First Do No Harm
By Lisa Cook Bayer
Lisa Bayer, J.D., CCM, Certified Geriatric Care Manager, is President of Life Management Resources, LLC, a private elder care advocacy firm located in northern New Jersey.
So, you are not feeling so well and you call the doctor for an appointment. What’s one of the first things you are asked when you make the appointment with a new doctor (often before the scheduler will even begin looking at availability)? You got it. “What insurance do you have?” And then, if the doctor is a specialist, that is usually followed with “Do you need a referral?”
I get it. In this day where insurance premiums are prohibitive for most families and providers are getting paid cents on the dollar we all have to be concerned with who is going to pay, and how much.
I have the highest regard for physicians. After all, my father wouldn’t be alive today but for the team in New York and Boston that helped facilitate and execute the bone marrow transplant protocol that saved his life over seventeen years ago.
About a month ago we called to make an appointment for a client with a specialist. Let’s call him “Dr. MD.” The receptionist asked all the usual questions about insurance and then made an appointment. Since my client was a new patient of Dr. MD we requested that the office mail any paperwork that needed to be filled out ahead of time in order to save time during the appointment. The receptionist said that wasn’t necessary and that we could easily take care of it the day of the appointment. The same receptionist even called the day before the appointment to confirm. Simple enough, right?
Not so. My client does not drive and ambulates only with assistance. The appointment day arrives and my business partner Heidi, my client, my client’s home health aide and my client’s driver all meet at the office of Dr. MD. They filled out and returned the necessary paper work. Suddenly, the receptionist announces that Dr. MD does not accept my client’s insurance and that to be seen it would be $350 on the spot. Heidi explained that they went over the insurance and that she, the receptionist, specifically confirmed that Dr. MD accepts my client’s insurance. The receptionist stated that she never makes this kind of mistake and that Heidi should put the $350 on her credit card or leave. Heidi offered to lay out $100 since they were all already at the office and while it wasn’t what was discussed it would make sense for the client to be seen. The receptionist refused. When Heidi said they were leaving and asked for the paper work back the receptionist THREW it at her. Can you just imagine this scene? And you may ask (as I did) where was the doctor during all this? Observing. Dr. MD saw and heard the whole thing but never said a word.
I shared this story with a group of friends and something similar—minus the thrown paperwork--happened to one of them (different doctors). She ended up staying for the appointment and agreed to pay out of pocket. I asked her why she did so and she said that while it wasn’t fair she didn’t care about the money and it wasn’t worth the effort for her to reschedule.
In my client’s case, my client appreciated our advocacy and was glad to leave. And, a week later, my client ended up seeing a fabulous new doctor that my client never would have gotten to see if we had in fact paid the $350 to see Dr. MD. It seems things do usually work out for the best.
So what is the lesson here (other than never going back to Dr. MD)? We learned to always try to get things done in writing ahead of time. Whether for yourself, or for an older adult, try to complete and return the paperwork prior to the appointment. If necessary, contact the insurance company to verify that a particular doctor participates and the benefits that will be covered. They say hindsight is 20/20. Unfortunately I understand now why Dr. MD’s receptionist wouldn’t send us the paperwork prior the appointment. I guess they didn’t think that my client would actually refuse to pay $350 and leave without being seen.
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Lisa Bayer, J.D., CCM, Certified Geriatric Care Manager, is President of Life Management Resources, LLC, a private elder care advocacy firm located in northern New Jersey.
So, you are not feeling so well and you call the doctor for an appointment. What’s one of the first things you are asked when you make the appointment with a new doctor (often before the scheduler will even begin looking at availability)? You got it. “What insurance do you have?” And then, if the doctor is a specialist, that is usually followed with “Do you need a referral?”
I get it. In this day where insurance premiums are prohibitive for most families and providers are getting paid cents on the dollar we all have to be concerned with who is going to pay, and how much.
I have the highest regard for physicians. After all, my father wouldn’t be alive today but for the team in New York and Boston that helped facilitate and execute the bone marrow transplant protocol that saved his life over seventeen years ago.
About a month ago we called to make an appointment for a client with a specialist. Let’s call him “Dr. MD.” The receptionist asked all the usual questions about insurance and then made an appointment. Since my client was a new patient of Dr. MD we requested that the office mail any paperwork that needed to be filled out ahead of time in order to save time during the appointment. The receptionist said that wasn’t necessary and that we could easily take care of it the day of the appointment. The same receptionist even called the day before the appointment to confirm. Simple enough, right?
Not so. My client does not drive and ambulates only with assistance. The appointment day arrives and my business partner Heidi, my client, my client’s home health aide and my client’s driver all meet at the office of Dr. MD. They filled out and returned the necessary paper work. Suddenly, the receptionist announces that Dr. MD does not accept my client’s insurance and that to be seen it would be $350 on the spot. Heidi explained that they went over the insurance and that she, the receptionist, specifically confirmed that Dr. MD accepts my client’s insurance. The receptionist stated that she never makes this kind of mistake and that Heidi should put the $350 on her credit card or leave. Heidi offered to lay out $100 since they were all already at the office and while it wasn’t what was discussed it would make sense for the client to be seen. The receptionist refused. When Heidi said they were leaving and asked for the paper work back the receptionist THREW it at her. Can you just imagine this scene? And you may ask (as I did) where was the doctor during all this? Observing. Dr. MD saw and heard the whole thing but never said a word.
I shared this story with a group of friends and something similar—minus the thrown paperwork--happened to one of them (different doctors). She ended up staying for the appointment and agreed to pay out of pocket. I asked her why she did so and she said that while it wasn’t fair she didn’t care about the money and it wasn’t worth the effort for her to reschedule.
In my client’s case, my client appreciated our advocacy and was glad to leave. And, a week later, my client ended up seeing a fabulous new doctor that my client never would have gotten to see if we had in fact paid the $350 to see Dr. MD. It seems things do usually work out for the best.
So what is the lesson here (other than never going back to Dr. MD)? We learned to always try to get things done in writing ahead of time. Whether for yourself, or for an older adult, try to complete and return the paperwork prior to the appointment. If necessary, contact the insurance company to verify that a particular doctor participates and the benefits that will be covered. They say hindsight is 20/20. Unfortunately I understand now why Dr. MD’s receptionist wouldn’t send us the paperwork prior the appointment. I guess they didn’t think that my client would actually refuse to pay $350 and leave without being seen.
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