Monday, March 29, 2004

Climbing Mountains

It's the start of week 7 for me, and I've seen 12 patients so far in my fledgling practice. This week is a little different in that I kind of don't want patients to call for appointments this week. That's because I'm a chaperone for my daughter's Outdoor Science School. It is an annual trip for the 5th graders at her school, one that usually provokes a lot of excitement for the kids because, for many of them, it's the first time they've ever spent so much time away from home without a parent or relative. And for the same reason, it provokes a lot of anxiety for the parents.

It is in the local mountains, about 45 minutes from home, with no cell phone access. But I did change my answering machine greeting to include the phone number for the Ranch, just in case anyone needs to reach me. I was thinking that I could always go back down the mountain if a patient wanted to schedule an appointment. We'll see if anyone will.

In a way, it'd be a disappointment if NOBODY calls especially because I spent 4 1/2 hours last Friday at the local Senior Center checking blood pressures, and handing out business cards and brochures.

I'm still learning about medical insurance plans and how they worked. I saw a elderly gentleman last week because his wife thought he should have a complete physical. He had Medicare, which I can't take yet, and Blue Cross, which I thought I could. It turns out he is part of a Blue Cross Medicare HMO, which will not pay for him to see a unapproved provider, such as myself. By the time I figured that out, it was too late to call him back and tell him not to come. So I figured that I'd do a physical exam on him, and see how long it would take. As for payment, I figured I'd take whatever he was willing to pay.

I ended up spending an hour and fifteen minutes with him taking a complete history and physical exam. But I could've spent even more time talking with him. He and his wife were very pleased that I took all this time, of course. I ended up charging him $100 for the visit, with a "prompt pay" discount which brought my total charge to $80. He will get his blood test results from his recent physical at the VA, and bring them to me for interpretation. But now I know that I have to find out exactly which health plan a patient has, and whether or not I can get reimbursed for it. And even though I didn't charge him my full amount, I figured that at $80 for a one hour physical, I'm still getting paid more than I do when I work part-time shifts at Kaiser, which pays $60/hr.

Speaking of Kaiser, I saw one of my former patients last week. Even though he still has Kaiser insurance, he thinks I'm such a great doctor that he is willing to pay out of pocket to see me. He started going on and on about how I should get a bunch of people without insurance to pay me a small amount every month, rather than a large payment at the time of service. I explained to him that, while it is a good idea, this was already being done as part of prepaid health insurance plans, and that I didn't want to have to chase people down if they don't pay their monthly premiums.

He said that he knows a lot of people without insurance, and appreciates what I am doing as a way to help people without insurance. He took a lot of my brochures and business cards and said he will send me a lot of new patients. Which could get interesting because he is the manager of a strip club.

I guess I'll climb that mountain when I get to it. This week, I've got real mountains to climb.