Posted by allisonm on July 3, 2000, at 20:32:55
In reply to Re: Pdoc dropping insurance and pts., posted by harry b. on July 3, 2000, at 13:31:17
>
> As I said before my psychologist
> wants to charge me his full rate when I've used up
> my allowed # of sessions per my ins. co.
>
> In about 2 hrs I see my pdoc & will ask her the same
> question.This gets complicated. I'm in my third year of therapy. I have an HMO that is failing. They lost $19 million last year. They have requested/forced twice in the last year that the doctors under their plan accept rate cuts.
Under my HMO, the first visit is a $20 co-pay. For every visit thereafter up to 20 visits a year I pay half for the visit, or $56.93. When we've finished the 20 visits that my HMO allows each year, I have to request an Explanation of Benefits from the HMO, pair it with original statements from my doctor that show how much I paid, and send them all to my major medical insurance carrier to prove to it that it now has to cover my visits for the rest of the year. The trouble with this is that the major medical will only pay 40% of each visit, and only then after I have paid the full amount for the visits and submitted my receipts proving such. So after my 20 visits under the HMO at $56.93, I have to pay $140 for each weekly visit of 45-50 minutes (ie, with my HMO he gets paid $113). I send my statements in monthly as I get the monthly receipts, which means I have to lay out approximately $560 a month out of pocket and wait several weeks after the month to get the 40% back. The paperwork with all of this SUCKS, but in my third year of this, I have it down pretty much to a science.
That amount is my largest expense after my mortgage payment. But I could not afford this therapy at all if I didn't have major medical. I know that I am fortunate.
Doctors in my city are starting to drop my HMO. My psychiatrist hates my HMO, but he accepts it. He hates it for a lot of reasons, one of which is their stupid approval process for these visits. He has to file endless paperwork to get their permission to treat me -- usually only getting permission for two visits at a time. But I feel badly that he's having to get paid less just because I have this particular insurance that is forcing pay cuts. I plan to switch to another HMO in the fall. One is a Blue Cross plan, which will cost a little more than the current one, but I figure at least I won't be in danger of my doctor dropping it. The other is an HMO through the university I work for. Because the university owns it, it's dirt cheap if it isn't free and my psychiatrist, who is affiliated with the university and its hospital, is on their physicians list. However my PCP, whom I've seen for 15 years, is not on the list; I'll have to find a new one. So I can pay more than what I'm paying now for the BC HMO, or buy the almost-free university plan. I'm leaning toward going for the dirt-cheap one, keeping my psychiatrist cause I like him a lot, and finding a new PCP on this plan. UGH!!!
So, harrry b., I can empathize a lot and I wonder from your description whether your insurance is similar to mine.
Take care.
Allison
poster:allisonm
thread:38975
URL: http://www.dr-bob.org/babble/20000630/msgs/39235.html