients doesn't solve anything, because that money is already lost. There is no way to know who will be a deadbeat and who will not. It has nothing to do with how wealthy the patient is. This is a cultural problem. In the USA, doctors get paid last. You pay your phone bill, your cable TV bill, your Netflix bill first, then you pay the doctor when you get around to it. This is cultural....I know women who gladly pay $100 up front every month for their haircut, but they complain about paying the same for their doctors visit at the time of service? So collecting up front is a viable solution. My office started doing this a few years ago and we found out that the only patients upset were the ones who never intended to pay to begin with. Some patients have "voted with their feet" and gone elsewhere. Which I love because they are saving me the trouble and expense of chasing down a deadbeat.
You have now met an upset patient who always pays his bills. I won’t say more on this topic.
That's OK, I'll say more. It's a shame the 99% ruin it for the 1%.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by mattsm » Tue Aug 21, 2018 6:38 am

toofache32 wrote:
Mon Aug 20, 2018 11:27 pm
mattsm wrote:
Sun Aug 19, 2018 8:47 pm
Speaking of high deductible plans... you can't do the opposite which is get a price up front which drives me nuts. Go to doctor, find out weeks later what you owe for some procedure. It's f-ing nuts!

If you want me to pre-pay $120, then that should be the max possible you owe and I'd be fine with that.
I agree. And your doctor agrees too. If only the insurance company would make this information available up front....
Amazing people still think the doctors office knows how much insurance will pay for anything. Did you read the previous post of the doctor who had 600 insurance plans to keep up with?
I've asked for cash price too. Still can't answer at many offices.

simas
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by simas » Tue Aug 21, 2018 7:23 am

mattsm wrote:
Tue Aug 21, 2018 6:38 am
I've asked for cash price too. Still can't answer at many offices.
well.. get a different office where you can get an answer.. again, the 'market' (a bunch of self interest independent agents including consumers and providers of these services) is voting and we get significant diversity of options
- medical providers who want to do medicine (vs spending/wasting resources on highing the existing insurance system including spending their time and money to be fighting your insurance) try different models. if they estimated the need wrong and can not provide what we as consumers want to buy , they will have to adjust or go out of business
- consumers that scream of the idea of paying at the time the service is received or look for excuses go find other providers and bring their money there.


Here is an example of our local office - http://www.dupagefamilymedicine.com/billing/ , click self-pay and it would tell you exactly what the costs run.

Miakis
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Miakis » Tue Aug 21, 2018 8:05 am

My doctor stopped accepting insurance, as did my husband's. It sounds like yours should too, given their collections problems.

I understand that the policy seems unfair to you, since you have a low copay, but they wouldn't be implementing this policy if the majority of their patients had low copays. While you aren't unique, you are increasingly rare. It makes more sense for them to have a policy that works for the majority of their patients, rather than a policy for patients who have a decent insurance plan.

Personally, I would call them and ask them if there will be an exception made for you, since your copay is only $20. There's a good chance that since they can confirm your copay on the spot generally, that they will accept the copay payment instead of the full price. If they refuse to make an exception, then you can change doctors. If they say, "Of course, that letter was really only for people with high deductible plans" then you'll know that the policy doesn't impact you.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by SelfEmployed123 » Tue Aug 21, 2018 8:14 am

Miakis wrote:
Tue Aug 21, 2018 8:05 am
My doctor stopped accepting insurance, as did my husband's. It sounds like yours should too, given their collections problems.

I understand that the policy seems unfair to you, since you have a low copay, but they wouldn't be implementing this policy if the majority of their patients had low copays. While you aren't unique, you are increasingly rare. It makes more sense for them to have a policy that works for the majority of their patients, rather than a policy for patients who have a decent insurance plan.

Personally, I would call them and ask them if there will be an exception made for you, since your copay is only $20. There's a good chance that since they can confirm your copay on the spot generally, that they will accept the copay payment instead of the full price. If they refuse to make an exception, then you can change doctors. If they say, "Of course, that letter was really only for people with high deductible plans" then you'll know that the policy doesn't impact you.
This action by your doctor's office is probably not allowed. I consider it to be unethical. In my own private practice my biggest headache with insurance is situations in which the insurance company won't pay or delay paying a legitimate claim. There are also major headaches when people have multiple insurance plans, because then the insurance companies don't always agree who is primary and who is secondary. These headaches are unfortunately part of doing business in health care in America. In no way should this burden be placed on patients. A prior poster had suggested complaining to the doctor, to your insurance company, the state insurance commission, and the physician's licensure board. I think all of those are legitimate courses of action. If I were you I would start with complaining to your insurance company. They may investigate the matter themselves and terminate the physician's contract if there is a violation. The physician's contract with the insurance company almost assuredly forbids this kind of double billing.
"Get what you can, and what you get hold, 'Tis the stone that will turn all your lead into gold." | -Benjamin Franklin

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by hudson » Tue Aug 21, 2018 8:36 am

simas wrote:
Tue Aug 21, 2018 7:23 am

Here is an example of our local office - http://www.dupagefamilymedicine.com/billing/ , click self-pay and it would tell you exactly what the costs run.
I like your system! I'm lucky to have good insurance with a low co-pay...but I really like your à la carte...self pay price list.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dm200 » Tue Aug 21, 2018 9:24 am

HueyLD wrote:
Sun Aug 19, 2018 9:52 pm
To the OP,
I don't know where you live, but be very careful about switching your PCP.
As others have indicated, a good PCP is worth a ton of gold. In addition, there appears to be a shortage of PCPs in many parts of the country and many PCPs do not even accept new patients (including mine).
Our health care system is royally messed up indeed.
While I like my Kaiser PCP very much, if I had to switch - I am satisfied I could find one that I would be happy with.

In this area, there are plenty pf PCPs accepting new patients EXCEPT for Medicare.

A lot depends on the specific area.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by Atgard » Tue Aug 21, 2018 10:11 am

I would much rather know what the price is upfront and pay it at the counter (and possibly get something back from the insurer later as a pleasant surprise), than get some over-inflated bill 2 months later that you forgot about and it's much harder to contest.

I have no problem paying when the service is performed -- my biggest issue in my business (non-medical) is clients who are late or don't pay after I deliver the service. The lack of pricing transparency is a monstrous issue in our current health care system, and this should actually help it. Seeing the price at the counter will help avoid over-billing later.

Simple example, I went to urgent care where prices ranged from $80-$130. They billed me $130 (of course) as "new patient, extended visit." I was not a new patient (half the visit was updating my old address in their system) and the visit was 12 minutes from "time of visit" to "printed at XX:XX" on the receipt. But if they send that off to insurance, or I see it on a bill 2 months later, it's much harder to fight this widespread medical fraud.

Aside from getting random surprise over-bills later, it's a good thing for people to see what medical procedures actually cost. These are not "free" EVEN if you have insurance paying for some/all of it and EVEN if your employer pays some/all of your insurance premium. We need to realize that in the U.S. we collectively pay far more per capita than any other nation on Earth and we all pay for it somehow in higher premiums, lower salary if the employer is paying premiums, higher taxes, etc.

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Re: PCP Wants Full Charge Up Front

Post by GreenGrowTheDollars » Tue Aug 21, 2018 10:56 am

cockersx3 wrote:
Sun Aug 19, 2018 11:10 am
Have not heard of this at doctors, but have occasionally run into situations like this at lab service providers. At one national lab chain, they frequently ask to run my credit card and put a "hold" for list price of service. They can charge it immediately after insurance amount is established.

When this happens, I just politely decline. And they take my blood anyway. Just because they make a request does not mean you need to comply.

If I was the OP, I would just find another doctor. If the physician wants to create a new status quo that is more financially beneficial to him, good for him. But the OP has options too. Maybe if enough patients vote with their feet, the physician will change his kind.
I'm just the opposite. When Quest Diagnostics takes my credit card at the time of draw and then charges it for the $1.29 that is my balance after insurance, I'm happy. Dealing with a bill that small is a hassle I don't need.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by celia » Tue Aug 21, 2018 11:36 am

dougger5 wrote:
Sun Aug 19, 2018 10:25 am
If they accept Company X insurance policies, isn't there a contractual obligation of some sort to abide by the co-pay requirements of Company X's policies?
There's a big difference between "if they accept" and "if they are contracted". Almost everyone will accept payment from anyone who wants to pay your bill (your insurance, your parents, your neighbor, your dog, even you). This is different than following the contract they may (or may not ) have with your insurance company.

Is your doctor/ medical group contracted with the insurance company? If so, call the insurance company to see what they say.

Note that the receptionists and doctors probably won't know (assuming they work for a medical group). Call the insurance to see if they are contracted. Maybe the contract will be discontinued on that date when the new payment rules take effect.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by mattsm » Tue Aug 21, 2018 12:00 pm

simas wrote:
Tue Aug 21, 2018 7:23 am
mattsm wrote:
Tue Aug 21, 2018 6:38 am
I've asked for cash price too. Still can't answer at many offices.
well.. get a different office where you can get an answer.. again, the 'market' (a bunch of self interest independent agents including consumers and providers of these services) is voting and we get significant diversity of options
- medical providers who want to do medicine (vs spending/wasting resources on highing the existing insurance system including spending their time and money to be fighting your insurance) try different models. if they estimated the need wrong and can not provide what we as consumers want to buy , they will have to adjust or go out of business
- consumers that scream of the idea of paying at the time the service is received or look for excuses go find other providers and bring their money there.


Here is an example of our local office - http://www.dupagefamilymedicine.com/billing/ , click self-pay and it would tell you exactly what the costs run.
I don't disagree but I still need to stay in network so whatever I do pay counts against my deductible. I guess thats more of a preference though.

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Re: PCP Wants Full Charge Up Front

Post by kenoryan » Tue Aug 21, 2018 2:57 pm

mountaingoatcos wrote:
Sun Aug 19, 2018 11:43 am
this often has to do with high-deductible health plans. If you have a $20 copay but have not met your deductible, you are responsible for the full amount after any insurance discounts. Some doctors are not collecting any money besides the copay from patients on high-deductible plan because they decide not to pay the bill. I suspect this is why this doctor is doing it, and it is becoming more common.
Bingo!

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by simas » Tue Aug 21, 2018 3:18 pm

mattsm wrote:
Tue Aug 21, 2018 12:00 pm

I don't disagree but I still need to stay in network so whatever I do pay counts against my deductible. I guess thats more of a preference though.
this doctor is in my network so I do not see a contradiction here. the reason why I posted in this conversation originally was

- the 'up front' noise. no, payment (and trivial amount) at time service is rendered. anything else is doctor office fronting me a loan while they have to pay taxes, payroll, salaries for staff, etc.
- the no other models exist , no plenty of choice including example of doctor(s) we go to
- it is not patient responsibility to deal with insurance, absolutely false, it is exactly patients responsibility and patient contract with insurance.


for example, I have a plumber coming in tomorrow to give me a quote for service (water heater install). plumber would expect to get paid at the time procedure is complete and rightfully so. if I chose to file a claim, deal with GEICO or state farm, or deal with nobody, it is not plumbers business or concern and he (in this case) has zero desire of being between me and my insurances, he is trying to provide excellent service and reasonble price so he can get enough business to survive (along with world of mouth)..

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by simas » Tue Aug 21, 2018 3:29 pm

and one more thing - there is severe lack of perspective here complaining about "hardship" of medicine in US, just total immersion into first world arrogance and ignorance which is very sad to see.

in my home state of Tajikistan, if you need a difficult procedure (bypass surgery), you die as it is simply not provided as part of "free medicine". In theory it is available if you want to wait few years once your heart attack starts, in reality it is not available at all. no medicine service is available without paying at each and every step to each and every person involved , from each nurse on the floor, to each doctor, for every drug, for "being watched over" at night ,etc.

there are specialized heart clinics that will do bypass surgery and will do it well, all cash, <$4k. if you have the money, you live. you do not have the money, you die. no credit cards, no insurance companies, no state commissions to complaint to or about, if you do not have cash then you failed to plan better and dead. you may think you are very special and unique and the light of the universe however hundred thousand like you die every day

this is how the bulk of the world lives, think about as you whine and complain about 'broken US system' and this 'awful copay' that is ~1 day of wages on minimal wage..

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by kenoryan » Tue Aug 21, 2018 8:50 pm

Last year I had a dead pine tree in my front yard so I called a tree guy (no education) and he took it down and hauled it away for $800, at his convenience. I watched him as he chopped it down. It took all of 60 minutes to get the pieces into his trailer and he was off. With a check for $800 in his pocket. I wonder why people who whine about having to pay $120 to their doctor (12 years of schooling) who not only has to maintain an office, keep records on a computer, employ people to answer the phone and help take care of patients.

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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by dougger5 » Tue Aug 21, 2018 9:20 pm

simas wrote:
Tue Aug 21, 2018 3:29 pm
...think about as you whine and complain about 'broken US system' and this 'awful copay' that is ~1 day of wages on minimal wage..
kenoryan wrote:
Tue Aug 21, 2018 8:50 pm
...people who whine about having to pay $120 to their doctor (12 years of schooling) who not only has to maintain an office, keep records on a computer, employ people to answer the phone and help take care of patients.
Why do I get the feeling I'm being trolled?

I just asked a simple question...I wasn't expecting a Spanish Inquisition...

:wink:
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Re: PCP Wants Full Charge Up Front [Primary Care Physician]

Post by LadyGeek » Tue Aug 21, 2018 9:33 pm

Please stay focused on the financial aspects.
dougger5 wrote:
Tue Aug 21, 2018 9:20 pm
...I just asked a simple question...I wasn't expecting a Spanish Inquisition...

:wink:
To explain, see this classic British TV show: No one expects the Spanish Inquisition :wink:
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