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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by JennyR on July 1, 2000, at 16:44:15
I'm wondering if this is typical, or lousy.
My pdoc is dropping our insurance. I currently see him every 2 months for a $10 co-pay. He says our insurance doesn't pay him enough and he doesn't like the paperwork and hassles. He gets $50 for the 15 minutes from them, and privately he gets $125. He said he's willing to keep me if I pay $50. There are other providers who take my insurance that I could switch to, but I was just wondering, does this seem unprofessional or unkind of him, or just typical. It's not the first time he's mentioned money and not being happy with what insurance pays him.
He also lied to me once when I started seeing on the insurance statements that he was submitting it as psychotherapy instead of medication management. I asked him about it, since I am in therapy elsewhere and only see him for meds. He said some clerk at the insurance company must be putting the wrong code on. He also said, which contradicted that, that the code for medication management only allows for 5 minutes and he spends 15 with me, so he feels entitled to the rate for the psychotherapy code. I found out that it is he who puts the code on, and that it is 15 minutes, not 5, that is the time allotted for the medication management code. When I brought it up to him, I was calling to say there was a problem with the dosage, I also mentioned this and that it bothered me that he had said these things which I know to be untrue. He got very defensive and said "and how many minutes are we spending talking now that I don't get paid for?" I got kind of upset. He then called me back and said he has a memo from the insurance company saying he can use that code and he can FAX it to me to prove it. I told him that wasn't the point, that he had said a clerk at the insurance company was putting the code on, which wasn't true, and that also I know the description for the med management is 15 minutes and he kept saying only 5. He then said "let me look it up, oh yes, it is 15 minutes. Well, I'm sorry for any misunderstandings and I hope we can continue to work together." I stayed with him because he knows meds. I also always thought it was weird that he talks about himself a lot. Tells me what amusement parks he takes his kids to, what trips they take, how his wife feels about where they live, etc. All without my asking.
Anyway, now he's dropping me and others. Unless I want to pay more. Is this ethical?
Posted by ChrisK on July 1, 2000, at 17:23:09
In reply to Pdoc dropping insurance and pts., posted by JennyR on July 1, 2000, at 16:44:15
Moral - definitely not - your treatment as a long term patient should not be compromised by his business sense or lack thereof).
Ethical - borderline - patients should come before business in many situations which includes this one but that doesn't always hold true.
Tacky and uncalled for - definitely -
I hope you are on meds that are working well for you. If that is the case and you have been on them long term then your GP can prescribe the same meds for you. You don't really say if your pdoc is working with you on changing meds but I would guess that if you are only seeing him every other month that you are on a fairly stable regimen.
From the sounds of things I would also wonder if he would treat your case differently than another patient who is paying $125 per visit. If he is that hung up on the money he may not be very quick to call back if there is a problem or schedule an appt quickly. He sounds like he needs a lesson in basic human compassion and ettiquette. Maybe you should print out a copy of the Hipocrattic Oath and bring it to him. He has obviously not read it in a long time.
Posted by danf on July 1, 2000, at 17:52:00
In reply to Re: Pdoc dropping insurance and pts., posted by ChrisK on July 1, 2000, at 17:23:09
Jennny,
Your decision has to be based on your evaluation of the pdoc.
Do you trust him & has he helped you ? Is he competent, etc ?
Now a bit of a rant !
Immoral & unethical ? Crap !
He has not droped the patients. He is dropping a business arrangement with an insurance co. What does this have to do with the Hipp Oath ?
He has offered a discount rate to the patient. What do you want ? Him to do it for nothing ? Do you work for nothing ?
Tacky & uncalled for ? Where does this hyper moral attitude come from ? I am flat out amazed ! Then the conclusion that he provides substandard care based on nothing ! made up out of air !
The pdoc has every right to make a business decision. He has made a generous offer to discount his fees so that old patients can continue to see him. How much more kind & generous can one be ?
Posted by Abby on July 1, 2000, at 18:55:34
In reply to Re: Pdoc dropping insurance and pts., posted by danf on July 1, 2000, at 17:52:00
I don't want to get into a flame war. I probably should have posted under a different subject heading, because now I'm going to try to be fair and balanced. I'll only say a few things. A lot of doctors lie on forms if they think their patient won't get adequate treatment otherwise. I doubt that this is the problem here. So that makles me nervous about him.
The appropriateness of saying stuff about his family is hard to evaliuate without knowing the context. If it's just friendly chit chat about the amusement park before a meeting, then I think it's okay. The fact that you're just seeing him for meds changes things somewhat---more like the relationship with other doctors.I think a limited amount of description from a psychiatrist's life can be all right and helpful. If it's targeted to a particular issue. Say a walk in a park where she watched two children interacting or something like that.
It isn't unethical to want to be paid a certain amount. My question is how much notice did he give you. Doing it all of a sudden seems unprofessional.
I wouldn't stay unless you feel that his medication knowledge was so superb that it was worth the extra money. He wants you to pay a $50 copay above what your insurance reimburses? $125/15 minutes comes out to about $400/hour, since a psychiatrist's hour is 50 minutes (unlike a baker's dozen in that you get less not more). That's a bit steep. Is this guy really worth it?---Abby
Posted by harry b. on July 1, 2000, at 19:41:36
In reply to Pdoc dropping insurance and pts., posted by JennyR on July 1, 2000, at 16:44:15
>He got very defensive and said "and how many minutes
>are we spending talking now that I don't get paid for?"That comment, from a doc, demands an apology. Other-
wise, I'd knock him on his ass and tell him the lesson
was free.
>I also always thought it was weird that he talks about
>himself a lot. Tells me what amusement parks he takes
>his kids to, what trips they take, how his wife feels
>about where they live, etc.If it is during your session, it is inappropriate. If
it is chit chat before or after, it comes down to
how you feel about it. You can control distance
and conversations too.It is his right to decide which insurance programs
he wants to participate in. Offering a reduced rate
to current patients is fair, not immoral or unethical.Your descriptive slant gives the impression you do
not really care much for this guy. So drop him.In a few weeks I will have used up my insurance
plan's quota of sessions with my psychologist. I
asked him several weeks ago what he will then
charge me. He wants his full fee.I believe that is unjust for a current patient. He
is accepting the insurance allowance plus my $10.00
co-pay now. That combined amount would be just.
If I have to pay the full fee, I may shop around.
hb
Posted by shellie on July 1, 2000, at 23:47:40
In reply to Re: Pdoc dropping insurance and pts., posted by harry b. on July 1, 2000, at 19:41:36
I loved my pdoc, but she gave six months notice to say she will no longer be a provider for my insurance, which basically means I must pay her $125 per session (1/2 hour).
I was stable on meds and doing well, so I switched fairly easily to someone else. This January when I took a downward turn, I felt my new pdoc was too conservative--so I left. I tried two other pdocs. It is really stressful to go through med trials. I didn't feel comfortable with either (one had too little information; the other treated me with little respect.)
My old pdoc knew more about meds than anyone I've yet met. She also has always been available by phone as often as I needed for support. So when push came to shove, she's the one I wanted to be with until my meds are stablized again.
You don't even like this guy.
I agree with Abby that unless this guy has something you can't find elsewhere, find someone else. Especially, if, as Chris said you're stable on meds. Are most med appointments 15 minutes? I wouldn't let my pdoc focus on anything but me if I had 15 minutes! And, truthfully, I think 15 minutes isn't worth the time to get to a doctor's appointment, unless you are completely stablized on meds, and then it should be only every three months or so--just so he can reassure himself you haven't turned green or something. Shellie
Posted by paul on July 2, 2000, at 1:29:24
In reply to Pdoc dropping insurance and pts., posted by JennyR on July 1, 2000, at 16:44:15
this guy sounds like a greedy thief whose only concern is his own bloody wallet. what a schmuck!! like he dont git enuf outa you already!! is his med knowledge/lies/timewasting worth what he wants from you?? he oughta pay YOU for continuing to tolerate him! i'd keep him while i look for someone else, and then just leave, no explanations, no goodbyes. just silence. it feels better that way. it's sad that these socalled "professionals" can see thier way clear to treating other people like you've been treated. i'd report him to the state medical board as well-especially re: the insurance runaround/code confusion-and the lies.
pcl
Posted by ksvt on July 2, 2000, at 21:49:30
In reply to Re: Pdoc dropping insurance and pts., posted by paul on July 2, 2000, at 1:29:24
> this guy sounds like a greedy thief whose only concern is his own bloody wallet. what a schmuck!! like he dont git enuf outa you already!! is his med knowledge/lies/timewasting worth what he wants from you?? he oughta pay YOU for continuing to tolerate him! i'd keep him while i look for someone else, and then just leave, no explanations, no goodbyes. just silence. it feels better that way. it's sad that these socalled "professionals" can see thier way clear to treating other people like you've been treated. i'd report him to the state medical board as well-especially re: the insurance runaround/code confusion-and the lies.
> pclI think mental illnesses are so isolating and that it's critical to feel like you have someone in your corner whom you can trust. It sounds like this guy has definitely flunked the trust piece of this and I think you should stop seeing him,
Posted by noa on July 3, 2000, at 11:40:32
In reply to Re: Pdoc dropping insurance and pts., posted by ksvt on July 2, 2000, at 21:49:30
I think psychiatrists are under seige by the managed care industry. It does not allow them to practice real medicine as they used to. There is less and less reimbursement and more pressure to take more and more patients and see them for less time.
Unfortunately, there is a trend in which many psychdocs are not working with insurance anymore. Which leaves the less resourced of us with fewer docs on plans, which means even more difficulty getting appointment time.
I can't tell if your doc as an individual is doing anything of major concern ethically. Perhaps to ensure continuity, stick with your doc for a while. (As I understand it, he was asking you to pay $50, ie, the total fee according to what the insurance was paying him. Would your insurance then reimburse you a percentage of that as out-of-network services? )
However, you could start shopping around to see if there is someone who is on your plan who knows meds and who you like.
You might want to check out the following website, run by the Coalition of Mental Health Professionals and Consumers:
www.nomanagedcare.org
Posted by harry b. on July 3, 2000, at 13:31:17
In reply to Re: Pdoc dropping insurance and pts., posted by noa on July 3, 2000, at 11:40:32
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.
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
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