[Villages PL]

....an office visit that was my semiannual check up. He went over the results of my blood test, we talked about it, he went to the computer to plan for my next blood test, and then cleaned some wax out of both ears.

In a letter I received from Freedom Health, it shows that he put in a charge of $203.00 dollars. But all they gave him was $10.

The nurse weighed me, took my blood pressure and pulse. She also asked a few standard questions. By the time the doctor pays her salary and the salary of a couple others plus other office expenses, how much do you figure he'll have left for himself out of $10. dollars?

[dbussone]

Originally Posted by Villages PL

....an office visit that was my semiannual check up. He went over the results of my blood test, we talked about it, he went to the computer to plan for my next blood test, and then cleaned some wax out of both ears.

In a letter I received from Freedom Health, it shows that he put in a charge of $203.00 dollars. But all they gave him was $10.

The nurse weighed me, took my blood pressure and pulse. She also asked a few standard questions. By the time the doctor pays her salary and the salary of a couple others plus other office expenses, how much do you figure he'll have left for himself out of $10. dollars?

If you are enrolled in the HMO your physician likely receives a "per patient per month" payment for each individual under his/her care. The $10 payment is probably for some additionally recognized work approved by Freedom Health. If you are in the Medicare Advantage plan I would doubt your doc will participate in Freedom Health next year.

[gerryann]

Originally Posted by dbussone

If you are enrolled in the HMO your physician likely receives a "per patient per month" payment for each individual under his/her care. The $10 payment is probably for some additionally recognized work approved by Freedom Health. If you are in the Medicare Advantage plan I would doubt your doc will participate in Freedom Health next year.

Very correct. For every contract for HMO's, the doc receives a monthly check. You will also get inferior care when he/she knows they will get the check regardless of weather they see you or not. If one is with a private insurance company (secondary to Medicare) the doc might do a lot of add on's, cause he'll get paid for it.

I disagree that the doc will drop his contract with Freedom Health. The more HMO's , the more checks he receives. It's a sure thing.

Obviously, not all docs are out for strictly the money. I'm sure somewhere here in TV there are some truly caring docs.

[dbussone]

Originally Posted by gerryann

Very correct. For every contract for HMO's, the doc receives a monthly check. You will also get inferior care when he/she knows they will get the check regardless of weather they see you or not. If one is with a private insurance company (secondary to Medicare) the doc might do a lot of add on's, cause he'll get paid for it.

I disagree that the doc will drop his contract with Freedom Health. The more HMO's , the more checks he receives. It's a sure thing.

Obviously, not all docs are out for strictly the money. I'm sure somewhere here in TV there are some truly caring docs.

Just a minor correction. Freedom Health also has a Medicare Advantage plan (non HMO). If VPL is in that plan the doc will only get paid for the visit, not PPPM. If the doc only receives $10 for a visit I really don't think he'll stay with that plan for long.

[gerryann]

Originally Posted by dbussone

Just a minor correction. Freedom Health also has a Medicare Advantage plan (non HMO). If VPL is in that plan the doc will only get paid for the visit, not PPPM. If the doc only receives $10 for a visit I really don't think he'll stay with that plan for long.

I stand corrected....but I thought that Freedom Health Medicare Advantage Plan had only the one HMO plan (except for special needs).......therefore meaning you have to ONLY go to the Dr's in the plan. Is their another one?

[dbussone]

Originally Posted by gerryann

I stand corrected....but I thought that Freedom Health Medicare Advantage Plan had only the one HMO plan (except for special needs).......therefore meaning you have to ONLY go to the Dr's in the plan. Is their another one?

I thought Freedom also had a Medicare Advantage plan as well. But I've been wrong before!

[gerryann]

Originally Posted by dbussone

I thought Freedom also had a Medicare Advantage plan as well. But I've been wrong before!

They do have a medicare advantage plan. But I thought it was an hmo.

[dbussone]

Originally Posted by gerryann

They do have a medicare advantage plan. But I thought it was an hmo.

Advantage plans are more like traditional insurance, and typically are fee for service based. One of the ways an advantage plan saves money is by restricting your choice of docs and facilities. HMOs are much more inclusive in terms of what they cover, but they are very restrictive in terms of the physicians and facilities you can use. Typically a primary care doc holds the referral reigns, determining whether you need to see a specialist or not. Except for super sub specialists, docs and facilities are almost always paid for on a PPPM basis.

[blueash]

One other possibility, doctor billed for two services, an office visit and a minor procedure of cleaning ears. Insurance only allows one service to be paid and paid the ear clean service denying the office visit as unbundling. Doc should resubmit with correct modifier for separately identifiable service. Pure speculation

[fred53]

Originally Posted by gerryann

Very correct. For every contract for HMO's, the doc receives a monthly check. You will also get inferior care when he/she knows they will get the check regardless of weather they see you or not. If one is with a private insurance company (secondary to Medicare) the doc might do a lot of add on's, cause he'll get paid for it.

I disagree that the doc will drop his contract with Freedom Health. The more HMO's , the more checks he receives. It's a sure thing.

Obviously, not all docs are out for strictly the money. I'm sure somewhere here in TV there are some truly caring docs.

"You will also get inferior care when he/she knows they will get the check regardless of weather they see you or not"...

Not only do you not personally know this, but it bespeaks of a deeper problem you might have...oh and it's spelled "whether" not "weather" which of course is what happens to our atmosphere...

[dbussone]

Originally Posted by blueash

One other possibility, doctor billed for two services, an office visit and a minor procedure of cleaning ears. Insurance only allows one service to be paid and paid the ear clean service denying the office visit as unbundling. Doc should resubmit with correct modifier for separately identifiable service. Pure speculation

Good point blueash.

[sunnyatlast]

And people wonder why doctors get fed up and go to direct primary care for a reasonable retainer fee, with NO involvement with public or private insurance octopus!!

An example....
Atlas MD | Wichita

[gerryann]

Originally Posted by fred53

"oh and it's spelled "whether" not "weather" which of course is what happens to our atmosphere...

I'm sure glad we have you for correcting spelling.

[gerryann]

Originally Posted by fred53

"You will also get inferior care when he/she knows they will get the check regardless of weather they see you or not"...

Not only do you not personally know this, but it bespeaks of a deeper problem you might have....

Actually I do personally know this. I have worked for more Dr's than you probably have seen in your lifetime.

I also wonder why you are on a public, friendly forum with nasty comments about my having a deeper problem. If you have an agenda or are just generally unhappy, it might be beneficial to stay off of a public forum.

[Barefoot]

Originally Posted by fred53

Not only do you not personally know this, but it bespeaks of a deeper problem you might have...oh and it's spelled "whether" not "weather" which of course is what happens to our atmosphere...

Please play nice.