The rate requests for 2016 marked the first year in which insurers could rely on actual data from exchange enrollees. In many cases, insurers participating in exchanges in other states requested double-digit rate increases. New York is the second-largest state to receive final approval of its rate requests. Earlier this week, California insurance regulators approving an average rate increase of just 4 percent.
To the relief of customers of industry leader Oxford/UnitedHealthcare the rate increase for groups will be 3.9 to 6.5%. Importantly, the rates are a collective average and may range depending on one’s particular health plan. Additionally, Helath Insurers can opt to tweak or remove plans. Reminder: be sure to check back again our site in 30-60 days. Rates will be posted upon Health Insurer’s release. Also 2016 Individual Exchange Marketplace opens Nov 15th.
Individual Market
On average, insurers requested a 10.4 percent increase in health insurance rates for 2016 in the individual market. DFS reduced that average increase more than 30 percent to 7.1 percent – which is below the approximately 8 percent average increase in health care costs.
Starting on January 1, 2016, New York will add a new Basic Health Plan a.k.a ” Essential Health Plan” to the plans that can be purchased by lower income New Yorkers through NY State of Health. Households at or below 150 percent of the federal poverty level ($17,655 for a household of one; $36,375 for a household of four) will have no monthly premium for the Basic Health Plan. Those with slightly higher incomes at 200 percent of the federal poverty level ($23,540 for a household of one; $48,500 for a household of four) will have a low monthly premium of $20 for each adult.
The Basic Health Plan will provide the same covered services as other plans offered on the Marketplace. The Basic Health Plan has no annual deductible and lower copayments, making health care even more affordable for hundreds of thousands of New Yorkers. For example, a person who earns about $20,000 a year and uses moderate health care services including an inpatient hospital stay, prescription drugs and doctor’s visits, will pay about $730 a year for premiums and out-of-pocket costs under the Basic Health Plan in 2016 as compared to about $1,830 in 2015 if they were enrolled in a Qualified Health Plan.
Small Group Market
On average, insurers requested a 14.4 percent increase in health insurance rates for 2015 in the small group market. DFS reduced that average increase by 32 percent to 9.8 percent. A number of small businesses will also be eligible for tax credits that would lower those premium costs even further.
2016 Small Group Rate Actions – Overall Summary
Company
Requested
Approved
Reduction
Aetna Life
23.87%
21.47%
-2.40%
CDPHP HMO*
-19.84%
-19.84%
0.00%
CDPHP UBI*
16.56%
16.56%
0.00%
Emblem HIP*
29.74%
29.74%
0.00%
Empire Assurance
8.70%
3.40%
-5.30%
Empire HMO
9.21%
4.37%
-4.84%
Excellus*
13.90%
10.00%
-3.90%
Health Republic*
20.00%
20.00%
0.00%
HealthNow*
8.06%
0.66%
-7.40%
Independent IHA*
-15.60%
-15.60%
0.00%
Independent IHBC
-6.19%
-6.19%
0.00%
Managed Health
5.60%
3.94%
-1.66%
Metro Plus*
-0.81%
-0.81%
0.00%
MVP Health Plan*
7.28%
6.36%
-0.92%
MVP Services*
16.71%
15.90%
-0.81%
North Shore LIJ*
3.27%
3.27%
0.00%
Oxford OHI
13.61%
6.75%
-6.86%
Oxford OHP
10.58%
3.90%
-6.68%
United UHIC
18.79%
11.61%
-7.18%
All Companies Combined
14.41%
9.80%
-4.61%
You may view the DFS press release, which includes a recap of the increases requested and approved by clicking here.
For specific details on all available health plans in 2015, contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Anyone who has moved has been confronted with the question “How to Order Your Medical Records?”. Requesting your medical records may seem complex at first its simpler than one thinks.
1. Get a HIPAA release form. The federal law known as HIPAA entitles every person the right to access his or her medical records, receive copies of them, and request amendments to them.
2, Select your records. I would make this at least one month no more than 2 months This will give the office plenty of time to get you the records together. Specify the effective date, medical providers name, address, your name, address, medical record number ( you can get this from the staff) any identification numbers; i.e., Social Security Number or insurance ID number.
3. Submit forms. Fill out an authorization form giving one medical provider permission to share your records with another.Mark on that form which types of records you want included. Pay any fees that result.
4. Wait. The turnaround time under HIPAA can be 30 days. Most facilities, however, do not require that much time—many can fulfill a request in five to 10 days. Individual state laws may also dictate how quickly a facility must fulfill a request.
5. Follow up. In an imperfect world things can go wrong. What to do?
If your doctor has moved, you should be able to find your records at the practice she left. If that practice was affiliated with a hospital, the records may be housed within the hospital’s records system.
If your old provider says the records have been sent, but your new doctor’s office hasn’t received them, ask that they be re-sent. Doublecheck to make sure the old provider has the right contact information for your new one. You may find getting someone from your new doctor’s office involved could help. Having a nurse advocate for you, for instance, could put you in a better position.
If you’ve tried everything and are getting nowhere, offer to pick up the records yourself (but be aware that this may cost you), ask to speak with a manager or your doctor directly, or, as a final resort, contact your state medical board to file a complaint. This step is rarely necessary, but even suggesting you’ll have to go this route could get things moving on your request.
The Value of Requesting Your Records
There are many good reasons to request a copy of your medical records. Physicians don’t always share complete patient information or exchange a patient’s health records, so if a patient is seeing a new provider it is beneficial to ensure a copy of their record is sent to the new physician.. Also, it is beneficial for patients or caregivers dealing with multiple doctors and facilities to have all medical records in one place, which can then be used by providers to ensure thorough care.
Reviewing your record is an important way to ensure your provider has complete, correct, and up-to-date information, such as your known allergies. If you find information in your record that is incorrect or that you disagree with, contact the provider’s Health Info Management department.
Finally, it can be good for your health to keep a copy of your medical records, . Keeping an up-to-date copy of your health information will prevent redundant care, like repeat tests, and give all your physicians essential information about your health.
Consumer complaints about receiving inadequate reimbursement from their insurers for medical services that they received outside of a provider network have been answered by New York’s “Emergency Medical Services and Surprise Bills” law. As of March 31, 2015, consumers will have protection from “surprise” medical bills for emergency medical services and certain out-of-network medical services.
The state of affairs today for small business plans offering both in and out of network is an exception with only 2 insurers in Downstate covering out of network at catastrophic high deductible levels. For Individual Marketplace it is even more dire with NO OUT OF NETWORK coverage at all.
The Problem. This has been a pattern in recent years and posted in Out of Control Out of Network Charges (March 2012). According to an investigation report commissioned by Governor Cuomo recognizing the unexpected out-of-network claim problem. Officials say that this is now “an overwhelming amount of consumer complaints.” Some examples cited in the report An Unwelcome Surprise – “a neurosurgeon charged $159,000 for an emergency procedure for which Medicare would have paid only $8,493.” Another example: ” a consumer went to an in-network hospital for gallbladder surgery with a participating surgeon. The consumer was not informed that a non-participating anesthesiologist would be used, and was stuck with a $1,800 bill. Providers are not currently required to disclose before they provide services whether they are in-network.” The average out-of-network radiology bill was 33 times what Medicare pays, officials say.
The blog post goes on to say “Today, 90% of SMB members have in network only benefits but the few remaining consumers are paying for eroding out of network benefits with little transparencies and necessary protection from new out of network billing practices. The NY Dept of Financial services is calling for providers in non-emergency situations to disclose whether or not all services are in-network, what out-of-network charges will be and how much insurers will cover.”
Balance Bill Protection. The long awaited bill passed last April protects patients from out-of-network providers from “balance-billing” consumers for emergency care or when patients can’t choose their doctors. Balance-billing occurs when health workers who don’t accept a patient’s insurance try to collect the difference between their charge and the insurer’s reimbursement.
Provider Disclosure Requirements. Hospitals will now be required to disclose anticipated charges. Patients most often receive these surprise bills in emergency cases, when they can’t choose the doctors who treat them. Its not unusual for a Provider to come into the picture who may read your tests or touch you thats not in network. Under the new law all medical providers will have to notify patients before treatment if they don’t take their insurance. If not, patients will be required to pay only a regular co-pay as if the provider was in network.
Providers will need to provide patients with disclosures of the health plans with which they participate and the names of the providers that may be billing them. They are also required to disclose procedures to follow with the an independent dispute-resolution entity (IDRE) which will be the arbiter of disputes under the law if a patient feels that a bill is inappropriate.
Network Adequacy. While the Affordable Care Act didn’t address surprise bills, the government has imposed network adequacy requirements that prevent health plans from having too few providers, which may reduce the number of cases where patients find themselves inadvertently out-of-network. New York will now require doctors and hospitals to disclose their network status before treatment in non-emergency procedures. Insurers will have to update online provider directories within 15 days of a change.
Prior to the Surprise Bill Law, these network adequacy rules only applied to health maintenance organizations (HMOs) and other “managed care” plans. HMO’s normally have more Provider/Insurer responsibility shifting form the patient. As with most non-HMO plans, however, the responsibility rests with patient to make sure everything is pre-authorized and in network is possible. Starting next month Health plans that are also based on more comprehensive PPO and EPO are also required to be certified as having provider networks that can meet the health needs of their members without having to rely on more expensive out-of network services.
A patient protection law is a welcome respite form the unfair unwelcome surprises out of one’s control. Common sense finally prevails!
WestMed Medical Group has now joined the North Shore LIJ’s insurance – CareConnect Network! This is not a purchase. This partnership expands their footprint and makes CareConnect a compelling fit for individuals and groups located in Westchester. In addition, CareConnect has just announced CareConnect’s Network Expansion! Yale-New Haven Health and all their facilities are now in-network with CareConnect. Tools are available to search for providers with updated expansion to be added shortly.
A combined Hospital Insurance system is an intriguing concept thats not all that new. Pittsburgh’s UPMC has been delivering the same model in Western PA successfully. In NYS an integrated medical approach is new on the other hand and challenging in an open competitive loop. A high quality smaller network that is priced affordably and can offer Patient Concierge like service may be what the market is asking for. They may also be in a better position to manage patient health and Preventative Medicine. For Jan 2015, NSLIJ CareConnect will have a 20% reduction in most regions such as Westchester and NYC. For new rates, benefits and provider listings click – CareConnect NSLIJ
For more information, please
Press Release#
Award-Winning WESTMED Joins CareConnect!
We’re pleased to announce our continued network expansion with the addition of WESTMED Medical Group. With this practice, CareConnect members now have more access in Westchester County:
• 289 physicians in eleven office locations • On-site laboratory and radiology services • Four urgent care centers • Three NCQA recognized programs including the patient-centered medical home and diabetes Stay tuned as we continue to add access for your groups around the CareConnect service area
It’s not about a number … The North Shore-LIJ CareConnect network is built around the North Shore–LIJ Health System, its employed physicians and thousands of select affiliated community providers.
This network is designed to provide you access to the highest quality doctors, so choosing the right provider is worry free.
-17 hospitals, 8,000 providers, and an additional 12,000 contracted providers
-Future expansion includes network in northern NJ, Western CT, and Westchester.
-Partnership with CVS/MinuteClinic to provide basic care outside of the service area.
-New “Tradition” plans put the co-pay first, like we’re used to.
What makes CareConnect unique:
Concierge style service.
Call their customer support, speak with a real person empowered to help.
They’ll even find a doctor, and schedule an appointment, for a time that works for you.
Integrated care.
Low denial rate.
Integrated medical management.
Customer care centers for those who want to stop in and ask questions on their plan, their care, or even payment assistance.
Voluntary Dental,Vision, Life, Accident and Disability
Dental
HealthPass offers four great dental options; Guardian Managed DentalGuard (DMO),Guardian Managed DentalGuard Plus, (DMO), Guardian DentalGuard Preferred (DMO/PPO, and Guardian DentalGuard Preferred Plus (DMO/PPO)). Managed DentalGuard provides you and your family with accessible, quality care. The DentalGuard network is comprised of carefully selected dentists dedicated to delivering personalized In-Network services, with an emphasis on preventive treatment. DentalGuard Preferred combines the freedom of choice of In-Network or Out-of-Network care, although you will typically receive a higher level of benefits and save on out-of-pocket costs if you visit an In-Network dentist.
Guardian VisionGuard provides access to the Davis Vision network. Exams and materials are covered and members can visit any doctor they wish using both In and Out-of-Network benefits. Members have access to to generous discounts including up to 25% off laser vision correction, discounts on glasses and cosmetic enhancements such as tints, special lenses and scratch-resistant coating.
HealthPass makes it easy for employers to offer EverGuard, EverGuard Plus and now the EverGuard Dual Option. Personal protection from Guardian offers Term Life, AD&D and Long Term Disability. The coverage is available on a guaranteed basis, no medical examination and no industry will be excluded. These complete benefit packages are offered with low monthly premiums based on ages.
All employees enrolled in medical coverage have access to this advocacy and assistance company. Registered nurses can help guide members through questions regarding claims, healthcare bills, authorizations, finding doctors and hospitals as well as scheduling specialists. Click herefor additional information.
** Healthpass Renewal Enrollment/Change Form ** – need this form to make changes such as switching plans, insurers, dental, vision, life insurance/disability package before your renewal. You cannot make plan changes midyear.
It’s not about a number … The North Shore-LIJ CareConnect network is built around the North Shore–LIJ Health System, its employed physicians and thousands of select affiliated community providers.
This network is designed to provide you access to the highest quality doctors, so choosing the right provider is worry free.
-17 hospitals, 8,000 providers, and an additional 12,000 contracted providers
-Future expansion includes network in northern NJ, Western CT, and Westchester.
-Partnership with CVS/MinuteClinic to provide basic care outside of the service area.
-New “Tradition” plans put the co-pay first, like we’re used to.
What makes CareConnect unique:
Concierge style service.
Call their customer support, speak with a real person empowered to help.
They’ll even find a doctor, and schedule an appointment, for a time that works for you.
Integrated care.
Low denial rate.
Integrated medical management.
Customer care centers for those who want to stop in and ask questions on their plan, their care, or even payment assistance.
Employers incentivizing fitness by lowering lower insurance premiums in exchange for wearing fitness tracking bracelets. Bloomberg reports that BP Plc drive for occupational wellness offered an employee’s spouse the option “to wear a fitness-tracking bracelet from FitBit Inc. to earn points toward cheaper health insurance,” which is “an example of how companies, facing rising health expenses, are increasingly buying or subsidizing fitness-tracking devices to encourage employees and their dependents to be more fit.
” The article notes that UnitedHealth Group Inc. (UNH), Humana Inc. (HUM), Cigna Corp. (CI) and Highmark Inc. have developed similar programs, in which “consumers wear the device and the activity data is uploaded to an online system so it can be verified to give a person their reward.” The article notes, however, that “the moves also let employers and insurers gather more data about people’s lives, raising questions from privacy advocates,” one of whom notes that “when financial incentives are involved, Dixon said it forces employees’ hands and narrows the question of whether or not they should participate.”
Wear This Device So the Boss Knows You’re Losing Weight
To fight rising medical costs, oil company BP Plc (BP) last year offered Cory Slagle — a 260-pound former football lineman — an unusual way to trim $1,200 from his annual insurance bill.
One option was to wear a fitness-tracking bracelet from Fitbit Inc. to earn points toward cheaper health insurance. With the gadget, the 51-year-old walked more than 1 million steps over several months, wirelessly logging the activity on the device. Twelve months later, Slagle has added to his new exercise regimen by trading burgers for salads and soda for water, dropping 70 pounds (31.8 kilograms) and 10 pant sizes in the process.
“I can see my toes now,” said Slagle, a middle-school administrator whose wife, Kristi, works for BP in Houston. The company’s program, he said, is “pushing me to get off the couch and make the right decisions.”
Slagle’s wife is thrilled with his thinner frame — as is BP. His once-high blood pressure and cholesterol are now in a normal range, significantly lowering BP’s risk of covering treatments related to heart trouble or other medical problems.
Slagle’s experience is an example of how companies, facing rising health expenses, are increasingly buying or subsidizing fitness-tracking devices to encourage employees and their dependents to be more fit. The tactic may reduce corporate health-care costs by encouraging healthier lifestyles, even as companies must overcome a creepy factor and concerns from privacy advocates that employers are prying too deeply into workers’ personal lives.
Source: Cory Slagle via Bloomberg
Cory Slagle wore a fitness-tracking bracelet from FitBit Inc. to earn points toward… Read More
Insurers Too
Apart from BP, insurers includingUnitedHealth Group Inc. (UNH),Humana Inc. (HUM), Cigna Corp. (CI) and Highmark Inc. have also created programs to integrate wearable gadgets into their policies. The aim is to get people more invested in taking care of themselves. Consumers wear the device and the activity data is uploaded to an online system so it can be verified to give a person their reward.
“What employers want is the person to take an active role in their health,” said Dee Brock, who has incorporated wearable devices into wellness programs for Pittsburgh-based HighMark.
Privacy Flags
The adoption of wearable devices by companies and insurers is increasing as spending on corporate wellness incentives has doubled to $594 per employee since 2009, according to a study by Fidelity Investments and National Business Group on Health. Technology is creating new forms of wellness programs to measure whether employees are making improvements, similar to a trend in the car-insurance industry where drivers who put a monitoring sensor on their vehicle can earn lower rates based on how well they are driving, instead of their driving history.
Source: Cory Slagle via Bloomberg
Cory Slagle lost 70 pounds after starting to wear a FitBit given to him by energy…Read More
Yet the moves also let employers and insurers gather more data about people’s lives, raising questions from privacy advocates. Wearable gadgets are advancing beyond tracking steps, with sensors to monitor heart rates, glucose levels, body temperature and other functions.
“The focus on preventive health at the expense of privacy is dangerous,” said Pam Dixon, founder of the World Privacy Forum in San Diego, which focuses on health privacy issues. “Right now it’s tracking steps per day, and the reach isn’t that far with these devices, but in time it will be quite sophisticated.”
When financial incentives are involved, Dixon said it forces employees’ hands and narrows the question of whether or not they should participate. The gathering of health data also opens the door for people to eventually be charged more or less based on the information, she said.
Security Requirements
These are among the ethical questions still to be addressed about the appropriateness of companies tracking the physical activity of employees, said Harry Wang, a researcher for Parks Associates who has been studying the market. With wearable devices, collecting more sensitive information is likely to bring tougher government oversight, he said.
“There will be high levels of privacy, security and compliance requirements,” Wang said. “There will be high expectations from consumers about how the data will be used.”
Companies and insurers said they protect the privacy of people using wearable gadgets, and comply with federal laws that prevent employers from seeing certain health information about employees without consent. The wearable programs are voluntary and often administered by third-party vendors like StayWell, which works with BP.
Aggregated Only
As part of the BP program, employees who use a Fitbit to log 1 million steps earn half of the 1,000 points needed each year to qualify for lower co-pays, deductibles and out-of-pocket health expenses. BP bought 25,000 Fitbit devices for North American employees, including those at refineries and drilling rigs. Points can also be earned by getting an annual physical, taking an online health class and other initiatives.
“We think the device is easy to use, gets people aware of how little they are walking and helps trigger people to get active,” said Karl Dalal, director of health and wellness benefits at BP. “BP doesn’t see any of the data except in the aggregate.”
The market for wearable devices is small — about 2 percent of the 1 billion smartphones shipped globally last year — so creating interest from employers and insurance companies is key to growth. Some 22 million fitness-tracking devices will be sold this year, and 66 million by 2018, with about a third coming from corporate-wellness programs, according to Parks Associates. The incentives an employer or insurance company can offer is a way to keep people using the gadget, instead of throwing it in a drawer once the novelty wears off.
Targeting Businesses
Under the Affordable Care Act, the new national health-care law, companies can spend as much as 30 percent of annual insurance premiums on rewards for healthy behavior.
Technology companies are taking note. Apple Inc. (AAPL), which has new health-tracking software called HealthKit that will be released this year and is said to be developing its own wearable device, has talked with UnitedHealth, the biggest U.S. insurer, and Humana, about its health initiatives, executives at the insurance providers said. The companies wouldn’t provide specifics about the conversations. Apple declined to comment.
Fitbit has a sales force dedicated to pitching employers and insurance companies, and touts software to make it easier to log the activity of workers, down to specific individuals if a company wants, said Amy McDonough, who coordinates deals for Fitbit with companies. Other makers of wearable devices, including Jawbone, Samsung Electronics Co. (005930) and iHealth Lab Inc., have also targeted businesses.
Samsung leads the smart wearable-band market, according to a report today from Canalys. The researcher estimated the wearable band market grew almost eightfold in the first half of 2014 from a year ago.
Insurance Link
Some employers are encouraging the use of wearables without the gadgets being tied to lower insurance rates. Houston Methodist, owner of a chain of hospitals in the Houston area, got about 6,000 Fitbits this year and is offering employees the chance to win $10,000 if they walk more steps than the company’s top executives. Fitbit said it also works with Time Warner Inc. (TWX) and Autodesk Inc. (ADSK)
“Walking alone isn’t going to beat diabetes, but it’s certainly going to help,” said Marc Boom, chief executive officer of Houston Methodist. “Being more active results in better health. That’s indisputable.”
Scotty’s Brewhouse
At Scotty’s Brewhouse in Indianapolis, where the $15 “Big Ass Brewhouse Burger” includes four quarter-pound beef patties and American cheese, owner Scott Wise offers an extra day of vacation for managers at his 11 restaurants who use a Jawbone UP device to log an average of 10,000 steps a day for three months. That has some managers like Brian Winnie exercising more to earn time off for a trip he wants to take to Memphis, Tennessee.
“Outside of work, I picked up riding my bike to add extra steps that way,” Winnie said in an interview.
Despite some early enthusiasm, many companies are waiting to see whether the use of wearables is a fitness fad. No major research has been done that shows the use of these devices leads to lower health-care costs and many employers want to know “if this is something that’s a passing trend or something that has staying power and can have proven results,” said Eric Herbek, who runs digital engagement for Cigna.
The gadgets have been worthwhile for Chris Barbin, CEO of Appirio Inc. in San Francisco. He said about 40 percent of his staff, which numbers around 1,000, participates in a voluntary fitness program that includes uploading their activity with Fitbit.
$300,000 Discount
While health costs weren’t the priority for the program, Barbin said that by sharing the data with the company’s health care provider he negotiated $300,000 off his company’s roughly $5 million in annual insurance costs by showing his staff is getting healthier. He said privacy protections are in place for those who want to keep the data secret. The program has become one of the most popular forums on Appirio’s internal social network, he said.
“We had an initial batch of data about people who had lost weight, and people who had moved from high risk to moderate risk,” he said. “When we could show all that information to our insurer, that’s pretty powerful.”
Kristi Slagle, whose husband slimmed down through BP’s program, isn’t concerned about privacy with the gadgets. She said the program injects more fairness into the system because those who are healthier currently end up shouldering more costs for those who aren’t.
“I like that BP is making people more accountable,” she said.
OK so this may not be the catatonic movie of our favorite State starring Zach Braff and Natalie Portman but just the same Oxford couldn’t resist using the same logical name for the new network. Starting Sept 1, 2014 Oxford will be offering the Oxford Garden State Network on all size NJ group business. The 18,000 Doctor and 65 hospitals network will answer the call for a flexible lower cost plan option.
Judging by the #1 selling plan – Oxford Liberty HMO the market supports a smaller lower cost quality network. Taking the same playbook Oxford unveiled their plan last Friday. The plan will cover members outside NJ only on emergencies. Unlike the Liberty HMO some plans options are non-gated plans not needing referrals to for access to a Specialist Doctor.
The Garden State Network provides access to the 21 New Jersey counties only.The Garden State Network does not provide national access to the UnitedHealthcare Choice Plus network. For NJ 1-50, up to 4 plan options can be selected and the Garden State products can be paired with Liberty and Freedom network options. With this network, employers can select which of the 13, in-network only plan designs available will work best for their needs and for the needs of their employees.
Oxford/United has been purchasing Provider groups since 2011 , see our post UnitedHealthcare Buying Medical Groups? This strategy of late is by no means exclusive to this Insurer but it is worth pointing them out as they are a national leading health Provider and worth paying attention to.
Some highlights of the plan designs available with the Oxford Garden State Network are below:
∙ Routine, in-network preventive care covered at 100 percent
∙ In-network only coverage
∙ Choice between 11 non-gated and two gated plan designs (gated plan designs will require a referral)
∙ Plan designs with copayments, deductible and coinsurance, and Health Savings Accounts (HSA) are available.
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
Painful wait times at the doctor’s office… It’s an old story with few exceptions.
As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (My wife did it once, I think, then she promptly retired from this job.). However, waiting at the pediatrician is not something I have to do. So, I can’t truly empathize with you on this one….
Because you guys know me and know I’m not one to defend the status quo…I’m going to go ahead and defend the status quo a little bit. Or, at least, sound like I am (whether I am or not).
Here are some (in my mind) acceptable reasons why wait times are long:
Scheduling – Doctors, pediatricians specifically, are often over-scheduled. We generally come out of school with the same amount of debt as our doctor friends who have entered more “lucrative” specialties. The only way to make up some of the difference (and pay back our loans) is to see more patients. Thus, patients are scheduled closer together. This normally does not cause problems…but stuff happens.
Emergencies – If you have a doctor with hospital privileges (especially one who goes to deliveries), emergencies will happen. Getting called to a C-section can ruin an entire afternoon for a busy pediatrician. Great partners (like the ones I had in Abilene) will try to pick up the slack while you are gone but it is a strain on the whole system. What about other little “emergencies”? The teenager who reveals during their well child exam that they are depressed and suicidal. The 6-year old getting an MRI for headaches that turn out to have been caused by a brain tumor. Yes, I could assign those conversations to someone else by referring to the ER or the specialist, but wouldn’t you want it to be your pediatrician walking you through that?
Here are some (in my mind) unacceptable reasons why wait times are long:
Too Much Time Out-of-Room for the Doctors – I heard a story once about a doctor whose patients complained that his wait times were too long. He in turn complained to his staff that they were too slow. Come to find out, every morning, before he saw any patients, he sat down at his desk and read the entire paper, cover to cover. He had patients waiting 15 minutes completely ready for him to see but was sitting in the back office. 15 minutes might not be terribly inconvenient but that 15 minutes, on a bad day, will turn into 30-45-60 minutes that could have been avoided. Reading the paper may not be much of a temptation these days, but spending time on the computer doing other stuff is huge. I have to make a point not to be on Facebook, Twitter and other social media during patient care time. I do my social media and blogging before patients arrive and at lunch.
Poor Work-Flow in the Office – In Abilene, I had a very hard working MA and LVN (shout out to Nikea and Beth!) that understood how important this issue was to me. There are other ways to know if work-flow is the problem but one thing is certain: if you can’t see your first patient of the day in time, then there’s something wrong.
Chronic Over-Scheduling – While I do understand the issues related to scheduling, I don’t excuse the doctor for always having a schedule such that they run behind every day. Something can be done.
Now, you can read over this and take it however you want, but keep this in mind: you almost always have a choice in medical care. Unless your child needs a specialist for which there is only one in town or you live in such a rural area that there is only one provider, you have a choice. When we make any choice, we prioritize what’s important…someone might choose to see a doctor they love and tolerate the fact that their wait times are longer (but continue to complain on Facebook about it-I get it, it’s ok). Other people might drive more miles to see one they love. The choice still lies in the hands of the parents.
Ultimately, waiting anywhere is hard. Waiting in the doctor’s office is especially hard when you have a sick child, no one slept the night before, and the only appointment available was right in the middle of nap time.
I promise to keep working on those things that I can do in order to shorten your wait time and you can stay tuned for tomorrow’s post:
Justin Smith is a pediatrician who blogs at DoctorJSmith. He can be reached on Twitter @TheDocSmitty.
No More Surprises – NY Surprise Medical Bill Law
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