Concierge-ish medicine
 

I waffled (note to Ye Olde Schoole Dwellares: waffle!! hahahahaa!) about putting this under Current Events, but I decided I don't want a current events/politics discussion so much as more nuts & bolts, what are people doing with this stuff.

In yesterday's snail mail, I learned that my doctor has signed up with Privia Health. To those who haven't heard the term "concierge medicine," this article, which mentions Privia by name, seems a good introduction.

I'm just wondering if anybody else has signed up with any of these outfits. Any other thoughts?

To my situation specifically, my doctor has an independent solo practice and employs two nurse practitioners. In the current climate, I wouldn't have been a bit surprised if he had merged with another practice or sold out to one of the conglomerate systems in the area. I've never been dissatisfied with the level of care, but this is giving me pause. I can see the benefit of the "concierge" model, whether I like it or not. But this Privia setup seems to be a half-assed version of it--to be sure, at half the price ($45/month). I don't know.

Dunno anything about it SteveD. I must say that the $45 is an attractive number though.
Beats the heck out of my $300+ just for me. Oh, and I haven't seen a doctor in over 2 years.

While none of our doctors run on a specific concierge plan or have a retainer-style fee, I can tell you that nowadays I work almost exclusively with doctors who have an up-front hourly rate, during which they spend an actual hour with us, and I have direct email access to them (and they reply in a timely fashion, for free) as well as personal cellphone numbers of a couple (which are for specific purposes and I am not to abuse, but still.)

On the downside, I have to file for the insurance myself, and whether I get any reimbursement is my problem, not theirs. But this style of medical care has been a major, vast, ridiculous improvement on the mainstream model. If you know this doctor and you like him, I'd go for the plan, personally.

Hey Clodfobble, a couple questions. I like how you've described your situation, and it sounds attractive to me too. I am curious about the second part there. I'm sure you're an infinitely better paperwork processor than I am; I'm not even trying to make such a comparison there. But I imagine when you first got into this mode you were less adept at getting the insurance reimbursements and that you're better now. At this (presumably) better level, how much work is involved in the reimbursement/insurance side of your situation?

I don't even know how you'd quantify it. You must be part insurance adjuster, part bill collector, part front office clerk (not counting all the other stuff you do as an amazing parent). It seems you're essentially doing what the front/back office staff is doing in the kind of doctors' offices I'm used to. I just flash my card, pay my copay and then wait. Then see the doctor for a short time then go away.

You are doing much more work. What is that costing you? Or what is that saving you?

It costs me time, plus a little bit of ink and paper, and lots of minutes if I use my cell phone rather than the home phone. Saves me nothing, but it's the only way to see the doctors I want to see. It's not actually much time invested at any given moment, it's about the long-haul persistance.

First, we get a superbill from the doctor's office, which will include the diagnosis codes and CPT codes, because these doctors know we will need that information. (A CPT code indicates what procedure was done, like "office visit established patient," "consultation and medication management," etc. These are standardized by the American Medical Association across all practices, as are the diagnosis codes. They are updated periodically, moreso the diagnosis codes than the CPT codes. This can include really significant changes to the medical understanding of a disease; for example, in October 2010 they released a new codebook that among other things split the diagnosis codes for autism from one code, 299.0, into two codes, 299.00 -- autism current or active, and 299.01 -- autism passive or inactive. They acknowledged kids are recovering, without anyone really noticing.)

The superbill will also include pertinent information like the doctor's tax ID, and their NPI (kind of like a medical license ID number.) With this, we fill in a standardized form, being careful NOT to sign box 13, which would allow payment to go to the doctor. Without the signature, the insurance company pays you instead.

Form only takes about 10 minutes, less if you are very familiar with it. Mail it in, and wait 6 weeks. They'll mail a check, or an explanation of benefits telling you why they didn't pay, or didn't pay as much as you think they should have. Call them back, 15-20 minutes total counting on hold and then talking to someone, tell them why they're wrong, wait another 6 weeks. Repeat as necessary.

Best-case scenario, we float the cost of the visit for 6 weeks and then get everything back minus a standard copay, and over the last few years this has happened maybe 30% of the time. Worst-case scenario, they will continue to bungle the claim in a series of different ways, adding new errors each time an old error is corrected, and ultimately take 9 months and countless phone calls to pay you all of the $5,000 they owe you, in tiny increments. Most fall in the middle, where we get the money relatively quickly, but they say that the "standard cost" for the procedure is less than what our doctor charged, and they're only going to reimburse us the standard cost. The big problem is there aren't many CPT codes to validly indicate the doctor spent a whole hour with you, so we're stuck using codes that inherently indicate 15 minutes of time, and the "standard cost" is already considered to be a quarter-hourly rate, not an hourly rate. Regular doctors won't spend an hour with you even if they want to, because they're not going to get paid for more than 15 minutes.

My beloved childhood physician transitioned to a concierge practice some years ago, and I was no longer able to see him. I loved him dearly and respected his skills (kind of like House, but with a personality and without the vicoden), but I could not afford to go to him.

For Clodfobble:

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More here.