Doctor Passing Me off to Assistant

[McButterpants 2,846]

All of my follow ups are with the surgeon - I like that. Is it overkill? Perhaps...I pay $198 per visit (everything related to weight loss is out of pocket.) My surgeon is also a Bariatric Nutritionist, so I get the benefit of having her talk me thru the nutrition stuff as well.

[VSGAnn2014 12,992]

All of my follow ups are with the surgeon - I like that. Is it overkill? Perhaps...I pay $198 per visit (everything related to weight loss is out of pocket.) My surgeon is also a Bariatric Nutritionist, so I get the benefit of having her talk me thru the nutrition stuff as well.

Whoa -- a surgeon who's also a nutritionist. That's pretty unusual, but very cool.

[FocusOnMeNow 599]

Ok I am not a PA or an NP but in health policy, and you had better get used to paying the same co-pay for a PA and be grateful that one is even willing to see you. My surgeon's office set this up right so I had a visit with the PA prior to surgery and love her. I also know what surgeon's consider their job - cut you up. The surgeon who is also a nutritionist sounds awesome and like someone who is truly holistic. It sounds like you are having other issues with your follow up care but IMHO the way you are complaining for a co-pay to see a PA just does not sit well with me. If you're not getting good care then it doesn't matter if its from an MD, PhD or a PA or NP. If you are getting good care it shouldn't matter either. Also, to refer to our entire health care system as "for-profit', is not neccessarily 100% accurate (understanding that most folks don't really know that). There is massive price-setting my Medicare and other players. Many physicians offices would actually lose money if the surgeon provided all of your follow up care. A lot of that can also be attributed to the higher malpractice insurance in certain markets. That insurance alone can be $100k a year and many docs get out of school with $200k in loans. That is why they have "physician extender" PAs and NPs who are very highly educated and skilled at what they do. In some markets this may increase profit margin, but in some markets the margins are so thin that they would have to literally close their doors. Medical care is also incredibly highly regulated. If I had to put up with all the scrutiny and over the shoulder looking in my job that doctors do in theirs I would quit in a heartbeat. I'm not trying to say that most surgeons are barely getting by when clearly they are doing very well. I can guarantee that unless you are the CFO of an integrated health system you have no idea what the actual costs of your surgery and/or follow up care are. In addition the amount they charged you and the amount that was reimbursed also will differ and neither may be the same as the actual cost of delivering that care. PAs and NPs provide valuable service, and I am delighted whenever I get to see a PA and/or NP who is so great at answering all my questions, and will usually be more thoughtful in their responses and take much more time with me than any surgeon ever could. I'm sorry that's not your experience.

[McButterpants 2,846]

I think we all need to be our own best advocate for quality care. I agree with the above - you can get great care from a surgeon, PA, or a NP just the same as you can get inferior care of each of them.

If you feel you aren't getting quality care, voice your concerns - your health is not going to be as important to anyone else as it is to you.

I had a doctor that I went to for years and loved his practice - he moved to NP's and PA's and I never got to see him. I decided I needed to find a new practice, one where I could get into the see the doctor. I was put off by giving my symptoms to an NP, then her leaving the room coming back with a prescription signed by the doc. I'm not saying this happens all the time, it happened to me. I felt I was getting inferior care, so I found a new doctor.

Find your voice with your health care professionals - you are a consumer of their product.

[Elode 8,093]

@@FocusOnMeNow This just makes me smile! Everyone deserves to be happy with their care. I say do what makes you happy. If your not getting the care you feel you want/deserve then leave. It may sound harsh but I can assure you there will be 50 more in line to take your place. That's why healthcare is a secure job. If your good at what you do you will always have patients waiting to see you. I would rather one of my patients leave and find a new care provider than be unhappy with me. Hopefully you will find someone you will be happy with!

[Wendyfm 494]

The only time I've seen my surgeon was one appointment before surgery,surgery, and while in the the hospital otherwise it's always been the the nurse practitioner.

[Thinside 155]

@@Wendyfm the only time I saw mine was once before the surgery and when I was on the table. All my post-op -- and pre-op -- visits except for one 10 minute visit were with PA's or NPs. I am a bit put off by this, to be honest.

[FocusOnMeNow 599]

@@Elode - I agree with you. People should get the care that they need. All I was trying to say is that bedside manner, time, focus, attention and overall knowledge of your condition frequently matter more than the degree. Your decision should be based on the level of care you are getting rather than their degree. For instance a general surgeon might not be able to answer all your aftercare questions as well as a PA or NP who has focused on bariatrics for years and years. And folks should NOT be surprised much less outraged that they have to pay the same co-pay for a visit with a PA or MD when they are both providing the SAME service. I could not be more thrilled with my care, my surgeon, my NP etc. Honestly, my NUT is not the best, and I may never know how qualified she is or isn't because she just has a bad attitude. It sounds like the OP is having overall issues but without seeing the PA she will never know if they would have been better or worse than the surgeon. It is, dare I say, prejudiced to just assume that they are going to get inferior care. That is much different than Babbs situation where she had a legitimate concern which the PA was not adequately addressing. And yes for some issues and/or complications and MD might have a better background. But you really don't know until you go. I'm not trying to tell anyone what to do about their own care: everyone should do what is best for them, rather I am just trying to encourage folks to keep an open mind and the actual level of care you may receive is less about the degree than one might think.

[OutsideMatchInside 10,166]

I have already said several times I have no issues with PA or NP in general. In this specific case,I have an issue because of how it is being handled along with the other previous billing issues. I am not going to pay to see someone I don't know, have no name for, and no opportunity to research. I am not sure why that is a hard concept to grasp. I select my health professionals based on education and credentials. I have gone to college hospitals and clinics, where you see a variety of people at different levels of education.

I am not in healthcare, I am a business person. You don't switch sales people in the middle of a deal, and if you have to, at the very least you provide a proper introduction. I am getting none of that. Usually most doctors will see you with the PA or the NP at least once, to introduce you. I have never seen this PA/NP (the person making the appointment wasn't sure which it would be and couldn't provide a name). Do you really that that is good medical care or business practices? This surgeon has been seeing all of his patients for post op care until this month, when they decided to make this change. Most doctors will still give you a choice to see them or their PA. The level of medical care and what is expected in Illinois and Missouri are pretty different. I am going to stick to my side of the river, and keep out of Missouri if this is the kind of crap I can keep expecting.

I don't trust this office anymore and I won't be going back.

It sounds like the OP is having overall issues but without seeing the PA she will never know if they would have been better or worse than the surgeon. It is, dare I say, prejudiced to just assume that they are going to get inferior care.

Edited August 28, 2015 by OutsideMatchInside

[NikkiDoc 312]

OP I will address the copay. You likely should not be paying any copay for your 6 week visit. You should be in your post-op day period. Any care that is within the post-op period is considered part of the fee for the surgery. The surgeon should not be charging you a co-pay and should not be billing insurance, nor should the insurance pay for visits during the post-op period.

Any major surgery should have a post-op period. It will vary depending on the surgery. The insurance companies use fairly standard guidelines. I think for the sleeve it is 90 days. (If you have a visit with the same surgeon for an issue not related to the surgeon a copay would apply.) The surgery fee is a global fee.

I would check with the office and your insurance to verify if you will even have the $50 copay. If not, I would reschedule with the NP/PA. I would not use your PCP for the follow-up. Use your surgeon's practice for follow-up. The surgeon and his staff have the experience with bariatrics, your PCP not so much. If the NP/PA has a question or concern then the surgeon is right there to ask or maybe even pop in the room. If you plan on doing any future follow-ups or if you do have complications and need to go back then your bariatric record is all complete and at your surgeon's office. When I did my follow-ups I also saw the dietician. I would think that your bariatric PA/NP is going to be better versed in the nutritional aspects for a bariatric patient than your PCP will be. (Assuming you don't see a dietician separately). Can you tell that I pay health insurance for a living?

10 years ago I tore my ACL. I used a very good surgeon. He had awful bedside manners but is a great surgeon. I did not mind seeing his PA. His PA was able to spend much more time with me, he was easier to ask questions and gave more detailed answers than the surgeon. I was paying the surgeon for his OR skills. Yes, I paid the higher $40 specialist copay for his PA. But I got more bang for my buck with the PA for the follow-up visits than I would have with the surgeon.

I view picking a surgeon as two fold: I am picking his skills as a surgeon and I am picking his program. That program includes his pre-op diet, pre-op testing, post-op diet, post op care and his staff. Like you I was 1 hour 15 minutes from my surgeon's office.

I quit an orthopedic doctor's office over his front office staff- they never returned phone calls, never passed messages to the surgeon and let me run out of refills on my medicines even when I started calling for a refill 1.5 weeks before. My PCP recommended him for my husband and I would not let him use that practice. The staff is a very important part of the program. Don't shortchange the NP/PA that your surgeon picked. There is a reason they employ that person. Presumably they trust them for a reason.

Like I said if the $50 copay is one of your big sticking points you should verify that you will even owe it for this visit. Maybeing have the visit free will make the drive worth it to you.

[Jessica Ellison-Correa 66]

i work in psychiatry and in my office the innitial evaluation is done by our therapist this usually throws people off because they are used to getting diagnosed by a psyciatrist but thats how we do things. op i think you will find with most surgeons they pass off after care to nps or pas because they are good at cutting not follow up jjust my 2 cents

[OutsideMatchInside 10,166]

OP I will address the copay. You likely should not be paying any copay for your 6 week visit. You should be in your post-op day period. Any care that is within the post-op period is considered part of the fee for the surgery. The surgeon should not be charging you a co-pay and should not be billing insurance, nor should the insurance pay for visits during the post-op period.

Any major surgery should have a post-op period. It will vary depending on the surgery. The insurance companies use fairly standard guidelines. I think for the sleeve it is 90 days. (If you have a visit with the same surgeon for an issue not related to the surgeon a copay would apply.) The surgery fee is a global fee.

And this is the issue right here. They charged a co-pay for my one week follow up visit. I thought it was odd, and I questioned it and told them this was my one week post-op visit and they said, yest I still had to pay a co-pay. At the time I just wrote the check because I knew I met my out of pocket for the year and blue cross will refund it. All of my claims process in about 3 days from service. I get an email, I can view them online. Within 10 days I have a check refunding me for my out of pocket.

That first post-op visit from over a month ago still has not billed. When I asked about it, I got the run around. Their billing number has a menu that is just a loop. I want them to bill Blue Cross so I can get my money back.

This already left a bad taste in my mouth. I spent 28 hours in the hospital, my one week post-op should not have had a co-pay in my opinion. Again, I brushed it off, because I knew it would be refunded. Then they wanted to change my appointment, then not only is there a change, but there is also a different provider completely unknown to me.

They are ripping me off and no one will give me a straight answer. $50 is not a large sum of money in the big scheme of things but it makes me feel like I can't trust them, they are either crooked or incompetent. Either one makes me not want to do business with them again.

If I can't trust someone with $50 I certainly can't trust them with my health.

Edited August 29, 2015 by OutsideMatchInside

[Alex Brecher 10,484]

OutsideMatchInside, I definitely sympathize with you – it’s really frustrating for that to happen, and I agree that you should have been informed of that possibility before the process began. Before you give up on the clinic and just go to your primary care doctor, though, I would ask you whether you have any questions about the sleeve.

If you’re just going for a check-up to make sure you’re okay, your own doctor can probably do that, as some of the other posters have said. If you have some questions, though, I’d still consider sticking it out and going out to the surgeon’s office to see a NP or PA. They may not have gone through medical school, but compared to a primary care doctor, they are more focused on a daily basis on sleeve patients. They may be better able to answer specialized questions.

I’m glad everything seems to be going well with you, though! Keep us updated!

[VDB 800]

Yes, it is the norm for my office, but I too wish I could also see the surgeon so I could thank him in person... the PA assisted with my surgery, so she knows the scoop. I think if you want to see your surgeon, you should get to....it is your body, and you are in charge.

[sennypoo 1]

I am trying to plan for my surgery. Went the seminar. Have had two out of three weight loss management with my regular GP. cardiac appointment done now I just want to try to eat some of the foods that I can. I heard you only get chicken broth for the first 12 weeks . after that I'm not sure what you can eat and after seminar the doctor said something about following the South Beach Diet? has anyone else been told that? any comments will be greatly appreciated on little hints on what to expect and do. thank you.