Doctor MIA? Insurance Issues? Maybe the Answer Lies In “Uber”-Style Medicine?

I know laying out this “business side of medicine” seems a trite & boring discussion that no one should care about. But it’s anything but that.  This is something everyone, whether they have chronic illness, rare diseases, or not can relate to & I’m sure find equally frustrating when it’s happened.  How many of us have called to book an appointment with their primary care doctor or specialist & been told (less than nicely, I might add), “Dr. X is no longer with the practice”. Or “Dr. X no longer takes (insert name) insurance.”

With more & more doctors being employed by hospital systems rather than private or group practice, this is a growing concern.  It’s frustrating as a patient to develop a relationship & come to rely on a specialist or primary care doc we trust & then just be nonchalantly told by a staff member that we can no longer see them when calling to book our next appointment.  It used to be that we would receive communications if & when a doctor moved or changed systems but this is no longer the case because to do send such communications now, is considered “stealing” patients.  But guess who pays the ultimate price in this tug of war? It’s the patient. We are more than just a number or dollar sign.

This news article is a bit dated, but as we journalism grads say, the story itself is “evergreen”.  The sad truth is that practice may full well know where the doctor is, but do not want to risk losing patient loads or revenue.  I do sometimes feel for office staff who have to communicate this because I’m sure it’s not easy, especially after the 25th call in a day, but some seem to lack empathy of where the patient is coming from & get downright rude if the patient tries to press for any information or ask any questions.

If one has a rare or chronic illness & was lucky enough to find a doctor willing to work with them or learn more about their  condition(s) & keep up with that, it can be very daunting to have to completely start from scratch with no notice.  This has happened to me more than once.  Likewise, if you’re healthy but find a doctor you feel comfortable with, there’s something to be said for that because not everyone feels that way, but it is something that should be aspired to on all ends.

The first time this happened to me, I knew how to do the detective work to find the doctor. It took me six months, but luckily that doctor (specialist) just changed systems & was still in the area. After I located him, I was able to pick up where we left off with little to no disruption since I was healthy at the time & had another specialist who could step in to help me with any prescription issues or anything that came up in the interim.

Yet, I had to sign release upon release for his prior notes to be transferred over to the new practice, & I was told that he could have faced penalties had he told me in advance he was leaving the other practice (he apologized profusely for it).  So in this case, I blame hospital system bureaucracy for tying the hands of everyone.

I cheated by using my customer service insurance skills to my advantage to find my primary care doctor the second time around.

Most major insurance carrier sites with a doctor that is in-network list the doctors name & NPI number on their site.  I used that NPI to search different sites in an attempt to find the doctor. I tried each month until I was successful.    Unfortunately, the second time this happened, the doctor had moved out of my immediate area, so I was left to shop & start from scratch. But what if he had been out-of-network or I didn’t know where to find an NPI look up tool & had a few months to shop? I could have been in a world of hurt.  Keep in mind, that even with the NPI, it can take a while for the search engines & systems to catch up to provide the new location of said doctor.  Typically this can take anywhere from 3-6 months.

So, left to shop again, I was picky & it took some time, but I did find someone I felt comfortable with. However, I admit I tire of reviewing my history over & over again, even though I do it & know I have to.  I know most doctors are way too busy to keep up with the current research & lack time to know my rare diseases in-depth especially if I’m their only patient. At least if they know enough to have a conversation about research advances, potential trials, or coordinate with my specialists who do more that’s a very strong step & can work with that. I take a lot of onus on myself to communicate & be compliant & proactive; but I admit it gets exhausting.  It’s incredibly difficult because you do build relationships & it can be hard to let go of someone who is both on-the-ball & compassionate.  I’ve been fortunate to have more good experiences than bad but it took awhile.

One can easily be in this situation too if they have to change insurance & then the doctor is no longer in their insurance carrier’s network. However, most physicians I still see are willing to work on that with patients or try to give them advanced notice to make work-arounds.   This happened to me as well a few years back.  Refreshingly, my doctor was very forthcoming about it. He told me he didn’t agree with the decision, but in this case the practice he was with at the time decided to drop because they didn’t like the reimbursements they were getting from that particular carrier.

However, he made special arrangements for his patients through his billing office ahead of time to plan for this.  At the time, I was going through some serious health issues & did not know about transitional or continuation of care benefits or to think to ask my insurance company of instances & language where out-of-network doctors could be considered in network. These are both critical questions to ask for provisions in writing from one’s carrier about. However, in the end it worked out for me because I never did receive a bill for any of those visits & I was able to just pay the regular copay I had been paying when I went in. I respect that, because I know that was a lot of extra work on his part, plus the fact that he was probably working for less by continuing to treat patients like me, but he refused to penalize me for a problem that wasn’t mine to fix.  Yet another bureaucratic entanglement that happens way to often, period. I feed this “inside baseball” now on the insurance aspect so hopefully it can save someone else some grief if it happens to them.

I realize & respect that medicine is a business. However, patients are also a key part of that business & are often finding themselves on the short end of the stick when it comes to the bottomline & are seen as dollars or numbers, rather than people. We understand it, but it can be frustrating to feel like we’re the ones who are constantly bearing the brunt & penalities of these administrative nightmares.

As a closing tangent, I hope that an Uber for healthcare  (as this WSJ article points out) does come along soon. This could potentially solve many of these bureaucratic nightmares for at least routine care issues or at least give a patient an alternative when stuck in the above binds to continue some care without a huge disruption & relatively low cost.

It may even give both doctors & patients more control & freedom to avoid such aggravating bureaucratic situations & be an easier way for doctors to consider remaining in private practice rather than moving to salaried hospital employment (one can at least dream).

It does also have the potential for more similar pitfalls customer service-wise as current models, & some other criticisms. This article highlights many. Yet it’s quite possible that if it’s more person (patient) focused (which at least the start-ups out there trying it out now seem to be) that’s less likely to be an issue & the concept as a whole at least warrants discussion. (Here’s another summation for “geeks” who want to explore more in depth than what I tossed around in this post.)

It will be interesting to see how this plays out.

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