2007/07/17

Health Care Myths - The Same Day Appointment

A day or two ago, I was surfing Zen Yenta's World when I came across a wholly foreign concept. Ms. Yenta mentioned that she hadn't been feeling well and went to the doctor. "Do you mean," I replied, wonder in my voice, "...on the same day? Is that even possible?"

Out here in the Sodom by the Sea, the same day appointment is like winning the lottery. In other words, it doesn't happen to real people. At my GP, nurses and administrators screen everyone who calls to determine whether or not your complaint is life threatening. If not, you get an appointment one to five days in the future which guarantees that either: 1) You'll be over it or 2) You're dead. Either way, they don't have to treat you. And the response if you happen to disagree with their 20 second diagnosis? "Well then go to the emergency room." Which is just another way of saying, "If you don't mind paying for it out of pocket, you can get all the health care you need."

Consequently, I've found that the only way to get timely access to care is to game the system. Go without an appointment and sit in your doctor's lobby until they see you. Coughing a lot, sneezing-- in short making a germ spreading ruckus--seems to speed things along.

How are things where you incubate?

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21 Comments:

If I need to go see my Dr - I can get in the same day. I may spend a bit of time in the waiting room, or see another guy in the team instead of Dr. Nick, but as long as their office is open, I can usually get in.

Also, the hospital he is affiliated with has a "urgent care" center right across the street from his office that has weekend and evening hours, and is covered by my insurance as if it were his office.

(Despite the incomprehensible EOB's, my insurance does not suck tepid pond slime COMPLETELY)

If there is something wrong that needs to be looked at (like the former lump on my neck), but not of "emergency" status, I can get in the next day for certain. And if I can't, they'll often just phone in a script for me if I know what the problem is (like when I put my back out.)

I've not had any real problems.
I'm lucky, I guess...I've never had to go to the Doctors office since I was a little kid and was hit in the face with an icicle and had to get some stitches. I've been to the emergency room since, and I've been to sick call while in the military, but that's socialized medicine we have in the military and as everyone knows civilians don't want that.
At the GP, they can usually get you in the same day if you call early in the morning. I think they keep some spots open with the NP just for that.

At the OB-GYN, it's a week or two for any complaint, and months for a checkup.

The pediatrician can always work in a same-day appointment. I think they hold some slots for urgent care, too.

Speaking of urgent care, a local hospital has at least 3 Urgent Care Centers in the area. Insurance will usually pay for this, but if you're not insured, I think the fee is about $65 (not counting any extras, such as tests). They're not the best, but I did there on a Sunday when I was really ill, and they prescribed an antiviral medication (which has to be given within a certain timeframe)for me. I had to follow-up with my doctor. I think it was a better alterntive than the ER.

Anyway, I can't really complain except to say that I've been without insurance before, and I had to pay $300 for a checkup required by the state of MO for my youngest to enter Kindergarten. Ouch? My Jedi have insurance now, but I will soon be on a skimpy policy, barely worth the moolah invested, except it should keep me from going bankrupt if disaster strikes.
All,

What I'm hearing is that this may be a regional issue.

Here in the Bay Area most larger practices work with a "health-care administrator", an intermediate level of bureaucracy, that administers health benefits on behalf of many different insurers. The Catch-22 of these evil little organizations is that they impose procedures on the care givers but serve the interests of the insurers.

So for example, the "vetting" of all health care issues is a way to keep insurer costs down by effectively denying care under the guise of keeping doctors "optimally" loaded with patients.

As for urgent care...unless you're with Kaiser Permanente, forget it! Doesn't exist because all non-life-threatening urgent care requires your Primary Care's authorization which you can't get because you can't see him/her.

Basically it sucks to live our here.
We have express care at my doctor's office where you can be seen same day if you are willing to wait. But, if I want to see my doctor, it is usually 2-5 days
the emergency room is the cop-out method to quick patch-me-ups or getting admitted for further work-ups. it costs a fekcin fortune and takes forever, forever, forever... all unless you are truly dying and they need to resuscitate or intubate/ventilate you.
Scott... Out here even if you wait that 1 to 5 days, chances are you'll see a nurse practitioner. I've actually seen my personal physician in years.

RAFFI... Emergency treatment is really tricky. You need to read your plan's fine print with the diligence of an attorney to make sure you don't get fleeced.
When I call my doctor, it takes three to five days to get an appointment. I'm in a big city. perhaps it's easier in smaller towns.
I live in a small town and usually have no problem getting in to see my doctor, however, my children live in a large metropolitan area and that's another story. Several times they've ended up in acute care, which is cheaper than the ER, but still costs more than the doctor's office - and the wait time can be several hours.

Scheduling tests like MRI's, CAT scans, etc., is another story. It can literally take weeks and weeks to get an appointment for an MRI, and the hospital schedules appointments 24 hours a day. My elderly mother once had an MRI performed at 3:30 in the morning!
TomCat... My experience is similar to yours.

Kathy... Around here, as I mentioned above, acute care is only available to people with full HMOs like Kaiser. Pretty much doesn't exist for anyone else.
well you can read my saga this year here: http://ilanna127.blogspot.com/2007/04/health-care-and-drama.html

but basically i was dealing wiht all kinds of issues trying to get referrals etc, and my insurance is pretty decent. My new doctor saw me same day as a NEW patient which was impressive. haven't tried getting in since b/c I hvaen't been sick (knocking loudly on wood) but there are tons of times when you can't get in with your primary doctor, even on an emergency though not life threatening basis etc...

sad state these days.
maybe I get special treatment as a frequent patient
Ilanna... You know those health-care administrators I mentioned above? I was once turned down as a new patient, not because of my insurance, but because of the administrator of the plan. The physician told me that she would not adhere to their rules regarding patient care. A sad state indeed!

Scott... :-) So then that would be like a "volume discount" huh?
I haven't seen my primary doctor in years! I have tried to make appointments to get in but it can take weeks. Half the time he isn't in that day or he is on vacation. WTF! I don't like him much but I can't find anyone that I like any better. My old doctor retired several years back and I have yet to find anyone half as good as he was. Several times I have ended up seeing the nurse rather than the doctor.
I was half dead from pnuemonia before I could get in. And this right on the heels of my child having been diagnosed w/pnuemonia the previous week. Pointing that out to the person answering the phone got me no where. When I finally got in and was too weak to even sit up the doctor upon walking in the examining room said, "Mary! Why didn't you get in here sooner!" So we're on the same page as you.
When I lived in the Bay Area I always got in same day for cheap (I had my parents' Kaiser Permanente).

Under other insurance plans (Cigna, Cigna HMO, Aetna) around the country (Wyoming, Michigan, Florida, Colorado) I've also gotten in same day for myself and my children. But for those off-hours visits, urgent care costs $35 and ER $70. We're lucky enough to live in an area with not much ER action. I got in and out in 45 minutes a couple of times.

And the monthly deductible for medical, dental, vision, life, ADD, and long-term disability is around $160/month. Is that good?
I live in a Chicago suburb and have no troubles getting in to see my GP on short notice. We've also got plenty of clean, helpful urgent care centers (except they can't call them urgent care centers anymore because of a lawsuit I'm assuming - three years ago they all switched to "prompt" care centers). However, I've been told repeatedly by different doctors that where we live is the absolute worst place to have a head injury. All of our brain surgeons are moving away because of lawsuits which means a head injury = airlift to a hospital 60 miles away. I'll take waiting 5 days for a doctor over permanent brain damage any day.
I'm moving to Chicago! I haven't seen my primary care physician in years. Every time I do get an appointment he's running 45 minutes late. We need some Michael Moore out her in California.
Liberality... That's almost exactly my experience. The doctor I like retired, the one I have I don't like, and they shunt me to the nurse all the time.

Mary... I feel for you. Was the doctor able to do anything about his/her braindead staff?

Julie... That's exactly my experience with Kaiser. Though their a little bit on the rushed side. 15 minutes with the doc, no more.
Hedy... 60 miles! EEK! And in Chicago no less. You'd think that the concentration of doc would be so high...

Fashiongirl... I wouldn't uproot that quickly. Note what Hedy said about the surgeons.
Getting a 15 minute appointment with my M.D. is generally a next-day thing, but she will make time if she feels it is urgent. I can actually call her directly at certain times of the day.

Getting a specialist might take a few days or even a week.

Mostly since I live in the Capital, it is a little harder.

The upside? I pay $70 per month for full medical with no deductible whatsoever.

Obviously, I don't live in America.

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