Home Forums Discussions General Discussion highest copay ever

So, what's the highest copay you've seen for an office visit? Not specialist, pcp.

We just got on that's $100.

$80. Shocked me to see it clearly printed on the card.

Well, possibly this is heading in the right direction and making patients more involved in considering the cost of their health care. As long as they are spending what they perceive to be somebody else's dollar they will not hesitate to spend. Of course, when they are spending their own dollar they spend less freely.....I think this will knock some of the "fluff" out of the system. This will also have a financial impact on the doctors, I suspect it will reduce the volume of visits and not just necessarily the uneccesary visits....a higher proportion of the visits will be for patients who are sick and actually need the doctor, of course, some of them will wait too long and be sicker than they would have been if they had come in earlier. No easy solution.

How many other businesses have 3rd party payers. We just triaged a patient with fever at 10:30 am, who couldn't wait until 1 pm and went to the ED.

Cost if they had come here: $0.00

Cost if they go to the ED: $0.00

Cost for a patient with private insurance to go to the ED: Around a $150 copay.

Cost for a patient with private insurance to come here: $20.00

Cost for a patient with self pay to go to the ED: Full cost of ED visit.

Cost for a patient with self pay to come here: Cost of 99213 minus 35%.

I would think that a high co-pay may affect frequency of visits for primary care; not so much for specialty/procedural care since the costs of the latter are so much more that the co-pay seems like more of a bargain. Yet another disincentive for people to get preventative care, and another stone on the backs of primary care.

The interesting thing about this $100 "copay" is that most insurers don't reimburse the docs $100 for, say a 99213. Or a 99203 I dont think. At least not here, I'd have to go check the records. So, her copay is more than UHCs fee schedule. Are we supposed to reimburse the difference? After all, its not more than OUR fee schedule. This particular patient was diabetic and had not seen a doctor in over a year....because of the high copay.

Now, I don't have a problem with an insurance plan that does not cover typical office visits, but only covers ER and hospitalizations. But I do have a problem with them PRETENDING to cover office visits. They could just say its not covered and ask the doctor what the fee is. Instead, they have this farce where they pretend they are covering the visit, and have the patients believe that they are saving them lots of money. As if all visits are $200-$300 bucks. See? a $100 copay saved you $200 on your evaluation of your sore throat! What frakking BS! Now, this girl's visit would have been kinda expensive, since it was a first visit and multiple issues like DM and HTN. But only the first visit. Oh, and the policy does pay 100% for the Annual Preventive. I told her to schedule her next visit as a Preventive, but she's still gonna need some visits till she's stable.

I think this simply creates more pressure on the patient to try to take advantage of managing chronic disease by e-mail or telephone. And of course we don't charge (or get paid) for e-mail or telephone.

IT IS IMPERATIVE that we get the upper hand on e-visits, and keep them as a CASH option for our patients, NOT reimbursed by insurance. It is a real camels nose under the tent. Once we have some (and of course California and I think Massachusetts have already got a couple of insurance plans paying)plans paying, they all will, and when they all do, they will "negotiate" lower and lower rates.

This is especially important as I under a study will soon be out that claims 80% of primary care interactions can safely be handled as an e-visit. With the profoundly lower overhead of these visits we MUST make use of these.

actually, here plans are already paying of for online and only pay about $30/online consult. But they only will do it if its with RelayHealth's system.

Some of the internists in Fort Worth have set up something called a "medical home" in which the patient pays an annual fee of $300 to $400, this allows them to email or telephone with qustions for medical advice....somehow refills are also involved, I don't know the details. I also don't know if it is working for them. "E-medicine" has lower overhead costs for sure but I think we will get a lot of push back from the patients when we ask them to pay for this....right now I view this as a way to keep lots of patients happy without TOO much trouble on my end.

Frankly, if I had had my head on straight when we implemented it, I would have charged $250 - $300 per year for a patient to have access to our "Electronic Services and Online Office" or some such. This would have included access to our patient portal and its features (which include an Online Office visit). They would still have to pay for the Online Office visit. It would also include access to Online Scheduling. Too bad, because I cant do it now. You cant take something that was for free and start charging for it. Well, you can but.....

Oh, and UHC strikes again! Some patients now have a higher copay for their Annual Physical than for a regular office visit. For example, $45 for the Preventive, but $25 for other office visits. So, they raise their rates, then they lower reimbursements to doctors, then they use hidden methods to reduce the amount of the fee they chose that they pay. Because the 3 patients we've seen with this had not noticed (naturally).