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Do offices actually do this?

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  • Do offices actually do this?

    So I'm looking for a new doctor for myself and my husband and as I was browsing through the site of a potential office I noticed that they had a complete list of all the insurances they accepted. This brought me back to a few years ago when I had the misfortune of working for one of the most dysfunctional offices ever ran and I have to wonder if part of myself is thinking they were that bad out of spite or if they really were that bad. So I thought I'd ask.

    Getting back to the list of accepted insurance, when I was working at this little slice of paradise I was in scheduling. People would often ask if their insurance was accepted by this office. I asked the manager of scheduling if there is a list of accepted insurances so I can answer this question. I was told to tell them they have to call their insurance company to see if they will cover a visit to this office.

    Now, I'm not very old but I've got about 10 years experience of scheduling my own doctor's appointments. Never once was I ever told that I had to call my insurance company and ask them if an office will accept them.

    Another little nugget of joy was how many calls I would get from specialists saying that a patient is there for an appointment but that the office never received a referral from the patient's PCP. Every single day I got calls about this and every single time I looked in the patient's chart there was no referral at all. There were notes that the PCP would like the patient to follow up with said specialist but no actual referral. I would call or send a message to the MA's of these physicians to let them know and I was told one of two things.

    First: We here in scheduling are responsible for filling out the referrals.

    Um . . . sorry . . . what? Scheduling is supposed to be filling out referrals? Since when? I thought that was the doctor's job or at least the MA's. Nope, it's us. The peeps on the phone, some of whom aren't certified to take blood pressure, are supposed to be writing these referrals. What, you want us to write prescriptions too?

    Second: The specialists don't actually need the referrals.

    Oh really? Then why I keep getting calls from other offices every single day asking for a referral? Am I supposed to tell them that they don't know what they're talking about?

    The office manager didn't seem to bat an eye at any of this so I have to wonder. Is any of this standard or was the office manager just grossly incompetent?

  • #2
    I'm not American, and have never worked in a doctor's office; but it sounds stupid.

    I can't think of any reason for it to be hard to assemble a list of which insurances the office accepts. Tedious, perhaps, but not hard. And once assembled, it can be in a quick-reference booklet (or something) for everyone on the phones.

    As for the referrals: my own doctor's office has form letters. The doctor fills in the specialist and the patient's name, and the reason, and the computer generates the form. The doctor clicks print, and the patient has a copy of the referral before she even leaves the office. Another copy is faxed to the specialist, and the whole lot is saved in the patients' records. Done.
    Seshat's self-help guide:
    1. Would you rather be right, or get the result you want?
    2. If you're consistently getting results you don't want, change what you do.
    3. Deal with the situation you have now, however it occurred.
    4. Accept the consequences of your decisions.

    "All I want is a pretty girl, a decent meal, and the right to shoot lightning at fools." - Anders, Dragon Age.

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    • #3
      I don't work in an office setting, but something does not sound right.

      A referral is just a suggestion that a patient see a particular doctor. Now in some states, the PCP is a sort of gatekeeper to specialists. You can't see a specialist (if you have insurance, if you have cash you can do what you want) until your PCP has decided you need a specialist. In some insurance plans, you play even more mother may I games (HMO's are bad for this). The whole point is to keep people from seeing specialists.

      But there generally isn't any paperwork that needs to be done. Usually the PCP office either calls and makes the appointment for the patient, or just gives the patient the name of the doc to call and see.

      I guess your mileage may vary.
      They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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      • #4
        Quoth Seshat View Post
        As for the referrals: my own doctor's office has form letters. The doctor fills in the specialist and the patient's name, and the reason, and the computer generates the form. The doctor clicks print, and the patient has a copy of the referral before she even leaves the office. Another copy is faxed to the specialist, and the whole lot is saved in the patients' records. Done.
        This is what mine does and I am American. Not only faxed but also copied electronically into my file where it can be pulled up everywhere, even by me.

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        • #5
          My insurance doesn't require a referral for specialists, but my PCP's office staff will contact a specialist and ask the specialist's office to contact us to schedule. From the sounds of it, the office you worked at didn't know who was supposed to actually do the job...


          Speaking of which, I need to fire a neurologist and find one that specializes in headaches.. Long story and I'll about posting it tomorrow.
          If I make no sense, I apologize. I'm constantly interrupted by an actual toddler.

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          • #6
            I now have to get a referral to see a specialist. I agreed to it to get a discount on my monthly premium. I don't need a fancy form though; just to see my PCP first.
            They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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            • #7
              The form our doctors fill out isn't fancy, it's just an autogenerater for a form letter.

              Dear (doctor so and so)

              Please see my patient (whoever) for (whatever).

              (fill in any relevent information here)

              She is currently on (list of medications) to treat (condition or list of conditions).

              Thank you for your time,

              (referring doctor).


              It also adds the header giving the referring doctor's name and contact details, and if the specialist is already in the med center's database, it'll fill all that in too.

              And the doctor doesn't fill in the list of meds or conditions by hand - just has to click a kind of 'yes' or 'no' for whether or not to add that to the form letter.
              Seshat's self-help guide:
              1. Would you rather be right, or get the result you want?
              2. If you're consistently getting results you don't want, change what you do.
              3. Deal with the situation you have now, however it occurred.
              4. Accept the consequences of your decisions.

              "All I want is a pretty girl, a decent meal, and the right to shoot lightning at fools." - Anders, Dragon Age.

              Comment


              • #8
                Quoth Crescent Cat View Post
                Getting back to the list of accepted insurance, when I was working at this little slice of paradise I was in scheduling. People would often ask if their insurance was accepted by this office. I asked the manager of scheduling if there is a list of accepted insurances so I can answer this question. I was told to tell them they have to call their insurance company to see if they will cover a visit to this office.
                I'd say lazy. I know my ins. company, makes sure that every participant knows you must check with the DOCTOR'S office to see if they still accept a certain plan, and its posted on my plan's website to do so, since things change. The docs sign agreements with each insurer, and if for some reason its terminated, well, maybe the ins. company hasn't updated their website. So I'd think the actual office would know better which plans they take, rather than the company!

                As for referrals, it really depends on the type of plan you have. I've had HMO's, where you need to see your PCP to get a referral, and currently have a PPO, with no requirement. I have, in the group I go to, been given a referreal slip from one doc to another, but i think that's more THEIR internal practice and policy than anything having to do with my insurance.

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