Gatefleecing and Professional Services in the Pandemic

[Scubamax]

I was going to put this into the "rant" sub forum, but its happened a couple of times over the past couple of months so decided to put it out in this forum (mods feel free to relocate).

Item 1: Our pets go into the vet twice a year, once for an annual checkup and the other for a series of shots/tests which are given "off cycle" from the annual exam date. Prior to Covid 19 this was a routine visit and we were in and out pretty quickly and not charged for an exam since it was not necessary. Now this year during the off-cycle visit, the tech tells us that an exam is necessary, even though it was never charged in the past, but I know its due to the fact that business for them is down and they need to make up lost revenue. Well after a lot of back and forth and some firm persistence they did not charge us for the unnecessary exam. Savings of $ 150.

Item 2: I needed a refill for a statin. Have been on it for nearly 20 years at the lowest dose. Got my last labwork done in April with no red flags. Since the RX is good for 180 days I need to get the Dr. to do a refill....typically this is done by me via online request or a quick call to the clinic. This year I have been informed that my DR has had a baby and has left the practice so I will need to come in for an appointment to establish a relationship with a new Dr. in order to get the RX refilled. Needless to say this got under my skin as a perceived gatekeeping by their staff in order to generate some additional revenue.

ME: So your Dr. quits, and its now my problem?
THEM: Well you need to establish a relationship with a new Dr.
ME: Well I have a relationship with your clinic, and this is a routine refill. and we are in the middle of a pandemic and I really don't want to come in for a visit so you can charge me and my insurance for a visit that is not necessary.
THEM: Well we can't refill without the visit
ME: In this state, the NP can do a refill, and you have my chart, as I have been a patient of this clinic for years
THEM: We could do telemedicine if you have the internet
ME: How much would you charge for this (knowing the next response already)
THEM: I can't tell you that. I don't do billing
ME: So you require me to visit or have a telemedicine for a routine RX refill for this statin which I have been on for 20 years and you cant even tell me how much it will cost? Let me speak to someone who has authority to make reasonable decisions.

The office manager did not call me back but I put another request in the system via the portal that day and the next day CVS calls me to come pick up my RX!

In both instances by being persistent and hoping for logic to prevail, I was able to stick to my guns and save unnecessary expense. I am not a cheapskate, but as they say.."don't poke the bear". I just wonder how many other folks simply roll over for such tactics.

Would love to hear if anyone else has experienced this sort of gatefleecing!

 

[Gulfbeach]

Have not had this with my doctor but definitely with the vet. My dog has his annual checkup in June and my vet was not using procedures I felt safe with so I took him to the vet where he goes for grooming.

In December he has a tech visit for the two strain flu shot. When I called to schedule they said he would have to have a exam there before the flu shot.

A week later I got a reminder post card that he needed flu shot and when I called to respond to that they booked it and we did our usual pull up, call to check in, and two nice techs come out and give him the shot and lots of sweet talk and pats through his window.

15 minutes and 21 dollars. But the annual exam more than makes up for that!

 

[MrsHaloFIRE]

My doc will never ever do anything I ask via the secure messaging system for patients. (Military) 100pct if the time her nurse writes back "schedule an appt." Fine. So now they've rolled out telemedecine which is a phone call with your doc. So I message and say maam, I want the following routine lab work ordered. I want A B and c. And anything else you want for someone my age/health. You can order it, or I will schedule a phone call with you and tell you im well but want labs and you will say ok. So let me know which way you want to do this thing and we will do it.
Email back says "ma'am your labs have been ordered"

So thank goodness for covid in this one tiny instance dragging my clinic forward into the 1990s.

So im reporting the opposite of gatekeeping

 

[Ready]

I would think doctors are quite busy now being in the middle of a pandemic. It’s hard to imagine they are having trouble drumming up business right now.

 

[jollystomper]

The only area that we have experienced similar to that is with eye doctors. We received calls this year from our 2 previous eye doctors (we left one after 2016 because of the high sales pressure for expensive glasses, the other after 2018 because they close their close by office and we would have to drive an hour to their nearest office) saying they had not seen us in a while, please call to schedule an exam, it is important to have one every year. It was the first calls we received from them since we left them.

 

[rk911]

with the exception of one doc who is doing phone/video visits we haven't experienced any issues with doctors, dentists, our vet or refills. other than the one all are doing office visits. we usually make our appointments 6 or 12-mos in advance and refills are usually coordinated between the pharmacy and the doc. our primary doc (he's been our doc for ~20-yrs) is changing his practice to medicare advantage patients only so we'll be seeing a new doc in june (unless a new issue arises) but the old doc is handling our refills until then. i appreciate your problems and wish you well.

 

[SnowballCamper]

We stopped going to a regular vet for vaccinations because they charge the exam fee. There is a “good neighbor vet” that does them out of a van in local retail parking lots. It took a while to find a vet that would do other services on an as needed basis, but we found one.

 

[GalaxyBoy]

I would think doctors are quite busy now being in the middle of a pandemic. It’s hard to imagine they are having trouble drumming up business right now.

I wish I could dig up the reference but one of my podcasts last week said the opposite; there is an alarmingly high percentage of doctors going out of business due to the pandemic. One example they gave was an ENT who said that while telemedicine is fine for some things, you just can't get a good look into the orifices in peoples' heads with Zoom, and people are just staying home. Going forward, although you can graduate new MD's by the truckload (albeit in 8 years) there are limited slots for residents to get hospital training. On top of that, a recent survey showed a high percentage of doctors considering early retirement soon.

Regarding the OP, I changed doctors several years ago because the guy I was seeing insisted I come in every 3 months for blood work to support my statin Rx. Never mind I'd been on it for years and the doc before him (who retired early) had me on a yearly schedule since my blood work was always good. My current GP, whom I think is great, has me on a yearly basis.

EDIT: The podcast was Marketplace and the story is here:

https://www.marketplace.org/2020/12/18/doctors-are-leaving-medicine-because-of-the-pandemic/

 

[Sunset]

I would think doctors are quite busy now being in the middle of a pandemic. It’s hard to imagine they are having trouble drumming up business right now.

The ones in a hospital, no doubt.

But when I went to my regular doc, in their doc building, it was a ghost town.
The waiting room had only a few other people waiting. I was called in quickly.
No lineup to sign in.
It was business as usual, except for the LACK of patients.

All signs they are not getting the business like normal.

 

[razztazz]

I wish I could dig up the reference but one of my podcasts last week said the opposite; there is an alarmingly high percentage of doctors going out of business due to the pandemic.

https://www.marketplace.org/2020/12/18/doctors-are-leaving-medicine-because-of-the-pandemic/

I've had to see y primary care doc maybe 4 times since last April. The place was a ghost town. Even if they were open 24 hrs a day they couldn't see the number of people they used to run through there on a normal day.

Not many people are really running to a doctor from COVID. It's not like 1918 or 1350. I think people in general are avoiding doctor's offices. I know I have. I even cancelled a visit to my cardiologist that I thought was not essential since his office is inside a hospital. Plus, the offices have distance rules which creates the situation of not being allowed to have more than so many people in the building at a time.

 

[zinger1457]

But when I went to my regular doc, in their doc building, it was a ghost town.
The waiting room had only a few other people waiting. I was called in quickly.
No lineup to sign in.
It was business as usual, except for the LACK of patients.

That was my experience when I went in for my annual physical a month ago, the office looked empty, got there 15 mins early and went straight in. Then they used the wrong billing codes use for my lab test and I asked them to resubmit with the correct codes, two weeks later nothing was changed. Their excuse was they were too busy because of covid, hearing that excuse more and more now for poor service, it's getting old.

 

[MrsHaloFIRE]

My dentist is doing calls and mailing out postcard coupons for new patients.

 

[tb001]

I too have been getting the weekly calls from my dentist. And experienced the same thing with our vet. If I thought we could actually stay on top of vaccinations I would just go to the local clinics. It seems ridiculous to pay for an exam every 6 mo.

When we went in to the pediatrician last, it was totally empty. The dr said they have maybe 3-5 patients per day and a few more tele visits. Part of it is people don’t want to come in, but a big part is people just aren’t getting sick. She told me they’re going to have to lay off physicians if it doesn’t pick up. Two Drs have since retired from the practice.

Labcorp was the same way when I went for blood tests. One other patient in a facility that’s usually standing room only.

 

[Time2]

The only area that we have experienced similar to that is with eye doctors. We received calls this year from our 2 previous eye doctors (we left one after 2016 because of the high sales pressure for expensive glasses, the other after 2018 because they close their close by office and we would have to drive an hour to their nearest office) saying they had not seen us in a while, please call to schedule an exam, it is important to have one every year. It was the first calls we received from them since we left them.

I had an irritated cornea from contact over use, I suspect a got a couple of extra visits just 3/4 days apart. It was my eye so I was a compliant patient.
Then I recently called in to renew a prescription, I got 30 days and was told I needed to get blood tests and make an appointment for anymore. I was put on new meds 9 months ago, so maybe reasonable. But in both cases, I have to wonder if it is because I recently went on Medicare and they feel more comfortable billing Medicare for maybe less needed appointments. I'll never know, but, I am happy with the recovered eye symptom and happy to see my doc ordering more blood tests, as I feel he has always been, kind of, patient not presenting with symptoms, no need to try to fix something. I have never had this wide range of blood testing in my whole 65 years. I am interested in the results.

 

[JustCurious]

I would think doctors are quite busy now being in the middle of a pandemic. It’s hard to imagine they are having trouble drumming up business right now.

As others have said, I'm sure hospital doctors are quite busy, but I don't think the same applies to office based primary care doctors or non emergent care doctors, I get the impression that they are less busy now because of Covid. In my case I have put off going to my primary care doctor for my routine physical, not because I am afraid of Covid, but because I don't want to deal with the hassles of waiting outside of the office and waiting for them to come outside to get me and then being escorted in and wearing a mask and all of the other restrictions.

The media is in the hyperbole business, they create the impression that the U.S. healthcare system is overburdened because of Covid, but for routine primary care or non emergent care the opposite is true.

 

[marko]

I once had a bad gout attack while in San Francisco. I called my Dr in Boston where I live to ask if he could send my usual Rx to the local CVS in SF.

I was told that I had to come in to see the Dr. I told them, once again that I was 3,000 miles away and all he had to do was prescribe what he usually prescribes for me and send it to the CVS in SF.

No dice!! I was amazed.

I ended up going to a local SF feel-good Dr who could prescribe but...he had to look up in a book what a good Rx for gout was....as I left, he asked "anything else you'd like?" The tip off were all the photos of him with celebrities in his office.

I relayed all this to my local Dr later on and he said "Oh, you should've called my direct assistant...the ladies at the desk shouldn't do that."

 

[Amethyst]

Whenever I've gotten an Rx, there is always a "number of refills allowed" on the bottle. Usually only one, sometimes zero.

The reason given used to be that the Dr. needs to see the patient in order to verify whether the patient still needs the medication. In recent years, the pharmacies have started noting that the *insurance company* requires this verification.

"Needing to establish a relationship with a new doctor" sounds like somebody's clumsy attempt to make the above two reasons sound warm and fuzzy, when all one really wants is logic.

 

[Out-to-Lunch]

as I left, he asked "anything else you'd like?"

So, it worked out quite well, then, huh?

 

[OldShooter]

We have completely solved this problem for dentistry by switching to our local university dental school clinic. The students and professors there have no economic interest in what they recommend, so they are never selling. In fact at DW's last visit the discussion was whether they could avoid recommending a crown. Quality control is excellent, too, with the professors watching and checking every step of the work. To frost the cake, prices are maybe half what solo dentists charge.

On the primary care front we are in a concierge program that's imbedded in a large clinic. We're on a first name basis with the staff with phone calls and emails responded to (at no charge) within hours. One time I got back from a trip and called to say I needed to come in. Response: "The Dr. can see you this afternoon; what time would you like to come?" Appointments are scheduled for an hour.

 

[ls99]

The Doc's office I've dealt with for the last ten or so years, refilled prescription via phone call, a few times I actually needed, and forwarded it to a phamacy. I do not take any meds currently or for the last several years. BTW the Doc is not "my doctor". He is a doctor who gets paid to solve medical problems I happen to have. Am sure if it was not for him reviewing the record on his laptop, on the other side of the door befor entering the exam room, he would have no idea who the hell I was, nor I am sure, cares after he leaves the exam room.
Am also of the opinion that he spends way too much time looking at his laptop screen and typing, clicking, while talking and "listening". The actual hands on time ranges from none to maybe a minute, two tops.

Though office visits once or twice a year when they nag me about it, usually are short, not truly open to any dicussion lasts 5 or 10 minutes, not counting the nurse's questions and her taking vitals.
Have searched for concierge docs around SW PA, Westmoreland county, none found.

OTOH, seems to me that the computerized record keeping encourages doctors to slice the salami really thin: For nearly any question, they enter a diagnostic code or sometimes divide it into multiple codes and charge for them. Even though medicare and my supplemental covers all, I find this practice annoying.
Each year they order a bunch of blood tests, often call and leave message the next day or so of the results. Usually want a call back re: High cholesterol which I had for over fifty years. For over twenty years refused meds for it, the med crap (various statins) nearly killed me a few times, it is in their records. I suppose they just want continued CYA.

 

[trumpeting_angel]

I would think doctors are quite busy now being in the middle of a pandemic. It’s hard to imagine they are having trouble drumming up business right now.

Not 100% sure about now, but in the spring and summer physicians and hospitals were hurting for business. People were afraid to come in, and concerned they wouldn't get access to a hospital. Elective procedures were cancelled. Many people missed routine checkups, cancer screenings, and pediatric vaccinations.


This may be different now.


ETA: Sorry I didn't read the whole thread before posting!


Signed,

Department of Redundancy Department

 

[travelover]

I think dentists are really hurting. Normally when I have a cleaning I get a goody bag full of free samples - floss, toothpaste, a toothbrush. Last time when I checked out I found I'd paid $6 or so for the "free" samples.

Vets seem to all over the place. My last vet insisted on an "exam" for any visit plus what ever you actually needed. And a heart worm blood test yearly even if you gave the meds year around. My new vet just renews the prescription as long as the heart worm meds have been given continuously. It is a racket.

 

[OldShooter]

... Vets seem to all over the place. My last vet insisted on an "exam" for any visit plus what ever you actually needed. And a heart worm blood test yearly even if you gave the meds year around. My new vet just renews the prescription as long as the heart worm meds have been given continuously. It is a racket.

The economists call this an "agency problem." You have hired the vet (or dentist) to act as your agent to do something, but it is in their best interest to do something else. IOW, you have hired the dentist to do necessary work on your teeth but it is in his interest to do unnecessary work as well. For the vets, heartworm tests and expensive pet sedation and toothbrushing seem to be attractive revenue sources.

FWIW, DW just saved about 20% on some $2/each dog pills at chewy.com. They contacted the vet, got the scrip information, and shipped her the pills. You might price the heartworm pills there before you buy from the vet.

 

[Sunset]

I think dentists are really hurting. Normally when I have a cleaning I get a goody bag full of free samples - floss, toothpaste, a toothbrush. Last time when I checked out I found I'd paid $6 or so for the "free" samples.

....

We didn't see our dentist, so we probably have lost the 2nd visit we prepaid in our yearly deal ($450 for 2 x 2 visits).
But I'm not going to risk covid over it.

I haven't asked their office if they will credit me for the visit whenever I get around to coming in

By the summer will have been well over a year since we have seen the dentist. At that point I might try out one of the new ones locally that offer $40 first visit deals.

 

[Scubamax]

Whenever I've gotten an Rx, there is always a "number of refills allowed" on the bottle. Usually only one, sometimes zero.

The reason given used to be that the Dr. needs to see the patient in order to verify whether the patient still needs the medication. In recent years, the pharmacies have started noting that the *insurance company* requires this verification.

"Needing to establish a relationship with a new doctor" sounds like somebody's clumsy attempt to make the above two reasons sound warm and fuzzy, when all one really wants is logic.

I don't think those two reasons are why they are acting this way, inasmuch as I have never had a problem with a mid-cycle refill for the statin with this clinic, and I use GoodRX for this prescription at CVS so its not a matter of insurance gatekeeping. I think its all about "revenue enhancement".