First and likely last excperience with a 'walk in clinic'

[cute fuzzy bunny]

So the wifes been having more allergy problems in the new location than in the old, and wanted to get some flonase to help alleviate it...except our new health coverage doesnt kick in for 2 weeks.

So I looked up a couple of local "walk in anytime", checked in with the nearest one and it sounded fine. $89 and their current wait time was 20 minutes. Great!

Dropped her off and picked her up. She was steaming. The doctor saw her promptly, she told him what she wanted, he asked her a couple of questions and wrote her the prescription. Then she had to wait 15 minutes to get the bill for $180.

What happened to the $89? "Oh, thats just for prior customers and a basic exam. You're a first time customer and you needed a comprehensive exam". After 5 minutes of arguing, she just walked out.

I cant wait to be covered by insurance again, and I sincerely feel bad for anyone without it.

 

[mykidslovedogs]

That's terrible service! I'm surprised they wouldn't work with her. Do you have "Emergicare" in your town? I have walked in with my kids several times and $89 was the amount....even for the first visit.

Well, I guess $180 is better than paying $1300 for Cobra.... Unfortunately, we have such a shortage of primary care physicians that it really doesn't matter if they give poor service, because they'll still get plenty of business....shortage of primary care doctors is a sad side affect of having too many people on gov't sponsored care (Medicare & Medicaid). If it weren't for the low, low reimbursement levels from the gov't for Medicare and Medicaid patients, we'd have plenty of primary care physicians, and then they'd be competing for our business.

 

[Rich_by_the_Bay]

The doctor saw her promptly, she told him what she wanted, he asked her a couple of questions and wrote her the prescription. Then she had to wait 15 minutes to get the bill for $180.

What happened to the $89? "Oh, thats just for prior customers and a basic exam. You're a first time customer and you needed a comprehensive exam". After 5 minutes of arguing, she just walked out.

I'd have handled that one for any of my established patients with a 3 minute phone call. No charge. 5 minutes of my time including calling in the prescription. Even if they were caught in an insurance gap -- in fact, especially in that case.

 

[lets-retire]

WOW $180. Even when I go to urgent care it's less than that.

 

[loosechickens]

In our family, we call this the $250 ear wax cleaning experience. As fulltime RVers, we seldom have the luxury of being somewhere where we have a regular doctor, and are usually at the mercy of these urgent care clinics when needed.

Last year I poked a Q-Tip in my ear, and all of a sudden couldn't hear out of it....yeah, yeah, I know Jiminey Cricket says "don't put anything smaller than your elbow in your ear", but I forgot.

There was an urgent care clinic quite close to where we were. So I went in, inquired as to the cost......it, also was $89. The doctor looked in my ear, said, "yep, ear wax", and turned me over to the young lady who was working at the front desk and obviously doubled as the "ear wax person". She couldn't get it softened, so she gave me some drops to put in every few hours and to come back in the morning. I asked if there would be another office visit charge, and she said "no". So I paid the $89 fee and left.

I went back in the morning with my softened ear wax, and she successfully cleaned it out with warm water and a syringe, and I left. A week or so later, we got our forwarded mail and there was a bill in it for an additional $160. We called and inquired......we were NOT charged for the second visit, but instead were charged $160 for the "consultation" with the doctor.

It really steamed me.....the doctor's whole contribution to this was to look in my ear and say "yeah, ear wax". The entire rest of the procedure was done by a twenty-something office worker. And, obviously, if you are coming to an urgent care clinic, it is to be seen by a doctor. Why do they quote a price that doesn't even include a doctor's attention in the equation? Do they actually expect folks to come in and just say, "Well, I'll just take the $89 special which only entitles me to the attentions of the young lady typing over there"?

Most of those places are real ripoffs, making their real money on Workman's Comp business. We've used a few good ones......the urgent care clinic attached to the Redland's Community Hospital in Redlands, CA comes to mind, but in general, they're bad news. They tend to employ the docs that graduated last in their classes, or who have had previous experiences walking on the wild side of drug or alcohol problems....(another experience).

Just count your lucky stars that you were just in a few week period without a regular doctor. One of the definite downsides of fulltime RVing is the catch as catch can medical care. We've been at this long enough now that we do have some areas of the country where we have medical contacts, but it's a crap shoot out here. Best to just stay healthy, that's for sure.

LooseChickens

 

[FIRE'd@51]

Most doctors have a higher initial rate for new patients (and insurance companies allow it). Last year I had to go to my primary care physician whom I hadn't been to for 8 years (I usually see specialists), and they had gotten rid of my records, although they knew I had been there before. I was charged the $220 new patient fee (which was lowered to $198 via the insurance-negotiated rate).

Along the lines of Rich's post, I'm curious why her previous doctor from your old place didn't just call in the prescription to your new pharmacy?

 

[Rich_by_the_Bay]

I do have some concerns about "Doc-in-a-box" clinics, though they serve a purpose by filling that gap between true emergency care and routine care. Problem is they are by nature opportunistic - grabbing a demographic that is too busy to take time off during the day to see their primary doctor, and not sick enough to put up with the purgatory of an ER. You pay. Also, the quality of the doctors who regularly work there is variable, both techincally and interactionally.

When I was in primary care (25 years worth), I or my partners were available 24/7. We considered an urgent care visit by one of our patients to be a flaw in our systems - either the patient wasn't educated to call us first, or we got lazy and failed to provide the service they needed. I admit this kind of availability become increasingly burdensome as reimbursement decreased (phone medicine was usually not charged for or covered, busier practices, HMO complications, etc).

Then there were patients who'd go directly to an urgent care clinic, get cared for, pay cash on the line, then call me the next day to complain that the medicine they received is making them nauseated, could I please prescribe something else. :

But primary care is primary care. If you have a relationship with a patient you stick by them. I miss that. Of course, if I had stayed with it I wouldn't be thinking about retirement for another 5-7 years. Maybe in semi-retirement...

 

[TromboneAl]

After 5 minutes of arguing, she just walked out.

Walked out without paying, or after paying?

the doctor's whole contribution to this was to look in my ear and say "yeah, ear wax".

Yeah, but to be fair, that doctor spent a lot of money and years to be able to say that.

 

[Nords]

So the wifes been having more allergy problems in the new location than in the old, and wanted to get some flonase to help alleviate it...except our new health coverage doesnt kick in for 2 weeks.

One question, one word: "Wal-Mart?"

TromboneAl, you've had that graphic up for a couple weeks and I still smile every time I see it...

 

[lets-retire]

Do they actually expect folks to come in and just say, "Well, I'll just take the $89 special which only entitles me to the attentions of the young lady typing over there"?

We're talking about health care here, but since you brought it up, it depends on how she looks.

 

[cute fuzzy bunny]

No, she paid before leaving, but that may be contested. I've been a little busy today with a 27 month old monster.

Walmart isnt offering the cheapo clinics in our area yet, nor is walgreens or any of those guys.

We did call our old primary care doctor and asked his staff if he'd phone in a prescription for us. She worked with the guy for 11 years. Even with a followup call the next day to be sure they remembered, it never happened.

I guess that mentality was "Sorry, you moved and theres no further income for us", or maybe it was just a comeuppance on his staffs behalf as my wife complained to the doctor about them several times when they screwed up stuff or didnt follow up on something.

But theres a clear message here...make sure you know what the fee structures are before accepting treatment when dealing with non insured health care options.

And dont expect any help or loyalty from your old provider after the insurance is canceled.

Stupid part is, had we paid for the cobra, we probably both would have continued doing office visits with him for the two months we were on cobra before the new health plan kicked in.

 

[modhatter]

I know were talking about people-not dogs, but have to share this one. Last year my dog was hit by a car. She wasn't run over, but the car wacked her rear end good. Didn't know if anything was broke. it was almost 6 PM and by the time I got to the closest vet, they were closing. Doctor came over to us and looked in her eyes and felt her back side, and said she was closing and I have better take her to the new 24 hour walk in clinic to xray her hip.
She then charged me $80 for that (to tell me she couldn't treat her)

Then went to the walk in clinic where they would xray hip area -and were told I should leave her over night in case she went into shock. Said I could pick her up at 8 AM in the morning. My son picked her up for me the next morning telling me he would put the charge on his charge card and I could re-imburse him.

They did nothing but take one xray, put her in a cage, and give us some pain pills in the morning. The bill was $890.00 I called and argued with them, but it did no good. That was there fee. Absolute robbery.

My point being, people or dogs- walk in clinics - better hold on to your wallet. !!

 

[lets-retire]

modhatter--I think I'd argue the point with the first vet and/or find another one. As for the second vet they were open. I used to work at a gas station that was open 24/7, we'd have people come in at 3-4 AM and complain about the price of our gas. It was about 10 cents more expensive than the two stations next to us. My only response was we're open they aren't. It's funny none of them wanted to wait the 2-3 hours until one of the other stations opened.

 

[chinaco]

Been to urgent care a few times...only in a pinch for something minor.

My minor problems were taken care of...

You could be correct about he quality of the docs... But I have not had problems... At the same time, I would only go for something minor. I have noticed in a few cases, where the doc appeared to be semi-retired.


Probably a good way for a doc to do part-time work and not have the hassle of running ones own office.

 

[ferco]

Just curious...a question for the panel

What do you think is a FAIR charge for treatment of a

Sore throat

Treatment of an asthma attack

Suturing a laceration

Telephone consultation

 

[REWahoo]

What do you think is a FAIR charge for treatment of a

Sore throat

Treatment of an asthma attack

Suturing a laceration

Telephone consultation

I'd say a fair charge charge would be 'aggravated sexual assault', but you'd have a tough time making the charges stick if you were the one who initiated the phone call.

 

[mykidslovedogs]

Just curious...a question for the panel

What do you think is a FAIR charge for treatment of a

Sore throat

Treatment of an asthma attack

Suturing a laceration

Telephone consultation

Ferco - Good question. I've found that many on this board would like someone else to spend 12-15 years going to medical school and then treat every one of their ailments for "free" or at least have someone else pay for it. If someone else, (ie...the government), doesn't want to pay the doctor enough, then, we are either supposed to raise taxes without limits, but only for the wealthy (who are evil and don't deserve to have wealth), so they can pay for it, or the doctor is expected to just deal with it, and take it in the shorts. The doctor is expected to continue to service these people --especially poor people (who shouldn't be expected to incur any out of pocket responsibility) -- for practically free, even if the substandard government reimbursement rates make it nearly impossible for the doctor to keep his/her doors open, chalk up for their liability insurance, pay for staff, and pay off their medical school bills. (After all, the doctor is also one of those evil rich people who doesn't deserve to take any profit or have any wealth, either). You'll see it mentioned many times here that doctor's services, are a personal "right", just like life, liberty and the persuit of happiness.

Private insurance, where doctors and hospitals, in a free-market society, are able make up for all their lack of pay from Medicare, Medicaid, and goodwill, pro-bono services is an evil and profiteering nuisuance, viewed to be outrageously expensive only because of the "profit" factor....and not possibly because it is the fallback for inadequate reimbursement rates from the government, which, IMO, will not be any better if we nationalize.

 

[JPatrick]

Ferco - Good question. I've found that many on this board would like someone else to spend 12-15 years going to medical school and then treat every one of their ailments for "free" or at least have someone else pay for it. If someone else, (ie...the government), doesn't want to pay the doctor enough, then, we are either supposed to raise taxes without limits, but only for the wealthy (who are evil and don't deserve to have wealth), so they can pay for it, or the doctor is expected to just deal with it, and take it in the shorts. The doctor is expected to continue to service these people --especially poor people (who shouldn't be expected to incur any out of pocket responsibility) -- for practically free, even if the substandard government reimbursement rates make it nearly impossible for the doctor to keep his/her doors open, chalk up for their liability insurance, pay for staff, and pay off their medical school bills. (After all, the doctor is also one of those evil rich people who doesn't deserve to take any profit or have any wealth, either). You'll see it mentioned many times here that doctor's services, are a personal "right", just like life, liberty and the persuit of happiness.

Private insurance, where doctors and hospitals, in a free-market society, are able make up for all their lack of pay from Medicare, Medicaid, and goodwill, pro-bono services is an evil and profiteering nuisuance, viewed to be outrageously expensive only because of the "profit" factor....and not possibly because it is the fallback for inadequate reimbursement rates from the government, which, IMO, will not be any better if we nationalize.

Well said dogs. Of course if the doc spent 12 to 15 years in med school he was either slow or came away with one hell of a specialty and doesn't worry about getting paid. But I get your drift.
DS is in the process of picking his specialty and he won't get near family practice for the reasons you outline. He enjoyed OB/gyn, but the liability issues rule that one out. His thoughts pretty much are those of the entire class. Bad news for the future

 

[cute fuzzy bunny]

I'll answer the question. For someone who went through all that training and experience, I'd consider something in the $50-100 range for a 3 minute consultation to be satisfactory. For something more extensive, like an asthma attack or a suturing job, both of which entail an hour or two of work and monitoring plus associated risks, perhaps 2-3 times that.

But $180 to have someone tell you what they want and then giving it to them, totalling a few minutes...$180 is a bit ridiculous.

I guess their business model is like a car salesmans. Grab what you can now and wait for the next sucker.

 

[chinaco]

I'll answer the question. For someone who went through all that training and experience, I'd consider something in the $50-100 range for a 3 minute consultation to be satisfactory. For something more extensive, like an asthma attack or a suturing job, both of which entail an hour or two of work and monitoring plus associated risks, perhaps 2-3 times that.

But $180 to have someone tell you what they want and then giving it to them, totalling a few minutes...$180 is a bit ridiculous.

I guess their business model is like a car salesmans. Grab what you can now and wait for the next sucker.

Your are right... they stuck it to you. Kinda like a mechanic that works on your car. They just charge the listed rate for the expected time listed in the manual. If the expected time to do the work is 1 hour... thats what they charge even if it took 5 minutes.

 

[mykidslovedogs]

How about some positive news about a walk-in-clinic? DH was working on his classic car today and put a nice gauge in the top of his thumb! He went down to Emergicare, which is right down the street from our house...about a 5 min. drive. Emergicare takes Humana One, our insurance company. Mind you, we have a 5000 deductible, but our healthplan entitles us to a network discount with Emergicare, so we are only responsible for an $89.00 office visit charge, and we cannot be balance-billed. DH ended up needing three stitches in his thumb. He was in and out of the clinic within 20 minutes, and the charge was only $89.00! What a bargain!

I guarantee you a visit to the ER would have cost in excess of $300, and the wait would have been one or more hours. People who have health insurance should never use the ER unless they are having a life-threatening emergency. But, our wonderful employer-sponsored health insurance programs do nothing to discourage wasteful and un-necessary use of the ER. Instead, those $50 copays get abused to the point where our ER wait times are outrageous. I hope more employers adopt HSAs and HRAs. It will help tremendously to cut down ER wait times.

 

[youbet]

our wonderful employer-sponsored health insurance programs do nothing to discourage wasteful and un-necessary use of the ER.

Well, some may not. DW's plan provides 100% coverage (no deductible or copay) for using Emergicare facilities for emergencies and has a relatively high copay for using the ER. So, in a situation where we can clearly see what's wrong, such as a cut needing a few stitches, we head to the Emergicare joint and save some money. For situations where we don't know what's wrong, such as lots of internal pain, we still head to the ER where they have immediate access to sophisticated test gear and damn the cost.

 

[mykidslovedogs]

Well, some may not. DW's plan provides 100% coverage (no deductible or copay) for using Emergicare facilities for emergencies and has a relatively high copay for using the ER. So, in a situation where we can clearly see what's wrong, such as a cut needing a few stitches, we head to the Emergicare joint and save some money. For situations where we don't know what's wrong, such as lots of internal pain, we still head to the ER where they have immediate access to sophisticated test gear and damn the cost.

That is exactly the kind of healthplan I would like to see more employers adopt. The ER visit should simply be a deductible expense, and that would help resolve some of the overcrowding issues we have. Anyone who doesn't have a true emergency should be triaged to an urgent care center immediately. I think all hospitals should establish a first-come, first-served urgent care center located nearby the ER for minor emergencies staffed by one or two docs, a couple of interns and a couple of nurses. Anyone who comes in with a cold or minor flu symptoms, a small cut that needs stitches, or a minor fracture should be triaged to urgent care.

 

[Joss]

"I guess their business model is like a car salesmans.  Grab what you can now and wait for the next sucker." 

And this is exactly the problem.  There be sharks in the water now, hiding behind the obsolete image of the caring country doctor. 

Parts of the medical community are doing what's actually "bait and switch" advertising.  To do this, they are relying on the public's reluctance to call bull$hit on the practice.  Businesses such as these, in ANY other field, would be required to produce a "menu" for their customers to rely on. 

And callous pricing, after the service, will ultimately catch up with the industry.  This will either take the form of legislated price controls, or a "shopping public" that evolves to demanding to know the price BEFORE agreeing to the treatment. 

At that point, in the eyes of the public, medical professional's prestige will have sunk to the ranks of lawyers, tv preachers and used car salesmen. 

 

[winnie]

But $180 to have someone tell you what they want and then giving it to them, totalling a few minutes...$180 is a bit ridiculous.

I guess their business model is like a car salesmans. Grab what you can now and wait for the next sucker.

We just had dinner with two new doctor friends who are owner-operaters at their own medical clinic in washington (though it isn't a walk-in clinic).

They were both initially recruited out of medical school for a clinic which went belly-up in the same location. Business at their new clinic is booming and is extremely profitable.

So, I asked, what makes one medical clinic profitable when the other went bankrupt? They both answered in unison: "Two words: bill up." By which they meant, if you look at someone's ear wax, don't bill it as a level one or two visit, bill it as a level 3 visit ("pre-operational review" or something...I"m making the terminology up, but this was their drift.)

Fine (i suppose) if the patient has full insurance. But not so fine for those of us (like me) who carry HSA plans. Walk-in clinics are not the only culprits in over-billing (extortion?)

Winnie