Doctor Passing Me off to Assistant

[jess9395 5,450]

Dang! I have the same co pay wether I see a doctor, NP or PA and I have a "Cadillac" Blue Cross plan.

[NikkiDoc 312]

I pay insurance for a living. The NP/PA always bill at the same rate as the doctor and has the same co-pay. Every time there is anesthesia there is a bill for the anesthesiologist that oversees the Certfified Nurse Anesthesiologist. The billed amount is exactly the same amount for each. The fees I see always are based on the procedure code and geographic area not the degree of the person providing the service. The PPO allowed is the same for MD/DO as it is for NP/PA. I am extremely surprised that it is different in your area. The insurance companies and TPA's that I work with are nationwide.

I do not believe a doctor/surgeon is doing you a favor. I just understand that when I select a surgeon or physician I select his whole team. That includes the NP/PA, receptionist, billing department, nursing staff. I will and I have left practices if the surgeon is wonderful but a portion of the team sucks. I also don't mind a surgeon that has sucky bedside manners if he has a good team to balance that out. I am paying him for his surgical skills and he be better have a good team for follow-up care and scheduling and billling.

[OutsideMatchInside 10,166]

They defiantly bill at different levels if they are being honest in the billing. The only way they bill the same is if the doctor is present in the room. I have had insurance but also been self pay for a number of years. It is not the same thing. Negotiated insurance reimbursement is not the same as billed amounts. A cardiologist visit does not cost the same and a family practice visit.

Never in my life have in had to pay a co-pay for seeing a NP and I saw one instead of my OB/GYN for years.

That still isn't really the point even though pwople are hung up on it. They are charging me for co-pays and not billing my insurance for visits that should be included. Which is my largest beef with them.

Adding a new person to the team and not bothering to introduce them is just the last straw. There are other people on this board that have seen this doctor and he never had a PA until this month.

His front office staff have terrible personalities which I overlooked because I felt so confident in him. However they can't answer basic billing questions or provide the name of the PA or NP they are not even sure which. My Doctor is now doing 10 surgeries a day. This is obviously more about making money than patient care.

Edited September 1, 2015 by OutsideMatchInside

[DianeSav 10]

I havent seen the surgeon since surgery. It common practice these days. Besides the PA or Nut knows more about you than the surgeon.

Edited September 1, 2015 by DianeSav

[missheidi47 127]

I am fortunate that mine is a Center of Excellence. I knew beforehand that it was a "team" of professionals. I paid a one-time program fee before surgery and I will never have a co-pay or out-of-pocket fee for follow-up visits.

I saw my surgeon twice before surgery and twice after surgery. Subsequent visits were with her PA. I also see the nutritionist at each visit. So, it goes, nurse, PA, nutritionist (and once with the exercise specialist for assessment).

I am happy with my surgical team. They are very professional and knowledgeable and they are keeping me on track.

My experience has been similar, also at a Center of Excellence. I see the surgeon and the PA or NP. The surgeon is great, but I've had better answers from the PA in relation to follow up issues. My initial fee covered 3 months of follow up visits, but I don't have to pay the copays for the rest of 2015 because I met the out of pocket max. I appreciate the team approach, because I know it is unlikely that the entire team will leave the practice from visit to visit. I know that some of the players may change as time goes on, but I've still got a great team around me.

[missheidi47 127]

This is a well known bariatric center of excellence.

That is disturbing. If you are uncomfortable, you have to do what you know is best. If they don't straighten out the billing issue to your satisfaction, consider reporting them to the insurance commissioner in your state.

[Elode 8,093]

If your surgeon is doing "10 surgeries a day" then he obviously doesn't have time for you. You've made the remark now a couple of times about how "these people act like they are doing you a favor" or you think you are doing them the favor"......How is that? The same way you can find another provider a provider can refuse service to you too. You're not in the ER. It sounds like your surgeon is too busy for you so the PA increased his load and took you off his hands..so yeah maybe he/she was doing you a favor. Lol! If they can't get your billing correct and you don't feel you should have to pay a specialist copay for a NP or PA in a specialist setting then move on. It sounds like you have lots of backup plans worked out and you didn't like the people at the front desk either. You only seem to like the surgeon. Perhaps they should have been more clear with you in the beginning and let you know that the surgeon is not the only person working in the office. I understand, it happens! Sometimes our expectations just aren't met. Now you know what questions to ask when you find a new one. It's a win win for everyone! Keep on that insurance and get your money back. oh side note: We don't "all have school loans to pay" I know I don't.

[BLERDgirl 6,417]

I am 6 weeks post op. I am suppose to go for a doctor visit next week. The office has called a few times to reschedule. I returned the call today to learn that my Surgeon will not being seeing me, but an Nurse Practitioner or Physicians assistant will. I am still required to pay the same $50 specialist co-pay.

I do not have any complications and I am doing very well. I just commented to my friend recently that I don't even feel like I had surgery at all until I eat and feel the restriction.

I would still rather see my surgeon at this point. I understand, seeing patients for follow up isn't as profitable as surgery, but as a patient I wish I knew this information before selecting this surgeon. I could have made an educated decision and maybe selected a different Doctor or program.

I end up cancelling my appointment and I guess I will make one with my primary and save myself the 1.5 hour drive to my Surgeons office.

This is not an uncommon practice. Many surgeons do this. If you are not experiencing any complications chances are you will be seen by the PA and/or possibly the surgical resident. You can call your doctor's office and request to be seen by the surgeon, but chances are that may not be able to accommodate you. Rest assured if you have chosen a good practice that the PA or resident are more than qualified to see you for follow up care.

[BLERDgirl 6,417]

Dang! I have the same co pay wether I see a doctor, NP or PA and I have a "Cadillac" Blue Cross plan.

It depends on how they bill and how the practice is set up. When there is a team approach, you have an initial visit. That s typically with the surgeon, the nurse, NP, PA and nutritionist. Follow ups are then with the team and typically at a lower rate of service. However your copay often does not change. The change is the total amount of the office visit bill. The copay is based on your insurance company's regulations. Depending on insurance a certain amount of post op follow up may or may not be included in your surgical bill. For example I have Keystone 65. I had a $200 copay day of surgery, but did not have any copays for my 2 week, 6 week and 3mth f/u appoints. After that I went back to my regular copay fee for my 6mth appt and I will have a copay for my 1 year f/u in a few weeks. According to my plan I have a copay of $15 for my primary and ANY specialty visit is $45. It doesn't matter if it's an xray, or I see the orthopedist. The lone exceptions are eye doctor and dental visits.

My advice for anyone looking into bariatric surgery is to look into everything it entails. Some decisions are made by the insurance company and others by the medical practice.

[jess9395 5,450]

Dang! I have the same co pay wether I see a doctor, NP or PA and I have a "Cadillac" Blue Cross plan.

It depends on how they bill and how the practice is set up. When there is a team approach, you have an initial visit. That s typically with the surgeon, the nurse, NP, PA and nutritionist. Follow ups are then with the team and typically at a lower rate of service. However your copay often does not change. The change is the total amount of the office visit bill. The copay is based on your insurance company's regulations. Depending on insurance a certain amount of post op follow up may or may not be included in your surgical bill. For example I have Keystone 65. I had a $200 copay day of surgery, but did not have any copays for my 2 week, 6 week and 3mth f/u appoints. After that I went back to my regular copay fee for my 6mth appt and I will have a copay for my 1 year f/u in a few weeks. According to my plan I have a copay of $15 for my primary and ANY specialty visit is $45. It doesn't matter if it's an xray, or I see the orthopedist. The lone exceptions are eye doctor and dental visits.

My advice for anyone looking into bariatric surgery is to look into everything it entails. Some decisions are made by the insurance company and others by the medical practice.

Oh I just meant in general. All I ever see for Gyn care is a nurse practitioner. Ditto dermatology. And it's all the same copay as when I see an orthopedic surgeon. Specialist is one and GP/ObGyn another. But doesn't matter if it's an MD of NP or PA.

And I had copays for follow ups for my WLS, my Wrist surgeries, my gallbladder surgery... Not for the first follow up but everything after that for all surgeries.

[jess9395 5,450]

And I was just meaning in comparison to what the OP said about not having copays with NP or PA.

[HappyValleyHappy 48]

Many years ago, when I moved to this area, I made an appt with a family medical practice doctor. Highly recommended by friends.

My initial visit I was seen by the nurse practitioner. She is very professional and much more personable than any dr I've ever seen.

In 16 years of visits I have seen my actual dr only once per year.

My health has always been good and never any major issues.

I've discovered that a nurse practitioner or a medical assistant are the offices best asset.

[Madeleine Renee 77]

I saw my surgeon once last year when he took my history, and approved me for the bypass.

I was recommended for this surgery by my endo, family dr and psychiatrist. I had my surgery on August 18 and entered the operating room without seeing him. Before they put me to sleep, I yelled, eh! wait a minute I want to see my surgeon and make sure he is here! He lowered his mask and laughed.

During my 3 days post-op, I saw his resident once or twice a day. I was peeved! But, I also have to admit that I had to complication whatsoever.

I have an appt. on Sept 17, 1 month follow up and was told I will be seeing him!

To be continued!