I noticed something that is not intuitive to me. Is there a reason why an office visit to a primary care nurse practitioner would be more expensive than a visit to a specialist (like a cardiologist or GI or podiatrist or whatever)?

Perhaps within noise levels (+- 10%?) is one thing but to see it be around 50% higher is not intuitive to me. Primary care vs Specialist. Nurse practitioner vs MD.

What am I missing?

quote:

Originally posted by konata88:
What am I missing?

Possibly good medical care. I have had mixed results with PAs and lost a friend due to misdiagnosis by one.

Everything is codes and what insurance will reimburse for them. Perhaps your doc is a better physician than he is a coder? Oh course, the poor patient is not usually permitted to see the codes and the actual services they represent on their EoB's.

There is even a job category, medical code specialist. You can bet these clerks know how to code stuff every invoice sent to an insurance carrier. Some of them might be more honest than others, or afraid of being overseen by an actual physician (e.g. if a patient can discover enough to complain about being over-charged).

Could be the insurance contract amount for the provider, if the Doc is a member of a larger group they may have higher agreed to pricing.

Higher price isn't always better care though... but, you don't want the cheapest doc on the block either...

When I need to go to the Doctor I expect to see a Doctor, not a glorified nurse.
If I need surgery I expect that the Doctor I chose will be the Doctor doing the surgery not a student.

I haven't encountered that myself.

It's always been a small copay for a PCP office visit, and a larger copay for any specialist office visit.

Now, if my PCP ends up doing some lab tests or a procedure, then copay + my portion of the labs/procedures for the PCP could end up costing more than just the specialist office visit, but that's not apples to apples for strictly the visits alone.

A “visit” is about as vague as you could possibly be.

It’s really about all the things done at each and the reason for being there, diagnoses, symptoms etc. That’s before we even get to insurance and if you’re talking about gross charge (irrelevant unless uninsured)or insurance allowable.

quote:

Originally posted by armored:
If I need surgery I expect that the Doctor I chose will be the Doctor doing the surgery not a student.

Surprise - you were probably put under by a nurse anesthetist not a doctor, though one was supervising your room along with several others.

quote:

Originally posted by RogueJSK:
I haven't encountered that myself.

It's always been a small copay for a PCP office visit, and a larger copay for any specialist office visit.
<snip>

Similar for me. UHC Plan N.

Check your EOBs for the various doctor visits to see exactly what you were charged for to make sure it is an apples to apple comparison. There are charges for a basic "office visit" and then add ons such as labs, injections, in office "surgery", medications, diagnostics, materials, etc listed as "service" with corresponding CPT code. Also your deductible can come into play too so check that when comparing. For basic office visit PCP copay is typically less than specialist. Also I often find that doctors offices over charge us not adjusting for "network discount" until I bring it up with my EOB in hand.

quote:

Originally posted by Georgeair:
A “visit” is about as vague as you could possibly be.

It’s really about all the things done at each and the reason for being there, diagnoses, symptoms etc. That’s before we even get to insurance and if you’re talking about gross charge (irrelevant unless uninsured)or insurance allowable.

quote:

Originally posted by armored:
If I need surgery I expect that the Doctor I chose will be the Doctor doing the surgery not a student.

Surprise - you were probably put under by a nurse anesthetist not a doctor, though one was supervising your room along with several others.

My last two surgeries ( Total knee replacements) I confirmed in the pre-op meeting, that was also attended by other patients ( witnesses), that the Doctor I hired was doing the entire surgery ( except the closure). I confirmed, with my wife present, with the anesthetist when he performed my spinal block that he would be the Doctor monitoring.
I read several cases about Surgeons running multiple surgeries and having other Doctors do the actual surgery while they ran from operating room to operating room monitoring the progress.
This was at the highest ranking orthopedic hospital in the Chicago area. Several of there top Doctors were disciplined for this practice.
One of those Doctors told me that I would need to pay him an additional $8000 dollars per knee above what Medicare paid. I did NOT choose him.

Since Covid I don't trust any Doctors or the medical profession anymore.

The charges are technically based upon the services rendered. The NP may have performed a complete history and physical examination whereas the specialist performed a focused exam and limited history. There’s significant variability between providers and also regional differences. I guess in layman’s terms the NP did a full wash and detail on the car for $250 while the specialist changed the in cabin air filter for $100. The air filter change took 10 minutes while the detail took 4 hours.

I learned a few years back that a patient can be charged an additional "professional services" fee if you ask the Doc questions about your health and he "counsels" you. To be honest, I don't even bother with basic checkups any longer - I can weight myself, take my BP and I know what my resting HR is. I still do an annual blood test for PSA, liver tri's, etc.

Look at EOB--should detail what was charged. May have started as a "well" visit, then you said X, oh and Y, and then Z. Billing separately for X, Y and Z will add $$$. You ordered off the a la carte menu--not the price fix menu.

Many folks here seem to have poor health insurance. And/or poor healthcare providers.

My health insurance isn’t cheap, but I don’t get nickel-and-dimed to death. And my healthcare provider, UCSD, is excellent.

ETA: Also, UCSD utilizes a wonderful app, MyChart, that enables me to see upcoming, and past, medical visits. And to see test results. And send/receive messages/questions to/from my GP and specialists. At no additional cost. And to make copays with instant confirmation. Many other features too.

I have a $30 co-pay with my PCP, and I pay $45 when I see the cardiologist.

quote:

Originally posted by armored:
When I need to go to the Doctor I expect to see a Doctor, not a glorified nurse.....

So glad I saw this, makes my day.