Healthscient Blog

DPC Dr. Efe Sahinoglu out of Birmingham, Alabama

Healthscient Interview with DPC Dr. Efe Sahinoglu

DPC Dr. Efe Sahinoglu out of Birmingham, Alabama

We at Healthscient are big fans of the rapidly emerging Direct Primary Care practice model. Dr. Efe Sahinoglu opened Birmingham Direct Primary Care in Birmingham, AL in mid-2018. We recently sat down with Dr. Efe to hear about why he chose this model, this market, and what he’s seeing so far.
 
 
 
 
 

Healthscient:

Why did you decide to practice Primary Care? What was the attraction?

Dr. Efe:

I was attracted to the prospect of longitudinal care. I like the idea of a continuous physician-patient relationship and being there to support a patient every step of the way throughout his or her life. Prevention, treatment, and assistance in coordinating care with specialists are all a part of continuous care and that’s important to me. Being a family medicine doctor allows me to provide care to patients of all ages and genders and allows me to provide care over the span of many years. I’ve seen so many patients with medical problems that could have been easily prevented through proper medical guidance and a healthier lifestyle. Many of these patients didn’t have easy or affordable access to a primary care physician and so their highly preventable or manageable conditions became worse and worse and increasingly problematic. The importance of a good primary care doctor – a “care quarterback,” if you will – cannot be overstated.

Healthscient:

Why did you establish a Direct Primary Care practice (DPC)? What is the appeal?

Dr. Efe:

The Direct Primary Care model allows me to take the time to listen to a patient’s concerns without putting them on an assembly line of 30 patients a day. I can focus on caring for patients and solving medical problems rather than wasting time on medical insurance coding, paperwork, and other interferences. My patients can keep in touch with me – and also help me monitor the course of their progress or treatment – which can be done through text, phone, email, or some type of video conferencing like Skype as well as office visits. I like the ability to spend more time with patients during office visits (like 30 to 60 minutes rather than 7 to 10 minutes per visit) and patients like same or next day appointments and no waiting in our lobby!
 

Healthscient:

What exactly IS Direct Primary Care in your words? What’s its promise? What’s the difference between DPC and a typical primary care practice?

Dr. Efe:

It’s the care I always envisioned providing to patients. It’s not the traditional primary care model where the doctor has about 7 minutes per appointment to try to provide comprehensive and preventive medical care. Seven minutes or so is all the time a doctor can devote to each patient in a typical primary care practice because the physician has to see 25-30 patients per day just to stay afloat. As a side note, this kind of relentless and unrewarding work is the primary reason for rampant physician burnout. Direct Primary Care is about the patient, not the practice. Time, easy access, affordability, focus, and longitudinal care greatly, greatly benefit the patient. Fortunately, the model is good for physicians, too. Being freed from the burden of billing and a mountain of time-consuming administrative requirements translates to being a better, more attentive doctor. Lasting, meaningful relationships are formed and care becomes more collaborative.

Healthscient:

Who should consider joining your DPC practice? Is there an “ideal” patient?

Dr. Efe:

Direct Primary Care is ideal for just about any type of patient. Generally healthy people of any age, people managing multiple chronic conditions and medications, people beginning to experience age related illnesses, families with kids, college students away from home, and young people just getting off a parent’s insurance plan due to age are all suited perfectly for DPC.
People concerned about the cost of quality care can benefit. The actual cost savings this type model provides, of course, depends on the patient case by case. For example, a common feature of DPC is wholesale medication and lab pricing. Just the savings from wholesale drug pricing (dispensed from the practice) can more than pay the membership fee for a patient requiring multiple, ongoing medications. Busy people who just hate going to a doctor’s office because of the huge difference in wait time and facetime with the physician will love DPC. Not only is there convenient access and no waiting, but many, routine medical problems can be handled over the phone. Time is money for everybody. On a similar note, DPC is also ideal for college students who are busy with their studies and may prefer to use technology to communicate with their doctor rather than go through the hassle of trying to squeeze in an appointment between classes. Often, parents of college students feel relieved that their kids, who may be miles away, have access to quality, concierge style medical care at an affordable price. Patients who require frequent monitoring by their primary care physician will appreciate the “no co-pay” feature of Direct Primary Care.
Cost savings are important, of course, but ultimately Direct Primary Care is perfect for any person who values an ongoing physician-patient relationship, values expert, focused attention, or who values quick, easy and convenient access to medical care.

Healthscient:

Did you transition from a traditional practice or start from scratch?

Dr. Efe:

I started from scratch, despite many traditional practice positions being available to me. I felt that running my own DPC practice was financially appealing for a younger physician fresh out of training with lots of medical school debt. After going through my training, I did not want an “administration” to tell me how to see my patients and to be continually telling me to “hurry up!” I wanted to be a doctor – practicing medicine – rather than be enslaved by medical insurance coding and paperwork.
During my medical school and residency training, no one really taught me how to start my own practice – especially not a DPC practice. (Dr. Sahinoglu notes that the majority of his practice management courses in medical school were focused on proper coding. Geez…)

Healthscient:

How do you feel about your decision so far? How are things working out?

Dr. Efe:

I knew it would be tough starting out. Many people have not heard about the concept of Direct Primary Care as it really hasn’t made its way down here (Birmingham, Alabama) like it has in some other cities or states. So, it is taking some time to educate the general public. However, I’m just excited to be part of this movement and it’s definitely exciting to see its growth here in Birmingham – slow though it may be. I’m really looking forward to the years ahead. I have no doubt that the Direct Primary Care model is going to continue to spread throughout the greater Birmingham area as people start to become aware of the option.

Healthscient:

So, why DID you choose to set up your practice in Birmingham, Alabama?

Dr. Efe:

I spent 20 years in Alabama and really just wanted to stay in the state and serve its great residents. About a quarter of this time was in Birmingham, including my medical training. I loved the diversity, the small city feel with the bigger city advantages. I have family in Montgomery and the rest of the state is quite accessible from Birmingham. Also, I noticed the DPC model wasn’t well known to Birmingham (at the time of this interview, there was only one other DPC clinic in the city) and wanted to help make this model of providing quality, affordable primary care more available to the good folks of Birmingham.

Healthscient:

Well, finally then, what would you like the good people in the Birmingham, Alabama area to know and how do they get in touch with you?

Dr. Efe:

This model is for everyone. Whether or not you have health insurance. Young or old. If you would like to be part of a 600 person patient panel rather than the typical 2000-5000 and if you want a physician to truly know and care for you and your family. If you like the idea of no co-pays and if same or next day appointments are attractive to you. If you want longer facetime with your physician when needed and want to be able to communicate via text, phone, email, video conference or office visits. If you want access to greatly reduced medications and lab costs. Check us out at:
www.BirminghamDPC.com
205-582-3322
info@BirminghamDPC.com
 

About Dr. Efe Sahinoglu

Efe Sahinoglu, MD, is a full board certified family medicine physician. He is from Montgomery, Alabama. He attended Auburn University (Auburn, Alabama) where he finished his bachelor’s in chemical engineering with honors, and worked as an engineer before attending medical school at the University of Alabama School of Medicine. He received his third and fourth years of clinical education from the Medical School’s main campus in Birmingham. Afterwards Dr. Sahinoglu completed his family medicine residency at University of Alabama Family Medicine Residency Program.

Healthscient Interview on the “Medicine on Call” Podcast by Dr. Elaina George

We are excited to share that our founder and CEO, Matt Larsen, had the opportunity to be interviewed on Dr. Elaina George’s popular podcast, Medicine on Call, a weekly talk show that explores health issues and the politics of medicine on Americas Web Radio and Liberty Talk.fm Radio.

During the interview, Matt talks about:
– the free market side of healthcare, and what trends are disrupting the industry
– the story behind Healthscient, and why we are building solutions for a new era of healthcare
– the criticality of both communication and collaboration for high-quality healthcare
– the growth of telemedicine, and why it matters

Listen to the interview here:

https://libertytalk.fm/healthcare-is-broken-yours-does-not-have-to-be/

About Dr. Elaina George

Dr. Elaina George is a Board Certified Otolaryngologist. She graduated from Princeton University with a degree in Biology, received her Master’s degree in Medical Microbiology from Long Island University, and received her medical degree from Mount Sinai School of Medicine in New York.

Healthscient-Insurance-Open-Enrollment

Open Enrollment: Stay Calm, Think, and Do the Work.

The beginning of open enrollment for health insurance feels a lot like shopping on Black Friday. It tends to be frenetic, anxiety-inducing, and overwhelming.

We get it.

Of all the health insurance purchasing advice available to you right now – and there’s plenty of it to be sure – perhaps the most sound is to summon your consumer mindset, stay calm, and do the work.

Thinking like a consumer and doing the work are really important. A stunning open enrollment survey conducted by Aflac shows that 80% of employees spend less than one hour researching their plan options, with 57% spending less than 30 minutes. And 93% of employees simply choose the same benefits year after year with little or no research.

Whether you are choosing an employer-provided plan option or shopping on the open exchanges, do some work ahead of time. Stop and think, and take control. If at all possible, the driving question you should ask yourself is, “What do I need?” or “What makes sense for me?”, rather than, “What can I afford?”.

For example, let’s say you are evaluating 3 plan options: Bronze, Silver, and Gold. Start by looking at the premium and maximum out-of-pocket costs for each option, and then add those two numbers together. Those sums are your worst-case scenarios! Compare them. What is the likelihood that you will reach your maximum out-of-pocket cost in a typical year? It’s not very likely in most cases. Which option offers you the most favorable maximum out-of-pocket expense? Given that we most often do not reach the maximum out-of-pocket number anyway, is the higher monthly premium (that’s normally needed to achieve a lesser out-of-pocket maximum) really worth it?

To be clear, the example above is arbitrary and fictional. YOUR decisions should be based on YOUR needs and circumstances. Nobody – and we mean nobody – can decide what’s best for YOU, all things considered. Only YOU can do that. And, it takes some effort. So, stay calm and think.

For more help with making a decision regarding open enrollment/health insurance, read the last chapter – Spend on Care, Not on Coverage – of our free eGuide, 5 Steps to Better Healthcare at Lower Cost. And if you do nothing else to prepare for open enrollment, be sure to at least scan over the chapter – we strongly believe it will help!

Want Better and Less-Expensive Healthcare? Read our free eGuide, 5 Steps to Better Healthcare at Lower Cost

For detailed, step-by-step encouragement and assistance on achieving better healthcare for you and your family, download our free eGuide, 5 Steps to Better Healthcare at Lower Cost. Also, be sure to visit our home page for practical tips and healthcare insights.

Healthscient eGuide, 5 Steps to Better Healthcare at Lower Cost

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People holding puzzle pieces

Unbundle: A Key to Healthcare Decision Making

There are, of course, myriad factors and considerations when pursuing optimized health, achieving better healthcare, and containing healthcare costs. It’s a lot to take in, especially when you try to do it in one, big gulp.

The key is to unbundle.

Set everything else aside, for the moment, and consider three things first. But, consider them one at a time – by themselves – and in a particular order.

1) Be Honest with Yourself & Set Realistic Health Goals

First, be honest with yourself about your current health and set some realistic, achievable health goals. General goals are fine to begin with. Don’t get bogged down with specifics (just yet).

    • How well do you take care of yourself?
    • What chronic conditions are you managing?
    • What’s in your family history that causes you concern?
    • What age-related conditions might creep in?

Then…

    • What do you hope for your health in the future?
    • What do you want to be able to physically do or accomplish?
    • What do you want to feel like?
    • What do you want to look like?
    • What do you NOT want to worry about?

Fix these things in your mind. Write them down. Don’t move to the next thing too quickly.

2) Think Objectively and Define What You Want in a Primary Care Physician

Second – and separately – you are going to need a good primary care physician. We all do. Your health and chronic conditions may necessitate any number of specialists, but concentrate on primary care for the moment. Disregard the things that customarily keep us attached to a particular PCP (“takes” your insurance, has been your doctor for years, is located in convenient proximity to you…etc.) and think objectively.

    • What do you really want in a doctor-patient relationship?
    • What do you need from him?
    • How accessible is your doctor?
    • How long does it take to get an appointment?
    • How much face time do you actually have with your doctor during appointments?
    • Is your doctor proactively engaged in your health and well-being or does she simply medicate you when you’re sick?
    • Does your doctor suggest and encourage natural, holistic approaches to health maintenance? Does she offer nutrition and fitness advice – tailored for you specifically?
    • How about follow-up or ease of communication?
    • Does your doctor really know you or are you primarily a name on a chart? Does that matter to you?
    • What kind of doctor-patient relationship gives you the best chance for optimized health? Do you have that now?

When you have generally defined what you want – and deserve – in a primary care physician, move to number three.

3) Consider the Economics

Third, you have to consider the economics of it all. But, as with numbers one and two, think objectively. Set aside the inclination to make health and healthcare decisions from a place of fear. Oh, the fear is real enough. Most of us are more concerned about not being able to “afford” the healthcare we need than we are of being sick. And for good reason.

But does the way you pay for healthcare right now have to be? Might there be another way that makes more sense for you? Are you carrying too much health insurance? Do you really need the degree of comprehensive coverage you now have? (Remember, health insurance and healthcare are two different things. Healthcare can make and keep you well. Health insurance cannot. Learn more in Step #5 of our eGuide, 5 Steps to Better Healthcare at Lower Cost).

Have you considered some type of health savings account (HSA)? Have you looked into the possibility of paying for most of your healthcare out-of-pocket instead of a sole reliance on health insurance? Is it better for you to pay for insurance only, or to pay a subscription or membership fee to a direct primary care or concierge physician? How about one of the medical cost sharing plans available? Are you sure you are getting your money’s worth right now? Research and understand how the options work.

Now that you have considered and clarified these three things separately – that is, you’ve unbundled them from each other – start to put them back together. How can you best make them piece together to form your desired healthcare universe? Chances are you have some decisions to make. But remember this, you DO have options. You’re not locked into anything, necessarily.

Want to learn more? Read our latest eGuide

For detailed step-by-step encouragement and assistance, read our free eGuide, 5 Steps to Better Healthcare at Lower Cost and visit Healthscient.com for practical tips and important healthcare insights.

Healthscient eGuide, 5 Steps to Better Healthcare at Lower Cost

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A Perspective on Short-Term Health Insurance

Let’s remember: healthcare and health insurance are not the same thing. To be sure, we need both. But, it’s important to keep in mind that both your healthcare and your health insurance should be personalized and tailored to fit your unique needs and objectives. One size does not fit all.

Your healthcare decisions – beginning with choosing the right primary care physician – should be fundamentally driven by your health and health goals. What health providers (including primary care and others) give you the best chance of optimizing your health and well-being?

The same kind of thought process applies when researching, evaluating, and selecting health insurance. How much coverage should you have and what kind of coverage should that be? How can you insure yourself against a medical cost catastrophe without over-insuring or breaking the bank? What kinds of insurance plans and options are accessible to you? Are alternative options – like Medical Cost Sharing plans – a reasonable possibility for you and your family?

You get the drift. One size of health insurance does not fit all.

The U.S.’s recent changes to short-term insurance policy

Many of the millions of us who do not have access to employer-provided health insurance are keenly aware of the Affordable Care Act (ACA/Obamacare) and the exchanges and mandates that go along with it. We are also keenly aware of subsidy restrictions and rising premiums. The term “affordable” simply does not apply for many of us.

The U.S. Departments of Health and Human Services, Labor, and Treasury have recently announced that the rules for short-term health insurance will be expanded, loosened, and adjusted. That’s welcomed news for many. The removal of the individual mandate, which taxes those who did not maintain an ACA type of health plan, may also be good news for many, but not everyone.

Short-term health plans are nothing new. They’ve been around for a while, mainly in the form of indemnity plans. Prior to the ACA, short-term indemnity plans were offered in 3 month, 6 month, and 1 year increments. The ACA capped short-term plans at 3 months and then mandated the purchase of ACA coverage.

That changed earlier this month. The new plans – available as early as October of this year – will allow people who do not have employer-provided insurance to purchase short-term health insurance at prices that may be considerably less than ACA coverage. Considerably less.

Some of the positive highlights of the new health insurance changes:

    There are NO narrow networks, which is typical of indemnity plans. There are no contracts with specific doctors or hospitals, enabling you to seek medical attention wherever you please.

    Premiums are predicted to be much, much lower. This will be particularly beneficial to younger (healthy) consumers, healthy people of any age, healthy people who have been unable to afford insurance in the past, and perhaps people who are between jobs and need a little coverage until their next gig.

    There is NO enrollment period. This is a big change. You may sign up at any time unlike most insurance plans (including those offered by Obamacare) where enrollment periods are strictly regulated.

    Coverage begins almost immediately.

Sounds great, right? It may very well be for some of us. If it works for you, fantastic! Take full advantage! But remember, one size does not fit all.

Health and Human Services (HHS) does not claim that these plans are the same as those offered on the exchange. In fact, James Parker, a senior advisor for health reform at HHS, recently stated on a conference call with reporters, “We make no representation that it’s equal coverage.”

Some things to be aware of from the policy changes include:

    Pre-existing conditions will likely disqualify you. Practically any chronic condition (cancer, diabetes, high blood pressure) will work against you. So will a history of unhealthy habits like smoking and excessive alcohol or drug use.

    The Affordable Care Act mandated that insurance providers cover what the government determined to be essential benefits. That does not apply to these short-term plans. These plans won’t cover things like maternity care, mental health, preventive exams, prescription medications, vaccinations, or tests and screens. Be aware.

    The ACA included regulations to protect consumers. Those consumer protection regulations do not exist in these short-term plans. Rescission – or, retroactively rescinding coverage at the whim and whimsy of the insurance carrier – is an example. Again, beware.

    There are no limits on out-of-pocket costs or lifetime costs.

    While these short-term plans are available to people for up to 3 years, you have to reapply each year. They are not renewable from year to year.

So, generally speaking, it will be the younger, typically-healthier people who will likely benefit most from this new policy. It’s really good news for them – and some others of course – and they will likely abandon the ACA individual marketplaces in droves. While it remains to be seen, this transition may mean that an older, less healthy group will be left behind. That’s bound to have an effect, right?

What should you do next?

Research and evaluate options. Be aware and informed. Make the best possible decisions available and accessible to you. And remember (dare I say it again?), one size does not fit all.


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How to Achieve Peace of Mind in Your Healthcare

Peace of mind…

It’s what we all really want at our core. It’s what we seek. We are keenly aware – and grateful – when we have it. We are also keenly aware when we don’t. We tiptoe around tentatively – apprehensively – waiting for the proverbial other shoe to drop. And the continual gnawing of discontent is often mentally, physically, and emotionally exhausting.

Confidence. Tranquility. Liberation. Freedom. Peace of mind.

That’s what we want when it comes to our healthcare, too. We want healthcare peace of mind for ourselves, our partners, our children, and our aging parents. We want the peace of mind that comes with freedom from worry.

Though it often feels elusive, peace of mind is attainable. In fact, it is within your grasp right now. You can journey toward it, taking one step at a time. You’ll need to make some real choices about your health and health goals along the way. Peace of mind is not possible when you know in your heart of hearts that you’ve left some things on the table. No, rather, it comes from knowing that you have done all that you can (or are willing) to do in pursuit of optimized health.

You’ll also need to be the overseer of your own healthcare landscape. Peace of mind is not possible when you give that power (and responsibility) to someone else. That power shouldn’t belong to your doctor, nor to your insurance company, nor to your pharmacist, nor to your hospital.

The overseer of your healthcare should be you.

Speaking of doctors, you’ll also need to ask yourself some tough questions about your relationship and interactions with your primary care physician. Lack of access, lack of attentiveness, lack of communication, and lack of proactive partnership are not the ingredients of healthcare peace of mind. Feeling virtually invisible to a primary care practice does not breed a sense of calm. It does quite the opposite instead.

Ways and means to assist you on your journey toward optimized health (and peace of mind) abound. There are monitors, trackers, tests, and screens all around you. And many of them are accessible and affordable. Peace of mind is not possible without at least having a little insight into how your health journey is going at any given point in time. Knowledge is power. Power is freedom.

The trickiest step – the steepest climb – for most of us is money. Or, maybe more accurately, the steepest climb is fear. The two are related. Most of us are more fearful of being unable to pay medical bills than we are of being sick. Let that sink in for just a second. Most of us are more fearful of being unable to pay medical bills than we are of being sick. Medical debt is real, no doubt. But it is the fear that drives so many of our decisions. We might over-insure. We so often under-expect. Fear is not peaceful.

Achieving healthcare peace of mind may seem daunting and unreachable to you right now. But fortunately that’s not the case. Peace of mind is within your grasp. Right now. Just start walking. Take one step at a time.

For an overview and infographic on how you can attain healthcare peace of mind, click here.

Also be sure to subscribe to our mailing list to receive new Healthscient content as it’s published and be notified when our newest e-guide, “5 Steps to Better Health at Lower Cost” is published and available for download!

 

Wearables Are Revolutionizing Healthcare

A major component of achieving good health that results in lower healthcare costs is prevention.
That’s a no-brainer. Additionally, early detection plays a key role in the prevention of acute health problems and emerging conditions.

The rapidly growing wearables industry is helping make both prevention and early detection more readily attainable than ever before. And as wearables keep getting better, they continue to do what made them great in the first place: encouraging and nudging us to exercise more, sleep better, and eat well.

And all of these great innovations (in wearables) that we’re seeing right now are likely just the beginning.

TechRadar, a self-proclaimed gaggle of geeks who research and report on the latest technology products and trends, describes the inventive wearable industry this way:

“It feels very much like we’re reaching a tipping point: ever-smaller, ever-smarter devices are making the previously impossible possible, enabling us to learn more about our bodies and how to look after them. Plenty of technologies promise to change your life, but wearables genuinely will.”

Just ask Deanna Recktenwald, whose watch warned her that her resting heart rate was surging. Her kidneys were beginning to fail.

Sarah-Jayne McIntosh’s Fitbit warned her of a similar condition, helping her avoid possible cardiac arrest.

New Yorker William Monzidelis was alerted by his Apple Watch to seek medical attention. At the hospital, he learned that that he had suffered an erupted ulcer and received life-saving surgery.

There are scores of stories of doctors being able to better diagnose and determine courses of treatment for patients who present as unable to communicate by digging in to archived health data on the patient’s wearable device.

To put it succinctly, we’ve come a long way from simply counting steps.

L’Oreal, the beauty firm, recently launched a wearable UV sensor to help protect against skin cancer. Their new wearable is tiny, fits on your thumbnail, and tells you when it’s time to get out of the sun.

There are practical uses for wearables too, like Carelink, who creates wearables that can locate and help dementia patients who may be prone to wandering.

In Closing

Here at Healthscient, we agree with TechRadar: the wearables market is poised to revolutionize everything. You can read their full article on wearables here.

If you haven’t already, be sure to sign up for Healthscient email updates. You’ll be the first to receive our free e-Guide titled “5 Steps to Better Health at Lower Cost” and we’ll deliver it to your inbox in the days ahead. For a sneak peek, see this infographic below and our related blog post!.

Unexpected medical bills

How To Lower Your Risk of Receiving an Unexpected and Costly Medical Bill

We hear the horror stories time after time. Someone has received necessary medical attention and then gotten stuck with a bill their insurance company has refused to pay. The doctor or hospital informs the patient that she’s on the hook for it and the payment is often beyond budget.

Take Brittany Cloyd’s story for example, which was shared and published by Vox Media.

[Brittany] was doubled over in pain when she arrived at Frankfort Regional Medical Center’s emergency room on July 21, 2017. “They got me a wheelchair and wheeled me back to a room immediately,” said Cloyd, 27, who lives in Kentucky.

Cloyd came in after a night of worsening fever and an increasing pain on the right side of her stomach. She called her mother, a former nurse, who thought it sounded like appendicitis and told Cloyd to go to the hospital immediately.

The doctors in the emergency room did multiple tests including a CT scan and ultrasound. They determined that Cloyd had ovarian cysts, not appendicitis. They gave her pain medications that helped her feel better, and an order to follow up with a gynecologist.

A few weeks later, Cloyd received something else: a $12,596 hospital bill her insurance denied — leaving her on the hook for all of it. Her insurance company denied the claim – saying an ER visit for ovarian cysts was unnecessary and inappropriate.

How was she supposed to know?

 
Or like Scott Kohan’s story, another eye-opening story shared by Vox Media.

[Scott] who woke up in an emergency room in downtown Austin, Texas, with his jaw broken in two places – the result of a violent attack the night before. Witnesses called 911, which dispatched an ambulance that brought him to the hospital while he was unconscious.

“The thing I remember most was my lips were caked in blood and super dry,” Kohan says. “My head was throbbing, so I touched the top of my head, and I could feel staples there.”

Kohan called for a nurse, who explained that he would need jaw surgery that night. In the meantime, he tried to check whether the hospital — Dell Seton Medical Center — was in his insurance network.

“I was on my iPhone lying there with a broken jaw, and I go on the Humana website and see the hospital listed,” Kohan says. “So I figured, okay, I should be good.”

Except he wasn’t: While the emergency room (where Kohan was seen) was in his insurance network, the oral surgeon who worked in that ER was not. That’s how Kohan ended up with a $7,924 bill from the oral surgeon that his health plan declined.

How could he have known that?

 
These stories, and many others like them, are part of a project by Vox to uncover, document, and report on such cases. These stories are real. And there are a lot of them.

So the questions become, “How do you lower the risk of receiving an unexpected, high dollar medical bill?” “What can you do if you find yourself in a similar situation?”

Here’s a practical list our team has put together to help you lower the risk:

  • Know your insurance plan (backwards and forwards) before you actually need to use it. Be knowledgeable about the can’s and can not’s, the do’s and do not’s, and the will’s and will not’s. Know your stuff.
  • When possible, have an advocate with you at the hospital. Drag along someone you trust who will ask good questions and help you make good decisions.
  • Never sign any kind of financial responsibility or insurance waiver before getting the necessary pre-authorizations unless absolutely necessary due to the urgency of your situation. If you need life-saving surgery or treatment right then – go ahead! Sort it out later. BUT – if you are presented with a waiver that requires you to assume full responsibility for payment simply to accommodate the hospital or doctor’s schedule – wait it out. Time slots frequently open up unexpectedly and you may be pressured to move ahead for the sake of the efficiency of the provider. Don’t do it. Get your pre-authorization.
  • As a bit of an aside, be aware of ambulance costs. These can sneak up on you. There should be a line item in your insurance plan. Uber may be smarter. Read more about it in this article by Kaiser Health or in this summary article by Frugal Nurse.

But let’s face it, sometimes it doesn’t matter how careful you are, as the stories above illustrate. Other times you are simply situationally incapable of making careful, informed decisions. And a whopping, unexpected medical bill is the result.

What to do then?

  • Don’t take it at face value. Contact your insurance company. Explain the situation. Argue like crazy. Ask about their appeals process. You’re the customer.
  • Know about the resources in your state that advocate and represent you. Consumers Union – an advocacy group within Consumer Reports – has a great online tool to help you know about agencies in your state that will help you appeal and negotiate high, unexpected medical bills.
  • Many states have laws on the books to prevent this kind of behavior by insurance companies. More legislation is on the way across the country. How about your state? The Commonwealth Fund may be able to help point you in the right direction.
  • Haggle. No kidding – haggle and negotiate with the originator of the denied claim. Very often, they are more than willing to reduce fees and work out payment plans with you. They just want to get paid.

 


Thank you for reading. Be sure to subscribe to our mailing list for more healthcare insights, tips, and news! We’ll keep you informed, but we won’t annoy you.

View From the Other Side of the Examination Table

At Healthscient, we wholeheartedly encourage healthcare consumers like you to consider partnering with a primary care physician who proactively aligns with your health goals and offers a payment model that makes good, financial sense. After all, your health is your greatest asset and…well…money is a consequential issue.

Partnership is an important word. It suggests a cooperative arrangement between two or more parties. In this case, it suggests a cooperative arrangement between you and your doctor. Both doctors and patients want this kind of partnership – it’s the dream scenario. So why does your relationship with your doctor so often feel like something less?

There is, of course, a myriad of reasons and contributing factors as to why. But consider these few from a typical primary care physician’s side of the table:

    • They often carry hundreds of thousands of dollars of medical school debt into their 40’s or 50’s.
    • They have to manage a patient load of between 2000-3000 clients to simply make their economics work.
    • That means they have to see between 20 and 30 patients a day in about 10 minute increments.
    • It takes about 13 minutes per patient to simply complete the insurance billing and administrative paperwork. That costs real money.
    • 30 percent of appointments are no-shows (on average).
    • On top of it all, as high as 50 percent of patients with at least one chronic illness do not adhere to prescribed treatment plans.

Clearly, we patients are to blame for some of these reasons. We have to own our part of the problem and commit to doing better. But the fact remains that a typical primary care physician is trapped and ensnared by a broken system. It’s why there is record burnout among these doctors. It’s also why so many of them (in steadily growing numbers it seems) are opting for a different kind of model. Many are moving to Direct Primary Care or Concierge medicine.

And we think you should consider moving with them.

 
For a little more on the topic (albeit transparently biased), we highly recommend reading this article. Also, to help kick start your journey, download our infographic: 5 Steps to Better Healthcare at Lower Cost.
 


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Direct Primary Care – The Moment I Finally Made the Switch

I like my doctor. I really do.

We’ve been together for over a decade now. Oh sure, I only see him once or twice a year unless I get sick. And, sure, it’s pretty tough to schedule a timely appointment. I understand I’m not the only patient he has and that he can’t really afford to spend too much time with me during those infrequent visits. I don’t really mind that he continues to call me Robert – though no one else on the planet does.

I guess I don’t really mind that it’s never actually him who calls me back with an answer to a question I’ve phoned in. I will say, however, that asking subsequent follow-up questions through an intermediary is less than ideal – no offense to capable, well-intended staff. But, I really do like him and I think he is a good doctor.

Nothing is perfect, right?

As I turned the corner and headed north of 50 years old, I began to feel like I wanted a little more from this relationship. (I’ll resist the temptation to say, “It’s not him…it’s me.”) As I looked toward retirement, I realized that my health is my most important asset. I had begun to feel more and more like a number to his practice – like just a customer.

To be clear, I wasn’t mistreated in any way but I didn’t feel like I was all that “visible” either. I was feeling like I wanted more of a partner – someone a bit more engaged in my ongoing health instead of just a provider. I was already kind of feeling this way.

And then something happened.

 
I had my annual physical just two months before (it lasted a quality 13 minutes.) My blood pressure was running a little high (as it has been since high school – I’ve always been on the top end of normal) so we decided to add a little medication to my daily regimen. The doctor sent me a letter a couple weeks later re-capping the things we talked about and giving me the results of my lab work.

Two months later, I began receiving those annoying automated calls reminding me of an upcoming appointment and warning me that I’d be charged if I didn’t show up. I didn’t remember making the appointment (not to mention why) but I showed up.

I went super early in the morning for lab work before a mid-afternoon appointment. I was told my lab results should be ready by the time I saw the doctor (a fairy tale) but mainly I went early so I could eat.

When I checked in for my appointment, the conversation started like this:

Receptionist: Do you have your medication list?

Me: Don’t you still have it in your records? We just did this 60 days ago.

Then I asked the receptionist if she could tell me why I was there.

She couldn’t.

 
After spending a good bit of time in the waiting room, I was “taken back” about 30 minutes after my appointment time. My weight was measured on the way in to the examination room, as per normal. I hate that part. The nurse took my temperature and blood pressure, as per normal.

She then said to me, “What brings you in today?” And I said, “Funny, I was going to ask you the same question.” Perplexed, she looked at the papers in her hand and said, “‘Nurse Requested’ is checked, but I didn’t request it. Hang on. I’ll be right back.”

She returned and basically hemmed and hawed. No substantial answer.

Fifteen minutes later, my doctor arrives. “Hello, Robert.” I could tell by the way his eyes averted mine that he couldn’t tell me why I was there either. I assume the nurse had gone out to ask him. The next three minutes were spent with him essentially reading the report from my physical – reading aloud the letter he had sent me two months ago. I kid you not. He then told me that my lab results from that morning weren’t ready yet (big surprise) and that he’d send me another letter.

To be fair, I believe he was embarrassed. I believe that he was thinking, “Geez, what am I doing here?” Doctor burnout, by the way, is rising at an alarming rate.

No one could tell me why I was there.

On my way out, the checkout person says, “OK, let’s schedule your next appointment.”

“Thank you”, I said, “but no.”

My very next spoken words were, “Siri, show me Direct Primary Care doctors in Atlanta.”
 


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