I’ve been working in medical offices for a long time and I’ve seen and heard a lot of confusion about how they work. So, I’ve decided to take a moment and give some tips for the next time you have to go.
Don’t Blame the Receptionist
No one really wants to go to the doctor. So it’s doubly frustrating when you get there and are made to wait in a waiting room for anywhere from minutes to hours after your appointment time. I know this because I am a patient, myself. Every month when I visit the doctor I have to plan to be there for at least two hours. But here’s something I don’t do: I don’t blame or act rudely toward the receptionist because I know not only what they go through but also that there’s nothing they can do about it.
I cannot tell you how many times I have been cussed at, threatened or given the death stare by patients when we’re running behind. Then, when they see the doctor – the one with the control over the situation – they’re all sunshine and rainbows. It’s quite frustrating.
Here’s some inside info: every office’s schedule is different. Some offices schedule one patient per time slot (generally in 15-minute increments) and others schedule multiple patients per time slot. One thing that is universal across offices, however, is who decides what that schedule will be, which is usually a manager or the physician themselves. In my experience, it is always the physician. This means that it is completely out of the receptionist’s hands.
Offices get behind schedule for a myriad of reasons, but the general culprit is that the doctor goes over their time limit with one or more patients, which slowly but surely backs everything up. This could be because the patient has more issues than they said on the phone, or it could be because the doctor is telling the patient all about a recent vacation. Either way, it puts them behind.
I personally hate the fact that these days doctors offices treat patients like cattle, moving them through as quickly as possible. I hate that when I go to my doctor she has to spend more time looking at a computer screen than listening to me. I wish that more doctors would take more time with their patients and understand that most would love to but can’t. I could rant all day about what’s wrong with our healthcare system, but for now, this is what we have.
Another reason things get delayed is if another patient has an emergency and all of the office’s resources have to be put toward said emergency. This is unavoidable and no one’s fault.
Also, you aren’t the only one who suffers. When the schedule gets behind, not only do the receptionists have to deal with irate patients, but this also means that they don’t get to take a break or go home when they’re supposed to. If the office closes for an hour for lunch – say from 12 to 1 pm – and the doctor is behind, the receptionist has to wait until they’re done. If there are patients coming in at 1 pm, they have to be back in time. Therefore, when the last patient leaves at 12:30 or 12:45, that cuts their lunch time. The same happens at the end of the day, too.
This isn’t to say that it’s never the receptionist’s fault because sometimes it is, but for the most part, you’re blaming the wrong person; if you really want to make a difference you should complain to the doctor or office manager instead.
Understand Your Insurance Coverage
The office itself is only responsible for informing you if they don’t accept your insurance. That’s why when you call to make an appointment you are asked what insurance you have if any. You are responsible for understanding your insurance and what it covers.
Our health insurance industry is a scam, there’s no other way to say it. It’s a racket that I have been rallying against since I got into healthcare. Because we have allowed capitalism to take over our healthcare system, insurance companies get rich off of patient’s suffering. That’s how it works.
Most plans have multiple parts. You have your premium, which is the amount you pay every month to have the plan. Then you have your deductible, which is the amount you have to spend out of pocket every year before your plan pays their share. Your co-pay (which is generally due at every appointment – deductible met or not) and co-insurance is what you pay after you’ve met your deductible.
I have been cussed out so many times in this job by people who don’t understand their plan. I’ve been told that I am a horrible person and that I would be going to hell when I died (more than once, actually. I’m apparently gonna burn for eternity times, like, 5). Recently I called a patient to inform them that their bill was because of their deductible and was told, “That’s bullshit, I pay my premiums!” They hung up on me before I could explain the difference between premiums and deductibles.
The only time you will see a doctor and not pay out of pocket for it (other than your premium, which you have to pay no matter what) is if you are having your annual physical. However, if during your physical you mention an issue you’re having, your insurance then decides that it isn’t a wellness visit and your deductible comes into the equation.
Doctors offices and insurance companies negotiate “allowed amounts”, which means that no matter what the doctor charges, they will only get paid the amount they agreed to with the insurance company. However, because every insurance company negotiates a different amount, the doctor’s office itself will decide how much each procedure/visit/etc. should cost and sends the same amount to every insurance company.
For instance, if the doctor feels that a certain procedure is worth $100, but Aetna will only pay $40 and Blue Cross will pay $70, the doctor is still going to send a bill of $100 to each company. Whatever the insurance doesn’t pay the doctor writes off. This is why you’ll get an explanation of benefits that says the doctor charged $400 for your visit but only got paid $200 (or is charging you $200 because of your deductible). Ultimately it doesn’t matter what the doctor charges, it matters what your insurance company deems acceptable.
I’m not saying that there aren’t greedy doctors out there because there definitely are. I’m not saying that offices don’t make mistakes because we do. And I’m not saying that the billing process is fair or easy because it isn’t. I agree that a hospital charging hundreds of dollars for a medication you can get for $5 at a pharmacy is ridiculous. What I am saying is that our whole system is screwed and that the insurance companies are the ones running the show.
Don’t Be Intimidated
Unfortunately, there is a pervasive attitude in the medical profession (which, ashamedly, I have had at times, as well) that the doctor knows best and that the patient should just shut up and listen and how dare someone seek a second opinion?
Now, I am not a huge fan of self-diagnosing. There is a difference between reading forums and going to school for eight years and then practicing medicine for another twenty. Many diseases or health problems share symptoms with others, so just because a few people on a forum have been diagnosed with carpal tunnel syndrome because of the numbness in their hands doesn’t mean you also have it because of the numbness in yours.
That being said, don’t be afraid to disagree with your doctor and don’t be afraid to get a second opinion. You know yourself best and Google is good for researching procedures and treatment options. Doctors are human just like everyone else and they make mistakes. Not only that, but research and science is constantly improving and some doctors just aren’t good at keeping up to date. If you are having symptoms and your doctor won’t listen to you, find another one who will. You may get some pushback, but don’t let it bother you; this is your life and your health and you need to be sure you’re doing the right thing.
If you go to a doctor and they want you to undergo a surgical procedure or any other invasive procedure – or anything you aren’t comfortable with, really – get a second opinion. Don’t let a provider intimidate or scare you into making a rash decision that you aren’t comfortable with.
Most physicians and medical professionals got into the business because they care about helping others. The majority are good, kind, hardworking and well-meaning people. This is not to bash those people, this is to say that it’s okay to research all of your options before making a decision that might change your life.
So, there’s my list. I hope it helps someone out.