“I only need what’s necessary and nothing more when I see my doctor. Is this possible?"
Entering the realm of Medicare can be a daunting journey for seniors, filled with hopes for accessible and affordable healthcare. Yet, the reality often falls short of our expectations, leaving seniors feeling confused, frustrated, and even exploited by healthcare providers.
Picture this:
You arrive at their doctor's office, filled with trust and anticipation, only to be greeted by a receptionist handing you a paper to sign. The paper states that they are responsible for paying for procedures not covered by their insurance. It's a disheartening start, but we all comply, unaware of the implications.
As we wait in the exam room, we are approached by a nurse who begins asking questions about our lifestyle habits: smoking, alcohol use, falls, and home safety. We answer truthfully, unaware that these seemingly routine inquiries could result in additional charges not covered by Medicare.
Then, the doctor arrives, performing a thorough examination. But along with the necessary tests and procedures, they tack on "extras" – additional tests or procedures that we didn’t even know weren't covered by insurance. It's a shock to discover that what we assumed was routine care is actually a way for the healthcare facility to recoup fees from us because they are denied by insurance companies.
When the bill arrives, the reality sinks in: we are responsible for a multitude of events during the office visit that were not covered or even requested. We feel deceived, taken advantage of, and burdened by unexpected expenses.
The Ugly Truth
This scenario isn't an isolated incident; it's a widespread issue affecting countless seniors across the country. Healthcare providers, facing financial pressures and denied claims from insurance companies, resort to questionable practices to make up for lost revenue. They prey on the vulnerability of seniors, exploiting their trust and lack of knowledge about healthcare billing.
But this isn't just about money; it's about ethics and integrity in healthcare. Seniors deserve transparency, honesty, and respect from their healthcare providers. They shouldn't have to fear being blindsided by hidden fees or unnecessary tests during a routine office visit.
So, what can we do to protect ourselves from falling victim to these predatory practices? First and foremost, we must advocate for themselves.
"But Suzanne, I don’t want to make waves or the practice might fire me. Then where will I go?"
TRUE STORY
Let’s look at Isa who knew she had to speak up, even though she felt intimated and afraid that her doctor might not treat her with respect or like her. She went in to see her eye doctor for her annual eye exam. The medical assistant brought her back and immediately started checking her vision by closing one eye and then the other. You know, the “Which looks better?” test.
Isa stopped her and asked her if this test was covered in her visit or would she be charged extra for this. It’s called a refractive test. The medical assistant said she thought it was covered but if not, then they would take it off the bill. Isa asked if she could get that in writing from the medical assistant since she had to sign a paper stating she would pay for all additional charges not covered by insurance while she was at the receptionist's desk. She went on to explain that billing departments are not prone to remove charges so this paper would help support her request.
The medical assistant stated that the doctor, her employer, wanted this test done on every patient. Isa understood that the medical assistant was caught between a rock and a hard place so she suggested that she might talk with the doctor first about the need to do the test, the cost of the test, and then perhaps we “could do the test after she spoke to the doctor.”
The medical assistant left the room and returned with the eye specialist. As Isa explained she was on a fixed income and paid enough for Medicare, she wanted to be a good steward of her finances.
The medical assistant then called the billing department. They knew right away that it was not covered and they consistently charged all patients a $68 fee for the test.
Isa asked what the test was for. The doctor explained it was a test to see if she needed a new prescription for her glasses. Isa then explained that she doesn’t wear prescription glasses and if she did, and didn’t plan on getting new glasses, would she still need it?
The doctor said, "No." and realized the test was unnecessary.
True or false. If I speak up the doctor will get mad.
There are many reasons why seniors do not speak up and all of them are found to be false narratives.
Here's WHY….
- Physicians are more than happy to accommodate their patients and give them the care that they need. 99% of all doctors want their patients to ask questions. They want their patients to discuss with them what they're worried about. They want the opportunity to reassure the patient and work together for a common treatment plan that works for both the doctor's skill and knowledge and the patient's feelings.
- I can't tell you the number of times our members have said when they speak up and ask the doctor some questions, they find the floodgates open, and they have a much more rewarding and trusting relationship with their doctor. In fact, many patients have told me that the doctor turns away from their computers and actually sits down and starts listening and conversing with their patients.
- Doctors are humans, too. Sometimes they may feel threatened so always explain why you are asking. There is no better profession that practices empathy than medicine so once you explain where you are coming from, your doctors will understand.
- Doctors, physician assistants, and nurse practitioners are under insurmountable pressure from their employers, the healthcare facilities to bill, bill, bill. Many employers will "write the provider up" if they don't bring in extra money.
- But it's not always the facility's fault, either. The insurance companies are not paying what was promised.
COMMON SENSE: This are no different from any homeowner who ever filed a claim and didn't get a check for what they were expecting. This is the new and and unfortunate common practice insurance companies have migrated to.
Seniors deserve better – doctors deserve better - healthcare facilities deserve better. We all deserve healthcare that is transparent, affordable, and respectful of our rights, dignity, and pocketbook.
