[*** I'm moving this to a new thread as this is now completely
off-topic from the original thread.  I'm not even sure if this is the
most appropriate Usenet group for such a discussion.  If there is one
more appropriate, please feel free to inform me as such. ***

The original article to which this is being followed-up to can be
found here:
<http://groups.google.com/group/sci.med.vision/browse_thread/thread/1ca532ca17931
36c/e336b67c78d62d8d#e336b67c78d62d8d>]

On Fri, 09 Jun 2006 18:58:58 GMT, "Quick"
<quick7135-news@NOSPAMyahoo.com> wrote:

[snip]

[snip]

[snip]

But see the problem -- they want the convenient fix, but they are
unwilling to pay for it.  Maybe not even unwilling -- they just want
to try and see if they can get it for free.  That was my point.

I am more than happy to make it convenient for patients, but I am
unwilling to do it for free.  I charge for my services.  If a
patient's medical insurance (e.g., PPO for which I am not on the
panel) allows a panel doctor to bill/get reimbursed for such a
service, why would a patient expect I would do it for free?

A patient can go through their HMO (less cost) or go through me (more
convenient).  It is not altruistic to provide "free medical care" for
this patient who has medical insurance, it is catering to the cheap,
lazy patient.

I mean -- that's the reason a person typically has a HMO right?  They
pay less money (upside) for having to jump through the hoops
(downside).  They have to go to a particular general doctor.  They
can't self-refer to a specialist, etc.

I guess such patients want PPO service at HMO prices.

The "quick shot" for, say, dry eyes is for a patient to not go to the
doctor and try over the counter artificial tears.

When you come into the doctor's office with a chief complaint (i.e., a
"non routine eye examination), you want problem(s) evaluated and
solutions offered that you are either unable or not comfortable
solving on your own.  A doctor went to school and makes his living
providing such a service and deserves to be properly compensated for
such.

Maybe I should go back to wearing a white coat like I did when I did
my residency at the VA?  :)

We do that.  We submit claims for PPO medical insurances, especially
when when know and deal with the particular insurance in the past.
Medicare, Blue Cross/Shield, etc. are (typically) easy to deal with in
this way.

What I was writing about was when a patient makes an appointment at
our office for a medical eye problem and has the expectation/
assumption that their well-vision insurance will cover it.  We have to
inform them it won't.  And then when we ask them what their medical
insurance is, they state it is an HMO.  There a ton of different HMOs
around here, and as we aren't on their panel, we don't know the
particulars of how they work.  All we do know is WE aren't on them and
THEY won't reimburse us -- so a patient has two choices: (1)  Go
through us on a cash/fee-for-service basis, or (2)  Go through their
HMO.  All we can tell them is, in general about their HMO, if they
want this problem to be covered under their insurance, they need to
make an appointment with their primary care physician (PCP) who will
evaluate them and make the proper referral.  Many times patients who
end up having a routine eye examination but have an additional medical
eye problem (e.g., dry eye, diabetic retinopathy), we will write a
quick note explaining what we believe the problem to be and who they
should be seen by in an attempt to expedite the process if they choose
not to be seen by us for a non-covered service.

We do what we can, but here is a real life example of a common problem
and I am all ears for a solution different than our current policy.
This happened ALL THE TIME.   Our office is a small one.  At the most,
we have two doctors in the office and two office staff.  No opticians
and no techs doing pretesting.  At other times, there is only two
doctors and one office staff.  Other times still there is only one
doctor and one office staff.

Patient will come into our office with a medical eye problem.  Patient
presents their well-vision insurance information under the assumption
that that is what covers the problem.  Office staff explains that this
problem is not covered under routine vision insurance.  Patient then
presents their medical insurance for unknown XYZ medical plan and is
completely unaware of whether it is a straight PPO (can go to any
doctor), select provider PPO (can go to any doctors, but pays more for
doctor that is out of network), HMO (has to go to HMO doctor), etc.  

Patient then requests that we call the number on the card to see if
they are covered at our office, and the particulars of the plan (e.g.,
deductibles, copays, etc.) just like you and I would slap down a VISA
card to pay for dinner and expect that to take care of the situation.
Office manager is on the phone going through automated messages, being
placed on hold and getting transfered around from insurance
representative to other representative to find out after 20-30 minutes
that the insurance is a HMO.  We then tell the patient, sorry, to be
covered under this, you have to go to your primary care doctor first.
The patient then says "Well that sucks", takes their card and leaves.

Our office manager just spent 20 minutes on the phone finding out that
they can't come here.  Sometimes, she is the only one there besides
the doctor, so she is having to juggle this between other patients
walking in, the other line ringing, etc.

(Why this occurs is because on the patient's well-vision insurance
information, we are listed as a participating doctor.  The vast
majority of patients have no idea their well-vision insurance only
covers routine eye examinations for problems involving basic optical
correction.  These well-vision insurance companies don't make this
distinction clear/obvious enough and the human resource (HR)
department's representatives are, in my opinion, not well informed
enough to most efficiently direct their employee to either the vision
or medical insurance by asking the right questions.)

So we've flat-out had to stop doing it.  We tell patients who present
with any medical insurance that we are unfamiliar with the following:
Patient needs to pay usual & customary fees.  We will then take the
patient's medical insurance information and submit a bill on a HCFA
form to the patient's medical insurance with the proper medical
diagnosis and CPT codes.  And we will fill it out so any check or
reimbursement will be sent directly to the patient.

For some patients, this is acceptable.  Others don't want to take that
"risk".

I suppose we could ask the patient up front, "If your medical
insurance ends up not covering you here, would you still like to be
seen on a 'fee-for-service' basis?"  If they say, "No."  Then we
should say then bluntly, "Then why should we call?  If we call and
your covered, no problem.  If you aren't, then we will just have spent
20 minutes on the phone for nothing.  If you are unwilling to spend 20
minutes on the phone determining your coverage, then why should we?"

** Finally, I would like to say that I really enjoying hearing your
opinion on the subject.  It is very enlightening and informative to
hear this from a patient's perspective.  It is uncomfortable
discussion for this doctor to have with his patients, but very
comfortable to do in an anonymous manner here. **