T Nation

Playin' Doctor

hey i just hooked up the health insurance and went to see the doc for the first time. just wanted a physical, blood work, etc.but then after they ran me through in 5 minutes i realized i really didn’t kow what i wanted Cause the physical amounted to blood pressure, weight, " do you smoke how do you feel " let me try out my shiny new stethescope and you’re outta here. i suppose just 'cause i look healthy he looked me over like the mechanic looks over a new car for the inspection sticker.

i expect when they call with the results of my blood work they’re just gonna tell me " you’re fine " and that’ll be it.

i was really surprised to find, when you figure what that visit costs, that i get better service at the pub ordering a $2 beer.

what should i expect from this process ?

any tips on playing this game ?

thanks. -swivel

sox 13 oakland 5 wakefield gets the win

expect to feel like you just got a sygmoidoscopy when you get billed every month when there is nothing wrong with you.

Also expect to have a hard time and be confused when you get a bill that isn’t a bill but you still have to pay it.And a co-pay.

If you have supplemental, make sure it is actualy supplemental. Too many people find out that they are not going to get paid for missing work after they have already been injured, missed work and filed a claim.This is always a good selling point, but unless you have it in writing, don’t expect it.I know 12 people who have fallen for this one.

Swivel,
I just recently got coverage again and had an experience very similar to yours. I expressed my lifestyle and fitness goals as an athlete and told the doc that I’d like to get blood work done as a baseline to use for future comparisons. The doc basically shrugged me off and said I didn’t need all that stuff, I was healthy, etc. While he has a point, I am healthy, I(we) obviously aim a little higher. Obviously I need to find a new doctor, but the question is how? This one I just picked out of a list of local providers. (PPO/HMO hybrid insurance)

Does anyone know of a resource that would indicate a doctor that is sympathetic/knowledgeable of the athletic community?

Heh. Managed care, guys. Managed care.

[quote]apayne wrote:

Does anyone know of a resource that would indicate a doctor that is sympathetic/knowledgeable of the athletic community? [/quote]

Hmm. If you know of any, perheps you could ask a sports rehabilitaion doc who specializes in athletes to recommend a good GP. They usually undertand our goals and may come from an athletic background themselves.

can you just go to a lab and get things like hematocrit, testosterone , blood ph, fats and cholesterol profiles done ?

do you need the doc to do it ?

why are doctors so disinterested ? to use the mechanic comparison again if i take my car in and say give this thing a thourough check up they start drooling. is it that the doc has already got his money in the bag and isn’t getting much more. ?

i read somewhere- i think tc wrote it - that men should seek women doctors because of the natural competition factor. i bet it’s true.

sox 3 a’s 2 millar again ! 2 run hr 9th

Doctors try to do the minimum required because that is all they get paid to do by the insurance company or HMO.

If they start adding all sorts of blood tests not normally required for your situation the insurance company won’t pay.

If you want better service pay for it yourself.

If you think it is bad be glad we do not have socialized medicine.

what’s socialized medicine got to do with it? how 's it different than what i’m getting right now ? and pay for it myself? i’m already paying close to 5 grand a year and he’s telling me to come see him again in a year. got a letter from the doc today w/the results of my bloodwork. it’s a single page and it says

" the results of your bloodwork done on 4/14/05" are within normal limits. "

and that’s it.i don’t even know what they tested for. is this normal ? shouldn’t i get to a copy of the numbers ? shoudn’t he doc help me decode stuff or at least point me in the right direction ? did they even do a test ?

shouldn’t he at least give me a report ??? would i be better off using the money i spend for “insurance” on getting the checkups and info and consulting i want ?and what’s the secret code to get that info do i throw him wink and say i’m paying cash in hand or what ?

i’m not bitching about this. i’m looking for advice. there must be people out there who get better service for their money than i got. how is the game played ?

sox 6 a’s 5 varitek hr bottom 9th !

Working your insurance is definetly a game and an art.

I also think that healthcare and making sure that you are getting what you are paying for is largely your (you in general, not you specifically) own responsibility, because doctors are like personal trainers. Just because someone has a piece of paper and a title, doesn’t mean that they know shit or give a shit about your health, it’s just a job.

Also, like a personal trainer, your doctor, is essentially employed by you. Your doctor is working for you at a rate of what, $100/hr? $200/hr? More? So, if you don’t like something, if you aren’t comfortable with something, if your aren’t safisfied with an answer, if you don’t understand something, you have every right to ask until you do. And if you are still not satisfied, find a new doctor.

And the best doctor is not a mind reader so as much as possible it is important to educate yourself as to what you want/need before you go in. A physical is kind of a vague term. For example, at my current doc, my first physical lasted for hours, and included assorted x-rays, a glucose tolerance test, a battery of blood tests, urine and stool samples, and on and on and on. I have never had a poking and prodding like that! My subsequent physicals have been slightly less invasive, but I was told the initial physical was to establish a point of reference. My previous doc didn’t even do any blood work, he essentially looked in my ears, down my throat, knocked my on the knee, told to lose weight, and sent me on my way.

This doctor has also been instrumental in helping me get things covered by insurance that people can’t believe insurance will cover. I have lost a fair amount of weight, and this fall enjoy an insurance sponsored boob job, among other cosmetic procedures. Insurance also covers my massages, up to three times/week, colon hydrotherapy, accupucture treatments, chiropractic, and facials, and laser hair removal. Seriously. Having a good doc is elemental in working your insurance because proper billing codes and following certain procedures will make all the difference, otherwise what the fuck are you paying for, right?

And, by the way, my insurance is by no means top of the line. It’s just middle of the road, not as good as some, could be worse.

that’s killer info sabrina thanks.none of my friends have insurance so they aren’t a source of experience for me. i guess i need to start gathering information from as many sources and as i can.
what you said was gold as far as changing my perspective of the relationship from deferential to business. that’s worth alot. thx again .

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You have to think about how insurance works. You are paying $ 5000 a year.

The insurance company tries to keep your doctor bills as low as possible so they can make a profit.

The insurance company gives your doctor guidelines on what he procedures and test he should do depending on your condition.

Sabrina is exactly right. If your doctor does not effectively play the insurance game, you will not get any extras.

As to whether you should drop your insurance and pay for the doctor out of your pocket, it would be cheaper as long as you stayed healthy.

If you were to get seriously ill or injured without insurance you could find yourself in some real bad debt.

[quote]
Sabrina wrote:
Working your insurance is definetly a game and an art…

This doctor has also been instrumental in helping me get things covered by insurance that people can’t believe insurance will cover. I have lost a fair amount of weight, and this fall enjoy an insurance sponsored boob job, among other cosmetic procedures. Insurance also covers my massages, up to three times/week, colon hydrotherapy, accupucture treatments, chiropractic, and facials, and laser hair removal. Seriously. Having a good doc is elemental in working your insurance because proper billing codes and following certain procedures will make all the difference, otherwise what the fuck are you paying for, right?

pushharder wrote:
Folks, remember this quote next time someone you know is bitching about skyrocketing insurance premiums.[/quote]

Ouch. I have to admit that a boob job seems a little out of line with a medical insurance program. So are facials and hair removal. Maybe if the patient was hirsute… hmmm, better not go there. Anyway, I’m happy for ya Sabrina, but it sounds to me like you either don’t have normal medical insurance or your doctor is committing fraud.

Quick factoids for anybody who might care:

The last time I checked into it, diabetes and the complications from it (hypertension, congestive heart failure, the list goes on forever) gobble up almost 70% of all Medicare dollars.

And: 30% or more (it’s hard to estimate) of all health care dollars are lost through fraud.

The art of “working” an insurance company is called “larceny” usually. Think about that the next time you hear a doctor talking about his next summer home he wants to buy. :slight_smile:

[quote]lothario1132 wrote:

Quick factoids for anybody who might care:

The last time I checked into it, diabetes and the complications from it (hypertension, congestive heart failure, the list goes on forever) gobble up almost 70% of all Medicare dollars.

And: 30% or more (it’s hard to estimate) of all health care dollars are lost through fraud.

The art of “working” an insurance company is called “larceny” usually. Think about that the next time you hear a doctor talking about his next summer home he wants to buy. :)[/quote]

so you’re saying mcdonalds and coca-cola are responsible for 70% of medicare dollars ? ha just kiddin !! sort of :slight_smile:

[quote]swivel wrote:
hey i just hooked up the health insurance and went to see the doc for the first time. just wanted a physical, blood work, etc.but then after they ran me through in 5 minutes i realized i really didn’t kow what i wanted Cause the physical amounted to blood pressure, weight, " do you smoke how do you feel " let me try out my shiny new stethescope and you’re outta here. i suppose just 'cause i look healthy he looked me over like the mechanic looks over a new car for the inspection sticker.

i expect when they call with the results of my blood work they’re just gonna tell me " you’re fine " and that’ll be it.

i was really surprised to find, when you figure what that visit costs, that i get better service at the pub ordering a $2 beer.

what should i expect from this process ?

any tips on playing this game ?

thanks. -swivel

sox 13 oakland 5 wakefield gets the win[/quote]

Tips? Yes. You have to ASK for what you want. Tell them what you need, and they should do it.

Tips? Yes. You have to ASK for what you want. Tell them what you need, and they should do it.[/quote]

since i wrote this i’ve been asking everyone i come in contact with and that has been the one thing everyone says. you gotta be that squeeaky wheel. thanks.

[quote]swivel wrote:
Tips? Yes. You have to ASK for what you want. Tell them what you need, and they should do it.

since i wrote this i’ve been asking everyone i come in contact with and that has been the one thing everyone says. you gotta be that squeeaky wheel. thanks.

[/quote]

And you have to be assertive about it. Remember, doctors are gods and know everything, so some puny mortal asking them to deviate from their usual MO is just asking for THE SNEER.

We get better service at McDonalds than we do the typical doctors office. Do you know why that is? It’s called competition! McDonalds knows that if they keep you waiting to long you might pull away and drive over to Burger King or one of the other like joints.

Doctors on the other hand know that they have you right where they want you! There is simply not enough of them to go around. It’s all about supply and demand!

What we need to do in this country is have government assistance to send people to med school. As soon as the market is flooded and there is plenty of competition then the cost of medical attention will come down, and the service will improve.

[quote]ZEB wrote:
We get better service at McDonalds than we do the typical doctors office. Do you know why that is? It’s called competition! McDonalds knows that if they keep you waiting to long you might pull away and drive over to Burger King or one of the other like joints.

Doctors on the other hand know that they have you right where they want you! There is simply not enough of them to go around. It’s all about supply and demand!

What we need to do in this country is have government assistance to send people to med school. As soon as the market is flooded and there is plenty of competition then the cost of medical attention will come down, and the service will improve.
[/quote]
Oooo… tough call there ZEB. There is a point of diminishing returns on this. For example, we in Tally are currently training a bunch of young doctors in the anticipation of the baby boomers getting sick, but I would say that less than 20% of them speak english very well. I don’t have anything against foreign folks coming in to achieve their dreams of being doctors, but I would hesitate to say that things are going to be a lot better. You baby boomers are going to be a pain in the ass for me, I hope you know. :slight_smile: