RE: what Annie and all of us hope for

March 4, 2008

What, ballpark do you charge for an evisit, ie. price comprable to a 99212 or

99213? Are you or is anyone else charging when the prescription requires

preauthorization, sometimes twice a year. Currently I answer phone calls like

the evisit below as well as preauthorize for no charge and grumble while I do

it. I am trying to figure out how to tell patients that all of these things

that I used to do for gratis, I am now charging for. How to do that without

resentment. Other clinics in the area would have a nurse taking care of the

above with an MD glancing at the message and grunting out a brief answer that is

then relayed to the patient, but it is free.

Kathy Broman MD

Mason City, IA

On Tuesday, March 04, 2008, at 07:01AM, " "

wrote:

>

>here is a little email exhcange:

>

>1.

>Good Afternoon ~

>

>I just went to pick up my prescriptions and was told that my insurance

>company needs a pre-authorization for Differin Gel because I am over 25.

>It was going to cost $324.00!! Is there another product that is easier

>to get?

>

>They also filled the prescription for FloVent (it is also $60.00) but I

>told them just to hold it until I had used up the Azmacort.

>

>Hope you have a nice weekend ~

>

> 2.

>well well.DOn't et me started on money and insurance companies You should

>see the letter I went home to yesterday at ,my house..

>

> the first best thing we use for acne is benzoyl peroxide which is over the

>counter did you try that yet?

>

>if not ,the questions will be WHAT will they pay for if you are over 25?

>ASk them about retin A/

> clinda T / ery gel and let me know

>DR A

>

>3.

>

>I finally heard back from Anthem in regard to acne medications. They need

>prior authorization on all, if patient is over 25. That can be done by

>calling 1- or faxing 1-. I am happy to pay your

>$25.00 fee for this service. In response to your earlier question about

>peroxide, I have tried just about all the over-the-counter formulas over the

>years.

>

>Thank you for your help,

>

March 4, 2008

and i mean it not just about getting paid for the work we doBecasue you get paid you can be sustainable in the business of the fabulously good care you give as an IMP in which you spend time with peopleI do not mean appear to be completely mercenary .I mean, I like money . I don't need that much but I like it. The jeep is at 264,000 miles and the house needs painting an d id I tell you I need a new furnace? And I filled the oil tank this week thank god we are moslty heatng with wood. 712.00 for a tank of oil. ARE THEY KIDDING ME?? That is 100.00 more than the mortgage on t he first house we had.

So when I get an extra 100.00 a week from a few e-visits the patients get MY care ,continuity, legible safe interact- checked scripts, reminders for mammograms etc, and they get to come to a practice that can stay open to see people on time by me and only me where even the state of MAine tells me my mediciad children patietns are in the ER less than the state average.

What, ballpark do you charge for an evisit, ie. price comprable to a 99212 or 99213? Are you or is anyone else charging when the prescription requires preauthorization, sometimes twice a year. Currently I answer phone calls like the evisit below as well as preauthorize for no charge and grumble while I do it. I am trying to figure out how to tell patients that all of these things that I used to do for gratis, I am now charging for. How to do that without resentment. Other clinics in the area would have a nurse taking care of the above with an MD glancing at the message and grunting out a brief answer that is then relayed to the patient, but it is free.

Kathy Broman MD

Mason City, IA

>

>here is a little email exhcange:

>

>1.

>Good Afternoon ~

>

>I just went to pick up my prescriptions and was told that my insurance

>company needs a pre-authorization for Differin Gel because I am over 25.

>It was going to cost $324.00!! Is there another product that is easier

>to get?

>

>They also filled the prescription for FloVent (it is also $60.00) but I

>told them just to hold it until I had used up the Azmacort.

>

>Hope you have a nice weekend ~

>

> 2.

>well well.DOn't et me started on money and insurance companies You should

>see the letter I went home to yesterday at ,my house..

>

> the first best thing we use for acne is benzoyl peroxide which is over the

>counter did you try that yet?

>

>if not ,the questions will be WHAT will they pay for if you are over 25?

>ASk them about retin A/

> clinda T / ery gel and let me know

>DR A

>

>3.

>

>I finally heard back from Anthem in regard to acne medications. They need

>prior authorization on all, if patient is over 25. That can be done by

>calling 1- or faxing 1-. I am happy to pay your

>$25.00 fee for this service. In response to your earlier question about

>peroxide, I have tried just about all the over-the-counter formulas over the

>years.

>

>Thank you for your help,

>

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD

ph fax

March 4, 2008

Kathy- I agree that asking for money and routing people to e visits where I used to do them for free is hard. I didn't think I'd personally be able to do it, but- it seems to work (4 e visits past 10 days, 2 sinuses, one UTI, one back pain) - no one has flipped out on me yet, actually they seem quite agreeable. They are robustly cheerful that they don't have to come in. Could they be so altruistic that maybe they feel I shouldn't be working for free? I don't know. After they've emailed and or called with the problem, I tell them they can either come in for a visit, or check out the virtual visit page and they've opted to do the VVs. Getting this going was just as much of a mental block for me as collecting my own co pays was, but I'm mostly over that, and expect that I will get over this too. I think the key, as says, is to offer VV vs. an appointment (and not VV vs 'free' care), and if you need to go further, you can say something about the malpractice risk of a VV being less with the structured information in a virtual visit and preferred by your malpractice carrier. Onwards!I am - $100 richer- LynnTo: From: kbroman1@...Date: Tue, 4 Mar 2008 10:45:05 -0800Subject: Re: what Annie and all of us hope for

What, ballpark do you charge for an evisit, ie. price comprable to a 99212 or 99213? Are you or is anyone else charging when the prescription requires preauthorization, sometimes twice a year. Currently I answer phone calls like the evisit below as well as preauthorize for no charge and grumble while I do it. I am trying to figure out how to tell patients that all of these things that I used to do for gratis, I am now charging for. How to do that without resentment. Other clinics in the area would have a nurse taking care of the above with an MD glancing at the message and grunting out a brief answer that is then relayed to the patient, but it is free.

Kathy Broman MD

Mason City, IA

On Tuesday, March 04, 2008, at 07:01AM, "" <jantonuccifchn (DOT) org> wrote:

>

>here is a little email exhcange:

>

>1.

>Good Afternoon ~

>

>I just went to pick up my prescriptions and was told that my insurance

>company needs a pre-authorization for Differin Gel because I am over 25.

>It was going to cost $324.00!! Is there another product that is easier

>to get?

>

>They also filled the prescription for FloVent (it is also $60.00) but I

>told them just to hold it until I had used up the Azmacort.

>

>Hope you have a nice weekend ~

>

> 2.

>well well.DOn't et me started on money and insurance companies You should

>see the letter I went home to yesterday at ,my house..

>

> the first best thing we use for acne is benzoyl peroxide which is over the

>counter did you try that yet?

>

>if not ,the questions will be WHAT will they pay for if you are over 25?

>ASk them about retin A/

> clinda T / ery gel and let me know

>DR A

>

>3.

>

>I finally heard back from Anthem in regard to acne medications. They need

>prior authorization on all, if patient is over 25. That can be done by

>calling 1- or faxing 1-. I am happy to pay your

>$25.00 fee for this service. In response to your earlier question about

>peroxide, I have tried just about all the over-the-counter formulas over the

>years.

>

>Thank you for your help,

>

Shed those extra pounds with MSN and The Biggest Loser! Learn more.

March 4, 2008

Kathy- I agree that asking for money and routing people to e visits where I used to do them for free is hard. I didn't think I'd personally be able to do it, but- it seems to work (4 e visits past 10 days, 2 sinuses, one UTI, one back pain) - no one has flipped out on me yet, actually they seem quite agreeable. They are robustly cheerful that they don't have to come in. Could they be so altruistic that maybe they feel I shouldn't be working for free? I don't know. After they've emailed and or called with the problem, I tell them they can either come in for a visit, or check out the virtual visit page and they've opted to do the VVs. Getting this going was just as much of a mental block for me as collecting my own co pays was, but I'm mostly over that, and expect that I will get over this too. I think the key, as says, is to offer VV vs. an appointment (and not VV vs 'free' care), and if you need to go further, you can say something about the malpractice risk of a VV being less with the structured information in a virtual visit and preferred by your malpractice carrier. Onwards!I am - $100 richer- LynnTo: From: kbroman1@...Date: Tue, 4 Mar 2008 10:45:05 -0800Subject: Re: what Annie and all of us hope for

What, ballpark do you charge for an evisit, ie. price comprable to a 99212 or 99213? Are you or is anyone else charging when the prescription requires preauthorization, sometimes twice a year. Currently I answer phone calls like the evisit below as well as preauthorize for no charge and grumble while I do it. I am trying to figure out how to tell patients that all of these things that I used to do for gratis, I am now charging for. How to do that without resentment. Other clinics in the area would have a nurse taking care of the above with an MD glancing at the message and grunting out a brief answer that is then relayed to the patient, but it is free.

Kathy Broman MD

Mason City, IA

On Tuesday, March 04, 2008, at 07:01AM, "" <jantonuccifchn (DOT) org> wrote:

>

>here is a little email exhcange:

>

>1.

>Good Afternoon ~

>

>I just went to pick up my prescriptions and was told that my insurance

>company needs a pre-authorization for Differin Gel because I am over 25.

>It was going to cost $324.00!! Is there another product that is easier

>to get?

>

>They also filled the prescription for FloVent (it is also $60.00) but I

>told them just to hold it until I had used up the Azmacort.

>

>Hope you have a nice weekend ~

>

> 2.

>well well.DOn't et me started on money and insurance companies You should

>see the letter I went home to yesterday at ,my house..

>

> the first best thing we use for acne is benzoyl peroxide which is over the

>counter did you try that yet?

>

>if not ,the questions will be WHAT will they pay for if you are over 25?

>ASk them about retin A/

> clinda T / ery gel and let me know

>DR A

>

>3.

>

>I finally heard back from Anthem in regard to acne medications. They need

>prior authorization on all, if patient is over 25. That can be done by

>calling 1- or faxing 1-. I am happy to pay your

>$25.00 fee for this service. In response to your earlier question about

>peroxide, I have tried just about all the over-the-counter formulas over the

>years.

>

>Thank you for your help,

>

Need to know the score, the latest news, or you need your Hotmail®-get your "fix". Check it out.

March 4, 2008

Kathy- I agree that asking for money and routing people to e visits where I used to do them for free is hard. I didn't think I'd personally be able to do it, but- it seems to work (4 e visits past 10 days, 2 sinuses, one UTI, one back pain) - no one has flipped out on me yet, actually they seem quite agreeable. They are robustly cheerful that they don't have to come in. Could they be so altruistic that maybe they feel I shouldn't be working for free? I don't know. After they've emailed and or called with the problem, I tell them they can either come in for a visit, or check out the virtual visit page and they've opted to do the VVs. Getting this going was just as much of a mental block for me as collecting my own co pays was, but I'm mostly over that, and expect that I will get over this too. I think the key, as says, is to offer VV vs. an appointment (and not VV vs 'free' care), and if you need to go further, you can say something about the malpractice risk of a VV being less with the structured information in a virtual visit and preferred by your malpractice carrier. Onwards!I am - $100 richer- LynnTo: From: kbroman1@...Date: Tue, 4 Mar 2008 10:45:05 -0800Subject: Re: what Annie and all of us hope for

What, ballpark do you charge for an evisit, ie. price comprable to a 99212 or 99213? Are you or is anyone else charging when the prescription requires preauthorization, sometimes twice a year. Currently I answer phone calls like the evisit below as well as preauthorize for no charge and grumble while I do it. I am trying to figure out how to tell patients that all of these things that I used to do for gratis, I am now charging for. How to do that without resentment. Other clinics in the area would have a nurse taking care of the above with an MD glancing at the message and grunting out a brief answer that is then relayed to the patient, but it is free.

Kathy Broman MD

Mason City, IA

On Tuesday, March 04, 2008, at 07:01AM, "" <jantonuccifchn (DOT) org> wrote:

>

>here is a little email exhcange:

>

>1.

>Good Afternoon ~

>

>I just went to pick up my prescriptions and was told that my insurance

>company needs a pre-authorization for Differin Gel because I am over 25.

>It was going to cost $324.00!! Is there another product that is easier

>to get?

>

>They also filled the prescription for FloVent (it is also $60.00) but I

>told them just to hold it until I had used up the Azmacort.

>

>Hope you have a nice weekend ~

>

> 2.

>well well.DOn't et me started on money and insurance companies You should

>see the letter I went home to yesterday at ,my house..

>

> the first best thing we use for acne is benzoyl peroxide which is over the

>counter did you try that yet?

>

>if not ,the questions will be WHAT will they pay for if you are over 25?

>ASk them about retin A/

> clinda T / ery gel and let me know

>DR A

>

>3.

>

>I finally heard back from Anthem in regard to acne medications. They need

>prior authorization on all, if patient is over 25. That can be done by

>calling 1- or faxing 1-. I am happy to pay your

>$25.00 fee for this service. In response to your earlier question about

>peroxide, I have tried just about all the over-the-counter formulas over the

>years.

>

>Thank you for your help,

>

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March 4, 2008

We finally had to put our feet down and

start charging for things that were formally done gratis. We did a mass

mailing to all of our patients, with a letter and a copy of our new office and

financial policies. So far, no one who has asked for a form to be filled

out has batted an eyelash at the $20 fee. Some of the insurance plans are

actually even paying for it (billed as 99080)! You can see a list of our “non-covered

services” on our website, if you’re interested in seeing what we

are now charging for these formerly free items. www.prattmd.info (Look under New

Patients tab). We have our first phone visit tonight – we’ll

see if the insurance plan will actually pay for it. Patients who need to

talk to the doctor about lab results, etc, who have busy work schedules are willing

to pay out of pocket to NOT come in to the office (obviously only when

medically warranted).

Pratt

Office Manager

Oak Tree Internal Medicine P.C.

From: [mailto: ] On Behalf Of

Sent: Tuesday, March 04, 2008

11:25 AM

To: 'Kathy Broman '; ' '

Subject: RE:

what Annie and all of us hope for

right it is challenging to ask for money. period. And

challenging to ask

for money when we have been doin g it for free and

really also hard when everyone else does it for free.

I have no easy answers except that I say it in a routine sort a way--sure

kathy I can refill your dexedrine want to see me today or we can do it by

email if you want.( sort of l ike with two year olds, You don't ask them

can I check your ears becasue they will say no. You say which ear should

i chevk first?)

When Kathy whines and cries what??CAn't you just X?

well I gotta tell you if my emails make me look tough Actually i am a

complete pushover and much gets done for free but less than before .

I say stufflike " medicare makes me dostuff face toface " which si true

to be

paid.

I say I am getting into some trouble with the prescriptions I really have

to see you (yep and the trouble I am getting into s is money or they are

controlld subtances and it is my licnese.)

or I say I know DR just does it but you know I see you the day you

call and I se e you on time and I spend time with you. To do that I have to

sort out, well do I charge for my services like the plumber does or do I

blow you off with a 7 minutes visits like DR ?

I try to be charming as well as truthful.

IT is going pretty well.

One guy had a fit Called me asking whether chantix would be for him (YES!!

Diabetic hypertensive has never eve n thought about quitting smoking) but

were there any med interactions ? We talked . CAn you mail me a script doc?

well I happen to know he works at the mill wher e the copay is 30.00 to

see me so i say you know what we can do and

i explain e -vists ; he got huffy and said well it is not like this is a

medical issue!! I can get it form the mill doctor. AUgh Stab me in the

heart.

BUT the mill doctor faxed me a note saying I told L to come see you about

chantix. YES.

Of course I am still waiting but this guy I know , he will be able to save

face, and I will be charmingly slef -effacing and it will work

we are changing a paradigm but every time, kath, that at least one person

does this ,I get paid for formerly free work . And lots if not all people

LOVE IT! 25.oo is what I charge --when they have 20.00 and 30.oo copays and

have you noticed the price of gas? it is way easier to do this.

So I would advise that you start.Just start. TRY it in your own way . EAds

does it. Ho does it. Oaks i think yes?

Just try it out. How can I help?

jean

Re: what Annie and all of us hope for

What, ballpark do you charge for an evisit, ie. price comprable to a

99212 or 99213? Are you or is anyone else charging when the prescription

requires preauthorization, sometimes twice a year. Currently I answer

phone calls like the evisit below as well as preauthorize for no charge

and grumble while I do it. I am trying to figure out how to tell

patients that all of these things that I used to do for gratis, I am now

charging for. How to do that without resentment. Other clinics in the

area would have a nurse taking care of the above with an MD glancing at

the message and grunting out a brief answer that is then relayed to the

patient, but it is free.

Kathy Broman MD

Mason City, IA

On Tuesday, March 04, 2008, at 07:01AM, " " <

jantonuccifchn (DOT) <mailto:jantonucci%40fchn.org> org> wrote:

>

>here is a little email exhcange:

>

>1.

>Good Afternoon ~

>

>I just went to pick up my prescriptions and was told that my insurance

>company needs a pre-authorization for Differin Gel because I am over

25.

>It was going to cost $324.00!! Is there another product that is easier

>to get?

>

>They also filled the prescription for FloVent (it is also $60.00) but I

>told them just to hold it until I had used up the Azmacort.

>

>Hope you have a nice weekend ~

>

> 2.

>well well.DOn't et me started on money and insurance companies You

should

>see the letter I went home to yesterday at ,my house..

>

> the first best thing we use for acne is benzoyl peroxide which is over

the

>counter did you try that yet?

>

>if not ,the questions will be WHAT will they pay for if you are over

25?

>ASk them about retin A/

> clinda T / ery gel and let me know

>DR A

>

>3.

>

>I finally heard back from Anthem in regard to acne medications. They

need

>prior authorization on all, if patient is over 25. That can be done by

>calling 1- or faxing 1-. I am happy to pay your

>$25.00 fee for this service. In response to your earlier question about

>peroxide, I have tried just about all the over-the-counter formulas

over the

>years.

>

>Thank you for your help,

>

March 5, 2008

How exactly do you collect the fees? When the patients comes in next time? wrote: right it is challenging to ask for money. period. And challenging to askfor money when we have been doin g it for free and really also hard when everyone else does it for free.I have no easy answers except that I say it in a routine sort a way--surekathy I can refill your dexedrine want to see me today or we can do it byemail if you want.( sort of l ike with two year olds, You don't ask themcan I check your ears

becasue they will say no. You say which ear shouldi chevk first?)When Kathy whines and cries what??CAn't you just X?well I gotta tell you if my emails make me look tough Actually i am acomplete pushover and much gets done for free but less than before .I say stufflike"medicare makes me dostuff face toface" which si true to bepaid.I say I am getting into some trouble with the prescriptions I really haveto see you (yep and the trouble I am getting into s is money or they arecontrolld subtances and it is my licnese.)or I say I know DR just does it but you know I see you the day youcall and I se e you on time and I spend time with you. To do that I have tosort out, well do I charge for my services like the plumber does or do Iblow you off with a 7 minutes visits like DR ?I try to be charming as well as truthful.IT is going pretty well.One guy had a fit Called me asking whether chantix would be for him

(YES!!Diabetic hypertensive has never eve n thought about quitting smoking) butwere there any med interactions ? We talked . CAn you mail me a script doc?well I happen to know he works at the mill wher e the copay is 30.00 tosee me so i say you know what we can do andi explain e -vists ; he got huffy and said well it is not like this is amedical issue!! I can get it form the mill doctor. AUgh Stab me in theheart.BUT the mill doctor faxed me a note saying I told L to come see you aboutchantix. YES.Of course I am still waiting but this guy I know , he will be able to saveface, and I will be charmingly slef -effacing and it will workwe are changing a paradigm but every time, kath, that at least one persondoes this ,I get paid for formerly free work . And lots if not all peopleLOVE IT! 25.oo is what I charge --when they have 20.00 and 30.oo copays andhave you noticed the price of gas? it is way easier to do

this.So I would advise that you start.Just start. TRY it in your own way . EAdsdoes it. Ho does it. Oaks i think yes?Just try it out. How can I help?jean Re: what Annie and all of us hope forWhat, ballpark do you charge for an evisit, ie. price comprable to a99212 or 99213? Are you or is anyone else charging when the prescriptionrequires preauthorization, sometimes twice a year. Currently I answerphone calls like the evisit below as well as preauthorize for no chargeand grumble while I do it. I am trying to figure out how to tellpatients that all of these things that I used to do for gratis, I am nowcharging for. How to do that without resentment. Other clinics in

thearea would have a nurse taking care of the above with an MD glancing atthe message and grunting out a brief answer that is then relayed to thepatient, but it is free.Kathy Broman MDMason City, IAOn Tuesday, March 04, 2008, at 07:01AM, "" <jantonuccifchn (DOT) <mailto:jantonucci%40fchn.org> org> wrote:> >here is a little email exhcange:>>1.>Good Afternoon ~> >I just went to pick up my prescriptions and was told that my insurance>company needs a pre-authorization for Differin Gel because I am over25.>It was going to cost $324.00!! Is there another product that is easier>to get?> >They also filled the prescription for FloVent (it is also $60.00) but I>told them just to hold it until I had used up the Azmacort.> >Hope you have a nice weekend ~>>>> 2.>well well.DOn't et

me started on money and insurance companies Youshould>see the letter I went home to yesterday at ,my house..>> the first best thing we use for acne is benzoyl peroxide which is overthe>counter did you try that yet?>>if not ,the questions will be WHAT will they pay for if you are over25?>ASk them about retin A/> clinda T / ery gel and let me know>DR A>>>3.>>I finally heard back from Anthem in regard to acne medications. Theyneed>prior authorization on all, if patient is over 25. That can be done by>calling 1- or faxing 1-. I am happy to pay your>$25.00 fee for this service. In response to your earlier question about>peroxide, I have tried just about all the over-the-counter formulasover the>years.> >Thank you for your

help,>>

Never miss a thing. Make Yahoo your homepage.

March 5, 2008

credit card

They sign a document when i offer the visit and send it back with the info

You key in the number

Some more superior IMPS use sophisticated tools like on their web sites

they have paypal and instant medical history I put my toe in the water in

a simple fashion. My population is not into the web that much but may

have email alone.

My patietns also deeply resent paying for anything frankly( one lady told

me what she paid for her sweater r and thought it was outrageous -i

thought it was not that much) so i charge what the traffic will bear though

of course some people are furious as i said. It is a line we walk.

I then make them a receipt just as i do in the office and email it back

The credit card terminal receipt i save.